Hyde in modern areas of psychotherapy

We talk about the most famous of them: from psychoanalysis to techniques of awareness

It can be difficult to choose a psychotherapist: now there are dozens of different options for therapy, some of which may simply not come. At the request of the Cold, the clinical psychologist and creator of the telegram channel “The Sea is worried, but you are not” Galina Petrakova talks about the most popular and effective directions of psychotherapy.

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We will consider approaches that have an ethical code, curriculum and a supervision institution, and representatives of approaches have professional associations. This should at least guarantee the professionalism of a specialist.

Psychotherapy formats

Individual

Therapist’s work with a client is one on one. The problems that a person addresses can be any: from temporary difficulties caused by external stress to persistent symptoms of disorders or a diagnosed disease. At the same time, the therapist can direct the client to the psychiatrist, neurologist, social worker and other specialists. And sometimes they work in the team, jointly choosing a strategy for therapy: for example, a person with an obsessive-compulsive disorder (OCD), in addition to drug support that the psychiatrist appointed, meets a psychotherapist once a week for the treatment of disorder.

In rare cases, the therapist can hold a session without a client: for example, if he needs to talk with the adoptive parents or guardians of the child, where his presence is not required.

Pair

Partners visit the psychotherapist together. Work may concern general individual problems that affect their relationship. For example, a husband with a bipolar disorder and a wife with a generalized alarming disorder visit a psychotherapist once every two weeks to deal with how to jointly cope with stress in relations due to moving to another country.

Sometimes individual sessions can be needed with each of the partners. Nevertheless, most of the work is carried out together with the couple.

Family

As part of this format, the whole family can turn to the therapist: parents or guardians, children, perhaps the older generation or other relatives. The reasons for the appeal can be any: family conflicts, children's difficulties at school, adaptation after adoption. For example, constant conflicts of adolescents with a stepfather, in which grandparents indirectly or directly participate.

Group

Participants who have chosen this format (or who received a direction to the group) meet and work together with people unfamiliar to them with similar difficulties, problems, request. For example, people with alcohol or drug addiction and various periods of remission can meet weekly in a group, which are conducted by several therapists to support each other and find new ways to cope with life difficulties.

This format, like all of the above, can be adapted for participants in different ages and is carried out both on the basis of state institutions and in the framework of the private practice of a psychotherapist. Sometimes the leading group may not be a psychologist, but another helping specialist (for example, a social worker who has undergone appropriate training). For example, a group of adolescents with a diagnosis of ADHD gathers once a month in a social center under the guidance of a specialist in order to share difficulties, support each other and learn how to better concentration and more productive studies.

Psychotherapeutic approaches

All approaches are united by a common goal - to improve the psychological well -being of a person and the quality of his life through a conversation or other methods of communication.

Approaches have various origins, philosophy, evidence base. New studies regularly appear that change our idea of ​​the effectiveness of certain approaches for various disorders, symptoms, conditions. Some of them become more popular (cognitive-behavioral therapy), others, on the contrary, lose popularity (psychoanalysis).

At the moment, the most evidence-based base that meets modern standards has a cognitive-behavioral approach and its numerous branches. At the same time, other areas, despite the significantly smaller volume of research, continue to be widespread, enjoy the trust of specialists in the field of mental health and their customers and show positive results on specific therapeutic cases.

A specialist can work in one approach, use a combination of conceptually close approaches, or use the tools of one of the approaches, working in another. Ideally, he should focus on the effectiveness of various approaches for specific problems and cases in order to proceed from the needs of the client and his condition.

When choosing a psychotherapist, you can clarify the approach in which he works, his education, whether he goes through supervisions, whether it consists in specialized associations. It should be borne in mind that membership in Russian realities, alas, does not guarantee professionalism. There are associations that can only be included in the passage of serious training and certification, and there are those where you can enter by simply paying a fee and having received a basic psychological education.

Psychotherapeutic approaches can be grouped into several families.

Dynamic therapy

This is a family of approaches, which in one way or another proceed from the basic principles of psychoanalysis. Therapy is considered as an intensive “treatment with a conversation” (the term of Sigmund Freud), which helps a person penetrate his own conscious and unconscious mental processes. The purpose of treatment is to make the unconscious conscious and due to this to achieve a better understanding of oneself: their own life elections, reactions, relations with others.

Now dynamic approaches are losing popularity. This is largely due to the fact that there are practically no studies that comply with modern standards (randomized controlled tests, RCTs) and confirm the effectiveness of the approach. Many experts note that the specifics of the approach (long -term, lack of a clear structure) makes such studies difficult.

Psychoanalysis

This approach can be considered the beginning of modern conversational therapy. He relies on the fact that most of our thoughts, feelings and origins of behavior are hidden in the unconscious. To understand the problems we are now facing, we need to delve into this unconscious.

The specialist uses methods such as free associations, interpretation of dreams and analytical transfer (unconscious movement of emotions and attitudes towards one person to another - including a psychotherapist. For example, the transfer of fear or love in relation to his father).

Classical psychoanalysis looks like this: the patient lies on the couch, and the analyst sits out of sight, but close enough to hear a person. Sessions last 50 minutes and are held four or five times a week for at least three years. The main technique is free associations. This means that a person says not only what he wants to say consciously, but everything that comes to his mind is even if it seems meaningless, ill or unpleasant.

Psychodynamic therapy

It arose from psychoanalysis and uses its key tools (for example, free associations and transfer). The difference is that more attention is paid to the conscious part of the experience - a conversation about the problems that a person is faced with here and now.

Relief from emotional stress brings the search and awareness of a person of the connection of his current problems with the events of the past. In fact, this is a more modern version of psychoanalysis. It does not have such strict requirements for the number of sessions, and therapy can last much less than three years.

Humanistic therapy

This group of approaches is focused on the current experience of a person (how it interacts with complex and traumatic situations), and also pays special attention to the relations of the client and therapist, which arise and develop in the process of their work. This helps to understand how a person builds a relationship with the world. The client is considered not as a “patient” (in some way “imperfect”, “unprofitable” compared to the therapist himself), but as a person capable of self -development, personal growth and search for answers.

Client-centered therapy

Humanistic therapy is represented primarily by the approach of the American psychologist Karl R. Rogers. It is based on the relationship between the client and the therapist and the characteristics that should be present in them: empathy, kindness, impartiality, sincerity, faith in humans. According to Rogers, this is enough for therapeutic changes, given the client’s natural tendency to personal growth and healthy functioning.

This belief in an increase in growth inherent in a person is the basic principle of humanistic psychology: it is accepting and unlimited relations with the therapist, in which the client can freely express himself, help to develop internal resources, overcome difficulties and change for the better.

Gestalt therapy

The approach is based on the principle of “here and now”: a person learns to realize the connection of thoughts with the body and feelings and live in the present. All components of experience - feelings, thoughts, bodily sensations - are considered as a whole.

Much attention is paid to the needs of a person - the problems that he addresses is considered from this angle. For example, anxiety - an unsatisfied need for safety, difficulties in building relationships - in acceptance, professional difficulties - in recognition. In therapy, a person learns to realize and satisfy his needs (psychological and physical), take responsibility and successfully adapt to the world.

Like other humanistic approaches, gestalt therapy implies a person’s innate tendency to his health, integrity and realization of his potential.

Existential therapy

It is focused on a person’s awareness of values ​​and goals, life meanings and on the adoption of responsibility for choosing a life path in accordance with them.

The therapist does not use specific techniques and techniques, does not give interpretation and does not impose any points of view - instead he tries to reveal the client as a person based on what he says and does.

Within the framework of the existential approach, an important topic for discussion is death: it is the openness and awareness of the limbs of life that help a person to fully understand its value, look and find meaning in it.

Logotherapy

One of the most important directions within the existential approach literally means "therapy with meaning." It was created by a philosopher, psychologist and psychiatrist Viktor Frankl, who, on his experience in survival in a concentration camp, showed that the presence of meaning helps to go through even the darkest times.

The openness to the meaning, according to logotherapy, is a distinctive sign of a person, but the client does not invent him, but finds him in the surrounding world: in activity, creativity, work, love, art, nature and even in his own path, which can be full of deprivation and suffering (if other sources are not available).

Despite the prevalence of the humanistic and existential trends (especially in Russia), they are not widely studied at the clinical level and convincing data on their effectiveness for specific disorders and symptoms are rather absent. At the same time, there are a number of research and reports of specialists who speak of their benefits. Humanistic and existential therapy is usually not included in clinical recommendations for the treatment of mental disorders as preferred methods, but in practice they are also applied in these cases.

Cognitive, behavioral and cognitive-behavioral therapy (KPT, or CBT, Cognitive Behavioral Therapy)

These schools of psychotherapeutic thought are almost always united in the therapeutic process.

Behavioral therapy considers the impact of behavior on our mood and well -being. The meaning of the approach is that non -adaptive behavioral patterns (behavior that does not solve the problem, but only exacerbates it - for example, being in bed all day with depression or avoiding frightening objects or situations for phobias) and habits are weakened and eliminated, and adaptive, on the contrary, are strengthened.

Cognitive therapy considers how emotional reactions arise as a result of our thoughts. It is based on the fact that inadequate thinking causes and supports emotional problems. This approach is used in the treatment of various psychological problems, especially depression and anxiety.

At the junction of behavioral and cognitive therapy, cognitive-behavioral therapy arose, or KPT, which considers thoughts, feelings and behavior as the interconnected components of our experience. So, working either with negative thoughts or with behavior, the client can change his feelings.

Most cognitive and behavioral treatment methods are usually short -term. They give a fairly fast result and do not last for years. In this case, the duration of therapy depends on the method and a specific case.

KPT and its branches are the most investigated areas. Data on their effectiveness for different conditions, symptoms and disorders confirms many studies, including randomized controlled tests and their meta -analyzes .

Scheme-therapy

This approach appeared from cognitive-behavioral psychotherapy, but includes ideas of different directions. Initially, it was developed by the American psychologist Jeffrey Young for the treatment of personal disorders and the consequences of a comprehensive psychological trauma (arises from events that are repeated and which is difficult to avoid), which cognitive therapy did not successfully work.

The goal of the therapy scheme is to help a person learn to satisfy basic emotional needs. For this, the specialist helps to weaken maladaptive schemes (certain sets of beliefs, the templates on which we live, repeated throughout life) and dysfunctional styles of overcoming them and replace them with effective ones.

Acceptance and responsibility therapy (TPO, or ACT, Acceptance and Commitment therapy )

The approach created by the American professor of psychology by Stephen Heis. With the help of Mindfulnes practices, the client learns to observe and accept his feelings and various components of emotional experiences.

The meaning of therapy is that a person has invested internal resources in adhering to values, and not resist what is natural for human nature - unpleasant thoughts, negative emotions, poor physical well -being. Thus, the skill is developing to remain “true to yourself” - to fulfill obligations in various circumstances, realizing all aspects of their experience.

Desensitization and processing of eye movement (DPDG, or EMDR, Eye Movement Desentization and Reprocessing)

The psychotherapy method, designed to facilitate distress associated with traumatic memories and treatment of post -traumatic stress disorders (PTSD). Facilitates the access and processing of traumatic memories and other unfavorable life experience in order to lead them to adaptive resolution. So, the distress is removed, negative beliefs are reformulated, and physiological arousal is reduced. During EMDR therapy, the client returns in the mind of emotionally complex material with short consistent doses, while focusing on another stimulus. Such bilateral stimulation is usually ensured by the side movements of the eyes directed by the therapist, or other incentives are used, including hands tapping and sound stimulation.

Therapy focused on compassion (CFT, Compassion-Focused Therapy )

The type of psychotherapy, developed by the British clinical psychologist Paul Gilbert for customers who suffer from a high level of self -criticism and shame. The approach uses research instruments of cognitive-behavioral and evolutionary psychology, neuropsychology, the theory of affection, awareness.

CFT helps to develop compassion and kindness to oneself and others, to overcome a sense of shame and a tendency to self -criticism, as well as improve emotional regulation and increase stress resistance.

The main skill that a person is developing is a compassionate, maintaining position in relation to himself. This allows you to improve the quality of life and the level of psychological well -being, reduces the risk of depressive symptoms and anxiety.

Dialectical behavioral therapy (DPT, or DBT, Dialectical Behavior Therapy )

It was developed by the American psychologist Marches Linekhan for the treatment of people with a borderline personality disorder and strong emotional sensitivity. The approach teaches you to regulate emotional reactions to stressful situations, reduces the risk of suicidal, aggressive or self -regulatory behavior.

Подход развивает навыки, направленные на эмоциональную стабильность и оптимальное поведение. Клиенты учатся видеть и формировать разные точки зрения на ситуации, которые они воспринимают как невыносимые.

DBT обязательно включает групповую (развитие навыков общения) и индивидуальную терапию, а также экстренную поддержку в трудных ситуациях, которую клиент может получить от терапевта по телефону.

Унифицированный трансдиагностический протокол (УТП, или UTP, Unified Threat Protection)

Подход, разработанный экспертом в области психиатрии Дэвидом Барлоу и группой исследователей из Центра тревожных и связанных с ними расстройств Бостонского университета, для терапии людей с тревожными расстройствами, депрессией, другими эмоциональными расстройствами и их симптомами. Унифицированный протокол может быть применен к целому ряду различных расстройств и проблем (депрессия, паника, социальная тревожность, навязчивые мысли, импульсивное поведение).

Основная цель подхода — помочь клиентам с самыми разными эмоциональными проблемами научиться новым способам реагирования на негативные эмоции, которые доставляют им трудности.

Осознанность/Майндфулнес

Современная клиническая психология активно стала использовать майндфулнес с 1980-х годов. В течение некоторого времени термин «подход на основе майндфулнес» использовался в психологии как синоним «техник на основе медитации». Позже майндфулнес стали использовать для медицинских целей как практику, помогающую справляться с трудностями. Концепции и принципы осознанности — важность настоящего момента, принятие, безоценочность.

Большой массив исследований, в том числе обзор рандомизированных клинических исследований, подтверждает эффективность подхода для множества психологических проблем: стресса, тревоги, симптомов депрессии, эмоционального выгорания. Есть данные о том, что практики осознанности меняют нейрохимию мозга и вызывают функциональные нейропластические изменения (например, снижают активность миндалевидного тела, отвечающего за реакции на стресс).

Программа снижения стресса на основе осознанности (MBSR, Mindfulness-Based Stress Reduction )

Эта международная программа — золотой стандарт применения практик осознанности. Ее автор — биолог и профессор медицины Джон Кабат-Зинн. Это восьминедельный курс: раз в неделю участники встречаются в группе, обсуждают определенные темы и обучаются навыкам осознанности — перенесению внимания на настоящий момент без оценки себя или окружающей действительности, насколько это возможно. В перерывах между встречами участники самостоятельно практикуют навык, который разбирали на предыдущей встрече.

Цель программы — внедрить в ежедневную жизнь человека навыки, дающие и развивающие большую адаптивность, эмоциональную устойчивость, позволяющие регулировать депрессивную и тревожную симптоматику, улучшающие качество жизни и уровень психологического благополучия.

Когнитивная терапия на основе осознанности (MBCT, Mindfulness-Based Cognitive Therapy )

Подход, совмещающий методы КПТ и осознанности. Был создан для профилактики рецидивов у людей с тяжелым депрессивным расстройством. Может существовать как в виде восьминедельной программы, так и в индивидуальном формате.

На протяжении программы МBСТ участники обучаются навыкам большей когнитивной осведомленности, принятию негативных мыслительных паттернов и способности умело на них реагировать, возможности переходить от автоматического мышления к сознательной эмоциональной обработке (не ориентироваться на первую, автоматическую, реакцию на ситуацию, а рассматривать ее альтернативные оценки и варианты реагирования).