Psychodynamic approach

Classic psychoanalysis

The beginning of psychotherapy is associated with the creation of psychoanalysis by Sigmund Freud. The revolutionary nature of his views lay in the fact that he developed a psychodynamic approach to personality. Central to this approach is the assumption that personality and behavior are the result of the ego's efforts to reconcile unconscious psychic conflicts and the demands of the real world.

Freud believed that helping the patient is to better understand the unconscious conflicts that lie at the root of his problems. Freudian psychoanalysis offers a set of psychological procedures to achieve this understanding.

Much of what Freud proposed is used by psychotherapists in other theoretical approaches, for example: systematic exploration of the connection between the patient's life history and his current problems; emphasizing thoughts and emotions during treatment; exploiting the relationship between patient and therapist for therapeutic purposes.

The beginning of psychoanalysis

Psychoanalysis developed from Freud's medical practice; he was puzzled by patients suffering from hysterical symptoms—blindness, deafness, paralysis, or other symptoms that had no physical cause. Freud initially used hypnotic suggestion to treat these patients, but this therapy had a partial and temporary effect. Later, Freud and his colleague Joseph Breuer changed their tactics: they asked hypnotized patients to recall life events that might have caused their symptoms. The development of neurosis was presented as follows. A person perceives some events as mental trauma, which he cannot experience in its entirety because of its painfulness. In this regard, there is a delay in affect. The retained energy does not find a way out, but enters the body, disrupting its functioning. Due to this energy, symptoms are formed in the bodily area.

When painful events are repressed from memory and go into the unconscious, a symptom takes their place. The symptom sometimes seems random, but it seems to encrypt, hide the experience, preserving its meaning and elements of external manifestation. For example, Breuer's patient Anna O. could not drink from a glass or swallow water. In a state of hypnosis, she remembered a repressed episode from her memory about how the maid once allowed the dog to drink from a glass. Anna repressed the feeling of disgust. After the patient remembered this incident, she was able to drink from the glass freely. By reconstructing past events, repressed thoughts and feelings are released, pent-up affects are discharged, and symptoms disappear. This therapy, called the "talking cure" by Freud and Breuer, was based on its cathartic effect. Freud eventually stopped practicing hypnosis and simply asked the patient to relax on a couch and report the memories that came to mind (use free association).

As a result of generalizing practice and theoretical analysis of the concept of the unconscious, Freud shifted the emphasis in understanding neurosis from trauma to the dynamics of unconscious drives. Observations showed that neurosis is based not so much on real traumas as on infantile drives and fantasies.

Freud was struck by the fact that many of the symptoms of his patients turned out to be associated with memories of sexual seduction in childhood by a parent or close relative. The question was: was child molestation really that common, or were patient reports untrue? Freud favored the second hypothesis: hysterical symptoms may be based on unconscious desires and fantasies, and not simply on memories of actual events. Thus, the patient's memory of being molested in childhood reflects a childhood fantasy or desire for such an event. This explanation not only led to concepts such as infantile sexuality and the Oedipus complex, but also shifted the focus of psychoanalytic therapy from uncovering lost memories to exploring unconscious desires and conflicts.

Personality concept

The psychodynamic approach to personality emphasizes the influence of unconscious mental processes on the determination of a person's thoughts, feelings and behavior. Freud's theory of personality begins with the assumption that people are born with basic instincts or needs not only for food, water and oxygen, but also for sex and aggression. The needs for security, recognition, love, etc. are based on these fundamental needs. Each person is faced with the task of satisfying various needs in the world around them, which often frustrates them. According to Freud, personality is formed and developed in the process of solving this problem and is reflected in how it is solved.

Personality, according to Freud, consists of three main components. The first component is the Id (it) - a reservoir of unconscious energy called libido. The id includes the basal instincts, desires and impulses that people are born with, namely Eros - the instinct for pleasure and sex and Thanatos - the death instinct, which can motivate aggression or destructiveness towards oneself or others. The id seeks immediate gratification, regardless of social norms or the rights and feelings of others. In other words, the id operates according to the pleasure principle.

The second component of personality is the Ego (self). This is the mind. The ego seeks ways to satisfy instincts, taking into account the norms and rules of society. The ego finds compromises between the irrational demands of the id and the demands of the real world - it acts according to the reality principle. The ego attempts to satisfy needs while protecting the person from physical and emotional harm that may result from awareness, not to mention the reaction of impulses emanating from the id. The ego is the executive branch of the personality.

The third component of personality is the Superego. This component develops in the process of upbringing as a result of the internalization of parental and social values. Freud uses the term "introjection" for this process. The superego includes introjected values, our “shoulds” and “don’ts.” This is our conscience. The superego acts on the basis of a moral principle; violation of its norms leads to feelings of guilt.

The clash of instincts (Id), reason (Ego) and morality (Superego) lead to intrapsychic, or psychodynamic, conflicts. Personality is reflected in how a person solves a wide range of needs.

The most important function of the ego is the formation of defense mechanisms against anxiety and guilt. Defense mechanisms are unconscious psychological tactics that help protect a person from unpleasant emotions - repression, projection, reaction formation, intellectualization, rationalization, denial, sublimation, etc. Neurotic anxiety, according to Freud, is a signal that unconscious impulses threaten to overcome defense mechanisms and achieve consciousness.

Repression is one of the simplest mechanisms aimed at removing from consciousness the unacceptable content of feelings, thoughts and intentions for action, potentially causing the Superego. However, repressed into the unconscious, these “complexes” continue to affect a person’s mental life and behavior and are constantly looking for a way out. Therefore, keeping them unconscious requires a constant expenditure of energy. For example, a person can completely suppress his aggressive impulses, and they will make themselves felt only through slips of the tongue and slips of the tongue. A man faces an unpleasant mission, and he seems to accidentally forget the phone number he should call.

Regression is the return of a person to earlier stages of psychosexual development. In emotionally difficult situations, an adult can behave like a child, for example, believe in mysterious spirits and expect help from them. The return to the oral stage will be associated with oral gratification, such as drinking alcohol. A defensive reaction may be to fall asleep during the day. Regression can manifest itself in a wide range of forms of child behavior: damage to things, impulsive reactions, unreasonable risks, aggressive actions against authorities, etc.

Denial is an attempt not to accept as reality events that are undesirable for the Ego. What is noteworthy is the ability in such cases to “skip” unpleasant events in one’s memories, replacing them with fiction. As a typical example, Freud cites the memoirs of Charles Darwin: “For many years,” Darwin wrote, “I followed the golden rule, namely, when I came across a published fact, observation or idea that contradicted my main results, I immediately wrote it down ; I have found, by experience, that such facts and ideas escape memory much more easily than favorable ones.” Another example is alcohol anosognosia - denial of one's dependence on alcohol.

Reactive education is a defense in which a person’s behavior is opposite to his true feelings. This is the inversion of desire. For example, sexual impulses may be rejected through excessive shame, disgust and hatred of sexuality. The mother can completely suppress the irritation that causes

She has a child, is dissatisfied with his behavior, and shows increased concern for his upbringing, education, and health. This behavior differs from the mother’s natural care for the child by its intrusiveness, and the feelings by greater intensity. Or a dependent person demonstrates disagreement, negativism, and quarrels with parents. At the same time, the opinion of his parents will be decisive for him, but he constantly acts contrary to their advice and demands. The defensive nature of such behavior is revealed in its emotional intensity and rigidity (such a person does not follow any advice).

Projection is the subconscious attribution of one’s own reprehensible qualities, feelings and desires to another person. “You can’t trust your partner,” says a business man who himself is playing a dishonest game. “All men want the same thing,” you can hear from a woman experiencing strong sexual desire. The child gives his feelings to the toy.

Substitution is a change in the object to which feelings are directed. This mechanism is activated when the expression of feelings in relation to a given object is fraught with danger and causes anxiety. A similar situation can often be observed in life, when anger, initially directed, for example, at a boss, spills out on a random person.

When the described defense mechanisms operate, the conflict content does not enter consciousness at all. More complex “maneuvers” of the Ego are also formed, as a result of which the traumatic content partially enters consciousness, but is subject to distortion.

Isolation is the separation of a traumatic situation from the emotional experiences associated with it. The connection between thought and emotion is broken. Sometimes, with severe trauma, such as the death of a loved one, a person understands how great the loss is, but stops reacting to it emotionally. There is a kind of numbness, a decrease in sensitivity to the traumatic factor. Everything happens as if it were happening to someone else. The isolation of the situation from one’s own ego is especially pronounced in children. While playing with a doll, a child can “allow” it to do and say everything that he himself is prohibited from: being reckless, cruel, swearing, making fun of others, etc.

Rationalization is the justification of desires, feelings, and motives that are unacceptable to the individual. Without recognizing the real driving forces of actions, a person strives to find a socially approved justification for them. This is how the Superego copes with the Id.

Intellectualization manifests itself in the fact that a person knows about the presence of suppressed impulses, knowledge about them is present in consciousness, but these impulses themselves are repressed. For example, one may assume the presence of anger towards the father, but at the same time repress aggressive impulses directed at the father and other authority figures.

Due to the action of defense mechanisms, the unconscious becomes difficult to study, but Freud developed a method for this - psychoanalysis. Psychoanalysis includes the interpretation of free associations, dreams, everyday behavior (slips of the tongue, memory errors, etc.), analysis of transference…..

Free association

The patient was asked to enter a state of calm introspection, without delving into deep thoughts, and to communicate everything that comes to his mind, without conscious selection, without adhering to any logic. It is not logic that is important, but completeness. It is necessary to follow the surface of consciousness, refraining from criticism.

The content of free associations is the past and future, thoughts and feelings, fantasies and dreams. In them, the repressed unconscious breaks out to the surface of consciousness. Through free association, the patient learns to reproduce the traumatic experience. Freud believed that there is no chance in human behavior and that Ariadne's thread of free associations will lead the patient to the entrance to the dark cave of the unconscious. Reduced sensory activity, where even the psychoanalyst is not in the patient's field of vision, gives him freedom to express repressed thoughts and feelings.

Transfer

The mechanism of the transference phenomenon is that the patient subconsciously identifies the doctor with the objects of his pregenital sexual desires. In other words, the patient “transfers” to the doctor the feelings that he previously experienced towards other people, primarily towards his parents. There are positive and negative transferences. Positive transference is manifested by feelings of sympathy, respect, love for the analyst, negative transference - in the form of antipathy, anger, hatred, contempt, etc.

Taking on a role in this play, the psychoanalyst must rewrite and direct a new play.

Resistance

Resistance is the patient’s internal forces that are in opposition to psychotherapeutic work and protect neurosis from therapeutic influence. In form, resistance is a repetition of the same defensive reactions that the patient used in his daily life. Resistance operates through the patient's ego, and although some aspects of the resistance may be conscious, much of it remains unconscious.

The psychoanalyst's task is to uncover how the patient resists, what and why. The immediate cause of resistance is the unconscious avoidance of painful phenomena such as anxiety, guilt, shame, etc. Behind these universal reactions in response to an invasion of the patient’s inner world are usually instinctive impulses that cause a painful effect.

Dream analysis

The technique of working with dreams occupies a particularly significant place in psychoanalysis. According to Freud, dreams are guided by unconscious impulses that a person does not want to admit to being conscious. During sleep, control of consciousness weakens and forbidden impulses come out. Strong impulses can disturb sleep, so the dream disguises them, clothing them in symbols.

Freud viewed dreams as the translation of the hidden (latent) content of the unconscious into the language of symbols. Hidden content was understood as repressed desires. Explicit content is obtained through the processes of condensation, displacement and secondary processing.

Psychoanalysis (and any other method within the psychodynamic approach) sets itself two main tasks:

1) to achieve in the patient awareness (insight) of an intrapsychic, or psychodynamic, conflict;

2) work through the conflict, that is, trace how it affects current behavior and interpersonal relationships.

For example, psychoanalysis helps the patient become aware of hidden, repressed feelings of anger towards a parent. This awareness is further complemented by working to enable the patient to emotionally experience and release repressed anger (catharsis). This work then helps the patient become aware of how unconscious conflict and associated defense mechanisms create interpersonal problems. Thus, the patient's hostility toward a boss, senior employee, or other “parental figure” may be a symbolic, unconscious response to childhood conflicts with a parent.

Thus, the psychodynamic approach emphasizes the importance for understanding the genesis of emotional disorders and their treatment of intrapsychic conflicts, which are the result of a dynamic and often unconscious struggle within the personality of its contradictory motives.

Cathexis

Psychoanalysis is viewed as a dynamic psychological approach. This means that the core of psychoanalysis consists of ideas about psychic energy and the distribution of this energy between the Id, Ego and Superego. The id is the source of the psychic energy present in the body: in turn, the id receives energy from instincts. Sexual arousal is an example of the movement of instinctive psychic energy. As the Ego and Superego are formed, they also become energized. Libido is the energy inherent in the instincts of life; aggressive energy is inherent in destructive instincts.

Cathexis are charges of instinctive energy seeking discharge. While anticathexes are charges of energy that make such a discharge impossible. The id has only instinctive “cathexes of the primary process” tending to discharge. The ego and superego have both motivating cathexis and restraining anticathexis. Two characteristic features of libidinal cathexis are mobility, the ease with which they move from one object to another, and, in contrast to this, a tendency to fixation, or attachment to specific objects.

The psychoanalyst always tries to understand the disproportionality of the cathecting of libido and tries to redistribute it.

Types of psychoanalysis

Some of the varieties of psychoanalysis, unlike Freudianism, are less focused on the id, the unconscious and infantile conflicts. They pay more attention to current problems and how the power of the Ego can be used to solve them. In these therapies, patients are helped to understand not the Oedipus complex, but how deep-seated feelings of anxiety, insecurity, and inferiority lead to disordered thoughts and problems in relationships with other people.

This includes first of all analytical psychology of Carl Jung . Jung believed that psychic energy, called libido by Freud, is not based only on sexual and aggressive instincts. He viewed it as a more general life force, comprising an innate urge not only for instinctual gratification, but also for the productive fusion of basal drives with the demands of the real world. Jung called this tendency the transcendental function.

Jung believed that each person has not only a personal unconscious, but also a collective unconscious, a kind of memory bank in which all the images and ideas that the human race has accumulated since its evolution from lower forms of life are stored. Some of these patterns are called archetypes because they consist of classical images or concepts. The idea of the mother, for example, has become an archetype; everyone is born with a predisposition to perceive and respond to certain people as mother figures. A more sinister archetype is the shadow (similar to Freud's idea of the id); it includes the most ancient instincts, going back to pre-human centuries. Jung believed that the shadow was responsible for concepts such as "sin" and "devil."

1. Basic personality archetypes:

Persona is how we present ourselves to the world: character, social roles, clothing, individual style.

The ego is the center of consciousness.

The shadow is the center of the personal unconscious.

Anima - Animus are ideal unconscious structures that reflect ideas about the image of femininity and masculinity.

The Self is the central archetype of order and integrity of the individual.

The collective unconscious, the content of which are archetypes.

Individuality is the most internal, permanent, and incomparable uniqueness.

Individuation - becoming oneself or “self-realization”, is a process of development towards integrity, comprehension of one’s own unconscious, as well as the unfolding and manifestation of one’s unconscious potential in real life.

Instead of identifying specific stages in personality development, Jung proposed that people exhibit varying degrees of introversion (the tendency to focus on the internal world) or extraversion (the tendency to focus on the social world). In addition, people differ in the degree to which they emphasize specific psychological functions, such as thinking and feeling. The combination of these tendencies creates individuals who exhibit individual and predictable patterns of behavior.

2. General characteristics of Jungian analysis.

Task- creation of a new intersubjective space.

According to K. Jung, psychotherapy is the treatment of the soul and the treatment of the soul.

Purpose of analysis– to reveal the creative potential of each experience, to help the client assimilate it in a way that is useful for themselves, to individuate it.

The role of reflection in analysis.

3. Stages of the therapeutic process .

The first stage is analytical. a) recognition, b) interpretation (interpretation)

The second stage is synthetic. A) training, b) transformation (mini-individuation).

Changing the psychotherapist's position during the analysis process: 1) the image of a trickster. 2) cultural transformer, patron and savior, ideal parenthood, 3) the image of a hero, 4) ritual of vision, revelation of spiritual reality.

4. Methods of Jungian psychotherapy.

1. Free associations .

Associations are like webs or circles, they revolve around affectively charged images, and are the connecting element around key images. The bundle of associations has a universal, i.e. archetypal, meaning.

The specificity of the method in Jungean analysis is circular or circular associations. The essence of the method—contact with the unconscious—should be embodied in a free, metaphorical, fantasy atmosphere of analysis.

2. Active imagination - free fantasy, like composing a waking dream, in which the therapist gently guides the client to solve his problem.

Four stages of active imagination (according to M-L. von Franz): 1. Empty ego-mind or purification of the field of consciousness. 2. Allowing the unconscious to fill the vacuum, 3. Adding an element of ethical attitude. 4. integration of imagination into everyday life.

Rules for working with the method: get rid of critical thinking, spontaneous emergence of an image from the unconscious, allow others to live their own lives, do not try to interfere, avoid jumping from topic to topic, allow the unconscious to analyze itself, ensure the unity of the conscious and unconscious.

3. Interpretation.

Features of interpretation in Jungian analysis:

Must be emotional;

Support the client;

Establish stable positive relationships;

The rational, “solar” element is balanced by the “lunar”;

Creative activity of the client himself;

Avoid over-conceptualization;

Stable preserved ego functions.

Full interpretation – dominant complex, resistance and defense systems. It should cover three times: past, present and future. The complex must also affect the analyst emotionally.

Dynamic (psychodynamic) psychotherapy is known as psychoanalytic psychotherapy, insight-oriented therapy, and explorative psychotherapy.

The basis of the psychodynamic direction in psychotherapy is the achievement of an understanding of the dynamics of an individual’s mental life, based on the concept of the unconscious. Any approach in psychoanalytic psychotherapy is based on the client’s gradual awareness of previously unconscious problems and conflicts. Painful symptoms, in turn, are viewed as an unconscious expression of the client’s hidden conflicts. The process of understanding the hidden mechanisms of disease development leads to profound personal changes and gradually smoothes out painful symptoms. Most hechodynamic approaches are long-term.

The psychodynamic approach originates from classical psychoanalysis (3. Freud). The most famous:

1) analytical psychology (Jung - S. G. Jung);
2) individual psychology (Adler - A. Adler);
3) volitional therapy of Rank (O. Rank);
4) active analytical therapy Stekel (W. Stekel);
5) Sullivan’s interpersonal psychotherapy (N. S. Sullivan);
6) intensive psychotherapy FrommReichmann (F. FrommReichmann);
7) characterological analysis of Horney (K. Homey);
8) humanistic psychoanalysis (Fromm - E. Fromm);
9) egoanalysis Klein (M. Klein);
10) Chicago school (Alexander - F. G. Alexander, French - T. M. French);
11) sector therapy by Deutsch (F. Deutsch), objective psychotherapy according to Karpman (B. Karpman);
12) short-term psychotherapy (Sifneos - R. E. Sifneos, Malan - D. N. Malan, Bellak - A. S. Beliak);
13) psychobiological therapy by Mayer (A. Meyer);
14) biodynamic concept of Masserman (J. N. Masserman);
15) adaptation psychodynamics of Rado (S. Rado);
16) Hypnoanalysis (Wolberg - L. R. Wolberg).

According to the psychodynamic approach, the determining factor in understanding the nature of man and his illnesses is that all mental phenomena are the result of the interaction and struggle of intrapsychic forces. In accordance with the theory of conflict of instincts, Freud described the main forces in this struggle that are involved in the origin of neuroses: “A person becomes ill as a result of an intrapsychic conflict between the demands of instinctive life and resistance to them.” He considered the etiology of neuroses to be sexual in nature. The psychoanalytic approach includes five fundamental principles: dynamic, economic, structural, developmental, adaptive.

The psychoanalytic heritage is based on these principles, for which the following provisions are the most significant.

1. Of primary importance are human instinctual impulses, their expression and transformation and, most importantly, their suppression, through which painful feelings or experiences of unpleasant thoughts, desires and the influence of consciousness are avoided.
2. The belief that such repression is essentially sexual, that the disorder is caused by abnormal libidinal or psychosexual development.
3. The idea that the roots of abnormal psychosexual development are in the distant past, in childhood conflicts or traumas, especially with regard to the parental Oedipus complex, expressed in the classic desire for the opposite parent.
4. Confidence in resistance to the identification of the Oedipus complex and its rapid restoration.
5. The idea that, essentially, we are dealing with a struggle between biological internal impulses (or instincts - Id) and the Ego, which acts as a defense in relation to external reality - in the general context of moral rules or standards (SuperEgo).
6. Adherence to the concept of mental determinism, or causality, according to which mental phenomena, like behavior, undoubtedly do not change by chance, but are associated with events that precede them, and, if not made conscious, are involuntarily the basis for repetition.

Therapeutic changes and the healing process in psychodynamic psychotherapy have as their ultimate goal the awareness of the unconscious (to formulate this task in the shortest possible form), and the use of this approach can be possible and useful for any person, not necessarily with any diseases.

The psychotherapist is looking for a way to reveal predominantly sexual repressed content in the patient and resist it. He achieves this by slowly, carefully explaining and unraveling the historical (past experience) meaning of psychic phenomena and the indirect forms in which the camouflaged conflicts underlying them are expressed. It is clear that therefore the dynamic target is sometimes significantly removed.

The dynamic approach is implemented primarily by means of verbalization, including the patient’s free associations and the psychotherapist’s analysis of transference and resistance reactions. Analysis as a psychotherapist's task is facilitated by four specific procedures: confrontation, clarification, interpretation and elaboration. From the very beginning, the technique of free association is the main way the psychotherapist interacts with the “uncensored” content of the patient’s psyche. It serves as the main procedure for identifying the “raw” material on which the analysis is based.

The analysis also includes coverage of dreams, which 3. Freud considered “the royal road to the unconscious.” Confrontation is addressed to the patient’s recognition of specific mental phenomena to be examined; clarification involves bringing phenomena into sharp focus to separate important from unimportant aspects; interpretation follows the received material, determining (in interrogative form) the main meaning or reason for the event; elaboration turns to repetition, a gradual and elaborate exploration of interpretations and resistances until the material presented is integrated into the patient's understanding.

Interpretation is the most important procedure, and elaboration is the most time-consuming part of psychotherapy. Processing necessarily includes the patient’s independent work outside of psychotherapeutic hours. However, short-term psychodynamic therapies are also possible.

Within this approach, we consider the following areas of psychotherapy:

psychoanalysis (general basics);
psychoanalysis 3. Freud;
analytical psychotherapy by K. Jung;
individual psychology of A. Adler;
introspection by K. Horney;
child psychoanalysis;
structural psychoanalysis by J. Lacan;
transactional analysis;
short-term psychodynamic psychotherapy;
symboldrama.

The history of psychoanalysis begins in 1880, when J. Breuer, a Viennese doctor, reported to Freud that one patient, talking about herself, apparently recovered from the symptoms of hysteria. Under hypnosis, she was able to reveal a deeply traumatic event in her life while experiencing an extremely strong emotional reaction (catharsis), and this led to a relief of symptoms. After emerging from the hypnotic state, the patient did not remember what she said under hypnosis. Freud used the same technique with other patients and confirmed Breuer's results.

3. Freud considered this complex to be key for neuroses, meaning that the desires and fears of the Oedipus situation are the same as during the development of neurosis. The process of symptom formation begins when unconscious childhood drives threaten to break through the barrier set by repression and enter consciousness for implementation, which turns out to be unacceptable for other parts of the psyche, both for moral reasons and out of fear of punishment. The release of forbidden impulses is perceived as dangerous, and the psyche reacts to them with unpleasant symptoms of anxiety. The psyche can protect itself from this danger by again and again expelling unwanted impulses from consciousness, i.e. as if renewing the act of repression.
3. Freud discovered that the principles that allow the interpretation of neurotic symptoms apply equally to other mental phenomena, both moral and psychological. Dreams, for example, represent a continuation of daytime life in such an altered state of consciousness as sleep. By applying the psychoanalytic research method, as well as the principle of conflict and the formation of a compromise, the visual impressions of a dream can be interpreted and translated into everyday language.

See: Introduction to psychoanalysis. Sociocultural aspect. 3rd ed., erased. St. Petersburg: Lan, 2002.

The term “psychodynamics” usually refers to movement, unfolding, growth and decay, interaction and struggle of forces within the human psyche. Then the psychodynamic approach is an approach according to which the processes occurring in the psyche that are visible to a person are determined not by external circumstances, not by the mind or will of a person, but by the independent dynamics (interaction and struggle) of forces within the psyche.

"We do not want to simply describe and classify phenomena, but strive to understand them as a manifestation of the struggle of mental forces, as the expression of purposeful tendencies that work in accordance with each other or against each other. We adhere to a dynamic understanding of psychic phenomena." - Z. Freud, Introduction to psychoanalysis.

The psychodynamic approach is based on the assumption that the human psyche has its own movements and interactions of energies that cannot be reduced to physiological or social influences.

Historically, it all began with psychoanalysis, proceeding from a dynamic understanding of psychic phenomena “... as manifestations of the struggle of mental forces, as expressions of purposeful tendencies that work in accordance with each other or against each other” (3 Freud, 1915).

K. Jung, A. Adler, O. Rank, G. Sullivan, K. Horney, E. Fromm and many others worked in the psychodynamic approach. Today in practical psychology, within the framework of these approaches, (among the most well-known schools and directions) transactional analysis, psychodrama (as its variety - systemic constellations) and body-oriented psychotherapy work. The desire for superiority and the inferiority complex are also concepts of the psychodynamic approach. Domestic personality-oriented reconstructive psychotherapy, based on the psychology of relationships by V.N. Myasishchev, is a type of psychodynamic psychotherapy. Existential-humanistic psychotherapy is similar. If we list all schools and directions, then the list is as follows >

The psychodynamic approach does not always give clear answers about the reasons for what is happening and the patterns of its occurrence; we are often satisfied with general indications of the direction in which to search for such mechanisms. If, time after time, sometimes in a dream, sometimes in reality, strange images and memories emerge in us, as if we are standing on the edge of a cliff and cannot decide to take a step forward, although we feel that we may have wings, we can assume that that such pictures can be associated with such and such repressed desires. By understanding when and why you suppressed these desires and what these suppressed desires are now doing to you, you find yourself within the psychodynamic approach.

The psychodynamic approach admits that some aspects of our behavior cannot, in principle, receive simple explanations.

If we assume that the ideas of our ancestors live in us, that we are living our next life in a string of our lives, then we will interpret our strange insights in connection with these assumptions. This is also a psychodynamic approach, although not related to any science.

The dynamics of internal energies do not have to be deep; they can lie on the surface and be elementary for understanding. “Action equals reaction,” “The more you push, the greater the resistance...”

It is important to understand that simple speakers are not synonymous with “unimportant”. The dynamics of distraction or patterns of fatigue are things of exceptional importance, although it is difficult to attribute them to deep dynamics.

On the other hand, deep dynamics are not synonymous with something necessarily important and significant. During auto-training of the highest level, color discharges begin to occur in a person’s consciousness. There is some pattern in them, we can assume that this is connected with the dynamics of some internal, apparently deep energies, but whether this reflects something important or is just “internal noise” is difficult to say.

Not all dynamics dictate a person’s behavior. Despite the fact that classical psychoanalysis describes cases when a person’s behavior was strictly controlled by internal dynamics and was a necessary consequence of internal impulses and states, in Jungianism and the humanistic approach it more often turns out that despite the influence of deep dynamics, a person’s external behavior can fully correspond to the circumstances, be social adequate and within reasonable limits.

Where do psychologists and clients of psychologists get interested in the dynamics of human internal energies? - Oddly enough, this is not a simple question. Knowledge of the laws in science makes it possible (at least theoretically) to predict the course of the processes under study, but this is practically not in demand in psychological work. Sigmund Freud and his followers believed that the client's understanding of his internal situation, his awareness of the internal conflict, removes it, but this assumption was not confirmed: awareness may or may not affect what is happening inside us1.

However, it must be taken into account that many clients feel better simply because they have received an explanation of what is happening, even if nothing has really changed for them. In addition, we cannot exclude simple curiosity and the desire of many people to delve into themselves.

Depth psychodynamic approach

It so happened that very elementary things, such as adapting the internal tempo to a change in the rhythm of life or the communication of the interlocutor, although they are a typical manifestation of the dynamics of internal energies, are usually taken “for granted” and theories that use them are usually not classified as a psychodynamic approach. The solid title of “psychodynamic approach,” meaning a deep psychodynamic approach, is more often assigned to theories that describe non-obvious and untestable phenomena, usually attributed to the unconscious life of a person.

According to the deep psychodynamic approach, the real guiding and driving processes of our mental life are unconscious and hidden from us. We tend to consider ourselves quite knowledgeable about the motives and reasons for our behavior, but in a depth psychodynamic approach this is called into question. Rather, it is assumed that the choice of this or that style of behavior, the inclination to this or that work, the characteristics of our romantic ideal, habits and sexual preferences often develop not due to our conscious and controlled choice, but are only comprehended and formalized by consciousness - being already formed by hidden mental processes.

At the same time, the psychodynamic approach does not a priori assert that deep dynamics is an obligation to collide primary sexual drives with the principle of reality. These can be a wide variety of drives both during adolescence and even more diverse socially unacceptable drives and beliefs that have already formed in an adult. In this case, understanding these conflicts and realizing them is the task of the psychodynamic approach, but Freudianism has nothing to do with it.

Dynamic (psychodynamic) psychotherapy is also known as psychoanalytic psychotherapy, insight-oriented therapy, and exploratory psychotherapy. This approach to psychotherapy proceeds from the fact that a person’s mental life is only the surface, under which lies a huge, iceberg-like foundation - the unconscious. And the unconscious lives by conflicts, the struggle of internal forces. The task of the psychotherapist is to help the client become aware of this dynamic, to become aware of his unconscious. See more details >

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Psychodynamic approach
Classic psychoanalysis

When painful events are repressed from memory and go into the unconscious, a symptom takes their place. The symptom sometimes seems random, but it seems to encrypt, hide the experience, preserving its meaning and elements of external manifestation. For example, Breuer's patient Anna O. could not drink from a glass or swallow water. In a state of hypnosis, she remembered a repressed episode from her memory about how the maid once allowed the dog to drink from a glass. Anna repressed the feeling of disgust. After the patient remembered this incident, she was able to drink from the glass freely. By recalling past events, repressed thoughts and feelings are released, pent-up affects are released, and symptoms disappear. This therapy, called the "talking cure" by Freud and Breuer, was based on its cathartic effect. Freud eventually stopped practicing hypnosis and simply asked the patient to relax on a couch and report the memories that came to mind (use free association).

The clash of instincts (Id), reason (Ego) and morality (Superego) lead to intrapsychic, or psychodynamic, conflicts. Personality is reflected in how a person solves a wide range of needs.

Denial is an attempt not to accept as reality events that are undesirable for the Ego. What is noteworthy is the ability in such cases to “skip” unpleasant events in one’s memories, replacing them with fiction. As a typical example, Freud cites the memoirs of Charles Darwin: “For many years,” Darwin wrote, “I followed the golden rule, namely, when I came across a published fact, observation or idea that contradicted my main results, I immediately wrote it down ; I have found, by experience, that such facts and ideas slip from memory much more easily than favorable ones.” Another example is alcohol anosognosia - denial of one's dependence on alcohol.

The content of free associations is the past and future, thoughts and feelings, fantasies and dreams. In them, the repressed unconscious breaks out to the surface of consciousness. Through free association, the patient learns to reproduce the traumatic experience. Freud believed that there is no chance in human behavior and that Ariadne's thread of free associations will lead the patient to the entrance to the dark cave of the unconscious. Reduced sensory activity, when even the psychoanalyst is not in the patient's field of vision, gives him freedom to express repressed thoughts and feelings.
Transfer

Taking on a role in this play, the psychoanalyst must rewrite and direct a new play.
Resistance

1) to achieve in the patient awareness (insight) of an intrapsychic, or psychodynamic, conflict;

2) work through the conflict, that is, trace how it affects current behavior and interpersonal relationships.

Cathexis are charges of instinctive energy seeking discharge. While anticathexes are charges of energy that make such a discharge impossible. The id has only instinctive “cathexis of the primary process”, striving for discharge. The ego and superego have both motivating cathexis and restraining anticathexis. Two characteristic features of libidinal cathexis are mobility, the ease with which they move from one object to another, and, in contrast to this, a tendency to fixation, or attachment to specific objects.

The psychoanalyst always tries to understand the disproportionality of the cathecting of libido and tries to redistribute it.
Types of psychoanalysis
Some of the varieties of psychoanalysis, unlike Freudianism, are less focused on the id, the unconscious and infantile conflicts. They pay more attention to current problems and how the power of the Ego can be used to solve them. In these therapies, patients are helped to understand not the Oedipus complex, but how deep-seated feelings of anxiety, insecurity, and inferiority lead to disordered thoughts and problems in relationships with other people.

1. Basic personality archetypes:

Persona is how we present ourselves to the world: character, social roles, clothing, individual style.

The ego is the center of consciousness.

The shadow is the center of the personal unconscious.

Anima - Animus are ideal unconscious structures that reflect ideas about the image of femininity and masculinity.

The Self is the central archetype of order and integrity of the individual.

The collective unconscious, the content of which are archetypes.

Individuality is the most internal, permanent, and incomparable uniqueness.

2. General characteristics of Jungian analysis .

Task- creation of a new intersubjective space.

According to K. Jung, psychotherapy is the treatment of the soul and the treatment of the soul.

Purpose of analysis– to reveal the creative potential of each experience, to help the client assimilate it in a way that is useful for themselves, to individuate it.

The role of reflection in analysis.

3. Stages of the therapeutic process .

The first stage is analytical. a) recognition, b) interpretation (interpretation)

The second stage is synthetic. A) training, b) transformation (mini-individuation).

4. Methods of Jungian psychotherapy.

1. Free associations .

2. Active imagination - free fantasy, like composing a waking dream, in which the therapist gently guides the client to solve his problem.

3. Interpretation.

Features of interpretation in Jungian analysis:

Must be emotional;

Support the client;

Establish stable positive relationships;

The rational, “solar” element is balanced by the “lunar”;

Creative activity of the client himself;

Avoid over-conceptualization;

Stable preserved ego functions.

Full interpretation – dominant complex, resistance and defense systems. It should cover three times: past, present and future. The complex must also affect the analyst emotionally.

4. Transference and countertransference.

5. Amplification – expansion, increase, multiplication. Restoring a holistic picture of connections existing in the unconscious, without attaching the image to a specific interpretation from the point of view of the client’s current problems. Amplification is a method of contact with the collective unconscious and archetypal world.

6. Interpretation.

Further, the types of psychoanalysis include individual psychology of Alfred Adler , who emphasized the role of innate social drives in the formation of personality. Adler started from the assumption that every person is born in a helpless, completely dependent state, which creates feelings of inferiority. These negative feelings, combined with the natural desire to become a full member of society, are a stimulus for personal development. He called this process the desire for superiority, by which he meant the desire for self-fulfillment, and not just the desire to be better than others. If feelings of inferiority are very strong, then they can motivate a person to compensate, even to overcompensate for his inferiority. He called this an inferiority complex.

According to Adler, the ways in which a person attempts to achieve personal and social fulfillment determine the lifestyle. Adler argued that this lifestyle is guided by conscious ideas, goals and beliefs (not unconscious, as Freud said) and that these ideas come through experience. For example, a spoiled child may develop the belief that he is “special” and free from the rules of society. This guiding fiction of “I am special” is likely to lead to a selfish lifestyle in which personal fulfillment comes at the expense of others. On the contrary, leading fictions such as “there is something good in everyone” or “tomorrow will be better than today” create positive lifestyles.

Therapy.

The goal of therapy is to return the person to humanity.

Objectives – development of social feeling: development of cooperative behavior, determination of life goals (work, friendship, love), correction of life style.

Three main aspects of therapy: understanding a specific lifestyle, helping to understand oneself, increasing social interest.

Five sources of reliable personality research:

Early childhood memories;

Dreams and daydreams;

The order of birth of a child in the family;

Childhood difficulties;

The nature of the exogenous factor that caused the disorder or disease.

Methods of psychotherapy.

Interviews, early memories method, qualitative analysis of early memories, dream analysis, questionnaires and questionnaires, analysis of adverse situations in childhood.

Another type of psychoanalysis is egopsychology (Anna Freud, Hartmann, Klein) . Ego psychologists viewed the Ego not simply as a mediator in conflicts between the Id, Superego and the environment, but as a creative, adaptive force. The ego is responsible for language development, perception, attention, planning, learning and other psychological functions.

Neo-Freudian theorists such as Erich Fromm, Karen Horney, Harry Sullivan , followed Adler's path by focusing on how other people contribute to the formation of individual personality. They believed that once biological needs are satisfied, attempts to satisfy social needs - protection, security, acceptance - become most influential in shaping personality. When these needs are not met, people feel great discomfort and seek to solve the problem by using other people who can give them what they need socially. The strategies people use to achieve this, such as seeking dominance over others or being overly dependent on others, shape personality. (Note the similarity to Adler's concept of lifestyle.) Sullivan went even further, saying that the concept of personality is simply an illusion, a name for the pattern of interpersonal behavior of each individual person.

Another example of expanding the role of social needs and relationships in the modern psychodynamic approach is the work object relations theorists such as Melanie Klein, Otto Kernberg, Heinz Kohut. Object relations theories emphasize the importance for personality development of the very early relationships between children and their love objects, usually the mother and the child's primary caregivers. Particularly critical in a person's life is how primary figures provide support, protection, acceptance and approval and, in other words, meet the child's physical and psychological needs. The nature of these object relations has an important impetus for personality development, including secure early attachment to the mother or mother surrogates, gradual separation from the attachment figure, and finally the ability to relate to others as an independent individual. Disturbed object relationships create problems associated with the process of personal development and lead to the formation of inadequate self-esteem, difficulties in communicating with other people and more serious mental disorders.

Other varieties of psychoanalysis have retained most of Freud's ideas. F. Alexander ( F . Alexander ), S. Ferenczi ( S . Ferenczi ), O. Rank ( O . Rank ) the emotional component of the interaction between doctor and patient was brought to the fore. Since the 1930s Among leading psychoanalysts, the opinion began to spread that recollection of past events was not the only factor in treatment. Freud also noted that interpretation itself is ineffective in psychoanalysis. Understanding the meaning of symptoms and their connection to past events is not enough for cure. Moreover, the return to consciousness of repressed material began to be interpreted not so much as a cause, but as a result of a certain type of therapeutic interaction between doctor and patient. The most important type of this interaction is transfer. The main point in treatment is not the memory, but the opportunity to accept it and work with it. So, if in childhood an authoritarian father blocked the manifestation of aggressiveness and emotional expansiveness, then in the future the adult will experience difficulties when interacting with people with high status. It is important not only to understand the origins of such reactions, but also to feel sufficient strength and self-confidence to resist attempts at suppression in the present. The ability to accept reconstructed unconscious experience depends on ego strength, which is strengthened in the therapeutic interaction. It is important for the patient to experience a new emotional experience when working with a doctor. The psychotherapist ensures that the experience is beneficial and that the treatment is effective by managing the transference relationship. At the same time, for a transfer to occur, it is important to evoke and restore past events in memory. Thus, treatment requires an optimal combination of intellectual and emotional components.

Other varieties of psychoanalysis have changed treatment, making it less intensive, less expensive, and applicable to a wider range of patients. For example, psychoanalytically oriented psychotherapy (Alexander) or short-term dynamic psychotherapy uses basic psychoanalytic methods, but in a more flexible way. Goals may range from psychological support to basal personality changes, and therapy may consist of 30 sessions or less. Instead of lying on a couch, the patient can sit in a chair facing the therapist and spend more time talking to him than freely associating. The therapist is more active in drawing the patient's attention to current conflicts.

There are three main directions, or approaches, in psychotherapy: psychodynamic, phenomenological (existential-humanistic), behavioral (cognitive-behavioral).

Psychodynamic approach

In order to understand the essence of this approach, it is necessary to turn to the basics of the personality theory of its creator, Sigmund Freud.

The psychodynamic approach states that human thoughts, feelings and behavior are determined by unconscious mental processes. Freud compared a person's personality to an iceberg: the tip of the iceberg is consciousness, but the main mass, located under water and invisible, is the unconscious.

Personality, according to Freud, consists of three main components. The first component is " eid"(it) is a reservoir of unconscious energy called libido. The "id" includes the basal instincts, desires and impulses with which people are born, namely: Eros - the instinct for pleasure and sex and Thanatos - the death instinct, which can motivate aggression or destructiveness towards oneself or others. The id seeks immediate gratification, regardless of social norms or the rights and feelings of others. In other words, the id operates according to the pleasure principle.

The second component of personality is “ ego" (I). This is the mind. The “ego” looks for ways to satisfy instincts, taking into account the norms and rules of society. The ego finds compromises between the irrational demands of the id and the demands of the real world - it acts according to the reality principle. The ego attempts to satisfy needs while protecting the person from the physical and emotional harm that may result from recognizing, let alone reacting to, impulses emanating from the id. “Ego” is the executive power of the personality.

The third component of personality is “ superego" This component develops in the process of upbringing as a result of the internalization of parental and social values. Freud uses the term “introjection” for this process. The “superego” includes introjected values, our “shoulds” and “don’ts.” This is our conscience. The “superego” acts on the basis of a moral principle; violation of its norms leads to feelings of guilt.

Instincts (id), reason (ego) and morality (superego) often do not get along with each other and come into conflict - intrapsychic, or psychodynamic, conflicts arise. Freud believed that the number of these conflicts, their nature and methods of resolution give shape to the personality and determine many aspects of behavior. Personality is reflected in how a person solves the problem of satisfying a wide range of needs.

Normally, adaptive behavior is associated with a small number of conflicts or with their effective resolution. Numerous, severe or poorly managed conflicts lead to deviant personality traits or mental disorders.

The most important function of the ego is the formation of defense mechanisms against anxiety and guilt. Defense mechanisms are unconscious psychological tactics that help protect a person from unpleasant emotions. These are repression, projection, reaction formation, intellectualization, rationalization, denial, sublimation, etc. Neurotic anxiety, according to Freud, is a signal that unconscious impulses threaten to overcome defense mechanisms and reach consciousness.

Psychoanalysis (and any other method within the psychodynamic approach) sets itself two main tasks:
1. To achieve in the patient awareness (insight) of an intrapsychic, or psychodynamic, conflict.
2. Work through the conflict, that is, trace how it affects current behavior and interpersonal relationships.

Now we can formulate the essence of the psychodynamic approach in psychotherapy: it is an approach that emphasizes the importance for understanding the genesis and treatment of emotional disorders of intrapsychic conflicts, which are the result of a dynamic and often unconscious struggle of conflicting motives within the individual.

Types of psychoanalysis

Classical Freudian psychoanalysis is not as popular now as it once was. This is partly because Freud's instinctual theory of personality is outdated, and partly because psychoanalysis is expensive and time-consuming. The most criticized was Freud's idea that all symptoms are reactions to conflict caused by frustration of infantile sexual impulses. Many varieties of psychodynamic theories of personality and the treatment of emotional disorders have emerged.

Some of these varieties are less focused on the id, the unconscious, and the past than Freudianism. They pay more attention to current problems and how “ego power” can be used to solve them. In these therapies, clients are helped to recognize that they are not Oedipus complex”, but how deep-seated feelings of anxiety, insecurity and inferiority lead to emotional disturbances and problems in relationships with others.

This includes primarily the individual psychology of Alfred Adler (1927), who emphasized the role of innate social drives in the formation of personality. Adler theorized that every person is born into a helpless, dependent state that creates a feeling of inferiority. This negative feeling, combined with the natural desire to become a “fledged” member of society, is a stimulus for personal development. Adler explained this process as the desire for superiority, by which he meant the desire for self-fulfillment, and not just the desire to be better than others. If feelings of inferiority are very strong, then they lead to compensation, even overcompensation of inferiority - to an “inferiority complex.” Neurosis develops when a person fails to overcome an inferiority complex; neurosis allows the patient to maintain self-esteem, attributing his weakness to the disease.

Another type of psychoanalysis is ego psychology (Anna Freud, 1946, Hartman, 1958, Klein, 1960). Ego psychologists viewed the ego not simply as a mediator in conflicts between the id, superego and the environment, but as a creative, adaptive force. The ego is responsible for language development, perception, attention, planning, learning and other psychological functions.

Neo-Freudian theorists such as Karen Horney (1937), Erich Fromm (1941), Harry Sullivan (1953) followed Adler's path, focusing on the study of how the social environment participates in the formation of personality. They believed that the most significant for the formation of personality is the satisfaction of social needs - the need for security, safety, recognition (acceptance). When these needs are not met, people experience great discomfort and seek to solve the problem by using other people, getting from them what they need. The strategies used for this - the desire for superiority over others or, on the contrary, excessive dependence on others - shape the personality. Sullivan placed so much importance on interpersonal relationships that he defined personality as " pattern of an individual's interpersonal behavior».

In the modern psychodynamic approach, the line of neo-Freudians is continued by object relations theorists, such as Melanie Klein (1975), Oggo Kernberg (1976), Heinz Kohut (1984).

Object relations theories emphasize the importance for personality development of the very early relationships between children and their love objects, usually the mother and the child's primary caregivers. Particularly critical in a person's life is how primary figures provide support, protection, acceptance and approval, or in other words, meet the child's physical and psychological needs. The nature of these object relations has an important impetus for personality development. In its development, a healthy personality goes from a secure early attachment to the mother or her substitutes through a gradual distance from the object of attachment to the ability to build relationships with other people as an independent individual. Disturbed object relations can create problems that interfere with personal development processes and lead to inadequate self-esteem, difficulties in interpersonal relationships, or more serious mental disorders.

A type of psychodynamic psychotherapy is our domestic personality-oriented (reconstructive) psychotherapy, developed at the Psychoneurological Institute named after. Bekhterev, the theoretical basis of which is the psychology of relationships by V. N. Myasishchev (1960).

The main goal of this model is to reconstruct the system of relationships that was disrupted in the process of personality development under the influence of social factors, primarily distorted interpersonal relationships in the parental family. A disrupted system of relationships does not allow a person to rationally resolve intrapsychic conflicts that arise in a difficult life situation, which leads to the emergence of neurosis. Awareness of conflict is one of the important tasks in the process of psychotherapy. The concept of personality of V. N. Myasishchev and the concept of personality-oriented (reconstructive) psychotherapy are presented in detail in separate lectures.

According to the phenomenological approach, each person has a unique ability to perceive and interpret the world in his own way. In the language of philosophy, the mental experience of the environment is called a phenomenon, and the study of how a person experiences reality is called phenomenology.

Proponents of this approach are convinced that it is not instincts, internal conflicts or environmental stimuli that determine a person’s behavior, but his personal perception of reality at any given moment. Man is not an arena for resolving intrapsychic conflicts and not behavioral clay from which a personality is molded thanks to learning, but, as Sartre said: “ A man is his choices" People control themselves, their behavior is determined by the ability to make their own choices - to choose how to think and how to act. These choices are dictated by a person's unique perception of the world. For example, if you perceive the world as friendly and accepting, then you are more likely to feel happy and safe. If you perceive the world as hostile and dangerous, then you are likely to be anxious and defensive (prone to defensive reactions). Phenomenological psychologists consider even deep depression not as a mental illness, but as a sign of an individual’s pessimistic perception of life.

In fact, the phenomenological approach leaves out of its consideration the instincts and learning processes that are common to both humans and animals. Instead, the phenomenological approach focuses on those specific mental qualities that distinguish humans from the animal world: consciousness, self-awareness, creativity, the ability to make plans, make decisions and responsibility for them. For this reason, the phenomenological approach is also called humanistic.

Another important assumption of this approach is that every person has an innate need to realize his potential - to grow as a person - although the environment may block this growth. People are naturally inclined towards kindness, creativity, love, joy and other highest values. The phenomenological approach also implies that no one can truly understand another person or his behavior unless he tries to look at the world through that person's eyes. Phenomenologists, therefore, believe that any human behavior, even those that seem strange, is full of meaning to the one who discovers it.

Emotional disturbances reflect a blockage of the need for growth (self-actualization) caused by perceptual distortions or lack of awareness of feelings. Humanistic psychotherapy is based on the following assumptions (D. Bernstein, E. Roy et al., 1988):
1. Treatment is a meeting of equal people (“encounter”), and not a medicine prescribed by a specialist. It helps the patient regain his natural stature and feel and behave in accordance with who he really is, rather than what others think he should be.
2. Improvement in patients occurs on its own if the therapist creates the right conditions. These conditions promote awareness, self-acceptance and expression of feelings by patients. Especially those that they have suppressed and that are blocking their growth.
3. As with the psychodynamic approach, therapy promotes insight, however, in phenomenological therapy, insight is the awareness of current feelings and perceptions, rather than unconscious conflicts. The best way to create these correct (ideal) conditions is to establish a relationship in which the patient feels unconditional acceptance and support. Therapeutic changes are achieved not through the use of specific techniques, but through the patient's experience of this relationship.
4. Patients are fully responsible for choosing their own way of thinking and behavior.

The most famous forms of phenomenological therapy are “client-centered therapy” by Carl Rogers (1951) and “gestalt therapy” by Frederick Perls (1969).

Carl Rogers practiced psychodynamic therapy in the 1930s. But he soon began to doubt its value. He was especially not impressed by being an impartial expert who “understood” the patient. He became convinced that a less formal approach was more effective and began using what he called " non-directive therapy”, that is, he allowed his patients to decide what to talk about and when, without direction, evaluation, or interpretation from the therapist. This approach is now called "client-centered therapy" to emphasize the role of the client. The foundation of Rogers' treatment is the creation of an attitude characterized by three important and interrelated positions (Rogers' triad): unconditional positive regard, empathy, congruence.

1. “Unconditional positive regard”. The therapist must show that he genuinely cares about the client, accepts him as a person, and trusts his ability to change. This not only requires a willingness to listen to the client without interrupting him, but also to accept what is being said without judgment or judgment, no matter how “bad” or “weird” it may seem. The therapist does not need to approve of everything the client says, but must accept it as a real part of the person being assessed. The therapist must also trust clients to solve their own problems, hence they do not give advice. Advice, says Rogers, carries a hidden message that the client is incompetent or inadequate - making him less confident and more dependent on help.

2. Empathy. Many forms of therapy offer an outside perspective on the patient. Empathy requires an inward view, focusing on what the patient may be thinking and feeling. The client-centered therapist acts not as an outside observer who seeks to place a diagnostic label on the client, but as someone who wants to understand what the world looks like from the client's point of view.

Empathy cannot be communicated by saying, “I understand,” or, “I know how you feel right now.” The therapist conveys empathy by showing that he is actively listening to the client. Like skilled interviewers, client-centered therapists make contact with the client through their eyes, nod their heads when the client speaks, and provide other signs of attention. A tactic called reflection is also used. Reflection shows that the therapist is actively listening and also helps the client become aware of the thoughts and feelings they are experiencing. Indeed, most clients respond to empathic reflection by paying close attention to their feelings.

3. Congruence is the consistency between what the therapist feels and how he behaves towards the client. This means that the therapist's unconditional positive regard and empathy are real and not faked. Experiencing the therapist's congruence allows the client to see, perhaps for the first time, that openness and honesty can be the basis of human relationships.

As an illustration of the use of Rogers' principles in practice, below is an excerpt from his conversation with a patient (K. Rogers, 1951, p. 49).

Client. I can't be who I want to be. I guess I don't have the strength to kill myself, but if someone else would let me off the hook, or if I had an accident, I would... I just don't want to live.

Therapist. Nowadays everything looks so gloomy that you don't see the point in life. (Note the use of empathic reflection and the absence of any criticism.)

Client Yes, I regret agreeing to this therapy. I was happy when I lived in the world of my dreams. In it I could be whatever I wanted. But now there is such a wide gap between my ideal and what I am... (Note that in response to reflection the client gives more information.)

Therapist Yes, I understand how hard it is to delve into yourself and that at times it is so tempting and convenient to hide in the world of your dreams. (Reflection.)

Client; My dream world or suicide... In a word, it’s not worth wasting your time, coming twice a week... I’m not worthy... What do you think?

Therapist. It's up to you... I'm not wasting my time. I would be glad to meet you whenever you come, but it's up to you... (Notice the congruence in the sincere desire to meet with the patient and the unconditional positive attitude that expresses trust in her ability to make choices and take responsibility for them.)

Client: Are you going to suggest that I come more often? Aren't you afraid for me and don't think I need to come every day until I get out of this? ..

Therapist. I believe that you can make your own decision. I will receive you as soon as you want to come. (Positive attitude).

Client: (speaking in awe), I believe that you are not afraid for me... I understand... I may be afraid for myself, but you are not afraid for me. (She experiences the therapist's confidence in her.)

Therapist Are you saying that you may be afraid for yourself and are surprised that I am not afraid for you? (Reflection.)

Client You trust me more than I trust myself. Perhaps I will visit you next week.

The client was right. The therapist actually trusted her more than she trusted herself (by the way, she didn't commit suicide). Rogers noted that in the process of client-centered therapy, clients not only become more self-confident, but they become more aware of their true feelings, accept themselves, behave more comfortably and naturally with other people, rely more on their own assessment than on opinions of others, and become more productive and calm.

Behavioral approach

Behavioral therapy as a systematic approach to the diagnosis and treatment of psychological disorders arose relatively recently - in the late 50s. In its early development, behavior therapy was defined as the application of "modern learning theory" to the treatment of clinical problems. The concept " modern learning theories” then referred to the principles and procedures of classical and operant conditioning.

The theoretical source of behavioral therapy was the concept of behaviorism of the American zoopsychologist Watson (1913) and his followers, who understood the enormous scientific significance of Pavlov’s doctrine of conditioned reflexes, but interpreted and used them mechanistically. According to the views of behaviorists, human mental activity should be studied, as in animals, only by recording external behavior and should be limited to establishing the relationship between stimuli and reactions of the body, regardless of the influence of the individual. In attempts to soften the clearly mechanistic positions of their teachers, neobehaviorists (Tolman, 1932, Hull, 1943, etc.) later began to take into account the so-called “ intermediate variables" - the influence of the environment, needs, skills, heredity, age, past experience, etc., but still ignored the individual. In essence, behaviorism followed Descartes' long-standing doctrine of "animal machines" and the 18th-century French materialist La Mettrie's concept of "man-machine."

Based on learning theories, behavioral therapists viewed human neuroses and personality anomalies as an expression of maladaptive behavior developed during ontogenesis. Wolpe (1969) defined behavior therapy as:

“the application of experimentally established learning principles for the purpose of changing maladaptive behavior. Non-adaptive habits weaken and are eliminated, adaptive habits arise and strengthen” (quoted by R. A. Zachepitsky, 1975).

At the same time, elucidating the complex mental causes of the development of psychogenic disorders was considered unnecessary. Frank (1971) even stated that revealing such causes is of little help to treatment. Focusing on their consequences, that is, on the symptoms of the disease, according to the author, has the advantage that the latter can be directly observed, while their psychogenic origin is captured only through the selective and distorting memory of the patient and the preconceptions of the doctor. Moreover, Eysenck (1960) argued that it is enough to relieve the patient of symptoms, and thereby the neurosis will be eliminated.

Over the years, optimism about the special effectiveness of behavior therapy began to wane everywhere, even among its prominent founders. Thus, Lazarus (1971), a student and former close collaborator of Wolpe, objected to his teacher's assertion that behavior therapy supposedly has the right to challenge other types of treatment as the most effective. Based on its own catamnestic data, Lazarus showed " disconcertingly high» the frequency of relapses after his behavior therapy in 112 patients. The resulting disappointment was vividly expressed, for example, by Ramsay (1972), who wrote: "The initial claims of behavior therapists regarding the results of treatment were astonishing, but have now changed... The range of disorders that respond favorably to this form of treatment is now small." Its reduction was also reported by other authors, who recognized the success of behavioral methods mainly in cases of simple phobias or insufficient intelligence, when the patient is not able to formulate his problems in verbal form.

Critics of the isolated use of behavioral therapy methods see its main defect in its one-sided focus on the action of the elementary technique of conditioned reinforcement. The prominent American psychiatrist Wolberg (1971) pointed out, for example, that when a psychopath or alcoholic is constantly punished or rejected for antisocial behavior, they themselves repent of their actions. Nevertheless, they are pushed to relapse by an intense internal need, much stronger than the conditioned reflex influence from the outside.

The fundamental drawback of the theory of behavioral therapy is not the recognition of the important role of the conditioned reflex in human neuropsychic activity, but the absoluteization of this role.

Behavior therapy has undergone significant changes in both its nature and scope in recent decades. This is due to the achievements of experimental psychology and clinical practice. Now, behavior therapy cannot be defined as an application of classical and operant conditioning. The different behavioral therapy approaches today differ in the degree to which they use cognitive concepts and procedures.

Cognitive therapy

The beginning of cognitive therapy is associated with the work of George Kelly (Ch. L. Doyle, 1987). In the 1920s, George Kelly used psychoanalytic interpretations in his clinical work. He was amazed at the ease with which patients accepted Freudian concepts that Kelly himself found absurd. As an experiment, Kelly began to vary the interpretations he gave to patients within a variety of psychodynamic schools.

It turned out that the patients equally accepted the principles offered to them and were full of desire to change their lives in accordance with them. Kelly concluded that neither Freud's analysis of childhood conflicts, nor even the study of the past as such, were of decisive importance. According to Kelly, Freud's interpretations were effective because they disrupted patients' habitual ways of thinking and provided them with the opportunity to think and understand in new ways.

The success of clinical practice with a variety of theoretical approaches, according to Kelly, is explained by the fact that during the course of therapy there is a change in how people interpret their experiences and how they look at the future. People become depressed or anxious because they are trapped in rigid, inadequate categories of their own thinking. For example, some people believe that authority figures are always right, so any criticism from an authority figure is depressing to them. Any technique that leads to a change in this belief, whether it is based on a theory that associates such a belief with the Oedipus complex, with the fear of loss of parental love, or with the need for a spiritual guide, will be effective. Kelly decided to create techniques to directly correct maladaptive ways of thinking.

He encouraged patients to become aware of their beliefs and examine them. For example, an anxious, depressed patient was convinced that disagreeing with her husband's opinion would cause him to become very angry and aggressive. Kelly insisted that she nevertheless try to express her own opinion to her husband. Having completed the task, the patient was convinced that it was not dangerous. Such homework assignments became routine in Kelly's practice. Sometimes Kelly even offered patients the role of a new person with a new view of themselves and others - first in therapy sessions and then in real life. He also used role-playing games. Kelly concluded that the core of neuroses is maladaptive thinking. The neurotic's problems lie in present ways of thinking, not in the past. The therapist's job is to identify unconscious categories of thinking that lead to suffering and teach new ways of thinking.

Kelly was one of the first psychotherapists to try to directly change the thinking of patients. This goal underlies many modern therapeutic approaches, which are collectively known as cognitive therapy.

At the present stage of development of psychotherapy, the cognitive approach in its pure form is almost never practiced: all cognitive approaches use behavioral techniques to a greater or lesser extent. This is also true for " rational emotive therapy"A. Ellis and to "cognitive therapy" by A. Beck.

The Emergence of Cognitive Behavioral Therapy

Experimental work in cognitive psychology, particularly Piaget's research, provided clear scientific principles that could be applied in practice. Even studies of animal behavior have shown that we must take into account their cognitive capabilities to understand how they learn.

In addition, there was an emerging understanding that behavior therapists were unknowingly tapping into the cognitive capabilities of their patients. Desensitization, for example, takes advantage of the patient's willingness and ability to imagine. Social skills training is not really conditioning: patients learn not specific responses to stimuli, but a set of strategies needed to cope with fearful situations. Using imagination, new ways of thinking, and applying strategies involves cognitive processes.

Behavioral and cognitive therapists have found a number of similarities (Ch. L. Doyle, 1987).
1. And those others are not interested in the causes of disorders or the past of patients, but deal with the present: behavioral therapists focus on current behavior, and cognitive therapists focus on what a person thinks about himself and about the world in the present.
2. Both view therapy as a learning process and the therapist as a teacher. Behavioral therapists teach new ways of behaving, and cognitive therapists teach new ways of thinking.
3. Others give homework assignments to their patients so that they can practice outside the therapeutic environment what they learned during therapy sessions.
4. And those others prefer a practical, devoid of absurdity (meaning psychoanalysis) approach, not burdened with complex theories of personality.

The clinical area that brought the cognitive and behavioral approaches closer together was neurotic depression. Aaron Beck (1967), observing patients with neurotic depression, drew attention to the fact that themes of defeat, hopelessness and inadequacy constantly sounded in their experiences. Beck concluded that depression develops in people who perceive the world in three negative categories: 1) a negative view of the present: no matter what happens, a depressed person focuses on the negative aspects, although life provides some experiences that bring pleasure to most people; 2) hopelessness about the future: a depressed patient, drawing the future, sees only gloomy events in it; 3) decreased self-esteem: a depressed patient sees himself as insolvent, unworthy and helpless.

Influenced by Piaget's ideas, Beck conceptualized the problems of the depressed patient: events are assimilated into a non-gavistic, absolutist cognitive structure, resulting in withdrawal from reality and social life. Piaget also taught that activity and its consequences have the power to change cognitive structure. This led Beck to create a therapeutic program that used some of the tools developed by behavior therapists (self-monitoring, role-play, modeling, homework, etc.).

Another example is Albert Ellis's (1962) rational-emotive therapy. Ellis proceeds rather from the phenomenological position that anxiety, guilt, depression and other psychological problems are caused not by traumatic situations as such, but by how people perceive these events, what they think about them. Ellis says, for example, that you are upset not because you failed an exam, but because you believe that failure is a misfortune that indicates your inability. Ellis therapy seeks to first identify such self-defeating (“self-defeating”) and problem-producing thoughts that the patient has acquired as a result of incorrect learning, and then help the patient replace these maladaptive thought patterns with more realistic ones, using modeling, encouragement, and logic. As in A. Beck's cognitive therapy, Ellis's rational-emotive therapy places a lot of emphasis on behavioral techniques, including homework.

So, a new stage in the development of behavioral therapy is marked by the transformation of its classical model, based on the principles of classical and operant conditioning, into a cognitive-behavioral model. The goal of a “pure” behavior therapist is behavior change; The goal of a cognitive therapist is a change in the perception of oneself and the surrounding reality. Cognitive behavioral therapists recognize both: knowledge about the self and the world influences behavior, and behavior and its consequences influence beliefs about the self and the world.

Cognitive behavioral therapists, like their predecessors, are not interested in the past or causes of neurotic disorders. They say that no one knows the real causes, and besides, it has not been proven that knowledge of the causes has anything to do with healing. If a patient comes to the doctor with a broken bone, the doctor's task is to fix it, and not to study the conditions that led to it.