Family psychology psychotherapy. Systemic family psychotherapy - what is it? What you need at the start

FAMILY PSYCHOTHERAPY

A special type of psychotherapy aimed at correction interpersonal relationships and with the goal of eliminating emotional disorders in the family, most pronounced in a sick family member (Myager V.K., Mishina T.M., 1976).
In the last quarter of the XIX century. arose the doctrine of "family diagnosis" and "family treatment" (Malyarevsky IV, 1886; Smith Z., 1890) of various mental disorders. I.V. Malyarevsky was the true founder of the art industry in Russia and one of the first in the world. In 1882 in St. Petersburg, he founded a medical and educational institution for mentally ill children and adolescents, whose staff paid great attention to the diagnosis of relationships in families of mentally ill, the role of disharmonious upbringing in the formation of certain manifestations of mental illness. With the relatives of sick children, "family education" was carried out - a prototype of modern S. p.
The population's demand for industrial production increased in all countries of the world, especially since the mid-1940's. XX century, after the end of World War II (Spiegel J.R., Bell N. W., 1959), and in the USSR - in the 70s. and after 1990 (Myger V.K., 1976; Eidemiller E.G., 1994). Currently, there are several main directions in S. p.: Psychodynamic (Myger V.K., Mishina T.M., 1976; Kostereva V. Ya., 1979; Tregubov I.B., 1987; Babin S.M. , 1996; Ackermann NW, Franklin PF, 1985), systemic and strategic (Eidemiller E.G., 1990, 1994; Chaeva S.I., 1992; Haley J., 1976; Minuchin S., Fishman H.S., 1981; Palazzoli M. S. et al., 1981; Burnham G., 1991), as well as eclectic (Eidemiller E. G., 1980; Zakharov A. I., 1982).
Historically, the first in S. p. Was the psychodynamic direction, which grew, as it is believed in the West, from the analysis of Freud (Freud S.) of the case of "little Hans" (Sakamoto J., 1967). It is known that Hans's father kept a diary and wrote letters to Freud, in which he reported on the process of interpreting the experiences of his son, suffering from an obsessive fear of horses, and in return received advice on how to carry out this work. The main features of the psychodynamic approach were formulated: analysis of the historical past of family members, their unconscious desires, psychological problems and mutual projections experienced at the early stages of ontogenesis and reproduced in actual experience. The task of psychotherapy was to achieve insight - an awareness of how unresolved problems in the past affect relationships in the family at the moment and how neurotic symptoms and non-constructive ways of adapting to life in some of its members arise from this disturbed context of relationships. At present, such an approach, which requires a lot of effort both on the part of the psychotherapist and on the part of family members, a huge investment of time, is considered economically less viable, but highly effective.
As shown by the composition of the participants in the 2nd international conference (Krakow, 1990), the 3rd (Jyvaskyla, 1991), and the 6th (Jerusalem, 1992) international congresses on social education, representatives of the psychodynamic direction were 25%, and supporters of the systemic family psychotherapy - about 60% of the total number of participants. Representatives of the eclectic direction combine methods of different therapeutic mechanisms in psychotherapeutic work with families: hypnosis, autogenous training, meditation, homework on behavior modification, analysis and interpretation of relationships, group discussions, etc.
In the course of S. of the item, the duration of which can vary from several weeks to several years, a number of stages are distinguished. S.'s duration of the item is determined by the severity of mental disorders in the "symptom bearer", the severity of interpersonal conflicts in the family, and the motivation of family members to achieve therapeutic changes. When participants in psychotherapy asked Satir V.: "How long will family therapy last?" decide for yourself if this is enough for you or if you want to continue working with me. " In the beginning, S. p. Is carried out with a frequency of 1-2 sessions per week, and then meetings take place 1 time in 2 weeks, and then - 1 time in 3 weeks.
Often 4 stages are distinguished in the S. p. (Eidemiller E.G., 1976; Eidemiller E.G., Yustitskiy V.V., 1989):
1) diagnostic (family diagnosis),
2) elimination of family conflict,
3) reconstructive,
4) supportive.
A family diagnosis is understood as the typification of disturbed family relationships, taking into account the individual and personal characteristics of family members and the characteristics of the disease of one of them (Mishina T.M., 1983). Diagnostics of family relations is carried out in the process of joining the family group of a psychotherapist, who puts forward and tests problem diagnostic hypotheses. The peculiarity of the procedure of family diagnostics is that it is of a cross-cutting nature, that is, it accompanies S. of the item at all stages and predetermines the choice of psychotherapeutic techniques. Another feature of the diagnosis of family relations is its stereoscopic nature. This means that if information about what is happening is received from one of the family members, at one-sided meetings, then it should be compared with information from other family members and the impression that the psychotherapist has on the basis of questioning and observing the behavior of participants in the process. psychotherapy ("family through the eyes of a child", "family through the eyes of parents", "family through the eyes of a psychotherapist", "what we really are"). At the second stage, in the course of one-sided meetings of the psychotherapist with the patient and his family members, the sources of the family conflict are identified and clarified and eliminated through the emotional response of each family member involved in the conflict, as a result of establishing adequate contact with the psychotherapist. The psychotherapist helps the parties to the conflict learn to speak in a language that everyone understands. In addition, he takes on the role of a mediator and transfers information about the conflict from one family member to another in an agreed volume. The non-verbal component of this information can be transmitted by the psychotherapist at a session of a joint meeting, for which the “robotic arm” technique is used. Having heard the contradictory message of the participant in the session, the psychotherapist translates it into the language of gesture, and the expressiveness of the gesture correlates with the sensitivity and tolerance of the participants. Thus, at this stage, the following psychotherapeutic methods turn out to be leading: non-directive psychotherapy, aimed mainly at verbalizing unconscious personality relationships, as well as specially developed methods of influencing family members on each other (an attempt to establish contact and achieve an effect, influencing in a hierarchical order on various parties personalities of the participants) (Eidemiller E.G., Yustitskis V., 1999). At the stage of reconstruction of family relations, a group discussion of topical family problems is carried out either in a single family, or in parallel groups of patients with similar problems and their relatives. In the same groups, role-based behavioral training and teaching the rules of constructive dispute are conducted. At the supportive stage, or the stage of fixation, in natural family conditions, the skills of empathic communication and the increased range of role behavior acquired at the previous stages are consolidated, answers are heard about the dynamics of intrafamily relations, counseling and correction of acquired communication skills are carried out in relation to real life.
Allocation of stages allows you to structure the process of S. of the item, substantiates the sequence of application of certain psychotherapeutic methods, depending on the goals and volume of diagnostic information. According to E. G. Eidemiller, V. V. Yustitskis, the concept of "stage of S. p." and the choice of an adequate psychotherapeutic technique are interrelated phenomena. The psychotherapeutic techniques most often used in S. of the item include the following (Mishina T.M., 1983):
1) efficient use silence,
2) listening skills,
3) learning with questions,
4) repetition (recap),
5) total repetition,
6) clarification (clarification) and reflection of affect,
7) confrontation,
8) playing roles,
9) creation of "living sculptures",
10) analysis of videotape recordings (Perrez M., 1979).
Supporters of an expanded understanding of the content of S. of the item believe that any individual psychotherapeutic influence on family members, pursuing the goal of a positive influence on the family as a whole, can be regarded as one of the options for S. P. (Bach O., Scholz M., 1980; Kratochvil S., 1985). This assumption turns out to be true if, while listening to the patient and putting forward a hypothesis about a family diagnosis, the therapist thinks in terms of an integral family structure and, therefore, “preliminarily assesses how this or that influence affects family relationships as a whole” (V.V. Stolin, 1981 ). In addition, the meaning of the principle of consistency is manifested in the light of the idea of ​​"circular causality" in the family, that is, on the interdetermination of personality and interpersonal relations, according to which the style of communication, the nature of interaction, the type of upbringing, on the one hand, and personality traits family members - on the other hand, form a closed, constantly reproducing homeostatic cycle (Andolfi M., 1980). S. p. Is an attempt to destroy this cycle and create constructive alternatives to family functioning.

Psychotherapeutic encyclopedia. - S.-Pb .: Peter. B. D. Karvasarsky. 2000 .

See what "FAMILY PSYCHOTHERAPY" is in other dictionaries:

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4.1. Definition of Systemic Family Psychotherapy

Family psychotherapy is usually understood as a set of psychotherapeutic methods and techniques aimed at treating the patient in the family and with the help of the family, as well as optimizing family relationships(Eidemiller E.G., Yustitskis V., 1990,1999; Family psychotherapy, 2000; Systemic family psychotherapy, 2002). Family psychotherapy - it is a special type of psychotherapy aimed at correcting interpersonal relationships and aimed at eliminating emotional disorders in the family, which are most pronounced in a sick individual. Currently, family psychotherapy is divided into several main directions: psychodynamic (Mager A.K., Mishina T.M., 1976; Ackerman N., 1958, 1966, 1982), systemic and strategic (Eidemiller E.G., 1990, 1992; 1994, Selvini Palazzoli M. et al., 2002; Minuchin S., Fishman HS, 1981; Fritz B. Simon, Helm Sterlin, 1984), as well as eclectic (Eidemiller E. G, 1980; Zakharov A.I. , 1982).

Historically, the first direction in family psychotherapy was psychodynamic, which grew, as it is believed in the West, from the analysis of the case of "Little Hans" (Freud 3., 1990). Hans's father, one of the students of Z. Freud, consulted with him about his son, who suffers from an obsessive fear of horses. In several conversations and letters, Freud gave his father advice on how to talk to his son. Such indirect interpretations and influences led to the complete cure of Hans.

The psychodynamic approach to family therapy is a psychological effect on a person. By clarifying and correcting the relationships of family members, such psychotherapy helps the person become more mature and thereby helps to overcome family difficulties. The emphasis in this approach is on the individual rather than on the family as a whole. The focus of the psychotherapist is the analysis of the historical past of relatives, their unconscious desires and psychological problems experienced in the early stages of ontogenesis. The task of psychotherapy is to achieve insight - an awareness of how unresolved problems in the past affect relationships in the family at the moment and how neurotic symptoms and non-constructive ways of adapting to life in some of its members arise from this disturbed context.

Currently, this approach, which requires a lot of effort and a huge investment of time, both on the part of the therapist and the clients, is considered economically impractical, but at the same time highly effective.

With an eclectic approach in psychotherapeutic work with families, methods and techniques of personality-oriented and behavioral psychotherapy are arbitrarily combined, as well as suggestions and changes in consciousness based on the therapeutic effect of hypnosis, AT, meditation, etc. For example, members of one family are immersed in a hypnotic trance by a psychotherapist ... They are then presented with symbolic keywords, which are a metaphorical form of presenting real family problems of the past and present. In response to these stimuli, emotional reactions, various verbal associations arise, a response occurs at the unconscious level, the establishment of a peculiar cohesis "a(feelings of cohesion) (Czabala J. Cz., 1990; Meinhold W. J., 1990).

On the present stage The development of family psychotherapy is considered to be one of the most promising areas from an economic and therapeutic point of view. Its representatives view the family as an integral system. With this approach, the individual is not the client and the target. The whole family is the client.

Like all living organisms, the family system seeks both to preserve the established connections between elements and to their evolution. In a living system, which is formed and preserved, thanks to the effect of the exchange of energy and matter in non-equilibrium conditions, vibrations, both internal and external, turn it into new structure(new quality). There is an increase in its complexity, differentiated ™. Figuratively speaking, the family, as a living system, exchanges information and energy with the external environment. Oscillations are usually accompanied by a reaction that returns the system to its steady state. But when they intensify, a crisis may occur in the family, the transformation of which will lead it to a new level of functioning.

Throughout its existence, the family goes through regular "developmental crises" (Family Psychotherapy ..., 2000): marriage, separation from parental families, mother's pregnancy, childbirth, his admission to preschool and school institutions, adolescence, graduation schools and the choice of "their own path", a break with parents, retirement, etc. It is during these periods of their existence that families are unable to

we solve new situations in the old ways, and therefore they face the need to complicate their adaptive reactions.

As already mentioned, families perform their functions using certain mechanisms: the structure of family roles, family subsystems, external and

internal borders.

Family Role Structure prescribes to relatives what, how, when and in what sequence they should do, entering into relations with each other (Minuchin S., 1974). Repetitive interactions set certain standards, which, in turn, determine with whom and how to interact. In normally functioning families, the structure of roles is holistic, dynamic and alternative in nature. When the needs of relatives are not met within the framework of the existing structure, they make efforts to find alternative options for fulfilling roles. According to our research, 66% of families in which adolescents with neuropsychiatric disorders lived have either rigidly fixed pathologizing family roles or the initial absence of this structure. Patologizing family roles are understood as those that, by virtue of their form and content, have a traumatic effect on family members (Eidemiller E.G., Yustitsky V.V., 1990).

Family subsystems (holons)- this is a more differentiated set of family roles, which allows you to selectively perform certain functions and ensure livelihoods (Nickols M “1984; Minukhin S, Fishman Ch., 1998). One of the family members can be a member of several subsystems - parental, marital, child, male, female, etc. However, the simultaneous functioning in several subsystems is usually ineffective.

Boundaries between subsystems- these are the rules that determine who and how performs family functions in a particular aspect of family life. In normally functioning families, the boundaries between subsystems are clearly delineated and permeable. In the dysfunctional families we examined, either rigid or blurred boundaries were observed. In the first case, communication between subsystems is sharply limited; there is no information exchange. In the second, the stresses experienced in some subsystems are easily irradiated.

to others.

Based on this, the tasks of systemic family psychotherapy can be formulated as follows:

1. Unification of the psychotherapist with the family.

2. At the first stage of psychotherapy - assimilation and maintenance of processes that ensure the preservation of the usual functioning of family subsystems, the distribution of roles and boundaries between subsystems.

3. At the second stage - by joining the psychotherapist to different subsystems, creating a situation of frustration in order to initiate the transition of the family to a different, more complex level of functioning.

4.2. Indications and contraindications for systemic family psychotherapy

Family systemic psychotherapy is indicated for the following nosological classes: neuroses and other borderline neuropsychiatric disorders, psychosomatic diseases, alcoholism, low-grade schizophrenia. In addition, an indication for family psychotherapy is a number of psychological problems - the desire of relatives to resolve acute and chronic conflicts, to optimize their relationships, especially if there is a danger of transformation of the structure of pathologizing roles and dysfunctional subsystems into a family with a “symptom bearer”.

Contraindications include: persistent character deviations in one of the family members in the form of hysteroid, epileptoid and paranoid psychopathies, as well as temporary psychotic states - disturbances in thinking and consciousness, pronounced depressive and manic phases, delusional experiences. In these cases, it is necessary to prescribe an appropriate biological therapy, and then decide on the choice of the method of psychotherapy, its tasks and scope.

Family psychotherapy is not indicated in cases of rigidity of life attitudes, especially those associated with old age. Possible changes in the functioning of the family can lead to psychosomatic disorders in the elderly and even death.

Extreme caution should also be exercised in cases where, as a result of a violation of the context of the relationship, one of the relatives - the child - falls ill, the family agrees to treatment, but destructive tendencies prevail over constructive ones, and the risk of parental divorce is very high. In such situations, spouses tend to shift responsibility for their divorce to the therapist and sometimes try to take revenge on him.

4.3. Basic techniques of systemic family psychotherapy

These exercises are given in accordance with the stages of development of the process of family psychotherapy, combined by themes and tasks, with the predominant orientation of classes on interaction "here and now". As mentioned above, we distinguish two stages in the process of family systemic psychotherapy. At the first stage, the psychotherapist joins the family system, identifies, differentiates and complicates the cognitive scenarios that regulate family relationships. The second stage is the reconstruction of these relations.

The techniques of the first stage of systemic family psychotherapy

As a rule, the “initiators of the appeal” to the psychotherapist were the mother and the child - the “bearer of the symptom”. At the first stage of work, the psychotherapist was faced with the task of creating and strengthening these clients' motivation to invite all family members living together to the next session. Such a proposal was often met with resistance. It could be weakened if one of the following techniques was used.

S Providing clients with information about the role of the family in the origin of neuropsychiatric disorders in children and adolescents. Emphasizing that any family contains not only and not so much a pathogenic factor as a sanogenic factor.

S Positive emotional reinforcement of the very attempt to seek help: “Only a very responsible person like you could take the initiative and come to the appointment. I think that this quality will help you to influence the rest of the family. "

S Appeal to the sense of justice from the "initiator" of the appeal: "You and your son discuss your problems out loud, but other family members do not have such an opportunity."

■ S An indication of the likelihood of an inadequate solution to the problem and uneven distribution of efforts to solve it due to separate meetings with several family members and lack of involvement in psychotherapy of others: “While we are working here with you, they come up with something of their own. They will not help us, and we will not help them. "

Thus, the psychotherapist strove for all relatives who live together and therefore are in psychological dependence on each other to take part in each session.

The next task is to connect the therapist to the family. To this end, in his behavior, he tried to move from the roles of "observer", "arbiter of destinies", "magician", "omnipotent wizard" (the family tries to ascribe them to him) to the position of one of the elements of the family system ("the one who says how we "," the one who, it turns out, has the same problems, but he has already solved them "). The accession is facilitated by the observance of an important rule - the preservation of the family status quo. If there is a clear leader in the family who rigidly prescribes certain behavior to the others, who is used to speaking for others, depriving them of their voice, or being a “translator”, voicing the thoughts of their relatives, then the psychotherapist makes all appeals to the family through such a leader. "May I ask your wife?" - he turns to the male leader, etc.

When family members begin to talk about a problem, it is very difficult for them to figure out what is important and what is secondary in their message. Therefore, in order to structure information, the psychotherapist usually repeats in a concise form the most significant of what has been said: "As far as I understand, we are talking about ...".

The family as a system reveals in front of the psychotherapist a certain language of verbal and non-verbal behavior, with the help of which its members ensure their integration and integrity. There are high-expressive families

with fast speech, active gestures and facial expressions, there are very restrained, controlling both the manifestation of emotions and the words spoken. With the help of reception mimesis "a(imitation) the therapist tries to enter into communication in the language that is understandable and characteristic of the family.

Other psychotherapeutic techniques are used at a time when family members formulate their problem. They aim to hide from clients that they are being manipulated and that they are being emotionally supported. Non-directive leadership ("leadership behind the back") means that the psychotherapist uses interjections and remarks like: "Wow!", "How interesting!", "Oh!" something important to yourself. At the same time, the verbal "slag" does not receive any reinforcement from the psychotherapist.

Demonstration of the psychotherapist's personal involvement in a family problem is used in cases where relatives talk about difficulties that were or are relevant to him. In this case, he does not hide, but, on the contrary, shows how close it is to him. This is one of the ways to convince the participants of the interaction that psychotherapy is real work. real people with a therapeutic purpose, in contrast to the widespread in society illusory ideas about the mysterious possibilities of manipulative influences.

Our experience in conducting systemic family psychotherapy has shown that in the first sessions one should not reflect emotional reactions, analyze the motivation of the behavior of the participants in the session, and use value judgments. On the one hand, this blocks the personal growth of clients, puts them in a clearly unequal environment. On the other hand, it strengthens the mechanism of both individual and group psychological defense.

We concluded that we should also not stimulate family members to accelerate the acquisition of communication and analysis skills in a situation "here and now", as is the case in some models of group psychotherapy. This is due to the fact that the desire to speak out and look for the cause of the problem not in the present, but in the past in the surveyed families is very strongly expressed. We call such a technique “a smooth transfer of analysis from a“ there-and-then ”situation to a“ here-and-now ”situation.

We have also developed special program psychotherapeutic exercises, the purpose of which is to develop skills of non-verbal communication, empathy, expression of their experiences, development and enrichment of cognitive scenarios. This program is carried out either in classes that are conducted in parallel with the main psychotherapy, under the guidance of a co-therapist, or fractionally and sequentially in the process of the most systemic family psychotherapy.

Systemic Family Psychotherapy Phase II Techniques

At the second stage, the reconstruction of family relations is carried out. The criterion that a family is ready to confront its unconscious problems is the trust and freedom with which its members begin to talk about themselves, to cite facts that previously caused them to express negative feelings.

active reactions. Using his personal and professional potential, the psychotherapist consistently frustrates various subsystems of the participants in psychotherapy. For this, the following techniques are used:

Change of seating;

Separation of family members and unification into new coalitions;

Positive reinforcement of participants in the same subsystems and blocking

Analysis of thoughts, feelings, actions that arise "here and now." Actualization and structuring of the received material is carried out with

using role-playing situations and gestalt therapy exercises:

- "rounds";

Dialogue of the “I” parts of a family member;

Non-verbal dialogue between participants of different family subsystems. Based on a specific situation, during a session or as assignments for

a home psychotherapist can give the family special guidelines. Let's distinguish three types of them: direct, metaphorical and paradoxical. The purpose of these tasks:

Change the behavior of family members;

Provide additional incentive to building a therapist relationship

with family members;

Study the reactions of family members when they perform tasks;

Provide indirect support to family members, since during the assignment, the psychotherapist seems to be invisibly among them.

For the successful implementation of directives, the motivation for completing tasks should be strengthened. For this, it is necessary to reach agreement between family members and the psychotherapist in the formulation and achievement of the goal. This situation often occurs in late sessions of the second stage of family psychotherapy. In this case, the task is given in the form of direct instructions. When indirectly instructing, all previous attempts by family members to resolve the situation should be discussed. Each variant of the solution should be ended with the words: "It's a pity, but it was not possible either ..." After such a discussion, the participants, as a rule, have great confidence in the directives of the psychotherapist.

If family members show despair, which is reflected in remarks like "How bad we are!", The therapist agrees with them: "Yes, you feel bad!" Then there is a unification based on the emotion of despair. In the case of expressed resistance, the psychotherapist accompanies his task with the words: "This is so insignificant that it is not worth talking about." For families enjoying a dramatic change in their lives, the importance of the assignment should be emphasized. The psychotherapist's manifestation of power contributes to the success of its implementation. To do this, he takes the role of a competent expert: "I know this very well ...", "All my experience speaks ...", "In such cases, the famous American psychotherapist Salvador Minukhin does this and that ...". If the therapist thinks that the assignment is too unexpected or could pose a threat to the hyper-normative attitudes of family members, then the directive should be preceded by the words: "I want to ask you to do something that may seem silly, but I still want to ask you to do it."

The wording should be clear, understandable and specific. It is necessary to monitor the reactions of family members, encourage them to assimilate the task. Participants in psychotherapy can be asked to repeat the therapist's verbal instructions.

Examples of direct directives. If the therapist notices that a coalition is formed during the session, for example, between the grandmother and the granddaughter, and the girl's mother loses all influence on her daughter, you can try to change this situation, since her long experience in family life has caused the girl's symptoms of neurosis. The psychotherapist gives the task to the girl to do something that the grandmother does not like very much, and the mother gets the task to protect her daughter at all costs. The result of this interaction can be an increase in the distance between the grandmother and the granddaughter.

In the case of conflict relations between representatives of family subsystems, for example, in the case of a mother who has a negative attitude towards her daughter, despite the fact that the father either does not stay at home until late or passively watches their quarrels, one can offer to “build a wall for them”. During the session, the psychotherapist deprives the mother and daughter of the opportunity to communicate with each other: "If you want to say something to each other, then do it through your father." At home, for a certain time, they are invited not to communicate with each other, but also to transmit all their wishes through their father. The fulfillment of such tasks leads to the elimination of the conflict and, in addition, activates the role of the father, who, perhaps for the first time, realizes that a lot depends on him, and he begins to like it.

To improve the empathic abilities of the mother, who is in a symbiotic connection with the child, to help her establish distance with him and accept his autonomy, she can be offered a homework task: to hide something from the child so that he would spend no more than ten and not less than five minutes. The mother should repeat this task until she succeeds.

In the case of depressive reactions in psychotherapy participants, they may be offered a series of tasks that require activity. For example, a psychotherapist says: “And now I will ask you to play the role of a timekeeper, you will count to yourself how much time everyone is talking. Then you will report the result. " Completing such a task can cause the performer to feel irritated and even angry, which ultimately will weaken the depressive reaction.

Metaphorical tasks. Such tasks are based on the search for analogies between events, actions, which, at first glance, are very different.

A brilliant example of metaphorical assignments that Milton Erickson used in his work is given by Jay Haley (Haley J., 1976). A married couple is frustrated by the monotony of their sexual relationship, but hesitates to discuss it directly. Then the therapist comes up with an analogy for sexual intercourse - the procedure for a joint dinner. "How do you dine?" - these are the questions the therapist asks to the spouses. He then encourages discussion of aspects of the meal that may resemble sex life. For example, he may say, “Sometimes the wife wants to try the appetite-stimulating seasonings before eating and eat slowly. While the husband likes to immediately pounce on potatoes with meat. "

Or, "Some husbands praise their wives for being so beautifully prepared, while others do not pay attention to it at all, and therefore their wives do not try at all." Then you can turn the conversation to some neutral topic so as not to frighten the participants in psychotherapy, and then touch on other aspects of the dinner: "Some people like to dine by candlelight, while others like bright lights in which everything is visible." At the end of this discussion, the therapist should instruct the spouses to have lunch together. They must choose a night when they are alone and prepare a pleasant dinner together; each other's tastes must be respected, and they should only talk about the pleasant aspects of the feast, not the day's worries. The wife should try to whet the husband's appetite, and he, in his heart, provide everything to please her. If the dinner goes well, then the very experience of the joy of communication will lead the spouses to have sexual intercourse. The stimulus to change activities, thus, works on an unconscious level, and the changed behavior in the future leads to an expansion of the spouses' awareness of their experience.

Paradoxical tasks. In this case, the psychotherapist gives instructions so that family members oppose their implementation and thereby change their behavior in the right direction. The use of such techniques is justified in cases of pronounced resistance to therapeutic change. Assignments can be given to the entire family and its individual subsystems. The instructions for the whole family require very careful preparation and supervision.

As an example of a paradoxical task to the marital subsystem, let us give one that we often use in our practice. A married couple who often quarrels and resolves conflicts unconstructively may be given the task of fighting for at least three hours upon returning from work on certain days. The rational explanation for the task the therapist gives to the spouses is to observe and study each other during an argument. The goal of the assignment is to reduce the number of quarrels, since people do not like to make themselves unhappy if it is someone else.

orders.

Each task of the psychotherapist must be completed, with the exception of any objective reasons that prevent it. Failure to do so prompts us to analyze its causes, so that families can understand that they themselves are responsible for this and deprive themselves of the opportunity to learn something new and valuable about themselves.

We also used paradoxical tasks to stop psychotherapy when we became confident that the family system changed its functioning and began to effectively solve its problems. For example, a psychotherapist, who until recently played an outwardly imperceptible role and established communication between subsystems, suddenly declares: "None of you know your problem as well as I do, so do this and that ..." Such a contrast in his behavior usually arouses protest among family members, a desire to unite and stop visiting such a harshly "stupid" doctor.

Another example of a paradoxical task addressed to spouses, which is used to facilitate the completion of psychotherapy, is the following statement: "It seems to me that you will quarrel soon." After that-

Then the spouses have an incentive to strengthen their cohesion and release from the influence of the psychotherapist.

The directive position of the psychotherapist also contributes to the successful conduct of systemic family psychotherapy. This is due to the fact that throughout the work, he personifies power, which is used not only to initiate changes in relationships, but also to optimize the functioning of the subsystems of the family group, which retains its fundamental importance: spouses fulfill the needs for reciprocity, parents raise children, children socialized, etc. This is the difference between the position of the family psychotherapist in comparison with the model of group psychotherapy, in which all participants can apply for any group roles, and therefore does not require such an explicit control of the therapeutic process.

4.4. Model of integrative systemic family psychotherapy

We have developed a model of integrative systemic family psychotherapy. It can be described as the following technological chain.

1. Joining the therapist to the role structure presented by the family

/ Establishing constructive distance - free disposition of family members.

■/ Connecting through breath synchronization with the family member who is reporting the problem.

/ Receptions mimesis(Minuchin S., 1974) - direct and indirect "mirroring" of postures, facial expressions and gestures of participants in psychotherapy.

■ S Joining by prosadic characteristics of speech to the applicant of the problem, identified by the patient (speed, volume, intonation of speech).

■ S The use of predicates by the psychotherapist in his speech, reflecting the dominant representational system of the applicant of the problem and other family members.

■/ Tracking the oculomotor reactions of psychotherapy participants in order to verify the correspondence of the verbally presented problem to deep feelings.

s Maintaining the family status quo, that is, the structure of family roles that the participants demonstrate to the psychotherapist. In this case, there may be a clear leader, the initiator of the appeal and the applicant of the problem. The leader can hide behind silence and non-verbally instruct someone from the family to play the role of a "translator" who speaks on behalf of everyone. In each of these cases, the psychotherapist, performing the attachment, until its completion, retains the presented structure of roles.

2. Formulating a therapeutic request S As a rule, the initiator of the appeal presents the psychotherapist with a manipulative request for the mud: “My child has a symptom (does not study well, is disobedient). Make it different. " This formulation allows the initiator of the appeal to distance himself from unconscious or perceived feelings of guilt, to relieve himself of responsibility for what is happening in the family and to transfer it to the child and the psychotherapist.

/ Metamodeling techniques and psychotherapeutic metaphors make it possible to transfer the request from a superficial manipulative level to the level of parents' awareness of their ineffectiveness in the parental role.

/ The exploration by family members of themselves as unsuccessful parents allows them to move to the realization of their ineffectiveness as spouses.

S In parallel with formulating the request, the psychotherapist examines the resource states of individual family members and the family system as a whole: “Was there a moment in your life when you were successful together? How did you do it? "

Thus, we have developed a technology for formulating a therapeutic request, which we called: XR-> YR-> ZR, where: X- the level of manipulative request; U - the level of self-awareness as ineffective parents; Z - the level of awareness of their incompetence as spouses; R- resource states of the family system and individual family members. At the stage of formulating a therapeutic request, it is also important to determine the goals that are set by each family member and which they want to achieve in the course of psychotherapy. At this moment, it is important to transfer psychotherapeutic work from the plane of studying the past to the plane “here and now”. Excursions into the past are made only to search for resource states from family members. The formulation of the goals of each family member led to the formation of the goal of the family as a single psychological organism.

3. Reconstruction of family relations

S The work of a psychotherapist contributes to the establishment of boundaries between subsystems, strengthening the functioning of some and reciprocal weakening of others. For example, spouses used to spend most of their time unconsciously mixing parental and marital contexts. And this, on the one hand, led them to dissatisfaction with the marriage, and on the other, it caused problems or symptoms in the child. The separation in the process of psychotherapy between parental and marital contexts contributed to the effectiveness of clients both as spouses and parents. The progenitors learned to recognize the boundaries of their subsystem, the quality of its functioning and the motives for which they crossed internal boundaries inconsistently.

■ S Throughout family psychotherapy, the same techniques are used that are used in the model of group psychotherapy we have developed:

a) balance in the study of negative and positive experiences;

b) the use of two-level feedback;

c) psycho-sculpture, family psychodrama.

4. End of psychotherapy and disconnection

The following facts testified to the completion of psychotherapy:

/ Achievement of the formulated goals.

/ Compliance with the agreed time context. After the stage of joining, which usually took 1-2 sessions of 2 hours each, the participants in psychotherapy stipulate the boundaries of the temporal context necessary to achieve psychotherapeutic changes. The minimum time for family reconstruction is 8 hours - 4 sessions, and the maximum time for family psychotherapy is 16 hours - 8 sessions.

■ / Environmental review - family members create an image of their future. At the last lesson, in a number of cases, we invite the participants to imagine themselves in a segment of the future - how they interact there, what they succeed in and what they fail. Discussion of this work allows us to determine the most successful ways to use these states. Our experience has also shown the high effectiveness of the non-verbal procedure we have developed "joint drawing of family happiness", with the help of which we often complete family psychotherapy. Each participant draws their own idea of ​​happiness with their non-dominant hand, eyes closed. After that, everyone puts the fragments together into a coherent picture and discusses what happened.

4.5. An example of the use of systemic family psychotherapy

As an illustration, we present a fragment of the transcript of a session of systemic family psychotherapy (psychotherapist - N.V. Aleksandrova).

■ Fragment of the transcript of the systemic family psychotherapy session

The session is attended by a father, mother and daughter of 6 years old.

Complaints from the mother: whims of the girl, unwillingness to sleep in her bed.

Psychotherapist (P.) (after meeting all family members): Who will tell you what brought you to the consultation? (During the conversation with the parents, the second therapist draws with the girl.)

Mother (M.): My daughter is six years old, she is capricious, she’s not like that, but because of her I lost my job, I’m only doing it, she also doesn’t want to sleep at home at night, tries to sleep with her father ...

P: Please tell us how your family lives, how is it arranged?

M .: We have a separate apartment, three rooms. In one room I and my daughter, or rather, her bed, in the other - my husband, the third - the living room.

P: What does it mean that the husband is in another room?

M.: The daughter is restless from an early age, and he goes to work early, and so it happened ...

P: Who was the initiator of this division into rooms?

M.: I don't remember, probably both ...

NS. (addressing the mother): May I turn to your husband, maybe he can add something to your words? M .: Yes, please.

NS. (addressing the father): Did you hear what your wife said, what can you say about this?

Father (O.): We should probably start from the beginning ... When my wife found out about pregnancy, she didn't really want to leave her, I insisted ... She wanted to write a dissertation. Heavy pregnancy, difficult childbirth. When she returned from the hospital, it was difficult for her, her daughter was restless, ate and slept poorly, and somehow it happened that I went to another room ... P: And how did your intimate relationship develop after giving birth? A: Yes, perhaps not ...

NS.: (addressing his wife): What can you say about what you heard? M.: Yes, I was not up to it ... And in general, he worked, met people, and I am within four walls with a screaming daughter ... And the dissertation is not finished ... But he defended himself and found a good job. ..

NS. (to the mother): How would you say who is the daughter in your life? M.: I love her, I put so much strength, sometimes she gets sick, sometimes she doesn't sleep, sometimes she doesn't eat, but she's grown up, and everything clings to her father: only his bell at the door - she immediately runs, throws herself around her neck, the dress demonstrates ... I tell her that her dress does not suit her, they say, put it on, and he kisses her, says: "You are my beauty," and she melts. In the evening you can't put her to sleep, everything is trying to run to him, and at night I wake up - and she is already with him ...

O. (barely waiting for the end of the words of the mother): So after all, you keep sawing and sawing - it’s not like that, it’s not like that, so she runs to me ...

NS. (addressing the father): When your daughter greets you like that, what happens to you?

O .: So only she keeps me with her (nods at his wife), so I probably would have left ...

NS. (to father): As you understand - why does the daughter come running to you at night?

O .: Yes, she wants warmth, she wants to be caressed ... She will hear enough comments for a whole day ...

NS. (addressing the mother): And what happens to you when you find that your daughter

M.: I'm angry, offended - I gave her everything, and she kept everything to her daddy ... It's easy for him to be affectionate ... I would try to listen to her whims all day - I won't go to a speech therapist, I won't study English ... I tell her: "You will grow up a fool, you will not become anyone, no one will marry" ...

P: How do you feel as a wife?

M.: Well, someone has to feed him ... Yes, and she loves him ... and I ... what?., Somehow ...

P: Can we assume that your daughter's behavior and your not entirely satisfactory marital relationship have a certain connection with each other?

The parents thought about it. They look at each other and at their daughter, who at that time was also distracted from her occupation and was looking at them.

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Family systemic psychotherapy Theoretical provisions

Supporters of an expanded understanding of the content of family psychotherapy believe that any individual psychotherapeutic influence on family members, with the goal of positively influencing the family as a whole, should be considered as one of the options for family psychotherapy (Bach O., Scholz M., 1980; Kratochvil S., 1985 , 1991). This assumption turns out to be true if the psychotherapist, listening to the patient and putting forward a hypothesis about a family diagnosis, thinks in terms of an integral family structure and, therefore, preliminary estimates how this or that influence will affect family relationships as a whole "(V.V. Stolin, 1981).

In addition, the meaning of the principle of consistency is clarified in the light of the idea of ​​"circular causality" (that is, the mutual determination of the personality and interpersonal relations) in the family, according to which the style of communication, the nature of interaction, the type of upbringing, on the one hand, and the personal characteristics of family members - on the other hand, they form a closed, constantly reproducing homeostatic cycle (Andolfi M., 1980). Family psychotherapy is an attempt to break this cycle and create constructive options for family functioning.

Currently, the systemic direction is considered to be one of the most widely represented, promising, economically feasible and therapeutically effective areas of family psychotherapy.

The largest representatives of family systemic psychotherapy are Mara Selvini-Palazzoli, Luigi Boscolo, Gian-Franco Chekkin, Jay Haley, Clu Madanes, Salvador Minukhin, Hana Weiner, Allan Kuklin, Jil-Gorel Varne and others.

A significant influence on the development of this direction of family psychotherapy was exerted by the provisions of the general theory of systems (Prigozhiy I., 1991) (see Chapter 2, section "Violation of the mechanisms of family integration"),

In psychotherapy of the first half of the XX century. dominated by mechanistic reductionist theories of the "stimulus-response" type, as well as psychoanalytic theories about a person as a "lone hero": mental pathology was considered as a consequence of unresolved intrapsychic problems, the behavior of an individual - as a reaction to internal and external circumstances, a family with gathering of individuals with disabilities.

Many family therapists felt the limitations of this approach. One of the first to take an interest in systems theory was Murray Bowen (1966). Somewhat later, Salvador Minukhin proposed the paradigm of “a person in circumstances”, meaning by this not the impact of a person on circumstances, but the impact of circumstances on a person.

In the USSR, much earlier than these scientists, V.N.Myasishchev wrote about this (V.N. , G. L. Isurina and V. A. Tashlykova) and family psychotherapy (including systemic therapy in the USSR and Russia).

In modern neuropsychiatry, a prominent place is occupied by the theory of polyfactorial etiology of neurotic and somatoform disorders (ICD-10), in which the leading role is assigned to the psychological factor.

To the greatest extent, the content of the psychological factor is revealed in the pathogenetic concept of neuroses and the "psychology of relationships" developed by V.N. environment.

VN Myasishchev saw in neurosis a deep personality disorder due to disturbances in the system of personality relations. At the same time, "attitude" was considered by him as a central system-forming factor among many mental properties. "The source of neurosis, both physiologically and psychologically," he believed, "are difficulties or disturbances in the relationship of a person with other people, with social reality and with the tasks that this reality poses before him" (VN Myasishchev, 1960).

What place in history does the concept of "relationship psychology" occupy? This concept developed in a totalitarian society. While the leaders and ideologists of the USSR, relying on the teachings of K. Marx, consciously or unconsciously created conditions and grounds for enslaving the citizens of their country, V.N. F. Lazursky and his colleague M. Ya. Basov, turned to the living thing that was in the philosophy of K. Marx - to the thesis of K. Marx that "the essence of man is the totality of social relations." According to L.M. Wasserman and V.A. and to the environment.

If the concept of "relation" for I.F. meant not so much integrity as activity, that is, the ability of the psyche not only to reflect the environment, but also to transform it.

For AF Lazursky, the concept of "attitude" had three meanings:

1) at the endopsychic level - the interconnection of the essential units of the psyche;

2) at the level of exopsyche - the phenomena that appear as a result of the interaction of the psyche and the environment;

3) the interaction of endo- and exopsychics.

M. Ya. Basov - until recently, almost unknown to a wide circle of the psychiatric community, a student of V. M. Bekhterev and colleague of V. N. Myasishchev - strove to create a "new psychology" based on the approach that was later called the systemic one. He considered "the dismemberment of a single real process of life into two incompatible halves - physical and mental - one of the most amazing and fatal illusions of mankind." The relationship of the organism / personality and the environment are mutual, and the environment is an objective reality in its relation to the organism / personality.

Schematically, it may look like this (Fig. 31).

Rice. 31. The interaction of subject and object.

In his teaching V.N.Myasishchev not only integrated the ideas of V.M.Bekhterev,

AF Lazursky and M. Ya. Basov, but also put forward their own. He identified the levels (sides) of relations that are formed in ontogeny:

1) towards other persons in the direction from the formation of an attitude towards one's neighbor (mother, father) to the formation of an attitude towards the distant one;

2) to the world of objects and phenomena;

The attitude of a person to himself, according to B.G. Ananiev (1968, 1980), is the latest formation, but it is this that ensures the integrity of the system of personality relations. The relations of the individual, united among themselves through the attitude towards oneself, form a hierarchical system that plays a guiding role, determining the social functioning of a person.

Three components are distinguished in the structure of relations (Karvasarsky B.D., 1980): cognitive, emotional and behavioral. Normally, at the cognitive level, a person knows something about the object, on the emotional level he experiences the emotion corresponding to knowledge, on the behavioral level he builds behavior / reaction corresponding to knowledge and emotions. In pathology, the components of the relationship, as a rule, are not coordinated. Hence the neurotic disorder (in the understanding of the school

B. N. Myasishcheva) is a psychogenic disease in which a certain constellation of symptoms (syndrome, or form) is caused by certain types of psychological conflict, disturbances in the system of personality relationships and inconsistencies in the components of these relationships. A disorder of the system of relations, leading to neurosis, is a violation of the integrity of the system of relations (their hierarchical structure); the presence of contradictory relationships that are equally significant for the individual; violation of communication between blocks of relations; and a qualitative or quantitative change in such characteristics of individual relations as activity, selectivity, consciousness (which leads to the inadequacy of relations to the object). All of this is a source of neurotic conflicts and neuropsychic stress, which is controlled to a certain extent by means of psychological defense mechanisms and is channeled through the formation of symptoms. The main importance in neurotic decompensation is acquired by a violation of the attitude towards oneself, manifested in a low and contradictory self-esteem at all stages of personality ontogenesis (Isurina G.L., 1984; Eidemiller E.G., 1994).

In the pathogenetic concept of neuroses, a typology of neurotic conflicts is proposed, taking into account the personal mechanisms of their development - the concept personal profiles in the form of personal radicals in children and personality accentuations in adolescents and adults (Leonhard K., 1981; Garbuzov B.I., 1977; Eidemiller E.G., 1994). We consider the concept and typology of personality accentuations as internal conditions for the formation of neurotic disorders in Chapter 2 of this book.

VN Myasishchev proposed to divide neurotic conflicts into three types: hysterical, neurasthenic and obsessive-psychasthenic. A hysterical conflict is an unconscious insoluble contradiction between “I want” (an overestimated level of claims) and “I can” (an underestimation of one's capabilities and the real situation). The neurasthenic conflict is characterized, on the contrary, by increased demands on oneself, exceeding the real capabilities of the individual (the conflict between "must" and "can"). Obsessive-psychasthenic - associated with the inability to make a choice between actualizing drives and normative attitudes (the conflict between "must" and "want"),

Currently, with the noted clinical pathomorphosis of neuroses (Ababkov V.A., 1994), neurotic conflicts do not occur in their pure form, and researchers speak of a multidimensional neurotic conflict (Karvasarsky B.D., 1990).

Based on the above provisions, an indispensable condition for restoring broken relationships during "pathogenetic" or personality-oriented (reconstructive) psychotherapy is the awareness of internal contradictions and the verbalization of the emotional component of the relationship, teaching the client to test reality, including impulses and sensations in his own body, understanding the surrounding reality, and own goals.

Summarizing what has been said, we can state the interconnection and mutual conditioning of external and internal (in relation to the personality) systems of relations, thanks to which the impulses, content and forms of development of the personality / organism are created.

Following V.M.Bekhterev, V.I. Myasishchev paid great attention to the study of childhood, the formation of the psyche at different stages of ontogenesis, the influence and interaction of society and the microsociium in the formation of a system of personality relations in health and disease. VN Myasishchev was the first in the USSR and Russia to discover that marital and family conflicts played a leading role in the origin of neuroses (in 80% of the examined patients with neuroses).

In the late 60s - early 70s. XX century created the most favorable conditions for the development of family psychotherapy in the USSR and Russia - both at the theoretical and methodological, and at the organizational and practical levels (Myager V.K., Zakharov A.I., Mishina T.M., Spivakovskaya A.S., Eidemiller E.G.). The development and evolution of family psychotherapy in Russia, its paradigms and methods are similar to the development of the family approach in the USA, Great Britain, Germany and other countries. At first, these were psychoanalytic, psychodynamically-oriented models of family psychotherapy, methods of directive counseling, then they were replaced by systemic and eclectic models.

At present, the "psychology of relationships" continues to develop in Russia and contributes to the development of the concept of personality-oriented (reconstructive) psychotherapy (Karvasarsky B.D., 1985), family psychotherapy, psychology of activity (Leontiev A.N., 1977; Leontiev D.A. ., 1994), the psychology of communication (Bodalev A.A., 1983). "Psychology of relations" was the starting point of psychotherapeutic research of personality in Poland (Leder S, 1990), Germany (Lauterbach V., 1995) and other countries.

Modern psychoanalysts note a significant similarity between the concept of V. N. Myasishchev and the concepts of 3. Freud, A. Freud, 3. Fawkes. But the strongest side of V.N.Myasishchev's teachings is the understanding of personality as an integral biopsychosocial structure, where social, psychological and biological components are closely interrelated, which necessitates an impact on all three components.

In family systemic psychotherapy, the family is viewed as an integral system, which, like all living systems, seeks both to preserve the existing connections between elements and to their evolution. Paraphrasing the provisions of classical thermodynamics and the systems approach, it can be argued that the family, as a living system, exchanges information and energy with the external environment (Prigozhiy I., 1991; Minuchin S., 1974; Minuchin S., Fishman H. C, 1981). In such a system, vibrations (both internal and external) help to acquire a new level of complexity and differentiation, usually accompanied by a reaction that returns the system to its stable state. When the fluctuations intensify, a crisis state may occur, the transformation of which will lead the system to a new level of functioning. As a result, the psychotherapist is faced with the task of joining the family, catching its vibrations, and then, together with the family, reinforce them in order to give an impulse to change and cause frustration with a therapeutic goal.

Throughout its existence, the family goes through regular "crises of development" (Caplan G., 1964, cited in: Semichev S. B., 1972): marriage, separation from parental families, wife's pregnancy, childbirth, child arrival in preschool and school institutions, adolescence in a child's life, graduating from school and choosing "his own path", the child's break with his parents, their retirement, etc. It is during these periods of their existence that families are unable to solve new problems in the old ways and therefore are faced with the need to complicate their adaptive reactions.

Families perform their functions through certain mechanisms: the structure of family roles, family subsystems and the boundaries between them. The structure of family roles dictates that family members should do what, how, when, and in what sequence when entering into relationships with each other. Repetitive interactions establish certain standards ("interaction standards" according to Minukhin S, 1974), and the standards, in turn, determine with whom and how to interact. In normal families, the structure of family roles is holistic, dynamic and alternative in nature. If the needs of family members within the existing structure cannot be met, then efforts are made to find alternative options for fulfilling family roles. According to our data, in 66% of families of adolescents with borderline neuropsychiatric disorders, either the structure of rigidly fixed pathologizing family roles is noted, or the initial absence of structure as such. By pathologizing family roles, we mean those that, due to their structure and content, have a traumatic effect on family members (Eidemiller E.G., Yustitsky V.V., 1990).

Family subsystems ("holons") (Minuchin S., Fishman C, 1981) are a more differentiated set of family roles, which allows you to selectively perform certain family functions, to ensure the life of the family. One of the family members can be a member of several subsystems - parental, marital, child, male, female, etc. Simultaneous functioning in several subsystems is usually ineffective. When a mother scolds her son for a bad grade at school, and at the same time remarks: “This is because your father is a rogue, he does not want to show what a real man”, She unconsciously begins to function in two subsystems at once - parental and marital. This behavior leads to the fact that neither the son nor the husband does not accept criticism, but take measures, sometimes together, to protect themselves from it.

The boundaries between subsystems are the rules that govern who performs family functions and how. In normal families, they are clearly delineated and permeable. In the families we examined, either rigid or blurred boundaries between subsystems were observed. In cases of rigid boundaries, communication between subsystems is sharply limited, there is no information exchange. With blurred boundaries, the stresses experienced in some subsystems easily spread to others.

The main principles of the Milan Institute for Family Studies, founded in 1967 by Mara Selvini-Palazzoli, are:

1) putting forward therapeutic hypotheses;

2) the principle of circularity;

3) neutrality;

4) a positive interpretation of the symptoms or problems of the client and his family (Selvini-Palazzoli M. et al., 1978).

Before the first family session, psychotherapists who are part of the therapeutic team, after listening to family members, put forward a number of hypotheses about the paradoxical nature of relationships in the family, leading to the formation of symptoms of the disease in one of its members (in our understanding, this is “family dysfunction”) (Eidemiller E. G ., Justitsky V.V., 1990).

Circularity is understood both in the etiopathogenetic sense (see “principles of circular causality” by Mario Andolfi, 1980), and in the practical sense, when participants in psychotherapy are interviewed in a circle. If a participant, for example, says: “When my mother frowns, my mood falls,” the therapist asks other family members: “How do you feel when the mother frowns? And you yourself, mom? "

The therapist maintains an accepting, neutral attitude towards all family members.

Finally, the patient's symptomatology is considered as a way of adaptation, so the task of psychotherapy is to find other ways of adaptation for the patient.

Based on these principles, it is possible to formulate the main steps of family systemic psychotherapy (Eidemiller E.G., 1994):

I. Uniting the therapist with the family, joining him in the role structure presented by the family.

1. Establishing constructive distance - free disposition of family members.

2. Attachment through breath synchronization to the family member who is reporting problems.

3. Techniques of "mimesis" (Minuchin S., 1974) - direct and indirect reflection of postures, facial expressions and gestures of participants in psychotherapy.

4. Joining by prosodic characteristics of speech to the applicant of the problem, identified by the patient (speed, volume, intonation of speech).

5. The use by the psychotherapist in his speech of predicates that reflect the dominant representational system of the applicant of the problem and other family members.

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3.6 FAMILY PSYCHOTHERAPY

the author Eidemiller Edmond

Family Communicative Psychotherapy Within the framework of the systematic approach, family communicative psychotherapy is distinguished, which grew out of the Palo Alto school. The leading figures are G. Bateson, D. Haley, D. Jackson and P. Vaclavik. According to M. Nichols (Nickols M., 1984), communicative

From the book Psychology and psychotherapy of the family the author Eidemiller Edmond

Family psychotherapy constructs

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Family Behavioral Psychotherapy The theoretical background of family behavioral therapy is contained in the works of BF Skinner, A. Bandura, D. Rotter and D. Kelly. Since this direction in the domestic literature is described in sufficient detail (Kjell L., Ziegler

From the book Psychology and psychotherapy of the family the author Eidemiller Edmond

Family psychotherapy for schizophrenia Sullivan offered his own approach, different from the approach of traditional psychoanalysis, to understanding the nature of mental illness - "interpersonal" (Sullivan H. S., 1946, 1953, 1956). In his opinion, schizophrenia in children is

From the book Psychology and psychotherapy of the family the author Eidemiller Edmond

Family psychotherapy for addictions According to A. Yu. Egorov, addictive disorders, which include chemical, non-chemical and food forms of addiction, are characterized by six main features (Egorov A. Yu., 2007): 1) addiction with overvalued

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The main theoretical provisions 1. Each organism strives to achieve a state of full functioning, which means the addition (or completion) of the internal organization. Gestalt psychologists have shown that a person, in the process of perceiving the external world, does not

the author Team of authors

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Family psychotherapy with spouses Family psychotherapy with spouses is the main configuration of family psychotherapy. In his article "Merging and Differentiation in Marriage," Phil Klever (Klever, 1998) proposes the following strategy based on Family Systems Theory

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Systemic family psychotherapy considers the family as an independent organism with its own history, values ​​and laws of development. The therapist is sufficiently involved in the therapy process, he observes or acts as a trainer. Along the way, he asks questions, controls, can create an artificial conflict or any other situation. The systems direction is currently the leading one in family psychology.

Older directions considered one person as an object of psychological influence, while the systemic one takes the family and its entire system as such an object. Such a theory arose not from any previously existing psychological knowledge, but from cybernetics. Cybernetics has a general systems theory. It says that the whole is greater than the sum of its parts. All parts and processes of the whole mutually condition each other.

The family system is a group of people with a common place of residence, connected by certain relationships. It is argued that the actions of family members are subject to the laws and regulations of the entire family system. Something doesn't always happen because of the wishes of family members. The family system constantly communicates with the environment.

Goals and methods of systemic family psychotherapy

The psychotherapist allows everyone to speak and provides comfort for the rest. Together with his family, he is looking for an opportunity to change the functioning of the family system for the better. At the same time, there is no task to change the individuals included in the system. Systemic family psychology has several currents, some of which do not require the presence of all family members at a psychotherapeutic session. They work with those of them whose problems and behavior became the reason for the whole family to turn to a psychotherapist. Through it, the negative aspects of intra-family communications are eliminated.

Any pathology of the psyche is regarded as a manifestation of inadequate relationships within the family. Families have their own rules, myths, patterns of behavior. It is their specificity that can provoke mental illness in family members. In childhood, a child accumulates negative patterns of behavior observed in adults. Subsequently, he begins to unconsciously reproduce them in adulthood.

Therapy techniques: circular interview. One family member is asked how the other two relate to each other. Sometimes the therapist uses supervision by placing colleagues behind the one-way mirror. Colleagues observe the process and share their thoughts. Also, the therapist uses such a technique as a positive redefinition of the problem with which the family came. The point is not to diminish the difficulties, but to present them as friends who will help you find a way out of the situation.