Psychological assistance to families in crisis situations. ==Psychological assistance in crisis situations.doc - Psychological assistance in crisis situations. Basics of crisis psychological assistance
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Concept of a crisis situation
A crisis situation is any deviation from the usual mode of functioning of the system
a person or its individual element, causing stress reactions and characterized by
the need to make non-standard decisions, mobilize personal potential and
the presence of both negative and positive consequences.
A crisis state is a phenomenon characterized by signs of irreversibility of individual
processes caused by a crisis situation, requiring larger-scale intervention in order to
preventing them from degenerating into a crisis.
Stages of development of the crisis process
A crisis state is a state or period characterized by experiences
client, if it is impossible to resolve difficult life situations. Crisis state
characterized by flow and output
Stages of development of the crisis process.
The crisis goes through 3–4 stages:
shock and numbness (ignoring traumatic events),
awareness of reality and search for meaning (anger, feelings of injustice, attempts
"destroy reality")
acute grief and despair (mental pain, difficulty concentrating, loss of energy),
reorganization and birth of a new one (creation of a memory image).
The following stages of the crisis state are distinguished (Ambrumova A.G., Poleev A.M.,
1986):
"mental shock": a period of disorganization of mental activity lasting up to three
days from the moment of receiving psychological trauma;
disorganization: a period of “living” a psychotrauma lasting from a day to two weeks;
demobilization; a period of full awareness of the current situation and its hopelessness
(impossibility of replenishing the loss, etc.)) which often serves as a trigger for the formation
depressive disorders lasting from several days to several weeks;
adaptation ("acceptance" of the current situation): the period of rationalization of psychotrauma, inclusion
it (or its consequences) into the intrapersonal picture of the world, as well as resolution
a traumatic situation lasting several weeks;
recovery: a period of normalization of mental activity lasting up to several
months.
The most suicidal stages are the stages of disorganization and demobilization.
Basic principles of social work with CS, applied in practice,
can be summarized into the following provisions.
1. The individual (or family, group, community) is subject to periods of strengthening of internal and external
stress, which disrupts the normal life cycle and the usual state of balance with the environment
environment. Such situations are usually caused by some kind of traumatic event, which may How
external blow, and internal increasingly increasing tension. The event may be
a single catastrophic incident or a series of small failures.
2. Exposure to a traumatic event upsets the balance of the personality and leaves the cha vulnerable.
a situation that manifests itself in increased tension and anxiety. Trying again
To achieve equilibrium, the human body goes through several stages. 1) an attempt is made to use
own habitual methods of solving problems. 2) When it doesn't help and anxiety
intensifies, then they mobilize without previously using backup methods of overcoming. However, if
the problem persists even after this and cannot be solved, avoided, or
to restate, the tension continues to build to breaking point.
3. At this moment, some factor may become the “last straw” that leads the individual to
a state of active crisis, accompanied by disorganization and cessation of resistance.
This is followed by a period of gradual recovery until the state is again achieved.
balance.
4. During the period of development of the CS, the individual can perceive the initial and subsequent
traumatic event either as a threat to one's instinctual needs, personal autonomy and
well-being, or as a loss of self. their attributes (role or status) or their abilities,
or he is faced with the task of survival, growth or improvement
5. Each of these situations evokes a corresponding emotional response that reflects
subjective significance of the event for the individual. The threat entails an intensifying state
anxiety; “losing oneself” intensifies the initial feelings of depression, deprivation and grief: in
at the same time, setting the task of survival causes a moderate increase in anxiety plus
awakening hope and expectation, thus stimulating new efforts to solve
Problems.
6. Although CS was neither a disease nor a pathology and reflects the individual’s real struggle with the current
stressful situation, it may be associated with previously unresolved or only partially
resolved conflicts, resulting in an inadequate response. Intervention in
such a situation may involve resolving present difficulties, overcoming previous
conflicts or destruction of the connection between them and current stress.
7. The length of time between the accident and leaving the CS varies widely and
depends on the severity of the traumatic event, the individual's response, and the nature and complexity of the tasks that
must be resolved, the available resources and means to resolve the conflict. However
in fact, the state of active imbalance is limited in time and usually lasts until 46
weeks while some acceptable form of resolution to the situation is found.
8. Each specific CS (eg, the death of a beloved person or the situation in which a person became
victim of violence) entails a specific sequence of conditions that may be
predicted and the response to which can be planned. Determining which one
a specific state on the way to a new balance, there was a “fixation” of the individual, which can give the key
to understanding where the individual is “stuck” and what lies behind his inability to cope
situation.
9. During the period of awareness and clarification of the CS, people are especially sensitive to help. Habitual
defense mechanisms are weakened, usual behavior patterns seem inadequate, and
becomes more open to outside influences. A minimum effort during this period can often give
maximum effect, and a little help directed accordingly can improve the situation
more effective than more intensive assistance during periods of less emotional sensitivity
10. During the recovery phase, new conflict resolution mechanisms may emerge and
develop new adaptive ways that will help you more effectively in the future
cope with the same or similar situation.
Basic techniques of psychotherapy in a crisis situation
Psychotherapeutic assistance to people in crisis is called psychotherapy.
Three CBT methods: crisis support, crisis intervention and adaptation enhancement,
necessary to resolve the situation. Schematically, these tasks can be represented in the form
next program.
1. Crisis support
Establishing psychological contact.
Disclosure of suicidal feelings.
Mobilization of personal protection.
Concluding an agreement to overcome a crisis situation.
2. Crisis intervention
Consideration of untested ways to solve a crisis problem.
Identification of non-adaptive attitudes that block optimal resolution methods
psychological crisis.
Correction of non-adaptive attitudes.
Activation of the attitude towards resolving a crisis situation.
3. Increased level of adaptation
Training in untested adaptation methods.
Developing skills of self-control and self-correction in relation to maladaptive attitudes.
Introducing new significant others to support and assist in continuing skills training
adaptation after completion of psychocorrectional work.
CP/T can be implemented in individual, family and group forms. P/T methods should
match the type of crisis; individual therapy should be combined with group therapy, the nearest
tasks (exiting the crisis) - with distant goals (increasing the adaptability of the individual).
In some cases, it is enough to relieve stress and find the most successful way out.
situations, in others a deep correction of the motivation system, direction, and direction is necessary
and, provide profiles of conflict-stress situations in the future, as there are
danger of relapse.
Problems associated with professional activities and their solutions (8, 35)
Factors that caused the crisis
1. Crisis of educational and professional guidance (1415 to 1617 years)
∙ Unsuccessful formation of professional intentions and their implementation.
∙ Lack of formation of the “Self-concept” and problems with its correction (especially uncertainty with
meaning, contradictions between conscience and the desire to “live beautifully,” etc.)
∙ Random fateful moments in life (a teenager is very susceptible to bad influences...)
Ways to overcome the crisis
∙ Choosing a professional educational institution or method of professional training
∙ Deep and systematic assistance in professional and personal self-determination
2. Crisis of vocational training (training time in vocational training
establishment)
∙ Dissatisfaction with professional education and professional training
∙ Restructuring of leading activities (testing the student’s “freedom” in comparison with the restrictions of school
mi). Earning money, what facts allow us to talk about leading activities for many students
∙ Changes in socio-economic living conditions. The student has “objectively” more money than
high school student. But “subjectively” there are always not enough of them, because... increase sharply
Ways to overcome the crisis
∙ Change of motives for educational activities. Firstly, there is a greater focus on the upcoming
practice. Secondly, mastering a large amount of knowledge at a university is much easier when you have
the student has some idea, a problem that is interesting to him, a goal...
∙ Correction of the choice of profession, specialty, faculty. it is better if the student has during the first 2
3 years of study available = get your bearings and then choose a specialization or
department
∙ Good choice of supervisor, course topic, diploma, etc.
3. Crisis of professional adaptation
∙ Difficulties in professional adaptation (especially in terms of relationships with colleagues of different backgrounds, new ones)
∙ Mastering a new leading activity - profession
∙ Discrepancy between professional expectations and reality
Ways to overcome the crisis
∙ Intensification of professional efforts. It is recommended to check yourself in the first months of work and quickly
indicate the "upper limit" ("upper bar") of your capabilities
∙ Adjustment of labor motives and “self-concept”. The basis of such adjustment is the search
the meaning of work and the meaning of work in a given organization
∙ Dismissal, change of specialty and profession is an undesirable method for this stage.
"Weakling"
Professional growth crisis (2325 years)
∙ Dissatisfaction with the possibilities of the position and career. Often this
is aggravated by comparing one’s “successes” with the real successes of one’s recent classmates.
∙ Need for further training
∙ Starting a family and the inevitable deterioration of financial capabilities
Ways to overcome the crisis
∙ Advanced training, including self-education and education at your own expense
∙ Career orientation. A young specialist must show with all his appearance that
strives to be better than he really is.
∙ Changing place of work or type of activity is already acceptable at this stage, because young worker already
proved to himself and others that he is capable of overcoming the first difficulties of adaptation. profession
self-determination will actually continue, only within the chosen field of activity
∙ Taking up hobbies, family, and everyday life is often a kind of compensation for failures in the main job.
Professional career crisis (3033 years)
∙ Stabilization of professional situation
∙ Dissatisfaction with oneself and one’s professional status
∙ Revision of “self-concept” associated with rethinking oneself and one’s place in the world. ∙
Ways to overcome the crisis
∙ Transition to a new position or job. At this age it is better not to refuse tempting
proposals, because even in case of failures nothing is lost.
∙ Mastering a new specialty and advanced training
∙ Care for everyday life, family, leisure activities, social isolation, etc., which are a kind of
compensation for failures at work = not the best ways to overcome crises at this time
stage
Crisis of socio-professional self-actualization (3842 years)
∙ Dissatisfaction with opportunities to realize oneself in the current professional situation
∙ Correction of “self-conception” is also often associated with a change in the value-semantic sphere
∙ Dissatisfaction with oneself, with one’s socio-professional status
∙ Professional deformations, i.e. negative consequences of long-term work
Ways to overcome the crisis
∙ Transition to an innovative level of performing activities (creativity, invention,
innovation). ∙ Excessive social activity, transition to a new position or
work. If at this age he does not dare to realize his plans, then for the rest of his life he will
will regret ∙ Change of professional position, sexual interest, creation of a new family.
Crisis of extinction of professional activity (5560 years, i.e. the last years before
pension)
∙ Anticipation of retirement and a new social role
∙ Narrowing of the socio-professional field (the employee is assigned fewer tasks related to
new technologies)
∙ Psychophysiological changes and deterioration of health status
Ways to overcome the crisis
∙ Gradual increase in activity in non-professional activities. Here
passion for hobbies, leisure pleasures or housekeeping may well be considered as
desirable way
∙ Socio-psychological preparation for a new type of life activity
Crisis of social and psychological adequacy (6570 years, i.e. the first years after reaching
pension)
∙ A new way of life, the main feature of which is the emergence of a large
amount of free time.
∙ Narrowing of financial opportunities.
∙ Socio-psychological aging,
∙ Loss of professional identification
∙ General dissatisfaction with life
∙ The feeling of being “useless,” which, according to many gerontologists, is especially
severe factor of old age. ∙ Sharp deterioration in health
Ways to overcome the crisis
∙ Organization of social and economic mutual assistance of pensioners
∙ Involvement in socially beneficial activities
∙ Socio-psychological activity.
∙ Mastering new socially useful activities (the main thing is that the old man, or rather
the elderly man was able to feel his “usefulness”).
Help from a psychologist in situations of change in social status or social
rejections(36)
Psychological assistance (PA) and its individual members in the situation of the birth of a child with
disabled or disabled child. Recently there has been an increase
number of children with various developmental disabilities, learning difficulties and school
adaptation, disturbances in the emotional-personal sphere, etc., which makes it necessary
consideration of the peculiarities of organizing psychological assistance to families with similar problems.
It is advisable to organize an integrated approach to diagnosis and correction of work with
such children, the involvement of various specialists (speech therapists, teachers, defectologists and
psychoneurv). At the same time, the effect of PP for a family with a “problem” child will largely determine
psychotherapist component of work with families. Contents of the PP for a family with a “problem” child
includes the following points:
1. Identification of the fact of violation.
2. Informing parents and referring the child to specialists of the required profile
(psychiatrist, pediatrician, neurologist, defectologist, speech therapist, etc.).
3. Psychotherapeutic work with the child’s relatives.
The effectiveness of PP for a family, according to Semago, depends on the willingness of parents to perceive and
assimilate information provided by a specialist. If the family continues to deny the existence
problem or its members are under the influence of strong affects, then all attempts to inform
parents about the need for certain steps in the development and upbringing of the child may turn out to be
premature.
The tasks of a psychologist are:
1. Creating conditions for parents to adequately perceive the situation associated with deviations
in the development of their child, mental readiness for long-term work on its development, correction and
education.
2. Working through the feelings of guilt experienced by parents, overcoming stress and
achieving emotional stability of family members.
To effectively solve the problems of the consultation, it is necessary to assess the nature of the reaction of this family
on the crises that took place in its development, as well as ways to overcome them as resources of this
families.
The specificity of providing PN to a family with a problem child lies in the fact that, as a rule, the family
comes for a consultation involuntarily, on the recommendation of a specialist who has assumed the presence of
developmental disorders in the child. In most cases this means a lack of voluntariness and,
therefore, the lack of self-motivation to receive PP. In some cases, parents
hide (consciously or unconsciously) unfavorable features in the development of the child, which
presents additional difficulties for objective diagnosis of the level of its development. Therefore in
When working with the family of a problem child, it is necessary to increase the motivation of parents to
long-term interaction with a psychologist to obtain the necessary help.
Usually, the family member who is responsible for caring for the child turns to a psychologist for help.
seriously ill. An attempt to solve one’s own problems is due to great physical and mental
load, the presence of a significant number of personal and interpersonal difficulties related to the situation
and is caused by the need to plan future life (social, professional,
personal).
PP may include solving the following tasks:
1. Inform the applying family member about the nature of the illness or redirect him to
to a specialist who can competently explain what kind of diagnosis the patient has been given, how
the disease develops and how to behave with such a patient.
2. Support, which consists in the fact that the psychologist tries to listen and understand the client, taking into account
the specifics of his situation. If the latter wants to leave a sick family member or decides
break off the relationship (eg, the husband wants to leave the family with a disabled person), place the patient in
special medical institution, then he may experience feelings of guilt, shame, moral
pressure from surrounding and other family members. The consultant's task is to help the client
understand his feelings and experiences and support his decision regarding this
situations without exerting pressure and without using socially approved norms and stereotypes.
3. Discussion of such special issues as acceptable ways of interacting with the patient and
handling one’s own feelings that arise in response to the patient’s possible reactions.
It is advisable to start by identifying the client’s expectations from the patient and, if necessary,
make their correction in accordance with the nature and severity of the disease. Necessary
discuss responsibilities that can be assigned to the patient that would allow him to remain
included in the family system, adapt to the disease and continue to function as
family member.
Features of choosing a strategy and assistance depending on the type of crisis situation and
degree of its complexity (48) +
Crisis therapy consists of the following:
main provisions:
there are no special crisis
technologies and practices;
crisis assistance excludes the use
psychopharmacology;
the main strategy for helping the individual and group in
krm sosti mainly sworn in techniques (working with
fear, thoughts “I’m not myself…”, feelings of guilt,
the experience of “inferiority”, etc.), directed towards
growing awareness of the fact that what is now
what happens is normal, correct and useful,
the main tactics when working with CS existentials is
support, awareness and experience of feelings.
The lack of specific “crisis technologies and techniques” in psychotherapy is due to
the uniqueness of each world's experience of existential and existential crises. The feature is still in
that psychotechnologies are required that can simultaneously work on cognition
(conscious) level and deep (unconscious), where access is possible only through symbolism and
metaphors. Therefore, art therapy techniques and others give good results.
In crisis situations
Unfortunately, very often people find themselves in difficult living conditions: they receive
psychological trauma, experiencing a crisis. Such situations require professional
psychological assistance.
Psychological assistance in crisis situations differs from regular counseling
psychologist. It is aimed at giving a person the opportunity to express his condition, not
withdraw into yourself and help survive and overcome this crisis. The main task is
psychological assistance is a way out of a traumatic situation without loss to health.
The reasons for a crisis situation may be family conflicts, dismissal from
work, various types of violence (physical, mental or sexual); as well as what happened
catastrophe, terrorist attack or natural disaster.
Psychological assistance in crisis situations is aimed at helping the person
express your painful experiences, which are saturated with a wide variety of emotions,
such as fear, hopelessness, guilt, helplessness, hopelessness, loneliness, etc.
Psychological assistance in crisis situations has its own characteristics. They are connected with the fact that
a specialist working with a crisis must have sufficient professional training
and one’s own resistance to stress, since without special skills, constant work with
grief and pain of other people leads to professional burnout.
Psychological assistance in crisis situations includes:
helping a person talk about what happened;
assistance in expressing feelings about what happened;
work with acceptance of the situation;
supporting a person during a crisis situation.
Psychological assistance in crisis situations is one of the most important
areas of work of specialists at the psychological center “Respect”.
|
"Day by day" September 5 Voice of conscience What is a constant feeling of dissatisfaction,
anxiety, our usual feeling, if not the muffled voice of conscience speaking within us,
besides our consciousness, and often, breaking our will, about the untruth in our lives. And while we live
contrary to the bright law given to us, this voice will not be silent, since it is the voice of God himself in
our soul... Read more...
Voice of conscience
What is a constant feeling of dissatisfaction, anxiety, our usual feeling, like
not the muffled voice of conscience, speaking in us, apart from our consciousness, and often, breaking our
will, about the untruth in our lives. And while we live in defiance of the bright law given to us, this
the voice will not be silent, since it is the voice of God himself in our soul. The opposite is a rare feeling
complete satisfaction, completeness and joy, is the joy of the union of the divine principle
our soul with the general harmony and divine essence of the world.
Do I understand well why a feeling of dissatisfaction may arise in me?
God, help me to be consistent in restructuring my life so that peace and peace of mind
never left her again.
Today, feeling peace of mind, I will not forget to thank God for this:
God help me stay sober today
WHAT TO DO?
Real help for an alcoholic begins with the wife, parents, and for this you need to give up
struggle and complicity. The hardest thing is to understand what your husband/son/daughter will do anyway
as they see fit, and it is not in your power to change an alcoholic. It is within your power to take a step towards
recovery of your loved ones. The first thing you must do is learn to separate the person from
his illness, i.e. love your husband/son/daughter, but hate the disease. Chinese wisdom says:
“To hold requires strength; to let go requires wisdom.” Loving doesn't mean everything
do for another person. To love means to respect a person’s right to his own destiny.
Each person is individual and he came into this world to go his own way.
development from start to finish. And many wives and parents take full responsibility for his
recovery, thereby depriving him of the opportunity to fight for life. When does it stop
overprotection on the part of the wife, parents, then the drug addict/alcoholic most often develops fear for
their further existence and there is a chance to really look for a path to recovery. We
We understand that now there will be a storm of protest, you are not obliged to do this, but we know for sure that
Many addicts decided to do something for their recovery only when they
I had to take responsibility for the consequences of my illness myself.
Here's your second piece of advice.
Do not force a drug addict/alcoholic to undergo treatment, because... those who are treated under pressure have
During therapy, there is only one goal: to reassure relatives. And after discharge from the hospital, rehab center
the first thing he will do and most often on the first day, week, month he will run for a dose/bottle.
There is a good saying: “You can lead a horse to water. But you can’t make it drink!!!”
Third, don’t get involved in endless, exhausting arguments about your lifestyle.
husband/son/daughter, their friends and acquaintances. Thus, you increase the “gap” between you and
close person. Your main task now is to begin to recover yourself, since you
live in a state of chronic stress. The family of an alcoholic can recover even in those
cases when the alcoholic is not treated. "Tough love" from the "12" program can help with this
Steps" If your child (or another loved one) is an alcoholic/drug addict Tough love Loved ones,
those living next to a person addicted to alcohol/drugs react to change
his behavior is usually the same: resentment, anger, guilt, nervous breakdowns, feeling
uselessness and powerlessness.
Guilt
The entire family of an alcoholic/drug addict is thrown out of the normal rut of life and suffers. Usually
parents feel responsible for the child’s condition and ask themselves questions: “Where did they miss?
what is our mistake"? The questions are legitimate, but even after answering them, you will not find a way out
situations. The alcoholic/drug addict himself benefits from the fact that you feel guilty, and he/she
also stick to this thought: “It’s all your fault; you never understood me! You’ve always
They only tried to suppress me, command me, humiliate me (or you didn’t care about me, etc.)." And
all this further increases the feeling of guilt of parents (or spouses). Anger. Everyone in the family becomes
irritable. It is not surprising that people who are usually balanced and sensible
adults, under the influence of their child’s dramatically changed behavior, begin to speak and
perform actions that were previously unknown to them. During a mental breakdown, people may
act like violent madmen. Parents can: reproach, threaten, call names, scold,
beg, even beat. But none of these remedies, of course, benefit the situation.
The drug addict/alcoholic only feels threatened and rejected by those close to him; these feelings add to him
confusion to a sick state.
Harmful defense of your child
In order to protect and save from unnecessary troubles, many parents themselves pay off debts,
made by an alcoholic/drug addict, calling school or work and making up reasons for it
absence, lying on phone calls. Parents are afraid that an alcoholic/drug addict will harm their
life, so they try to intervene and correct his actions, based on the best intentions.
Perhaps many, first of all, think about their reputation. Many people do it all
driven by feelings of guilt. Others find it unbearable to see their son/daughter suffering. Rewards for
bad behavior When an alcoholic/drug addict is saved and his mistakes are made up for, this is precisely what
parents reinforce his tendency to continue the behavior that is the main cause of his
troubles. After all, for his bad behavior he receives a reward, first in the form of a buzz from
alcohol/drugs, and then also alleviation of all the consequences at work, everything is settled, debts
given away, sold items replaced with new ones. Thus, "caring" parents did everything
so that the child does not face the result of his behavior and does not draw conclusions. Child,
who is constantly forgiven for the fact that he/she misses, and then loses his/her job/study because
does not have responsibilities around the house, such a child loses (and then steals) money or things
practices in his family to be irresponsible, unfit for life in society. Love is leaving
In a family where addiction to alcohol and drugs increases, there is a decrease in feelings of love.
We are only human, so often your love is conditional. If love is not rewarded
expected, it fades away. Love lives by love. If there is nothing good in response to love,
it becomes bitterness. Tough love needed When drugs (including alcohol) become
for those who use them, more important in meaning than their loved ones, the feeling of love is subjected to
trials and, unfortunately, often abuses gradually kill love. Parents
alcoholics/drug addicts who have already realized the destructiveness of their complicit behavior have identified
An alternative to this behavior is “tough love.” Loving your child with tough love
means caring about him enough to be able to say “no!” in response to abuse, not
harm him, but be prepared to offend the offender. Tough Love Says to the Alcoholic/Addict:
"That's enough. We refuse to get you out of the problems you create for yourself; we
We love you and therefore we tell you: if you want to suffer, suffer. If you don’t want to, look for a way of salvation.”
When parents find the strength and patience to practice tough love, the carrying begins.
everyone's responsibility for themselves, and, consequently, the healing process. This is the only chance
to get rid of the disease - alcoholism/drug addiction, which affects all family members, in one or another
to a different degree. So that relatives can better understand the essence of this disease, I suggest
read a symbolic letter from an alcoholic to his relatives:
TO MY RELATIVES
I'm sick of addiction. I cannot cope with this disease alone. I need yours
help, and so I ask you: Don't let me deceive you. Taking my lies for
the truth, you encourage me to lie further. Facing the truth may turn out to be
it hurts, but please do it. Don't fall for my tricks, with their help I
I'm trying to get rid of responsibility for myself. And besides, having outwitted you, I can
lose respect for you. When I'm not sober, don't lecture me, don't try to scold me.
or praise me, blame me or argue with me. Even if it makes you feel better,
the situation will only get worse. Don't believe my promises. I give them away to delay
retribution. And don’t make concessions if we’ve already agreed on something. Nervous and upset
Because of me, you are ruining yourself, which means you are losing the opportunity to help me. Even out of fear for
don't do to me what I should do myself. Don't try to hide mine from others
problems with alcohol and do not try to smooth out their consequences - this will only prolong my
disease. And most importantly, don’t deceive yourself like I’m trying to do. Addiction -
my illness will get worse until I stop drinking. And in order to stop, I need
help from a doctor, psychologist, recovering alcoholic, help from God. I'm not the only one
cope with. I hate myself, but I love you. If you don't help me, I will die.
Please, help!
Your sick relative, friend or just acquaintance. In most families in which they live
patients with chemical dependence, complications are discovered that in the last 15 years
began to be designated by the term codependency (I already wrote about this above). When they talk about low
effectiveness of treatment for a patient with chemical dependence, they often complain that “the patient
returned to the same environment." Indeed, the environment can contribute to the relapse of the disease, especially
intra-family environment. Chemical dependency is a family disease, so help
necessary for both the patient and the relatives living with him.
FROM THE AUTHOR
At the end of the 20th century, a huge number of disasters and catastrophes occurred, the world literally
An epidemic of terrorist attacks is sweeping the country. The concepts of extreme, crisis and
emergency situations have not yet been comprehensively defined. It appears that
it is not enough to consider them only from the point of view of objective features, without taking into account
attention psychological components, such as, for example, perception, understanding,
reactions and behavior of people in such situations. A person is somehow psychologically
involved in an extreme situation: as its initiator, or as a victim, or as an eyewitness.
People who find themselves in extreme situations go through a series of psychological states
stages. First, an acute emotional shock occurs, which is characterized by a general
mental stress with a predominance of feelings of despair and fear with aggravated
perception.
Then comes psychophysiological demobilization, a significant deterioration in health and
psycho-emotional state with a predominant feeling of confusion, panic reactions,
a decrease in moral standards of behavior, a decrease in the level of operational efficiency and
motivation for it, depressive tendencies. At this second stage, the degree and nature
psychogenic disorders largely depend not only on the most extreme situation, its
intensity, suddenness of occurrence, duration of action, but also on the characteristics
the identity of the victims, as well as from the persistence of danger and from new stressful influences.
This stage is replaced by the resolution stage, when the mood gradually stabilizes and
well-being, but a reduced emotional background and contacts with others remain
limited. Then comes the recovery stage, when the interpersonal
communication.
At the third stage, a person who has experienced extreme stress experiences a complex
emotional and cognitive processing of the situation, assessment of one’s own experiences and sensations.
At the same time, psychologically traumatic factors associated with
changing life stereotype. Becoming chronic, these factors contribute to
the formation of relatively persistent psychogenic disorders. Their feature is the presence
pronounced anxiety tension, fear, various autonomic dysfunctions that generate
subsequently psychosomatic disorders. Those who survived an extreme situation significantly
performance decreases, as well as a critical attitude towards one’s capabilities.
When providing psychological assistance to people who have been in extreme situations, one should
take into account one very important point - real disaster occurs when
The disaster ends and assistance to the victims begins. After all, on the one hand, not
only the emergency situations themselves, but also the scale of their destructive actions, their suddenness,
the prevalence of stress they cause, etc. are largely determined by the characteristics
pre-catastrophic development. On the other hand, only in the post-catastrophe period can one really
determine the degree of destructive influence of the disaster on the dynamics of the social structure, on
production, sociocultural, psychological interaction of people, demographic
processes in disaster zones. That is why in modern conditions it is increasingly relevant
questions of psychological and psychosocial work with various categories of people arise,
who have been in extreme situations. However, despite all the importance and relevance
providing psychological assistance to the population during and after extreme situations, problems
these remain relatively new both for practical psychology and for psychological
practices.
The book offered to your attention is a reference book on the theory and methods
providing psychological assistance to people both directly during an emergency situation,
and at distant stages. Therefore, the book essentially consists of two parts: the first chapter
is dedicated to the work of a psychologist in an emergency situation.
It includes not only currently known psychological intervention techniques
(for example, such as debriefing), but also a set of recommendations for survival in extreme
situations and methods of providing first aid to victims. We thought it was important
include these sections in the reference book, since these skills, of course, must be mastered
psychologist working in an emergency situation.
Other chapters of the reference book are devoted to describing methods of psychological work with distant
consequences of extreme situations. These situations are characterized primarily
extreme impact on the human psyche, causing traumatic stress,
the psychological consequences of which, in their extreme manifestations, are expressed in
post-traumatic stress disorder (PTSD), which occurs as a prolonged or delayed
reaction to situations involving a serious threat to life or health. General patterns
the occurrence and development of PTSD do not depend on what specific traumatic events
caused psychological and psychosomatic disorders, although in psychological
the picture of PTSD is specific to the traumatic stressor (military action, violence, etc.),
is undoubtedly reflected. However, the main thing is that these events were
extreme nature, went beyond ordinary human experiences and caused
intense fear for one's life, horror and a feeling of helplessness.
Chapter 2 examines the diagnostic issues of PTSD, and Chapter 3 describes some
models and techniques of psychotherapy that have proven themselves when working with this
disorder.
Chapters 4–8 are devoted to the consideration of specific cases of extreme situations, most often
leading to PTSD, such as: violence against women and children, participation in combat
actions, experiencing acute grief (loss), suicidal behavior. Each chapter is built
in such a way that a large part is occupied by the description of specific techniques for psychotherapy of PTSD, in
primarily in the form of group trainings.
Chapter 9 is devoted to issues of secondary traumatization of people working with trauma - psychologists,
rescuers, liquidators. Possession of psychological self-help and mutual assistance skills in conditions
crisis and extreme situations is of great importance for emergency service specialists
psychological assistance - not only in order to prevent mental trauma, but also for
increasing resistance to stress and readiness to respond quickly to
emergency situations.
The directory is intended for practicing psychologists and psychotherapists working as
directly in extreme situations, and with their long-term consequences. Is not
a textbook on theory and not research. This reference book is, first of all, a collection of techniques, or more precisely -
exercises that a psychologist (psychotherapist, consultant) can use in his
practical work.
We would like to especially note that the exercises offered in this book are not intended for
independent use by people without psychological education. Classes
are carried out under the guidance of a therapist, and only after any technique has been
mastered, they can be completed independently, for example, in the form of homework.
PREFACE
Emergency situations are becoming increasingly important in modern socio-political conditions.
wide use. Increasingly, children and adults find themselves in man-made disasters,
natural disasters, are subjected to violence, become hostages. Therefore, interest in
psychology of extreme situations in the modern world is steadily growing, both among politicians,
sociologists, philosophers, and among practical psychologists. Psychology of extreme situations
currently constitutes one of the most important branches of applied psychology, which
includes both the diagnosis of the mental states of a person experiencing or
survivor of emergency circumstances, as well as directions, methods, techniques, techniques
psychological assistance: psychological correction, counseling and psychotherapy.
Considerable attention is paid in psychological literature to identifying, psychological
analysis and classification of various mental phenomena that arise in victims
extreme incidents. In particular, psychological phenomena that arise in conditions
impacts of emergency factors are described in the literature under the title
post-traumatic stress syndrome, or post-traumatic stress disorder,
Various negative mental states arising as a result of
exposure to extreme factors: stress, frustration, crisis, deprivation, conflict. These
conditions are characterized by the dominance of acute or chronic negative emotional
experiences: anxiety, fear, depression, aggression, irritability, dysphoria. Emerging in
In these states, affects can reach such a degree of intensity that they have
a disorganizing effect on a person’s intellectual activity, making it difficult
the process of adaptation to current events. Intense emotional experiences such as
how fear, panic, horror, despair can make it difficult to adequately perceive reality,
correct assessment of the situation, interfering with decision-making and finding an adequate way out
stressful situation. These phenomena reflecting the phenomenology of mental functioning
person in crisis, are the focus of attention of both psychiatrists and psychotherapists, and
psychologists providing psychological assistance to people affected by emergencies
situations.
In a significant proportion of cases, the consequences of traumatic stress associated with the experience
extreme life situations are such forms of addictive behavior as
alcoholism, drug addiction, substance abuse, drug abuse. Alcohol
or the drug can be used as a relaxant to relieve or
partially neutralize acute discomfort, tension, confusion, fear. Excessive stress
can also affect vital functions, such as sexual behavior or nutrition.
Thus, the consequences of traumatic stress are not only long-term or acute
emotionally negative states that make a person’s life difficult, but also
behavioral disorders, which already represent the sphere of interest of psychiatrists. Meanwhile
such behavioral disorders have psychological causes associated with insufficiency
personal resources to cope with stress or with excess and redundancy
maladaptive influences in emergency circumstances.
There are situations in life, familiar to everyone, that are so traumatic
that require outside help, since the person himself cannot cope with the experience of stress
Maybe. For example, the situation of death, loss of a loved one, breakup - when
personal resources may not be enough. To cope with extreme stress
impact, people experiencing loss often begin to abuse alcohol,
medications. Due to chronic stress, they may also experience
and various psychosomatic disorders. Psychologists are actively researching the reasons
the occurrence of so-called psychosomatic diseases, in which the greatest importance
have psychological factors. Somatic suffering such as peptic ulcer
stomach and duodenum, ulcerative colitis, hypertension or
coronary heart disease - often occurs as a result of emergency circumstances against the background
prolonged and intense states of anger, rage, rage or fear, despair, depression and
sadness. Thus, people who have experienced stress may end up being the doctor's patients.
The psychology of extreme situations has both its theoretical aspect associated with the study
features of mental functioning in crisis, as well as practical application, which
determined by the need to provide psychological assistance to victims in critical
situations to people. Such psychological assistance is necessary to prevent violations
behavior and prevention of psychosomatic disorders. It involves normalization
mental state with the leveling of negative experiences that have such
destructive impact on both mental and somatic functions of a person.
The main task of psychological assistance is the actualization of adaptive and compensatory
personal resources, mobilization of psychological potential to overcome negative
consequences of emergency circumstances. The consequence of effective psychological assistance
affected is the optimization of a person’s mental state and behavior in
extreme situations.
In the reference book of a practical psychologist dedicated to extreme situations, which
is brought to your attention, are revealed as theoretical aspects that allow you to understand
the specifics of these situations, their significance for humans, as well as practical, applied aspects: author
offers specific ways to overcome traumatic stress, specific forms
behaviors to cope with emergency situations. Here are also given
specific recommendations that can be useful not only to practical psychologists, but
also to all persons providing assistance to victims: doctors, rescuers, military personnel, firefighters.
Solovyova S.L., Doctor of Psychological Sciences, Professor,
Head of the Department of Psychology and Pedagogy of St. Petersburg
State Medical Academy named after. I.I. Mechnikov
The material was prepared by educational psychologist - E.M. Bondar
"Psychological assistance in stressful and crisis situations"
Introduction
Crisis psychology and psychotherapy are relatively new, but rapidly developing areas of psychological practice. They owe their emergence, first of all, to the negative fruits of civilization - man-made disasters, military actions, accidents.
Studies of the mental state of people - participants, victims or witnesses of such events or natural disasters - have revealed that many have various mental disorders, including a special condition - post-traumatic stress disorder. Society gradually realized the problems of maladjustment among war veterans, witnesses of nuclear power plant accidents, natural disasters and other extreme events.
The discovery of a large number of suicides, acts of violence committed by former war veterans, mental disorders and problems of maladjustment among victims and witnesses of disasters has forced the development of programs to study the long-term consequences of traumatic events and ways to prevent and eliminate them. The concepts of developmental and life crises have been developed within the framework of personality and developmental psychology, and research in these areas has also provided information about the possible serious adverse consequences of crises other than global and widespread disasters. A crisis as a turning point in human destiny, in which the very foundations of a previous life collapse, and a new one does not yet exist, requires a special approach and specific forms of assistance to the person experiencing it. Often the task of a professional is, first of all, to identify potential opportunities for overcoming a crisis state and their activation, or to determine the degree of risk of the crisis developing in an unfavorable direction.
1.Theory of stress
crisispsychologystress
One of the main ones in the psychology of crisis situations is the theory of stress, the founder of which, G. Selye, defined stress as “a response to any demand presented to the body.” Modern researchers understand stress as a nonspecific reaction of the body to any impact of an extreme factor (stressor) that threatens disruption of homeostasis, which consists of stereotypical changes in the functions of the nervous and endocrine systems.
Since the nervous and endocrine systems are the main regulatory systems of the body, further changes occur throughout the body. The activity of the cardiovascular, respiratory, muscular, and excretory systems is sharply activated, while the activity of the digestive tract and reproductive system is inhibited. As a result of the redistribution of energy, the body is able to continue functioning in changed conditions, and, emphasizing the protective function of stress changes occurring in the body, G. Selye gave stress another name - general adaptation syndrome. He also described the phases of the body's response to a stressor:
) stage of anxiety (6-48 hours), during which the surface reserves of the body are activated;
) stage of resistance, adaptation or anti-shock, which is possible by attracting the activation of the body’s deep resources. The duration of the stage depends on the general adaptive potential of the organism and can often last for years. However, if the stressor is chronic or its intensity increases over time, then conditions arise for the transition to the third stage;
) stage of exhaustion, which makes itself felt by the appearance or exacerbation of chronic diseases of any system or organ. (It should be noted that if the stressor is eliminated in the second stage, then the resilience stage will be followed by the recovery stage).
Those physiological changes that occur in the body after interaction with a stressor are known in science as Selye’s triad. It includes:
increased activity of the adrenal cortex, an increase in their size;
shrinkage of the thymus and lymph glands;
pinpoint hemorrhages and ulcers along the gastrointestinal tract.
One of the important concepts of stress theory is distress, which means a failure of the adaptive response, followed by a disruption of homeostasis. As a rule, distress occurs under conditions of an extremely strong or chronic stressor.
The stress reaction occurs at all levels of personality organization and includes the following subsyndromes:
vegetative subsyndrome, which affects the activity of internal systems and organs, as a result of which changes in their functioning are observed in accordance with the integrating task - adaptation of the body to the stressor;
emotional-behavioral subsyndrome, which consists of changing the emotional processes and states of a person when faced with a stressor, and changing his behavior. Changes can occur both in the form of intensification and increase in emotional and behavioral manifestations (crying, screaming, aimless running, etc.), and in the type of their decrease until complete absence (stupor, indifference, etc.);
cognitive subsyndrome, which manifests itself as a change in cognitive processes of the type of increase (intensification of thinking, the appearance of positive psychopathological symptoms) or decrease (weakening of vision, memory, etc.);
a socio-psychological subsyndrome that occurs as changes in the communication of a person under stress in one of two types: increased (hypercommunication, a large number of, as a rule, superficial contacts) or decreased (closedness, withdrawal).
G. Selye's theory of stress is one of the theories that explains the emergence of psychosomatic diseases. The mechanism is that the constant tension of all systems and organs leads to the depletion of an organ that is usually weak genetically or hereditarily.
Analysis of the concept of “stress” shows that this is precisely the internal reality, in relation to which the stressor (i.e., the factor causing stress) acts as an external, reflected reality, and the nature of the reflection as a whole depends on the subject of the reflection. This position does not contradict existing research, according to which stress can have both positive and negative effects, the patterns of which are described by the Yorks-Dodson law. According to this law, as the activation of the nervous system increases to a certain critical level, the efficiency of activity increases. However, as the stress level of the operating factors increases, performance indicators begin to decline.
As mentioned earlier, stress is a nonspecific reaction of the body to a damaging factor. The nonspecific nature of this reaction indicates that this reaction does not involve differentiation of the stressor, i.e. Stress develops under the influence of both physiological and mental stressors. However, if in relation to physiological stressors, stress acts as a general adaptation syndrome, then it does not contribute at all to resistance to mental stressors, and often, on the contrary, only hinders. This is the problem with stress.
Unfortunately, nature has not endowed us with any innate schemes that allow us to withstand this threat. However, it has provided us with a universal property that allows us to notice the impending danger in time. This property is the psyche, the highest level of development of which arises in a person and is called consciousness. It is consciousness that acts as a means of protection from the dangers that a person faces due to rapidly changing living conditions. Mental stressors are a product of progress, their number is growing rapidly. This means that the development of consciousness, as well as its content, performs important protective functions for a modern person functioning in conditions of an abundance of mental stressors. In this sense (and statistics confirm this), education is needed to live not only more successfully, but also longer.
The ability to withstand significant mental stress caused by intense activity is called stress tolerance. Thus, tolerance to stress in this understanding can be considered as a mechanism of adaptation to intense activity and extreme conditions, which is ensured by mechanisms of self-regulation of activity. It is no secret that changes in a person’s performance and effectiveness under stress depend on the individual form of reaction determined by personal characteristics.
Identifying the conditions that ensure tolerance to stress is one of the particularly pressing problems of modern psychology and psychophysiology. Numerous studies have identified particularly significant characteristics that must be endowed with consciousness in order to effectively reflect stressors. These include: adequate self-esteem, self-acceptance, internal locus of control - internality (i.e. responsibility for occurring events), etc. The psychological mechanism of their protective action is very simple. Since the stress reaction caused by mental stressors does not begin with the action of the stressor, as is commonly thought, but from the moment it is reflected by the body (see Fig. 1), it is the reflection that acts not only as a barrier, but also as a filter of stressors. (Research is now emerging that suggests this pattern is also true for physical stressors).
In the absence of self-esteem or its inadequacy, consciousness acts not as a filter of extreme factors, but as their generator, when any stimulus is perceived as threatening homeostasis. In addition, it is the personality, with its system of values, expectations and needs, that acts as a criterion for the significance of certain everyday events.
Thus, a person acts as a subject of stressful situations, and it is his activity that determines the effectiveness of stress resistance. And since stress is one of the factors reducing the life expectancy of a modern person, stress resistance is an important condition for maintaining the quality and duration of life.
2.Psychological assistance in stressful situations
Every modern person knows about the existence of specialists who provide psychological assistance to people in need. At the same time, the profession of these specialists is often incorrectly called by ordinary people. At the same time, every educated person should know that psychological assistance is provided by psychologists, and its meaning is to support a mentally healthy person facing problems. Psychiatrists work with mentally ill people. A somewhat intermediate position is occupied by psychotherapists, who can work with both healthy clients who need medication, and with patients. However, the main method in their work remains psychological assistance.
Psychological assistance is described by several concepts that can be considered as several types of assistance:
psychological correction;
psychotherapy;
psychological counseling.
2.1 Psychological correction is a targeted psychological impact for the full development and functioning of the individual
The question of the relationship between the concepts of “psychotherapy” and “psychological correction” remains open today, and here two main points of view can be indicated.
One of them is to recognize the complete identity of the concepts of “psychological correction” and “psychotherapy”. However, this does not take into account that psychological correction, as a targeted psychological impact, is implemented not only in medicine (two main areas of its application can be indicated: psychoprophylaxis and treatment itself - psychotherapy), but also in other areas of human practice, for example, in pedagogy. Even ordinary, everyday human communication may contain, to a greater or lesser extent, purposefully used psychological correction.
Another point of view is based on the fact that psychological correction is primarily designed to solve the problems of psychoprophylaxis at all its stages, including during the implementation of secondary and tertiary prevention.
2.2 Psychotherapy - in the narrow sense, it is treatment, getting rid of a problem using a psychological means, a system of therapeutic effects on the psyche and through the psyche on the human body
At the same time, this is also the field of medicine. Although in a broad sense, psychotherapy and psychological assistance are equivalent concepts.
Help in resolving psychological problems is provided using various methods. Among the most popular methods, we note suggestion (i.e. suggestion, including hypnotic), art therapy, body-oriented psychotherapy, psychodrama, neuro-linguistic programming, metaphor method, fairy tale therapy, etc.
The main theoretical directions of psychotherapy are psychodynamic, cognitive-behavioral and existential-humanistic directions.
Dynamic direction in psychotherapy. Dynamic psychotherapy originates from the classical psychoanalysis of Freud. Within this direction, the search for the causes of the problems that a person has encountered is carried out in the psychotraumas he received in childhood. It is believed that over time, the baggage of a person’s psychotraumatic experience becomes unbearable, which determines the appearance of various kinds of symptoms, including neurotic ones.
Behavioral psychotherapy considers the cause of most problems to be a lack of knowledge, skills or abilities. Accordingly, therapy involves teaching the client using various types of reinforcement.
Existential-humanistic direction in psychotherapy. When considering the nature of man and his problems, representatives of this direction exalt man in order to level out his alienation, and psychotherapy involves the most complete study of the uniqueness and universality of his nature.
2.3 Psychological counseling
Traditionally viewed as a process aimed at helping a person resolve (search for ways to resolve) the problems and difficulties of a psychological nature that arise. Experts identify three main approaches to psychological counseling:
a) problem-oriented counseling, focusing on analyzing the essence and external causes of the problem, finding ways to resolve it;
b) person-oriented counseling, aimed at analyzing the individual, personal causes of problem and conflict situations and ways to prevent similar problems in the future;
c) counseling focused on identifying resources to solve the problem.
The main similarities and differences between psychotherapy and psychological counseling relate to the following characteristics:
Means of influence (methods): psychotherapy and psychological counseling use psychological means of influence, but in psychological counseling, information is the leading technique.
Goals: psychotherapy and psychological counseling are aimed at achieving pronounced positive changes in the cognitive, emotional and behavioral spheres in the direction of increasing their effectiveness, psychotherapy is aimed at achieving significant personal changes, and counseling is aimed at helping a person to better use their own resources and improve quality life.
Functions: psychotherapy performs the function of treatment and partially rehabilitation, and psychological counseling - prevention and development (naturally, we are talking about the primary focus of psychotherapy and psychological counseling, since in some cases these functions may overlap).
Theoretical validity: psychotherapy and psychological counseling have psychological theories as their scientific basis.
Empirical verification: psychotherapy and psychological counseling need to study the effectiveness of interventions.
Professional activities: psychotherapy and psychological counseling are carried out by specialists within a professional framework. Additional characteristics:
Duration of influence: psychotherapy involves a duration of at least 15-20 sessions, psychological counseling may be limited to 1-5 sessions.
Place of change: in psychotherapy, changes occur directly during therapy and are the essence of the psychotherapeutic process; in psychological counseling, solutions to a specific problem are analyzed, but the solution and changes are made by the person not within the framework of counseling, but after its completion.
The degree of independence of the client: in psychotherapy, the process of change is accompanied by a psychotherapist; in psychological counseling, changes are carried out by a person independently without the accompaniment of a consultant.
Thus, in a broad sense, psychotherapy, psychological counseling, and psychocorrection are forms of psychological assistance. Moreover, each of the concepts captures the type of assistance that dominates over the others. As a rule, during the consultation, a practicing psychologist provides counseling, psychotherapy, and elements of psychocorrection, the specific version of which is selected in each specific case. At the same time, the key to effective assistance is a correctly formulated problem and criteria for its resolution. A person will not be able to solve a problem until he determines for himself by what signs he will know that the problem has been solved. After this, the psychologist helps determine possible ways to solve this problem, selecting the appropriate arsenal of assistance methods. The end result of the interaction between the psychologist and the client should be a person’s confidence in his own potential and his readiness to solve the current life situation in the most constructive way.
3.The concept of crisis situations
A critical or crisis situation (or crisis from the Greek krisis - decision, turning point, outcome) in the most general form can be defined as “a turning point, a revolution, a decisive time of transition.” This concept was introduced into psychology by L.S. Vygotsky, who identified stable and critical periods during ontogenesis, which separate one stable period from another. The specificity of crisis periods are manifestations of regression, difficulty in educating the child, difficulties in relationships with others, while development during these periods noticeably accelerates. The essential cause of crisis periods in the most general form is the current contradiction between the achieved level of development, which has prepared a change in human needs, and the lack of external opportunities to satisfy these needs.
Modern researchers carrying out a psychological analysis of the concept of “crisis situation” distinguish two types of crises:
ü developmental crises (age crises), which are associated with some ontogenetic periods (newborn crisis, crisis of one, three, seven years, teenage crisis, crisis of middle age and retirement age). It was these crises that were analyzed by L.S. Vygotsky as necessary stages of mental development;
ü crises of circumstances (probabilistic crises) in which modern man increasingly finds himself involved. This type of crisis is associated with the presence of situations such as, for example, man-made and natural disasters, leading to the threat of loss of health or life of the subject, which significantly violates the basic sense of security and may be accompanied by the development of traumatic crisis conditions.
A crisis state (crisis) is a state of emotional and mental disorganization of the individual, arising in most cases as a result of the simultaneous action of several traumatic factors, but in some cases it can be the result of erosion (destruction) over a long period of time. The subjective severity of a person’s condition is often associated with the fact that it is usually filled with very intense mixed feelings, which may include depression, hopelessness, meaninglessness, rage, guilt, resentment, etc., which is experienced by the person as a feeling of internal chaos, dead end and hopelessness.
Presence of stressors. In this case, the stressor is not an objectively dangerous situation, but a situation that is assessed by a person as threatening, which means the presence of an element of activity (activity) of the subject of the crisis situation.
Limited or distorted perception that is almost always present in unfamiliar situations. The consequence of limited or distorted perception can be a feeling of inferiority; feeling of guilt in the absence of real grounds, paranoid perception of reality (in the spirit of one, leading idea); feeling of hopelessness, etc.
Failure of adaptive mechanisms used by a person to solve problems that arise in everyday life. Firstly, crisis situations have no analogues in experience; and secondly, the stereotypical thinking of a person, as a rule, does not allow him to effectively and in the shortest possible time adjust the previously used adaptive mechanisms.
The absence or failure of support systems for loved ones, which increases the feeling of loneliness and isolation of a person in a crisis situation.
Thus, the crisis state is not derived from external circumstances. The presence of a stressor is only one of the variety of factors involved in the occurrence of crisis conditions. It can be argued that a certain readiness of the subject is necessary for the destructive perception of the stressor and the transformation of its influence into an internal state, defined as a crisis.
Most researchers agree that there are two main options for an individual to overcome a crisis.
The first (constructive) is associated with an increase in the adaptive capabilities of the individual, who, as a result of active interaction with the crisis, has acquired new life experiences that have made him more mature. To date, studies describing the characteristics of subjects using this type of behavior are very few. As a rule, characteristics are described under which the choice in favor of a given behavior option is impossible.
The second (destructive) type of behavior develops if a way out of the crisis is not found, which prolongs the depressive state and pushes one to leave the situation. The analysis of theoretical models of crisis situations and their subjective manifestations, as well as our own experience of observing people in crisis and extreme situations, allowed us to classify the following as manifestations of destructive personality behavior in these conditions:
“leaving” into addiction;
“departure” into a psychosomatic illness.
Thus, the situation of difficulties that a person faces due to his lack of adequate forms of behavior is not only a threat, but also a stimulus for his activity. But the way a person behaves in a crisis situation is associated with at least the following points:
degree of perception of external requirements;
the degree of motivation to meet these requirements.
4.Basics of crisis psychological assistance
Psychotherapeutic assistance to people in crisis is called crisis psychotherapy.
Crisis psychotherapy has fundamental differences from the methods of psychotherapy used in the clinic of borderline states, which include:
the urgent nature of assistance, associated, firstly, with the presence of a vital problem for the patient, requiring urgent active intervention of the psychotherapist in the situation, and, secondly, with the expressed need of patients for empathic support and, at first, for guidance of his behavior;
focus on identifying and correcting maladaptive cognitive phenomena that lead to the development of suicidal feelings and contribute to relapses of suicidal risk;
search and training of untested methods for resolving current interpersonal conflict, which increase the level of socio-psychological adaptation, ensure personal growth, and increase frustration tolerance. By its nature, crisis psychotherapy is close to cognitive behavioral psychotherapy and includes three stages: crisis support, crisis intervention and increasing the level of adaptation necessary to resolve a conflict situation.
4.1 Psychological debriefing
One of the group methods of crisis psychological assistance used shortly after a traumatic event is psychological debriefing. The term “psychological debriefing” refers to a crisis intervention designed to reduce and prevent trauma-induced stress reactions in normal people who are experiencing extreme stress. The purpose of psychological debriefing is to prevent the development of persistent consequences of emotional trauma by creating an opportunity for conscious cognitive assessment and emotional processing of the traumatic event. Debriefing contains three main therapeutic elements:
ventilation of emotions in the context of group support;
normalization of reactions;
information about psychological response after a traumatic event.
This method involves analyzing traumatic experiences, encouraging emotional expression, and stimulating cognitive understanding of the experiences. Among the main tasks of psychological debriefing are the elaboration of impressions, reactions and feelings, reducing tension, mobilizing resources, strengthening group support, etc.
In general, the emergency psychological assistance service performs the following basic functions:
ü practical: direct provision of emergency psychological and (if necessary) pre-medical medical care to the population;
ü coordination: ensuring connections and interaction with specialized psychological services.
4.2 Crisis intervention
Crisis intervention is emergency psychological assistance to a person in a state of crisis. It is based on the principles of short-termism, realism, personal involvement of a crisis care professional or volunteer, and symptom-centered control.
The leading methods of crisis intervention are crisis counseling and crisis psychotherapy.
Crisis psychotherapy is indicated for so-called complicated crises, that is, with the development or high risk of developing painful conditions in a person experiencing a crisis.
Of course, any threatening or hurting situation causes changes in a person's feelings, behavior and thoughts. If these transformations are controlled by a person and he is able to cope with them on his own, then the intervention of a psychotherapist is not required. If negative changes become long-lasting and are beyond the zone of independent control, then there is a need for professional psychological and psychotherapeutic help.
Basic principles of crisis intervention
Empathic contact. This is the most important condition for crisis assistance. Empathy and understanding of the psychological state of another person is the simplest and most difficult thing. Crisis intervention begins with the establishment of empathic contact.
Urgency. Crisis intervention is characterized by immediacy, extreme urgency.
High level of consultant activity. The counselor should be as proactive as possible in establishing contact with the person experiencing a crisis and in gathering information in order to assess the situation as quickly as possible and outline a plan of action.
Limiting goals. The immediate goal of crisis intervention is to prevent catastrophic consequences. The main goal is learning to use adaptive ways to overcome a crisis and restore psychological balance.
Support. When working to overcome a crisis, a consultant (volunteer, psychologist, psychotherapist) first of all provides support to the patient.
Focus on the main problem. Crisis intervention should be structured enough to help focus on the underlying problem that led to the crisis.
Respect. A person experiencing a crisis is perceived by the consultant as knowledgeable, completely competent, independent, striving to gain self-confidence, and capable of making an independent choice. Crisis care needs to be realistic and goal-oriented, so its overall strategy can be modeled after problem-solving strategy training.
4.3 Crisis Assistance Program as a Problem Solving Model
Identifying the problem. The task of a crisis consultant is to help clarify the central problem of the crisis. The development of a problem involves changes in life and in a person’s ability to cope with new circumstances. Therefore, it is useful to ask the following questions: “What has changed today compared to yesterday?”, or: “What new has happened in the last days (weeks)?” It is important to find out all the circumstances of the crisis problem, as well as the role of significant people in its development, since they can help or be the cause of the crisis. If the crisis is caused by a traumatic event, it is essential to reconstruct the picture of what happened and help the victim explain the traumatic events.
Determining the actions of a person experiencing a crisis. It is important to find out what has already been done to resolve the problem. The question “What have you been able to do to improve the situation (your condition)?” and others like it reflect the consultant’s confidence that a person can regain control over events and find a way out of the crisis. It also helps to rethink what happened. A person experiencing a crisis is overwhelmed by strong emotions; he may experience fear, despair, and confusion. His ability to think clearly is blocked. One of the purposes of clarifying events and actions is to reduce the patient's emotional stress and help restore the ability to think rationally.
Help in finding ways out of the crisis. Sometimes you should start with a very small goal, the main thing is that it is realistic and achievable. At first, it is very important to simply change the emotional state of the person experiencing a crisis, increase activity or, conversely, calm him down. All possible options for a person’s behavior in the coming days are consistently discussed: “What will you do in an hour, tonight?” etc. It is very useful to draw up a specific action plan for the period until the next meeting (“anti-crisis plan”), but if this does not work, you should not force events by forcing a person to do more than he can at the moment. Any excessive intervention can lead to a worsening feeling of helplessness and impasse. It is important to remember that the self-esteem of a person experiencing a crisis often decreases sharply. Therefore, care should be taken to restore it without deliberately offering any examples of highly effective behavior as an example, since this may increase the patient's anxiety and feeling of weakness.
Possible negative and positive consequences of the planned actions are discussed together, and the most practical options are selected. As a result of crisis intervention, a person must realize that he solved his problems on his own, and did not receive ready-made “recipes” of behavior from specialists; Only in this case will psychotherapeutic assistance not be limited to leading the client out of a given crisis, but will enhance the individual’s adaptive capabilities and serve to prevent crisis conditions in the future. Thus, at the stage of crisis intervention, the psychotherapist’s position should be more of a partnership than a directive, and the methods of influence should be indirect and soft.
So, the general meaning of the described action strategy is to help (1) in understanding the meaning of what happened, that is, in “constructing” a subjective theory of the crisis event, (2) in restoring a sense of control over one’s life, (3) in restoring realistic self-esteem.
Conclusion
The main task of psychological assistance is to update the adaptive and compensatory resources of the individual, mobilize psychological potential to overcome the negative consequences of emergency circumstances. The consequence of effective psychological assistance to victims is the optimization of a person’s mental state and behavior in extreme situations.
Such psychological assistance is necessary to prevent behavioral disorders and prevent psychosomatic disorders. It involves the normalization of the mental state with the leveling of negative experiences that have such a destructive impact on both mental and somatic functions of a person.
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Malkina-Pykh I.G. Extreme situations: Handbook of a practical psychologist. - M.: EKSMO, 2005. - 916 p.
Mulleneisen B. Stress syndrome. - Kazan: KSU Publishing House, 1993. - 134 p.
Selye G. Stress without distress. - M.: Progress, 1982.
Karvarsarsky B.D. Psychotherapy: Textbook for universities. - St. Petersburg: Peter, 2002. - 672 p.
Menovshchikov V.Yu. Psychological counseling: working with crisis and problem situations. - M.: Smysl, 2005. - 182 p.
Osipova A.A. A psychologist's guide to working in crisis situations. - Rostov n/d: Phoenix, 2005. - 315 p.
Osukhova N.G. Psychological assistance in difficult and extreme situations. - M.: Academy, 2005. - 288 p.
Romek V. G., Kontorovich V. A., Krukovich E. I. Psychological assistance in crisis situations. - St. Petersburg: "Rech", 2004.
S.L. Psychology of extreme situations / S.L. Solovyova. - St. Petersburg: ELBI, 2003 - 128 p.
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Lecture 15. Help in special cases, crisis and extreme situations. Crisis intervention
The concept and socio-psychological content of a crisis and extreme situation.
PTSD as a consequence of an extreme situation.
Crisis intervention.
Question 1. The word "crisis" in Greek means "turning point"; any moment that influences the course of an event. Strictly speaking, a psychological crisis can be either a sudden improvement or a sudden deterioration in a person’s psychological state or development. Any sudden interruption of the normal, habitual course of events in an individual’s life, which requires a reassessment of the situation, oneself or other people, a change in habitual activities, behavior, and thinking, is also a crisis. An interruption of the normal course of events becomes critical under one circumstance: when a person loses control over a changing situation. The main psychological difficulty of a person in crisis is that he does not see a way out of the current problem situation. On the one hand, he experiences a feeling of hopelessness (and difficult experiences in connection with this). On the other hand, a person in crisis is maximally open to new experiences, which allows him to provide professional psychological assistance aimed at changing his personality.
Crisis intervention (intervention) is a special type of psychological assistance provided in various situations that fall under the definition of crisis. Such situations include situations of sudden, unexpected loss (health, personal identity, certain psychological functions, work, loved ones, etc.). Events that involve a real or imagined threat of death, serious injury, or physical integrity to oneself or others may be a crisis. Although for the latter, the term “extreme situations” is more suitable, life circumstances in which not only go beyond the usual, but are also characterized by extreme complexity, danger, and extreme tension. Extreme situations can be considered a type of crisis. The long-term consequence of such situations is post-traumatic stress disorder (PTSD).
Question 2. The category of post-traumatic stress disorder as a specific human mental disorder was identified at the end of the 20th century. The basis for combining various symptoms into a single group was observations made during military operations and immediately after them. Initially, they were relegated to the competence of cardiologists and neurologists, because the cause of the observed symptoms was considered to be physical overexertion (physiological distress). In accordance with the nosological model, general weakness, tachycardia, and chest pain were recognized as the leading symptoms, while anxiety and mental exhaustion were associated symptoms. Within the framework of this model, the nosological category “physioneurosis” was formed: a stressful maladaptive reaction caused by a serious military or civil disaster. It was this understanding of the essence of psychotraumatic reactions that was incorporated into the first classifications of mental disorders DSM-1 (1952) and DSM-2 (1968). However, quite soon this approach was recognized as erroneous. At the end of the 70s of the 20th century, studies by a group of scientists led by M. Horowitz were published under the general title “Stress Response Syndromes” (1978). The point of view of this group changed the view of most psychiatrists and clinical psychologists on physioneurosis. After this study, the DSM-3 identified the category of post-traumatic stress disorder, which was already classified under the group of neurotic anxiety disorders. The reason for the development of this condition could be the experience of severe mental trauma of any kind. An important indication was that for PTSD to develop, the severity of the stressor must exceed the limits of normal human experience. M. Horowitz and colleagues identified a diagnostic triad of PTSD: 1) obsessive repetitive experience of the event, 2) the desire to avoid everything that may remind of it, 3) general psychological arousal that was absent before the onset of this event.
Further development of views on PTSD has significantly advanced researchers beyond its initial understanding laid down by M. Horowitz. The modern interpretation of this disorder differs from the classical one in a number of significant parameters.
In ICD-10, post-traumatic stress disorder is coded F43.1. This code means that PTSD is part of a group of stress-related neurotic disorders that are based on psychological, predominantly psychosocial, rather than organic causes. The term “neurosis” itself is currently considered obsolete, its use is justified only within the framework of the pathogenetic approach to psychological disorders, while recently the descriptive (phenomenological) approach to explaining the functioning of the psyche has become increasingly popular. The concept of neurosis is retained in modern psychology and psychiatry not as a fundamental principle, but only in order to facilitate the identification of those disorders that some specialists may traditionally consider neurotic.
PTSD refers to maladaptive reactions that occur as a result of one of two factors: either an exceptionally stressful life event or a significant life change that results in long-term unpleasant circumstances. PTSD is thus understood as a violation of the adaptive response to personally significant life events that are perceived by the individual as extremely difficult, which leads to disruption of social functioning.
Among other adjustment disorders, PTSD has a number of specific characteristics. It occurs as a delayed or prolonged reaction to a stressful event or situation that is perceived by the individual as threatening or catastrophic. These can be disasters, wars, serious accidents, watching the violent death of other people, and the role of a victim or witness of torture, humiliation, rape, terrorism and any other crime. Personal factors are believed to only predispose to a decrease in the threshold of sensitivity to these events, which only accelerates the development of PTSD or aggravates its course. But the presence of these comorbid personality factors is not necessary for the development of PTSD or its explanation.
Diagnostic criteria according to DSM-4 (1993):
A. Persons who have experienced a subjectively difficult life event, characterized by the presence of the following signs:
Individuals have experienced, witnessed, or otherwise encountered an event(s) involving a real or perceived threat of death, serious injury, or physical integrity to themselves or others.
The presence of a personal reaction in connection with this event in the form of a feeling of fear, helplessness or horror (in children, restless or disorganized behavior is possible).
B. This event is constantly experienced in at least one of the following ways:
Intrusive, recurring memories of an event, including images, thoughts or sensations associated with it (children may play games that reflect themes or aspects of the experience).
Obsessive repeated dreams or nightmares about the event (children may have terrible dreams without recognition of the content).
A person acts or has experiences as if the traumatic event took place in the present (including illusions, hallucinations, sudden images of the event “like in a movie” appearing in the mind (dissociative flashbacks), including when waking up from sleep or in the background consciousness altered by psychoactive substances).
Inappropriate affective, behavioral, or physiological reactions in response to external or internal cues that symbolize or resemble some aspect of a difficult life event.
B. A constant desire to avoid stimuli associated with a difficult life event, as well as rigid behavioral stereotypes characterized by at least three of the following features:
The desire to avoid thoughts, feelings, conversations that this person associates with a difficult life event.
The desire to avoid actions, places or people that evoke memories of a difficult life event.
Inability to remember an important aspect of the injury.
A noticeable decrease in interest in or participation in personally significant past activities.
Feeling alienated from other people.
Decreased capacity for positive affective experiences (for example, love).
A feeling of limited social prospects (for example, a career, the ability to have a family, children, or a normal life in general).
D. Signs of increasing mental arousal that were not present before the injury, at least two of the following:
Difficulty falling or staying asleep.
Irritability and outbursts of anger.
Difficulty concentrating.
Hypervigilance.
Exaggerated startle reactions.
D. The duration of the violations is more than one month.
E. There are disturbances in social functioning in personally significant areas (work, family or others).
Optional symptoms may include increased anxiety, depression, suicidal thoughts, and substance abuse.
We can talk about PTSD when the disorder occurs following trauma after a latent period of several weeks to several months (but rarely more than 6 months).
PTSD has an undulating course. Over the course of months and even years, the symptoms of the disorder may fade or return, and with retraumatization they usually flare up with renewed vigor. In most cases, spontaneous resolution of the disorder occurs. Epidemiological studies show that the prevalence of PTSD in a population exposed to a stressor during their lifetime is 30%, whereas after several years in the same group, only 10% of people still show signs of PTSD.
Only in certain people does PTSD become chronic, which leads to the development of another condition, which is called “Persistent personality changes after experiencing a catastrophe” (F62.0), which also includes personality changes after suffering a mental illness, loss of loved ones, etc.
Thus, PTSD should be distinguished from the long-term chronic effects of debilitating stress that occur decades after stress exposure. The diagnostic criteria for distinguishing between PTSD and Persistent personality changes after experiencing a disaster are the following:
a hostile or distrustful attitude towards the world;
social isolation;
feeling of emptiness and hopelessness;
chronic feelings of anxiety, constant threat, or being “on edge”;
alienation;
duration of symptoms for at least two years.
A logical question arises: if PTSD tends to spontaneously resolve itself, is it really necessary to teach specialists how to work with it?
This is necessary precisely in cases where the existing signs cause serious disruptions in current social functioning and deterioration in interpersonal relationships. Spontaneous self-resolution of PTSD makes a person less resilient to new stresses and reduces the ability to adapt to new situations. Long-term observations also show that in old age, people who have suffered PTSD develop it again. Therapy for PTSD also allows you to turn it into a launching pad for personal growth.
What does a psychologist need to know to work with PTSD?
The basic element of experiencing trauma is the fragmentation of life experience: before the trauma, after the trauma. The task is to bridge the gap and restore the integrity of experience. You need a new context for seeing your life. A person does not have the power to form this context. The most important thing is to create conditions in which the client can restore contact with himself, with his repressed experience. To do this, the psychologist must be able to adequately reflect this experience. Ability to listen and ask questions. Communication skills come first.
Three stages of working with PTSD:
Creating a safe atmosphere and trusting relationships.
Working with memories and experiences.
Inclusion in everyday life.
The psychologist’s ability to build a communicative space helps the client to talk about important relationships, ideas, fantasies, difficulties and conflicts that preceded the injury, and to talk about the traumatic event itself. This reprimand creates the context in which the client himself understands the meaning of the traumatic experience. During the conversation, it is important to shift the client’s attention to emotional reactions (your own and those of significant others), to images and sensations of your body. The psychologist plays the role of a witness and ally, helps the client recognize his reactions as normal, facilitates the storytelling process, helps to identify reactions and share the emotional burden. Why is it necessary to update statements? To integrate experience. And for this it is necessary to actualize the trauma. With the help of a psychologist, the trauma story is transformed from a story of shame and humiliation into a new story, devoid of these feelings, a feeling of strength to cope with this experience emerges, and a sense of dignity is restored.
The techniques themselves do not define anything without a communicative space. Therefore, any techniques that a psychologist owns can be used, and which allow you to work with suppressed, unconscious material, with the body. It is important to have basic counseling skills: paraphrasing, identifying and reflecting the client’s feelings, reflecting on one’s own experiences, nonverbal communication, the ability to build and maintain contact, explore the client’s request, and be able to distinguish between a problem and a situation. Individual and group forms, systemic family psychotherapy are used.
Helping children cope with stress.
The main symptoms of PTSD in children are regressive behavior, increased physiological excitability, social isolation, and obsessive reenactment of a traumatic incident.
Regressive behavior: the emergence of various fears: fear of separation from family and the accompanying “clinging” behavior, fear of strangers, fear of a stimulus associated with a traumatic experience (place, person, TV program, etc.), fear of death.
Increased physiological excitability: irritability, increased anxiety,
The more effectively you cope with your stress and your experiences, the more effectively you can help your children. Address your stress management needs first.
Talk to your children about what happened, their worries and fears.
Encourage children to ask and answer their questions based on their needs, interests, and ability to understand the event. Teach them to experience - to understand how the event affected them, their lives, the lives of the people they love.
Reassure children that they are safe.
Explain to them what happened (or ask someone who can do it).
If you have lost someone close, tell your children about this person.
Question 3. When does a crisis occur? A crisis may be the result of a long-term process. A crisis can arise under the influence of a sudden action of one or more factors. A crisis can arise in response to a disaster. A crisis can arise from a minor event of the “last straw” type.
The crisis is limited in time: it lasts from two to six weeks.
Three stages of the crisis process.
1. Stage of normal adaptation. It is characterized by an increase in tension, stimulating habitual ways of solving problems. At first (when faced with a problematic situation), a person uses past experience to cope with the problem. At this stage, familiar defense mechanisms and ways of solving problems are used, familiar resources are used, flexibility in problem solving is maintained, tension and relaxation are balanced. At the first stage, people rarely resort to the help of a psychologist.
If the usual ways of solving problems do not work, the second stage begins.
- 2. Mobilization stage. It is characterized by a further increase in tension: the feeling of uncertainty and fear grows, new resources, external and internal sources of help are mobilized, readiness for new ways to overcome the situation awakens, flexibility in the approach to solving problems decreases. Tension begins to rise above relaxation. At this stage, there is a readiness to receive professional psychological help. If he does not receive it, then the third stage begins.
- 3. Critical stage. It is characterized by increased anxiety, which is accompanied by feelings of helplessness and hopelessness, emotional and cognitive disorganization of the individual (feeling of chaos). The usual mechanisms for coping with problems are destroyed, the support system collapses (family and loved ones are no longer perceived as a source of help). It is possible to resort to such methods of resolving the situation as suicide, murder or other illegal actions. Professional psychological help at this stage is necessary. A psychologist can help a person gain control over the situation and turn to internal resources. Even if the problem cannot be solved in principle, it can help a person see the possibilities of the choices being made.
A crisis can end at any stage if a) the danger disappears, b) a solution is discovered.
The goal of crisis intervention is to reduce the severity and duration of the crisis and create conditions for a) continuation of life, b) examination and treatment.
Crisis intervention is working with strong feelings and problems. Help with crisis intervention is centered on the problem, not the person (this is how this type of help differs from psychotherapy and counseling). In crisis counseling, there is no need to analyze the past and the reasons for what happened. Attention is focused on the current situation. Sometimes unresolved past problems are woven into a crisis situation and aggravate the severity of the present experience. It happens that the client realizes this. Sometimes not. If he is aware, then it is necessary to identify these past problems, indicate their place in the current situation, and then concentrate on the current problem. For effective crisis intervention, it is important to clearly define the problem at hand. It doesn't have to be resolved. It is important to show the possibility of feasible work on the problem.
Crisis intervention includes the following aspects:
expression of strong emotions;
reducing confusion (through paraphrasing, reflecting feelings, clarifying, connecting feelings to content - all of which reduce chaos and make it easier to regain control);
opening the internal possibility of studying the problem;
developing an understanding of current problems;
creating a foundation for subsequent acceptance of the experience.
Three stages of working on a crisis.
- 1. Collection of information. At this stage it is necessary to identify and express feelings and connect them with content. This allows you to reduce emotional intensity and defines the crisis through individual events and problems. “The mountain breaks down into separate pieces that can be raked one by one.” Here it is important to explore the problem as fully as possible together with the client. Problems: 1) a person in crisis wants immediate relief; 2) the consultant has a desire to quickly jump from studying the problem to solving it in order to reduce the intensity of the client’s experiences. If you attempt a solution prematurely (before the problem has been thoroughly researched), important information may be missed, and the client may begin to repeat his mistakes. You need to identify the specific circumstance that caused the crisis and try to separate past problems from the current situation.
- 2. Formulation/reformulation of the problem. As a result of studying the situation, a person can more clearly formulate a critical problem, because before that he did not see the most important aspects of the critical situation, did not see individual aspects of a big problem (which he did not know which side to start solving), and confused past problems and the current situation. Here it is important to clarify what the client has already done to solve the problem (repetition of ineffective solutions may be part of the crisis picture). By separating the problem from the ineffective ways to solve it, you can reframe the problem and approach its solution in a new way. Ask the client what helped him deal with the problem in the past. This can help the client discover that they have many useful skills.
If the definition/reformulation of the problem is inhibited, then it is necessary:
give a particular definition of the problem, abandoning generalized definitions;
or move from a particular to a general definition;
check whether any actor is missing when defining the problem;
see if there are hidden, underlying problems.
3. Alternatives and solutions. Give up trying to solve the problem: unsuccessful solutions only make the crisis worse. Switch to coping with the problem. This is especially necessary if the client is trying to control events that he cannot control in principle or when the solution only makes the problem worse. If the client tends to set unattainable goals, then refuse to set goals. Find out if there is anything that could be done to simply improve the situation rather than fix it. Ask what has helped in the past in difficult situations. Don't make premature decisions.
An example is the option of crisis counseling when informing a person of a diagnosis of an incurable infectious disease - HIV infection.
If the blood test result is positive for HIV, the main goal of post-test counseling is to communicate the positive result, prepare the patient to continue the examination and to possibly live with HIVAIDS, prevent unwanted emotional reactions, and provide primary psychological assistance.
The first communication should take place in a secluded place in an atmosphere of complete confidentiality. The main condition for conducting this consultation is to provide the person being examined with sufficient time to perceive the message.
If post-test counseling is conducted by the same consultant who spoke with the subject in pre-test counseling, then before reporting a positive test result, he should ask the client (patient) if he had any questions while waiting for an answer.
After discussing the issues that have arisen, you should update the situation of modeling a positive result, which was used in the pre-test consultation: “Ivan Ivanovich, last time you and I played out different options for the outcome of a laboratory test of your blood for HIV. Each result, as you remember, has "
The consultant's task is to have the client pronounce the test result himself. As soon as these words are spoken, the consultant should seize the initiative and continue the conversation. It is necessary to confirm the client’s words directly, briefly, in a neutral tone (without regret or sympathy): “This is really so. But this is far from a death sentence, as you yourself are well aware.”
When reporting, the consultant should remain completely calm and not show excessive concern or sympathy. You should strictly avoid evaluative statements like “Well, how can that be?!” or “You see what this lifestyle has brought you to,” etc. Wait until the person reacts emotionally to unpleasant information, do not try to calm him down - this will not lead to anything good. Moreover, any information in a state of passion will be incorrectly perceived.
After the person releases his emotions, tell him that the feelings and reactions that arise are quite natural and happen to all people in a similar situation. Support the client’s own dignity and self-confidence.
If the client has a pronounced feeling of powerlessness, danger, bewilderment and uncertainty in the future, loss of control over the situation (and corresponding emotional distress), emotional paralysis due to the inability to find an acceptable solution in this situation (everything seems useless, the results of possible actions are worthless and even dangerous) , then crisis counseling should begin.
Crisis counseling:
Start by confirming the state in which the client is: repeat in your own words all his statements and agree with them. You cannot reduce the severity of the problem in your speech. You cannot say: “You are exaggerating,” even if the client really is exaggerating. You should listen carefully and comment, reflect the strength of the feelings experienced, and encourage the client’s efforts to master the problem that has arisen.
The basic rule of crisis counseling is to focus on the client’s feelings and fully accept all of his definitions of the situation.
You should not panic, offer reassurances that are far from objective reality, give advice, or be offended. In every crisis there are four elements that are responsible for a person’s irrational behavior: shock, horror, flight from the problem, acceptance of the problem. These elements are also successive stages of mastering the situation.
A blow is a strong emotion that arises from fear or the realization that life has turned upside down, something will now be completely different; blaming yourself for what happened, etc.
Horror is a state that arises due to the fact that a struggle of emotions begins in a person; he understands all the complications of the current situation. And the horror then turns to flight.
Escape (avoiding the problem and its solution) is a natural but transitory reaction. The consultant should not be afraid of her. You can use the following three techniques to get your client out of a crisis. This is structured questioning, acceptance or emotional support.
In a structured interview, it is necessary to clearly identify, together with the client, the main problem that arose during the communication of a positive result, and then build a hierarchy of subordinate problems. Resolution (clarification) of problems occurs strictly one by one.
When choosing an acceptance technique, it is necessary to absorb the client’s emotions as follows: “You can be angry at yourself, at me, at other people. I fully accept your feelings and agree with them.”
When choosing a support strategy, the consultant should try to hold the client for a subsequent constructive conversation: “Perhaps you are very anxious or scared and you need more time to talk. I am completely at your disposal. You can count on me.”
Each strategy requires:
- - focus on the client’s current feelings and talk through them with him: “Yes, it’s really very difficult for you. Yes, it’s terrible”;
- - note where the client shows the ability to make a decision, and where he releases his feelings of helplessness, hopelessness and loss of control;
- - find out for yourself what the client considers a crisis and what he agrees to in order to resolve it;
- - start solving with one of the easiest problems.
It is always necessary to remember that inadequate actions and thoughts associated with a positive result of blood testing for HIV AT carriage are caused not so much by the fact of virus carriage itself (this is only the external appearance of cause-and-effect relationships in the behavior of the virus carrier), but by a state of fear about loss personal control over the circumstances of one’s life (in psychology the term “decreased locus of control” is used). A person has a feeling of being unable to do anything at his own discretion, of being unable to control the process of virus carriage (at least stop, delay the destruction of the immune system). The fear of torment arises, and not the fear of imminent death. Often fear is caused by the unknown, an uncertain future, unclear ideas and completely negative prospects for living with HIV.
Thoughts about suicide can arise if a person believes that something is preventing him (or may prevent him in case of illness) from living, that it is impossible to live in the current situation, if interpersonal relationships have been disrupted and cannot be established again.
Therefore, the consultant’s task when reporting a positive result is to show the possibility of maintaining a personal locus of control when carrying HIV and to clarify unclear issues. It is important to point out life guidelines and convince not to act rashly. After all, death will not solve all problems.
As soon as the client sees the fundamental solvability of his situation (at least in just one aspect), this increases the chances of restoring control and self-esteem, which will mean a transition to the acceptance phase.
After this, the conversation should be structured into the following four parts.
I. Repetition of rational arguments used in pre-test counseling when discussing the possibility of obtaining a positive result: HIV infection and AIDS are not the same thing, a blood test only indicates virus carriage, which can last for years, the importance of a personal attitude towards the fact of virus carriage (“everything is in your hands”), etc.
II. Discussion of the need and possibility of obtaining medical care at the local territorial center for the prevention and control of AIDS (for anonymous clients, it must be emphasized that this assistance is possible only after disclosing their anonymity and registering with this center).
III. Prevention of “existential neurosis” - the client must be brought to the idea of the need to clarify the meaning of life with HIV infection. In this part of the conversation, the concept of the “three meanings of life” of the humanistic direction of the American school of psychology (V. Frankl) works very well. You can use crisis counseling techniques used in suicidological practice.
IV. Discussion of further actions of the client:
explain the safety of household contacts,
find out from whom the client can get help and support,
discuss the question of who, when and how the client intends (or can) tell about what happened,
develop a joint action plan to strengthen support from loved ones and reduce the negative consequences of an HIV-positive person’s status,
discuss legal issues (infecting others, protecting the rights and freedoms of HIV-infected people, etc.).
In conclusion, give the addresses and telephone numbers of support services and organizations (if any in your city).
You should not try to solve all the issues of providing psychological assistance and support to a person with HIV infection at once. Post-test counseling in case of a positive result only prepares the client for further work with a psychologist or psychotherapist. It should be made clear that this is not the end of the conversation between the HIV-infected person and the consultant. If the consultation was conducted by a doctor without special psychological training, then he should refer him to a psychologist at the basic center for the prevention and control of AIDS.
Test questions for the lecture.
What is a psychological crisis?
When is crisis intervention necessary?
What is Post Traumatic Stress Disorder?
What signs might indicate that a client has post-traumatic stress disorder?
What is the basic element of experiencing psychological trauma?
What stages of working with PTSD do you know?
What stages of a crisis are you familiar with?
What is the purpose of crisis intervention?
What is the purpose of a psychologist’s work in crisis intervention?
Bibliography.
Vasilyuk F.E. Psychology of experience. - M., Moscow University Publishing House, 1984. Chapter 1, section 1.
Gladysheva N.V. A person’s attitude to unfavorable life situations (adaptation of the Lewinson questionnaire of unpleasant events R.M.) // Problematicism in professional activity: theories and methods of psychological analysis. / answer ed. Wild L.G. - M., IP RAS, 1999. pp. 252-281.
Kononchuk N.V. On the psychological meaning of suicide // Psychological Journal. 1989. Volume 10, No. 5.
Kociunas R. Fundamentals of psychological counseling. - M.: Academic project, 1999. Chapter 5, section 15.
Peltzman L. Stressful conditions in people who have lost their jobs // Psychological Journal. 1992. Volume 13, No. 1.
Malkina-Pykh I. G.
– M.: Eksmo Publishing House, 2005. – 960 p. – (Handbook of a practical psychologist).
ISBN S-699-07805-3
The book is a reference book on the theory and methods of providing psychological assistance to people both directly during an extreme situation and at its remote stages.
Various aspects of the work of a psychologist in an emergency situation are analyzed. They include currently known psychological intervention techniques, as well as a set of recommendations for survival in extreme situations and methods of providing first aid to victims. Methods of psychological work with the consequences of extreme situations and work with post-traumatic stress disorder are described.
This reference book is, first of all, a collection of techniques, or more precisely, exercises that a psychologist (psychotherapist, consultant) can use in his practical work.
UDC 159.9 BBK 88.3
PREFACE................................................... ........................................................ .................................... 8
WORK OF A PSYCHOLOGIST IN THE SOCIETY OF AN EXTREME SITUATION.................................................................... 10
1.1 CLASSIFICATION OF EXTREME SITUATIONS.................................................... ....... 10
1.2 EMERGENCY PSYCHOLOGICAL CARE IN EXTREME SITUATIONS 12
1.2.1 Emergency psychological assistance techniques.................................................... ....... 18
1.2.2 Psychogenies in extreme situations.................................................... ............... 24
1.2.3 Psychology of terrorism.................................................. ............................................... thirty
1.2.3.1. Explosions........................................................ ........................................................ ................... 31
1.2.3.2. Hostage taking................................................................... ................................................... 33
1.2.4 Spontaneous mass behavior of people in extreme situations......... 46
1.2.5 Psychological debriefing.................................................... .................................... 51
1.3 FIRST MEDICAL AID FOR VICTIMS IN EXTREME SITUATIONS......................................................... ........................................................ ........................................................ ................... 57
CHAPTER 2 POST-TRAUMATIC STRESS DISORDER: MODELS AND DIAGNOSIS ........................................................ ........................................................ ........................................................ ........................ 78
2.1 STRESS, TRAUMATIC STRESS AND POST-TRAUMATIC STRESS DISORDER (PTSD)................................................... ........................................................ ........................... 79
2.2 HISTORICAL OVERVIEW.................................................... ........................................................ ..... 81
2.3 DIAGNOSTIC CRITERIA for PTSD.................................................................. ........................... 83
2.4 THEORETICAL MODELS OF PTSD.................................................... ..................................... 90
2.5 EPIDEMIOLOGY................................................... ........................................................ ............... 94
2.6 INDIVIDUAL VULNERABILITY AND PSYCHOLOGICAL CONSEQUENCES OF TRAUMA...................................................... ........................................................ ........................................................ .................... 94
2.7 DISSOCIATION AND PTSD.................................................... ........................................................ .... 101
2.8 METHODS OF DIAGNOSIS OF PTSD.................................................... ........................................... 105
CHAPTER 3 PSYCHOTHERAPY FOR POST-TRAUMATIC STRESS DISORDER (PTSD)......................................................... ........................................................ ........................................................ .................... 150
3.1 GENERAL APPROACHES TO PSYCHOTHERAPY FOR PTSD.................................................... ................. 150
3.2 PSYCHOTHERAPY FOR EMOTIONAL TRAUMA USING EYE MOVEMENTS (EMDR)................................................... ........................................................ ........................................................ ................... 157
3.3 GESTALT THERAPY.................................................... ........................................................ .......... 166
3.4 COGNITIVE-BEHAVIORAL PSYCHOTHERAPY.................................................................. ... 183
3.5 SYMBOL-DRAMA (METHOD OF CATATYMIC EXPERIENCE OF IMAGES)......................... 199
3.6 FAMILY PSYCHOTHERAPY.................................................... ........................................... 204
3.7 NEUROLINGUISTIC PROGRAMMING..................................................... 213
CHAPTER 4 PTSD IN PARTICIPANTS OF MILITARY ACTIONS.................................................... .............. 222
4.1 DIAGNOSIS OF PTSD IN PARTICIPANTS OF MILITARY ACTIONS.................................... 223
4.2 FEATURES OF SEXUAL DYSFUNCTIONS.................................................................... .......... 230
4.3 COUNSELING PSYCHOTHERAPY FOR PARTICIPANTS IN MILITARY ACTIONS 231
4.4 TRAINING ON PSYCHOPHYSIOLOGICAL AND SOCIAL READAPTATION OF PARTICIPANTS IN MILITARY ACTIONS......................................................... ............................................... 234
CHAPTER 5 VIOLENCE AGAINST WOMEN.................................................... ........................................... 269
5.1. DOMESTIC (FAMILY) VIOLENCE.................................................... ........................... 269
5.2 RAPE.................................................... ........................................................ ............... 277
5.3 COUNSELING VICTIMS OF DOMESTIC VIOLENCE.................................................... 279
5.4 COUNSELING VICTIMS OF SEXUAL ASSAULT.................................................... 286
5.5 TRAINING IN RHYTHMOMOTOR THERAPY.................................................... .......... 288
CHAPTER 6 VIOLENCE AGAINST CHILDREN.................................................... ........................................................ .. 320
6.1 EMOTIONAL ABUSE.................................................... ........................................... 323
6.2 PSYCHOLOGICAL VIOLENCE.................................................... .................................... 324
6.3 PHYSICAL VIOLENCE.................................................... ........................................................ ... 325
6.4 SEXUAL VIOLENCE.................................................... ........................................................ 326
6.5 VIOLENCE AT SCHOOL.................................................... ........................................................ ............. 332
6.6 CONSEQUENCES OF VIOLENCE IN CHILDREN.................................................. ................................. 333
6.6.1 Disorders of physical and mental development.................................................... 334
6.6.2 Diseases as a consequence of violence.................................................... ....................... 334
6.6.3 Mental characteristics of children affected by violence.................................... 335
6.6.4 Social consequences of child abuse.................................... 337
6.7 COUNSELING CHILDREN VICTIMS OF VIOLENCE.................................................... ........ 338
6.8 GROUP PSYCHOTHERAPY WITH CHILDREN.................................................... ........................... 342
6.9 TRAINING WITH CHILDREN SURVIVORS OF SEXUAL VIOLENCE................................... 343
CHAPTER 7 SUICIDAL BEHAVIOR.................................................................... .................................... 372
7.1 SUICIDAL RISK FACTORS.................................................................... ............................... 377
7.1.1 Socio-demographic factors.................................................... ........................... 377
7.1.2 Individual psychological factors............................................................ .......... 378
7.1.3 Medical factors.................................................... ........................................... 380
7.1.4 Natural factors.................................................... ........................................................ .380
7.2 INDICATORS OF SUICIDAL RISK.................................................................... ........................... 382
7.2.1 Situational indicators................................................................. .................................... 382
7.2.2 Behavioral indicators of suicide risk.................................................... 382
7.2.3 Communication indicators.................................................... ................................ 382
7.2.4. Cognitive indicators................................................... .................................... 382
7.2.5 Emotional indicators.................................................... ................................... 383
7.3 COUNSELING SUICIDAL CLIENTS.................................................................... 383
7.4 COUNSELING SURVIVORS AFTER SUICIDE.................................................... 393
7.5 SUPPORT FOR CONSULTANT.................................................................... ................................... 394
7.6 GROUP CRISIS PSYCHOTHERAPY.................................................... ................ 396
7.7 REORIENTATION TRAINING.................................................... ................................... 397
CHAPTER 8 LOSS SYNDROME.................................................... ........................................................ .......... 425
8.1 GRIEF AS A PROCESS. STAGES AND TASKS OF GRIEF.................................................... 425
8.2 COUNSELING A BEREAVED CLIENT.................................................... 435
8.3 TRAINING “HEALING FROM Grief”................................................................. .................................... 442
8.4 TRAINING ON SHORT-TERM POSITIVE THERAPY.................................................... 456
CHAPTER 9 SECONDARY TRAUMA.................................................... ........................................................ ...... 472
9.1 BURNOUT SYNDROME AND SECONDARY TRAUMA............................................................ ......... 472
9.2 ASSESSMENT OF SECONDARY TRAUMATIZATION.................................................... ....................... 481
9.3 SUPERVISION................................................... ........................................................ ....................... 486
9.4 WORKING WITH SECONDARY TRAUMA.................................................... .................................... 490
Preface................... 11
Chapter 1. WORK OF A PSYCHOLOGIST IN A SITE OF EXTREME
SITUATIONS...............AND
1.1 CLASSIFICATION OF EXTREME
SITUATIONS................... 15
1.2 EMERGENCY PSYCHOLOGICAL CARE
IN EXTREME SITUATIONS........ 18
1.2.1 Emergency psychological assistance techniques. ■ ■ ■ 29
1.2.2 Psychogenies in extreme situations...... 40
1.2.3 Psychology of terrorism............ 51
1.2.3.1 Explosions........................ 52
1.2.3.2 Hostage taking........... 56
1.2.4 Spontaneous mass behavior of people in extreme situations.................. 79
1.2.5 Psychological debriefing........... 87
1.3 FIRST MEDICAL AID FOR VICTIMS
IN EXTREME SITUATIONS........ 98
Chapter 2. POST-TRAUMATIC STRESS
DISORDER: MODELS AND DIAGNOSIS. 134
2.1 STRESS, TRAUMATIC STRESS AND POST-TRAUMATIC STRESS DISORDER (PTSD)....... . . . 136
2.2 HISTORICAL OVERVIEW. . . ......-............140
2.3 DIAGNOSTIC CRITERIA for PTSD. " 143
2.4 THEORETICAL MODELS OF PTSD....., ....... 156
2.5 EPIDEMIOLOGY....... 162
2.6 INDIVIDUAL VULNERABILITY
AND PSYCHOLOGICAL CONSEQUENCES OF TRAUMA 163
2.7 DISSOCIATION AND PTSD. . 174
2.8 PTSD DIAGNOSIS METHODS.........181
Chapter 3. PSYCHOTHERAPY OF POST-TRAUMATIC
STRESS DISORDER(PTSD) ... 276
3.1 GENERAL APPROACHES TO PTSD PSYCHOTHERAPY... 276
3.2 PSYCHOTHERAPY FOR EMOTIONAL TRAUMA USING EYE MOVEMENTS (EMDR)....... 290
3.3 GESTALT THERAPY.................. 306
3.4 COGNITIVE-BEHAVIORAL
PSYCHOTHERAPY......................... 335
3.5 SYMBOL-DRAMA (METHOD OF CATATYMIC EXPERIENCE OF IMAGES).......... 365
3.6 FAMILY PSYCHOTHERAPY.......... 373
3.7 NEUROLINGUISTIC PROGRAMMING........... . 389
Chapter 4. PTSD IN MILITARY PARTICIPANTS. 405
4.1 DIAGNOSIS OF PTSD IN PARTICIPANTS OF MILITARY ACTIONS.................................... 408
4.2 FEATURES OF SEXUAL DYSFUNCTIONS. . 420
4.3 COUNSELING AND PSYCHOTHERAPY FOR PARTICIPANTS IN MILITARY ACTIONS......422
4.4 TRAINING ON PSYCHOPHYSIOLOGICAL AND SOCIAL READAPTATION OF PARTICIPANTS IN MILITARY ACTIONS............427
Chapter S. VIOLENCE OVER WOMEN......489
5.1 DOMESTIC (FAMILY) VIOLENCE......490
5.2 RAPE......504
5.3 COUNSELING VICTIMS OF DOMESTIC VIOLENCE......508
5.4 COUNSELING VICTIMS OF SEXUAL VIOLENCE........,......520
5.5 TRAINING IN RHYTHMOMOTOR THERAPY. 525
Chapter 6. VIOLENCE AGAINST CHILDREN..........583
6.1 EMOTIONAL ABUSE......588
6.2 PS ICHOLOGICAL VIOLENCE........ 590
6.3 PHYSICAL VIOLENCE........... 592
6.4 SEXUAL VIOLENCE........... 594
6.5. VIOLENCE AT SCHOOL............... 604
6.6 CONSEQUENCES OF VIOLENCE IN CHILDREN....... 607
6.61 Disorders of physical and mental development. . 608
6.6.2 Diseases as a result of violence....... 609
6.6.3 Mental characteristics of children affected
from violence.................. 610
6.6.4 Social consequences of abuse
with kids. . . "............... 615
6.7. COUNSELING CHILDREN - VICTIMS OF VIOLENCE. 616
6.8. GROUP PSYCHOTHERAPY WITH CHILDREN..... 622
6.9. TRAINING WITH CHILDREN SURVIVING
SEXUAL VIOLENCE........... 625
Chapter 7. SUICIDAL BEHAVIOR......678
7.1. SUICIDE RISK FACTORS...... 687
7.1.1 Socio-demographic factors.„.,... 688
7.1.2 Individual psychological factors..... 690
7.1.3 Medical factors, ........... 693
7.1.4 Natural factors............ 694
7.2 Indicators of suicide risk........ 697
7.2.1 Situational indicators.......... 697
7.2.2 Behavioral indicators,..,..-„... 698
7.2.3 Communication indicators......... 698
7.2.4 Cognitive indicators........... 699
7.2.5 Emotional indicators.......... 699
7.3. COUNSELING FOR SUICIDAL PERSONS
CLIENTS................... 700
7.4. COUNSELING SURVIVORS
SUICIDE......... 718
7.5. "SUPPORT FOR CONSULTANT....... 720 h
7.6. GROUP CRISIS PSYCHOTHERAPY.... 723
7.7 REORIENTATION TRAINING........ 727
Chapter 8. LOSS SYNDROME........... 776
8.1 GRIEF AS A PROCESS. STAGES AND TASKS OF GRIEF.................................... 776
8.2 COUNSELING A BEREAVED CLIENT.................................... 795
8.3 TRAINING “HEALING FROM Grief”. ... . . . 806
8.4 TRAINING ON SHORT-TERM POSITIVE THERAPY.................................... 832
Chapter 9 SECONDARY TRAUMA........... 862
9.1 BURNOUT SYNDROME AND SECONDARY INJURY.. 862
9.2 ASSESSMENT OF SECONDARY TRAUMATIZATION..... 880
9.3 SUPERVISION............ 887
9.4 WORKING WITH SECONDARY TRAUMA....... 895
LITERATURES............ 923-
At the end of the 20th century, a huge number of disasters and disasters occurred; the world was literally overwhelmed by an epidemic of terrorist attacks. The concepts of extreme, crisis and emergency situations have not yet received a comprehensive definition. It seems that it is not enough to consider them only from the point of view of objective features, without taking into account psychological components, such as, for example, perception, understanding, reaction and behavior of people in such situations. A person is somehow psychologically involved in an extreme situation: as its initiator, or as a victim, or as an eyewitness.
People who find themselves in extreme situations go through a number of stages in their psychological states. First, an acute emotional shock occurs, which is characterized by general mental tension with a predominance of feelings of despair and fear with heightened perception.
Then comes psychophysiological demobilization, a significant deterioration in well-being and psycho-emotional state with a predominant feeling of confusion, panic reactions, a decrease in moral standards of behavior, a decrease in the level of efficiency of activity and motivation for it, and depressive tendencies. At this second stage, the degree and nature of psychogenic disorders largely depend not only on the extreme situation itself, its intensity, suddenness of occurrence, duration of action, but also on the personality characteristics of the victims, as well as on the persistence of danger and new stressful influences.
This stage is replaced by a stage of resolution, when mood and well-being gradually stabilize, but a reduced emotional background remains and contacts with others are limited. Then comes the recovery stage, when interpersonal communication is activated.
At the third stage, a person who has experienced extreme stress undergoes complex emotional and cognitive processing of the situation, assessing his own experiences and sensations. At the same time, psychologically traumatic factors associated with changes in life stereotypes also become relevant. Becoming chronic, these factors contribute to the formation of relatively persistent psychogenic disorders. Their peculiarity is the presence of pronounced anxious tension, fear, and various autonomic dysfunctions, which subsequently give rise to psychosomatic disorders. Those who have survived an extreme situation significantly reduce their performance, as well as their critical attitude towards their capabilities.
When providing psychological assistance to people who have been in extreme situations, one very important point should be taken into account - a real disaster occurs when the effect of the elements ends and assistance to the victims begins. After all, on the one hand, not only the emergency situations themselves, but also the scale of their destructive actions, their suddenness, the prevalence of the stress they cause, etc. are largely predetermined by the features of pre-catastrophic development. On the other hand, only in the post-disaster period can one really determine the degree of destructive influence of the disaster on the dynamics of the social structure, on the production, socio-cultural, psychological interaction of people, on demographic processes in disaster zones. That is why, in modern conditions, issues of psychological and psychosocial work with various categories of people who have been in extreme situations are becoming increasingly relevant. However, despite the importance and relevance of providing psychological assistance to the population during and after extreme situations, these problems remain relatively new both for practical psychology and for psychological practice.
The book brought to your attention is a reference book on the theory and methods of providing psychological assistance to people both directly during an extreme situation and at long-term stages. Therefore, the book essentially consists of two parts: the first chapter is devoted to the work of a psychologist in an emergency situation.
It includes not only currently known psychological intervention techniques (for example, debriefing), but also a set of recommendations for survival in extreme situations and methods of providing first aid to victims. It seemed important to us to include these sections in the handbook, since these skills, of course, should be possessed by a psychologist working in an emergency situation.
Other chapters of the reference book are devoted to describing methods of psychological work with long-term consequences of extreme situations. These situations are characterized primarily by an extreme impact on the human psyche, causing traumatic stress, the psychological consequences of which, in their extreme manifestation, are expressed in post-traumatic stress disorder (PTSD), which occurs as a protracted or delayed reaction to situations involving a serious threat to life or health. The general patterns of the emergence and development of PTSD do not depend on what specific traumatic events caused psychological and psychosomatic disorders, although the specificity of the traumatic stressor (military action, violence, etc.) is undoubtedly reflected in the psychological picture of PTSD. However, the main thing is that these events were of an extreme nature, went beyond ordinary human experiences and caused intense fear for one's life, horror and a feeling of helplessness.
Chapter 2 is devoted to the consideration of diagnostic issues for PTSD, and Chapter 3 is devoted to a description of some models and techniques of psychotherapy that have proven themselves in working with this disorder.
Chapters 4–8 are devoted to the consideration of specific cases of extreme situations that most often lead to the occurrence of PTSD, such as: violence against women and children, participation in hostilities, experiencing acute grief (loss), and suicidal behavior. Each chapter is structured in such a way that most of it is occupied by a description of specific techniques for psychotherapy of PTSD, primarily in the form of group trainings.
Chapter 9 is devoted to the issues of secondary traumatization of people working with trauma - psychologists, rescuers, liquidators. Possession of the skills of psychological self- and mutual assistance in crisis and extreme situations is of great importance for specialists of the emergency psychological assistance service - not only in order to prevent mental trauma, but also to increase resistance to stress and readiness to respond quickly in emergency situations.
The directory is intended for practicing psychologists and psychotherapists working both directly in extreme situations and with their long-term consequences. This is not a theory book or a study. This reference book is, first of all, a collection of techniques, or more precisely, exercises that a psychologist (psychotherapist, consultant) can use in his practical work.
We would like to especially note that the exercises offered in this book are not intended for independent use by people who do not have a psychological education. Classes are conducted under the guidance of a therapist, and only after any technique has been mastered can they be completed independently, for example, in the form of homework.
PREFACE
Emergency situations are becoming increasingly widespread in modern socio-political conditions. Increasingly, children and adults find themselves in conditions of man-made disasters, natural disasters, are subjected to violence, and become hostages. Therefore, interest in the psychology of extreme situations in the modern world is steadily growing, both among politicians, sociologists, philosophers, and practical psychologists. The psychology of extreme situations is currently one of the most important sections of applied psychology, which includes both the diagnosis of the mental states of a person experiencing or having experienced emergency circumstances, as well as directions, methods, techniques, techniques of psychological assistance: psychological correction, counseling and psychotherapy.
Considerable attention is paid in the psychological literature to the identification, psychological analysis and classification of various mental phenomena that arise in victims of extreme incidents. In particular, psychological phenomena that arise under the influence of extreme factors are described in the literature under the name post-traumatic stress syndrome, or post-traumatic stress disorder. A variety of negative mental states that arise as a result of exposure to extreme factors are studied: stress, frustration, crisis, deprivation, conflict. These conditions are characterized by the dominance of acute or chronic negative emotional experiences: anxiety, fear, depression, aggression, irritability, dysphoria. The affects that arise in these states can reach such a degree of intensity that they have a disorganizing effect on a person’s intellectual and mnestic activity, making it difficult to adapt to current events. Intense emotional experiences, such as fear, panic, horror, despair, can make it difficult to adequately perceive reality, correctly assess the situation, preventing decision-making and finding an adequate way out of a stressful situation. These phenomena, reflecting the phenomenology of a person’s mental functioning in crisis, are the focus of attention of both psychiatrists and psychotherapists, as well as psychologists providing psychological assistance to people affected by emergency situations.
In a significant proportion of cases, the consequences of traumatic stress associated with experiencing extreme life situations are forms of addictive behavior such as alcoholism, drug addiction, substance abuse, and drug abuse. Alcohol or drugs can be used as relaxants to relieve or partially neutralize acute discomfort, tension, confusion, and fear. Excessive stress can also affect vital functions, such as sexual behavior or nutrition. Thus, the consequences of traumatic stress are not only long-term or acute emotional-negative states that complicate a person’s life, but also behavioral disorders, which are already the sphere of interest of psychiatrists. Meanwhile, such behavioral disorders have psychological causes associated with insufficient personal resources to overcome stress or with excess and redundancy of maladaptive influences in emergency circumstances.
There are life situations, familiar to everyone, that are so traumatic that they require outside help, since the person himself cannot cope with the experience of stress. For example, the situation of death, loss of a loved one, breakup of a relationship - when personal resources may not be enough. To cope with extreme stress, people experiencing loss often begin to abuse alcohol and medications. Due to chronic stress, they may also experience various psychosomatic disorders. Psychologists are actively researching the causes of so-called psychosomatic diseases, in which psychological factors are of greatest importance. Somatic suffering such as gastric and duodenal ulcers, ulcerative colitis, hypertension or coronary heart disease often arise due to emergency circumstances against the background of prolonged and intense states of anger, rage, rage or fear, despair, depression and sadness. Thus, people who have experienced stress may end up being the doctor's patients.
The psychology of extreme situations has both its theoretical aspect, associated with the study of the characteristics of mental functioning in a crisis, and its practical application, which is determined by the need to provide psychological assistance to people affected in critical situations. Such psychological assistance is necessary to prevent behavioral disorders and prevent psychosomatic disorders. It involves the normalization of the mental state with the leveling of negative experiences that have such a destructive impact on both mental and somatic functions of a person. The main task of psychological assistance is to update the adaptive and compensatory resources of the individual, mobilize psychological potential to overcome the negative consequences of emergency circumstances. The consequence of effective psychological assistance to victims is the optimization of a person’s mental state and behavior in extreme situations.
The handbook of a practical psychologist devoted to extreme situations, which is brought to your attention, reveals both theoretical aspects that allow you to understand the specifics of these situations, their significance for a person, and practical, applied aspects: the author offers specific ways to overcome traumatic stress, specific forms of behavior that allow cope with emergency situations. It also provides specific recommendations that can be useful not only to practical psychologists, but also to all persons providing assistance to victims: doctors, rescuers, military personnel, firefighters.
Solovyova S.L.,
Doctor of Psychology, Professor,
Head of the Department of Psychology and Pedagogy of St. Petersburg
State Medical Academy named after. I.I. Mechnikov
“Kostanay kalasy akimdiginin bilim boliminin Chapaev negizgi mektebi” MM
State Institution "Chapaevskaya Basic School of the Education Department of the Akimat of the City of Kostanay"
»
"Psychological assistance in crisis situations"
Vedernikova S.P.
teacher - psychologist
Kostanay, 2014
“Dagdarys zhagdayyndagy psychology komek »
"Psychological assistance in crisis situations"
The concept of “crisis” (from the Greek krisis - decision, turning point, outcome) is a turning point, a difficult transitional state, an exacerbation, a dangerous unstable state. In Chinese, the concept of crisis is defined as “a chance full of danger,” as an opportunity for the growth of the human personality, which an individual gains by going through a state of mental crisis and experiencing various resistances.
Crisis is a state of a person when his purposeful life activity is blocked at a certain moment in personality development. A protracted, chronic crisis carries the threat of social maladjustment, suicide, neuropsychic or psychosomatic suffering. The chronicity of the crisis is inherent in people with a pronounced accentuation of character, an immature worldview (“the world is beautiful” - “the world is terrible”), and one-pointedness of life attitudes. It is precisely such people who need help during a period of crisis, which is considered not only as a difficult and responsible period of life, but as a dead end that makes further life meaningless.
Both theorists and practitioners believe that in a crisis situation, when trying to master a stressful state, a person experiences a certain type of physical and psychological overload. Emotional tension and stress can lead either to mastery of a new situation, or to disruption and deterioration in the performance of life functions. Although some situations can be stressful for all people, they are crises for those who are particularly vulnerable due to personality characteristics.
In domestic and foreign literature, various classifications of situations are presented:
critical situations (F.E. Vasilyuk);
conflicts, situations of physical danger, situations of uncertainty (K. Levin);
affectogenic life situations (F.V. Bassin);
conflict situations leading to a psychological crisis (A.G. Ambrumova);
difficult situations (A.Ya. Antsupov, A.N. Shipilov), etc.
A crisis is a situation when a person faces an obstacle in realizing important life goals and cannot cope with this situation using usual means.There are two types of crisis situations: those caused by changes in the natural life cycle or traumatic life events.
Situations classified as critical can basically have objective and subjective components. The objective component is represented by the influences of the external, objective and social world, while the subjective component consists of a person’s perception and assessment of the situation as critical. Based on this, a critical situation can be characterized as a social situation, the dynamics of which develop in two directions (A.G. Ambrumova):
a) personal, when the emerging internal conflict is justified by the characterological characteristics of the individual and appears first, regardless of the favorable external situation at that time; only then the internal conflict tension of the psyche begins to modify the forms of human behavior and communication, creating reasons and reasons for the deterioration of the external situation and its restructuring into a conflict, even stressful;
b) situational, when a number of unfavorable external influences, traumatic stimuli fall on the basis of not clearly functioning protective mechanisms of the psyche, low tolerance in relation to emotional stress.
Therefore, two groups of critical situations can be distinguished:
determined by external conditions;
determined by the nature of perception, as well as the individual typological characteristics of a person.
A necessary condition for the emergence of a crisis is significant emotional stress, blocking the most important needs of the individual and his specific personal reaction to this. Mental trauma contributes to the emergence of post-traumatic syndrome (PTS). Trauma can be physical, nervous, emotional. Regardless of its nature, it is accompanied by a threat to the right to life, personal well-being, and a feeling that the world is hostile. The causes of post-traumatic stress are negative life experiences and lack of optimism.
Crisis situations and crises are as varied as human life itself. The psychological literature identifies the main types of crises that a person can experience:
development crises (age crises);
crises of loss and separation;
traumatic crises
crises of relationships and states of mind;
crises of the meaning of life;
moral and ethical crises.
An age crisis is a transition period between age stages, which is inevitably experienced by a child when moving from one age stage to another upon completion of certain stages of development. First of all, this type of crisis is caused by physiological changes in the child’s body, morphofunctional changes. The peculiarity of the course of the age crisis depends on the innate properties of the nervous system (temperament), character, individual, biological and social relationships. During a crisis, the child’s personality, as an open system, becomes unstable, responding even to weak stimuli with unreasonably intense responses.
Age crises are natural, normative crises. Adverse external influences and stress factors during these periods have a huge impact on the further formation of the child’s personality, in particular on the development of his sexuality and ways of responding to environmental influences.
L.S. Vygotsky identifies the following age-related crises in children: the crisis of one year, three years, seven years and the teenage crisis (13-17 years).
It is important for a psychologist working with a child or adolescent who finds himself in a developmental crisis period to know the features and typical conflicts characteristic of a particular age-related crisis. Unresolved crises in combination with traumatization can turn into neglected ones or result in neurotic, inconsistent or aggressive actions: escapes, running away, vandalism, murder, suicide.
During puberty, a teenager’s problems and conflicts can turn into protracted crises. It is at this age that the first peak of suicidal activity (suicidal attempts and suicides) appears as a regressive decompensation of the crisis, the risk of negative addictions (alcohol, drugs, toxic substances, etc.), depression, psychogenic attacks with the experience of alienation (derealization and depersonalization) arises. .
Types and forms of providing psychological assistance to children
in a critical situation
We can suggest some of the most effective types and forms of work with children from 3 to 18 years old, which can become the basis for drawing up rehabilitation and psychocorrection programs.
Game therapy. The main form of work of a psychologist with children who have experienced a critical situation is the use of different types of games. These can be games in images, games based on literary works, on improvised dialogue, on a combination of retelling and dramatization, etc.
Using imagery in play has a number of psychological benefits. The most favorable conditions are created for the child’s personal growth, the attitude towards one’s “I” changes, and the level of self-acceptance increases. This is facilitated by restrictions on the transfer of the child’s emotional experiences associated with low self-esteem, self-doubt, and anxiety about oneself; tension is reduced, and the severity of the experiences is relieved.
The use of play as a therapeutic tool is based on two reasons:
a) the game can be used as a tool for studying a child (a classic psychoanalytic technique in which desire is repressed, one action is replaced by another, lack of attention, slips of the tongue, hesitations, etc.);
b) free repetition of a traumatic situation - “obsessive behavior”.
We see that play serves to reveal and treat distortions in a child’s development. Game therapy is valuable because it casts a shadow on the subconscious and allows you to see what in the game a child associates with a trauma, a problem, a past experience that prevents him from living a normal life.
To work with children, free play and directive (controlled) play are used. In free play, the psychologist offers children different game materials, thereby provoking regressive, realistic and aggressive types of games. Regressive play involves a return to less mature forms of behavior (for example, a child turns into a very small child, asks to be picked up, lisps, crawls, takes a pacifier, etc.). Realistic play depends on the objective situation in which the child finds himself, and not on the child's needs and desires. For example, a child wants to play what he saw and experienced at home: a search, drinking, a fight, violence. And he is offered to play what he sees in this institution: a circus performance, a theater performance, a birthday, a holiday, etc. An aggressive game is a game of war, flood, violence, murder.
In their games, children can constantly return to stressful situations they have experienced and will continue to experience them until they get used to what they experienced. Gradually, experiences will become less acute and strong, and children will be able to transfer their experiences to other objects. But for this, the psychologist must teach children new ways of behavior and other experiences.
To organize such games, you can use unstructured playing material: water, sand, clay, various types of plasticine. With such play material, the child indirectly expresses his desires and emotions, since the material itself promotes sublimation. The activity turns out to be more effective if the psychologist organizes games with such material in a directive form.
To carry out rehabilitation work, it is good to include structured play material in the developed program, which provokes children to express their own desires, master social skills, and learn ways of behavior. For this, it is effective to use human figurines symbolizing the family, cars, objects and dolls, sets of toys, etc. For example, family figures, cars, bedding provoke a desire to take care of someone; weapons – contributes to the expression of aggression; telephone, train, cars - the use of communicative actions. When organizing games with children, it is necessary to monitor what the child ignores: what toys, what color and what shape, and also record the child’s inability to play with a certain toy.
In addition to using games using toys, the following types of games can be recommended when working with children: entertainment games (chasing, tickling, etc.), exercise games (wrestling, climbing, running), story games (based on imitation of adults), procedural games - imitative games (imitate an orchestra, cars, etc.), traditional folk games (spinning top, paints, etc.), role-playing games (family, home, theater, etc.).
To carry out rehabilitation work on the basis of a game library, it is necessary to develop a special program based on the use of game therapy. The possibilities of the toy library for conducting psychocorrectional work with children of different ages are very wide. When carrying out rehabilitation and psychocorrectional work through a toy library, you can help a subgroup or group of children feel unity with others, strengthen self-confidence, learn to make independent decisions and combine them with group decisions, cooperate, negotiate with others, respect others, sympathize with them, etc. .
The use of different types of games and specially developed rehabilitation and psychocorrection programs using games is very valuable, since in the game one can overcome traumatic experiences. This happens when the integration of awareness and experience is successful, through it mental stress is relieved, the ability to perceive new impressions is formed and children’s imagination is transferred to topics not related to violence or trauma experienced, which can contribute to the development of self-confidence and affirmation of one’s own “I” ", increasing self-esteem and trust in adults around the child. The use of games in working with this group of children is only a stage in the process of rehabilitation and correction of the child’s personality.
Art therapy. This method is based on the use of art as a symbolic activity. The use of this method has two mechanisms of psychological correction. The first is aimed at the influence of art through the symbolic function of reconstructing a conflict-traumatic situation and finding a way out through the reconstruction of this situation. The second is related to the nature of the aesthetic reaction, which allows you to change the reaction of experiencing negative affect towards the formation of positive affect that brings pleasure. When working with children, the psychologist, using play therapy, complements it with art therapy methods. There are several types of art therapy: drawing therapy, art therapy, bibliotherapy, drama therapy and music therapy.
It is advisable to use applied arts as therapy through art. You can recommend tasks on a specific topic with a specific material: drawings, modeling, appliqué, origami, etc. The psychologist offers children tasks on an arbitrary topic with an independent choice of material. As one of the options, it is recommended to use existing works of art (paintings, sculptures, illustrations, calendars) for their analysis and interpretation.
You can also use a combination of some types of work, for example, offering a child a reproduction of a painting and asking him to copy it, without limiting his creativity. And finally, we can recommend joint creativity between the psychologist and the child (modeling, drawing, knitting, embroidery, etc.), giving the child greater independence in doing the work.
The most favorable way to solve correctional and rehabilitation problems is to depict artistic images that allow the child to realize all the benefits of art and creativity. Primitive forms of representation, such as scribbles, undivided objects, and low potential for symbolization, do not allow the child to fully realize the task and realize his feelings and move forward in resolving his problem.
The use of drawing methods is determined by the level of formation of the symbolic function, which allows the child to transform visual activity into activity of a symbolic type. Children under 5 years of age are still just mastering the methods of representation, and the symbolic function is only at the beginning of its development. Therefore, the use of drawing tests is not effective enough. When working with children under 5 years of age, play methods of correctional work should prevail, and drawings should be included in the context of play tasks.
For older ages - from 6 to 10 years - children have access to forms of symbolic expression that allow them to affirm their own “I” and communication skills for interacting with other people.
During adolescence, the need for self-expression and affirmation of one’s identity becomes especially important. However, the level of adolescents’ requirements for the quality of the results of drawing activities increases significantly, which complicates the use of this method. It is better to give teenagers ready-made drawings rather than asking them to just draw something. Spontaneous drawing will quickly disappear from the activities of teenagers and will not have an effect in their work.
In practical work with children, two methods of using drawing therapy have proven themselves - directive and non-directive. In most cases, a reasonable combination of elements of the two therapies is used. The child is given a drawing theme and given freedom to experiment and find the most adequate form of expression. You can use the following types of tasks and exercises when working with children:
Subject-thematic type - drawing on free and given topics. Examples of such tasks are drawings “My family”, “I’m at school”, “My new home”, “My favorite activity”, “Me now”, “Me in the future”, etc.
Figurative - symbolic type - depiction of a child in the form of images. Topics can be: “Good”, “Evil”, “Happiness”, “Joy”, “Anger”, “Fear”, etc.
Exercises to develop figurative perception: “Drawing by dots”, “Magic spots”, “Complete the picture”. They are based on the principle of projection.
Games-exercises with visual material for children of primary preschool age - experimenting with paints, paper, pencils, plasticine, chalk, etc. “Drawing with fingers and toes”, “Destruction-construction”, “Overlaying color spots on each other”, etc. d.
Tasks for joint activities - writing fairy tales and stories using drawing. Techniques of sequential alternating drawing such as “Magic Pictures” are used - one child starts, the other child continues, etc.
Music therapy. A separate type of psychological assistance can be specially organized work using musical works and instruments. It is recommended to use pieces of classical music. The works of Bach, Liszt, Chopin, Rachmaninov, Beethoven, Mozart, Tchaikovsky, Schubert and some types of sacred music are well recommended in this type of work. The proposed type of work is aimed at organizing the ability to listen to music. Extending the time of listening to music from 3-5 minutes to 1-1.5 hours requires a specially developed method of organizing children. The duration of use of a musical work allows children to listen to music, experience various kinds of experiences, listen to their feelings, and evoke an emotional state of internal balance, joy, and stress relief. At the same time, you can listen to music with your eyes closed, the main thing is to hear it!
When working with children who show anxiety, worry, fears, and tension, you can add a task. For example, when presented with calm music that evokes pleasant sensations, the child is instructed to think about objects that cause him fear, anxiety, etc. You can ask children to rank scary situations from minimal to most severe.
An adult can show by personal example how to listen to music. For this purpose, you need to sit next to the child, listen to music together, listen to music while hugging, etc. First, before listening to music, you can ask what the child wants to feel while listening to music: joy, pleasant sensations, good mood, warmth, pleasant memories ?
Listening to classical and sacred music will help your child practice social competence skills: the ability to consider the feelings of others, not to disturb others, respect the feelings of other children, empathize with others while listening to music, etc.
The use of music therapy helps create conditions for children to express themselves and the ability to respond to their own emotional states. The musical cycle used when working with a group or individual children can be continued in visual activities, when children are asked to draw the music they heard, draw their experiences, the feelings they experienced while listening to music, etc.
A slightly different direction appears with the use of musical instruments, when playing a musical instrument with a child. First, a situation is created that they are performers of music, then they are composers of music, then they play in an orchestra. A variation of this work is the performance of various dances to the sound of musical instruments played by the child and the psychologist. You can combine playing musical instruments with the movements of children (walking on a narrow plank raised above the floor - to overcome feelings of fear, self-doubt, etc.).
Bibliotherapy . A method of influencing a child, causing his experiences and feelings by reading books. For this purpose, the psychologist selects literary works that describe children’s fears, forms of experiencing stressful situations, and a way out of situations that are scary for children. To carry out this type of work, we can recommend for children of different ages the use of works by classics of literature: L.N. Tolstoy, B. Zhitkov, V. Oseeva, A. Gaidar, etc. These are works such as “The Coward”, “Arishka the Coward” , “On the Ice Floe”, “Collapse”, “Honestly”, fairy tales “Fear has Big Eyes”, “Boy-Kibalchish”, etc.
The use of works on this topic is based on the age characteristics of children: contagiousness with the feelings of others, understanding the feelings of others, etc. After listening to a work read or narrated, children understand that feelings such as fear, anxiety occur in many children, they understand what causes Such feelings distinguish between different types of threats, threatening situations, and causes of fear. Together with the heroes of literary works, children experience the same states and at the same time learn how to act in a given situation, which allows children to expand their social competence.
Logotherapy. This is a method of talking therapy, which differs from a heart-to-heart conversation aimed at establishing trust between an adult and a child. Logotherapy involves a conversation with a child aimed at verbalizing his emotional states and verbal description of emotional experiences. Verbalization of experiences can cause a positive attitude towards the one who is talking to the child, a readiness for empathy, recognition of the value of the personality of another person. The child does not always show self-exploration, that is, a measure of involvement in the conversation. It can be defined as minimal when the child is asked to answer a series of questions with a doll or use dolls and characters (Parsley, Barbie, Malvina, Pinocchio, dog, tiger, etc.). Children can use their favorite image or toy for this purpose. The use of this method assumes the emergence of self-congruence - the coincidence of external verbal argumentation and the internal state of the child, leading to self-realization when children focus on personal experiences, thoughts, feelings, desires. To carry out such work, the psychologist can offer the child a conversation about how he felt when he played with other children, what he liked about playing with individual children, what he experienced when he went to visit a friend, etc. In case of difficulties in describing your emotions and feelings, you can invite the child to imagine that a doll was playing instead of him. To work more effectively with children, you can use dark glasses, different types of masks that children put on themselves, and, distracting from their own experiences, they talk on behalf of someone or over the phone. A psychologist can also use space boundaries when talking with a child, for example, suggesting a conversation from different rooms, places where the child feels like the master.
Free word association method. This method is used by psychologists as a method of art of inventing stories. Children can be asked to come up with different stories using a set of words. The psychologist suggests words between which there is a semantic connection: grandmother, girl, wolf, train, etc. Children are invited to come up with any story, the main thing is that the stories do not repeat themselves.
A variation of this method is to come up with stories using one property of an object: for example, come up with a story about a country where everything is made of glass, soap, wood, sugar, candy, etc. As a variant of the word association method, you can invite children to come up with stories about things where everything is the opposite of what it really is. For example, children in this country are taller than adults, or children live in a country where everything is possible and nothing is impossible, etc. A good effect is achieved by using a method where children imagine a country in which Candies, toys, rain, snow, money, flowers, etc. are falling non-stop from the sky.
Psychodrama or drama therapy . Use of puppet dramatization in the work of a psychologist. Adults (or older children) perform a puppet show, “playing out” situations that are conflicting and significant for the child, inviting him to look at this situation from the outside and see himself in it. With children who show anxiety, fear, who have experienced stress, or various types of trauma, the greatest effect is achieved by using the biodrama method. Its essence is that children are preparing a performance, but all the characters in it are animals. Children distribute the roles of animals or beasts among themselves and play out conflict and life situations using the example of animals. When acting out a play, performance or situation, children act and speak differently than when using puppets. Children's experiences, realized through the images of animals, differ from human ones and at the same time help to understand the feelings of others.
As a variation of using this method, we can recommend exchanging roles with adults or other children; the child speaks for the teacher, psychologist, teacher, peer, etc. A good technique is to use a mirror: the child tells others about himself by looking at himself in the mirror.
Moritatherapy . A method by which a psychologist puts a child in a situation of having to make a good impression on others. The psychologist invites the child to express his opinion about something, and then corrects his ability to speak out, give an assessment, take a pose accordingly, use facial expressions, gestures, intonation, etc. d. In other words, this method helps to educate the rules of good manners, to comply with the norms and rules of the culture of the society in which the child is currently located. A psychologist can recommend to educators and social workers how to teach a child to behave in a specific situation in which he finds himself. For example, how to behave at a party, how to talk about yourself, how to talk about what you do in your free time, etc.
Gestalt therapy. This method can be used by a psychologist for individual work with children, in heart-to-heart conversations. It is carried out as a transformation of a child’s story into action. An example would be a type of work such as “Unfinished Business”, “I Have a Secret”, “My Dreams”. The child tells the psychologist what he dreamed, and the psychologist asks him to show what he dreamed with the help of movements, actions, materials, toys, masks, plasticine, etc.
Self-help in a critical situation
Ways to deal with negative emotions
Speak out! This technique is possible when there is someone nearby who is definitely friendly and willing to listen to you, even if in silence. In social psychology, such a person is conventionally called a “vest”. Usually these are middle-aged, sincere people who know how to keep other people's secrets. There are often cases when a conversation with a random fellow traveler brings relief. The anonymity factor comes into play here. Lonely people with pets often vent everything that is boiling over to them (with a full guarantee of maintaining the secrecy of confession!).
Write a letter! If there is no suitable listener or you do not want to resort to the first technique, write down all your grief and experiences in the form of a letter. The addressee is not important. Moreover, this letter does not have to be sent, and if you save it, then after some time it will be very interesting for you, and most likely useful, to re-read it, analyze it and draw some conclusions.
Give yourself a gift! This recommendation can be fulfilled both literally and figuratively - by “giving” yourself a few hours or a whole day of pleasant pastime. At the same time, remember that this kind of “gifts” cannot be given too often, otherwise the joy from them will noticeably fade.
Help someone else! There is always a person who needs someone's help, at least to be listened to. By switching your energy to helping your “neighbor,” you will not only do a good deed, but also help yourself get out of a passive, decadent mood, activate yourself, because doing good is always pleasant.
Dissolve your sadness in your sleep! If you can fall asleep, then this is one of the simplest ways to part with despondency and bad mood that has been used throughout the centuries. A rested brain will direct thoughts towards more constructive solutions and an optimistic attitude towards life and the problems that inevitably arise. It is no coincidence that almost all nations have a proverb that corresponds to the famous Russian “The morning is wiser than the evening!” Just don’t forget, before you fall asleep, to set yourself up so that when you wake up, you look at the world without the same bitter thoughts that make you give up and nothing changes for the better.
“Every cloud has a silver lining!” This famous saying can serve as a motto for the direction of your thoughts and actions. Make a list of all the good things that are present in your situation, dispassionately analyzing the event that plunged you into despondency and melancholy. Having compiled it, direct all your efforts to bring to life what is written - let the good gradually begin to outweigh the bad!
How to deal with stress and win.
Stress is a state of tension that occurs in a person under the influence of strong influences.
Stress is a protective reaction of the body in response to unfavorable environmental changes.
Stress is a state of increased nervous tension caused by a strong impact.
Stress is everything that surrounds us. It bursts into our lives from the very morning, along with the scream of the alarm clock, and then... traffic jams, work, problems with children, quarrels with loved ones, bad sleep. Is it possible to live without stress? Science says it's impossible. Life does not tolerate constancy and stability, and it is precisely this that is the main source of stress, therefore it is possible to completely get rid of stress only after death. But you can influence your state of mind for the better during your lifetime.
Try:
1. Change what can be changed, and accept as fate what cannot yet be changed. And always remember: when God closes a door, he always opens a window.
2. Live for today and enjoy it.
3. Never be offended by fate and remember that everything could have been much worse.
4. Avoid unpleasant people and don’t get annoyed by fools. Be glad you're not like that.
5. Evaluate yourself and worry less about what others think of you.
6. Communicate more with interesting people.
7. Plan your life so as not to waste time.
According to Hans Selye, stress is not what happens to us, but how we perceive it. And if life without stress is impossible, you should learn to distinguish failure from disaster, relax more often, play sports, remember to praise yourself for your achievements and think more about the good.
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