Autogenic training Mikhail Mikhailovich Reshetnikov

Rational psychotherapy

Explanatory, logically based therapy is difficult to distinguish as an independent method. Rather, it is a set of general principles of the relationship between doctor and patient. It is difficult to imagine a doctor who, in the process of psychotherapy, would not address the patient’s mind, would not explain to one degree or another the essence and possible causes of the painful condition, and would not indicate ways to overcome the disease. In our country, this method was actively used and promoted by V. M. Bekhterev, B. N. Birman, V. A. Gilyarovsky, Yu. V. Kannabikh, S. I. Konstorum, A. I. Yarotsky and many others. etc.

The recognized founder of rational psychotherapy is the Swiss neurologist P. Dubois, who believed that neuroses arise due to weakness of the intellect and errors of judgment. Naturally, at present these theoretical constructions cannot be accepted unconditionally. At the same time, many of Dubois’s observations, conclusions and recommendations, made in a surprisingly imaginative and understandable form for the patient, have undoubted practical value. As an example, we can take the description of Dubois’s conversation with a patient suffering from insomnia, which A. M. Svyadoshch cites in the third edition of his monograph “Neuroses” (1982): “Don’t think about sleep - it flies away like a bird when they’re chasing it.” ; destroy your empty worries with healthy thinking and end the day with some simple thought that will allow you to sleep peacefully.” The intellectual multi-level psychocorrectional work of a doctor, aimed at changing the patient’s inadequate relationship to the environment or situation that caused the disease, is the essence of rational therapy. Most often, rational therapy is carried out in the form of a dialogue between the doctor and the patient.

Considering the question of the relationship between rational therapy and other psychotherapeutic techniques, P. Dubois contrasted “suggestion” and “persuasion,” believing that if the latter is addressed to criticism, to the patient’s reason, then the former acts bypassing and even contrary to them. On this issue, the authors tend to agree to a certain extent with A.P. Slobodyanik (1978), who believes that “in the very conviction and explanation, suggestion is already hidden” - direct or indirect. However, this is a special, conscious suggestion, based on evidence and appealing to the patient’s logic. The distinctive features of self-hypnosis and self-persuasion are presented in table. 2.

The basic principles of rational psychotherapy, developed in detail by Du Bois, must undoubtedly be included in the structure of any method of treatment. At the same time, the active role of intellectual (rational) influence can vary significantly depending on both the treatment methods used and the disease being supervised. In any case, from the very beginning, a reliable connection based on trust and mutual sympathy must be established between the doctor and the patient. If for some reason this connection does not arise, it is better to immediately find a delicate reason to transfer the patient to another specialist. The results of the first meeting with the doctor largely determine whether the patient will strive for subsequent meetings, whether he will believe in recovery, whether he will consciously and strictly follow all prescriptions and recommendations, whether he will become an active assistant to the doctor in the fight against his illness.

In the process of systematic communication with the patient, the doctor consistently explains the essence of painful symptoms and conditions, thereby forming a critical attitude towards them. In these explanations, it is necessary to adhere to simplicity and clarity of presentation, accessible to the patient’s understanding of the argumentation, avoiding spectacular phrases and special terminology, and even more so statements such as that existing deviations are “only a figment of fantasy.” When conducting rational psychotherapy, the doctor’s personality, his authority, or, as A. A. Portnov figuratively notes, “the halo that surrounds his name” are of great importance. From the first visit, the patient should feel that he is seen not as an “interesting case” [Slobodyanik A.P., 1978], but as a suffering person in need of help. Dubois attached a special role to instilling confidence in the patient in recovery, systematically emphasizing any, even the most insignificant fact, indicating the positive dynamics of the disease. The patient's complaints, no matter how numerous they may be, must be listened to with the greatest patience. “Letting the patient speak” is also a very important therapeutic technique. The patient’s false and often erroneous ideas about his illness must be criticized extremely delicately, while simultaneously noting the correctness of his individual judgments, even if they are far from it. It is very important to notice the strengths of the patient’s personality and character, which, of course, can be found in every person. It is equally important to make these strengths available to the patient and actively use them in the psychotherapeutic process.

Patients, as a rule, tend to tell loved ones, acquaintances, and sometimes even unfamiliar people about their condition and experiences. The psychological content of such “openness” is to seek sympathy and a reassuring (but not dismissive) answer that the existing disease is not dangerous. Unfortunately, such interpersonal communication in the clinic and outside does not always give positive results, so it is necessary to explain to the patient that it is best for him to talk about his illness only with his attending physician. Sometimes it is advisable to involve assistants from among medical psychologists for this purpose. An indirect rational influence through family members and people from the immediate environment also has a positive effect. In the process of therapy and recovery, it is necessary to gradually, step by step, “distance” the patient from himself, stimulating in him a sense of independence from the doctor and confidence in his future.

The therapeutic effectiveness of changing the patient’s inadequate attitude towards his environment, the positive influence of the sthenic reaction on overcoming the disease, its outcome, the advisability of functional training with the explanatory and persuasive role of the doctor were repeatedly emphasized by V. N. Myasishchev, M. S. Lebedinsky, K. I. Platonov , N.V. Ivanov and other prominent Soviet psychotherapists. A well-known specialist and enthusiast of autogenic training, A. M. Svyadoshch (1982), noted: “No matter how the doctor treats a patient with neurosis, the method of persuasion will always be important not only for eliminating a painful symptom, but also for preventing relapse of the disease.” Persuasion and explanation therapy is an integral part of the modern autogenic training system, playing a greater or lesser role in it depending on the modifications used. Regardless of the group or individual application of the method, it is always preceded by an interview aimed at studying the patient’s personality and her relationships. The content of this conversation organically includes the influence of explanation and persuasion, the basis of which is the formation of a critical attitude of the patient towards himself and his feelings without revaluing them.

A thorough objective neurological examination of a patient suffering from neurosis serves as the foundation for an authoritative explanation that it is not somatic (organic) disorders that underlie pathological symptoms, but emotional stress and overexertion, trace effects of previously suffered mental traumas and experiences. It is advisable to explain to the patient in an accessible form the differences between “organic” and “functional”, logically justifying the connections between the concepts “nervous - functional - curable”.

During an objective examination of a patient with neurosis, assessment of the state of muscle tone has not only diagnostic, but also psychotherapeutic significance. It is important, already during the first conversation, to draw the patient’s attention to the tension of the facial muscles, which is not uncommon in such diseases, tightness of breathing and intermittency of speech, changes in general muscle tone, expressed in the revival or decrease in reflexes. Against this background, the explanation of the relationship between the neuro-emotional state and the tone of the skeletal muscles finds specific (obvious for the patient) reinforcement in the manifestations of the disease in the person under study. Awareness of this fact contributes to a better understanding by the patient of the therapeutic importance of muscle relaxation training and exercises in regulating muscle tone. A person with sufficient training can draw analogies from the direct and feedback mechanisms known in cybernetics.

An accessible explanation of the causes of neurotic disorders and the psychophysiological processes underlying them can be carried out through joint, including group, discussion of popular publications previously recommended by a doctor for reading. A certain spiritual maturity and the presence of the necessary minimum knowledge, the patient’s preparedness for a meaningful perception of the autogenic training technique is the key to the success of therapy, forming an active attitude towards treatment in the patient and making him an accomplice in the therapeutic process. In turn, the patient’s active position opens up prospects for self-influence, restructuring of one’s own personality, self-persuasion and optimization of mental processes.

Our experience shows that, in contrast to pure forms of autosuggestion, in the methodology of autogenic training, the dominant role is played by self-persuasion (auto-didactics) based on the purposefully developed reflexive function of consciousness. This position is justified by the fact that what is “external” for consciousness, that is, what it can actively and transformatively influence, is not only the external world, but also the internal environment of the organism as a whole (K. K. Platonov). The main essence of the reflexive function of consciousness is the possibility of influencing oneself. With full preservation of initiative and self-control, this self-influence makes autogenic training an intellectual and volitional, extremely specific process in its essence, leading to a rational restructuring of the personality.

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Founder of RET A.Ellis formulated a number of provisions that are actively used in practical correctional psychology. One of these principles, often quoted by Ellis, is the saying: “It is not the things that disturb people, but the way they see them.” (Epictetus).

Based on emphatically scientific approaches in the structure of individual consciousness, A. Ellis strives to free the client from the bonds and blinders of stereotypes and clichés, to provide a freer and more open-minded view of the world. In the concept of A. Ellis, a person is interpreted as self-evaluating, self-supporting and self-talking.

A. Ellis believes that every person is born with a certain potential, and this potential has two sides: rational and irrational; constructive and destructive, etc. According to A. Ellis, psychological problems appear when a person tries to follow simple preferences (desires of love, approval, support) and mistakenly believes that these simple preferences are the absolute measure of his success in life. In addition, man is a creature extremely susceptible to various influences at all levels - from biological to social. Therefore, A. Ellis is not inclined to reduce all the changing complexity of human nature to one thing.

RET identifies three leading psychological aspects of human functioning: thoughts (cognitions), feelings and behavior. A. Ellis identified two types of cognitions: descriptive and evaluative.

Descriptive Cognitions contain information about reality, about what a person has perceived in the world; this is “pure” information about reality. Estimated cognitions reflect a person’s attitude to this reality. Descriptive cognitions are necessarily connected with evaluative connections of varying degrees of rigidity.

Biased events themselves evoke positive or negative emotions in us, and our internal perception of these events is their assessment. We feel what we think about what we perceive. Disorders in the emotional domain are the result of disturbances in the cognitive domain (such as overgeneralization, false conclusions and rigid attitudes).

Psychotherapy is a type of treatment in which the doctor uses the word as a tool to influence the patient’s psyche. In the broad sense of its understanding, this area covers communication between the patient and the doctor as a whole. After all, when treating diseases of any profile, the doctor, communicating with his patients, inevitably has a psychological impact on them. That is why the moment of establishing contact is so important, as well as a personal approach to each person, taking into account the characteristics of his personality and specific social conditions.

The main advantage of rational psychotherapy is the elimination of manifestations of the disease by changing a person’s attitude towards himself, towards his condition and towards everything around him.

Ways to heal with words

What are the main directions that are elements of psychotherapy? They are represented by the following main ways to eliminate diseases:

Rational psychotherapy.
This method includes waking suggestion, which occurs when a person is in a state of hypnotic sleep, as well as self-hypnosis, which is called autosuggestion.
Group or collective psychotherapy. It can be domestic, behavioral, or playful. Imagotherapy and psychoesthetotherapy are also distinguished.
Narcopsychotherapy.

All of the methods listed above will have the maximum effect on the patient when combined with other types of elimination of the disease, including drug treatment, physiotherapeutic procedures, occupational therapy, exercise therapy, etc.

Direction of rational psychotherapy

To get rid of diseases, the doctor can influence the patient with the help of explanations. The main thing is that they are logically reasoned. A similar method is known in medical practice as “rational psychotherapy.” When using it, the doctor must explain to his patient what he does not understand and does not know, and what can shake his false beliefs.

Along with the direct verbal influence of rational psychotherapy, indirect suggestion is also accompanied. For example, the method of explaining the situation is sometimes used to other persons in the presence of the patient. This allows for the therapeutic effect to be achieved indirectly. In addition, rational psychotherapy uses various didactic techniques, as well as emotional influence.

Most often, treatment is a dialogue that the doctor conducts with his patient. Such an interview makes it possible to explain to the person the circumstances that led to the disease. At the same time, the doctor describes the nature and prognosis of the intended treatment. The psychotherapist must maintain simplicity and clarity in his argumentation. At the same time, he, using any facts and indicators that indicate even minor improvements, should try to inspire the patient and help him overcome his pessimistic ideas.

The success of using the method of rational psychotherapy largely depends on the personality of the doctor, on his interest in curing the patient, as well as on sincerity, the ability to persuade and listen patiently, to win sympathy and trust.

The first experiments in which the use of such a technique was considered were carried out on the basis of classical and operant conditioning described by I. P. Pavlov, as well as B. Skinner. The main formulation of these concepts consisted of a “stimulus-response” chain and adhered to the postulate that stated that behavior leading to the achievement of the desired result should be consolidated, and, on the contrary, behavior that does not lead to it should fade or weaken.

Today there are a large number of methods of rational psychotherapy. Let's consider those that are most widespread in practice.

Paul Dubois method

Rational therapy proposed by this Swiss neurologist is the most affordable way to cure the patient. It is used not only by narrow specialists, but also by general practitioners.

Du Bois's rational psychotherapy uses the patient's ability to draw logical conclusions, make comparisons, and prove the validity of existing facts. This method was an alternative to treatment by suggestion. At the same time, rational psychotherapy primarily relied on the patient’s thinking and reason.

Paul DuBois believed that the origins of the development of neuroses lie in errors of judgment and weakness of the intellect. Of course, at present these theoretical conclusions are not accepted unconditionally. Nevertheless, many of Du Bois's recommendations and conclusions, which he made on the basis of numerous observations, have great practical value. An example of this is the description of a conversation between a Swiss neurologist and his patient who suffered from insomnia. You can get acquainted with it in the book “Neuroses” by A. M. Svyadoshch: “Don’t think about sleep - it flies away like a bird when they are chasing it; destroy your empty worries with healthy thinking and end the day with some simple thought that will allow you to sleep peacefully.”

In his practice, Du Bois relied entirely on logic. Using this scientific direction about the laws of thinking, he quite convincingly demonstrated to his patient the errors that took place in his reasoning and were associated with an incorrect assessment of the pathological condition. Such an effect on the patient is the basis of this method. But besides this, Du Bois’s rational psychotherapy includes emotional influence, suggestion, study and further personality correction, as well as rhetorical didactic techniques.

Albert Ellis Method

This psychologist developed a method of rational-emotional psychotherapy. It is based on three main aspects of human mental activity. These are thoughts, or cognitions, as well as behavior and feelings.

In Ellis's rational-emotive psychotherapy, the following are distinguished:

Descriptive cognitions. These thoughts contain the objective information that was perceived by the individual.
Evaluative cognitions. This type of thoughts reflects a person’s attitude to reality.

According to the provisions of the method of rational emotional psychotherapy by A. Ellison, the two types of cognitions indicated above have connections of varying degrees of rigidity. Negative and positive emotions are caused not by objective events that have occurred, but by their assessment. In this regard, many psychopathological disorders and symptoms in the emotional sphere can be considered as a result of disturbances in the cognitive area, which is called irrational attitudes. They represent tight connections between descriptive as well as evaluative cognitions. These violations are expressed in instructions and requirements, orders, etc. and do not correspond to reality either in quality or in strength.

Being unrealized, irrational attitudes provoke the emergence of negative emotions in inappropriate situations, which complicate the life of an individual and prevent him from achieving his goals. For the normal functioning of the psyche, it is necessary to create a rational system of evaluative cognitions. Flexible connections that connect such thoughts with descriptive ones are also important.

What is the method of rational-emotive psychotherapy? It includes recognizing existing irrational attitudes, confronting them, as well as revising flexible (rational) attitudes and consolidating their functioning. A patient who has successfully completed this path begins to respond adequately to current events.

A. Ellison outlined his main ideas in the book “Humanistic Psychotherapy: A Rational-Emotional Approach.” In it, he pointed out that any person is able to control and influence their own emotional reactions in the form of behavior and feelings. Moreover, since he himself, albeit unwittingly, forced himself to suffer, he is also capable of doing everything to stop it. The book teaches its reader not to give in to suggestion and not to depend on circumstances. To do this, you just need not to think about how most people around you feel.

Aaron Beck Method

This researcher developed a method of cognitive psychotherapy. It is based on the assertion that mental disorders occur in connection with cognitive skills and structures that were acquired by a person in the past.

According to the statements of the American professor A. Beck, those psychological disorders that preceded neurophysiological disorders have a direct connection with aberrations of thinking. By this term, the researcher understood the incorrect processing of information, which as a result contributed to a person’s distortion of a situation or object. Such cognitions are the main cause of false beliefs. As a result, the patient experiences inappropriate emotional reactions.

Unlike other methods of rational psychotherapy, the method created by A. Beck contains rules for regulating behavior, which is based on two main parameters, namely danger/safety, as well as pain/pleasure. The axis of the first of these two combinations of elements includes those events that are associated with psychosocial, psychological and physical risk. However, the rules for regulating behavior in most cases do not take into account the real situation. This leads to the individual having various problems. Using the method of rational psychotherapy by A. Beck, it becomes possible to modify existing rules, make them more flexible and less personalized, that is, bring them into line with existing reality.

Cognitive psychotherapy for addictions

The real scourge of modern society is alcoholism and drug addiction. These are diseases that can be caused by a genetic factor or are a model of behavior of people who are unable to solve their problems, and relieve the tension that has arisen in the body with the use of psychoactive substances.

And here individual rational psychotherapy for drug addicts and people who drink alcohol excessively can come to their aid. What is this method? This is cognitive-rational psychotherapy aimed at identifying the main triggers, which are thoughts, situations and people that trigger drug or alcohol use. This method allows a person to get rid of bad habits. This happens thanks to awareness of one’s own thoughts, careful study of the situation and subsequent changes in behavior.

Psychodrama by George Moreno

Psychotherapy in rational therapy can also use a group approach. This is what distinguishes J. Moreno’s method, based on the theory of sociometry he created, designed to become the key to solving many social problems. When using this method, the doctor offers his patients a role-playing game. In its course, he creates conditions that force a person to spontaneously express his feelings about a problem that is relevant to him. The main postulate of this method is the statement that any individual has a natural ability to play.

Thanks to this, when performing a particular role, he can independently influence his problem and even stop a crisis situation. Such a psychotherapeutic process leads to overcoming unconstructive behavioral stereotypes and ways of emotional response, forming an adequate and deep self-awareness in the patient.

Behavior modeling

This method refers to the method used to stimulate the patient to independently solve his problems. Cognitive behavioral psychotherapy is carried out in three stages:

Self-observation with elements of self-control.
Conducting an analysis of problem behavior and identifying its source (teachers, parents, environment, etc.).
Conclusion of a psychotherapeutic agreement. This is a kind of contract, which is a register of planned changes, as well as protocols of what has been achieved after performing independent home exercises.

Techniques of rational psychotherapy

How can a person get rid of negative emotions? To do this, he will need to apply one of the techniques of rational psychotherapy. Most of them are used by professionals to treat neuroses in their patients. Sometimes with their help it is possible to eliminate psychosis.

The most common causes of such pathologies are accumulated negative emotions. The patient becomes fixated on traumatic situations, which causes him to have excessive acute experiences that cause illness.

Techniques of rational psychotherapy are most indicated for resentment caused by unfulfilled hopes. By the way, a person often resorts to this technique completely unconsciously. He shares his grief with relatives, a friend, and sometimes even with a stranger. First of all, he hopes to justify his own position in the conflict that has occurred. However, this is not the main point here. It is important to understand the reasons for what happened, which is why it may turn out that the offended person is to blame for what happened. And this means that there is no one to be offended by.

Abstraction

People also resort to this method in their lives completely unconsciously. We try not to think about the traumatic situation. However, this can be quite difficult to do.

The distraction method allows you to get the maximum effect with weak, but constantly affecting negative stimuli. In this case, negative emotions can gradually accumulate, leading a person to nervous breakdowns and neuroses.

How can you distract yourself from a traumatic situation? For this we recommend:

Sports games. Tennis, football or volleyball perfectly relieve irritation and eliminate grievances.
The use of aesthetic therapy. In a state of distress, it is recommended to visit an art exhibition, watch a good comedy, or listen to talented music.
Visiting good friends. Such a step will allow you to eliminate the bitterness that has accumulated in your soul and not take it out on your loved ones.
Communication with nature. Negative emotions are especially well eliminated near the river, in the forest, in the mountains and in other beautiful places where peace of mind returns to a person.

In case of prolonged exposure to negative factors, it is recommended to change the situation by taking a vacation and going on a trip.

Role-playing auto-training

When using this method, the patient will need to get used to the image of a cheerful or calm person. This method is great for preventing future conflicts and stressful situations. However, its effectiveness can only be felt by a person with an artistic nature.

In order to enter the role, you will need to choose a suitable ideal for yourself. The model can be either a real person or a movie character. But it is worth remembering: in order to remain calm in various situations using this method, you will need preliminary training.

Muscle relaxation

This method, which is also called autogenic training, is especially popular among psychotherapists. People often use it when working independently to solve their problems. Autogenic training is an independent method proposed in 1932 by a psychotherapist from Germany I. Schulz.

The main objective of this method is maximum relaxation while simultaneously instilling in oneself certain sensations, as well as learning to control the functioning of internal organs. Lightning-fast muscle relaxation allows you to quickly eliminate nervous tension, and do this in any situation.

Rational psychotherapy has long established itself as an excellent technique used in modern counseling practice. Over the half century that has passed since the advent of the method, it has absorbed all the best and most effective from various areas of psychotherapy, and therefore experts boldly claim that it can be used to solve almost any life problems.

The technique itself does not imply anything supernatural: the patient is simply shown in rational ways how erroneous his beliefs and views on life are, and how much these delusions worsen the quality of his life. In order to work with the problem as effectively as possible, the psychotherapist needs to thoroughly study the patient’s personality and establish which of his misconceptions are the source of the problem. After clarifying these points, rational psychotherapy involves eliminating them in the following ways:

Suggestion;
Logical persuasion;
Emotional impact;
Behavior correction;
Personality correction.

Rational psychotherapy helps to overcome many life difficulties

Neurologist from Switzerland Paul Dubois, who is the developer of the basic principles of this direction of psychotherapy, was confident that all neuroses and many mental disorders are provoked only by the fact that the person himself incorrectly perceives the reality around him, misunderstands something, makes erroneous conclusions and how the result is an inaccurate assessment of everything that happens around him.

That is why the first thing the doctor demanded from any technique of psychotherapy was the elimination of absolutely all misconceptions from the patient’s consciousness and an explanation for him of the correct, rational line of behavior. Paul Dubois was sure that there could be no universal methods in this matter. The psychotherapist must initially adequately and fully assess the patient’s personal qualities, understand what exactly the problem is, and, depending on the conclusions drawn, use one of the following treatment options:

Persuasion;
Clarification;
Belief;
Abstraction;
OK;
Didactics;
Rhetoric.

It does not matter whether one method or a combination of them is used: the main thing is that the main goal is achieved - the patient must learn to think logically, adequately evaluate the people around him and the events taking place, clearly see and understand cause-and-effect relationships.

In what cases is rational psychotherapy indicated?

Rational psychotherapy, the techniques of which have been successfully used all over the world for a long time, is not always effective. A truly qualified specialist will use it only if he is absolutely sure that no other method at his disposal will bring greater benefit.

Rational psychotherapy helps solve family problems

Those psychotherapists who have long used this direction in their practice note that with its help it is possible to solve a number of problems that complicate a person’s life:

Solving family problems.
Eliminating misunderstandings and difficulties in relationships with the opposite sex.
Behavioral disorders that occur in childhood and/or adolescence.
Elimination of stress caused by loss of ability to work, disability, detection of severe and/or incurable diseases, etc.

The technique also successfully copes with non-clinical psychological problems: inadequate self-esteem, self-doubt, self-rejection, etc. Indications for rational psychotherapy sessions are:

Neuroses;
Depression;
Anxiety;
Phobias;
Obsessive-compulsive disorders;
Eating disorders;
Stressful conditions caused by illness or injury;
Dependencies;
Additive behavior;
Antisocial behavior;
Lack of control over one's own impulses;
Mania;
Personality disorders;
Psychoses in remission;
Pain syndrome;
The need for rehabilitation after sexual assault or sexual offence.

Working with a psychotherapist using this method, patients gain self-confidence, they are able to assess which actions on their part will be most effective in achieving their goals, and gain control over their own thoughts, feelings and behavior.

Advantages of the technique

This type of psychotherapeutic influence has many advantages, but the main one is that the doctor needs relatively little time to help the patient. There is a direct relationship: the higher the patient’s level of intelligence, the more successful the specialist’s work with him. However, it cannot be said that working with illiterate patients is pointless - for them there is a simplified option, thanks to which rational psychotherapy is rightfully considered universal.

Any treatment is individual. If the doctor considers it appropriate, he can use other psychotherapeutic techniques in combination - for example, procedural.

Processual psychotherapy: the essence

Process-oriented therapy as a separate direction is approximately the same age as rational therapy. This is a unique combination of methods used by Western psychologists (Jungian analysis, art therapy, etc.) with the ideas presented in Eastern philosophy. Arnold Mindell, who is considered the founder of the method, expanded the Jungian analysis that was popular at that time, adding to it bodily signals, perception, belief, and ideas.

Processual psychotherapy involves expanding a person’s consciousness, thanks to which he looks at the problem not only from his own point of view, but also considers it from a different angle. Specialists working using this method prefer to help people using natural methods.

Processual psychotherapy involves expanding a person’s consciousness

Mindell and his followers believe that any problem in a person’s life is just a sign, after understanding which, he realizes how he should act further. There are two forms in this direction:

Primary- the one that a person is able to perceive with consciousness.
Secondary– unconscious to a person and includes dreams, movements, physical symptoms.

What problems does process psychotherapy solve?

It should be noted that the spheres of influence of these techniques are perceived by some specialists as beyond the scope of psychotherapy. However, numerous successes in treatment do not make it possible to completely deny this method of combating:

Depression;
Family problems;
Physical symptoms;
Comatose and/or near-death states;
Extreme states of consciousness, qualified as psychiatric disorders;
Problems in the individual's social communication;
Business problems related to the human factor.

Process therapy helps fight depression

Techniques of procedural psychotherapy

It cannot be said that this direction exists completely separately from others. Professionals working in this way often resort to role-playing sessions, persuasion, explanation, etc. The main difference, perhaps, from other methods is that a specialist working in this direction never gives advice to the patient and does not impose his opinion or vision of the situation. His task is to help the patient understand what exactly is tormenting him and how to get rid of it. That is why the client never becomes dependent on the psychotherapist and after solving the problem they may never meet again.

The main task of this technique is to make it clear to everyone that what is happening around them and directly with them is interconnected, which means that nothing will change in the world around them until the person himself changes.

A person must change himself, and then the world around him will change

The methods used in the described techniques help not only in solving problems related to the psyche. Their effectiveness has been proven for business, education, and simply communication between individuals. Conducting group classes, trainings and seminars - all these events involve psychotherapeutic techniques to one degree or another. Clients of psychotherapists who have learned to work in accordance with the recommendations given to them are always successful in their personal and professional lives and easily achieve their goals.

Rational-emotive therapy (RET) was created by Albert Ellis in 1955. Its original version was called “rational therapy,” but in 1961 it was renamed RET, since this term better reflects the essence of this direction. In 1993, Ellis began using a new name for his method - rational-emotional-behavioral therapy (REBT). The term “behavioral” was introduced in order to show the great importance that this direction attaches to working with the actual behavior of the client.

According to rational emotive therapy theory, people are happiest when they set important life goals and objectives and actively try to achieve them. However, when setting and achieving these goals and objectives, a person must keep in mind the fact that he lives in society: while defending his own interests, it is necessary to take into account the interests of the people around him. This position is opposed to the philosophy of selfishness, when the wishes of others are not respected or taken into account. Since people tend to be driven by goals, rational in RET means that which helps people achieve their basic goals and objectives, while irrational is that which prevents them from achieving them. Thus, rationality is not an absolute concept, it is relative in its very essence (Ellis A., Dryden U, 2002).

RET is rational and scientific, but uses rationality and science to help people live and be happy. It is hedonistic, but it welcomes not immediate, but long-term hedonism, when people can enjoy the present moment and the future and can achieve this with maximum freedom and discipline. She suggests that nothing superhuman likely exists, and believes that devout belief in superhuman powers usually leads to dependence and increased emotional stability. She also argues that no people are "inferior" or worthy of damnation, no matter how unacceptable or antisocial their behavior may be. It emphasizes will and choice in all human affairs, while accepting the possibility that some human actions are determined in part by biological, social, and other forces.

A. A. Aleksandrov identifies categories of patients for whom rational-emotional therapy may be indicated:

1) patients with poor adaptability, moderate anxiety, and marital problems;

2) patients with sexual disorders;

3) patients with neuroses;

4) individuals with character disorders;

5) truants from school, child delinquents and adult criminals;

6) patients with borderline personality disorder syndrome;

7) psychotic patients, including patients with hallucinations when they are in contact with reality;

8) individuals with mild forms of mental retardation;

9) patients with psychosomatic problems.

It is clear that RET does not have a direct effect on the somatic or neurological symptoms present in the patient, however, it helps the patient change his attitude and overcome neurotic reactions to the disease, strengthens his tendency to fight the disease (Fedorov A.P., 2002). As B.D. Karvasarsky notes, rational-emotional therapy is indicated primarily for patients who are capable of introspection and analysis of their thoughts. It involves the active participation of the patient at all stages of psychotherapy, the establishment of relationships with him that are close to a partnership, which is facilitated by a joint discussion of the possible goals of psychotherapy, problems that the patient would like to resolve (usually these are symptoms of a somatic plan or chronic emotional discomfort).

Getting started involves educating the patient about the philosophy of rational-emotive therapy, which argues that emotional problems are caused not by the events themselves, but by the appraisal of them.

Ellis puts forward a number of criteria for psychological health.

1. Compliance with one's own interests. Reasonable and emotionally healthy people usually put their own interests first and place them at least slightly above the interests of other people. They sacrifice themselves to a certain extent for those they care about, but they never fully commit themselves to it.

2. Social interest. Social interest is rational and, as a rule, a personal interest, because most people, having chosen to live and spend time in social groups or society, are forced to honor morality, respect the rights of others and promote social survival, otherwise they are unlikely to be able to create a world in which they they themselves could live comfortably and happily.

3. Self-government. Healthy people usually tend to take responsibility for their lives and at the same time prefer to cooperate with others. They do not need any significant help and support and do not demand it from others, although they may like IT.

4. High tolerance to frustration. Rational people give themselves and others the right to make mistakes. Even if they really dislike their own behavior or the behavior of other people, they are not inclined to directly judge themselves and others, but only judge unacceptable and intolerant actions. People who do not suffer from debilitating emotional distress do what St. Francis and Reinold Niebuhr did: correct those undesirable conditions they can change, accept those they cannot change, and have the wisdom to tell the difference.

5. Flexibility. Healthy and mature people are flexible, willing to change, non-fanatical, and pluralistic in their views of other people. They do not set rigid and unchanging rules either for themselves or for others.

6. Acceptance of uncertainty. Healthy men and women tend to recognize and accept the idea that we live in a world of probability and chance, where absolute certainty does not and may never exist. These people realize that life in such a probabilistic and uncertain world is fascinating and exciting, but it is certainly not terrible. They like order quite a lot, but they do not demand exact knowledge of what the future will bring them and what will happen to them.

7. Dedication to creative pursuits. Most people feel healthier and happier when they are completely absorbed in something external to themselves and have at least one strong creative interest or activity that they consider so important that they organize a significant part of their lives around it.

8. Scientific thinking. Less anxious individuals have more objective, realistic, and scientific thinking than more anxious individuals. They can feel deeply and act on feelings, but are able to regulate their emotions and actions by reflecting on them and evaluating their consequences depending on the extent to which they contribute to the achievement of short-term and long-term goals.

9. Self-acceptance. Healthy people are usually glad that they are alive and accept themselves just because they live and can enjoy it. They do not judge their inner worth by external achievements or what others think of them. They sincerely choose unconditional self-acceptance and try not to evaluate themselves - neither their totality, nor their being. They strive to enjoy, not to assert themselves.

10. Riskiness. Emotionally healthy people tend to take risks and try to do what they want, even if there is a high chance of failure. They are brave, but not reckless.

11. Delayed hedonism. Well-adjusted people usually strive both for the pleasures of the present moment and for those joys of life that the future promises; they rarely turn a blind eye to future losses for the sake of immediate gains. They are hedonistic, that is, they strive for happiness and avoid pain, but they admit that they still have some time to live and that therefore they need to think not only about today, but also about tomorrow and not allow momentary pleasures to take over them.

12. Dystopianism. Healthy people accept as a fact that utopia is unattainable and that they will never be able to get everything they want or get rid of everything that hurts. They are not trying to fight for unrealistic total happiness, perfection and joy or to completely get rid of anxiety, depression, self-blame and cruelty.

13. Responsibility for your own emotional disorders. Healthy individuals accept much of the responsibility for their emotional problems rather than defensively blaming others or social conditions for their own self-destructive thoughts, feelings, and actions (Ellis A., Dryden W., 2002).

RELATIONSHIP OF THE PSYCHOTHERAPIST WITH THE CLIENT

Rational-emotive therapy is aimed at solving problems. As A. A. Aleksandrov notes, patients take a dictatorial, dogmatic, absolutist position: they demand, they insist, they dictate. Emotional distress occurs when individuals have a strong belief that their desires should be satisfied. Their demands, their dictates, are that they must succeed; other people must approve of them. They insist that others treat them fairly. They dictate how the world should be and demand that it be more acceptable.

In the process of presenting complaints, the therapist asks the client to choose which problem needs to be solved first. RET is an active-directive therapy. The active-directive style is expressed in the fact that the therapist guides the client through clearly structured stages of therapy, energetically prevents deviations, offers methods and solutions, without being afraid to demonstrate how to master individual methods and techniques. The client is initially directed towards a strategic goal - the adoption of a new, rational philosophy, the replacement of irrational attitudes with rational ones in the problem area.

At the very beginning of therapy, the client can be given, for example, the following instructions: “The therapy we are starting is aimed at teaching you to manage your emotions and get rid of negative experiences. In the first stages of work, you will be given the opportunity to understand the ways in which you yourself created your negative feelings. You can also change these ways and thereby experience other, positive emotions. All this will require you to be active in your work both here in the office and at home, since therapy involves doing homework, listening to audio recordings, and reading specialized literature. I cannot be a magician and magician who, with the wave of an eye, can save you from illness and problems. I can be a guide who will help you walk the road to your desired goal” (Fedorov A.P., 2002).

Rational-emotive therapy is impossible without the patient's self-disclosure, so the therapist must create conditions that facilitate this process. He monitors and is aware of what the difficulties of self-disclosure are associated with: with fears of publishing facts, with insufficient experience of self-disclosure, with a rigid stereotype of behavior, which may hide an irrational attitude like: “A man should solve his problems himself.” In such cases, the psychotherapist must once again explain the essence of rational-emotional therapy, which requires sincerity and openness in discussing current painful and avoided topics.

Without establishing full contact between the doctor and the patient, the methods used may not give the desired effect, then the therapy will be aimed at goals that are irrelevant for the patient. Consideration of the pace of progress, support and assistance to the client, provided both through verbal and non-verbal interventions, can all contribute to the client's self-disclosure.

At the same time, rational-emotive therapy does not attach as much importance to empathic support as, for example, Rogers' client-centered therapy does. According to RET, one must, of course, accept patients, but at the same time one should criticize them and point out shortcomings in their behavior. Warmth and support often help patients live more happily with unrealistic notions. Ellis considers an active-directive, cognitive-emotional-behavioral “attack” on the self-defeating obligations and orders of patients to be effective. The essence of effective psychotherapy, according to RET, is the combination of complete tolerance towards the patient (unconditional acceptance of the client) with the fight against his self-defeating ideas, traits and actions.

When starting to work on a patient’s belief system, the therapist first of all strives to identify his irrational attitudes. As we already know, the presence of irrational attitudes means the existence of a rigid connection between descriptive and evaluative cognitions - a connection that presupposes a univariate development of events. Therefore, the identification of rigid emotional-cognitive patterns is helped by the use of words by patients such as “must,” “must,” “necessary” (“tyranny of the must”). They are the target of “therapeutic attacks.” Often the therapist “leads” the patient in a conversation to the use of these words, expresses hypothetical sentences containing them in order to force the patient to recognize their power over himself (Alexandrov A. A., 1997).

After identifying irrational attitudes, the therapist begins to reconstruct the belief system; the impact is carried out at three levels: cognitive, emotional and behavioral.

Impact at the cognitive level. Rational-emotive therapy tries to show patients that they need to let go of perfectionism if they want to live a happier, less anxious life. She teaches them to be aware of their “shoulds”, “shoulds”, “musts”; separate rational beliefs from irrational (absolutist); apply the logical-empirical method of science to yourself and your problems; accept reality, no matter how cruel and harsh they may be. RET helps patients sharpen cognitive processes. It is explanatory and didactic.

Rational-emotive therapy uses a Socratic type of dialogue between patient and therapist. Cognitive disputation is used. This technique involves proving the validity of the patient's irrational attitude. The psychotherapist's task is to clarify the meaning and demonstrate its logical inconsistency. In the process of such a dispute, a secondary gain can be identified, which comes from maintaining an irrational attitude. RET encourages discussion, explanation and identification of the causes of ineffective thinking, and teaches semantic accuracy. For example, if a patient is rejected, this does not mean that he will always be rejected; if a patient fails, this does not mean that he cannot achieve success (Alexandrov A. A., 1997).

Impact on an emotional level. The therapist uses various ways to dramatize preferences and shoulds so that patients can clearly distinguish between these two phenomena - “it would be better” and “should”, for which there is a role-playing game that demonstrates to patients what false ideas guide them and how this affects their relationships with other people. The therapist can use modeling to show patients how to accept different ideas. Using humor, the therapist reduces irrational thoughts to the point of absurdity and, through unconditional acceptance, shows that clients accept them despite the presence of negative traits, which gives clients the impetus to accept themselves. The therapist uses emotionally charged dissuading, leading patients to abandon some absurd ideas and replace them with more reasonable concepts.

The therapist encourages risk-taking behavior:

a) invites patients of a psychotherapeutic group to tell one of its participants frankly what they think about him. As a result, patients are convinced that it is actually not that risky;

b) encourages patients to self-disclose, asking, for example, to talk about deviations in their sex life. This experience reassures them that others can accept them despite their shortcomings;

c) invites patients to get in touch with their “shameful” feelings, such as hostility, which gives them the opportunity to uncover the thoughts that precede these feelings.

The therapist may also use techniques that provide sensory pleasure, such as cuddling with other group members. This is not done for immediate pleasure, but to show patients that they are capable of doing pleasurable things that they would never have done before, for the sake of pure pleasure, without feeling guilty, even if others do not approve of them for doing so. (Alexandrov A. A., 1997).

Impact at the behavioral level. Behavioral methods, notes A. A. Alexandrov, are used in rational-emotional therapy not only to eliminate symptoms, but also to change the cognitions of patients. Thus, patients’ tendency toward perfectionism can be reduced by performing the following therapist tasks:

a) take risks, for example, try to date a person of the opposite sex;

b) deliberately fail at solving any task, for example, deliberately perform poorly in front of an audience;

c) imagine yourself in situations of failure;

d) enthusiastically take on activities that the patient considers especially dangerous.

Rejection of patients' demands that others treat them fairly and that the world be ruled by goodness and justice can be achieved by asking them the following tasks:

a) stay in bad circumstances for some time and learn to accept them;

b) perform difficult tasks (for example, entering college or getting a prestigious job);

c) imagine yourself in a situation of deprivation of something and not feel upset;

d) allow yourself some pleasant activity (go to the cinema, meet friends) only after completing an unpleasant but necessary task (French lesson or completing a report for your boss), etc.

RET often uses operant conditioning to break bad habits (smoking, overeating) or change irrational thinking (for example, judging oneself for smoking or overeating) (Alexandrov A. A., 1997).

Other behavioral techniques used in REBT include:

1) the “Stay There” exercise, which provides the client with the opportunity to endure the chronic discomfort caused by being in an unpleasant situation for a long time;

2) exercises in which the client is encouraged to force himself to start doing things right away, without putting it off until later, while at the same time undergoing the discomfort of fighting the habit of putting everything off until tomorrow;

3) the use of rewards and punishments to encourage the client to take on an unpleasant task in pursuit of their deferred goals (severe punishments are especially helpful in the case of highly resistant clients);

4) from time to time the client is encouraged to behave as if he is already thinking rationally, so that he can understand from his own experience that change is possible (Ellis A., Dryden W., 2002).

In general, to achieve a change in mindset, Ellis recommends the following to clients.

1. Recognize that they largely create their own psychological problems and, although environmental conditions may play a significant role in their problems, they are usually a secondary consideration in the process of change.

2. Fully recognize that they are capable of thoroughly dealing with their own difficulties.

3. Understand that emotional disorders are mainly caused by irrational, absolutist and dogmatic views.

4. Identify your irrational beliefs and differentiate between them and their rational alternative.

5. Challenge these irrational beliefs using realistic, logical and heuristic methods, and by feeling and acting against them.

6. Work to internalize new, effective perspectives using a variety of cognitive, emotional and behavioral change techniques.

7. Continue the process of changing irrational beliefs and using multimodal methods throughout your life.

TECHNIQUES AVOIDED IN RATIONAL-EMOTIVE THERAPY

In summary, RET is a multimodal form of therapy that welcomes the use of techniques from the cognitive, emotional, and behavioral modalities. However, due to the fact that the choice of therapeutic techniques is determined by theory, some techniques are not used in practice or are used extremely rarely. Among them, the following should be highlighted (Ellis A., Dryden U, 2002):

1. Techniques that make clients more dependent (for example, excessive warmth of the therapist as a strong reinforcer, creation and analysis of replacement neurosis).

2. Techniques that make people more gullible and suggestible (for example, perceiving the world through rose-colored glasses).

3. Techniques are verbose and ineffective (for example, psychoanalytic methods in general and free association in particular, encouraging the client to give lengthy descriptions of the activating experience, or “A”).

4. Methods that quickly help the client feel better, but do not guarantee sustainable improvement (for example, certain experiential techniques in which there is a full expression of feelings in a dramatic, cathartic and abreactive manner are part of the methods and basic techniques of Gestalt therapy, dangerous in that they may lead people to practice the philosophy underlying emotions such as anger).

5. Techniques that distract clients from working on their dysfunctional worldview (eg, relaxation, yoga, and other cognitive distraction techniques). They can, however, be used together with cognitive challenge to give way to shifts in philosophy.

6. Techniques that may inadvertently reinforce a philosophy of low frustration tolerance (eg, gradual desensitization).

7. Techniques that contain anti-scientific philosophy (for example, treatment by suggestion and mysticism).

8. Techniques that attempt to change the activating event (E) before demonstrating to the client how to change their irrational beliefs (B) (for example, certain family therapy techniques).

9. Techniques that do not have sufficient empirical support (for example, NLP, non-directive therapy, rebirthing).

Example. Using a logical argument.

Here Ellis challenges the client's irrational belief that if he treats his friend very well and fairly, then the friend is simply obliged to treat him the same. Ellis uses mostly logical arguments.

Ellis. Suppose you accurately describe the situation with your friend - he treats you vilely and vilely after you have always acted well towards him. Why does the fact that you behave well towards him mean that he should respond kindly to you?

Client. Because it would be dishonest of him if he acted differently!

Ellis. Yes, we will agree with this. He really is dishonest, but you are decent. Can you jump like this: “Since I’m decent to him, he should be decent to me”?

Client. But he is wrong if he acts dishonestly when I act decently.

(At this point, Ellis and his client are pursuing opposing goals. Ellis continues to ask the client why his friend should be decent to him, and the client continues to answer that his friend is wrong and dishonest, which Ellis does not ask.)

Ellis. Agree. But from the fact that you are decent and supposedly honest, and from the fact that he takes advantage of your integrity, does it still follow that he must be honest and behave decently with you?

Client. It follows logically.

Ellis. Is it true? To me this looks like complete absurdity.

Client. How is this?

(It is typical for Ellis to change his emphasis. He argues that the client's belief is illogical and waits for the client to ask why before expanding on the topic; he wants to get the client to ask, "Why are you saying that?")

Ellis. It is good, logical and consistent that it would be preferable if he treated you decently when you do him good. But aren't you making the counter-intuitive - or "magical" - leap: "Since it would be preferable if he behaved decently towards me, he is absolutely obligated to do so"? What universal “logical” law leads to your: “He is absolutely obligated to do this”?

Client. Probably none.

Ellis. In logic we get the necessary conclusions, for example: “If all men are men and John is a man, then he must be a man.” Your “logic” says: “People who are treated decently often act decently towards others; I act decently towards others; I act decently towards my friend, so it is absolutely necessary that he behave the same towards me.”

Is this a logical conclusion?

(Here is another typical Ellis strategy. He begins with a remark in an instructive manner. As in this case, the remark illustrates a rational idea (here, a logical idea). He then counters it with the client's irrational idea (here, an illogical idea), but not tells the client that his idea is illogical, but encourages him to think for himself by asking: “Is this a logical conclusion?” This passage is worth studying in detail because it is very typical of Ellis's effective discussion.)

Client. I think not.

Ellis. Moreover, you seem to argue that because your friend treated you dishonestly when you did him nothing but good, his actions make him a low person. Is this reasoning logical?

(Ellis extracts the belittling of another from his client's "shoulds" and "musts.")

Client. Why not?

(As you'll see, Ellis answers the client's question right away. You could encourage the client to try to answer his own question before going on a didactic note.)

Ellis. It is illogical because you are overgeneralizing. You jump from his low actions - or even from one of his traits - to judging his essence, his totality, as "low". Why does such an overgeneralization follow from several of his actions?

(Here Ellis identifies the logical fallacy that the client is making, shows him how this fallacy is represented in his belief about his friend, and finally asks him about the logic of this belief.)

Client. Now I see that this is not the case.

Ellis. So what conclusion can be drawn instead?

(Here Ellis encourages the client to be active in his reasoning.)

Client. Well, I would think that he is not his main actions. He is a man who often, but not always, behaves dishonestly.