Psychotherapy

Psychotherapy - the systematic mental impact on the consciousness of the patient for therapeutic purposes or to ease his suffering. Psychotherapy exist as long as there is a cure, since the treatment, the doctor is always providing the patient is different, positive or negative psychological impact. Most important instrument of psychotherapy is "the word", aimed at explanation, persuasion, suggestion. Important for psychotherapy and has all the behavior of the health worker, because of its inherent to certain features of character and style, tone of voice, facial expressions and gestures, together with the word" form the understanding between the patient and the health worker, without which successful treatment of the patient is often unthinkable. The way of establishing the correct understanding between those who heals, and those who are in need, it is extremely diverse and give here the recipe is on all occasions is impossible. Learn and master the skill of the approach to the patient can, "if the doctor (medical worker) will be sufficient thoughtfulness, attention and interested goodwill treat the patient, if he is truthful and as simple as possible in the treatment of patients; hypocrisy, sugary, the more direct the wrong patient, especially mentally ill, will never forget and forgive - in the latter case, the doctor for a long time, if not forever, will lose any prestige in the eyes of the patient" (P. B. Gannushkin).
An important aspect in gaining the confidence and the location of the patient is great patience, the ability not only to say the patient needs, but also the ability to remain silent and listen. These comments relate mainly elementary psychotherapy, but they are necessary and psychotherapy systematic. The latter may be carried out only by a doctor.
There are the following types of psychotherapy:
1) the calming, soothing emotional response to the disease;
2) corrective, which task is to develop a correct attitude of the patient to his illness; 3) stimulating aimed at increasing social activity of a person, to urge the patient carefully to perform therapeutic regime.
There are two main methods of psychotherapy: hypnotherapy (see Hypnosis and psychotherapy in the waking state. The latter is addressed to the individual patient, who is in clear conscience. In this case, the most common are rational and emotional therapy. When rational psychotherapy doctor appeals to reason and logic patient with explanations and subsequent convictions. The patient perceives the thought of the doctor actively, i.e. producing the relation to her. In the basis of emotional psychotherapy, in addition to the explanation and persuasion, of great importance is the ability of a doctor to win the trust. Finally, psychotherapy awake the doctor may carry out, using the suggestion, i.e., mental effect on the patient, in which the necessary representation is made by the doctor in the consciousness of the subject passively, without any criticism from the side of the patient. Usually in practice, the doctor uses all these three ways, although the share of each of them can be very different. In psychiatry systematic psychotherapy is used primarily in the treatment of neuroses, of psychopathy and some reactive state, and in cases of psychoses, in particular with schizophrenia, systematic psychotherapy applicable only upon the occurrence of remission.

Psychotherapy (from the Greek. psyche - soul, spirit, consciousness, and therapeia - treatment) - the systematic use of mental effects for the treatment of the patient.
All kinds of mental impact on the patient, if they are used by the doctor carefully, methodically, in accordance with the form of the disease, taking into account peculiarities of the personality of the patient can be in the Arsenal of psychotherapy. Psychotherapeutic importance such elements everyday practice doctor how statements (in an interview with the patient or in his presence with colleagues about his condition, diagnosis, prognosis, and so on Awarding a prescription should accompany encouraging explanations. Ultimately, all the behavior of a doctor can and should be psihoterapevticheskie tight if the doctor remembers that it is necessary to give the patient courage, hope for recovery. Social events such as the organization favorable for the patient environment, including changes in the external environment, change of profession or occupation, if necessary, streamlining activities, distracting activities, creation of comfortable environment in the hospital, sanatorium, etc., often also referred to as psychotherapy, making this term broad interpretation. But in medical practice the concept of psychotherapy is usually used in a narrow sense, as a set of precisely medical visits therapeutic effects on the psyche of a patient. Theoretical substantiation and practical development of the most effective methods of psychotherapy is the task of the scientific psychiatry.
The purpose of the following types of psychotherapy: 1) sedative, aiming to reassure the patient, reduce pain, to alleviate the emotional response to the disease; 2) corrective, whose main task is to develop a correct attitude towards the disease, to weaken traumatic importance of etiological factors; 3) stimulating aimed at mobilizing compensatory protective forces of the body, increasing the social activity of a person (in particular, encourage the patient carefully to perform therapeutic mode); 4) psychotherapy aimed at eliminating pathologic stereotype, causing long-lasting hold symptoms.
In the basis of psychotherapy is the influence of the word, which the patient may be in a hypnotic, and in the waking state. Here are two completely method I].: hypnotherapy and psychotherapy in the waking state. The last known in several variants: distraction therapy, psychotherapy by teaching the patient to self-hypnosis; analytical, collective and other
Hypnotherapy - see Hypnosis.


Psychotherapy in the waking state is addressed to the individual patient, who is in clear conscience. This causes the complexity of the methods of influence on the psyche of a patient. The differences of these methods depend on what the person meant to send a psychotherapeutic effect mainly.
In the history of psychotherapy evolved in different directions. Rational psychotherapy Dubois (P. Dubois, 1905) aims appeal to the mind of the patient, logical reasoning beliefs. Emotional therapy Tejerina (J. Dejerlne, 1911) affects mainly the feelings of the patient. Psihologica of Kronfeld (A. Kronfeld, 1925) is a therapeutic rehabilitation. Psychotropedia Century A. Gilyarovskogo is a strict system of measures aimed at distraction of patients from focusing on the disease. Activating psychotherapy, proposed by S. I. by Kanstoroom, includes mandatory introduction to the work of patients suffering from neurosis. Individual therapy Leongard (K. Leonhard) is seeking adjustment of installations of personality by regular exercise program.
The main tasks of psychotherapy in the waking state, implemented in everyday practice by systematic interviews with patients, constitute together a certain treatment course. Schematically the content of psychotherapeutic conversations can be classified in several provisions. You must inform the patient with the nature of the disease, to convince him of the possibility of cure. While suffering from neurosis is a need to stimulate overcoming anxiety and doubtful depressive hypochondriac or revaluation of the gravity of the suffering; with somatic diseases - corrigiruet reactive layers, aggravating the severity of the disease. Discussions with patients in their living conditions should be aimed primarily at the clarification of the factors leading to the emergence of the disease and preventing healing. In psychogenic disorders is a need for detailed reporting and combating occurred traumatic experiences, the disclosure of conditions hindering recovery. Attention patient needs to attract the symptoms improve, at least briefly, to justify their positive value, to divert the attention of the patient, concentrated on the disease, to the "flashes", "Lumina", which testify to the upcoming improvement. Another important task of motivating the patient for a thorough fulfillment of treatment, medical prescriptions. With nervousness, besides, it is necessary active learning patient-specific techniques of systematic counteraction disease symptoms (teaching-suggestion, techniques autogenic training, targeted activities in opposition to the existing fears and concerns). Dosed, active, causing a sense of fulfilment labour activity is the most important medicinal factor.
The specific content of medical conversations is determined by the nature of the disease and the characteristics of the intended therapeutic regime. More fully described scheme can be provided in exchange application psychotherapy various neuroses. In the beginning of the course prevail sedative effect, in the second half of the course the doctor increasing emphasis is doing to trigger corrective guidance. Practice has shown the effectiveness of systematic psychotherapy in the clinic of internal diseases in the presence of neurotic layers, giving the atypical nature of the basic disease, illness in the system neuroses with prevalence of disorders of the cardiovascular system, gastrointestinal tract, and other systems. Useful psychotherapy also in the cases of neurotic commit somatic symptoms suffering at a time when the basic physical illness that caused the initial appearance of these symptoms are already eliminated. Effective psychotherapy, including hypnotherapy, diseases of internal organs, the pathogenesis of which a significant role is played by neurogenic factors (initial form of hypertension, angina, asthma, gipertireoze moderate severity). Causalgia, phantom pain also removed or mitigated by psychotherapy. The important place belongs psychotherapy for chronic diseases requiring long-term co-host of the same type of patients (for example, tuberculosis sanatoriums, hospitals for patients with lesions of the supporting apparatus). Psychotherapeutic influence in these cases, reduce the mutual induction patients generating skeptical attitude to the methods of treatment, lack of faith in healing. Especially valuable systematic psychotherapy in the period resort and Spa treatment: using all natural and physical factors of impact on the patient, the doctor in a conversation with the patient emphasizes their importance and thus increases their efficiency dramatically. Systematic medical interviews and sedative hypnotherapy in surgical clinic reduce fear of operation and improve the course as a pre-and postoperative period.
Soviet psychotherapy is based on a materialistic explanation of the essence of psychotherapeutic influence, which is derived from the teachings of I. P. Pavlov about the higher nervous activity (see). The principle of unity of mental and physiological makes legitimate and natural therapeutic use of mental influence, representing a complex of adequate stimuli second signal system. On the basis of materialistic understanding of the essence of psychotherapeutic influence, the Soviet psychotherapists important goal of their research is considered the refinement of the physiological mechanisms determining the effectiveness of such psychotherapeutic techniques like hypnosis or suggestion in the waking state. The principle of collectivism, which forms an integral property of the worldview of the Soviet people, the recognition of the primacy of the social life of man made in the Soviet psychotherapy fundamentally new thesis and social activation of the patient.
In the light of the materialist conception of psychotherapy Soviet psychotherapists have justified the legitimacy of wide use of psychotherapy in the clinic of internal diseases on the basis of established school of I. P. Pavlov laws kortiko-visceral relations.
In the Soviet psychotherapy is developing a common system of the directions of psychotherapy, in which the developed methods and techniques of mutually harmonically complement each other depending on the requirements of the clinic and no place characteristic for foreign psychotherapy constant struggle of different schools.
Distracting psychotherapy (C. M. Bekhterev). The patient is invited to take a comfortable position, close your eyes and listen carefully to the words of the doctor. The doctor assures the patient, instill in him should not focus on the symptoms of the disease, advises to escape from painful thoughts about it, to develop the installation of combating disease, actively perform therapeutic purpose, to search for new goals in life instead of some old, the implementation of which it becomes difficult to implement in connection with the disease.
Elaboration of the patient motivated self-suggestion. To a special kind of suggestive psychotherapy is the use of auto-suggestion with the medical purpose. Elementary methods of auto-suggestion applied to patients for medical advice, is that it focuses on some complex language and mentally repeating them.
Such so-called formula of encouragement should ensure the effectiveness of those units and ideas that the patient took from conversations with your doctor. Focus formula encouragement is determined by the nature of the symptoms. The patient may be advisable to include in the formula of encouragement imperative cancellation disturbing symptom. It is better to start not from all the symptoms that make up the picture of the disease, and E. single most troublesome symptom. Using a repeated phrase (for example, "I Have no more fear of heart; I know that this is just a nervous expression, so that the more I shall not be afraid") can to some extent to fix cardiophobia. In the formula of encouragement are often introduced in the memories of the events connected with well-being, for example, before going to bed patient suffering from insomnia, recalls the details of hypnosis, which made him feel good and deep sleep. Through auto-suggestion is switching from thoughts associated with the disease, the thoughts that generate positive emotional experiences. This technique is especially effective with paroxysmal manifested symptoms, e.g. if you have obsessive thoughts or at the beginning of the attack, cardiac arrhythmia.
Analytical psychotherapy. Psychoanalysis has as sources method of catharsis (purification), which is based on observations Breuer (J. Breuer) and Freud (S. Freud, 1893), establishing the fact of liquidation of hysterical symptoms after evoke memories of the past during hypnosis, and observations Vogt (O. Vogt, 1894-1895), demonstrated the possibility of realization of patients in the subsequent suggestions, data in hypnosis. The main technique typical of catharsis was to evoke patient hypnoides state order, weaken "censorship" of consciousness, again to reproduce in detail and with the
same brightness traumatic experiences. According to the authors, it provides the emergence of the state when the patient stands face to face with the content of the experience, i.e. release a "disadvantaged affect", causing a "cleansing" from pathogenic experiences.
Creating psychokinesis was the impetus for the development of the concept of the unconscious, put Freud the basis of psychoanalysis. Unconscious, according to Freud,is an active instance of the psyche. Arguing that the human mind has different levels, Freud postulated unconscious as the main, the most powerful lower court psychic, which had concentrated in itself the trend instincts, and absorbing all that is displaced from sphere of the consciousness: in particular, unacceptable for consciousness memories, desires, impulses. Consciousness, according to Freud,is the reception centre internal and external excitations, this is only the area of orientation that currently surrounds the man and affects him. The unconscious is subordinated to the "pleasure principle"and consciousness "principle to reality", i.e. those restrictions instinctive, given human civilization and culture; hence the constant conflict between the unconscious and the conscious with the dominance of the unconscious.
Overly overestimating the value of the unconscious, Freud argued that the basis of neuroses is the displacement unacceptable for "censorship" of consciousness views dictated by the trends of the unconscious. They still break through in encrypted symbolic form, which forms the neurotic symptoms of the disease. Therefore, as the main method of treatment of neuroses Freud puts psychoanalysis, which aims to reveal the symbols of the unconscious, to bring the extruded material, bringing it to a conscious decision that, according to the analysts, leads to the elimination of symptoms. Postulirovana based purely speculative conclusions all of the above provisions, Freud as practices used the method of free Association and dream interpretation. In time psychoanalytic session, the patient is invited to Express aloud everything that comes into his head. Psychoanalyst, using dogmatically compiled by Freud classification symbols representing one or another trend unconscious, "explains the" patient "hidden meaning" displaced associations. In essence he instills a patient his interpretation of its associations, claiming that they allegedly reveals that was ousted in the unconscious.
At fair expression of the progressive American philosopher G. wells, theoretical concepts Freud taken "with a side ways intellectual history of mankind". They are speculative, as speculative against excessive biologization of psychic phenomena, as completely ignored in social person, and idealistic interpretation of the essence of mental considered as a special energy, subordinate only to their own laws. Psychoanalysis as a method of psychotherapy does not represent any advantages in comparison with other methods. If psychoanalysts sometimes and have effect with nervousness, it is not due to some special features of the psychoanalysis, as a long time (sometimes years) contact a doctor with the patient.
Dogmatic build Freud and various of his followers, implemented in the method of psychoanalysis, the deeply alien to the fundamental theory and practice of Soviet psychotherapy. Soviet psychotherapy understands the analytical method thorough analysis of the external environment, embodying as social factors directly affecting the psyche, and the factors that change the somatic state of the patient.
Based on the understanding of a personality as product of socio-historical conditions that form the attitudes, beliefs, needs and patterns, V. N. Myasishchev as an essential task of psychotherapy of neurosis put holding psychogenetic analysis, i.e. a thorough clarification of the sources of origin of neurotic States, so that on the basis of the detailed study of the history of life of the patient to change his life reactions, restructuring incorrectly formed his relationship to the different sides of reality.
The analytic method proposed by the Soviet psychotherapists, in particular psychogenetic analysis is to examine the history and environment of the patient environment with discussion with the patient developed his system of relations with the surrounding world. The purpose of the discussion is to reveal the sources of origin of neurotic condition, corrigiruet incorrect installation of the patient and to create favorable for Pego conditions of life, to help him to overcome the disease. Corresponding to this direction of the analytical techniques of psychotherapy make a useful contribution to the Soviet system of psychotherapy, although its scope is limited to the treatment of neuroses and testimony to her greatly already in comparison with other methods of psychotherapy.