Integration psychotherapy. Integrative approach to psychotherapy

In the last two decades, there has been an increasing trend towards the integration of various methods of psychotherapy. In a review of The Integrative Movement in Psychotherapy (1989), B. D. Bateman, M. R. Goldfried, and J. S. Norcross are optimistic about the future of the integrative movement, which will become the “zeitgeist” of the next few decades for psychotherapy research and practice. The authors predict that unconfirmed theories about the psychotherapeutic process will give way to solid concepts that will include a variety of approaches. The great charismatic leader who proclaims the true path will have fewer and fewer adherents as psychotherapy becomes more and more pragmatic. New ideas will be welcomed as contributions, not as quantum outbursts into an unknown field of study. Trainees will be taught to recognize the value of each approach, as well as to recognize the inevitable influence of their own personalities on the psychotherapeutic process.

The importance of the integrative movement is evidenced, in particular, by the publication of the international “Journal of Integrative and Eclectic Psychotherapy.” The concepts “integrative” and “eclectic” combined in the title of the magazine complement each other. The use of the term "eclecticism" in psychotherapy is limited to the technical synthesis of clinical methods. “Technical eclecticism,” a term coined by A. Lazarus, uses procedures borrowed from various sources without necessarily agreeing with the theories that gave rise to them. The term "integration" has acquired a more theoretical meaning. "Integration" usually refers to the conceptual synthesis of different theoretical systems. "Eclecticism" is one of the components of the integration of psychotherapy; “Eclecticism” is atheoretical, but empirical in the pragmatic application of what already exists.

The integrative movement is not a fad of modern times, but a natural stage in the evolutionary development of psychotherapy. Many modern approaches can be considered as a higher stage in the evolution of psychotherapy - they contain previous ideas and concepts “in a filmed form”. Because of this, the integrative tendency of psychotherapy can be considered as an integral feature of its development, as in the recent past a spontaneous, and now a purposeful creative process based on the accumulated experience of predecessors. An excellent example in this regard is the Gestalt therapy of Frederick Perls, in which elements of psychoanalysis, psychodrama, body therapy and Zen Buddhism form a single alloy, illustrating the well-known position of Gestalt psychology that “the whole is not reduced to the sum of its constituent elements.” .

The main approaches to psychotherapy (psychodynamic, cognitive-behavioral and phenomenological) inherently contain the prerequisites for their integration into a single system, since the point of their application is a single object - the human personality, although each of them emphasizes its different aspects and problems, which determines the difference in methods of psychotherapy. Further, the idea of ​​integrating various psychotherapeutic techniques is inherent in the very essence of person-oriented systems of psychotherapy, since any psychotherapy focused on personal change, emphasizing, as a rule, one of the planes of personal functioning (cognitive, emotional, behavioral), cannot completely ignore others. Within a single psychotherapeutic approach, it is essential to use, depending on the specific tasks of each stage of treatment, certain techniques to influence the cognitive, emotional and behavioral stereotypes of the patient’s pathological response. Such techniques, developed in detail in the main psychotherapeutic areas, can successfully complement each other. In particular, at one stage of treatment, a psychodynamic approach is useful, expanding the patient’s sphere of knowledge (achieving insight); at another stage, a behavioral approach is useful, helping him develop new, more constructive and mature behavior. The integration of cognitive and behavioral therapy, the emergence of a new approach based on this merger - cognitive-behavioral - is an important milestone towards creating an integrative model of psychotherapy.

An important incentive for the integration of different approaches is the widespread introduction of group psychotherapy into practice. Group psychotherapy creates a unique therapeutic situation associated with the inclusion of the patient in real interaction with other people, which creates conditions for intense psychological impact on all planes of personal functioning. Group psychotherapy inevitably leads to the use of techniques designed to influence the cognitive, emotional and behavioral aspects of the personality, developed within the framework of various therapeutic approaches.

Other factors that contributed to the development of the integrative movement are: 1) the proliferation of numerous forms and methods of psychotherapy, making it difficult to choose, study and use them; 2) the inadequacy of any of the psychotherapeutic directions for all categories of patients; 3) the search for common basic processes characteristic of all forms of psychotherapy, and the gradual recognition of the fact that different methods, in fact, may have more similarities than differences; 4) approximately equal effectiveness of treatment regardless of the form of psychotherapy; 5) emphasis on the essential role of the psychotherapist-patient relationship in any form of psychotherapy; 6) socio-economic processes in society, which place increased demands on the quality, duration and effectiveness of treatment and have a more unifying effect than a separating effect on psychotherapists. The most important characteristic of the integrative movement in psychotherapy is that when choosing methods, the psychotherapist takes into account not so much his own theoretical positions, but rather the individual clinical and psychological characteristics of the personality and illness, as well as the needs of the patient.

In Russia, interest in integration problems is growing noticeably after the publication of a collection of scientific works by the Psychoneurological Institute named after. V. M. Bekhterev “Integrative aspects of modern psychotherapy” edited by B. D. Karvasarsky, V. A. Tashlykov, G. L. Isurina (1992), which for the first time considers the possibility of integrating the principles and methods of the main directions of foreign psychotherapy on the basis of domestic approach – pathogenetic psychotherapy by V. N. Myasishchev.

Myasishchev’s merit lies in the fact that he carried out a thorough “revision” of psychoanalysis, overcoming its biological orientation and creating a socio-psychological model of psychotherapy. Among those who sought to give psychoanalysis a more “cultural face,” Myasishchev was the most consistent and radical reformer: while retaining the concept of intrapsychic (psychodynamic) conflict, he discarded free interpretations of psychoanalysis based on mythology, replacing them with analysis real life relationships. Intrapsychic conflicts are described by Myasishchev not by content, as in Freud, but by structure. The psychotherapist’s task is to fill the intrapsychic conflict with content drawn from the patient’s specific life situation and analysis of his system of relationships. Concepts such as “psychological defense mechanisms”, “insight”, “emotional response” (“catharsis”), etc. were also borrowed from psychoanalysis. Thus, when developing pathogenetic psychotherapy, Myasishchev integrated into this system, the theoretical basis of which was the one he developed socio-psychological model of personality, famous achievements of psychotherapy of his time.

The current situation in psychotherapy is characterized by a conscious desire to integrate various methods of psychotherapy. Many psychotherapists, working within the framework of their chosen psychotherapeutic approach, borrow certain methods from other approaches, which is dictated by the desire to increase the effectiveness of psychotherapy. In this regard, there is a growing need to search for a unified integration platform, a theoretical and methodological basis for psychotherapy. From our point of view, this goal is best met by the model of person-oriented (reconstructive) psychotherapy. In the development of person-oriented (reconstructive) psychotherapy, three stages can be distinguished.

To understand the current state and trends of psychotherapy, it is necessary to trace its development over time.

The beginning of modern psychotherapy is considered to be the psychoanalysis of Sigmund Freud (late 19th - early 20th centuries). His undeniable merits are the recognition of the important role of the unconscious, the concept of neuroses as the results of unsatisfied and repressed needs from consciousness, the concept of defense mechanisms of the Ego (“I”), distorting the true causes of neuroses, etc. Psychoanalysis 3. Freud gave birth to psychodynamic direction, considering the problems of patients as a result of the dynamic interaction of consciousness and the unconscious and calling for consideration of current problems taking into account the dynamic development of the patient in the process of his entire ontogenesis (K. Jung, A. Adler, K. Horney, etc.).

In response to the spread of psychoanalysis in the United States, the science of behavior arises - behaviorism (J. Watson, B. Skinner, etc.), which, accusing psychoanalysis of being unscientific (lack of objectively measurable parameters), calls for dealing only with obvious behavioral manifestations. This was the strength of behaviorism, and its shortcomings were the refusal to study the actual psychological concepts: consciousness, feelings, thoughts. This gap was filled by cognitive, or more precisely, cognitive-behavioral, psychology and rational-emotional therapy (A. Beck, A. Ellis, etc.).

Subsequently, psychodynamic (psychoanalytical) approaches were enriched by the practical developments of Gestalt therapy by F. Perls, body-oriented therapy by W. Reich, psychodrama by J. Moreno, psychosynthesis by R. Assagioli, transactional analysis by E. Bern, etc.

Then humanistic psychology and psychotherapy appeared (K. Rogers, A. Maslow, etc.), which emphasized the creative potential of the client himself. Existential psychology and therapy focused attention on problems of spirituality and life meanings (J.-P. Sartre, W. Frankl, I. Yalom, R. May, etc.).

A. Lazarus and N. Pezeshkian proposed multimodal approaches, starting work with patients and clients not from theoretical paradigms, but from vital spheres of functioning.

In the West, Eastern methods of psychotherapy, mainly body-oriented and meditative, are becoming more and more widespread.

There is a clear trend towards the integration of schools and methods, which has resulted in eclectic And integrative psychotherapy.

Currently, more than 80% of American psychotherapists consider themselves eclectic, and at least half of them were previously psychoanalysts.

Usually, eclecticism is understood as a mixture of styles and therefore this term is often used disparagingly. However, in relation to psychotherapy, this term has defended the right to be taken seriously - the international “Journal of Integrative and Eclectic Psychotherapy” is now published, and there is an International Academy of Eclectic Psychotherapists.

Objectives of eclectic psychotherapy are determined taking into account the individual characteristics, problems and personality of each specific patient or client, as well as optimal suitability for certain therapeutic interventions. Methods of behavioral psychotherapy are increasingly combined with psychodynamic, cognitive and other techniques. A psychoanalyst, if necessary, can empathically interact with a patient contrary to traditional emotional neutrality, while a behavioral psychotherapist can attach importance to intrapsychic dynamics (for example, pay attention to the patient’s dreams), etc.

One of the reasons for the spread of eclectic psychotherapy is the dissatisfaction of practitioners with the one-sidedness and limitations of any one direction of psychotherapy, as well as the modern tendency towards short-term forms of psychotherapy, when, in the conditions of a supposedly single meeting, the psychotherapist uses a technique that is most suitable for a given patient.

For example, most introverts (with their penchant for self-examination) are closer to the psychoanalytic approach, while extroverts are closer to the behavioral one.

TO disadvantages of eclectic therapy include multiple changes in psychotherapeutic methods in the process of working with one patient, which often confuses both the client and the psychotherapist himself and creates a feeling of uncertainty.

One of the founders of eclectic psychotherapy is considered Frederick Thorne. He believed that therapy should be more “tied to the diagnosis, with clear formulation of indications and contraindications for the use of various methods” than to theoretical guidelines. Thorne argued that personal growth should be the goal of all approaches and that psychologists and psychotherapists should develop skills and theories that promote psychological health. He proposed a broad vision of psychological health that "depends on the extent to which a person has succeeded in actualizing his potential to learn to cope with all standard life situations, to live actively and creatively, and to perform well in a wide range of roles."

Let's consider different types and approaches of eclectic psychotherapy.

Functional eclectic psychotherapy provides a theoretical connection between behavioral, humanistic-existential and psychoanalytic approaches to therapy. J. Hart highlights seven aspects common to all representatives of functional eclecticism, which highlight differences from the classical psychoanalytic approach.

• 1. The clinician's focus is on the current moment (rather than early childhood memories), with particular emphasis on gaps in consciousness.
• 2. Feelings can be conscious (and not just unconscious) regulators of behavior; regulation is achieved through the purposeful expression of feelings, and not just insight (unexpected insight).
• 3. “I-concept” and associated “I-images” are always carefully (albeit critically) studied (while in psychoanalysis they are considered deliberately distorted and unreliable).
• 4. Voluntary (conscious) choices, plans of action, life philosophy and moral considerations are included in the scope of therapy.
• 5. Personal growth and health are given no less importance than psychopathology.
• 6. Conscious, subconscious and unconscious processes are considered, but in that order (i.e. priority is given to working with consciousness).
• 7. Preference is given to a pragmatic approach to therapy techniques and the use of a significant variety of techniques and strategies.

An eclectic approach distinguishes social skills training program (77. T pay er, B. Bryant And M. Argyll), which combines methods of psychodrama, social psychology, communication theory, linguistics, psychiatry, experimental and clinical psychology, as well as the concepts of cognitive behavioral therapy and environmental therapy. As a model, we take the image of a psychotherapist as a teacher, whose task is not only to diagnose, identify indications and treat deviations, but also to identify areas of dissatisfaction with life, set goals and teach skills. A similar eclectic social skills training program, more focused on working with healthy individuals, was described by F. Zimbardo. His program uses methods such as self-testing, personal journaling, relaxation, guided imagery, role-playing, and self-help groups to overcome excessive shyness.

Another type of eclectic approach based on the medical model is described by J. Everly And R. Rosenfeld. These authors propose a combination of multilevel analysis of the stress response, which includes biochemical, psychophysiological and psychological measures with a multimodal therapeutic approach, including instilling in the client a sense of self-responsibility, training in various relaxation techniques, dietary advice, pharmacological treatment, biofeedback techniques, hypnosis and exercise.

Integrative psychotherapy, unlike eclectic, provides a conceptual synthesis of different theoretical systems of psychotherapy and can be developed on the basis of the following approaches(Karvasarsky B.D., 1998):

• 1) the use of an eclectic model that combines various methods of psychotherapy, based on the needs of medical practice;
• 2) integration of relevant scientific disciplines - medicine, psychology, sociology, pedagogy, neurophysiology, philosophy, psycholinguistics, etc.;
• 3) synthesis of theoretical provisions of various psychotherapeutic orientations, taking into account the leading concept of personality and its development, psychopathology and symptom formation.

The following factors contributed to the development of the integrative movement in psychotherapy:

• 1) the spread of numerous forms and methods of psychotherapy, making it difficult to choose, as well as their study and application;
• 2) the inadequacy of any of the psychotherapeutic directions for all categories of patients;
• 3) the search for common basic processes characteristic of all forms of psychotherapy, and the gradual recognition of the fact that different methods in essence may have more similarities than differences;
• 4) approximately equal effectiveness of treatment regardless of the form of psychotherapy;
• 5) emphasis on the essential role of the psychotherapist-patient relationship in any form of psychotherapy;
• 6) socio-economic processes in society, placing increased demands on quality, reducing the duration and increasing the effectiveness of treatment.

Integrative therapy began to develop in the mid-1960s. German psychologist, theologian and philosopher Hilarion Petzold(Hilarion G. Petzold) along with his staff. According to Petzold, “integrative therapy associates the method with a conflict-centered depth approach, including exercises and testing of specific emotions.” It expands the principle of classical Gestalt therapy (“here-and-now”) and at the same time the time perspective, the horizons of the past and the future, while taking into account the time continuum, social and environmental space as a context. Petzold tried to combine the theory and practice of psychoanalysis, Gestalt therapy, psychodrama, body-oriented psychotherapy and cognitive behavioral psychotherapy in integrative therapy.

In 1967, Arnold Lazarus proposed concept of technical eclecticism, which prioritized empirical validity over theoretical validity. Efficiency was rated higher than the ability to provide an explanation or perform a synthesis.

Within a single psychotherapeutic approach, certain techniques began to be used to influence the cognitive, emotional and behavioral stereotypes of patients’ impaired responses, depending on the objectives of the treatment stage. Various complexes of methods developed in one or another psychotherapeutic direction complemented each other. In particular, at one stage of treatment, a psychodynamic approach is needed, expanding the scope of cognition (awareness of unconscious material), at another stage, a behavioral approach that helps the patient develop new, more constructive and mature behavior.

One of the general properties of the use of any form of psychotherapy is the presence of stages, or phases: establishing contact and active participation of the patient in the psychotherapeutic process; determination of the psychotherapeutic goal (symptoms, conflict, self-esteem, etc.); changing previous maladaptive ways of perceiving, experiencing and behaving; completion of the treatment course.

Attempts have long been made to synthesize psychoanalytic and behaviorist theories. However, everything was limited to reinterpreting behavioral techniques in psychodynamic formulations or paraphrasing the provisions of psychoanalytic theory within the framework of the concept of learning. We are talking about the development of psychotherapeutic approaches that combine psychodynamic and behavioral methods in the integrative therapy of patients (Murray M.E., 1976). In this case, the psychotherapist, when analyzing the formation of symptoms, takes into account both the intrapsychic dynamics and the patient’s current life situation and the circumstances that reinforce the manifestations of the disease.

Positive-learning approach as a synthesis of cognitive and behavioral directions in psychotherapy, on the one hand, it recognizes the importance of intrapersonal factors in adaptation, and on the other hand, it emphasizes the role of environmental variables that influence the phenomenology and functioning of the individual (Mahoney M.J., 1977). The essence of this new, integrative form of psychotherapy is based on the following premises:

• 1) the human body reacts not so much to surrounding circumstances as such, but to cognitive ideas about them;
• 2) these cognitive representations are functionally related to the processes and parameters of learning;
• 3) the majority of human knowledge is cognitively mediated;
• 4) thoughts, feelings and behaviors are causally interconnected.

These provisions also determine the main goals of psychotherapy: perception skills, motor (exercise) skills, associative skills. The patient is trained in fine perceptual discrimination between environmental influences and internal stimulation (thoughts, feelings, images, biochemical changes, etc.). The assimilation of this complex knowledge is complemented by training in the development and critical assessment of associations (in particular, beliefs, expectations). The patient is given the opportunity to see that thoughts and images can play an important role in the adaptation and phenomenology of the individual. Finally, the patient is usually offered training in executive skills that expand the choice of behavior in regulating external or internal influences.

A wide combination of different types of psychotherapy, primarily existential, is used in psychosiitis, the goal of which is the harmonization and integration into a single whole of all the qualities and functions of the individual. Neurolinguistic programming and the interdisciplinary integrative concept of psychotherapy provide the psychotherapist with a meta-model as a step-by-step strategy for psychotherapeutic behavior that expands the patient’s model of the world and creates conditions for the process of personality change. It is assumed that this meta-model can be used by a psychotherapist of any orientation and at a certain stage should be integrated into the treatment process with methods existing in already established types of psychotherapy.

Personality-oriented (reconstructive) psychotherapy B.D. Karvasarsky, G.L. Isurina, V. A. Tashlykova how an open psychotherapeutic system has expanded its capabilities in recent years through the integration of some theoretical principles and techniques of behavioral and humanistic psychotherapy (primarily client-centered psychotherapy and gestalt therapy). The formation of integrative personality-oriented (reconstructive) psychotherapy requires a synthesis of the conceptual foundations of the psychology of relationships, activity and communication of the individual, disorders of its development and reconstruction. On the basis of this integrative concept of psychotherapy, it is possible to include into this system the relevant and most effective treatment methods of other psychotherapeutic orientations.

Multimodal psychotherapy by A. Lazarus is the application of principles and techniques (based primarily on social, cognitive and experimental psychology, as well as clinical experience) “to reduce human suffering and increase the adaptability of life.” The tasks solved by this direction of psychotherapy can be characterized as educational, and the main attention is paid to intrapersonal functioning, processes and interpersonal interactions. Achieving lasting change requires a wide range of skills to cope with life's challenges. The individual must also have a self-perceived effectiveness of the Self.

The functioning of the client in the BASIC ID system is analyzed - an abbreviation made up of the first letters of words benaviors, affective reactions sensations, images, cognitions, interpersonal relationships, and d"i"ugs or biological factors(behavior, affective reactions, sensations, images, cognitive elements, interpersonal relationships and medications or other biological factors).

Since the main focus is on learning and developing skills to cope with difficult life situations, clarifying symbolic meanings or supposed repressed complexes, i.e. psychoanalytic approaches are given little time. Preference is given to techniques that have proven themselves in practice (for example, modeling, observational learning, social skills training, overwhelming exposure, desensitization, self-regulation methods, cognitive restructuring, relaxation methods), but in addition (Lazarus says) , “effective psychotherapy requires a reserve of clinical wisdom” that allows one to subtly shift the emphasis depending on the individual personality characteristics and conditions of the client. Sometimes all you need is psychological support. In other cases, the client also needs to eliminate certain deficits and should be given, for example, training to develop self-confidence. The point is to use a multimodal assessment to determine who or what will benefit the individual most. Most of the techniques used are borrowed from cognitive behavioral psychotherapy, since research shows that they are most effective for many disorders. But techniques from other areas are also widely used, for example, from Gestalt therapy, psychodrama, reality psychotherapy and transactional analysis. However, the psychotherapist using them does not necessarily have to accept the corresponding theoretical concepts. The ideal goal is to ensure clients have adequate "matching" responses, minimal affective distress, capacity for sensory pleasure and joy, positive self-image, rational beliefs, loving and rewarding interpersonal relationships, and adherence to healthy lifestyle habits (good nutrition, exercise and rest at well-structured times). The main goal is the client’s transition from self-doubt to the realized effectiveness of his own “I”.

Because multimodal psychotherapy recognizes that each person is unique and that psychotherapy must be tailored to the characteristics of each individual, the multimodal psychotherapist does not rely on any general theory. The Rogerian psychotherapist knows exactly what to do with any client: give him a large dose of warmth and empathy, while using a largely non-directive approach. But the first challenge facing a multimodal therapist is to create a plan that meets the client's goals. A multimodal psychotherapist must tailor his or her work style to suit the needs of different people.

The basic question we face is: how “directive” and how “supportive” should a therapist be? B.G. Howard, D.W. Nanes and P. Myers showed that four possible combinations (low directive/high supportive, low directive/low supportive, high directive/high supportive, high directive/low supportive) meet the needs of different clients, and also the changing needs of one client over time. The multimodal therapist must decide when and how to counter, nurture, admire, reinforce, ignore, or punish in response to a client's response.

The multimodal psychotherapist must decide what kind of psychotherapy will bring the greatest benefit to his client - individual, dyadic, triadic, family, group, or some combination of all these types.

In essence, the multimodal approach corresponds to a very high degree with the requirement put forward by Milton Erickson: “Each person is unique. Therefore, psychotherapy should be carried out in such a way as to meet the needs of this particular person, and not try to adapt the individual to the Procrustean bed of one or another hypothetical theory of human behavior.”

An analysis of publications on eclectic and integrative psychotherapy showed many approaches, the authors of which have different understandings of both eclecticism (selection of the best) and integration. Therefore, eclectic and integrative psychotherapy is not a new direction, but a general name for those who do not adhere to any one of the known directions.

Thus, some authors call an integrative approach, which covers all levels of consciousness, others - a combination of individual-personal, interpersonal and transpersonal approaches, others - a complex psychotherapeutic effect on the patient from the therapist, surrounding staff and the entire therapeutic atmosphere, this also includes psychosynthesis, multimodal therapy by A. Lazarus, NLP and much more. Almost any modern psychotherapy can be considered integrative, since a psychoanalyst often recommends behavioral techniques, and a behaviorist works with explanatory fictions (in fact, with Ego defense mechanisms), body-oriented therapy, Gestalt therapy, psychosynthesis and transactional analysis are based on psychoanalytic approaches to working with the unconscious. Therefore, there is a need to specify the names of schools and methods that classify themselves as eclectic and integrative psychotherapy.

Comprehensive scientific and practical direction holistic psychology and psychotherapy(A.N. Romanin, 1986) in turn also require clarification, since the term holistic (from English, wholesale- holistic) can be endowed with different meanings. It is necessary to clarify what and with what you consider holistically, combine and connect.

The holistic approach indicates the insufficient effectiveness of the isolated study and correction of individual biological, psychological and social problems, as well as the isolated application of certain areas of psychology and psychotherapy.

The holistic approach takes into account the mutual influence of the spheres of human activity: individual, family, professional and various levels of social life.

Schematically, the holistic approach can be represented as a matrix, where the main areas of psychological problems and therapeutic effects are listed in the left vertical column: problems of psychophysical health, family problems, professional and social problems, problems of creative self-realization and personal growth (these areas, in turn, are studied holistically, i.e. i.e. in their interaction and mutual influence). And along the top, horizontally, there is a list of directions and methods of psychological research and psychotherapeutic influence (which are also considered in their possible integrative relationship).

Let's consider the holistic interaction of the spheres.

Let's take, for example, a problem like alcoholism. We will designate it in the field of psychophysical health. But the threads from this point will stretch into the sphere of communication and into the sphere of creative self-realization. Moreover, in different cases these influences will be primary or secondary. That is, in some cases, drunkenness and alcoholism will be the root cause of family complications and creative self-realization. In other cases, the root cause of alcoholism will be family and professional problems. In the future, problems in these areas will aggravate each other. These same relationships should be used in psychocorrection, pulling one through the other.

The work of a holistic psychotherapist is conventionally divided into interconnected blocks: diagnosis and influence (correction and personal growth), which in turn go through the following stages:

• 1. Primary verbalization of the current problem by the client himself (further clarification together with the psychotherapist).
• 2. Determination of the main problem target area.
• 3. Identification of connections with other areas (mutual aggravation and “mutual withdrawal”).
• 4. Primary verbalization by the client himself of the reasons for the problem in this area and in others.
• 6. Multimodal diagnostics and analysis of physical, emotional and mental stress and conditions.

Let's take a closer look at each of these stages.

• 1. Primary verbalization. In most cases, the client's first presentation of his problem is not entirely accurate. However, in contrast to the classical psychoanalytic approach, we assume that the client can evaluate his problem with a significant degree of objectivity. To clarify the measure of this objectivity, we ask the client to make several attempts to formulate his problem more and more clearly. However, unlike the classic Rogerian approach, we not only listen to him empathetically, but can, if necessary, ask clarifying questions that stimulate his self-disclosure. Such clarification may take from one to several sessions.
• 2. Identification of the target problem area. Together with the client (or rather, the client with the help of a psychotherapist), the main area of ​​the current problem is localized: psychophysical health, communication, self-realization (activity). It may turn out that the problem will be equally expressed in two or even all three areas.
• 3. Identifying connections with other areas. A problem defined in terms of one of the listed areas will necessarily have a certain impact on other areas, and will also be negatively or positively influenced by these areas. These relationships are clarified, brought to the client’s consciousness and verbalized by him with the help of the therapist.
• 4. Primary verbalization of the causes of the problem. The client talks about the root causes of the current problem, expressing his opinion. These statements (formulations) are also clarified as much as possible. At the same time, the following are holistically combined: humanistic listening (but with possible clarifying intervention), a psychoanalytic-cognitive approach with determining the degree of objectivity of the client’s vision of the causes of the problem (but with a certain trust in his opinion), a behavioral approach (the problem is considered as a reaction to a stimulus, which in its turn the turn was a reaction to the previous stimulus, etc. until the root cause). An existential analysis of the client’s life meanings and values ​​as possible direct or indirect causes of the problem may be added.
• 5. Clarification of the reasons using psychodynamic, behavioral, humanistic, cognitive, existential approaches.
• 6. A multimodal approach allows us to outline ways to block the negative mutual influence of different spheres of life (psychophysical health, communication and self-realization) and the possibility of positive, targeted mutual influence of these spheres. Specific programs of activity are outlined in each area and in their holistic interaction.

Initially, a holistic psychologist and psychotherapist adopts a humanistic client-centered attitude, which includes:

• ? equal partnership cooperation with the client;
• ? faith in the client’s resource capabilities to independently solve the problem;
• ? the ability to instill this faith in the client himself;
• ? empathic listening;
• ? the ability to guide the client to an independent solution to the problem.

The holistic approach allows for some departures from the traditional humanistic approach. In particular, it allows, if necessary, more active intervention by the psychotherapist: leading questions and even recommendations, but not of an authoritarian, but of a deliberative nature, which should ultimately initiate the client’s own activity in solving his problem. Positive reinforcement (encouragement) of the client’s correct thoughts and actions is allowed (these are already elements of behavioral therapy).

When identifying a problem, clarifying its place in a specific area (psychophysical health, communication or creative self-realization), when analyzing its root cause and interaction with problems in other areas, psychoanalytic “benevolent distrust” is used, i.e. the desire to clarify and correct the client’s correct vision of his problem, its true causes and relationships with other problems. An attempt is made to identify and take into account the distorting influence of psychological defense mechanisms of the Ego.

In this case, a behavioral approach is simultaneously applied, considering the problem as a reaction to a certain stimulus, which in turn turned out to be a reaction to a previous stimulus, etc. along the entire chain of “stimulus-reactions” to a significant root cause. We emphasize the word “significant”, since in a holistic approach we can allow ourselves not to go unnecessarily to the earliest causes, but only to the moment from which they began their active influence on the formation of the current situation. Here the behavioral approach is holistically combined with the psychoanalytic one, since the root causes of the cause may be unconscious (distorted by defense mechanisms) and will need to be brought to the level of consciousness, including catharsis and insight.

At the same time, cognitive and emotional-rational approaches are used in diagnosis, i.e. analysis of the client’s thoughts, beliefs and emotions for their rationality, positivity and sanogenicity. The cognitive approach can cooperate with the existential one in order to diagnose life meanings and values.

Psychoanalytic influence goes in parallel with psychodiagnostics, since, according to 3. Freud, finding out and bringing to the patient’s consciousness the true cause of his suffering frees him. It does not make you absolutely happy (which is impossible), but it frees you from neurotic self-deception and allows you to gain mental health. However, with a holistic approach, we have the right not to limit ourselves to finding out the cause of suffering, but to help the patient learn to live and act in the real world. Here exercises from psychosynthesis by R. Assagioli and behavioral teaching of appropriate behavioral techniques can be added.

The psychoanalytic approach is combined with the humanistic one if the reason repressed from consciousness is considered as a blockage or distortion of the path of personal growth, and the therapist’s task is to eliminate this blockage and encourage the disclosure of the internal reserves of the individual. However, we believe that such an approach should not exclude elements of teaching behavioral techniques.

Lazarus believed that many of the successes of psychoanalysis are due to the behavioral techniques that patients are encouraged to master. A holistic approach allows you to avoid such discussions, and simply combine in a holistic approach to the patient the focus on self-realization inherent in nature with the psychoanalytic approach of finding out the true causes of the problem and with the cognitive-behavioral approach of teaching healthy patterns of thinking and behavior.

It is difficult to expect that there will be a sufficient number of specialists who deeply know all the main areas of psychotherapy. A holistic practical psychologist-psychotherapist must know holistically (in general) the approaches and techniques of these areas, and if it is necessary to go deeper, refer the client to a professional in the appropriate area.

Self-test questions

• 1. What are the main directions in modern psychotherapy?
• 2. How did modern psychotherapy develop step by step?
• 3. What is eclectic psychotherapy?
• 4. What are the similarities and differences between eclectic and integrative psychotherapy?
• 5. List the reasons for the spread of eclectic and integrative psychotherapy.
• 6. What is holistic psychology and psychotherapy?
• 7. What areas does holistic practical psychology consider?
• 8. Show an example of the interrelations of these areas and their negative and positive mutual influence.
• 9. How are holistic practical psychology and psychotherapy combined into a single direction?
• 10. What does holistic psychotherapy accept and what does it not accept from psychoanalysis, behaviorism, humanistic and existential psychotherapy?
• 11. How do holistic psychotherapy combine psychoanalytic, behavioral, humanistic and other approaches?

Over the past 50 years, we have all witnessed that there are more and more psychotherapeutic systems. According to various sources, their number ranges from 400 to 1000 and continues to grow...

And in a sense, this is very good... The famous humanistic psychologist Abraham Maslow liked to repeat the aphorism: “If you only have a hammer, then everything around you is a nail.” Many modern psychotherapists, faced with a difficult problem, grab their favorite tool. J. Norcross and J. Prochaska write: “Clinicians are too accustomed to recommending identical treatments—their favorite methods—to virtually every patient.”
In fact, the favored method only helps a certain number of clients.
In an effort to expand their capabilities, many psychotherapists begin to study and apply other methods that go beyond the single theory they were trained in, and some invent their own “new” methods.
Studies conducted in different countries have shown that the largest percentage of surveyed professionals consider themselves to be eclectic or integrative (from 27 to 53%).
It would seem that the problem of an individual approach to each client has been solved...
But another difficulty arises!
How do all these many theories and approaches fit together?
In a more global sense, does psychotherapy, with this approach, remain a scientific discipline or is it just a gathering of artisans, each of whom either somehow explains their actions in their own language, or ignores all explanations altogether, resorting to the formula: “Well, this works, and that means this Fine!"…
One from domestic research on the state of psychotherapy as a scientific discipline today was carried out as part of a comprehensive project to develop current theoretical and practical aspects of the direction of integrative and eclectic psychotherapy (the main implementers of this project are the department of psychotherapy, psychiatry - narcology, clinical and advisory Psychology RSPC MSPN, head – Professor A.L. Katkov; Department of Psychotherapy, Medical Psychology with a Course in Sexology and sexopathology RAPO, head – Professor V.V. Makarov. Their preliminary analysis revealed an almost complete discrepancy between the theory (or rather, theories) of psychotherapy and the codified criteria of scientific knowledge accepted at the present stage of development of science.

So, for example, according to the most important criterion, indicating about solvency and the maturity of any analyzed scientific direction - a well-developed subject area - we have to admit the absence of a clear definition of the subject of professional psychotherapy and even any satisfactory consensus on this issue.

According to such a criterion as the principle of confirmability (verification), which is usually adjacent to the principle of invariance (symmetry), both of these principles justify the presence of differentiated changes that arise precisely because of a certain impact; and if the nature of the influence changes, then the result also changes symmetrically - we should recognize the fact that in psychotherapy very often similar results are obtained when using different methods and different results when using the same method in an identical client group. In addition, almost all researchers note the lack of development and lack of consensus on the methods and criteria for determining the effectiveness of professional psychotherapy.

Further, according to the criterion of the presence of developed principles of falsification (on the basis of which the general field of professional psychotherapy can, firstly, be cleared of arbitrary and not justifying themselves theoretical constructions, and secondly - from ineffective practitioner) should be stated as almost complete failure, primarily due to the lack of real progress on the previous position (criterion of verification and symmetry).

The next criterion - observability and measurability of the dynamics of the subject area - in the general field of professional psychotherapy is represented by the ideological attitudes of each from numerous modalities (types of psychotherapy). Due to the lack of progress in the positions of the 1st and 2nd criteria, there is practically no chance of achieving consensus on the development of a unified scale for measuring psychotherapeutic effects.
The criterion of the so-called principle of simplicity, i.e. the presence of the most probable explanation of psychotherapeutic effects that does not require additional logical constructs, has also not been worked out, primarily due to the lack of progress in the 2nd and 3rd positions of the verification criteria and falsification.

According to the criterion of systematicity (consistency in relation to the conceptual core of the scientific direction under consideration or the methodology of its formation), it should be noted that there is disunity and uncovered variety of ideological concepts of psychotherapy. At the same time, any references to the supposedly multi-paradigmatic status of psychotherapeutic science and practice are simply inappropriate, since any psychotherapeutic ideology, as is clear from all of the above, is largely arbitrary and does not fall under the definition of a scientific paradigm.

Finally, according to the criterion of compliance with all the above-mentioned positions (for most of which, well-founded scientific disciplines must state a reasoned correspondence, and for other positions a clear explanation of the existing methodological difficulties and prospects for overcoming them must be presented), we have to admit that we are dealing with that rare case , when the specialty in question reveals an almost complete discrepancy with the generally accepted criteria by which the status of scientific disciplines is established.

In such an unpleasant situation for our profession, there are two ways out:
1) agree that psychotherapy, in its essential characteristics, meets the criteria of ideologically driven technological practice, fueled by arbitrary psychotechnical theories (i.e. professional psychotherapy is a craft, and not wealthy scientific and practical direction, formalized by the relevant institutions); and here we should say goodbye to the illusions of integration, since the proposed options, built in the spirit of arbitrary technical synthesis or on the basis of equally arbitrary general therapeutic factors, will, at best, repeat the fate of psychotherapeutic modalities (i.e., individual areas of psychotherapy), as is happening currently;

2) try to identify and systematize existing methodological difficulties (primarily in relation to the essential definition of the subject area, from which, in fact, the general outline of the methodological failure of psychotherapy as a scientific discipline originates), argue for the possibility of overcoming them through the development and implementation of a core research program (in the understanding of I. Lakatos) , the hypothetical part of which can be formed through the implemented methodology of epistemological analysis. In this case, professional psychotherapy, with some reservations indicating the status of a “young” and still emerging discipline, can with good reason be recognized as scientific.

We (Menovshchikov V.Yu.) adhere to the point of view of well-known theorists of psychotherapy - J. Prochazka and J. Norcross, who write: “... we do not approve of the endless proliferation of psychotherapeutic systems, each of which its developers proclaim as a unique and impeccable panacea for all ills, even when they have no reason or practical evidence for this. What our amorphous discipline really needs is a relentless attempt to bring together the fundamental variables involved in effective varieties of psychotherapy, and to abandon those that do not prove to be very effective in practice.
In other words, we are talking about a higher level of integration, the creation of a certain meta-theory that would enable a clear and distinct understanding and application of leading psychotherapeutic concepts.

Norcross and Prochaska further write: “Additionally, decades of teaching and supervision in psychotherapy have taught us that in order to acquire, analyze, and compare information, students need some kind of unifying theoretical structure, a rigid framework that allows them to sort the material into categories.” We (Menovshchikov V.Yu.) We also believe that this kind of theoretical structure is necessary for practicing psychotherapists. And although we consider the final integration and bringing of all therapies to only one such structure a utopia, the transtheoretical approach of J. Prochaska, C. DiClimente and J. Norcross, which we are developing, in our opinion, provides one of the wonderful opportunities to use a unifying theoretical framework that is time-tested and empirically supported its effectiveness.
Let us dwell further (in the next conference) on a brief historical outline of the development of the integrative movement and on the main forms of integration and eclecticism.

V.V. Kozlov, YarSU

The current situation in psychotherapy is characterized by a confrontation between the traditional (academic) approach and a huge number of schools, directions, and new therapeutic approaches to understanding the theory and practice of this science.

Academic psychotherapy is based on the biological and social determinism of human activity and gives preference to the materialistic, positivist paradigm of science.

Newly created eclectic “trends” and “schools,” especially those with an applied orientation, either have no methodological understanding or consider methodology a scholastic profanation of science.

The main problem is that neither practitioners nor theorists of psychotherapy try to reflect a holistic picture of a person’s mental reality. In psychotherapy there is no perception of a holistic picture of mental reality, which is manifested at all levels - from biological to spiritual.

Because of this, it is necessary to create and develop a fundamentally new methodology that would take into account the manifestation of the psyche at all levels of human existence.

At a first approximation, we can isolate, at most, two levels in this unified approach:

Explanatory - a system of basic postulates, principles of constructing science, as well as theories, concepts, semantic models that reveal the topology and dynamics of the psyche;

Influential - a system of methods, practices, abilities, skills, psychotechnics aimed at restoring the integrity of consciousness, personality, activity, and mental health.

Even the isolation of these levels is artificial in accordance with the integrative approach, because any explanation is an influence, and some theories have the quality of a model of the human world, which has ideological meaning. Any impact is conceptualized by the individual, and the most powerful of them completely change the explanatory scheme of reality, the life world.

The ideological eye of the integrative methodology is the principle of integrity, which implies an understanding of the psyche as an extremely complex, open, multi-level, self-organizing system that has the ability to maintain itself in a state of dynamic equilibrium and produce new structures and new forms of organization.

The concepts of “holistic approach” and “holistic personality” have been used for a long time by different directions and schools of psychotherapy: from Gestalt and humanistic psychotherapy to domestic directions (cultural-historical, activity approaches...). Probably, the very concepts of “goal” and “whole” are etymologically related (in Greek τελός - accomplishment, completion; ending, highest point, limit, goal; τελειός - finished, complete, accomplished; final, extreme, perfect). Achieving a goal simultaneously means the completion of an action, the closure of a circle, the ascent to completeness, perfection, and beauty.

The goal is achieved when a perfect symmetrical whole is built. Only at the present time, at the beginning of the third millennium, when knowledge about the human psyche is replenished not only through purely scientific research (in the general understanding of this), but also due to what has always existed as hidden esoteric knowledge, can we talk about a more holistic understanding, what is a person and his consciousness.

Esotericism has always understood a clear difference between the psyche and consciousness of a person, soul and spirit, in contrast to scientific psychotherapy, which tried to follow its own path, split mostly into two lines: materialistic and idealistic (which gave good results in the study of different aspects of the psyche, its objective determination and subjective essence).

The complexity of the subject of applied psychotherapy lies in the fact that personality, its content, is not determined only by a set of characterological traits or a certain problem state. As a rule, behind the problems there are deeper unconscious structures (gestalts, COEX systems, integrity of mental reality, subpersonalities, scripts, etc.). Moreover, from an integrative point of view, they are a simultaneous consequence of the entire psychic reality, including not only personal, but also interpersonal and transpersonal megastructures.

Integrative methodology is based on the postulate that man is a holistic being, that is, independent, capable of self-regulation and development. But man is not the only integral entity in the world. Everything in nature has integrity, nature itself is holistic and represents a hierarchy in which each element is a “whole” in relation to its parts and a “part” in relation to a larger whole. Both of these aspects of existence: both the part and the whole must be fully expressed in order to realize the potentialities of any being. This explains the human desire to go beyond one’s limits, to transcend, to be, to feel, to realize oneself as a part of the universe.

Everything in society as a social organism also has integrity, the social community itself is holistic at any stage of functioning (from a diffuse group to a collective and the sense of “we”) and regardless of the complexity and volume of the organization (from small groups to humanity as a mega-social system). Social communities, which are the object of PSYCHOTHERAPY, represent a hierarchy in which each individual is a “whole” in relation to its system components and a “part” in relation to social communities. Both of these aspects of existence: both the part and the whole must be fully expressed in order to realize the potential of any individual. This explains the human desire to go beyond one’s limits, to transcend, to be, to feel, to realize oneself as a part of social communities and the entire universe.

The fundamental integrative thesis is that the world is not a complex combination of discrete objects, but a single and indivisible network of events and relationships. And although our immediate experience seems to tell us that we are dealing with real objects, in fact, we are responding to sensory transformations of objects or messages about differences.

As Gregory Bateson argues in his work, thinking in terms of substance and discrete objects represents a serious epistemological error. Information flows in chains that go beyond the boundaries of the individual and include everything around us, social and natural.

Thus, in an integrative worldview, the emphasis shifts from substance and object to form, pattern and process, from being to becoming. The structure is the product of interacting processes, no more durable than the pattern of a standing wave at the confluence of two rivers. According to the integrative approach to PSYCHOTHERAPY, humanity is like a living organism, whose organs, tissues and cells have meaning only in their relationship to the whole.

The meaning of the integrative approach at the level of individuality is that the human psyche is a multi-level system that reveals in personally structured forms the experience of individual biography, birth, as well as a boundless field of consciousness that transcends matter, space, time and linear causality, which we can, upon closer approach, designated as interpersonal and transpersonal levels of mental organization. Awareness is an integrative open system that allows various areas of the psyche to be combined into integral semantic spaces.

The integrity of personality implies taking into account all its manifestations (at least those that have already been described, perhaps studied, but not fully explained): biogenetic, sociogenetic, personogenetic, interpersonal and transpersonal (in our opinion, including a number of features, or manifestations, there are still few accepted by official science, but no longer denied as non-existent).

If we talk about the existence of such a personality, then it has existed for more than one thousand years and exists in our time (regardless of scientific psychological fabrications and educational systems, although more often distorted by them, but functioning integratively and holistically)

Personality is a form of manifestation of the psyche, a medium of consciousness and has a fragmented structure, and conflict tension exists between fragments of different areas and levels. The binary nature of a person’s assessment of his own experience leads to increased intrapsychic tension.

Integration at the personal level implies awareness of conflicting tensions between fragments and levels of the psyche and open acceptance of what was previously rejected. The ability to integrate experience is the main criterion of mental health. A low ability to integrate leads to the formation of destructive personality reactions and, in extreme terms, to social deviation and psychopathological symptoms, but even with this option, the personality functions integratively and holistically.

Practical methods of socio-psychological work using an integrative approach include a wide range of psychological techniques, common to which is the use of personal and social resource potential.

The integrative approach is a fundamentally new semantic space both for professionals - psychologists, social workers, psychotherapists, and for their clients.

Any theory, concept, therapeutic myth, teaching, idea, everyday judgment about mental reality, despite their often seeming completeness and universality, are fair only under certain circumstances and with a certain degree of probability.

Currently, there is widespread interest in all kinds of schools and methods aimed at working with consciousness and personality. Many people turn to psychotherapy, Jungian analysis, mysticism, psychosynthesis, Zen Buddhism, transactional analysis, Hinduism, bioenergetics, psychoanalysis, yoga and Gestalt therapy. What all these schools have in common is that they try in one way or another to bring about changes in human consciousness and personality. This, however, is where their similarities end.

A person who sincerely strives for self-knowledge is faced with a huge variety of psychological systems that make the problem of choice extremely difficult, since these schools, taken as a whole, clearly contradict each other. For example, Zen Buddhism suggests forgetting or transcending the ego, and psychoanalysis suggests strengthening and strengthening the ego. Who is right? This problem is equally acute for both non-professionals and psychotherapists and practical psychologists.

But if we imagine that in reality these different approaches are approaches to different levels of the human “I”, then they do not contradict each other, but reflect real and very significant differences between different levels of mental organization, and all these approaches can be more or less correct in application to the corresponding levels of the environment of consciousness.

Various religious and psychological schools represent not so much different approaches to considering a person and his problems, but rather complementary approaches to considering different levels of human consciousness. At the same time, all the many schools fall into five or six clearly different groups, and it becomes obvious that each group is focused primarily on one of the main ranges of levels of mental organization.

To give some brief and general examples, the goal of psychoanalysis and most forms of traditional psychotherapy is to heal the split between the conscious and unconscious aspects of the psyche, so that the person comes into contact with everything that is going on in his soul. These schools of psychotherapy are aimed at reconnecting, to use Jungian terminology, masks and shadows to create a strong and healthy "ego" - a correct and acceptable image of oneself. In other words, they are all ego-oriented. They are trying to help the individual living at the mask level to remake the map of his soul so as to move to the ego level.

In contrast, the goal of most schools of so-called humanistic psychotherapy is different - to eliminate the split between the “ego” itself and the body, to reunite the psyche and somatics for the revival of the whole organism. This is why humanistic psychotherapy, called the “third force” (the other two being psychoanalysis and behaviorism), is also referred to as the “Human Potential Movement.” As a person's self-identification expands from one mind or "ego" to the organism as a whole, the enormous potential of the whole organism is released and becomes the property of the person.

If we go even further, we find disciplines such as early Taoism, Shakyamuni's third circle Buddhism, or Vedanta, whose task is to integrate the whole organism and environment to restore external identity with the entire Universe. They are aimed at the level of unity of consciousness in all diversity

Between the level of unity consciousness and the level of the whole organism lie the transpersonal, transpersonal ranges of psychic reality. Schools of psychotherapy that address this level are concerned with the in-depth study of “supra-individual,” “collective,” or “transpersonal” processes in humans. Schools focused on this level include psychosynthesis, Jungian analysis, various preliminary stages of yogic practice, “transcendental meditation,” various breathing psychopractices such as holotropic breathing, and so on. The goal of some of these therapies, such as Jungian psychotherapy, is to help us consciously recognize these powerful forces within ourselves, make friends with them, and use them, rather than being driven by them unconsciously and against our will.

In general, one will find that psychotherapy at any level will accept and acknowledge the potential existence of all those levels that lie above its own, but deny the essentiality of all those levels that lie below it, declaring these deeper levels to be pathological, illusory, or altogether non-existent.

Self-knowledge and personal growth, first of all, means expanding the horizons of the individual, moving his boundaries outward and in depth. In the process of spiritual search, a person rebuilds the map of his soul, expanding its territory. Growth is a constant redistribution, rezoning, re-mapping of oneself, recognition, and then the acquisition of ever deeper and more comprehensive levels of one’s “I”.

Currently, there is a boom in scientific disciplines in the pursuit of a holistic, all-encompassing understanding of man. The concept that is introduced to denote this desire is integrative. We can find in scientific publications the phrases “integrative approach in science”, “integrative psychotherapy”, “integrative pedagogy”, “integrative anthropology” and even “integrative gestalt therapy”.

Back in the early 90s, we founded an applied psychological direction, which we designated “intensive integrative psychotechnologies,” which we considered as a system of theories, concepts, models, methods, abilities and skills that lead a person to greater integrity, to less conflict, fragmentation of consciousness , activities, behavior.

At the beginning of the third millennium, we can, to some approximation, designate the approach itself as integrative psychology. Mass experiments with various psychotechnics and psychotechnologies have shown the correctness of the basic methodological premise - a holistic approach in the theoretical and practical activities of a psychologist, which implies not only a systematic analysis of the subject of science, but also a holistic vision of one’s nature, one’s clients in real activities.

We already understand that our concept of man as a living, open, complex, multi-level self-organizing system with the ability to maintain itself in a state of dynamic equilibrium and generate new structures and new forms of organization is a new categorical understanding of traditional holistic approaches in theology and philosophy. We will not touch upon the huge layer of Eastern philosophy and spiritual tradition, which called for maintaining the integrity and purity of worldview through a transcendental approach to reality. The transcendental approach (from the Latin word transcendere - to go beyond, to pass through), accepting the illusory nature of the material world in order to achieve Reality, considers interaction with its structures undesirable. In this case, a person’s efforts are concentrated on passing through the material world to Reality and minimal interaction with it. That is why, throughout the evolution of mankind, certain esoteric communities and closed religious social niches (sanghyas, monasteries, brotherhoods, orders, communities) were created in order to create a certain group subculture outside the confines of profane life. Preserving integrity through the cultivation of “wei wu wei” (the act of non-action) in Taoism, the dharma of Equanimity (non-involvement in experiences and relationships) in Buddhism are classic examples of the strategy when the very problem of integration and integration of the individual is removed, because “the mirror of consciousness is clear” and even the strongest emotions and emotions “do not cause ripples on the calm surface of the lake.”

In European philosophy, the founder of integrative psychotherapy can be considered Immanuel Kant (1724-1804), who in his philosophical treatises expressed the idea of ​​the integrity of human nature, outlining the hierarchical levels of his psyche. Philosophical anthropology, which arose at the beginning of the twentieth century in Germany, resurrected I. Kant’s views on the unity of human nature, but gave them a new interpretation that corresponded to the spirit of the times. At the same time (in 1921, Ernst Kretschmer’s book “Physique and Character” was published in its first edition), arguments about the need for an integral approach to improving the diagnosis of diseases and their treatment were made by psychiatry and medicine.

The integrative approach is traditional for Russian science and it finds its highest manifestation in the methodological principle of integrity.

At the same time, in the history of psychotherapy we can find several major crises that did not allow the ideas of integrative methodology to be realized. The first was when in July 1936 a party and government ban was imposed on the development of pedology as a comprehensive science about children. Thus, the biological foundations of developmental psychology were undermined. The second, when in 1951, during the famous scientific-academic session related to the study of the creative heritage of I.P. Pavlov, an attempt was made to reduce psychology to the study of the physiology of higher nervous activity.

Psychology experienced the third methodological crisis at the end of the 20th century, when, deprived of the usual materialistic methodology and experiencing the influence of a number of trends in foreign science, it runs the risk of losing certainty of purpose and clarity of guidelines with an uncritical perception of everything foreign. Today, more than ever, historical continuity and methodological specifications are needed when choosing paths for the development of psychotherapy. Integrative psychology fully satisfies these conditions.

In Russian psychotherapy, the doctrine of integral individuality by V.S. Merlin, which substantiated the somatopsychic unity of man with his subdivision at certain hierarchical levels, and the psychological anthropology of B.G. Ananyev, having built a bridge from human psychology to his psychophysiology and biology, served as a powerful stimulus for the emergence of integrative psychology.

In the second half of the twentieth century, there was a tendency to return to unified and integral ideas about man, which existed until the mid-nineteenth century and were destroyed by the process of differentiation of sciences. The theoretical possibility of a new synthesis of knowledge about man was substantiated by philosophers. The necessary prerequisites have arisen for the reconstruction of science, the central content of which would be ideas about the somatopsychic integrity of man.

At the moment, there is methodological uncertainty in the further movement of anthropological sciences. And as far as I understand, we can identify two main approaches:

Communicative methodology (V.A. Mazilov), which involves the cooperative interaction of sciences, schools and directions in solving specific issues of psychotherapy and other humanities;

Integrative methodology (K. Wilber, V.V. Kozlov), which involves the consolidation of many areas, schools, directions, levels of knowledge about a person in the semantic field of psychotherapy.

We are confident in the usefulness of both approaches. Moreover, communicative methodology may be a necessary stage in the formation of an integrative approach.

In this context, V.A. Mazilov’s remark is absolutely correct that today it is necessary to direct efforts to develop a scientific apparatus that makes it possible to really correlate different concepts and, thereby, contribute to the establishment of mutual understanding within the framework of scientific psychotherapy. The specific task to be solved first is to develop a communication-oriented model of psychological science methodology, i.e. implying an improvement in real mutual understanding:

Between different directions within the framework of scientific psychotherapy;

Between academic, scientific psychotherapy and practice-oriented concepts;

Between scientific psychotherapy and those branches of psychotherapy that do not belong to traditional academic science (transpersonal, religious, mystical, esoteric, etc.);

Between scientific psychotherapy and art, philosophy, religion

Between psychotherapies that objectify different levels of mental organization - person, interpersonal and transpersonal.

The second step after the implementation of the communicative methodology project should be the development of an integrative scientific model and methodological apparatus that makes it possible to really correlate different approaches both within psychotherapeutic science and those implementing other semantic forms of psychological knowledge.

Thus, the first step in the formation of an integrative methodology and at the same time a method of professional development of a psychotherapist is communication, openness to knowledge as a system-forming principle.

The generalization of scientific knowledge about man into a single whole can not only identify and eliminate the voids and blind spots of the latter on the boundaries of traditional sciences, but also expand the horizons of psychotherapy through the integration of knowledge and applied technologies from other sciences and those areas that, in accordance with the Cartesian paradigm, were considered unscientific and even anti-scientific.

By the end of the twentieth century, the fact was revealed that psychotherapy, which rightfully claimed to be the leader in human science, did not have the proper methodology for complex human cognition, including all levels of mental functioning. The methodological crisis that arose in Russian psychotherapy is a very productive state of evolution of anthropocentred sciences in the sense that it gave birth to the idea of ​​communicative methodology and outlined the vector of an integrative approach in psychotherapy.

We already have a fairly good idea that the doctrine of the integral individuality of man (V.S. Merlin) is a particular implementation of integrative methodology within the positivist understanding of psychotherapeutic science. To satisfy the modern understanding of integrativeness, methodological equipment of such a level is necessary that would not only absorb the best achievements of biological, historical, social sciences, but also metascientific concepts of a transpersonal, religious, mystical, esoteric nature, art and philosophy.

In this case, integrative psychotherapy should occupy a central position conceptually.

The change in the guidelines of state and social construction, experienced by Russia since the 80s, the intensity of interethnic relations, the search for new ideologies, the crisis in the humanities and in psychotherapy, the return to the traditional sources of spirituality, the emergence of the psychotechnical and psychotechnological layer of psychotherapy, diversity in the understanding of the subject, The tasks and conceptual content of hundreds of psychologies require efforts that would contribute to the emergence of integrative psychotherapy.

In our opinion, the development of psychotherapy is associated with an increasing integration of various approaches, which were initially viewed as contradictory and incompatible, but later turned out to be completely complementary. Moreover, we can designate the integrative approach as evolutionarily adequate. The development of psychotherapy leads to the increasing popularity of concepts focused on an integral, holistic approach. The most perfect expression of this idea is the integral psychology of Ken Wilber, who, continuing the tradition of I. Kant, F. Brentano, V. Dilthey and Carl Jung, was able to create a holistic picture of the evolution of human consciousness and describe the multi-level spectrum of mental reality.

A famous physiologist who radically influenced the fate of Russian psychotherapy, I.P. Pavlov wrote: “Life clearly points to two categories of people: artists and scientists. There is a sharp difference between them. Some - artists, writers, musicians, painters, etc. capture reality entirely... Others - scientists, precisely crush it and thus "They actually kill her, making a skeleton out of her. And then, as it were, they collect her parts again and try to revive her in this way, but they never succeed."

Using Ivan Pavlov’s metaphor, we can say that the time has come for scientists-artists who simultaneously holistically “capture reality” and at the same time do not lose analytical reflexivity.

The scientific paradigm, which is structured in social psychotherapy on the eve of the third millennium, must holistically represent all levels of human consciousness and be integrative in nature. Moreover, the future of human science lies in integrative psychotherapy. It takes into account not only the spiritual dimensions of human existence, but is also commensurate with the everyday life of human existence and is instrumentally adapted to its problems of life in society.

It is the integrative approach that makes it possible to have a broader, holistic and multifaceted view of understanding human nature and the entire Universe. From the perspective of this approach, it seems possible to bring together the main provisions of the three leading directions of psychology and psychotherapy: orthodox, humanistic and transpersonal within the framework of the conceptual scheme of the integrative approach.

My practical experience again and again indicates that there is no panacea in psychotherapy - methods should be chosen strictly individually, based on the characteristics of the situation and the unique personality of the client. Most often, effective psychological help is a thoughtful combination of techniques from various psychotherapeutic approaches. Consultation with a psychotherapist always means flexibility, the ability to deviate from rules and stereotypes.

For example, now I have several clients with various forms and attacks. Of course, I have an approximate algorithm for helping with this disorder, but in all cases, significantly or minimally, I deviate from it.

The last decades of development of psychotherapeutic science are, in my opinion, not the discovery of something new, but the search for combinations. The relevance of the integrative approach in psychotherapy is evidenced by the founding of the international “Journal of Integrative and Eclectic Psychotherapy.” Integrative psychotherapy, in contrast to eclectic psychotherapy, which uses a combination of techniques from various psychotherapeutic directions, involves, first of all, a conceptual synthesis of different theories of psychotherapy.

If we refer to the “Psychotherapeutic Encyclopedia”, the integrative model of psychotherapy can be developed based on the following approaches:

1) an eclectic model that combines various methods of psychotherapy, based on the needs of a particular client

2) integration of relevant scientific disciplines - medicine, psychology, sociology, pedagogy, neurophysiology, philosophy, psycholinguistics

3) synthesis of theoretical provisions of various psychotherapeutic orientations in the presence of a leading concept of personality and its development, psychopathology and symptom formation.

We can say that at different stages of assistance, different combinations of methods are required that will complement each other. In particular, at one stage in the process of consulting a psychotherapist, psychodynamic methods will be required to become aware of unconscious material, at another stage a behavioral approach will be required to help develop new, more constructive and mature behavior. One of the common manifestations of the use of any form of psychotherapy is the presence of phases: establishing initial contact; identification of psychotherapeutic “targets” (symptoms, complaints, conflicts, self-esteem, etc.); changing existing non-adaptive ways of assessing reality, excessive experiences and behavior; completion of the psychotherapeutic course.

Attempts have long been made to combine psychoanalytic and behavioral theories of psychotherapy. During the consultation process with a psychotherapist, an analysis of the formation of symptoms takes place, which takes into account both the person’s unconscious internal conflicts and the patient’s current life situation, which reinforces the manifestations of the disorder.

One option for combining areas of psychotherapy is attempts to integrate cognitive and behavioral approaches in psychotherapy. This option, on the one hand, recognizes the importance of personal factors in adaptation, and on the other, emphasizes the role of the environment in the development of the disorder. The essence of this integrative form of psychotherapy is based on the following premises:

1) a person reacts not so much to external stress factors as such, but to his own mental ideas about them

2) methods of perception can change with directed learning during psychotherapy

3) thoughts, feelings and behaviors are causally interconnected.

Psychosynthesis is another example of a wide combination of different types of psychotherapy, primarily existential. The goal of psychosynthesis is harmonization and integration into a single whole of all human qualities and functions. Neurolinguistic programming, an interdisciplinary integrative approach to psychotherapy, the concept of psychotherapy uses the so-called meta-model as a step-by-step strategy of psychotherapeutic behavior that expands the patient’s model of the world and creates conditions for the process of personality change. It is assumed that this meta-model can be used by a psychotherapist of any orientation and at a certain stage should be used in conjunction with other methods. Personality-oriented (reconstructive) psychotherapy by Karvasarsky, Isurina, Tashlykov as an open psychotherapeutic system uses the integration of some theoretical principles and techniques of behavioral and humanistic psychotherapy (for example, client-centered psychotherapy and gestalt therapy).

We can say that the future development of psychotherapeutic science is not only new discoveries, but also the pragmatic integration of existing approaches. The advantage of this approach is that the angle of perception of psychological problems expands, and also that in the process of consulting a psychotherapist, the opportunities to adapt the model of assistance based on the uniqueness of a particular case expand.

When writing the article, materials from the “Psychotherapeutic Encyclopedia” edited by B. D. Karvasarsky were used. – St. Petersburg: Peter Kom, 1998.

Psychotherapist, Candidate of Psychological Sciences, “Time of Joy”