Lecture
Plan.
one.
Regardless of the type of counseling and the situation in which the consultant carries out his work, most of the most important decisions that may entail either success or failure in treating an individual are made already in the first session. All too often, these decisions are made by a consultant unconsciously or based on “clinical flair” rather than on a more solid basis. The purpose of this chapter is to analyze the problems confronting the consultant at the first meeting with the client, namely: the problem of determining which therapeutic approach can be used in one way or another, which elements of the situation will constitute the focus of therapy, as well as a clear formulation of these questions in order so that the chosen method can be applied on the basis of observable reality, and not by touch or intuition.
The appearance of the client. A lot of attention is paid to the huge variety of problems, symptoms and prerequisites that a specialist or consultant finds in customer behavior. And too little time is allotted to the diversity of the individual's attitudes regarding the intended help and the influence of these attitudes on the entire therapeutic process. Let's look at a few of these client installations with respect to the assistance provided to them.
Take, for example, the case of a boy who was brought to the clinic by a bailiff. The boy was sullen and not communicative. He obviously considered the psychologist an assistant judge and resisted any friendly treatment. With his every gesture, every intonation, he tried to show that he did not need the help offered and that he was in the clinic against his will. Is counseling possible in this case? Another example: a young girl who herself came to a college counselor was clearly in a state of deep stress, confident that she would find help here and that she should speak to the therapist immediately. There is a strong desire to get help. A completely different setting is found in the child who was brought to the clinic by his mother. He can resist treatment because he resists the mother. He may well be quite indifferent to the procedure as a whole. He may be afraid of her because of the similarity of the situation with the medical office. Quite rarely does such a child really seek help. He comes because parents want it. Another example of clinical contact is when a student is sent for a session to a consultant by the dean of a faculty, either due to academic failure or for some other reason. Such a student may well need help and may, to some extent, be aware of this. Rather, he passively submits to the consultant, generally desiring help, but without any hint of initiative in this process.
These are some of the nuances of attitudes regarding therapeutic and counseling care. A consultant may be associated with everything against which an individual rises, or may be perceived as a person who is able to answer all questions and solve all problems. The individual wants to undergo treatment and considers it a fairly simple matter, or he behaves like a man who later admits that, having already decided to ask for help, he walked back and forth in front of the office door before he finally had the courage to enter.
When we realize that all the diversity of patient attitudes regarding the assistance of a consultant is directly proportional to the number of existing problems, as well as to the very diversity of human types, then we begin to understand the true complexity of the situation. An individual with deeply hidden emotional conflicts, a fierce offender, a teenager who irritates parents, a student who is tormented by the wrong professional choice, an employee who does not love his job are all components of the overall picture that we have to take into account. We should also know the differences in the abilities and properties of people, their stability and instability, mental defects, degree of development of intelligence. Bearing in mind all these basic variables, as well as unique individual situations that cannot be classified, we can ask ourselves: can we single out those principles, knowing that a consultant could implement his conclusions on a particular case with greater clarity?
What type of treatment is recommended? In the ideal case, the consultant would prefer to postpone the decision on which therapeutic approach to use until he carefully reads the client and his problems. In reality, this is impossible. Often, early stage diagnosis blocks the path to successful counseling. Therefore, it is necessary to carefully consider the treatment from the very moment the client appears in the office, or even before his arrival, if there is preliminary information in the form of a medical history or report from the school. The consultant must constantly ask himself all sorts of questions, the answers to which will serve as the decisive factor for choosing one or another method of treatment. We will look at some of these questions in order to analyze their importance in the process of therapy.
Is the client under stress? One of the first conclusions that a competent specialist should make right away is to what extent the client is immersed in a state of tension or stress. A consultant can help only when there is a state of a certain psychological distress arising from a state of imbalance. Such stresses can initially and almost entirely be psychic in nature, and they can be based on a conflict of needs. A socially unsuitable student wants to become more fit and at the same time seeks to protect himself from the sense of humiliation and inferiority that he experiences when he tries to enter into certain social relations. Another individual may be torn apart by strong sexual desires, on the one hand, and guilt feelings, on the other. Most often, stress is caused, at least in part, by environmental requirements that conflict with the needs of the individual. Marriage, for example, imposes a new obligation on a young person — a mature adaptation, and this obligation can be experienced as contrary to his own desire to be dependent or his need to see taboo in sex, or his need to dominate and subdue. In other cases, the requirements of the external environment may come from a social group. A bully from a neighboring gang may either not feel any internal conflict about his activity at all, or he may experience it to an insignificant degree, but stress or tension will appear to him when the standards imposed by the company conflict with his own. A student may not worry at all about his low academic performance until punishment by the management or college teachers causes psychological stress in him. For too long, mainly due to the classical Freudian tradition, we perceived conflict as an internal, mental phenomenon, without taking into account the fact that every conflict contains a significant cultural component and that in many cases the conflict is generated by a certain new culture requirement that conflicts with the need individual.
Medication treatment can be successfully used even in the absence of such stress. For example, a gang of hooligans can - by providing better leadership and good recreational conditions - be gradually reoriented from illegal activities to normal social activity, to do this correctly, without sharp conflicts between their own norms and community norms.
This is true for counseling and psychotherapy. They can be effective only when there is a conflict of needs and requirements, which creates tension and needs to be resolved. In fact, this can be most accurately expressed as follows: before the therapeutic effect is reached, the tension caused by the conflict should be more painful for the individual than the stress of trying to resolve this conflict.
Does the client want to accept help? Another question that should be troubling the consultant is: “Does an individual want help?” The success rate of counseling, ceteris paribus, increases significantly if the client wants to be helped and consciously recognizes this fact. When the need for help is strong enough, the client is able to quickly delve into meaningful material, and if the consultant is able to listen carefully and does not interrupt the flow of feelings expressed by the client, progress in treatment can be made very quickly. In order to concretize this thesis in some way, let us give an example where there is a strong desire of the client to get support with the full awareness of this desire by the individual himself.
Assuming that the client is experiencing some kind of conflict or stress, we should probably discuss two more factors contributing to a more constructive use of the consultative situation. First, there must be a physical possibility of making a conversation. Such a statement may seem redundant, although in fact it deserves some thought. Often in situations where the client is forced to undergo counseling (not the consultant himself, of course), it is the fact of being in this situation that serves as the starting point of the therapeutic process. So, often a child placed in a hospital or a boarding school can successfully undergo therapy and reach an understanding of himself and his problem, which could not have been possible if the child was in a state of free choice regarding whether he really needs such sessions. (Counseling in such situations raises many questions that will be discussed in the next chapter, in particular, the danger of confusing the roles of authority and consultant.)
But the physical capacity to do counseling is not enough. The client must be able to express in one way or another his conflicting aspirations that gave rise to the problem. He can do this through a game or another type of symbolization, but psychotherapy is powerless against forces generating a problem that are not involved, in one form or another, in therapeutic interaction. Whether or not an individual can express his feelings is a matter of the consultant’s ability to create a favorable therapeutic atmosphere, as well as the abilities of the client himself. But when deciding the advisability of counseling in each case, this factor must be taken into account.
Is the individual under family control? Another point that the counselor should pay attention to when planning therapeutic work, especially with a child or adolescent, is the nature of the client’s relationship with the family. If the child is emotionally dependent on the parents, subject to parental control and lives at home, therapy directed solely at the child often does not bring the desired result and may even create additional difficulties. We must once again recall that one of the assumptions about the outcome of therapeutic counseling is that the individual must be able and able to take some steps towards changing his situation, having reached some level of insight. Such an assumption is not often justified when working with children. Effective psychotherapy with a child usually includes working with parents so that an adult and a child can jointly make those changes that will lead to an increase in their level of adaptation. Otherwise, therapy with the child may lead to the approval of his main opposition to the parents and exacerbate the problem. Working only with a child is associated with the risk that an adult will become jealous of a child for a counselor, which leads to antagonism when the parent discovers that the therapist has established a close relationship with the child. This happens even when the mind of an adult wants his child to receive therapeutic help.
A completely different picture arises when the dependent individual is outside the sphere of parental care and control. Each college counselor is faced with students addicted to the same degree as an ordinary ten-year-old child. These are people who never choose their own clothes, never feel responsibility for their actions and completely rely on their parents. Such students, having left home and hitting college, are definitely open to counseling. The conflict between their desire to be dependent and the social norm of independent existence, which the college imposes on them, creates tension that must be relieved.
Thus, we can say that the effectiveness of a consultation procedure with children usually requires that the child or adolescent be emotionally or territorially free from family control. The only exceptions are those cases — they occur less frequently than might be expected — when the child’s problem has nothing to do with parent-child relationships. So, we can provide therapeutic and tutoring assistance to children, whose main problem is difficulty in reading. Perhaps the same is true of a teenager facing a professional choice. But again, if he is largely emotionally dependent on the family, counseling is most likely to be unsuccessful.
Is the client suitable for age, intelligence and sustainability? Although our data is very limited, there is reason to suggest that counseling is a more appropriate and effective procedure for people of a certain age category and a certain level of development of mental abilities. We cited data confirming this position when we demonstrated that in practice, in the clinical selection of patients for treatment through conversations, there is a tendency to select people with normal, mental abilities. Apparently, in rare cases, an individual with a low or borderline level is prescribed psychotherapy.
Having identified various points and questions that the consultant should keep in mind during the first contacts with clients, we can try to define them more clearly by formulating them in the form of criteria. In the next three sections, we tried to establish these criteria. They determine whether direct counseling or psychotherapy is preferable in a particular case. It should be emphasized that one of the reasons for their clearer and more detailed formulation was the desire to determine the method of their modification and verification through experiment.
The main conditions under which psychotherapy or counseling is possible. Based on the data discussed at the beginning of this chapter, it appears that direct consultative treatment of an individual, including planned and ongoing sessions, is recommended to be used if all of the following conditions exist:
1. An individual experiences a certain tension arising from contradictory inner aspirations or as a result of a conflict between social requirements and the demands of the external environment, on the one hand, and individual needs, on the other. The tension generated by this is stronger than the stress that arises in the individual in the process of expressing his own feelings about his problem.
2. The individual has a certain ability to cope with their life difficulties. He has adequate stability and sufficient capacity to control his situation. The circumstances with which he has to face are not so unfavorable and unchanging, so that he cannot control or change them if he wishes.
3. The individual has the opportunity to express his conflicting emotions during scheduled conversations with a consultant.
4. He is able to express this tension and conflicts verbally or by other means. A perceived need for help is preferred, but not necessary.
5. He is sufficiently independent emotionally as well as physically from immediate family control.
6. It does not suffer from excessive volatility, especially of organic origin.
7. He has sufficient intelligence - medium or high - to cope with his life situation.
8. Suitable for age criteria - old enough for independent actions and young enough to retain some flexibility in adaptation. Chronologically, this can be defined as the age from 10 to 60 years.
Necessary conditions for joint direct therapy of the child and parents. It is quite clear that the factors that speak in favor of separate therapeutic sessions with a child and an adult are somewhat similar, although not completely identical to those factors that confirm the advisability of applying direct therapy to an individual individual. We propose a set of these criteria, paying particular attention to those points for which there is a certain discrepancy.
Direct counseling of the child and his parents is recommended by various consultants if the following conditions exist:
1. The problem of the child is mainly rooted in parent-child relationships. 2.3 The child is still emotionally or dependent on the family. 4.5. Either the parent for the child. 6.7. An adult is relatively available for treatment. This means that: 8. a) he is satisfied with his personal achievements; b) it is quite stable; c) he has an average or above average level of intellectual development; d) he is young enough to show flexibility in adapting. 9. The child is more or less available for treatment. This means that: 10. a) it doesn’t have deviations of organic origin;b) he has an average or above average level of intellectual development; (c) it is not necessary.
2
Psychodrama is a group work method that represents a role-playing game, in which dramatic improvisation is used as a way to study the inner world of the group members and create conditions for the spontaneous expression of feelings associated with the most important problems for the client. Psychodrama is based on the gaming principle.
The concept of drama as a correctional method arose as a result of an experiment that was posed by Jacob Levi Moreno (1892-1974) at the end of the First World War. This experiment was called “spontaneous theater”. For the first time, Moreno thought about the therapeutic potential of gaming techniques when he paid attention to how children walking in the parks of Vienna played their fantasies. According to Moreno himself, the idea of psychodrama as a method of influence arose from him after one of the actors of his theater spoke about his problems with his bride. With the assistance of the troupe, Moreno brought the actor along with his personal problems to the stage. The experiment turned out to be very useful both for the groom and the bride, and for the whole group.
Moreno began experimenting with similar group representations further, applying more formalized research methods and developing techniques that later became an integral part of psychodrama. Creating his own technique, Moreno proceeded from the fact that a person has a natural ability to play and, playing various roles, gets the opportunity to experiment with realistic and unrealistic life roles, to work creatively on his own problems and conflicts. In the course of playing a situation, spontaneity, creativity, a genuine emotional connection between the participants of the situation, catharsis, which contribute to the achievement of creative activity and insight, arise. In psychodrama, a person is offered the role of a hero in a game, the content of which is focused on his problems. In this way,he can freely express his feelings in improvisations directed by a psychologist, while other actors play the role of the main characters of his real life.
There are corrections.
The purpose of psychodrama is the diagnosis and correction of inadequate states and emotional reactions, their elimination, the development of social perception, the deepening of self-knowledge. Psychodrama helps the client to uncover deep-seated emotions in a much brighter and more effective form than other methods allow, based on a verbal description of the experience. During the psychodrama, the search for effective ways to solve psychological problems of different levels: from everyday, everyday to existential. With the help of the host and the group, the client reproduces the significant events of his life in a dramatic act, plays scenes relating to his problems. Scenes are played out as if they were happening at that moment. The action is structured so as to help clarify and concretize the problem. New roles are analyzed,alternative, affective and behavioral styles, search and testing of more constructive problem solving models are carried out. Actions, physical movements, on which psychodrama is built, increase the possibility of using such an important source of knowledge of oneself and others as signals of nonverbal behavior.
The work of the psychodrama group is carried out in the form of a plot-but-role-playing game on a theme chosen by the clients themselves, which is a real problem for any of the participants. Roles in psychodrama are set and executed in such a way as to promote a deep understanding and solution of the problem.
Psychodrama is designed to help those clients who have difficulties in verbalizing their feelings and their life experience in general. In a psychodramatic situation, the client is both the protagonist of his drama, and its creator, a researcher of himself and his life.
This method is used in deviating behavior in children and adolescents to eliminate inadequate emotional reactions and to develop social perception skills. A. Voltman uses biodrama and puppet drama as a type of therapeutic drama. The peculiarity of biodrama is that between detm! roles of animals are distributed. The authors of this method believe that it is easier for a child, especially a preschooler, to accept the role of an animal than the role of himself, his comrades, or parents. In puppet dramatizations, adults act out puppet shows in front of the child, losing situations of conflict or meaning for him. It is advisable for I to use puppet dramatizations with pre-preschoolers — I and pre-schoolers with whom contact is difficult.
Another form is also possible, when one of the participants of the I group in a theatrical form talks about the events I of his life. At the same time improvisation and goodwill of the group are important.
The most successful psychodrama is used in complex I with other methods of group work (in particular, with group discussion, psychogymnastics), because it prevents I from excessive rationalization and intellectualization, it helps the client to express hard to bear emotions and contributes to achieve awareness. Psychodrama as an integral part of group work is widely used in correctional work with emotional disorders, some psychosomatic diseases, in work with children and adolescents, as well as in family psychocorrection.
The narrator, depending on the chosen form of work, can be a participant or a spectator, more or less influence the course of dramatization. A prerequisite for psychodrama is the goodwill of the group, spontaneity of behavior, improvisation. “Living” important situations, a person realizes in a new way problems, ways of his reaction, attitude to events, values, specific cases. It opens up new opportunities for building relationships and self-realization.
Great importance in psychodrama is given to the cathartic effect that arises when the internal conflicts that are detected during psychodramatic action respond.
The elements of psychodrama are widely used in other areas: in gestalt therapy, in behavioral therapy, in social and psychological training, business games, etc.
Tasks of psychodrama:
Психодраматическое разыгрывание ролей изменяет поение клиента, его отношение, установки, способы эмоционального реагирования. В качестве факторов, положительно влияющих на изменение установок, указывают: предоставление клиенту свободного выбора как относительно участия в психодраме, так и относительно роли, вовлечение клиента в исполнительскую деятельность, появление возможности внести в игру собственные импровизации, получение клиентом положительного подкрепления по окончании действия.
Психодрама способствует преодолению защитных позиций у клиента, усиливает эмоциональную вовлеченность, помогает изучению собственных проблем, достижению катарсиса и инсайта.
Классическая процедура психодрамы включает в себя 5 основных элементов:
The protagonist - the first player (from the Greek words "pro-tos" - the first and "agon" - the struggle, the game), depicts in the psychodrama of the hero, the main performer of the psychodrama scene, who presents his problems. The protagonist creates an image of his own life. He is the main character, and the views of the whole group are turned on him. With the help of the director, the audience and special staged techniques, the protagonist recreates his actual psychological reality in order to achieve insight and improve the ability to function in real life.
The director is the one who helps the client explore their problems. As a rule, it is a psychologist. Its functions include organizing psychodrama action, space, creating an atmosphere of trust, encouraging participants to spontaneity, preparing the protagonist and the whole group for a role-playing game, identifying problems, customer experiences, commenting, including auxiliary Characters, organizing discussion, emotional exchange and analysis, interpreting what is happening . The director creates a certain atmosphere in the group, assigns roles (starts performances, gives them certain directions), thereby giving all members of the group the opportunity to translate their thoughts and feelings into the language of dramatic action. A good director needs qualities such as flexibility, the ability to involve the entire group in psychodrama.
The director in psychodrama performs the functions of director, analyst, therapist.
In the role of director, the director organizes the work in the group, encourages the participants to express their thoughts in stage actions. The director must be extremely sensitive to all the verbal and non-verbal manifestations of the mental states of the psychodrama actors and the mood of its viewers. The main qualities of a good director are the creative approach to work, flexibility, the ability to involve all members of the group in the psychodrama action.
In the role of an analyst, the director discusses the actions of all the participants in psychodrama, interprets their behavior, thoughts and feelings. In the role of analyst, the team leader interprets and comments on the behavior of each member of the group during the presentation. In addition, he identifies and analyzes the general reactions of participants to individual episodes.
In the role of the therapist, the psychodramatic director directs him to the right psycho-correcting course. In the role of the therapist, the psychodrama director tries to help participants change unwanted behaviors. The therapist can afford to sit in a chair, allowing participants to conduct a performance on their own, or can be highly active, pushing members of the group to action. As any director, a director may be a target for criticism from a group, but being at the same time a member of a group, he must be open to criticism and not defend himself against attacks.
Supporting “I” are customers who play supporting roles and strengthen the functions of a psychologist. Auxiliary "I" can personify people significant for the protagonist or part of his own "I".
The main functions of the auxiliary "I": play a role that is necessary for the protagonist to implement the plan; help to understand how the protagonist perceives relationships with other characters; make visible the unconscious protagonist of the relationship; guide the protagonist in solving problems and conflicts; help the protagonist move from dramatic action to real life.
Due to intense empathy in the situation being played out, role feedback provides the protagonist with an opportunity to clarify even more to himself and understand the interpersonal relationships depicted in the drama.
The auxiliary "I" personifies those people who had a special meaning in the life of the protagonist. These characters are depicted in psychodrama by members of the group in order to enhance the impression of interpersonal relations of the protagonist. These can be the roles of an imperious mother, a despotic father, an ardent lover, an unjust boss, a caring friend, and others. A good performer of the role of an auxiliary "I" must be able to quickly enter this role, just to fulfill it. He should play as the protagonist presented the role or as intuition suggests, but not in the way he would have behaved in similar real circumstances.
In some groups, professional auxiliary "I" are introduced, which have undergone special training and can easily be included in any images.
Thus, the auxiliary "I" are members of the group, representing the missing people as they appear in the inner world of the client. Auxiliary "I" act in a double capacity: being, on the one hand, as if a continuation of the director in his interactions with a client, on the other - an extension of the client, as they help him to depict his internal relations to significant others in his life. The client protagonist usually chooses auxiliary "I" himself. They can be either other clients, or a director, or an audience.
Despite the fact that the client chooses a person who reminds him of a particular person as an auxiliary “I”, external similarity is not a decisive factor. For example, a client who has felt pressure from his mother all his life may choose to play the role of his mother a massive tall man, although in real life his mother may be of small stature and fragile build. It is important here that the client always perceived his mother as a giant and therefore chooses a very large man to depict her in psychodramatic action. The spectators are members of the group who are not directly involved in psychodrama action, but discuss the situation after its completion (not only regarding the protagonist and psychodrama participants, but also in relation to themselves). At the final stage of the lesson, they demonstrate their emotional attitude to what is happening, talk about their concerns and conflicts, which are similar to those played in psychodrama.
The spectators' task, on the one hand, is to help the protagonist, reacting critically or sympathetically to what is happening on the stage, on the other hand, to help themselves, experiencing what is happening on the stage and thus achieving insight regarding their own motives and conflicts. When the stage action ends, the audience can help the protagonist realize his own problems, without analyzing them according to the stereotype of the psychologist diagnosing the clinical case, but by telling various instances from his personal experience that are similar to what happened with the protagonist.
As a result, he feels more confident, knowing that he is not alone with his problems, that others may also experience similar difficulties and, as a result, they are able to empathize and understand his situation.
Literature.
Main literature.
Additional literature.
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The basics of psychotherapy
Terms: The basics of psychotherapy