When solving problems of psychotherapy, the therapist uses methods and forms of psychotherapy. It is necessary to distinguish between methods and forms (techniques) of psychotherapy.

Psychotherapy method- a specific way of implementing the general principle of treatment, resulting from an understanding of the essence of a mental disorder within the framework of a certain concept of psychotherapy.

Total There are currently more than 400 independent methods of psychotherapy. One of the reasons for the existence of various methods of psychotherapy is the lack of sufficiently convincing criteria for the greater effectiveness of some methods compared to others. Their range is very wide: conversational psychotherapy and other psychotherapeutic approaches of a humanistic orientation, a large number of behavioral techniques, psychodrama, various schools of psychoanalytic direction, etc. Each psychotherapeutic approach claims to be effective in treating almost all areas of psychopathology. The choice of a specific method of psychotherapy is determined by the mutual influence of specific clinical indicators of the patient and the disease, the characteristics of his personality and other psychological characteristics, the level of socio-psychological adaptation of the patient, as well as the structural and organizational form of psychotherapy.

For example, the concept of neurosis as a delusion of the mind, erroneous thinking gave rise to the method of rational psychotherapy. The idea of ​​neurosis as a disorder caused by being stuck in the unconscious realm of affect experienced in the past gave rise to the method of catharsis. The understanding of neurosis as a manifestation of infantile sexual desire repressed into the unconscious gave rise to psychoanalysis.

D.V. Aleksandrovich (1979) made an attempt to analyze the whole variety of meanings in which the concept of method is used in psychotherapy:

• methods of psychotherapy that have the nature of techniques (hypnosis, relaxation, psycho-gymnastics, etc.);
• methods of psychotherapy that determine the conditions that help optimize the achievement of psychotherapeutic goals (family psychotherapy, etc.);
• methods of psychotherapy in the sense of an instrument that we use during the psychotherapeutic process (such an instrument can be a psychotherapist in the case of individual psychotherapy or a group in group psychotherapy);
• methods of psychotherapy in the meaning of therapeutic interventions (interventions), considered either in the parameters of style (directive, non-directive) or in the parameters of the theoretical approach (learning, interpersonal interaction, dialogue).

There are a huge number of classifications of psychotherapeutic treatment methods. Let's identify some of them.

Classification of psychotherapy methods according to their goals, developed L.R. Volberg, distinguishes 3 types of psychotherapy:

1. supportive psychotherapy, the purpose of which is to strengthen and support the patient’s existing defenses and develop new, better methods of protective behavior that allow them to restore peace of mind;
2. retraining psychotherapy, the goal of which is to change the patient’s behavior by supporting and approving positive behaviors and disapproving negative ones;
3. reconstructive psychotherapy, the purpose of which is to understand the intrapsychic conflicts that served as the source of personality disorders, and the desire to achieve significant changes in character traits and restore the fullness of the individual and social functioning of the individual.

Classification of methods of psychotherapeutic treatment developed by FROM. Velvovsky et al (1984), includes the following sections:
1. Psychotherapy in a natural waking state(rational-associative forms and techniques; emotional-pitique and gaming methods; training-volitional forms; suggestive forms).
2. Psychotherapy in special conditions of the higher parts of the brain(hypnosis-rest according to K. Platonov; suggestion in hypnosis; post-hypnotic suggestion; various forms of autohypnotechniques; methods of autogenic training; relaxation according to Jacobson; narco-hypnosis; hypnosuggestion during electric sleep, etc.).
3. Psychotherapy under stress caused by:

1. mentally - by fear, acute positive or negative experience;
2. pharmacological or pain agents;
3. physical agents (cauterization with thermal cautery);
4. "attack by surprise", through an ethereal mask, according to A.M. Svyadosch, enhanced hyperpnea, according to I.Z. Velvovsky and I.M. Gurevich.

Of all the variety of psychotherapy methods among practicing doctors now the most common are the following:

1. suggestive psychotherapy (suggestion while awake, natural sleep, hypnosis, emotional stress psychotherapy, drug psychotherapy);
2. self-hypnosis(autogenic training, Coue method, Jacobson method);
3. rational psychotherapy;
4. group psychotherapy;
5. gaming psychotherapy;
6. family psychotherapy;
7. conditioned reflex psychotherapy.

Psychoanalysis, transactional analysis, Gestalt therapy, etc. are increasingly used. Within each of these methods there are dozens, hundreds of techniques, this is explained by the fact that, as S. Skoda notes, the dream of every ambitious psychotherapist is to create a new, unusual technique, to introduce his own original contributions to the history of psychotherapy.

Exists classification of principles for choosing a method of psychotherapy depending on the disease (Strotska, 1986):

• in case of acute hysterical symptoms, suggestion is used;
• for autonomic disorders - autogenic training;
• for life difficulties - “talk” therapy;
• for phobias - behavioral therapy;
• for characterological disorders - gestalt therapy, psychodrama;
• for disorders associated with family problems, family psychotherapy;
• for complex disorders with the presence of a previous predisposition - depth psychological methods.

The method of applying a particular method of psychotherapy is called a form of psychotherapeutic influence. The form of psychotherapy is the organization and structure of interaction between the therapist and the patient in the process of implementing a particular method of psychotherapy.

For example, the method of rational psychotherapy can be used in the form of an individual conversation with a patient, in the form of a conversation with a group, or in the form of a lecture. The method of suggestion can be used while awake or in hypnosis. Psychoanalysis is used in the form of observing the flow of free associations, studying associations, analyzing dreams, in the form of an associative experiment, etc. The same form of psychological influence can serve different methodological guidelines. Thus, hypnosis can be used both for the purpose of suggestion and for the purpose of catharsis.

A complex of various methods of psychotherapy, united by a common fundamental approach to treatment, forms the direction of psychotherapy. In certain areas of psychotherapy, separate methods are distinguished, and within each method there are various techniques and techniques.

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

Psychotherapy as a theoretical and applied direction of psychology

Psychotherapy has the following definitions:

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

Subject, purpose and objectives of psychotherapy

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

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

The general goal of psychotherapy is the return of the individual to internal well-being. The most important task that psychotherapy implies is to help people who are faced with their own inability to achieve goals and who experience frustration, deprivation, despondency and anxiety in connection with this, to create their own assets and liabilities and teach them to use their capabilities effectively, namely:

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

The objectives of psychotherapy can be presented as a list:

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

History of the development of psychotherapy

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

• how an ordinary person experiences the world around him;
• how a person plans his actions;
• how it really works.

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

Individual therapy arose simultaneously with ideas about the dyadic relationship between doctor and patient (“therapeutic alliance”). Counseling psychology emerged in the mid-20th century. In the first stages of its development, it was natural to be interested in the reality that the patient faces and which gives rise to problems and troubles that force him to see a doctor. This is where organizational psychology, family psychotherapy, etc. originated. Focusing on the “consultant-client” dyad posed the task of developing norms and rules for their interaction.

Interdisciplinary connections of psychotherapy

Areas of psychotherapy (including advisory) are based on the following branches of psychological science:

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

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

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

Theoretical and methodological psychotherapy is advisory psychology, that is, a branch of systemic scientific and applied knowledge. As for providing assistance in the form of a conversation, it is usually provided:

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

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

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

Psychological counseling and psychotherapy include: the activity of the client, the activity of the consultant and the result of this process - psychological new formations activated (formed) in the personality of the person seeking help. In this case, five main groups of questions are considered:

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

Basic models of psychotherapy

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

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

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

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

Theory-oriented behavioral psychotherapy becomes the best means of achieving goals within the behavioral model. On the other hand, this knowledge about the client does not guarantee that internal changes will occur in him, does not promise to “awaken” his internal processes. This is only possible in the case of something important, something that is not subject to conceptualization, which is almost impossible to learn, but without which deep behavioral psychotherapy cannot occur.

Psychological models

Within the psychological model, in turn, the following are distinguished:

1. Social-psychological model. This is an approach that is based on social influence, in which it is possible to develop social forms of behavior.
2. Person-centered model (client-centered), which provides for special interpersonal interaction between the therapist and the client. The doctor uses psychological theories and special communication techniques to solve the client’s personal problems.

Areas of psychotherapy

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

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

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

Family psychotherapy uses a set of techniques that are focused not only on problematic family situations, but also have the goal of analyzing the client’s past, reconstructing certain events and the structure of relationships, etc. The current direction in development is the development of methodological foundations, relying on which will help to avoid accidents, fragmentation and intuitiveness.

Clinical psychotherapy is a discipline whose goal is to eliminate various disorders and disorders, somatic diseases. This direction studies the mental and moral aspects of health: individual differences, the influence of environmental factors on the patient’s condition and the course of treatment, mental characteristics of experiences. The theoretical foundations of this psychotherapy technique: biopsychosocial concept of pathology; research methods in medical psychology; the concept of the “illness - health” continuum.

Features of bioenergy

In the last century, bodily psychotherapy was replenished with a new method of influence, which was called bioenergetics. One of the famous Dr. Reich's students, Alexander Lowen, developed this approach. By using a slightly different conceptual apparatus, for example, “bioenergy” instead of the concept of “organ,” the doctor to a certain extent neutralized the resistance of other therapeutic directions. His system became more widespread in the United States than Reich's similar teaching. At the same time, he included in his concept the theory of breathing developed by the teacher, and part of his techniques aimed at achieving emotional uninhibition through the use of blows, screaming, and tears.

Body-oriented psychotherapy, developed by Lowen, places the concept of bioenergy at the center. It unites the body and psyche in a functional way. The second important definition on which body-oriented psychotherapy is based is “muscle armor.” It interferes with the spontaneous flow of energy throughout the human body, so there is a set of exercises to help get rid of it.

Basic methods of psychotherapy

An ordinary patient who has never encountered the work of psychotherapists has a very vague understanding of what happens in a session. There are many methods of psychotherapy. Let's learn about the main ones.

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

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

Psychotherapy. Study guide Team of authors

Classification of psychotherapy methods

The variety of psychotherapeutic forms and methods is based on three main theoretical directions - psychodynamic, behavioral (cognitive-behavioral) and humanistic (existential-humanistic, phenomenological). Before moving on to the description of the main ones, it is necessary to note the components that are common to all these areas (J. Frank, 1978):

1. Patient (sick) – a person who exhibits objective signs of a mental (psychosomatic) disorder.

2. A psychotherapist is a doctor who, thanks to his specific training and experience, is perceived as capable of providing assistance to a specific patient (or group of them).

3. Personality theory, created by the founder of a certain direction and consolidated by his followers, which, through a certain set of provisions, makes it possible to describe the functioning of the psyche and predict the course and direction of certain mental processes in an individual or group of people normally; as well as the emergence, fixation and development of disturbances in these processes during the formation of pathology.

The listed provisions directly follow from certain philosophical, worldview and life ideas of the author of the proposed theory and, to one degree or another, bear the imprint of his personality. In addition, many of them are characterized by a claim to some ontological universality. The logical consequence is the creation of fairly powerful institutions in the form of societies, associations, journals that form the “correct” worldview of students, as well as certifying their right to officially be representatives of this direction and conduct their practice on this behalf.

Currently, one can note a certain “evolution” and transformation of theoretical approaches to personality in psychotherapy. At the beginning of the development of scientifically based psychotherapy, there was a clear tendency to create a “unique” theory of personality with a claim to ontological universality (i.e., the “only correct one”). A striking example is the psychoanalysis of Sigmund Freud. Currently, there is a clearly prevailing tendency to create certain “models” of the functioning of the psyche with an understanding of their limitations and relativity. For example, a modern approach that has taken the liberty of elevating this to the rank of its own ideology is neuro-linguistic programming. No less important is the fact that the attempt to do without personality theory altogether (an early version of behavioral psychotherapy) turned out to be historically futile.

4. A set of techniques (procedures) for solving the patient’s problems that directly follow from the theory.

At the same time, attention should be paid to the obvious change in the relationship between “personality theory and a set of techniques” during the existence of psychotherapy as such. The schools that formed at the beginning of the development of psychotherapy were characterized by an extremely strict determination of methods by the basic theory of personality. Deviations from “prescribed” practices were, to put it mildly, met with strong disapproval. For example, the famous French psychotherapist and psychoanalyst L. Shertok for a long time could not become a full member of a psychoanalytic organization, since he actively used hypnosis in his practice, which had previously been criticized by the founder of psychoanalysis, Sigmund Freud. Currently, a different attitude prevails. Almost all known cognitive-behavioral and existential-humanistic approaches not only endorse the use of a wide range of different psychotechniques, but also openly declare the creative approach of the psychotherapist (i.e., the creation of new techniques in each specific case). Even in the most “conservative” psychoanalytic approach, similar trends can be noted, for example, in the form of the emergence of “hypnoanalysis” or the inclusion of methods of other directions in the classical approach (psychosynthesis, neuro-linguistic programming, holotropic breathing, etc.).

5. A specific social relationship between a psychotherapist and a patient, which is aimed at creating a special “psychotherapeutic” atmosphere that creates favorable conditions for helping the patient, largely due to the formation of optimism in him about the possibility of resolving his problems and the possibility of a different, more positive worldview, world existence and coexistence with other people. From the point of view of some of the approaches (for example, client-centered psychotherapy by K. Rogers), the creation of these relationships is considered the main therapeutic factor.

In table Table 1 shows the main psychotherapeutic directions, their features and level of impact.

Table 1

Main directions of psychotherapy, their features and level of impact

An interesting classification, primarily for didactic purposes, is one that identifies different orientations of psychotherapists in their view of the main factors in the formation of pathology and, as a consequence, the nature of the interaction between the patient and the psychotherapist.

Nosocentric orientation– an approach to the treatment of the disease as such, without taking into account the patient’s personality, social environment, etc. As a consequence – the authoritarianism of the psychotherapist. The heyday of this approach has been observed since the end of the 19th century. until the 20s XX century This period saw the intensive development of classical, directive hypnosis and other suggestive methods. The psychotherapist is a teacher, the patient is an “object for orders.”

Anthropocentric orientation– emphasis on the study of personality structure, its development history and characteristics. Developed since the 20s. XX century During this period, the development of psychoanalysis, psychodiagnostics, autogenic training methods (J. Shultz), progressive muscle relaxation (E. Jacobson), and self-hypnosis techniques took place.

Sociocentric orientation– emphasis on social conditions, social connections of the individual, etc. This implies that personality is largely determined and shaped by society. The consequence of this is the need to “teach” the individual to adapt through external (social or behavioral) influence. This direction includes: Kurt-Lewin theory; behavioral psychotherapy (behaviorism); various theoretical and practical teaching methods, etc.

It should be emphasized that different directions and orientations do not contradict, but complement each other. The choice of psychotherapeutic influence depends, on the one hand, on the personality of the psychotherapist, on the other, on the characteristics of the patient’s personality and his existing disorders.

Before moving on to a description of the three main areas of psychotherapy, it is necessary to dwell on the main mechanisms (factors) of the therapeutic effect.

SUMMARY OF METHODS As noted at the outset, this book deals with only one type of therapy group that is most often encountered in clinical practice - the seated adult group. This excludes some special types of treatment without

COMPARISON OF TECHNIQUES A well-trained therapist should be familiar with all four common approaches and will vary his technique depending on circumstances, but in general will be more likely to adhere to one approach or another. Ideally, his preference would be