Lecture
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Since the personality of the consultant is his tool of work, its fullness and integrity becomes important for effective psychotherapy. Let us list the qualities necessary for the psychotherapist: the ability to attract people to himself, the ability to feel free in any society, the ability to empathy and other external attributes of charm. These qualities are not always innate, but are largely acquired. They appear as a result of a benevolent interest in people.
A psychotherapist is a trained specialist who is able to diagnose and treat diseases, mainly of psychogenic origin, purposefully applying psychological effects as a therapeutic agent. Due to the specifics of psychotherapy, he in one way or another brings to the healing process the peculiarity of his personality, his own system of values, his preferred theoretical orientations and psychotherapeutic technologies. Different areas of psychotherapy are characterized by different accents in assessing the significance of P.'s personal qualities or psychotherapeutic techniques for the effectiveness of treatment. This difference is found when comparing client-centered, behavioral, rational-emotional, psychodynamic psychotherapy.
Before counseling novice psychotherapists should undergo psychoanalysis themselves, otherwise they will subconsciously proceed from their own complexes when working. It helps the psychotherapist to know himself better. So says May.
The psychotherapist needs to develop in himself what Adler called the courage of imperfection, that is, the ability to courageously accept failure. The courage of imperfection is to gather all the forces in one decisive battle, the outcome of which can be both victory and defeat.
The psychotherapist should learn to enjoy the process of life itself. The pleasure received from life and work will eliminate the need to constantly motivate actions and weigh each step, depending on what he gives. The psychotherapist must be convinced that he is interested in people for their own sake.
K. Rogers believes that the assistant should be open and able to show unconditional positive attention, i.e. accept and perceive the client as reputable, no matter who he is, what he says or does; the congruence must be inherent in the assistant, i.e. he must use his feelings in the process of counseling, his verbal and non-verbal behavior must be open to the client and be consistent; The assistant must be authentic in his behavior. Those. be honest, frank and not hide behind your "facade"; he must show empathy, i.e. show the client that he understands the image of his thoughts and feelings and can see the world as the client sees it, but at the same time he maintains his separation from the client's world. This should be manifested in the behavior of the therapist so that the client can sense them.
Kulshed lists the qualities of an effective consultant:
A large number of specialists are inclined to believe that the quality of interpersonal relations between the client and the psychotherapist is an important factor. There are more complex relationships between the effectiveness of psychotherapy and the qualities of a psychotherapist. Truax and Karkhaf recognize the existence of a relationship between the effectiveness of the consultant and his empathy, respect for the client and the authenticity of his behavior.
The fact that the psychotherapist himself underwent a course of his own psychotherapy is not a guarantee of the effectiveness of psychotherapy. Gender and nationality do not affect the effectiveness of psychotherapy. The value of the work experience of the psychotherapist as a factor in the effectiveness of psychotherapy is controversial. Psychotherapists who have their own emotional problems are often less effective at work. Psychotherapists are more effective when they deal with clients who share their own life values.
The psychotherapist must have the skills of an expert. So, for example, in the research of Z. Freud, the principle of “allowing people to hear themselves” is open, it is described through the well-known metaphor that the psychoanalyst is “the patient’s mirror”. We list the skills of professional counseling:
In the course of behavioral psychotherapy, the specialist, as a rule, directs the treatment process and achieves the desired goals using certain psychotherapeutic techniques. The important properties of the psychotherapist are the professional manipulation of the process of interaction with the patient, the ability to encourage and reinforce his useful reactions, to convince and implicitly inspire. Together with the instructions, he gives advice and recommendations, acts as a teacher.
The style of work of the psychotherapist in the course of rational-emotional psychotherapy is determined by the need for active cooperation of the patient by the type of partnership at all stages of psychotherapy. The characteristics of the psychotherapist, such as empathy, metered openness, the ability to focus on a specific problem and avoid confrontation, if necessary, help to establish the optimal interaction. Relationships can at times acquire an educational character of the type of a teacher-student union.
The characteristics of the personality-oriented (reconstructive) psychotherapy of Karvasarsky, Isurina, Tatlykov dictate to the psychotherapist an active, but flexible style of behavior, mainly with an empathic approach, in which the extremes of the directive and non-directive styles are avoided.
In psychodynamic psychotherapy in accordance with the characteristics of the analytical situation, the therapist takes the position of empathic objectivity, restraint and neutrality. The term "neutrality" does not imply indifference, passivity, it is used to describe the general attitude of the psychotherapist and includes professional code, i.e. respect for the individuality of the patient, his right to be the master of his life, not to allow her to be intruded or her own preferences and needs of the analyst would violate (Greenson - Greenson RR, 1965). In the course of classical psychoanalysis, the psychotherapist's behavior is determined by Freud's statement (Freud S.) that the analyst is like a screen or mirror in relation to the patient, reflects its manifestations and does not contribute its own feelings and personal values, and also observes “technical neutrality” in order to prevent the possibility of portable erotic claims of the patient. Countertransference involves the analyst's own feelings, his attitude towards the patient and, according to Freud, is a hindrance in the practical work of the psychotherapist, being a manifestation of his unconscious needs and conflicts. According to modern psychoanalysts, countertransference is a useful practical tool for analyzing and understanding the psychotherapist of his reactions; it provides additional capabilities for recognizing the patient’s unconscious processes. In psychoanalytic psychotherapy, a physician is required to create a therapeutic alliance, or working union, with the patient, reflecting real rational and non-regressive relations. In Jung's analytical psychology (JungC.G.), The decisive role in the success of psychotherapy is played not so much by the highly specialized knowledge of the psychotherapist, but by the degree of his development as a person. For this reason, Jung was the first to introduce compulsory training analysis for all who wish to engage in a professional analytical psychology. He insisted on the need for rational, reasonable contact between analyst and patient. However, the doctor seeks to understand the patient, in the process of analysis, he approaches his own unconscious and encounters what turns him into a “wounded healer”. Jung was one of the first to use countertransference as a therapeutic tool; he considered it an important source of information for the psychotherapist. The analyst is able to tune into the inner world of the patient to such an extent that he will begin to feel or behave in a manner that he may later realize as a continuation of the intrapsychic processes of the latter projected onto him.
The psychotherapist needs to know his communicative features, ways to overcome difficulties in life, his problems. Often, the doctor’s unconscious need for submission and approval from the patient, excessive desire to lead and care for him, intolerance for opposition, negative reactions or aggressiveness of the patient make it difficult to establish proper contact. Negatively on the course of psychotherapy can be affected by low self-esteem of the psychotherapist, uncertainty, passivity, the search for recognition. In addition, the process of psychotherapy itself can be a source of psychological discomfort for the specialist. On the one hand, he should not be involved in the patient’s experiences in order to objectively assess the situation, but on the other hand, he should be open to his feelings in order to understand him. The physician is obliged to maintain composure with negative reactions of the patient in relation to him. A psychotherapist, as psychoanalysts believe, can free himself from his own inadequate emotional reactions and from an unconscious tendency to satisfy his frustrated needs (for example, difficulties in expressing aggression, the need for recognition, in satisfying sexual impulses, etc.) analytic training as a patient.
In other areas of psychotherapy, various training methods of training and improving the psychotherapist are widely recognized. The interpersonal training option for the psychotherapist is primarily aimed at deepening each participant’s awareness of ways to form and develop the group, its functioning in it, the characteristics of emotional communication with other people, and, if necessary, change the relevant aspects of their perceptions, experiences and behavior. Therapeutic training is a form of short-term group psychotherapy, which provides participants with the opportunity to analyze and correct their emotional problems, to master individual psychotherapeutic techniques in solving these problems. In the Balint groups, the psychotherapist clarifies his own feelings, behavioral stereotypes and "white spots" that prevented and prevented him from understanding and resolving a difficult situation in treating a patient and establishing effective communication with him. In this form of training, this is not about changing the personality of the psychotherapist, but about the necessary transformation of his professional self. The same goal can be achieved by a co-therapeutic (joint psychotherapy with an experienced psychotherapist) and a supervisory (supervision of an experienced psychotherapist) psychotherapist training model. In the process of training, an important place is occupied by such disciplines as psychiatry and medical psychology.
All psychotherapeutic areas emphasize the importance of psychotherapeutic contact between a doctor and a patient, not only to create optimal treatment conditions, but also as an instrument of psychological influence that can lead to positive changes in the patient's feelings, attitudes and behavior.
Psychotherapeutic contact contains the following therapeutic components: meeting expectations and needs, listening (responding or “venting” emotional stress), emotional support, feedback, when opening up their thoughts, experiences and behavior. Psychotherapeutic contact forms on the basis of the development of mutual understanding of communication between the psychotherapist and the patient. The most important task of the doctor at the same time is to create a stable trust relationship with the patient. The psychotherapist shows respect for the patient as an individual, accepts him without moral condemnation and criticism, shows a desire to help him.
Mutual understanding between the psychotherapist and the patient, necessary for optimal psychotherapeutic contact, is achieved by mutual verbal and non-verbal means of communication. The non-verbal behavior of the doctor (facial expressions, gestures, intonation) often turns out to be more meaningful for the patient than his statements. To understand non-verbal behavior, it is important to take into account such signs as distance between interlocutors, body body orientation, degree of eye contact, body orientation, etc. The warm, empathic attitude of the psychotherapist to the patient is expressed by the short distance between them, direct eye contact, smile, and posture patient, free and relaxed position of the hands, friendly and confident voice intonations, etc. Restrained, emotionally neutral, and sometimes "cold" attitude of the psychotherapist the patient manifests itself in the direction of the gaze and body to the side, in the negligence of posture, the presence of a “barrier” (table) between them, the absence of a smile, stiffness in body and arm position (drumming fingers on the table), in inexpressive and formal voice intonations, etc. signs of non-verbal behavior are observed in a patient with a positive or negative attitude towards the psychotherapist. With good psychotherapeutic contact, the patient in a non-verbal connection strives for synchronicity: the body movements of the patient, the position of the hands, nods, eyelid movements, breathing, etc., are coordinated with the sounds and content of the psychotherapist's speech. Duration, pace and volume of speech, the frequency of pauses, it also synchronizes with the verbal behavior of the therapist. The non-verbal accompaniment of an open, verbal expression of an emotional relationship to one another neutralizes, emphasizes, or produces the opposite effect.
In various psychotherapeutic areas there are peculiar emphasis on the main therapeutic mechanism of psychotherapeutic contact. In psychoanalysis, the central mechanism of psychotherapeutic contact is transference and countertransference as a manifestation of childish and inert emotional attitudes towards parents activated in the psychoanalytic situation. It is assumed that the patient becomes addicted again, now to the psychoanalyst, and as a result of working through the transference neurosis that has arisen, he is freed from this dependence. In client-centered psychotherapy, the creation of empathic communication allows us to avoid transference, and thanks to the special therapeutic conditions of psychotherapeutic contact (Rogers Triad), it becomes possible to have a new understanding of yourself and your life, responsible and self- solving of emerging problems. The therapeutic mechanism of psychotherapeutic contact during personality-oriented (reconstructive) psychotherapy by Karvasarsky, Isurina, Tashlykov is the identification and analysis, in conditions of trust, of emotionally warm communication, the main stereotype in the patient's personality relationship system, which violates his self-esteem and interpersonal functioning. The approach to understanding psychotherapeutic contact based on transactional analysis is unique. The patient's behavior reflects, at every moment of communication with the psychotherapist, one of the sides of his I: the adult I, the parent's I and the child's I. Thus, if the psychotherapist, instead of looking for the reasons for the patient's violation of medical prescriptions, confines himself to criticism or moralizing, the patient reacts with fear and humility or is outraged by the "instruction" of the psychotherapist. In this case, the psychotherapeutic contact is built according to the "Parent-Child" type.
After the initial psychotherapeutic contact has been established between the therapist and the patient, the communication process leads to the creation of certain relationships that persist during psychotherapy or change at different stages. VA Tashlykov (1984) identifies two main types of role interaction in psychotherapeutic contact: leadership and partnership. Leadership as an expression of the authority (power) of a specialist reflects the traditional medical model of the doctor-patient relationship, in which the doctor dominates, takes a leading, active position, takes responsibility for solving the main tasks during the treatment period, and the patient remains subordinate, relatively inactive. passive object of therapy. Such a psychotherapist is endowed with "magical" qualities, and patients are especially susceptible to his suggestive influences. For socially immature patients with severe addiction with low motivation for treatment, this type of contact is useful, especially in the first stage of treatment. On an outpatient basis, when the psychotherapist refuses to lead in relations with these patients, they tend to interrupt treatment and find another doctor who meets their need for addiction. At the same time, the psychotherapist uses methods of psychotherapeutic influence, containing calming, clarification, persuasion, suggestion, inspires hope, gives advice, recommendations. Psychotherapeutic contact reflects not only social (leadership in partnership), but also emotional distance (empathic and emotionally neutral approaches). Psychotherapeutic guidance, combined with emotional support, allows patients, through imitation and identification, to better internalize the therapist's influence and thereby develop more adequate attitudes and behaviors. The disadvantage of this type of psychotherapeutic contact is the low activity and responsibility of the patient, as well as often dependence on the psychotherapist. The greatest dissatisfaction and resistance of patients is caused by the leadership with the emotionally neutral approach of the doctor. Partnership as a model of non-authoritarian cooperation, a healing union presupposes the patient's active participation in the psychotherapeutic process, the development of responsibility and independence, the ability to make a choice between alternative solutions. The therapist empathically creates a safe communication atmosphere in which the patient can freely talk about painful experiences and express their feelings.
The negative results of psychotherapy, its ineffectiveness, the patient's withdrawal from the psychotherapist is often due to the wrong choice of psychotherapeutic contact, rigid behavior of the doctor and his psychotherapeutic incompetence, personal incompatibility between the patient and the psychotherapist, lack of agreement and understanding between them, failure of the patient to follow the recommendations on the treatment regimen and lifestyle, etc. From this point of view, the psychotherapeutic contract seems to be the most flexible among the various types of psychotherapeutic contact, since it is based on a mutually agreed understanding of the disease and treatment between the psychotherapist and the patient.
Let's highlight the requirements for a psychotherapist:
communicative competence is the dominant, system-forming component of the professional activity of a psychotherapist;
communication skills are an essential element of his professional qualifications.
Communication skills are understood as personality traits, as readiness for conscious successful implementation of communication in the unity of its 3 sides (communication, interaction, perception) in changed conditions.
The information side is associated with the identification and consideration of subjective attitudes, goals of each other, with the intention of each of the participants to influence. Influence the behavior of another, ensure your ideal "representation" in him.
Interaction is the side of communication aimed at building a general interaction strategy. It includes the choice of the optimal interaction strategy and communication tactics (the ability to find the necessary forms of communication with different people), self-regulation (the ability to consciously control behavior in various communication situations).
The implementation of successful communication is impossible without the implementation of perception, which ensures the process of forming the image of another person. The perception and understanding of another person is carried out in the performance regulation of activity, it consists in the choice of the subject of cognition of adequate methods of communication.
Correct understanding and perception is facilitated by the ability to interpret a person by her appearance and behavior, the ability of a person to perceive and understand himself correctly. the psychotherapist needs:
Integrative communication skills:
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The basics of psychotherapy
Terms: The basics of psychotherapy