Family Therapy Etymology.

Comes from the Greek. therareia - treatment.

Category.

A form of communication psychotherapy.

Specificity.

It is aimed at harmonizing family relationships. Among the researchers who have made the most tangible contribution to the development of this approach, the most famous are the following: V. Satir, K. Whitaker, S. Minukhin, M. S. Palazolli, D. Haley, M. Bowen, K. Madanes, L. Hoffman.

Psychological Dictionary. THEM. Kondakov. 2000 .

FAMILY THERAPY

(or) (English) family therapy) - modification of relations between family members as a system with the help of psychotherapeutic and psycho-corrective methods and in order to overcome negative psychological symptoms and increase the functionality of the family system. In S. t. psychological symptoms and problems are considered as the result of suboptimal, dysfunctional interactions of family members, and not as attributes to. family member ("identifiable patient"). As a rule, S. t. implements not an intra-, but an interpersonal approach to solving problems; is to change, through appropriate interventions, the family system as a whole.

Modern S. t. To.Rogers and V. Satir, systemic S. t. M. Palazoli, J. F. Chekin, G. Prat and L. Boscolo, positive S. t. ontotherapy A. Meneghetti and others. Within the framework of these theories, a wide range of original concepts (“closed pathology”, “mixing”, “pseudo-commonality”, “double bond”, “double message”, “metacommunication”, etc.) and methods have been created (“connection”, “circular interview”, “psychological sculpture of the family”, “positive identification of symptoms”, etc.). Let us consider the main theoretical orientations in the field of S. t.

Family behavioral therapy. The essence of this approach lies in the idea of ​​interdependence behavior individuals: in any interaction, each of its participants seeks to maximize "rewards" and minimize "costs". Rewards are defined as the pleasures received, while costs are defined as the expenditure of time and effort. Marital disagreements are described as a function of the low rate of positive reinforcement. A comparison of conflicted and non-conflicted married couples reveals lower levels of reinforcement and higher levels of punishment in conflict families. The main strategy of S. t. is an increase in the interaction of positive, rewarding behavior and a decrease in negative, punishing behavior. The object of correction is the communicative behavior of spouses and parents. Changes in behavioral patterns of interaction in dysfunctional families suggests the following. areas of correctional and educational work: 1) teaching direct expression of expectations, desires, dissatisfaction; 2) training in the specific and operational expression of desires and intentions; 3) learning to communicate in a positive, reinforcing, constructive manner, both verbally and non-verbally; 4) learning to strengthen feelings of reciprocity and adequate communicative feedback; 5) teaching spouses to conclude various contracts on a mutual and unilateral basis; 6) learning to achieve compromise and consensus in the family. Correction direction data can be implemented both in the context of individual counseling and in situations of group work. Model of behavioral S. t. the following is described. stages: ; alternative ways to achieve the goal; program of step-by-step movement to the goal; practical implementation of this program. Role-playing games, video training, and various kinds of homework are widely used to transfer acquired skills to real situations in the family.

The main drawback of the approach is that it ignores existential problems that cannot be reduced to purely behavioral difficulties. Since the problems faced by the therapist are multidimensional (they manifest themselves in behavior, in the cognitive and emotional spheres), behavioral S. t. tends to enrich its arsenal with methods cognitive psychology.

Psychoanalytic S. t. so far - the most common theoretical approach in S. t., his views are popular among psychiatrists and social workers. However, there is no consensus among psychoanalysts themselves as to whether a psychoanalyst should be considered a family therapist. This circumstance is explained by the fact that classical psychoanalysis is focused on the study and treatment of an individual. The orthodox psychoanalytic position on this issue can be characterized as follows. way: family disorders are symptoms that reflect individual psychopathology; people who turn to a psychotherapist about family problems have deeply personal (intrapersonal) conflicts. Therefore, psychoanalysis acts as an individual treatment of the patient, excluding a direct impact on his intra-family relations.

And in a number of neopsychoanalytic approaches (for example, ego psychology, object relations theory, etc.), the problems of marital relations are also defined as manifestations of intrapersonal conflicts in the context of interpersonal relationships. Internal conflict is seen as the result of events that occurred in early childhood. Common to theories with a psychoanalytic orientation (psychodynamic approach, object relations theory,) are the following. provisions: the cause of family conflicts is an early negative life experience; the determinants of ineffective ways are in the realm of the unconscious; therapy should be aimed at the awareness of family members repressed into the unconscious experiences that determine their behavior and are responsible for the emergence of conflicts. In neopsychoanalytic approaches, interpersonal relationships play a significant role as the causes of family conflicts. Techniques aimed at working with the whole family are beginning to be applied. The therapist takes a more active position, not only interpreting the unconscious experiences of family members, but also directive intervention in family interactions.

Milanese systematic approach to S. t. Formed in the 1970s. based on psychoanalysis, general systems theory, works of the Palo Alto school. Main provisions: - self-regulating and constantly developing system; any human action is a form of communication; behavior is organized in patterns of interactions that are circular in nature; non-verbal aspects of communication are more important than its content; family members are elements of a single system of interactions, the behavior of any of them affects the behavior of all others, but is not the cause of this behavior; the main regulator of interactions is the rules of the family; The therapist in his work with the family is neutral, non-directive, and addresses behavioral patterns rather than family members as individuals. His task is to free the family from pathogenic patterns of interaction, to give it the opportunity to develop without experiencing symptoms. In this sense, there is no fixed normative image of the family. The adaptive capabilities of the family are associated with its ability to change. Pathological families are characterized by the so-called. "family games" (the striving of each family member to define relationships with others in their own terms, while denying that they do so), which are based on the mistaken belief that there is the possibility of unilateral control over interpersonal relationships. In fact, the main rule of the game is that no one can ever win, because you cannot control the system of circular relationships. Psychotic behavior is a logical consequence of the family game. Thus, any mental disorders are considered as violations of social interactions. Therapeutic work consists of separate sessions: pre-session (discussion of preliminary information about the family by a team of psychotherapists, development of an initial hypothesis about the functioning of the family); interviews (obtaining basic information about the family, testing the initial hypothesis); a break in the reception (team discussion of the progress of work, development of a systemic hypothesis); intervention (presentation by the therapist of a positive statement, or a paradoxical prescription, or ritualized behavior to the family); post-appointment (team discussion of the family's reaction to the intervention, formulation of the general results of the admission). Team work (permanent supervision) is the cornerstone of systemic S. t. Here, such principles of therapy as hypotheses, cyclicity, and neutrality in working with the family are implemented.

The last principle is especially important, since it is traditionally believed that a pathological family must change (change itself). In fact, this erroneous t. sp. blocks the possibility of genuine change, which occurs only when the family is given real freedom (including the freedom not to change). The purpose of systemic S. t. is to help the family, as a system, free its members from symptoms, interdependencies, and defenses. Only by freeing himself from the system of pathological communications can a person solve his problems and gain a true individuality.

"dialogue" in the appendix to S. t. The fundamental concept of this approach is the concept of dialogue ( M.M.Bakhtin). Dialogue - a characteristic and basic condition for development consciousness and self-awareness of a person - the polyphony of personal manifestos and self-determinations of the surrounding people. Any behavior is a replica in the global dialogue. Any communication is dialogical. The degree of dialogicity is determined by overcoming various forms of resistance and protection characteristic of monologue (closed, role-playing, conventional, manipulative) behavior. The counseling situation is a kind of dialogue in which the therapist's activity is determined by his position of aesthetic outsideness: the client's inner world acts as a displayed and understood object, but not as a field of activity and an object of analysis; The therapist addresses various aspects of the client's inner world. Understanding presupposes communication with the client, as with a free person with a dialogic intention, presupposes counter activity of the client. The client's difficulty in entering into a dialogue poses the task of provoking his dialogical intention to the therapist. The general solution in this case is the "principle of silence": the deficit of meaningful reactions of the therapist in dialogue with the client. The dialogical position of the therapist is realized in the following. forms: the postulate of responsibility (the idea of ​​freedom and responsibility of a person for what is happening and for his own condition); orientation to meaning (setting a task for the client on the meaning of counseling with subsequent rethinking of life situations and tasks); fundamental openness (the ability for the client to contact the consultant again at any time, switch to other methods or other specialists); admissibility of advice (as a means of establishing contact with the client, actualizing certain contents in his mind, indicating ignored aspects of his own problems).

Orthodox tradition in the construction of S. t. God is the source of human spiritual energy. The image of God in a person is the core and essence of the personality, it is fundamentally indestructible and inexhaustible, the inner approach to it makes the person himself more and more unique. At the heart of any marriage, which is built on the right (spiritual) foundations, is a meeting (acquaintance as a revelation and). In the family, there are methods and mechanisms for constantly updating the experience of the meeting (individual and church-wide prayer, participation in the liturgical life of the Church), which are both a source of spiritual energy and renewal of interpersonal relationships in the family. These relationships are seen as archetypal and hierarchical (devoid of the fullness of revelation, but full of love). The family is rooted in the genus. The main materializing beginning of the family is the house as a bodily-mental-spiritual space. A house is built and maintained by the constant intercession of at least one member of the family before God. Various attributes of the house (from the roof to the basement) have special semantic meanings and loads in the Orthodox tradition. The house as a material and spiritual combination of these attributes is the need and goal of every person. The path of a particular family is determined by its fate (God's mind) and the joint and free will of all its members.

Main forms of education in the field of S. t.: traditional (lectures, seminars, study of literature); joint (practical work under the guidance of a teacher-supervisor); group (various trainings). The latter is the most effective form of training psychologists-practitioners. The training program of education solves 4 main tasks: informs the student, demonstrates situations and techniques, develops psychotherapeutic attitudes and skills, provides conditions for the process of self-research and personal growth of the student. Effective training assumes that the facilitator unites the group of learners, replenishes their self-worth, is authentic and congruent, active and empathic, positive. Constant study and awareness of their own problems by the therapist is a necessary condition for effective S. t. An important feature of such programs is the teamwork of the leaders. The main skills of the therapist: the ability to establish and maintain contact with the client; the ability to analyze the state of the client and his family system; the ability to provide effective directive and directive influence on the client and his family. (A. B. Orlov.)

Big psychological dictionary. - M.: Prime-EVROZNAK. Ed. B.G. Meshcheryakova, acad. V.P. Zinchenko. 2003 .

See what "family therapy" is in other dictionaries:

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Family Therapy- (family therapy), counseling or psychiatric. treatment of some or all family members as a dep. groups. With S.t. used a wide range of therapies and decomp. types of diagnostics, including videos that allow you to evaluate your own behavior, and ... ... Peoples and cultures

FAMILY THERAPY- A generic term for a range of therapeutic approaches that treat the family as a whole, without singling out specific individuals for independent treatment. This term is theoretically neutral; Family therapy can be practiced as part of… Explanatory Dictionary of Psychology

Family therapy is an indispensable tool in a situation where the family is in danger of destruction. This can happen in anyone's life, and you don't even have to be guilty. Many note that everyday life is filled with conflicts, and people cannot come to a mutual understanding so characteristic of the first time. Family therapy helps to find a common language, deal with problems together and avoid the disintegration of the social unit.

Well, I do not!

This is exactly what many people think when they find themselves in a situation of difficult family relationships, if friends, relatives offer to seek help from a specialist. Family therapy for some unknown reason seems to be something frightening, even embarrassing. The opinion is completely wrong. Systemic family therapy helps to cope with numerous difficulties, get rid of innuendo, a load of problems. With the help of a doctor who specializes in this matter, you can finally understand the mindset of a loved one, establish contact with him and restore peace in the house.

Families who are faced with difficult life situations often need help. Many people are by nature closed, they simply cannot afford to share their emotional state even with a loved one. Systemic family therapy comes to the rescue, allows you to form a productive dialogue. A timely trip to a specialist is a way to maintain marriage ties and prevent the destruction of the family. Systemic family therapy is a modern approach actively developed by psychologists and psychotherapists around the world. The accumulated experience shows that this is a really successful method of solving the problem of mutual understanding between family members.

Features of the situation

The Institute of Family Therapy was developed as a specialist response to the ever-increasing cases of crisis in relationships between loved ones. Observation of the cells of society gave an idea of ​​the most typical reactions of a person in a state of crisis:

• distrust of others;
• mockery;
• skeptical perception of the interlocutor.

Family therapy techniques are based on the following postulate: the interlocutor simply does not realize that a loved one is trying to convey such reactions to him. Many in this situation simply do not understand that relationships can be saved, restored, returned to their former glory.

general information

How does the modern Family Therapy Center work? This is a place within the walls of which only professional psychologists and psychotherapists conduct receptions. The task of specialists is to prevent possible problems in the near future, work on situations that have already happened in order to understand the behavior of all participants in the causes of what happened. Doctors help people understand what led to the crisis, what factors provoked it and stimulated the development of the situation. Family psychology and family therapy are an effective measure to prevent emotional breakdowns, from which, unfortunately, no family is immune, especially in the rather difficult social conditions of our time.

Turning to specialists for help, you can restore relationships with loved ones. There are several large clinics working in this direction. The result of the course is positively assessed by people who have visited the Minukhin School of Family Therapy, good reviews about Schwartz and some other authors of unique approaches.

How it works?

The Institute for Integrative Family Therapy provides interested individuals with relevant, useful, practical information in the following areas:

• the family system, the essence of the cell of society;
• the ability to realize oneself as part of the family;
• formation of a stable productive dialogue with objects that are difficult to communicate;
• restoration of understanding between loved ones;
• ways to achieve harmony in the family;
• methods of understanding others.

The Institute of Integrative Family Therapy helps to cope with the fears associated with insight into complex, controversial situations. Success is achievable only when blocking a superficial approach, understanding the essence of the factors that provoked the conflict situation. All problems, as psychologists assure, can be solved, and many patients, having completed a specific course, are surprised, looking back: how did they not understand before that building productive relationships is so simple?

What to pay attention to?

Integrative family therapy helps to define, formulate, establish the boundaries of relationships. This is equally true for the problem of "fathers and children", and for the relationship between parents. As part of the course, the psychologist helps clients find common themes and realize how important they are and how they can determine the future. At the level of sisters and brothers, a specialized approach will help create pleasant relationships, eliminate the harshness and conflict of perception of another person. Many note that only with the help of a psychotherapist they were able to realize the intimacy of a relationship with a loved one. At the same time, an important role in the systemic family therapy of subpersonalities is played by the fact of joint participation, awareness of the interest of all parties in communication in a positive result.

The task of the psychologist is to allow the client to understand that the family does not contain extra people, everyone is needed, there is a need for everyone. Thanks to this, it becomes easier to mutually overcome the differences that have arisen. When revealing betrayal, a psychotherapist will help analyze the painful situation. The task of family members is to understand that the preservation of events in the current situation will not give any benefit, in order to move forward, to develop relations, it is necessary to overcome this complexity. Often the most modern family therapy of subpersonalities, developed by a prominent figure - Richard Schwartz, comes to the benefit.

Equality and respect

Family therapy helps:

• achieve equal status for all family members;
• eliminate the situation of the appearance of a "scapegoat", including preventing such a position for oneself;
• to help each other within the family (this also needs to be learned!);
• reformat relations in such a way that the future is as prosperous as possible;
• realize the importance of the family and the values ​​associated with it.

Basic techniques

Currently, family art therapy is popular, psychodrama, joining, playing, observing are no less relevant. The specific method is chosen according to the situation. Many experts positively assess Schwartz's approach: systemic family therapy of subpersonalities. By the way, the author even published a fairly popular book based on his own achievements, written in a simple and understandable language, without the use of specific terms. If it is not possible to take a course of family psychotherapy, one can start by studying this work and applying its postulates in reality, gradually developing the situation and, possibly, bringing those close to the understanding of the need for external intervention - psychotherapeutic advice.

Accession

This approach involves the inclusion of a doctor in family relationships: the psychologist becomes a full participant. This allows you to understand the essence of what is happening between people and take measures to eliminate the conflict situation. This model belongs to the category of role-playing games and includes several successive stages:

1. Description of the problem by family members, which helps the psychologist to identify the most active, dominant member.
2. Collecting information about the position of each member, formulating a primary conclusion on the situation, confirming the fact that there is a problem.
3. Summing up first by clients, then with the participation of a psychotherapist.

As noted in psychotherapeutic practice, with this approach to solving a problem, the second step, associated with the formulation of conclusions, is often the most difficult. Many visitors to the sessions categorically disagree with the doctor's opinion, and the difficulties in mutual relations do not allow reaching an agreed position in the group of clients. Thanks to the transformation of an outsider into a family member, it becomes easier to understand what the essence of the problem is, to find the positive aspects of interaction, develop a strategy to strengthen them, and formulate a line of conduct in relation to a difficult situation. At the stage of debriefing, the psychotherapist controls that the problem is not solved under the direction of one of the group, but by the joint work of all participants. Only by combining efforts and showing everyone's interest can a truly productive result be obtained.

Summing up

The final stage of the role-playing game, which involves the addition of another family member, is the development of alternative solutions to the circumstances. Under the supervision of a psychotherapist, the participants play out a specific situation, each explains what he will do, how he will behave, how he will react to the actions of others. During the game, all those taking part have the right to stop others, correct their actions and express their vision.

The psychologist necessarily gives “homework”: work through, discuss what was understood during the session, do specific things and not perform certain actions. At the same time, it is monitored that all members of the incoming group take an active part - this condition is one of the key for family therapy.

Surveillance and processing

With this method of work, the psychotherapist carefully observes the interaction of clients within the group: how people listen, react to information coming from the interlocutor. The data obtained in this way is used to formulate conclusions, to draw up a program of recommendations for improving the atmosphere in the house.

Redesign involves emphasizing the important positive aspects of family relationships. The psychotherapist helps to realize the benefits, pleasant moments of interaction, provokes a desire to work on their development.

Techniques

Receptions are such means, the use of which helps to adjust the structure of interaction between family members. Sherman, Fredman, in their generally accepted works applicable in practice, formulated the following list of ways to influence the situation:

• sociometry;
• behavioral strategies;
• paradoxical approaches;
• use of imagination.

How about in more detail?

Sociometry is the most widely applied approach at present. The prevalence of the method is due to the universality of its application. Psychotherapists who have mastered this option of influencing clients to perfection can cope with any family difficulties, placing emphasis on the most powerful aspects of the relationship.

Assume the search for the cause of the arisen complex, conflict situation. The task of the psychotherapist is to help clients adjust their behavior so that the relationship becomes healthier. It is believed that this method is one of the most effective.

Paradox-based techniques show a quick positive effect, and the clients get the impression that the problem has exhausted itself. But for a psychologist, mastering the approach is not easy; its application is also associated with certain difficulties. Finally, the use of imagination involves art therapy, work with associations.

historical moments

Family therapy is a rather young and actively developing method at the present time. It was first used after World War II. The authors were the leading psychotherapists of America. It is now recognized that approaches need to be developed and improved. The peculiarity of psychotherapeutic techniques is that the doctor simultaneously works with a group of visitors at once, influencing the family as a whole. The Germans were the first to recognize this technique, then the method was approved by the Austrians and was adopted in Sweden.

Nowadays, family therapy is actively used in different countries of the world, it is recognized as economical, effective, and has a long-term result. From year to year, there are more and more numerous new proposals regarding possible methods and approaches, new dependencies and facts are being discovered, and ways of influencing people that are fundamentally different from those used previously are being worked out.

Not everything is so clear

While some see family therapy as the future of society, others firmly believe that this option is not suitable for permanent use. Feature - in the absence of their own concepts and unique theories accepted by wide circles. What is written in the key works for the direction and what is observed in practice often diverges. It is noted that family therapy is largely heuristic.

Curious Moments

The duration of the course of family therapy in the simplest cases is only a couple of weeks, but there are situations when medical assistance has been needed for years. This is largely determined by the carrier of the symptom and the presence of mental disorders, as well as the activity of interpersonal conflicts. In different cases, clients are motivated to achieve success to varying degrees, this also plays an important role. As a rule, classes begin with one or two sessions weekly, then the frequency is reduced to once every two weeks, then once every three weeks.

The main stages of the therapeutic course, indicated in the works of Justickis, Eidemiller:

• diagnostics;
• elimination of a conflict situation;
• reconstruction;
• support.

The most important thing is to start right

Diagnosis involves typing the identified problems. The task of the psychotherapist is to pay attention to the personal qualities of all participants in the process. The psychiatrist formulates hypotheses and seeks justification for them. At the same time, therapy is distinguished by the presence of a diagnostic component at all stages of interaction between the doctor and clients: this is the only way to choose truly effective methods of influencing people.

As part of the interaction with family members, the doctor should take into account that the data received from one participant may not coincide with the vision of another person. You need to be able to correlate the information received, form your own unique impression, question and control the behavior of the arriving group. The task of the psychotherapist is to look at the situation from the perspective of each of the family members in order to understand and realize their point of view and help to resolve the conflict situation.

What's next?

After the initial acquaintance with the situation, you can proceed to a deeper analysis of the circumstances. The psychotherapist meets with the family, identifies the source of the conflict situation, analyzes the emotional reaction of each interested person, and looks for ways to eliminate the consequences. As part of the workflow, it is necessary to create a productive dialogue between the client and the doctor, otherwise the event will not be successful.

The task of the psychotherapist is to help all participants in the situation establish mutually understandable contact, when each family member is able to perceive and understand the information presented by others. The doctor becomes an intermediary, helping to select such a volume of data that all parties to the conflict situation can currently perceive, his task is to control the very fact of transmission, to make sure that the information was heard and understood. The psychotherapeutic session is aimed at working with non-verbal informational components. As a rule, the doctor asks the client to express conflicting data with gestures, asking him to be tolerant and sensitive to others. The most widely used non-directive technology helps to verbalize relationships that are not recognized by family members. Additionally, the doctor can develop unique methods of influence that help clients establish a constructive dialogue.

Continuing work

Only a deep penetration into the family conflict can make a course of systemic therapy really effective. This requires the organization of group discussions with the participation of not only a particular family, but also other people who find themselves in a similar situation. The correct formation of groups allows you to conduct role-playing training, teach clients to discuss, adhering to the rules of constructive dialogue.

When clients have acquired a sufficient amount of empathic skills, the doctor thinks out and implements a course to consolidate the information received. This helps to correct ranges of behavioral responses and communication skills, thereby increasing the quality of everyday family life.

From the point of view of a number of psychiatrists of the second half of the twentieth century, this disease develops in complex dominant-subordinate relationships in the family.

G. Bateson et al. (1956) and T. Lidz et al. (1957) believed that the parents of schizophrenic patients are cold, tend to dominate and often provoke conflicts and quarrels in the family.

G. Bateson (1978) wrote about the phenomenon of mutually exclusive coercion (“double bond”), which is often found in the family of a schizophrenic patient.

Relations between the parents of a patient with schizophrenia in most cases are of a conflicting nature, at the same time they are quite confusing, and, despite the tension in family relations, divorces are relatively rare here.

AT Families that include schizophrenic patients almost always have distorted communications, peculiar interactions: positive and negative coalition, ignoring the position.

With a positive coalition, the strategy of controlling behavior, the patient's condition, and continuing the course of therapy dominates. With a negative type of coalition, the leading attitudes are the denial of the disease, the rejection of the position in relation to the diagnosis of a mental disorder, treatment, help from other family members. With an ignoring position, a cold, indifferent attitude, rejection of a mentally ill relative is noted. In this case, contacts between family members often have a formal connotation. Relations in the family are usually characterized by polarity, both in relation to the patient, and to problems associated with the acceptance of the fact of the presence of the disease, the development of the correct behavior, understanding the need for long-term therapy (Kuleshova N.A., 2005).

Many psychotherapists believe that regulate the time of communication of family members of a patient with schizophrenia between themselves.

Families of patients with schizophrenia, from the point of view of even the patients themselves, are quite hierarchical and closed. This is facilitated by: the desire to externally present the family as prosperous and over-involvement of loved ones, most often the mother, in the life of the patient (Dolnykova A.A. et al., 2007).

It is absolutely clear that family members of a schizophrenic patient may suffer from various mental disorders. These can be schizophrenic spectrum disorders, as well as neurotic, affective and psychosomatic disorders. It is possible that relatives of a patient with schizophrenia have personality disorders, alcoholism, and drug addiction. In connection with the foregoing, parallel treatment of relatives of a person suffering from schizophrenia is almost always necessary.

The attitude towards the patient in the family circle is often complex, on the one hand, close people show excessive pity, on the other hand, they do not notice mental disorders that are distinct to the eyes of others.

An important role in the process of helping the family of a patient with schizophrenia is played by psychoeducation.its members.

Most people have a vague idea of ​​the clinical manifestations and course of schizophrenia.

The patient's relatives have even less information about drug and especially psychotherapeutic treatment and forms of psychosocial assistance for schizophrenia.

Often the patient rejects the diagnosis of schizophrenia, considers it frightening, hopeless, erroneous.

A similar attitude towards the disease can also take place in the patient's family members. In addition, the very meaning of the diagnosis remains hidden from the patient and his environment. Usually excessive exaggeration of the danger of schizophrenia, fear of this mental disorder. We also meet with erroneous diagnosis of the disease, especially as a result of excessive expansion of the boundaries of schizophrenia, ignoring the data of studies of the nervous system, the results obtained from the psychological assessment of the patient's condition.

Often, the stigma of the diagnosis prevents revision, even if the course of the disease rules out the diagnosis of schizophrenia.

Of particular importance is family therapy at the stage of the first psychotic episode.. During this period, the reaction of a patient with schizophrenia and his relatives to the diagnosis of the disease is extremely acute. They experience severe stress, being in a traumatic situation, during this period hidden family conflicts may escalate. The lack of ideas about the disease and the features of its treatment often exacerbates the state of stress in the patient's family members. It is necessary to mitigate this reaction by forming an adequate attitude towards the disease, emphasizing the need for its long-term therapy, as well as the importance of observing the daily routine, the correct alternation of work and rest.

Relatives of the patient can have a negative impact on the state of the patient with schizophrenia if they are emotionally expressive, violently express their feelings, picky, aggressive or hostile to the patient, do not understand his actions and statements.

With a certain degree of conventionality, it should be considered that the family of a patient with schizophrenia is just as affected by the disease as he is. At the same time, the family can also be a source of social support for the patient, so its members should be involved as much as possible in the treatment and rehabilitation process.

In some cases, the psychotherapist is faced with the desire to lay responsibility for the microclimate in the family on or with closed relationships between members of the patient's family. Often, from the very beginning of therapy, the patient's relatives and the patient himself strive for separate communication with a specialist, mistakenly believing that in this case the conversation will be more frank, and psychotherapy more effective. In such a situation, the psychotherapist should pay attention to strengthening the relationship of trust between the patient and his relatives.

The patient can manipulate family members and the psychotherapist, demanding that information about the psychotherapy process be closed to relatives, insisting on frequent changes in the psychotherapist. In such cases, it is important to explain the negative consequences of such tactics, which complicate the process of psychotherapy and reduce the level of its effectiveness. In our opinion, even with the resistance of the patient, without his approval, the psychotherapist has the right to inform the members of the patient's family about the course of the psychotherapy process, provided that they maintain medical secrecy.

Particularly relevant is the work with family members at the stage of formation of remission, immediately after stopping the relapse of schizophrenia or at its threat.

Our experience has shown the effectiveness of parallel therapy of the patient's relatives already at the stage of stopping the psychotic episode.

Family therapy for schizophrenia is especially relevant for families of young patients, but it requires special training of staff.

For family members of a patient with schizophrenia, in some cases, a tendency to self-accusation and search for the causes of the disease is characteristic. Often, relatives overestimate the possibilities of therapy and blame the doctor for its failure.

Families of patients with schizophrenia have excessive emotional expressiveness., especially on the part of the mother (hostility, nervousness), avoiding solving family problems of the father, excessive criticism of the patient on his part.

Excessive "severity of emotions" of family members of a patient with schizophrenia (expressed emotion) affects the frequency of relapses of this mental disorder. The close environment of the patient affects the characteristics of the course of the disease. Frequent criticism, hostility, excessive involvement of one family member in the personal life of another and lack of warmth - all this contributes to the recurrence of schizophrenia (Brown G., Birley J., 1968). The vivid expression of emotions is a rather stable phenomenon, as a rule, reflecting the habitual style of communication in the family (Miklowitz D. et al., 1984). Moreover, this phenomenon is transculturally reproducible and reflects the difference in the course of schizophrenia between industrialized and developing countries (Barrelet L., et.al., 1988). According to H. Grunebaum (1986), deviant behavior of parents is an additional stressor for a patient with schizophrenia, creating cognitive dissonance in him and contributing to an increase in psychopathological symptoms, which, in turn, increase emotional expression in parents, thereby closing a vicious circle.

Rigidity and pseudo-solidarity are common signs of a family of a patient with schizophrenia (Eidemiller E.G., 1978).

The relationship between a mother and a child with schizophrenia is usually very close, the relationship with the father is often close, less often distant. Psychiatrists noticed that a patient with schizophrenia is usually the only child in the family (Ispolatova E.N., Denisenko M.A., Sofronov I.P., 2005).

Most experts are sure that the "mother of a schizophrenic" is usually the leader of the family, often endowed with paranoid character traits (Lichko A.E., 1985).

The emotional intensity of relations with the mother, who usually dominates the family and overprotects the patient, is a typical phenomenon, while the patient seeks to escape from this guardianship, and the mother either pities him or shows irritability, complaining about the lack of personal life.

More than 80% of mothers of patients with schizophrenia avoid discussing the problems of the disease even with relatives, reproach themselves for it, fear for the fate of the patient after their death, see the main manifestations of the disease in everyday helplessness, isolation, absent-mindedness of patients. At the same time, 40% of mothers believe that general practitioners neglect the complaints of their loved ones, 45% do not find understanding with psychiatrists, 70% seek to be heard when choosing treatment, need information about the disease and its treatment, benefits for families and want to often see their doctor. 85% of mothers come to terms with the fact of mental illness and see the benefits of treatment mainly in the rare placement of the patient in a hospital. These mothers believe that patients need useful leisure, employment and learning skills for independent living (Levina N.B., Lyubov E.B., 2006).

Aggression of the patient towards the mother is often the result of the overprotection that the latter shows. The patient often demonstrates an ambivalent attitude towards the mother, on the one hand, excessive dependence on her, on the other hand, hostility.

On the part of the patient's father, we most often encountered detachment, "escape to work", into the "autonomous world of hobbies", while the patient seeks to get the attention of his father, to spend more time with him. The coldness of brothers and sisters, their detached position towards the problems of a patient with schizophrenia is a frequent picture in his family.

Among the tasks of family therapy for schizophrenia is the correction of the expectations of family members regarding the prognosis of the course of the disease, the patient's social and labor status, and the effectiveness of treatment.

It is necessary to correct the point of view of relatives of patients in relation to the fatal attitude to the hereditary burden of schizophrenia.

Members of such a family are shocked by the diagnosis of the disease, often trying to shift the responsibility for the results of treatment to the doctor, experiencing distrust of psychotherapeutic methods of influence and avoiding family therapy. However, the psychotherapist, showing sufficient perseverance, should strive for psychotherapeutic work with the patient's family.

In many countries, it is considered extremely important from the first moments of the diagnosis of schizophrenia to maintain frequent contact with the patient's family. So, in particular, the Norwegian Psychiatric Association recommends interacting with the patient's relatives by phone within three days after the patient's admission to the hospital. The Association also recommends not to start treating the patient with medicines within one to two weeks after the identification of the diagnosis, in order to be able to clarify the diagnosis and make it more necessary to assess the patient's status. Assessment of the status in the dynamics of the treatment process is also considered an important component of the latter.

Therapy of a family in the presence of a patient with schizophrenia in it requires a certain flexibility of the psychotherapist. It is difficult to give any specific recipe here, but most often family therapy begins with individual meetings of the psychotherapist with each family member individually. This tactic can be especially recommended for novice psychotherapists.

Traditionally, family therapy begins with the diagnosis of the family system, determining its type, period of development, assessing intra-family relations, and elucidating the role behavior of family members.

When working with family members of a patient with schizophrenia, psychotherapists try to adhere to the "concept of expressed emotions."

In the "treatment of the family" appropriate: "bifocal therapy", structural family therapy, outlining the boundaries between generations. Most therapists speak negatively about the systemic and analytical therapy of the family of a patient with schizophrenia.

Treatment options for the family of a patient with schizophrenia:

1. Group cognitive-behavioral therapy of patients and their relatives at the stage of patients' stay in a hospital, including elements of psychoeducation, coping training and teaching the skills to control medication intake.
2. Behavioral family therapy sessions at home.
3. Outpatient psychodynamic groups.
4. Combination of group and individual therapy of family members, aimed at reducing the severity of emotional expression.
5. Discussion club for patients and their relatives.

popular behavioral family therapy techniques, developing the skills of proper communication in the family, and paradoxical forms of family therapy, as if leaving in the shade the true intentions of the psychotherapist.

Efficiency proven time and time again problem-oriented family therapy a patient with schizophrenia, which includes specially designed techniques. Partly problem-oriented therapy intersects with sociotherapy, psychoeducation. Typically problem-based therapy involves teaching the family how to support each other and how to help themselves. A psychotherapist working in the context of problem-oriented therapy may consider various strategies for solving problems through role-playing games.

With groups of family members, you can work using "conversational forms of psychotherapy", providing the necessary information for relatives of patients. Such groups can function without patients. The effectiveness of such groups in terms of emotional unloading of family members is noted. However, these forms of assistance to relatives of patients with schizophrenia cannot be an alternative to full-fledged family therapy.

The family of a schizophrenic patient should be integrated into a wide social network of care for people suffering from this mental disorder.