Behavioral therapy: exercises and methods. Psychotherapy Therapeutic methods in psychology

As Avicenna said, the doctor has three main tools: the word, the medicine and the knife. In the first place, of course, is the word - the most powerful way to influence the patient. That doctor is bad, after a conversation with which the patient did not feel better. A spiritual phrase, support and acceptance of a person with all his vices and shortcomings - this is what makes a psychiatrist a true healer of the soul.

The above applies to all specialties, but most of all to psychotherapists.

Psychotherapy is a therapeutic method of verbal influence, which is used in psychiatry and narcology.

Psychotherapy can be used either alone or in combination with medication. Psychotherapy has the greatest effect on patients with neurotic spectrum disorders (anxiety-phobic and obsessive-compulsive disorders, panic attacks, depression, etc.) and psychogenic diseases.

Classification of psychotherapy

Today, there are three main areas of psychotherapy:

Dynamic
Behavioral (or behavioral)
Existential-humanistic

All of them have different mechanisms of influence on the patient, but their essence is the same - the focus is not on the symptom, but on the whole personality.

Depending on the desired goal, practical psychotherapy can be:

supportive. Its essence is to strengthen, support the patient's defenses, as well as develop patterns of behavior that will help stabilize the emotional and cognitive balance.
Retraining. Full or partial reconstruction of negative skills that impair the quality of life and adaptation in society. The work is carried out by supporting and approving positive forms of behavior in the patient.

According to the number of participants, psychotherapy is individual and group. Each option has its pros and cons. Individual psychotherapy is a springboard for patients who are not prepared for group sessions or refuse to participate in them due to their nature. In turn, the group option is much more effective in terms of mutual communication and exchange of experience. A special variety is family psychotherapy, which involves working together with two spouses.

Spheres of therapeutic influence in psychotherapy

Psychotherapy is a good method of treatment due to three areas of influence:

Emotional. The patient is given moral support, acceptance, empathy, the opportunity to express their own feelings and not be condemned for it.

Cognitive. There is an awareness, "intellectualization" of one's own actions and aspirations. At the same time, the psychotherapist acts as a mirror that reflects the patient himself.

Behavioral. During psychotherapy sessions, habits and behaviors are developed that will help the patient to adapt in the family and society.

A good combination of all the above areas is practiced in cognitive-behavioral psychotherapy (CBT).

Types and methods of psychotherapy: characteristics

One of the pioneers of psychotherapy and psychoanalysis was the famous Austrian psychiatrist and neurologist Sigmund Freud. He formed the psychodynamic concept of the emergence of neuroses based on the oppression of the needs and requirements of the individual. The task of the psychotherapist was the transfer of unconscious stimuli and their awareness by the client, due to which adaptation was achieved. In the future, Freud's students and many of his followers found their own schools of psychoanalysis with principles that differ from the original doctrine. This is how the main types of psychotherapy that we know today arose.

Dynamic Psychotherapy

We owe the formation of dynamic psychotherapy as an effective method of dealing with neurosis to the works of K. Jung, A. Adler, E. Fromm. The most common version of this direction is person-centered psychotherapy.

The treatment process begins with a long and meticulous psychoanalysis, during which the patient's internal conflicts are clarified, after which they move from the unconscious to the conscious. It is important to lead the patient to this, and not just voice the problem. For effective treatment of the client, long-term cooperation with the doctor is necessary.

Behavioral psychotherapy

Unlike supporters of the psychodynamic theory, behavioral psychotherapists see the cause of neurosis as incorrectly formed habits of behavior, and not hidden stimuli. Their concept says that a person's behavior patterns can be changed, depending on which his state can be transformed.

Methods of behavioral psychotherapy are effective in the treatment of various disorders (phobias, panic attacks, obsessions, etc.). Worked well in practice confrontation and desensitization technique. Its essence lies in the fact that the doctor determines the cause of the client's fear, its severity and connection with external circumstances. Then the psychotherapist conducts verbal (verbal) and emotional influences by means of implosion or flooding. In this case, the patient mentally represents his fear, trying to paint his picture as brightly as possible. The doctor reinforces the patient's fear so that he feels the reason and gets used to it. A psychotherapy session lasts about 40 minutes. Gradually, a person gets used to the cause of the phobia, and it ceases to excite him, that is, desensitization occurs.

Another type of behavioral technique is rational-emotional psychotherapy. Here the work is carried out in several stages. At the first, the situation and the emotional connection of a person with it are determined. The doctor determines the irrational motives of the client and ways of his way out of a difficult situation. Then he evaluates the key points, after which he clarifies (clarifies, explains) them, analyzes each event together with the patient. Thus, irrational actions are realized and rationalized by the person himself.

Existential-humanistic psychotherapy

Humanistic therapy is the newest method of verbal influence on the patient. Here, an analysis is made not of deep motives, but of the formation of a person as a person. The emphasis is on the highest values (self-improvement, development, achieving the meaning of life). A major role in existentialism was made by Viktor Frankl, who saw the lack of realization of the individual as the main cause of human problems.

There are many subspecies of humanitarian psychotherapy, the most common of which are:

Logotherapy- a method of dereflection and paradoxical intention, founded by W. Frankl, which allows you to effectively deal with phobias, including social ones.

Client Centered Therapy- a special technique in which the main role in the treatment is performed not by the doctor, but by the patient himself.

Transcendental Meditation- a spiritual practice that allows you to expand the boundaries of the mind and find peace.

Empiric Therapy- the patient's attention is focused on the deepest emotions experienced by him earlier.

The main feature of all the above practices is that the line in the doctor-patient relationship is blurred.

Under psychotherapy refers to the treatment of mental disorders by psychological means. According to the declaration on psychotherapy adopted by the European Association for Psychotherapy in Strasbourg in 1990, psychotherapy is a special discipline from the field of the humanities, the exercise of which is a free and independent profession. Education within one of the psychotherapeutic methods should include theory, personal psychotherapeutic experience and supervised practice. Access to such education is possible on the condition of deep preliminary training in the field of humanities and social sciences.

Methods of psychotherapy aimed at changing motivation, emotions, behavior, habitual thought patterns and the relationship of the subject with the conscious environment. In table. 15.1 and 15.2 are the main methods and approaches to psychotherapy 1 .

Table 15.1

Methods of psychotherapy

		Basic techniques
Psychodynamic Therapy	Traditional psychoanalysis	Through the techniques of free association, dream analysis and transference, the unconscious origins of the client's current problems are revealed in order to approach them rationally.
Psychodynamic Therapy	Modern psychodynamic therapy (particularly interpersonal therapy)	More structured and short term methods than traditional psychoanalysis; focuses on the client's relationship with others in the present
Behavioral (behavioral) therapy	Systematic desensitization	The client is taught relaxation and then asked to imagine a hierarchically organized sequence of anxiety-producing situations and to relax while imagining each one.
Behavioral (behavioral) therapy	Play times in vivo	A method similar to systematic desensitization, except that the client is actually placed in the situation

1 G. V. Starshenbaum Dynamic psychiatry and clinical psychotherapy.

		Basic techniques
	Drowning	Variety of playing in vivo, in which the most feared object or situation is presented to the phobic individual for an extended period of time in such a way that the client is prevented from escaping
	Selective reinforcement	Reinforcement of specific behaviors, often in the form of tokens that can be exchanged for rewards
	Modeling	The process in which the client learns certain forms of behavior by observing and imitating others; often combined with behavior rehearsal (particularly confidence training)
Cognitive- behavioral		Therapies that use behavior modification techniques but also include procedures to change inappropriate beliefs
Humanistic therapy (particularly client-centered therapy)		In an atmosphere of empathy, warmth and sincerity, the therapist acts as a facilitator in the process through which the client develops ways to solve their problems.
biological	Psychotropic drugs, electroconvulsive therapy (ECT)	The use of drugs to modify mood and behavior. Client's brain receives mild electric shocks causing seizures

Table 15.2

Psychotherapeutic approaches

The end of the table. 152

	Orientation	Basic techniques
Realistic Therapy	Finding out the value of the individual, assessing current behavior and future plans in their connection with these values. Forcing an individual to accept responsibility	The therapist helps the individual see the consequences of a possible course of action and choose a realistic solution or goal. After the action plan is chosen, a contract can be signed in which the client agrees to undergo therapy
rationalemotional	Replacing some irrational ideas (it is important that everyone always loves and admires me; I must be competent in everything; a person cannot control his sadness and unhappiness) with realistic ones. Cognitive changes are expected to cause emotional changes	The therapist criticizes the individual's ideas and puts forward those that contradict them (sometimes subtly, sometimes directly), trying to convince him to look at the situation more rationally. There are similarities with Beck's cognitive therapy, but here the therapist confronts the client more directly.
mutual intentions	Awareness of the intentions with which the individual enters into communication, the removal of evasions and deceit so that he can correctly interpret his behavior	Group therapy. Relationships within a married couple or between members of a group are analyzed in terms of the personality component of the speaker - "parent", "child" or "adult" (similar to Freud's superego, it and ego) - and the intention behind the message. Destructive social interactions and games are identified to find out what they are
Hypnotherapy	Removal of painful symptoms and strengthening of ego processes by assisting the individual in distraction from reality and constructive use of the imagination	The therapist uses various hypnotic procedures to reduce the experience of conflict and doubt by diverting the person's attention, to correct symptoms by direct suggestion or repression, and to strengthen the individual's ability to overcome situations.

Let's consider the above methods in more detail.

Psychodynamic methods of therapy. The main task of the psychotherapist in this direction is to bring repressed emotions and motivations to consciousness. The main methods of dynamic psychotherapy developed within the framework of traditional psychoanalysis and its later modifications. Among these methods aimed at restoring unconscious conflicts, one should single out the method free associations and method dream analysis.

Analyzing dreams and associations, the therapist and the client are trying to extract the unconscious meaning. The client's relationship with the therapist is considered an important part of the treatment. Traditional psychoanalysis is a long, intensive and costly process.

Already during the life of Freud, his approaches to psychotherapy were modernized and resulted in the individual psychology of A. Adler and the analytical psychology of C. Jung, followed by the characterological analysis of C. Horney, the psychodrama of J. Moreno, the transactional analysis of E. Bern, etc.

In newer forms of psychodynamic therapy, the method of free association, as a rule, "is replaced by a direct discussion of current issues, and the therapist can act in more direct ways, independently raising certain topics and not waiting for the client to bring them up" . Studies show the effectiveness of interpersonal therapy in the treatment of depression, anxiety, and alcoholism.

Behavioral therapy is based on the principles of conditioning and learning. The main task of the therapist in this direction is to change the previously formed behavior associated with the learned ways of coping with stress. Behavioral therapy seeks to change maladjusted behavior, to make it adequate to the new situation. The treatment process consists of clearly identifying the problem and dividing it into a set of specific therapeutic goals.

One of the methods of behavioral therapy is the method systematic desensitization and playing in vivo. The essence of this method is to teach the patient deep relaxation. The next step is to compile a hierarchy of situations that cause anxiety from the least concern to the strongest anxiety. The patient is then taught to relax in situations of anxiety ranging from mild distress to severe anxiety. For playing out in vivo the client must really experience the situation. Procedures in vivo aimed at the gradual extinction of fear.

Another effective means of behavioral psychotherapy is the method modeling. Its essence is to observe the normal behavior of people in a situation that causes fear in the patient. In the processes of observation, individuals with maladjusted behavior learn effective strategies for coping with the situation.

In psychiatric practice, a simulation session is often combined with a role-playing game in which the patient plays adapted behaviors and learns them.

To consolidate the behavior learned during psychotherapy sessions, the client must be taught the skills self-control and self-regulation.“Self-regulation involves observing one's behavior and applying various methods (self-reinforcement, self-punishment, control of stimulus conditions, development of incompatible reactions) in order to change maladapted behavior.

A person monitors his behavior by keeping a careful record of situations that are incompatible with him. For example, a person concerned about drinking alcohol registers situations in which he is most tempted by alcohol and tries to avoid them, replacing them with others that are incompatible with drinking.

Cognitive Behavioral Therapy to a certain extent is the development of behavioral therapy. This method includes not only the correction of behavior, but also the correction of inadequate beliefs. The therapist seeks to help the person control emotional responses such as anxiety and depression by teaching them more successful ways of interpreting and reflecting on their experiences.

humanistic therapy comes from the natural inclination of a person to self-improvement and self-actualization. Like a psychoanalyst, a psychotherapist of this direction helps a person to become more aware of his emotions and motives, but does not interpret the patient's behavior and does not try to correct it. He does not impose his views on the patient, but helps him come to his own decision.

Humanistic therapy is usually associated with C. Rogers (client-centered therapy). Frankl's logotherapy is closely related to this trend. In this direction, neurosis is understood as the result of the suppression of the need for self-actualization, for the realization of the meaning of life. The main human values, according to Frankl, are creativity, experiences, relationships. Conflicts relate mainly to the spiritual realm. The specific method of logotherapy is paradoxical intention. The method is built on the fact that the patient must want to carry out what he is afraid of, or he himself was given the opportunity to do it. The process of finding the meaning of life is reduced to the general psychological laws of human cognition. Knowledge of the theory of the formation of the inner world can play a positive role in this.

Family therapy. The family is a special small group, with its own system of emotional, interpersonal and financial relationships.

There are many approaches to marriage therapy, but most of them focus on helping partners share their feelings, develop greater rapport, and develop productive ways to deal with conflict. One of these approaches, reflecting the views of the author, we present below. From the standpoint of a two-level construction of the inner world, a picture of love and possible directions of psychotherapeutic influence is revealed.

As studies of recent years show, nature has laid down its own deep mechanisms in the emergence of love. Firstly, it is manifested in the action of certain hormones: PEA, serotonin, endorphin, dopamine, norepinephrine. Each of them affects the behavior of the individual at different stages of the development of love. PEA hormones are manifested in human behavior in the early stages of love. Under the conditions of their action, the smell of a loved one, the sound of his voice, touch is enough for a person to feel the strongest excitement, experiencing deep satisfaction. At the same time, communication with a loved one contributes to the production of this substance. Therefore, when lovers for a long time do not have the opportunity to see each other, talk to each other, the amount of hormones in the body is reduced, and this, in turn, leads to negative experiences, a feeling of deep loss.

Studies show that, like any hormone, PEA acts on the body for 2-4 years. This is a critical period in a love relationship.

Romantic love does not last long, but this period is enough for people in love to give birth to a child and raise him in the first, most biologically difficult years. It is interesting to note that, according to statistics, a 3-4-year period of living together ends with the first wave of divorces. PEA is replaced by the action of other hormones: serotonin and endorphin, and then dopamine and norepinephrine. Their action is manifested much softer, but just as favorable for the development and preservation of love.

We also note that nature has laid in a person not just a mechanism of attraction, but an attraction to a well-defined type of individuals of the opposite sex. And it's determined at the genetic level. In other words, a person chooses a genetically suitable partner, or, as science says, a genetically complementary one. Signs of genetic compatibility are presented in the appearance of a person, his gait, gestures, voice timbre, smells. These signs-releasers are perceived by each of us at a subconscious level and trigger the mechanism of attraction, affect hormonal mechanisms, and shape love behavior. It is impossible to present the matter in such a way that biological mechanisms determine our choice of a particular person. They set a certain direction for selection.

Thus, nature conditions passion and loving behavior. But no less important is the second process, which develops on the basis of natural mechanisms and which constitutes the spiritual component of love. Let's call it a process. idealization loved one. The object of love is endowed with various virtues that make it even more attractive to the lover. In the object of love, the lover finds more and more qualities that he appreciates. He likes the appearance, and the voice, and the nature of the behavior of his beloved. And when hormones cease to act, the image of a loved one remains, which determines mature love. It is the two-level nature of the love process that takes it beyond the boundaries of biological attraction and creates conditions for love without time limits.

We have described the ideal picture of a love relationship. In reality, things may be different. The most common case - love is not two, but one. The second enters into a love relationship for various reasons: social, material. The principle of complementary ™ is violated. In this case, idealization does not occur, at least for one of the partners. The psychological basis of long-term love is not created. The second case - the process of idealization does not occur in any of the subjects. The reasons for this can be very different. Most often, the short duration of a bond that is not associated with complementarity. In this case, if people enter into a marital relationship, then their relationship remains based only on biological attraction and loses its basis as soon as this attraction is blunted. The connecting link here is the children, if they appear.

It is important to note that in cases of an ideal picture of love, when the process of idealization is observed from two sides, the image of a loved one can be transformed or destroyed. It is this case that is primarily the object of psychotherapeutic practice. For the image is not destroyed by itself, but first of all by those who love it. This process must be prevented.

In conclusion, we single out three more methods that can be used both on their own and included, as we have already seen, in other methods. These are methods of relaxation, meditation and exercise.

Relaxation. Earlier, considering various theories of emotions and feelings, we noted that they are closely related to the state of the periphery and human behavior (James-Lange theory). It is on this connection that the management of the emotional state through relaxation is based. By influencing the state of muscle tone, changing your heart rate and blood pressure, a person achieves emotional relaxation.

Meditation, concentrated thinking, distracting from unpleasant thoughts, is one of the methods of relaxation. Meditation, internal concentration, is accompanied by a change in almost all autonomic indicators: EEG activity changes, breathing and heart rate decrease, blood circulation stabilizes, etc.

Meditation has proven to be a good method of helping people with anxiety.

Physical exercises. “A healthy mind in a healthy body,” says folk wisdom. Anxiety often develops against the background of deteriorating physical health. Restoring physical fitness in this case is a good means of dealing with anxiety.

In concluding this chapter, we note that even a brief enumeration of psychotherapy methods is a vast field. To master all the methods with sufficient depth is a difficult task. This is on the one hand. On the other hand, the possibilities of each method are quite strictly canonized. Each of them is based on a certain theoretical approach.

Comparison of various methods of psychotherapy shows that their effectiveness is approximately the same. Against this background, an important issue "is the question of what treatment is most appropriate for each patient in given specific circumstances" . To date, criteria for the effectiveness of treatment with psychotherapeutic methods have not been developed. Some progress in this regard has been achieved in relation to the success criteria for the treatment of depression.

In the practice of psychotherapy, there has been a tendency to move from long (several months and years) treatment cycles to less long-term programs and methods.

Evaluation of the effectiveness of psychotherapy raised questions about the need for further development of its theoretical foundations, cost and feasibility.

One of the approaches to the development of a general theory of psychotherapy can be the development of laws for the formation and functioning of the inner world of a person. It is already clear today that many diseases are the result of a violation of the integrity of the world of inner life, violations of communication in the system of two-level functioning of mental processes, phenomena of isolation and dominance of individual segments of the inner world, and phenomena of cycling of the processes of spiritual life. These observations are in good agreement with scientific data on the pathogenesis of mental disorders. Scientists note that most mental disorders originate in organic pathology, in particular, are associated with biochemical disorders affecting a number of neurotransmitter systems.

And yet, in assessing the progress in psychotherapy over the past hundred years, we can say that "we have something to celebrate" and hope for success in the future.

See more: Starshenbaum GV Dynamic psychiatry and clinical psychotherapy. pp. 89-99.
There.
See: Introduction to psychology / R. L. Atkinson [and others].
See: Ibid.
Gleitman G., Fridlund A., Raisberg D. Fundamentals of psychology.
There.

Founder: Sigmund Freud, Austria (1856–1939)

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

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

About it: Z. Freud "Psychopathology of everyday life"; "Introduction to Psychoanalysis" (Peter, 2005, 2004); "An Anthology of Contemporary Psychoanalysis". Ed. A. Zhibo and A. Rossokhina (St. Petersburg, 2005).

Analytical psychology

Founder: Carl Jung, Switzerland (1875–1961)

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

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

About it: K. Jung "Memories, dreams, reflections" (Air Land, 1994); The Cambridge Guide to Analytical Psychology (Dobrosvet, 2000).

Psychodrama

Founder: Jacob Moreno, Romania (1889–1974)

What's this? The study of life situations and conflicts in action, with the help of acting techniques. The goal of psychodrama is to teach a person to solve personal problems by playing out their fantasies, conflicts and fears.

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

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

Gestalt therapy

Founder: Fritz Perls, Germany (1893–1970)

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

How does this happen? With the support of the therapist, the client works with what is going through and feeling now. Performing the exercises, he lives through his internal conflicts, analyzes emotions and physical sensations, learns to be aware of "body language", intonations of his voice and even the movements of his hands and eyes ... As a result, he achieves awareness of his own "I", learns to be responsible for his feelings and deeds. The technique combines elements of the psychoanalytic (translating unconscious feelings into consciousness) and the humanistic approach (emphasis on "agreement with oneself"). The duration of therapy is at least 6 months of weekly meetings.

About it: F. Perls "The Practice of Gestalt Therapy", "Ego, Hunger and Aggression" (IOI, 1993, Meaning, 2005); S. Ginger "Gestalt: The Art of Contact" (Per Se, 2002).

Existential Analysis

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

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

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

About it: A. Langle "A Life Filled with Meaning" (Genesis, 2003); V. Frankl "Man in search of meaning" (Progress, 1990); I. Yalom "Existential Psychotherapy" (Klass, 1999).

Neuro-Linguistic Programming (NLP)

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

What's this? NLP is a communication technique aimed at changing habitual patterns of interaction, gaining confidence in life, and optimizing creativity.

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

Family Psychotherapy

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

What's this? Modern family therapy includes several approaches; common for all - work not with one person, but with the family as a whole. The actions and intentions of people in this therapy are not perceived as individual manifestations, but as a consequence of the laws and rules of the family system.

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

About it: K. Whitaker "Midnight Reflections of a Family Therapist" (Klass, 1998); M. Bowen "Theory of family systems" (Cogito-Center, 2005); A. Varga "Systemic Family Psychotherapy" (Speech, 2001).

Client Centered Therapy

Founder: Carl Rogers, USA (1902–1987)

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

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

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

Ericksonian hypnosis

Founder: Milton Erickson, USA (1901-1980)

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

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

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

Transactional Analysis

Founder: Eric Bern, Canada (1910–1970)

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

How does this happen? The therapist helps to determine which aspect of our "I" is involved in a particular situation, as well as to understand what the unconscious scenario of our life is in general. As a result of this work stereotypes of behavior change. The therapy uses elements of psychodrama, role-playing, family modeling. This type of therapy is effective in group work; its duration depends on the desire of the client.

About it: E. Berne "Games that people play...", "What do you say after you said "hello" (FAIR, 2001; Ripol classic, 2004).

Body Oriented Therapy

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

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

How does this happen? The problems of patients are considered in connection with the peculiarities of the functioning of their body. The task of a person performing exercises is to understand his body, to realize the bodily manifestations of his needs, desires, feelings. Cognition and work of the body change life attitudes, give a feeling of the fullness of life. Classes are held individually and in a group.

About it: A. Lowen "Physical Dynamics of Character Structure" (PANI, 1996); M. Sandomiersky "Psychosomatics and Body Psychotherapy" (Klass, 2005).

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 direct intervention by the therapist who works more actively with the client. It emphasizes the use of the client's natural resources, 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 to explore personal and/or social issues in a creative environment, and to calmly reflect on established beliefs, attitudes and feelings, and find alternative ways to act 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 is 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 provide emotional support for difficult decisions and to stimulate 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 the appropriate adjustments to transform their respective worldview, which helps reduce limiting beliefs and decisions, overcome emotional and behavioral patterns, and create resources by expanding an individual'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.

The above applies to all specialties, but most of all to psychotherapists.

Psychotherapy is a therapeutic method of verbal influence, which is used in psychiatry and narcology.

Classification of psychotherapy

Today, there are three main areas of psychotherapy:

Dynamic
Behavioral (or behavioral)
Existential-humanistic

All of them have different mechanisms of influence on the patient, but their essence is the same - the focus is not on the symptom, but on the whole personality.

Depending on the desired goal, practical psychotherapy can be:

supportive. Its essence is to strengthen, support the patient's defenses, as well as develop patterns of behavior that will help stabilize the emotional and cognitive balance.
Retraining. Full or partial reconstruction of negative skills that impair the quality of life and adaptation in society. The work is carried out by supporting and approving positive forms of behavior in the patient.

Spheres of therapeutic influence in psychotherapy

Psychotherapy is a good method of treatment due to three areas of influence:

Emotional. The patient is given moral support, acceptance, empathy, the opportunity to express their own feelings and not be condemned for it.

Cognitive. There is an awareness, "intellectualization" of one's own actions and aspirations. At the same time, the psychotherapist acts as a mirror that reflects the patient himself.

Behavioral. During psychotherapy sessions, habits and behaviors are developed that will help the patient to adapt in the family and society.

A good combination of all the above areas is practiced in cognitive-behavioral psychotherapy (CBT).

Types and methods of psychotherapy: characteristics

Dynamic Psychotherapy

Behavioral psychotherapy

Existential-humanistic psychotherapy

There are many subspecies of humanitarian psychotherapy, the most common of which are:

Logotherapy- a method of dereflection and paradoxical intention, founded by W. Frankl, which allows you to effectively deal with phobias, including social ones.

Client Centered Therapy- a special technique in which the main role in the treatment is performed not by the doctor, but by the patient himself.

Transcendental Meditation- a spiritual practice that allows you to expand the boundaries of the mind and find peace.

Empiric Therapy- the patient's attention is focused on the deepest emotions experienced by him earlier.

The main feature of all the above practices is that the line in the doctor-patient relationship is blurred. The therapist becomes a mentor, as equal as his client.

Other types of psychotherapy

In addition to the verbal way of communication with the doctor, patients can attend classes in music, sand, art therapy, which help them relieve stress, show their creativity and open up.

Clinical Psychotherapy: Conclusions

Psychotherapy has an invaluable influence on the patient during treatment and rehabilitation. Disorders of the neurotic spectrum are more effectively amenable to drug correction, if it is combined with the work of a psychotherapist or psychologist, and sometimes even without medication, psychotherapy can lead to the complete disappearance of painful manifestations. In the future, patients move from taking drugs to using the skills acquired in psychotherapy sessions. In this case, it acts as a stepping stone from pharmacotherapy to self-control over painful manifestations (phobias, panic attacks, obsessions) and the mental state of the patient. Therefore, work with a psychotherapist must necessarily be carried out with patients and their relatives.

Considering the subject and tasks of psychotherapy, one should begin with a definition of what exactly this science is. There are a lot of concepts of direction, it can be called a set of therapeutic effects on the human psyche, a process that combines both treatment and education. At the same time, to solve the tasks set, various methods of psychotherapy are used, aimed at ensuring and preserving the patient's health.

There are many different methods of psychotherapy

Despite the many psychotherapeutic directions and different approaches, one can single out a common goal of psychotherapy - to help patients in their attempts to change their own thinking, behavior in order to achieve greater happiness and productivity. The goals are achieved through the use of various means - taking an anamnesis, conducting clinical and personality testing, showing empathy, explaining the "game" rules, establishing therapeutic contact, using psychotherapeutic techniques, continuous monitoring and evaluation of the dynamics of treatment, diagnosis and reducing the number of sessions.

When exposed, the goals of psychotherapy can be divided into certain tasks of psychotherapy, which include:

helping the patient to better understand their own problems;
elimination of emotional discomfort;
encouraging open expression of feelings;
providing new ideas or information regarding problem solving;
assisting in testing new behaviors, as well as ways of thinking outside the framework of an artificially constructed therapeutic situation.

In search of solutions to the tasks set, the specialist uses various methods of psychotherapy, their totality, however, the main focus is:

Providing psychological support - the specialist listens carefully to the patient, then providing balanced advice that fits into the difficult situation that has arisen. The necessary assistance is to provide the victim with the opportunity to realize and use their own strengths and capabilities.
Methods of psychotherapy are focused on psychological transformations in relation to maladaptive behavior, the construction of new behavioral forms.
Facilitating awareness and subsequent self-disclosure, leading to an improved understanding of one's own motives, discords, values and feelings.

For a more complete understanding of the problems, one can recommend the basic textbook by Nancy McWilliams “Psychoanalytic Psychotherapy. A Practitioner's Guide”, it will be very useful not only for professional psychotherapists and psychiatrists, but also for students, teachers and consultants, all those who are interested in a detailed study of depth psychology.

Indications for appointment

Before considering the forms and methods of psychotherapy, let's talk about the indications for psychotherapy. They are quite wide, since many pathologies require an integrated approach and the use of corrective action as an additional or main treatment. At the same time, the methods of psychotherapy, their focus, depth and duration of exposure are determined by certain factors, which in this case are indications for treatment, and the possible consequences of the disease, current or in history, are also taken into account.

If the cause of the pathology is a pathological factor, you will need the help of a psychotherapist

The main indication for the use of special techniques is the presence of a psychological factor that caused the formation and course of the pathology. The greater its significance, the stronger will be the subsequent psychotherapeutic impact. The possible consequences of a serious illness, when changes in the usual way of life, changes in social status, needs and aspirations, in the professional and family sphere, and so on, can also serve as indications.

But first of all, any department of psychotherapy will recommend a referral in cases where there are no contraindications to its implementation. In this case, the impact can be carried out only if the patient is motivated, on his part, informed consent regarding participation in therapy is provided.

Basic forms

Now let's consider the forms of psychotherapy that a specialist uses when solving the tasks. The form of influence is a way of applying a certain method, it is the structure of the interaction "specialist-patient" in the implementation of the chosen method of therapy. For example, the method of rational therapy is used both in the form of group and individual conversations or is carried out as a lecture. The most commonly used forms of psychotherapy include:

individual;
group;
family.

The basis of the individual form is the direct interaction of the patient and the psychotherapist, while the tasks are in the psychotherapy of personal history with the study of the patient's personality, identifying the mechanisms that have become the "trigger" of the formation and preservation of the pathological condition, correcting existing derogatory assessments - both of oneself and of a bygone period , the future. Also, the tasks include determining the interaction of the used methods of non-drug and drug exposure, assistance in the selection of an appropriate solution to traumatic conditions that form and maintain pathology.

The specificity of psychotherapy when considering a group form lies in the use of group dynamics - the complexity of interactions that develop between participants, not excluding the psychotherapist.

In general, the goals and objectives of group psychotherapy are to reveal, study, process the patient's problems, personal, interpersonal conflicts. This also includes the correction of inadequate relationships, stereotypes and attitudes against the background of the analysis of the use of interpersonal interactions. This form involves the use of many methods, each of which includes certain techniques of group psychotherapy. The basic methods of group psychotherapy include:

meeting groups;
psychodrama;
group training;
group gestalt;
transactional analysis;
cinema training;
art therapy;
body oriented therapy;
dance movement therapy.

Group psychotherapy -
the complex of interactions that develop between the participants and the psychotherapist

Now about the concept of group psychotherapy methods, let's briefly consider each of them:

The main idea of the meeting group is to achieve unity of consciousness with the body. The meeting implies the establishment of interpersonal relationships based on honesty, openness, awareness of oneself and one's own "I".
Trainings are a set of educational, psychotherapeutic and corrective methods, the selection of which depends on the final goals. In this method of psychotherapy, techniques and exercises may include role-playing games, non-verbal communication, group discussions.
The main long-term goal of transactional analysis is to review previously made decisions and change the life scenario.
The long-term goal of Gestalt therapy is for all participants to reach maturity by rejecting unproductive behaviors and introducing new ones.
Body-oriented therapy involves the knowledge of one's own body, awareness and acceptance of one's own inner motives, which allows one to develop the ability to harmonize and self-regulate in accordance with the existing deep aspirations.
Psychodrama as a method of psychotherapy is based on improvised role-playing games for children. Its essence is the creation of materials on stage for experiencing problem situations with the help of a specialist and group members - initially they act out, after which they discuss.
Art therapy is a method based on the expression of feelings through visual activity.
The main goal of dance-movement therapy is the development of feeling, awareness of one's "I".

As for the family form, it will combine methods of correction, study of interrelated relationships in the family circle associated with pathologies, therapy and recovery of the patient in society. In this case, it is customary to conduct psychotherapy techniques, give lectures with the help of one or two specialists, they also carry out observation, corrective measures not only in relation to the patient, but also to family members. Also, specialists can work with groups that include several families with similar problems.

During treatment, resistance in psychotherapy is considered to be a natural phenomenon, which cannot be perceived as a weakness or shortcoming of the patient - this is a factor that previously helped to survive, to get out of difficult situations. However, it is resistance that impedes progress in therapy. At the same time, the psychotherapeutic influence should not break the resistance, but should understand it, make such protection more flexible, providing the patient with more opportunities to lead a life filled with pleasure.

Resistance in psychotherapy hinders progress in treatment

Treatment methods

Let us continue our consideration of psychotherapy - the types and methods of psychotherapy are very diverse and it is impossible to cover them all in a sufficiently concise review. To date, this area has over 400 methods, so we will list the most used:

Rational psychotherapy is based on the patient's logical persuasion of the need to change his attitude towards himself, his own past, future, established illness, therapy, prognosis, own capabilities and future prospects, it is included in the most effective methods of treating neuroses.
Suggestive technique includes many techniques and is included in various forms of implementation, it is carried out both in the waking state and in hypnotic or drug sleep.
In any medical procedure, as an integral part, it is included indirect suggestion.
It is possible to conduct psychotherapy independently, using active self-hypnosis according to Coue- the technique is activated in a transitional state, after waking up or before going to bed. The suggestion is reinforced by multiple automatic repetition of one formula containing the main point of painful experiences. You can also use autogenic training, which the patient conducts on his own after a brief training.
Cognitive methodology teaches the patient to perceive both himself and the world more optimistically by reassessing false conclusions. This type of therapy is included in the treatment of mild to moderate depression, anxiety disorders, OCD psychotherapy methods.
Behavioral technique helps the victim reduce the level of anxiety about certain circumstances and is activated until the most significant provocative stimulus ceases to cause fear. The method is used as obsessive-compulsive disorders - OCD psychotherapy - panic, anxiety-phobic, dissociative-phobic disorders.
NLP - neurolinguistic programming- activates the basic communication channels (hearing, vision), identifying their priority. Indications for use are panic and adaptive disorders, an acute reaction to stressful situations, it is included in the methods of psychotherapy for the correction of ADHD - attention deficit hyperactivity disorder.
The method of meditative reincarnation psychotherapy based on meditation, the duration of which does not exceed a few minutes. At the same time, negative sensations are projected from the present beyond the limits of this life. The negative potential in the process of carrying out the technique flows into a positive one.

Another specific technique is positive psychotherapy, the techniques of which we will discuss below. The technique is designed to teach the patient to accept the world around him in all its diversity, avoiding confrontation with it. Positive therapy is a short-term therapy method that was proposed by Peseschkian. When conducting short-term psychotherapy, practical exercises allow the patient to make positive decisions in a variety of situations in the future by using personality reserves.

The methodology under consideration is based on faith in the abilities of people who can fully ensure a happy life. Any person has full access to opportunities that are inexhaustible and capable of providing both personal growth and its individual disclosure. When conducting positive psychotherapy, exercises may include various techniques - visualization or pronunciation techniques, “question-answer”, components of art therapy, and so on.

At the same time, the arsenal of this technique includes techniques that are unique to it, usually consisting of five levels:

removal from the problem situation;
elaboration of the current situation;
situational approval;
verbalization;
increasing the limits of life goals.

The question-and-answer technique is often used in psychotherapy.

The techniques used in the implementation of this methodology are used to solve a variety of problems, allow you to track and understand the causes of behavioral reactions. A positive approach forces you to look at the problem from a completely different point of view, often it is completely opposite to the original one.