Contents
Without a common approach to psychological counseling, we will always work in fragments, based on our usual vision and using our favorite “chips”. The community of counseling psychologists is faced with the task of summarizing experience, developing a common theoretical and methodological base, and integrating various approaches and areas of psychological counseling. We are far from taking the liberty of teaching our fellow psychologists how to work, our task is more modest: we want to share the experience of our training students at the University of Practical Psychology. We hope that this will excuse those points in our presentation that seem too simple, obvious and well-known to everyone: what is the ABC for an experienced professional is sometimes difficult news for a novice consultant.
Let me start with a quote from the collection «Psychotherapy — what is it?»
“…Let’s think about John: he’s in pain every time he turns his head. Trying to get rid of suffering, he can turn to a number of specialists, but he will start with the one about whom, on the basis of his experience and his ideas, he thinks that he will help him better than others.
And what? John will surely find that each specialist’s point of view and the measures proposed by this specialist will be most closely related to the education and life experience of this specialist. So, for example, John’s family doctor is likely to diagnose «increased muscle tone» and prescribe him drugs that relax the muscles. The Spiritualist, in turn, will identify John’s «disturbance of spiritual harmony» and offer him prayers and healing by the laying on of hands. The psychotherapist, on the other hand, will take an interest in who “sat on John’s neck,” and advise you to undergo psychological training, which teaches the ability to stand up for oneself. The chiropractor can detect a misalignment of John’s cervical vertebrae and begin to straighten the appropriate section of the spine, doing what chiropractic calls «manipulation.» A naturopath will diagnose an energy imbalance and suggest acupuncture. Well, John’s neighbor, a bedroom furniture dealer, will most likely say that the springs of the mattress on which our hero sleeps have worn out, and advise him to buy a new mattress … ”(Psychotherapy — what is it? Modern ideas / Ed. J.K. Zeig and V. M. Munion / Translated from English by L. S. Kaganov. — M .: Independent firm «Class», 2000. — 432 pp. — (Library of Psychology and Psychotherapy, issue 80)).
It is hardly worth arguing here which of them is right. I think it is more important for us to agree that all these reasons can, in principle, take place, and it makes sense to at least think through all these options. Do we always do this in our psychological work?
The need for an integrated approach
Schools of psychological counseling differ in many respects in what the psychologist prefers to work with: with the unconscious in psychoanalysis, with the body in gestalt, with behavior in the behavioral approach, with beliefs in the cognitive approach, with images (figuratively represented problems) in the narrative or process approach. .
Do you need to limit yourself? No.
In the East, when one of the sultan’s wives fell ill, the doctor could only see the patient’s hand. Yes, only by listening to the pulse, the miracle of the doctor could sometimes help the patient, but is such an art of the doctor needed today, if instead of it you can conduct a comprehensive examination of the patient and her own complex treatment.
Instead of isolated ad hoc approaches, an integrated approach is needed. The therapist, the psychologist-consultant should not have one approach (one tool), but a lot of different tools.
Comprehensive diagnostic skills
Possessing a variety of tools, the psychologist must understand what a particular client needs in this case.
Work with emotions? Suggest a job with the body? Work with beliefs? Or maybe more relevant work with behavior? Working with images? Dealing with a troubled past? Work with life meanings? Something else?
This or that direction of work of a psychologist-consultant is determined by the request of the client, but not only by him. Firstly, often the client’s request as such is absent, vague complaints are voiced, and secondly, the girl herself may not understand the essence of her problem and, in fact, tell the consultant what her mother or girlfriend told her about his problems.
After listening to the client’s request, the task of the consultant is to look at all the possible causes of the problems, and for this he must have such a list.
Like a doctor: if a client complains about skin problems, you need to do a lot of tests in a variety of ways, but very well known to the doctor. Doctors have such lists that you need to check — the same lists should be with psychologists-consultants.
Procedure for defining a real problem
If a patient at the doctor complains of abdominal pain, the doctor may have many assumptions: it may be an unusual diet for him, but appendicitis, and cancer, and problems with the gallbladder and liver. Maybe this client simply ate too much, or maybe he has yersiniosis or something else extremely rare. So that doctors are not in a hurry to cut out appendicitis where the patient has elementary indigestion, they have recommendations on how to identify problems.
Still, they start with the definition of something elementary, typical, obvious, and only if the obvious is not obvious, simple assumptions do not work, you should look for something deeper. When this rule is violated, it is said to be unprofessional.
One of my clients complained: he went to a skin doctor, he superficially examined him and said that it was all from the nerves. Also has recommended to address concerning a psychosomatics to the psychotherapist. The client, however, turned to a more professional specialist, he did tests, prescribed simple pills to restore the intestinal flora, and everything went away in a week.
It is not necessary to look for the root causes of problems until more elementary assumptions are tested.
Returning to psychological work, we repeat this most important principle:
It is not professional to look for the underlying causes of psychological problems until more elementary assumptions have been verified.
Obvious, probable and underlying psychological problems
Psychological problems can be of any topic: about money and love, “I don’t know what I want” and “I don’t trust people”, but they are called internal if a person sees the root of the problem within himself, and not in someone or something external.
Working with internal problems of clients, it is recommended to follow the following order, the following sequence of work with problems:
- Obvious causes of problems are difficulties and problems that are visible to the naked eye and solved at the level of common sense. If a girl is lonely because she just sits at home and does not go anywhere, first of all, she should be advised to expand her social circle.
- Probable causes of problems — non-obvious, but probable causes of the client’s difficulties, which have signs observable for a specialist. The girl cannot establish a social circle, because she has a bazaar style of communication and pronounced resentment.
- Root causes of a problem are assumptions about the causes of a client’s problems that have no observable indications. The cause of the girl’s loneliness can be assumed to be her childhood psychological trauma, and problems in the family memory of her family, and the crown of celibacy, and the neighbor’s curse.
If the client states any obvious problem, you should work directly with it first.
If a guy does not know how to get acquainted on the street, the first steps should be elementary — ask if he wants to learn, and if so, advise how and where to do it better. If a person is afraid of flying on airplanes, it is probably worth working with his fear of flying in the first place, and not asking him about the events of his difficult childhood. Elementary desensitization can remove fears in half an hour, and if the issue is resolved, it is resolved.
Obvious causes of problems can often be solved in obvious ways, for an experienced consultant — at the level of common sense. Only if this was not enough, the consultant should move to the level of hidden causes of problems, starting with the most probable ones, and only if all possibilities have been exhausted, can one dive into deep problems.
According to the principle of simplicity, you should not produce additional problems. If something can be solved simply, it should be solved simply, if only because it is faster and more efficient, less costly in terms of time and effort. What is solved quickly is not fair to do for a long time.
If the client’s problem can be explained in a simple, practical way, there is no need to look for complex explanations ahead of time.
If the client’s problem can be tried behaviorally, you should not take the path of depth psychology ahead of time.
If the client’s problem can be solved by working with the present, you should not rush to work with the client’s past.
If the problem can be found in the client’s recent past, you should not dive into his past lives and ancestral memory.
It must be remembered that deep problems are an area of the unprovable, where full scope is opened for both creativity and charlatanism.
The psychologist or therapist who proposes in-depth work that has no scientific credibility must ask himself: What are the long-term consequences of such work, how will this type of psychotherapy respond? Believing in evil eye and bad omens? A habit of relying on luck? A tendency to shift responsibility onto your unconscious? And a little something — to refer to the ancestral memory, instead of thinking for yourself? It seems that this kind of ethical considerations and checking for environmental friendliness is mandatory for a professional psychologist.
Professional work is consistent and follows the principle of simplicity. Professionally, start with common sense, with the definition of something elementary, typical, obvious, and only if the solution at the level of common sense does not work, you should look for something more hidden and deep. When this problem-solving sequencing rule is violated, it is said to be unprofessional.
The “whatever works is good” approach can be short-sighted and therefore not environmentally friendly. If the husband is tired, the wife can bring him 200 grams after work. We know it will give an effect, it will work, it will definitely feel better for my husband. You can also help him the next day. What is the ambush here? We know that in the long run this man turns into an alcoholic. What gives a reliable effect now can turn into serious and extensive problems later. Fortune tellers and sorceresses work no less efficiently than fellow psychologists, but the passion for mysticism and esotericism, the habit of relying on higher powers, is fraught with a decrease in the general culture, infantilism and a habit of irresponsibility.
Systematization of probable problems
In our practical work, we use a specific list of typical probable psychological problems. This is the time to remember about the integrated approach to counseling, about the fact that a person is not only a mind, but also a body, not only a body, but also a soul, immediately recall the life meanings that organize our life, the meaning of life and the life of the spirit. We said that a therapist, a counseling psychologist, should not have one approach (one tool), but a lot of different tools. What tools implement this integrated approach?
Today we bring to your judgment the following list:
- Problem speakers
Vengefulness, struggle for power, the habit of attracting attention, fear of failure. Rudolf Dreikurs (Dreikurs, R. (1968) Psychology in the classroom) provided a wonderful tool that is strange to pass up.
- Problem body
Tension, clamps, negative anchors, general or specific underdevelopment (lack of training) of the body. We are based here not only on the works of Alexander Lowen (A. Lowen «Psychology of the body»), we have here many of our original developments.
- Problem thinking.
Lack of knowledge, positive, constructive and responsible. The tendency to think in terms of “problems”, to see mainly shortcomings, to engage in ascertaining and experience without constructiveness, to launch parasitic processes that waste energy in vain (pity, self-accusations, negativism, a tendency to criticism and revenge). Here, the development of very many people helps us: Alfred Adler, Fritz Perls, Werner Erhard, at the same time this is the main direction in the development of the Syntone approach.
- Problematic Beliefs
Negative or rigid limiting beliefs, problematic life scenarios, lack of motivating beliefs. This line was started by Aaron Beck (Aaron Beck, Arthur Freeman. “Cognitive Psychotherapy of Personality Disorders”), Albert Ellis (Albert Ellis. Humanistic Psychotherapy: A Rational-Emotional Approach / Translated from English — St. Petersburg: Owl Publishing House; M. : EKSMO-Press Publishing House, 2002. — 272 pp. (Series «Steps of Psychotherapy»)) and Eric Berne (Eric Berne. «Games People Play»), productively continued since then by many.
- Problem images
Problematic image of I, problematic image of a partner, problematic image of life strategies, problematic metaphor of life. This is at least a narrative and procedural approach, working with pictures and metaphors.
- Problematic lifestyle.
It seems to us that this point is underestimated by modern practical psychology. This is about a disorganized and unhealthy lifestyle, when a young man lives mostly at night, a businessman gets drunk, a young girl smokes, this is about a life of loneliness or a problematic environment.
Practice
If a client comes for a consultation, first of all we consider it obligatory to hear his request, if necessary, to help him formulate it. If possible, we are looking for opportunities to transfer the client from the position of the Victim to the position of the Author, then we can work not only with a passive suffering patient, but also cooperate with a completely active, thinking, responsible person. If the client’s request is solved directly, at the level of an obvious problem, that’s fine. If not, we have a hint, a list of possible hidden problems.
Treason
Suppose a woman decides what to do in a situation where her husband is cheating on her. After a simple analysis, it turns out that their family life has been twelve years old, they have two children, her husband loves her, she loves him too, betrayal was more of an accident. Having calmed down, she understands everything with her head — it’s not worth getting divorced in this situation, it would be more correct to remove insults and improve relations, but her soul hurts and she wants to punish her husband. This is where we get to the hidden issues.
See if there are problematic speakers here? Do you need to work with a problematic body? How constructive is the thinking of a woman, is it possible to rebuild it in a more positive and constructive way? Are there problematic and limiting beliefs that hinder constructive thinking? What about a woman’s self-esteem, how does she feel, is it possible and necessary to change her image of herself? And by the way, how many nights has she not slept — maybe she needs to sleep first?
Slouch
The girl stoops, although there are no medical reasons for this. The obvious reason is that the girl does not take care of herself. Probable — cowardly to be bright and the first. The consultant didn’t, instead the therapist went down the path of digging into the unlikely root causes: «it’s all about holding back and inhibiting your emotions» … ↑
Fear of communication
The fear of communication in an adequate person can be easily removed by a combination of the following methods: desensitization, the practice of non-standard actions and training in effective communication (there are a lot of training centers). But this needs to be done, this needs to be learned. If a person is not ready to study and practice, or it still doesn’t help (anything happens) — yes, then it’s adequate to address more hidden and deeper problems.
Summary
As you can see, in teaching students of the University, we try to avoid thoughtless compilation, unsystematic and unprincipled approach «everything that works is good.» The approach proposed here is aimed at the complex and systematic use of the available tools, at the use of the best practices in practical psychology. I would like to believe that these reflections and such an approach can be useful not only to students, but also to our esteemed colleagues.
References
- Dreikurs, R. (1968) Psychology in the classroom
- Beck Aaron, Arthur Freeman. Cognitive psychotherapy of personality disorders.
- Bern Eric. Games People Play.
- Veselago E.V. System constellations according to Bert Hellinger: history, philosophy, technology.
- Lowen Alexander «Psychology of the Body»
- Psychotherapy — what is it? Modern ideas / Ed. J.K. Zeiga and V.M. Munion / Per. from English. L.S. Kaganov. — M .: Independent firm «Class», 2000. — 432 p. — (Library of Psychology and Psychotherapy, issue 80).
- Ellis Albert. Humanistic psychotherapy: Rational-emotional approach / Per. from English. — St. Petersburg: Owl Publishing House; M .: Publishing House of EKSMO-Press, 2002. — 272 p. (Series «Steps of psychotherapy»).
Article in English: Experience of system integration of basic trends in psychological counseling