Introduction to clinical psychology.
CLINICAL PSYCHOLOGY
LECTURE COURSE FOR STUDENTS
CORRESPONDENCE DEPARTMENT
SPECIALTIES PSYCHOLOGY
Togliatti 2006
LECTURE No. 1. INTRODUCTION TO CLINICAL PSYCHOLOGY…….…….2
LECTURE No. 2. GENERAL CLINICAL PSYCHOLOGY .................................................... 8
LECTURE № 3. METHODOLOGY
CLINICAL AND PSYCHOLOGICAL RESEARCH…….…….………..….11
LECTURE No. 4
LECTURE No. 5. PERCEPTION DISTURBANCES……………………………..…….16
LECTURE No. 6. MEMORY DISTURBANCES……………………………………………..21
LECTURE № 7
LECTURE No. 8. SPEECH, COMMUNICATION DISORDERS
AND LEARNING SKILLS……………………………………………………..…...27
LECTURE No. 9. VIOLATIONS OF voluntary MOVEMENT
AND ACTION……………………………………….………………………….……31
LECTURE No. 10
LECTURE No. 11 DISTURBANCES OF THE EMOTIONAL SPHERE.………..…..…….34
LECTURE No. 12 NEUROSIS. TYPES OF NEUROSIS……………………….……….…....37
LECTURE № 13. MANIC-DEPRESSIVE PSYCHOSIS…….…..…..…38
LECTURE No. 14. EPILEPSY…………………….………………………….…….39
QUESTIONS FOR THE EXAM……………………………………..…………………...40
REFERENCES…………………………………………..……………….41
TERMINOLOGICAL DICTIONARY………………………………………..……41
NEUROPSYCHOLOGICAL METHODS……………………………..………43
LECTURE №1. INTRODUCTION TO CLINICAL PSYCHOLOGY.
The subject of psychology as a science is the study of the patterns of formation and manifestation of the psyche. Psychology is divided into general and special (applied).
Clinical psychology is a branch of special psychology. It is located at the intersection of two sciences (medicine and psychology) and, accordingly, has its own subject of study both in the field of psychological and in the field of medical knowledge.
The terms "clinical" (from the Greek kline - hospital bed, bed) and "medical psychology" are close in meaning and content.
According to E. Kretschmer (1922), the main content of medical psychology is the psychological analysis of the nature of diseases.
According to the definition of N. D. Lakosina and G. K. Ushakov, the subject of clinical psychology is the diversity of the patient’s mentality and their impact on health and disease, ensuring an optimal system of positive psychological influences taking into account all the circumstances accompanying the examination and treatment of the patient.
The study of clinical psychology is impossible without knowledge of the basics of clinical medicine and related disciplines, such as anatomy, general pathology, hygiene, etc.
Medical psychology is of no small importance in preserving and strengthening the psychophysical health of a person; it is closely intertwined with the practice of mental hygiene and psychoprophylaxis.
TABLE OF CONTENTS
Introduction to Clinical Psychology…………………...………………….…..4
Psychology of the somatic patient. Psychosomatic medicine………20
Psychology of the somatic patient. The internal picture of the disease………..26
Psychology of the somatic patient. Neurology………………….……...40
Stress and adaptation……………………………………………………………....47
Psychology of medical-diagnostic process. Psychological features of professional activity…………………………………………………52 -59
Schizophrenia…………………………………………………………………….59 - 62
Topic number 1. INTRODUCTION TO CLINICAL PSYCHOLOGY
1. Branches of psychology. Development of clinical psychology.
2. Subject and tasks of clinical psychology.
3. Sections of clinical psychology (general and particular medical psychology, pathopsychology, neuropsychology, psychological expertise, psychohygiene, psychoprophylaxis and health education, psychological correction, psychological counseling and psychotherapy).
4. Basic methods of clinical psychology (clinical-psychological method, conversation with the patient, observation, study of products of mental activity, psychological experiment).
1. Branches of psychology. Development of clinical psychology.
Modern psychology is an extremely differentiated science. Various authors count from 50 to 100 relatively independent branches of it, claiming the status of full-fledged scientific disciplines.
The branches of psychology can be conditionally divided into general and special.
General industries matter in understanding and explaining the behavior of people, no matter who they are or what they do. These industries are sometimes referred to as " general psychology". General psychology studies the general patterns of the emergence and functioning of the psyche:
psychology of cognitive processes(sensations, perception, ideas, memory, imagination, thinking, speech, attention);
psychology of Personality(emotions, abilities, motivation, temperament, character, will).
psychology of abnormal development- a branch of psychology, divided into a number of branches: oligophrenopsychology, surdopsychology - the hearing impaired, tiflopsychology - the visually impaired and the blind, etc .;
social Psychology- a branch of psychology that studies the patterns of functioning of the psyche and human behavior in the process of his interpersonal interactions. Social Psychology includes conflictology.
differential psychology, or the psychology of individual differences, is a branch of psychology that studies the features that distinguish people from each other;
psychophysiology- this is a branch of psychology that studies the relationship of mental phenomena and human behavior with the work of the body and the central nervous system;
pedagogical psychology- a branch of psychology that studies the formation and change in the psychology of people in terms of learning;
medical (clinical) psychology- a branch of psychology that studies the features of the emergence and development of disorders of human mental activity and the role of external and internal factors in the pathogenesis and treatment of these disorders.
The first psychological clinic was opened in 1896. in Pennsylvania, USA by Lightner Whitmer (1867-1956), who in 1907. began publishing the journal "Psychological Clinic", in the first issue of which he proposed a new specialization for psychologists - clinical psychology. Formally, clinical psychology was recognized as an independent discipline in 1917, when a special section on clinical psychology was created in the USA, which was included in 1919. to the American Psychological Association.
In Russia, the term "medical psychology" has been adopted for a long time, defining the same field of activity. In the 1990s, as part of bringing the Russian educational program to international standards, the specialty "clinical psychology" was introduced in Russia. Unlike Russia, where medical psychology and clinical psychology often actually represent one and the same area of psychology, in international practice, medical psychology usually means a narrow sphere of psychology of the relationship between a doctor or therapist and a patient and a number of other highly specific issues, while while clinical psychology is a holistic scientific and practical psychological discipline.
In a number of literary sources, the German scientist is called the founder of medical psychology. Ernst Kretschmer, who developed a coherent classification system for personality typology, pointed out the patterns of transition of a certain type of personality into certain anomalies and diseases, and established relationships between personality types and body types. This scientist published the monograph "Medical Psychology" in 1922, which is partly why E. Kretschmer is considered the discoverer of this subject.
In fact, clinical psychology could not have arisen from scratch, all of a sudden. And here we turn to the names that are the pride of Russian science. In 1885 in Kazan Vladimir Mikhailovich Bekhterev(future St. Petersburg scientist) opened the first laboratory of experimental psychology and singled out among its tasks "the study of abnormal manifestations of the mental sphere, since they illuminate the tasks of the psychology of normal persons."
In 1896, Sergei Sergeevich Korsakov, an outstanding Russian psychiatrist, opened a similar laboratory in Moscow. Both of them are at the origins of one of the branches of our discipline - "Pathopsychology", which studies changes in individual mental processes in various conditions and at various diseases.
Among foreign scientists, a little earlier, Wilhelm Wund founded the first psychological laboratory in Leipzig.
Another German scientist Herman Ebbinghaus conducted capital research on the psychology of memory, the process of forgetting.
Around the same time, the French scientist Jean Ribot proposed to study the patterns of mental activity not only in healthy people, but also in mentally ill people, thus enriching the areas of work of German researchers.
Speaking of ancestors personal approach» to the study of mental activity, we should mention the famous Russian scientist Grigory Ivanovich Rossolimo, his work “Psychological profiles. A method for the quantitative study of psychological processes in a normal and pathological state” (1910). He was the first to use psychometric scales for research with the evaluation of results according to a 10-point system.
Statements concerning deontology and ethics, an integral part of clinical psychology, have been known since ancient times.
So, in the ancient Indian treatise "Ayurveda" (in translation - "The Book of Life", or "The Science of Life"), the concept of medical ethics is outlined and instructions are given to the doctor. Such teachings also developed in Ancient Greece, for example, in the writings of the famous Hippocrates, which is reflected in the "Oath" of his name, which is invariably taken by medical graduates. educational institutions. The "oath" in the time of Hippocrates was directed against charlatans, extortionists and money-grubbers from medicine.
An English nurse paid considerable attention to issues of deontology in her writings. Florence Nightingale founder of the teaching of the nursing process. A medal is named after her as the highest award for quality patient care.
In the XX century. the paths of domestic and foreign psychological science diverged markedly. In the USSR, a gradual substitution of psychology (in particular, clinical) physiology took place, and the consideration of individual mental processes, without detailed descriptions of their material substrate, threatened with accusations of subjective idealism. At the same time, new, often contradictory, psychological concepts were put forward in the West (by Freud, Jung, Adler, Skinner, and others). Most of them are controversial, but the proposed methods in clinical psychology, especially in neurosology and in the study of psychosomatic states, are still used.
At the end of the first half of the last century, a remarkable work appeared in domestic science. Roman Albertovich Luria"Internal picture of the disease and iatrogenic diseases" with a clear analysis of the reactions of patients to their own disease state. The term "internal picture of the disease" is still in use today.
The development of domestic psychology was made by the research of scientists from the St. Petersburg Psychoneurological Institute. V.M. Bekhterev. The work deserves special attention. Vladimir Nikolaevich Myasishchev in which an individual-personal approach to the disease was defended. Among his successors are such names as Modest Mikhailovich Kabanov, Mikhail Dmitrievich Karvasarsky, Andrey Evgenievich Lichko(creator of LOBI and PDO methods).
Also, a significant contribution to the development of medical psychology and psychotherapy was made by representatives of the Moscow school, in particular, Konstantin Konstantinovich Platonov, also a supporter of the "personal" approach to the patient, who argued that "the subject of medical psychology is the personality of the patient, as well as external and internal influences that may affect mental health."
Of the foreign works devoted specifically to medical psychology, the monograph of Czech scientists deserves special attention. Robert of the End And Milana Bouhala(1983), which provides the most detailed analysis of the psychology of the patient, the medical worker and the medical environment.
2. Subject, tasks and methods of medical psychology.
The specialty "clinical psychology" was approved by the order of the Ministry of Education of the Russian Federation No. 686 dated 02.03.2000. Until that time, the term “medical psychology” has been used in Russian literature.
Clinical psychology is one of the branches of general psychology, a science that studies normal mental processes and personality traits of a person.
Clinical psychology is closely related to related disciplines, primarily
turn, with psychiatry and pathopsychology.
There is no single definition of clinical psychology. Almost every well-known monograph or textbook contains more or less different definitions (Bleicher, 1976; Konechny, Boukhal, 19834 Kabanov et al., 1983; Matveev, 1989; Volkov et al., 1995; Levchenko, 2000; Shkurenko, 2002 ; Mendelevich, 2002; etc.).
According to professional orientation, the system of personnel training and the fundamental foundations of education, clinical psychology is a broad-profile psychological specialty that has an intersectoral character and participates in solving a set of problems in the healthcare system, public education and social assistance to the population.
The practical and research activities of a specialist are aimed at increasing the mental resources and adaptive capabilities of a person, harmonizing mental development, protecting health, preventing and overcoming illnesses, and psychological rehabilitation.
The object of clinical psychology is a person with difficulties in adaptation and self-realization associated with his physical, social and spiritual condition.
The subject of professional activity of a specialist is mental processes and conditions, individual and interpersonal characteristics, socio-psychological phenomena that manifest themselves in various areas of human activity.
Tasks clinical psychology:
The study of changes in individual mental functions in somatic and mental diseases.
The study of patient personality types (including accentuations and anomalies) that determine the patient's response to the disease. Definition and generalization of types of reaction to the disease.
The study of the psychology of health workers, their relationship (doctor, nurse, junior medical staff).
The study of the psychology of therapeutic interaction, including the psychology of communication with the patient; medical ethics and deontology.
The study of somatopsychic relationships and psychosomatic states as essential in the origin, course and treatment of the disease.
Study of the psychological profile of patients with various diseases.
The study of the so-called "deviant" (deviant) behavior, which largely determines the patient's reaction to the environment.
Developmental Clinical Psychology Research; age also largely determines the psychology of the patient, the possibility of psychosomatic and neurotic conditions in different situations.
The study of the psychology of family relationships, which are also of considerable importance in the event of a disease, affecting the course of the disease and the effectiveness of therapy.
Psychocorrection, psychotherapy, psychological counseling (the latter is the exclusive prerogative of a specialist psychologist).
Clinical psychology occupies a borderline position between psychology and medicine, being at the same time an area of both of these sciences, and includes the psychological aspects of the theory and practice of medicine, as well as questions of the psychology of patients. Clinical psychology serves the tasks and goals of medicine (diagnosis, treatment and prevention of diseases), but its theoretical foundations and methods are psychological.
It determines the role of psychological factors in the prevention, occurrence and course of the disease; studies the influence of diseases on the psyche; evaluates developmental disorders of the psyche; explores the psychological manifestations of the disease in dynamics; develops the principles and methods of psychological research in the clinic; engaged in methodological and theoretical development of such problems as the brain and the psyche, the body and the psyche, the norm and pathology (within the framework of general psychology).
It is conditionally possible to distinguish between general and particular clinical psychology.
General Medical Psychology includes:
study of the basic laws of the patient's psychology (criteria for a normal, temporarily altered and morbid psyche), the psychology of a medical worker, communication between a medical worker and a patient, the psychological climate of the department;
study of psychosomatic and somatopsychic relationships in the course of the disease;
the study of individual characteristics of a person (temperament, character, personality) and their changes in the process of life;
medical deontology (medical debt, medical ethics, medical secrecy);
psychohygiene and psychoprophylaxis.
features of the psychology of specific patients with certain mental and somatic diseases, physical defects;
mental phenomena in patients during the preparation and conduct of surgical operations;
medical and psychological aspects of labor, military, forensic examination.
Depending on the subject of study and the main tasks, the following areas of clinical psychology are distinguished.
pathopsychology. This is a section of clinical psychology that studies the patterns of violations of the structure and development of mental processes, as well as changes in the mental properties of a person during different types brain pathology. It reveals the processes that mediate the relationship of psychopathological manifestations with their pathobiological mechanisms, contributes to the knowledge of the nature of mental illness and the solution of clinical practice problems. If general psychology investigates the patterns of formation of mental processes, then pathopsychology studies the patterns of their violation. Pathopsychology studies not only painful manifestations, but also the intact aspects of the psyche.
TO tasks pathopsychology include:
Structure analysis mental disorders;
Establishing the degree of violation compared with the norm;
Differential diagnosis, for example, differentiation of schizophrenia and psychopathy, neurosis and schizophrenia;
The study of personality characteristics (for example, in order to identify the role of personality in the development of psychogeny, the study of the structure and individual typological characteristics of the personality to establish pathogenetic patterns and develop adequate psychotherapeutic techniques, determine psychotherapeutic targets, develop individualized rehabilitation programs);
Evaluation of the effectiveness of psychopharmacotherapy.
Neuropsychology. It is a branch of clinical psychology, but can also be an independent science. It is located at the intersection of three disciplines: psychology, neurology and neurosurgery. The subject of neuropsychology is the study of the localization of mental functions, the correlation of psychological functional structures with morphological cerebral macro- and microstructures in the norm, but understood through pathology. With the help of neuropsychology, topical diagnosis of local brain lesions is carried out, methods for restoring lost mental functions are developed, brain systems responsible for perception, speech disorders and purposeful conscious activity are studied, and mental functions are modeled.
Neuropsychology as a science is quite young - it is just over a hundred years old. It arose during the struggle localizationism And equipotentialism. Supporters of the latter direction believed that the degree of conduct disorder depends on the mass of the affected or removed brain substance. The basis of modern ideas about the localization of functions in the cerebral cortex was laid by the French scientist P. Broca, who in 1861 described the motor center of speech. The German psychiatrist K. Wernicke in 1873 discovered the center of verbal deafness (impaired understanding of speech). Thus, there was a selection of brain regions responsible for certain mental functions. In 1934, K. Kleist developed a localization map of mental functions. However, clinical observations have shown that a violation of complex mental processes (speech, writing, reading, counting) can occur with cortical lesions of various locations, which served as the basis for the formation of such a direction as antilocalizationism. The principles of the diagnostic approach emerged as an attempt to overcome narrow localizationism. Gradually, ideas about the dynamic systemic localization of mental functions (dynamic structures) were formed. The development of this doctrine was facilitated by the works of I.P. Ukhtomsky and A.A. Pavlov; its final principles were formulated by I.M. Sechenov in his work “Reflexes of the Brain”.
Psychological examination. Depending on the scope of its application, the following types are distinguished:
labor- objectifies the complaints of patients;
judicial- studies the psychological characteristics of offenders, the motives of the crime;
military - evaluates the compliance of the characteristics of human mental activity with the requirements of modern military equipment.
With the help of experimental psychological methods, fatigue is determined during various types labor (monotonous, dynamic, continuous, intermittent, automated, creative, motor, sensory), as well as the structure of intellectual impairment (the ratio of the ability to learn new things, abstraction, constructive thinking and its practical use in a specific objective activity).
Psychohygiene at the same time it is a section of clinical psychology and a branch of general hygiene (from the Greek psyche - soul, hygieinos - bringing health, healing). It is the science of providing and maintaining mental health. The purpose of mental hygiene is to develop a system of measures aimed at the formation, maintenance and strengthening of mental health, ensuring the harmonious development of the individual and determines the conditions necessary for the full manifestation of its positive properties in all areas of activity, develops recommendations on working and living conditions.
The following sections are distinguished:
Psychohygiene of family and marriage;
Psychohygiene of work and training (psychohygiene of mental work), focused on the formation of skills of mental work, the fight against monotony, the solution of psychological problems of leadership, the creation of a healthy psychological climate in the team;
Psychohygiene of life;
Age-related psychohygiene, for example, gerontopsychohygiene.
Both purely personal reasons (“biographical crises”) and social factors can have an adverse effect on a person’s mental health. Personal causes include family situations (marital problems, adultery, divorce, illness and death of a spouse, another relative, etc.) and domestic (housing and financial problems) nature. Among the factors of the social environment that have a destructive effect on the human psyche, there are: unfavorable environmental conditions; high pace of life and urbanization; complication of professional activity; heavy workload (overload) with work; loss and risk of job loss; long distance between work and home (traffic stress); insufficient wages and economic incentives.
Psychoprophylaxis It is aimed at preventing recurrence of diseases, reducing the duration of exacerbations, preventing the transition of diseases to a chronic form, social, psychological, labor rehabilitation and readaptation of patients. Psychoprophylaxis is divided into primary, secondary and tertiary psychoprophylaxis, each of which has its own tasks.
Primary prevention- this is a warning mental illness. It includes carrying out psychohygienic measures; creation of a healthy psychological climate in the workplace; training in psychohygienic skills. The effectiveness of primary prevention is determined by the rate of morbidity reduction and depends on the possibility of eliminating the etiological factors of diseases. For example, the normalization of microsocial circumstances and the prevention of psycho-emotional stress can prevent the development of borderline mental disorders. The leading role in providing primary psychoprophylaxis belongs to research and out-of-hospital institutions, which, using epidemiological and other methods, study etiological factors and determine the risk contingent.
Secondary prevention aimed at preventing the chronicity of mental illness; its effectiveness is evaluated in terms of pain.
Tertiary psychoprophylaxis focused on social and labor rehabilitation of patients, prevention of recurrence of existing diseases, disability, disability. This type of prevention is assessed by the dynamics of disability.
Sanitary and educational work is a treatment and prevention activity, the purpose of which is to involve the population both in individual prevention and participation in therapeutic measures, and in wider public prevention, i.e. above all to create a healthy living environment.
The most important areas of health education include:
Mental hygiene;
Prevention of neuroses;
sex education;
Maternal and child health care.
There are two forms of health education:
collective, aimed at the general population, at healthy individuals, both in general and purposefully (at certain groups of the population: for example, workers in hazardous production, patients with a particular disease, patients in one department of a hospital);
individual, which is in the nature of a short conversation with one patient and / or his relatives. Individual health education accompanies the entire treatment process.
It is useful in cases where it is constructive, i.e. focused on promoting ways of recovery, not intimidation. At the same time, the quality of psychological contact and personal characteristics of a medical worker play an important role, since his bad habits and views may conflict with the goals of health education. For example, a person who is addicted to tobacco will be less persuasive in promoting abstinence from smoking.
Psychological correction- this is a directed impact on psychological structures in order to ensure the normalization of the functioning of the individual.
This term became widespread in the early 70s of the last century. From a formal point of view, it is now generally accepted that a doctor is engaged in psychotherapy, and a psychologist is engaged in psychological correction. Other terms also appeared: “non-medical psychotherapy”, “non-clinical psychotherapy”, “psychological psychotherapy”. However, the question of the relationship between the concepts of "psychotherapy" and "psychological correction" remains open, and at present it is only possible to formulate two new points of view on this problem. The first of these is to recognize the complete identity of these terms. But this does not take into account that psychological correction as a purposeful psychological impact is realized not only in medicine in the field of psychoprophylaxis, treatment and rehabilitation, but also in other areas of human practice: for example, in pedagogy, labor organization. Another point of view is based on the fact that psychological correction is mainly designed to solve the problems of psychoprophylaxis, and its importance especially increases in the implementation of secondary and tertiary prevention. Psychological correction is aimed at solving the following problems:
Development of the psychological foundations of psychotherapy;
Improving the effectiveness of rehabilitation, which is a system of state, socio-economic, medical, psychological and pedagogical measures aimed at preventing the development of pathological processes leading to temporary or permanent disability, at the return of sick and disabled people to society and involving them in socially useful work .
Psychological counseling- this is help to a person in finding ways to solve his problems of a psychological nature. Currently, it is widely used in various areas of human practice: for example, school, professional, organized counseling. All these types psychological help based on knowledge about the characteristics of the socio-psychological aspects of interaction, group dynamics, etc. There are three main approaches to counseling:
1) problem-oriented consulting, based on the analysis of the essence and external causes of the problem and ways to resolve it;
2) personality-oriented counseling, aimed at studying the individual, personal causes of conflict situations and ways to prevent them in the future;
3) counseling focused on identifying the problem.
Obviously, person-centered counseling is close to psychotherapy in its focus. The definition of psychotherapy as work with the sick and as counseling with the healthy cannot be considered satisfactory. For example, psychological counseling is used in pregnant women with neurosis-like disorders, in patients with organic diseases, in people with serious personality disorders. At the same time, it is essentially no different from psychotherapy. The similarity of psychotherapy and psychological counseling lies in the fact that they use psychological means of influence; used for prevention and treatment; have as their goal the achievement of positive changes in the cognitive, emotional and behavioral spheres; contain psychological theories as their scientific basis; need empirical verification; carried out within a professional framework.
Some authors believe that there are a number of differences between psychotherapy and counseling, since psychological counseling is a process focused on prevention, and its task is to teach people to help themselves, to become their own consultants. The difference between psychotherapy and psychological counseling is also seen in the fact that psychotherapy focuses on personal reconstruction, while counseling focuses on helping a person make better use of resources and improve the quality of life. Unlike psychotherapy, much of the information gained in counseling is manifested in the mind of the patient during periods when he is trying to help himself on his own.
Thus, psychotherapy and psychological counseling can be considered as types of psychological intervention aimed at achieving positive changes in the cognitive, emotional and behavioral spheres, and differ in the following ways:
functions: psychotherapy is used mainly for treatment, while psychological counseling is mainly used for prevention and development;
means of influence: informing during counseling various therapeutic techniques in psychotherapy;
purposes: psychotherapy is aimed at personal changes, its counseling is aimed at helping a person use his own resources and improve the quality of life;
duration of impacts: counseling may be limited to one meeting, while psychotherapy involves at least several sessions;
time of change: in counseling - at the end of it, in psychotherapy - in its process;
degree of patient autonomy: in counseling, changes occur without the support of a consultant, and in psychotherapy - with the participation of a psychotherapist.
In psychological counseling, various theoretical approaches are used (for example, psychodynamic). Regardless of the theoretical orientation of the specialist, the following main tasks of psychological counseling can be distinguished:
Emotional support and attention to the experiences of the client;
Increasing the psychological competence of the client;
Change of attitude to the problem (from impasse to the choice of a solution);
Increasing psychological tolerance;
Development of realism and integrity of the worldview;
Increasing the responsibility of the patient and his readiness for the creative exploration of the world.
Stages of psychological counseling.
Establishing contact.
Giving the client the opportunity to speak out (sometimes this helps the person begin to better understand the problem and independently find ways to solve it).
Providing emotional support to the client and explaining his problem situation.
Joint problem solving with the client.
Conclusion of a dynamic contract (explaining the organizational aspects and share of responsibility of the client, correcting unrealistic expectations of the patient).
Register definition possible solutions problems (the consultant offers his professional and life experience only after the client has suggested 2-3 possible solutions).
Choosing the optimal solution from the patient's point of view.
Consolidation of motivation and ways to implement the chosen solution.
Completion of counseling with the right to re-contact the patient if necessary, or appointment of a subsequent support meeting.
Clinical interview this is a method of obtaining information about the individual psychological properties of a person, psychological phenomena and psychopathological symptoms and syndromes, the internal picture of the disease and the structure of the patient's problem, as well as a method of psychological influence on a person, produced directly on the basis of personal contact between the psychologist and the client.
The interview differs from the usual questioning in that it is aimed not only at complaints actively made by a person, but also at revealing the hidden motives of a person’s behavior and helping him to realize the true (internal) grounds for the changed mental state. The psychological support of the client (patient) is also considered essential for the interview.
Conversation and analysis of anamnestic information. A conversation with a patient is both a tool for both the formation and maintenance of psychological contact. It, as a rule, accompanies an experimental study, therefore, it should be aimed at forming in the patient an adequate attitude to the diagnostic procedure and motivation for self-knowledge, his mobilization for the implementation of techniques. During the conversation, the psychologist not only receives the information he needs, but also exerts a psycho-corrective effect on the patient, the results of which, obtained by the feedback mechanism, provide valuable diagnostic information. The conversation method refers to dialogic (interactive) techniques that involve the entry of a psychologist into direct verbal and non-verbal contact with the subject. This requires the use of a special technology for conducting a conversation, which, along with other components, implies control by the researcher of his own state and the ability to win over the interlocutor, which is possible if the psychologist understands the patient's condition, positively evaluates and accepts it, behaves naturally (authentically). The method of conversation consists in the analysis of the factors of a person's mental activity, collected in the process of direct contact with the patient.
In order for a clinical conversation to give the desired result, it is necessary to first outline the purpose and main questions of the conversation. All formulations must be clear to the patient. A necessary condition for the success of the conversation is a relaxed atmosphere that helps the patient sincerely answer the questions posed. The patient is not recommended to be interrupted, and if necessary, it is necessary to correctly ask additional questions that clarify the picture of the disease. During the conversation, the researcher receives anamnestic information about the patient's life, his labor activity, relationships with others, about the reasons with which the patient himself associates his disease. The attitude of the patient to the fact of the disease is clarified: an exaggeration of its severity or a lack of adequate awareness of the disease.
During the conversation, the presence or absence of characteristic psychological signs is determined and, on this basis, the mental status (state) of the patient is described. The anamnesis is divided into subjective (what the patient tells about himself) and objective (what the surrounding relatives, friends, colleagues report about the patient). This information complements each other, and the facts of the anamnesis receive objective significance.
Observation - this is a method of collecting primary information about the object under study by direct perception and direct registration of facts that are significant for the purposes of the study. Using the method of observation, they study mental processes (memory, thinking, attention), mental properties of a person (temperament, character, abilities), mental states (anxiety, depression). When using this method, the study of mental phenomena is carried out in natural living conditions. It differs from a natural experiment in that the psychologist is in the position of a passive observer and is forced to wait until he can again observe the phenomenon of interest to him. The main advantage of the method of observation over other psychological methods is that it does not disrupt the normal course of the studied mental phenomenon. Observation can be considered a method of psychological research only when it is not limited to the statement of facts and their description alone, but becomes the basis for a scientific explanation of the psychological nature of these phenomena and their relationship with other processes.
There are several types of observation. Introspection- analysis of one's actions and feelings, assessment of one's attitude towards other people and their attitude towards oneself. External observation is observation from the outside. free observation does not have pre-established frameworks and programs, and standardized, on the contrary, is predetermined and carried out according to a clear program. Included observation involves the personal participation of the psychologist in the study, when he turns into a homeless person, a religious fan, etc. At hidden observation, you can observe a person imperceptibly.
When using the method study of products of mental activity the characteristics of the patient's personality are judged by such materials as his writings, drawings, etc. This method is often used in psychiatric hospitals and psychological laboratories.
Experiment - This is a method that involves the active intervention of the researcher in the activities of the participant in the experiment in order to create conditions for testing a hypothesis.
A psychological experiment is a model of a life situation that is able to identify (objectify) the features of both individual mental functions and personal properties, attitudes, and motives for the activity of patients. Conditions are created in which the peculiarities of the patient's psyche, which are of interest to a specialist, can be clearly identified. Conducting an experiment in a clinic differs from an experimental psychological study of healthy people. The disease leaves an imprint on the pace and other dynamic characteristics of mental activity, on understanding the meaning of questions and the patient's attitude to the research procedure. The psychologist must take into account the relationship of these factors.
An experiment in psychology always involves the participation of people, which creates additional moral and ethical problems. First, people can be experimented on only with their consent. Secondly, experiments that can cause harm should not be done at all. Thirdly, the course and results of the experiment essentially depend on how the participants understand the goal, where, when and by whom the experiment is conducted, how the experimenter behaves, etc. In this regard, the experiment is used much less frequently than other methods.
The experiment can be laboratory when it takes place in specially created conditions, and the actions of the participants are determined by the instructions; natural when the study is carried out in natural conditions (for example, the development of deaf-blind-mute children); ascertaining when psychological phenomena are studied; formative, if certain psychological qualities of the participants in the experiment develop in its process.
Testing – it is a standardized and specialized method of psychodiagnostics, with the help of which it is possible to obtain a quantitative or qualitative characteristic of the phenomenon under study. Testing makes it possible to quickly assess the mental phenomenon and / or the level of its development in patients. The quantitative indicators obtained using the test are compared with the results obtained using the same test in many people, taking into account age, education, etc.
Psychodiagnostics is a procedure for assessing the individual psychological properties of a person.
Distinguish test task, assuming an estimate psychological qualities a person based on what he does; test questionnaire, based on a system of pre-selected and tested questions in terms of their validity (suitability) and reliability; projective test, which can be used to study processes that are not realized by a person.
5. The concept of health. Basic criteria for health. Health-related quality of life (SF-39).
In 1948 World Organization Health has defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or incapacity”. In medicine, the belief is emerging that the good health and well-being of the individual is a reflection of his psychological, social and physical adaptation.
In addition to the analysis of traditional indicators of public health, such as morbidity and mortality, there is a search for new ways to assess the effectiveness of health care. On present stage In the development of medicine, the problem of not just the “survival” of the patient, but also the quality of his life, is becoming more and more urgent. Currently, some analogy is being drawn between the category "quality of life" and the concept of "health", when the quality of life is understood as a kind of harmony within a person and between a person and the world, which the patient, doctor and society aspire to.
Initially, the idea of quality of life was intended to contribute to the process of humanization modern society as a philosophical category that reflects the degree of satisfaction of the needs of the individual. In sociology, the quality of life is a category that characterizes the assessment of the degree of satisfaction of needs, indicators of the content of work and leisure, satisfaction with them, the level of comfort in work and life, the quality of food, clothing and household items, the quality of housing, residential and environment in general, the quality of functioning social institutions, service sectors, the level of satisfaction of needs in communication, knowledge, creativity. They interpret the quality of life as identical to the way, level, style and way of life, others consider the quality of life and standard of living as mutually opposite concepts (the higher the standard of living, the lower the quality of life, and vice versa), others reduce it to the severity of stressful situations or the quality of the environment. environment.
Since the 70s of the XX century, the concept of "quality of life" has been introduced into world medicine, and the medical aspects of this problem - the quality of life associated with health - are being actively developed.
Allocate subjective and objective assessment of the quality of life, complementary to each other.
An objective way of measuring the quality of life is its assessment by another person (expert), usually a doctor or psychologist. Objective indicators of a person's quality of life include the level of his well-being, ability to work, physical activity, etc.
The subjective method is based on self-assessment. The subjective component of the quality of life reflects the satisfaction of the individual with his life, as well as his emotional state, which brings this category closer to the concept of the internal picture of the disease as a set of experiences and sensations of the patient, his emotional reactions to the disease and treatment, as well as certain ideas about the disease.
The quality of life is formed under the influence of the combined influence of somatic and psychological factors, in particular the severity and characteristics of the course of the disease, the personal characteristics of patients.
As an example of assessing the quality of life in patients with somatic diseases, the nozone-specific questionnaire SF-36 can be cited. this questionnaire allows you to analyze the satisfaction of patients with the level of their physical, mental and social functioning using several scales.
1. Physical functioning, reflecting the extent to which health limits physical activities such as self-care, walking, climbing stairs, carrying heavy loads, bending over, etc.
2. Influence physical condition on role functioning (work and performance of everyday activities).
3. Intensity of pain and its limiting effect on the ability to carry out normal activities, including work at home and outside the home.
4. General state of health - the patient's assessment of the state of his body at the moment and the prospects for treatment; disease resistance.
5. Vitality, or vitality (flux of vitality), which implies a sense of self full of energy and energy or, conversely, demineralised.
6. Social functioning - the degree to which the physical or emotional state limits social activity (communication).
7. Impact of emotional state on role functioning - offers an assessment of the degree to which the emotional state interferes with the performance of work or other normal daily activities, including a large expenditure of time, a decrease in the volume of work, a decrease in its quality.
8. An assessment of mental health that characterizes mood (presence of depression, anxiety, general indicator of positive emotions).
9. Comparative assessment of the state of one's health in relation to the one that was a year ago. Reflects a prognostic assessment of the prospects for treatment.
To resolve the issue of choosing a treatment method, when therapeutic goals are mutually exclusive and there is a choice between the quality or quantity of the patient's life, as, for example, in the case of substitution therapy;
For the timely diagnosis of disorders in the personal and interpersonal sphere of patients that have arisen in connection with the disease;
When evaluating the effectiveness of clinical trials and the activities of various health services;
To assess the success of the treatment of chronic diseases along with traditional indicators (survival rate, hospitalization rate, disability of patients, etc.);
As an integral indicator of the effectiveness of treatment and rehabilitation.
The possibility of using the quality of life for other purposes is also predicted, for example, to assess the severity of the patient's condition, in particular in the dynamics of the progression of the disease, as well as to conduct an examination of disability.
6. The main directions of modern psychology. Currently, there are 5 main approaches to the study of the human psyche: behaviorism, Gestalt psychology, psychoanalysis, humanistic psychology, cognitive psychology.
Behaviorism. The founder is the American psychologist John Watson (1878-1958). He proposed S-R scheme means that each situation (or stimulus S) corresponds to a certain behavior (or reaction R). He believed that with the help of this scheme, any human activity can be explained, and concepts related to consciousness should be excluded from scientific psychology.
Pretty soon, the limitations of this scheme for explaining behavior began to be traced. As a rule, S and R are in such a complex relationship that a direct connection between them cannot be established. The introduction by Tolman in 1948 of an intermediate variable I (the mental processes of a given individual, depending on his heredity, past experience and the nature of the stimulus) transformed the scheme into S-I-R.
Adherents of behaviorism believe that behavior is mainly conditioned reflex and is formed as a result of learning, i.e. fixing certain reactions to certain stimuli. As a result, encouraged actions are performed more often, and punished less often. Behaviorism is the psychological basis of behavioral psychotherapy and behavioral direction in medicine. In this context, health and disease are seen as the results of what a person has learned or not learned in life. In accordance with this, the goal of behavioral psychotherapy is the elimination of a pathological symptom by replacing non-adaptive behaviors with adaptive ones in the process of learning.
Gestalt psychology. The word "gestalt" does not have an exact equivalent either in Russian or in English. Very approximately, its meaning, depending on the context, can be conveyed by the words “image”, “form”, “structure”, “organized whole”, therefore, in psychological texts, “gestalt”, as a rule, is not translated.
The main position of Gestalt psychology is that a phenomenon as a whole is simply the sum of its parts. Human behavior, broken down into separate components, loses its meaning. A single part does not give any idea of the whole. Followers of Gestalt psychology try to convince behaviorists that the structural organization of behavior as a whole plays a more important role than individual actions.
One of the central concepts of Gestalt psychology is the relationship between figure and ground. This and other concepts of Gestalt psychology are reflected in Gestalt therapy, created by the psychologist and psychotherapist F.S. Perls.
In Perls' understanding, the figure acts as a dominant need. As a figure (gestalt) there can be desire, thought, feeling that prevail at the moment. As soon as the need is satisfied, the gestalt ends, loses its significance, recedes into the background - the background, giving way to a new gestalt.
Sometimes a need cannot be met. In this case, the gestalt remains incomplete, and therefore cannot be reacted and cannot give way to another. In the future, this becomes the cause of many problems. For example, if a person does not immediately express his anger or aggression, then later these feelings will not disappear, but will manifest themselves in other forms.
The goal of Gestalt therapy is to help the patient recognize his need, make it clearer (form a gestalt) and, ultimately, satisfy it.
To be oneself, to realize one's own needs, and not those imposed from outside, is the path of a healthy personality.
Psychoanalysis. The founder is the Austrian psychiatrist Sigmund Freud.
In mental life, Freud distinguishes 3 levels: consciousness, preconscious and unconscious. The unconscious and preconscious are separated from the conscious by "censorship". “Censorship” pushes into the area of the unconscious thoughts, feelings, concepts that are unacceptable to the individual (for example, a boy’s attachment to his mother, accompanied by hostility to his father), and also resists the unconscious, which seeks to manifest itself in consciousness.
TO unconscious include many instincts that are generally inaccessible to consciousness, and also supplanted by "censorship". These thoughts and feelings are not lost, but are simply not allowed to be remembered and therefore appear in consciousness not directly, but in a roundabout way - in slips of the tongue, typos, memory errors, dreams, neuroses.
preconscious The part of the unconscious that can become consciousness.
Freud believed that only 1/7 of the mental life is conscious, and the remaining 6/7 are manifested in obsessions, vague anxieties, fears, dreams, etc. At the bottom of the "iceberg" are the main reserves of psychic energy, motives, instincts. Freud tried to reduce a wide variety of instincts to two groups: life-supporting (sexual) and life-destroying (destructive).
Life-supporting instincts have sexual energy - libido (lat. desire), destructive instincts - aggressive energy. Our mental life is the result of the interaction and mutual influence of these energies.
The psychoanalyst is always trying to understand the processes of placing libidinal and opposite energies into various spheres of human mental activity and to redistribute them. Detection and canalization of psychic energy is one of the main problems of understanding personality.
Analyzing the dynamics of the development of the individual, Freud identified the following stages of psychosexual development: from birth to 1 year - the oral stage; from 1 year to 3-4 years - anal stage; from 3-4 years to 5-6 years - the phallic stage; from 6 years to the onset of puberty - a latent period; the stage of puberty is the genital stage. With the normal development of the personality, sexual ideas are completely forced out into the sphere of the unconscious, and the images corresponding to them are sublimated, i.e. reoriented from socially unacceptable to acceptable. Often the repression of ideas is not complete. There is a fixation at one of the stages, manifested, for example, in the habit of biting nails, smoking, masturbating; in the formation of excessive accuracy, stubbornness. Sexual preferences may change.
In the structure of personality, Freud distinguishes Id, Ego, super-ego (It, I, super-I). eid- this is the initial, central part of the personality, serves as a source of energy for the entire personality and at the same time is completely unconscious. Freud compares the Id to a blind and deaf dictator with unlimited power who can rule through intermediaries. Ego develops from Id. the ego is constantly under the influence of external (means) and internal (Id) impulses. Gradually developing, the ego gains control over the demands of the id. super ego develops from the ego and is its judge and censor. This is a repository of attitudes and norms of behavior developed by society.
The main goal of the interaction of the three systems is to maintain or restore, in case of violation, the optimal level of the individual's mental life. Since the demands on the ego from the id, the superego and the environment are sometimes incompatible, the individual can be permanently in a situation of conflict. The ego protects itself from the tension experienced in this case with the help of defense mechanisms. These include repression, sublimation, projection, denial, rationalization, reactive formations, isolation, regression.
Psychoanalysis as a psychotherapeutic method aims to help the patient realize the cause of his internal conflicts through the expression of free associations and their interpretation by the psychoanalyst.
Currently, psychoanalytic therapy has become widespread, which is based on the principles and methods of classical psychoanalysis, but is less intense and is aimed at the patient's self-knowledge of his inner mental life.
Humanistic psychology . It originated in the USA thanks to the works of Carl Rogers (C. Rogers) and Abraham Maslow (A. Maslow). Psychologists of this direction believe that each person can achieve the fullest realization of his abilities, if he is given the opportunity to choose his own destiny and direct it.
According to Rogers, each person has the desire to fully realize himself, and he is endowed with the necessary forces for this, but education and social norms often force him to accept other values.
Maslow, who created the hierarchy of needs, believed that people's ability to satisfy their basic needs is very often limited. “It can be estimated that more than 90% of people stop at the level of seeking security and good relations, absorbing all their energy.” This hinders the satisfaction of more high level, such as self-esteem self-actualization.
Maslow believed that only a self-actualizing personality can be recognized as truly healthy. In an effort to highlight the objective indicators of self-actualization, he compiled objective indicators of self-actualization, he compiled a list of characteristics of self-actualizing people, on the basis of which one can get a portrait of a healthy personality and outlined the ways in which self-actualization can be achieved.
Humanistic psychotherapy is one of the three main areas of modern psychotherapy. Representatives of this direction tend to see a person as an innately active being, increasing his capabilities, with an almost limitless ability for positive growth. pathology is understood as the result of blocking the possibilities of satisfying needs: “Neuroses are errors personal development". The psychotherapist's efforts are aimed at personal growth, and not just at the treatment of the disease.
cognitive psychology (English cognition - knowledge) - a direction in psychology, in which the main attention is paid to cognitive activity and internal thought processes. Cognitive psychologists are interested in how we think, remember, form our ideas about ourselves and the world around us. Currently, cognitive psychology studies dreams, hypnosis, meditation, and the effects of various drugs on the thinking process.
The main tasks of cognitive psychotherapy are the patient's awareness of inadequate ways of processing information and replacing them with adequate ones. For psychotherapy to be successful, the patient must generally accept the basic premise of cognitive psychotherapy: "If we want to change feelings, we must change the ideas that give rise to them."
Electism.
As emphasized above, each of the directions (behaviorism, Gestalt psychology, psychoanalysis, humanistic psychology, cognitivism) has its own idea of the human psyche, its origin and formation. This caused a lot of conflicts between schools, but now the disputes are dying down. As such, more and more psychologists are taking the electrical approach, using the most appropriate methods for the particular situation.
USED BOOKS:
Clinical psychology / Ed. M. Perret, W. Baumann. - 2nd ed. - St. Petersburg: Peter, 2003. - 1312 p.
Clinical Psychology: Textbook / Ed. B.D. Karvasarsky. - St. Petersburg: Peter, 2002. - 960 p.
Lakosina N.D., Ushakov G.K. Tutorial in medical psychology. - M.: Medicine, 1976. - 320 p.
Sidorov P.I., Parnyakov A.V. Clinical psychology: Textbook. -2nd ed., add. - M.: GEOTAR-MED, 2002. - 864 p.
Mendelevich V.D. Clinical and medical psychology. Practical guide. - M.: MEDpress, 1998. - 592 p.
Khomskaya E.D. Clinical psychology and neuropsychology: whole or part? // Issues of psychology. - 2003. - No. 5. - S.33-46.
Topic 1. Subject and structure of clinical psychology Plan
The subject of clinical psychology.
The history of the origin and development of clinical psychology
The main sections of modern clinical psychology.
Subject of Clinical Psychology
Ideas about the subject of clinical psychology are closely connected with its history and have undergone certain changes in the course of this history. Clinical psychology as a field of psychological science is directly related to medicine, therefore, for a long time, clinical psychology was understood rather narrowly as a branch of medical psychology, a science that arose at the intersection of medicine and psychology. Medical psychology was presented as "...a branch of general psychology that studies the state and role of the mental sphere in the occurrence of human diseases, the features of their manifestations, course, outcome and recovery" (Snezhnevsky, 1972). In other cases, clinical psychology was also defined as a branch of medical psychology, “the subject of which is the needs of the clinic - psychiatric, neurological, somatic; solution of immediate diagnostic problems of clinical medicine, based on psychological theories and psychological methods developed on their basis” (Polyakov, 1985).
Shraml (1970) was one of the first to suggest that clinical psychology should be understood as much broader than just psychology in the clinic. Recently, there has been a process of integrating clinical psychology into world psychology, where it is customary to understand clinical psychology as “a private psychological discipline, the subject of which is mental disorders (disorders) and mental aspects of somatic disorders/diseases. This includes the following sections: etiology (analysis of the conditions for the occurrence of disorders), classification, diagnosis, epidemiology, intervention (prevention, psychotherapy, rehabilitation, health care, assessment) ”(Perret, Bauman, 2002). To date, the following definition of clinical psychology seems to be the most adequate to the state of domestic and Western research and practice. Clinical psychology – “this is a part of psychological science that uses the conceptual apparatus of psychology, studies psychological disorders in mental and somatic disorders, as well as developmental deviations (including manifestations, dynamics, psychological and neuropsychological factors and mechanisms of these disorders), develops principles and methods of psychological diagnosis, prevention and help with various mental disorders, while clinical psychology relies on psychological knowledge about the normal development and functioning of the psyche "(Kholmogorova, 2003).
The history of the origin and development of clinical psychology
The formation of clinical psychology as one of the main applied branches of psychology is inextricably linked with the development of both psychology itself and medicine, physiology, biology, anthropology; its history begins in ancient times, when psychological knowledge was born in the depths of philosophy and natural science.
The origin of scientific clinical psychology dates back to the end of the 19th century, when the American L. Whitmer (1867-1956), who studied under Wundt in Leipzig, introduced the concept of clinical psychology, founding the first psychological clinic and the first special clinical psychological journal. But even earlier, Wundt's experimental methods penetrated into Kraepelin's psychiatric clinic, the first experimental psychological laboratories in Russia were opened in 1885 by Bekhterev in Kazan, Korsakov in Moscow, Sikorsky in Kiev. In the 20s of the 20th century. The first monographs on medical psychology by Kretschmer, Zhane, and others appear. Psychological laboratories are actively developing, in which experimental psychological methods are created for the study of patients with mental disorders. Among domestic scientists, the greatest contribution to their creation was made by Bekhterev, Rossolimo, Bernstein, and others. In Russia, the development of clinical psychology after the revolution went in line with the general development of psychology. Such outstanding psychologists as Vygotsky, Myasishchev, Luria, and others played an important role in the formation of its foundations. Humanistic ideas penetrate clinical psychology, and psychotherapy becomes one of the main forms of psychological assistance. A holistic approach focused on the activation of the patient's potential reserves becomes dominant. Within the framework of this approach, psychodiagnostics and psychological assistance are aimed not so much at identifying deficient as well as intact aspects of the patient's personality, developing the ability for spiritual growth, ways of coping with painful conditions.
A) Lectures
LECTURE 1-2. TOPIC: SUBJECT, STRUCTURE AND DEVELOPMENT OF CLINICAL PSYCHOLOGY (4 hours)
Plan:
- Subject, main sections and tasks and methods of clinical psychology
- From the history of the development of clinical psychology
- Ethical models of clinical psychologists.
Introduction to Clinical Psychology
Before discussing the subject and the current state of clinical psychology, it is necessary to consider and correlate the various concepts that exist to designate this field of knowledge. This area began to form at the end of the 19th century. The main impetus for its formation was the turn of psychology from studying theoretical questions about the structure of the human psyche to solving practical, applied tasks. There are several main sources of development of clinical psychology:
1) the creation by progressive psychiatrists of that time of psychological laboratories for the purpose of experimental study of mental functions disturbed as a result of illness (E. Kraepelin, P. Zhane, V.M. Bekhterev, S.S. Korsakov and others);
2) the creation of psychological tests by F. Galton and J. Cattell and the emergence of differential psychodiagnostics;
3) the organization by L. Witmer of the first consultative psychological center for children with various problems and the emergence of psychological and pedagogical counseling;
4) the development of the psychological theory of neuroses by Z. Freud based on the experience of working with patients with hysteria and the emergence of a psychoanalytic method of treating mental disorders.
The border area between psychology and medicine has become the main space for the formation of clinical psychology. To designate it, different authors at different times and in different senses used the following terms: clinical psychology, medical psychology, pathopsychology, abnormal psychology. Czech researchers R. Konechny and M. Bouhal back in the 1980s. paid much attention to the problem of terms, noting its extreme complexity, the chaos of views and opinions that reigns here. In particular, they noted that the terms clinical psychology and medical psychology are interpreted either extremely narrowly or, on the contrary, very broadly, covering all areas of psychological developments in medicine and, in fact, merging with each other. At present, there is still no unanimity of opinion regarding each of these terms, however, some general trends in their interpretation have been outlined.
In Soviet psychology, the terms pathopsychology and medical psychology became widespread, and the term clinical psychology until the 1980s. practically not used. The term abnormal psychology was discussed by a number of authors, but was also practically not used until 2004.
Term pathopsychology was used by representatives of Moscow and Ukrainian psychological science. pathopsychology , by definition B.V. Zeigarnik ( explores the structure of mental disorders,
patterns of its decay in their comparison with the norm, at the same time, a qualification of pathopsychological phenomena is given in terms of modern psychology). With this understanding of psychological tasks, the Moscow school was long time(1960-1970s) is mainly focused on solving fundamental theoretical questions about the mechanisms of the psyche.
The research focused on studying the nature of mental disorders in severe mental and somatic diseases and on the tasks of psychological diagnostics (B. S. Bratus, M. A. Kareva, V. V. Nikolaeva, S. Ya. Rubinshtein, E. T. Sokolova and others .).
A great contribution to these studies was made by the staff of the Department of Patho- and Neuropsychology of the Faculty of Psychology of Moscow State University. M.V. Lomonosov, as well as employees of the laboratory of pathopsychology of the Center for Mental Health of the Russian Academy of Medical Sciences, who, under the guidance of Yu.F. Kritskaya, N.S. Kurek, T.K. Meleshko, T. D. Savina and others). Among the Ukrainian psychologists who made an important contribution to the development of pathopsychology, we should mention V.M. Bleikher, L.F. Burlachuk and others.
Child pathopsychology has become a special field of knowledge, designed to investigate mental disorders and developmental deviations in children. childhood(I.A. Korobeinikov, V.V. Lebedinsky, S.Ya. Rubinstein, A.S. Spivakovskaya and others).
Term medical psychology was used mainly by representatives of the Leningrad psychological school. According to this tradition, medical psychology studies: a) mental manifestations of various diseases in their dynamics; b) the role of the psyche in the occurrence, course and prevention of diseases; c) the influence of various diseases on the psyche; d) developmental disorders of the psyche; e) principles and methods of psychological research in the clinic; g) the nature of the relationship of a sick person with medical personnel and the microenvironment surrounding him; h) psychological methods of influencing the human psyche in medical and preventive institutions (Lebedinsky M.S., Myasishchev V.N. - 1966; Kabanov M.M., Karvasarsky B.D. - 1978; Karvasarsky B.D. - 1982) .
In this understanding, the focus of medical psychology on solving practical problems is clearly visible. Accordingly, the psychological aspects of the etiology of neuroses, the issues of psychotherapy and rehabilitation were most actively developed in the Leningrad school.
So, in the Moscow school until the 1980s. The most important focus of attention was the theoretical issues of the norm and pathology, while in the Leningrad one - practical psychological problems within the framework of medicine. In addition, historically it turned out that the development of clinical psychology problems in the Moscow school was mainly carried out by psychologists with a basic psychological education, while in the Leningrad school many doctors with a basic medical education. This often led to disputes and disagreements, which aggravated in the 1990s. This time, the disagreements concerned the subject of clinical psychology, its relationship with medicine and general psychology, as well as questions vocational training clinical psychologists. Some of the results of this discussion were reflected in the collection of abstracts dedicated to the 100th anniversary of B.V. Zeigarnik (Clinical psychology. Materials of the first international conference in memory of B.V. Zeigarnik. October 12-13. M., 2001).
Representatives of the Leningrad school (L.I. Wasserman, O.Yu. Shchelkova) insisted on the identity of the concepts of medical and clinical psychology, as well as on the recognition of clinical psychology as a medical specialty with the possibility of training doctors in clinical psychology as a second specialty. The same opinion was shared by VD Mendelevich (Yaroslavl).
Representatives of the Moscow school (Yu.F. Polyakov, E. D. Khomskaya) emphasized the inextricable link between clinical psychology and psychological science and the need for fundamental psychological training of clinical psychologists. E. D. Khomskaya also pointed out various contradictions in modern interpretations the subject of clinical psychology and the need for its further theoretical development as an interdisciplinary and complex one (Khomskaya E.D. - 2001).
Term clinical psychology was rarely used in domestic studies until the 1990s. Sometimes clinical psychology was interpreted as part of medical psychology (Bleikher V.M. - 1976; Ivanov V.N. - 1974; Platonov K.K. - 1972), while its significance was narrowed down to the area of interaction between the doctor and the patient (Platonov K. K. - 1972) or was considered by analogy with the relationship between clinic and medicine in a broad sense (Bleikher V.M. - 1976; Ivanov V.N. - 1974).
In the latter case, clinical psychology was understood as the field of medical psychology, the applied value of which is determined by the needs of the clinic - psychiatric, neurological and somatic (Bleikher V.M. - 1976. - P. 7), respectively, pathopsychology, neuropsychology and somatopsychology were included in clinical psychology (Ivanov V.N. - 1974).
In foreign psychology, the fate of the terms under consideration was different. The terms medical psychology and pathopsychology, widely used at the beginning of the century, gradually lost their popularity. The term medical psychology is now increasingly used to refer to the amount of psychological knowledge that a doctor needs to master, that is, to refer to a psychology training course for doctors (Enke H. et al. - 1977). It also usually includes deontological problems (the relationship between the doctor and the patient) and some others.
Term pathopsychology was used by W. Specht in 1912 to refer to the general psychological doctrine of mental disorders. However, due to the lack of uniform methodological and theoretical positions various Western researchers have identified different psychological theories of mental disorders, and a general psychological doctrine has not emerged. This, apparently, explains the fact that the term pathopsychology is used relatively rarely in foreign science. It can be found in the most fundamental European textbooks on clinical psychology, where pathopsychology is understood as a psychological theory of mental disorders (Bastine R. - 1998). On the contrary, the term clinical psychology, proposed by W. Wundt's student L. Witmer back in the 19th century, took root in America, and then spread to Europe. This term is by far the most capacious and popular. If at first this term was used mainly as an analogue of practically oriented applied psychology, then later it was assigned the status of a serious scientific field aimed at developing issues of psychodiagnostics. With the accumulation of knowledge about various mental disorders, clinical psychology outgrew the area of solving purely diagnostic problems, its area of competence expanded, more and more capturing issues of psychological assistance. Already in the 1950s and 1960s. psychologists in the United States were actively involved in counseling and psychotherapy. A little later, the same thing happened in Europe. At present, the term clinical psychology has acquired a collective meaning for a variety of both applied and theoretical fields of knowledge.
In Russia, only in the 1980s. due to historical circumstances, an active process of expanding the applied tasks of psychology began, in particular, the area of competence of psychology in medicine.
With the help of Western trainers and specialists, psychologists are actively involved in the process of teaching the basics of psychotherapy and psychological counseling. The term clinical psychology has become important for mutual understanding and integration into world science, and also quite adequate for designating the expanded zone of participation of psychology in the field of mental health. As a separate specialty, clinical psychology was approved in 2000 by order No. 686 of the Ministry of Education of the Russian Federation. The graduate qualification is presented as a Psychologist. Clinical psychologist. Psychology teacher. The standard term of study is 5 years. The educational standard states that clinical psychology, in terms of vocational guidance, the system of personnel training and the fundamental foundations of education, is a broad-profile psychological specialty that has an intersectoral character and participates in solving a set of problems in the healthcare system, public education and social assistance to the population. The object of scientific and practical activity of clinical psychology in the educational standard is defined as a person with difficulties in adaptation and self-realization associated with his physical, social and spiritual state. Currently, in connection with the transition to new European educational standards, the task is to develop and test master's programs in clinical psychology.
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