I'm not a robot

CAPTCHA

Privacy - Terms

reCAPTCHA v4
Link



















Original text

We continue the “Frank conversation about Psychology”. And in this article we will try to understand what everyone seems to know, but everyone understands in their own way. Psychological counseling is for many psychologists the main tool of their practical work. But what is this tool actually? What are its capabilities and limits of application? Is there a difference between Psychological Consulting and Psychological Education? What is Counseling and how does it differ from Consulting? During the Conversation, a number of other questions will probably arise. We will try to answer them too. And we will start again with the definition: “Psychological counseling is a special area of ​​practical psychology associated with the provision of direct psychological assistance by a specialist psychologist to people who need it, in the form of advice and recommendations.” (Nemov R.S. “Fundamentals of psychological counseling: Textbook for students of pedagogical universities”). And at the same time, at the psychology department they constantly “drilled” into our heads the imperative, “psychologists do not give advice.” It is probably assumed that the advice and recommendations are fundamentally different from each other in some way (who knows these differences, please reveal this secret in the comments). But to this day I don’t see any difference (that’s why I don’t do psychological counseling according to Nemov). If advice and recommendations are removed from counseling, then the psychologist will only have to tell clients about the causes of their problems and concerns. In the work of a school psychologist, when consulting teachers and parents, this format is even encouraged. True, such counseling differs from Psychological Education only in that Education should be carried out for preventive purposes. What way out of this contradiction did I find for myself? The Psychotherapeutic Encyclopedia, edited by Karvasarsky, which was published a year before Nemov’s textbook on counseling, came to my aid. And here the authors “clearly identify three main approaches in Psychological Counseling: Problem-oriented counseling (consulting), aimed at analyzing the essence and external causes of the problem, finding ways to resolve it. Personality-oriented consulting (counseling), centered on the analysis of individual causes of the problem, the genesis of destructive personality stereotypes, the prevention of similar problems in the future. The approach is similar to psychodynamic psychotherapy, the consultant fundamentally refrains from advice and organizational assistance. Solution-oriented counseling (solution talk), centered on identifying resources to solve the problem.” So, what do we have: Consulting, Counseling and something with the beautiful name “solution talk” (talking about a decision). Consulting fits into the “non-Mov” definition of consulting, and solution talk, in my opinion, is simply its logical continuation. Therefore, they should be considered as one approach. Looking ahead, I will say that such an integrated approach eventually became part of my practice under the name “Crisis Analysis” (with its individual and group forms). But that was later, and to begin with, I took Counseling as a basis in my work. And largely also because some authors considered Counseling as psychotherapy for people with emotional problems that are not pathology. How could it be otherwise, since we were categorically forbidden to look in the direction of any pathologies: “Psychological counseling as a type of psychological assistance is addressed to mentally normal people to achieve the goals of personal development.” (Abramova G.S. “Psychological counseling. Theory and experience”). And borderline states and pathology should be dealt with by psychotherapists and psychiatrists! This is another popular imperative. But let’s simulate a situation in which any practicing psychologist might find themselves. A person comes to your appointment with complaints of bad mood and loss of strength. At the beginning of the work it turns out that poor sleep also occurs,decreased appetite and sex drive. There is asthenia with all the ensuing manifestations: fatigue, absent-mindedness, apathy, intolerance to bright light and loud sounds. And while you are going through suitable diagnoses in your head (depression, astheno-depressive syndrome or VSD), your client gradually moves on to a story in which traumatic moments are visible. Now you understand the nature of his emotional experiences, and you can no longer help but sympathize with this unfortunate person. You really want to help him, but you are not a doctor, you do not have a medical education. What to do in such a situation? Should you apologize and send the client to a familiar psychotherapist or keep him, assuming that apart from sympathy you will not help him in any way? And while you are thinking, let's take an unbiased, but more closely look at this dilemma. What thought process and what experiences led our psychologist to such a choice problem? The desire to help (and not lose the fee) struggles with the fear of breaking the Rules? Or do the diagnoses that suggest themselves, and even under the pressure of imperatives, cause fears of not being able to cope with this request? In this choice, fear of diagnosis is on the side of Responsibility, and financial interest is on the side of Empathy and Desire to help. In my opinion, there is no single correct solution to this dilemma. But there is a way to avoid the dilemma itself. Let's imagine what will happen if, when listing the client's symptoms, we do not spend our attention on determining the appropriate diagnosis. And what’s the point if we still can’t use the diagnosis in our work? What (besides the fear of losing in front of him) will he give us? A psychologist should not, moreover, (without medical education) does not have the right to make a diagnosis. In the work of a psychologist, diagnosis acts as a unifying factor, reducing all the individual characteristics of the client’s symptoms to one abstract nosological unit. And if in medicine treatment is selected based on diagnosis, then in psychological practice we look for an individual approach for each client. Therefore, I propose that etiopathogenetic diagnosis be carried out not for the purpose of making a diagnosis, but for understanding the “logic of symptoms.” What are they depriving, and what do these symptoms give our patient? What are they restrained from and what are they encouraged to do? We can use the answers to these questions, unlike the diagnosis, in our work. But let’s return to the situation we simulated. We did not strain our attention and memory, selecting a suitable diagnosis, but listened carefully to our interlocutor. They asked leading questions and clarified the contradictions in his answers. They tracked how his emotionality changes, which topics are more painful for him, and where he begins to “slip.” And if, as in our situation, we reach psychologically traumatic moments, our desire to help and do our job conscientiously will not be hampered by either diagnoses or imperatives. After all, we do not break any rules, since we work with a mentally normal person. And if you suggest that the client be checked at the same time by his general practitioner, at least in order to exclude purely somatic diseases, the dilemma described above simply will not arise. But, unfortunately, this does not mean at all that in the course of Psychological counseling, be it Consulting or Counselling, no other problems may arise. Among such problems I attribute the limitation of counseling to the framework of “awareness”. A consulting psychologist does not have the opportunity to discuss with a client what he is not aware of. And psychological counseling does not provide him with any other tools other than discussion. Otherwise, it will no longer be counseling, but something else. We will definitely talk about this “other” too, but a little later. In the meantime, plans include a review (or destruction) of modern Theories of Memory. If among them there is at least one that reliably and convincingly explains to us the nature of this mental phenomenon? EMIO therapy for neurotic disorders (depression, phobias, panic attacks, nervous