There are at least four definitions family psychotherapy. First: family psychotherapy is a form of carrying out the main method of psychotherapy in relation to the problems of a particular family (analytical family psychotherapy, behavioral, etc.).

Second: family psychotherapy is a set of techniques and methods of psychotherapy aimed at correcting the psychological, social and biological status of the client in the family and with the help of the family. According to this definition, the family contains both sanogenic and pathogenic potential.

Third: family psychotherapy - methods of psychotherapy within the framework of an independent direction based on certain theories (systems, cybernetics, communication channels, etc.).
Fourth: family systemic psychotherapy is a system psychological interactions two living open systems - the family and the psychotherapist in order to optimize the functioning of each [Eidemiller E. G., 2002].

Family therapy includes structural family therapy, strategic family therapy, behavioral family therapy, etc.

In the structural approach, the adolescent is seen as the "carrier of the symptom" and the family as the patient. The purpose of structural interventions is to change the structure of the family to improve the functioning of all its members and create a more balanced family system. For example, in a rigid family, organize more open communication and negotiations, help a chaotic family build a hierarchical structure, restore parental control and cooperation in the marital subsystem, which will provide adequate guidance for the family and the upbringing of children. In a disconnected system, the therapist helps bring the family together on the basis of helping the “identified patient” and clarifying the possible benefits for all family members. It is important to note that the goals set for changing family structures should correspond to the pace of the family's perception of feedback.

Often, dysfunctional families operate on an all-or-nothing basis in considering possible change. Often they fear that if changes occur in the family, they will be extreme in nature. For example, handing over responsibility to an adolescent in a "confused system" may be difficult due to the mother's fear of complete separation from the family and facing marital problems.

In strategic family psychotherapy, the main importance is given to the analysis of violations of the family hierarchy. The strategy used in this psychotherapeutic approach is based on the manipulation of power. In other words, the therapist redistributes power among family members. It is believed that behavioral deviations put young man to a higher position than their parents on the ladder of the family hierarchy. The hierarchy in the family is determined by the invariably repeating sequence with which one member of the family tells the other what he should do. In families where the behavior of children is characterized by serious deviations, the psychotherapist is faced with a situation in which adolescents, while continuing to be economically and emotionally dependent on their parents, refuse to do what their elders require of them. Psychotherapeutic interventions used by representatives of this school serve to establish a hierarchy in the family, in which parents begin to take a higher position in relation to young people. The content of communications between parents and children includes messages about parental expectations addressed to children, as well as about the rules that elders expect to follow, and, finally, about the next steps in case of violation of established rules. When a teenager loses power over his parents, he begins to behave in accordance with social requirements.

The behavioral direction of family therapy is based on the principles of learning theory. Techniques and methods of classical, operant and other types of learning are used (contracts, token system, parental competence training, problem-solving approach).

In modern family psychotherapy, the dominant trend is the development of constructivist or narrative psychotherapy. There is a direct translation of this word from English - narrative (literally - telling, describing, narrative, visual-figurative). The latter approach is considered more "humane". The stories told by the client can be sad and comical, and the conclusions can be absurd. This division, in our opinion, is arbitrary. Often one psychotherapy session uses many combined techniques. On the change of one millennium to another, the boundaries between different approaches family therapy are being erased. For example, in structural psychotherapy, as in behavioral psychotherapy, the starting point for psychotherapeutic intervention is observation of the behavior of family members. In strategic family therapy, the formulation of hypotheses and tasks by the psychotherapist brings his position closer to the directive behavioral approach. So, for example, when collecting a family history according to the genogram, family history, "metaphors", "symbols" and "themes" are taken into account. In each direction of family psychotherapy, one can find certain positive strategies and use them in working with children and adolescents.

In general, it is necessary to determine which dysfunctional family patterns can be changed. The affective, behavioral and cognitive expectations of each family member are taken into account. Regardless of the approaches used, the family should be actively involved in the treatment.

The object of intervention is not only a dysfunctional family, but also a family in crisis. A dysfunctional family is a family in which the performance of a certain function/s is impaired. A well-functioning family is one that creates or adopts the rules by which each member of the family and the family as a whole satisfy their needs for self-actualization, growth, change, acceptance and approval. It is important to find the resources of the family, the ability and motivation for change, and focus on solving urgent problems.

The general goals of various methods of family psychotherapy can be represented as follows: change in the family of a number of ideas (attitudes, assumptions) about the problem presented; transformation of the views of family members on their problem from an individual-personal to a systematic approach; modification of the permeability of boundaries between subsystems; creation of alternative time models problem solution through direct or indirect intervention; a decrease in the emotional involvement of family members in the symptomatic behavior of one of its members; correction various forms hierarchical mismatch; interruption of dysfunctional stereotypes of behavior taken from the parental family, bringing to the surface of important “unfinished business”, revealing family secrets, improving the communication style between family members.

Family psychotherapy is a special type of psychotherapy aimed at correcting interpersonal relationships and aimed at eliminating emotional disorders in the family, which are most pronounced in a sick family member. Typically, family therapy focuses on more than one family member, although it may deal with one of its members throughout the course of treatment.

1. Family therapy

2. Development of family psychotherapy

• Palo Alto School
• Family psychoanalytic psychotherapy

4. Other destinations

5. Marriage Psychotherapy

6. Family counseling

7. Psychotherapeutic correction of relationships in families

8. References

Family Psychotherapy

Family psychotherapy is a special type of psychotherapy aimed at correcting interpersonal relationships and aimed at eliminating emotional disorders in the family, which are most pronounced in a sick family member.

In the course of family therapy, the duration of which can vary from several weeks to even several years, a number of stages are distinguished. Its duration is determined by the severity of mental disorders in the “symptom carrier”, the severity of interpersonal conflicts in the family, and the motivation of family members to achieve therapeutic changes. Initially, family therapy is carried out with a frequency of 1-2 sessions per week, and then meetings occur once every 2 weeks, and then - once every 3 weeks.

Often, 4 stages are distinguished in family therapy (Eidemiller, Justickis):

• family diagnosis, diagnostic stage;
• elimination of family conflict;
• reconstructive;
• supportive.

Family diagnosis refers to the typification of disturbed family relationships.

taking into account the individual-personal properties of family members. Diagnostics of family relations is carried out in the process of joining the family group of a psychotherapist who puts forward and tests problematic diagnostic hypotheses. The peculiarity of the procedure of family diagnostics is that it accompanies family therapy at all stages and predetermines the choice of psychotherapeutic techniques. Its other feature is the need to correlate information received from some family members about what is happening with information from other family members and the psychotherapist's own impression, which was formed on the basis of questioning and observing the behavior of participants in the psychotherapy process (“family through the eyes of a child”, “family through the eyes of a psychotherapist”, “what we really are”).

At the second stage, in the course of unilateral meetings of the psychotherapist with the client and members of his family, the origins of the family conflict are identified and clarified and it is eliminated through emotional response each family member involved in the conflict, as a result of establishing adequate contact with a psychotherapist. The psychotherapist helps the participants in the conflict to learn to speak a language that everyone understands. In addition, he assumes the role of an intermediary and transfers information about the conflict in an agreed amount from one family member to another. The non-verbal component of this information can be conveyed by the psychotherapist at a family psychotherapy session, for which the “robot-manipulator” technique is used, when the psychotherapist translates the conflicting message of the session participant into sign language, matching the expressiveness of the gesture with the sensitivity and tolerance of the participants. So, at this stage of family therapy, the leading psychotherapeutic methods are: non-directive psychotherapy, aimed at verbalizing unconscious relationships of the individual, as well as specially developed methods for influencing family members on each other.

At the stage of reconstruction of family relations, a group discussion of relevant family problems either in a single family or in parallel groups of clients with similar problems and their relatives. In the same groups, role-playing behavioral training and teaching the rules of a constructive dispute are conducted.

The supportive stage of family therapy consists in consolidating the skills of empathic communication acquired at the previous stages and an expanded range of role-playing behavior in natural family conditions. Counseling and correction of the acquired communication skills in relation to real life are also carried out.

The allocation of stages allows structuring the process of family therapy, substantiates the sequence of application of various psychotherapeutic methods, depending on the goals and volume of diagnostic information. Techniques that are most often used in family therapy:

• Effective use of silence;
• The ability to listen;
• Learning with questions;
• Repetition;
• Summation, summary;
• Refinement (clarification) and reflection of affect;
• Confrontation, that is, the presentation of unconscious or ambivalent attitudes, attitudes or stereotypes of behavior to a married couple in order to comprehend and work them out;
• Playing roles;
• Creation of "living sculptures";
• Video analysis.

Development of family psychotherapy

In the last quarter of the 19th century, the doctrine of “family diagnosis” and “family treatment” of various mental disorders arose. The true founder of family therapy in Russia and one of the first in the world is I.V. Malyarevsky, who in 1882 in St. Petersburg founded a medical and educational institution for mentally ill children and adolescents, whose staff paid great attention diagnosing relationships in families of mentally ill patients, the role of disharmonious upbringing in the formation of certain manifestations of mental illness. With relatives of sick children, the so-called “ family education”, which was the prototype of modern family therapy.

The need for family therapy increased, especially since the 1940s, after the end of the 2nd World War. Currently, there are several main areas in family therapy: psychodynamic, systemic and strategic, as well as eclectic. Historically, the first was the psychodynamic direction, which grew out of Freud's analysis of the case of "little Hans". Then the main features of the psychodynamic approach were formulated, namely, the analysis of the historical past of family members, their unconscious desires, psychological problems and mutual projections. The task of psychotherapy was the achievement of insight - that is, awareness of how unresolved problems in the past affect relationships in the family at the moment and how neurotic symptoms and non-constructive ways of adapting to life arise from this disturbed context of relationships in some of its members. At present, this approach, which requires a lot of effort on the part of both the psychotherapist and the family members, is considered less cost-effective, although highly effective.

Currently, more than half of family psychotherapists work in line with systemic family therapy, a quarter represent the psychodynamic direction. Supporters of the eclectic direction combine methods of various healing mechanisms in psychotherapeutic work: hypnosis, autogenic training, meditation, homework on behavior modification, analysis and interpretation of relationships, group discussions and others.

Directions in family psychotherapy

I will briefly talk about the directions and schools of foreign family psychotherapy.

Palo Alto School

Jay Haley, a spokesman for the Palo Alto School, is the author of the "Problem Solving Therapy" method. Many of his techniques were borrowed from Milton Erickson. Haley believed that family relationships are determined by the outcome of the struggle of spouses for control over other family members. A symptom is one way to control the behavior of others. According to Jay Haley, the task of psychotherapy is to provide people with other ways of influencing. Therapeutic effect family therapy is greatly enhanced if all family members are brought together in a therapy session. Hayley's contribution to family therapy was various directives (tasks) to family members. The fulfillment of tasks ensured equality, each family member had the right to express his opinion or do something. The therapist gives tasks both during the session and at home. The purpose of these tasks:

• change the behavior of family members;
• find an additional incentive to build relationships between the psychotherapist and family members;
• to study the reactions of family members when they perform tasks;
• provide support to family members, as during the performance of tasks, the psychotherapist is as if invisibly present.

Haley also used metaphorical and paradoxical tasks. The first were based on the search for analogies between events and actions that at first glance are completely different; the second are such instructions that family members resist and thereby change their behavior in the right direction.

Another major figure in the Palo Alto school was Murray Bowen, who is considered one of the founders of family therapy in the United States. By the mid-60s of the 20th century, he developed a method of family psychotherapy, consisting of 4 principles:

Defining and clarifying relationships.

Teaching spouses effective emotional communication;

Occupation of "I-position".

Family Psychoanalytic Therapy

The goal of psychoanalytic family therapy is to change the personality of the participants in psychotherapy so that they are able to interact as whole healthy personalities on the basis of present reality, and not on the basis of unconscious relationships of the past. Psychoanalytically oriented therapists are also less directive than those from other schools.

The following techniques are used in this therapeutic direction: confrontation, clarification, interpretation and processing of experience, techniques for improving communication skills, technique “ free associations". Psychoanalysts prefer to watch and listen, abruptly ending empty discussion with questions.

Family systems psychotherapy

The largest representatives of this direction are Mara Selvini-Palazzoli, Clu Madanes, Salvador Minukhin and others. Currently, the systemic direction is considered one of the most widely represented, promising, cost-effective and therapeutically effective areas of family therapy. The provisions of Ilya Prigogine's general theory of systems had a significant influence on the development of this direction.

In systemic family therapy, the family is seen as complete system, which seeks to preserve and evolve the existing ties. Throughout their existence, families go through natural developmental crises (marriage, separation from parental families, pregnancy, childbirth, child's admission to preschool / school institutions, graduation from school and choice of his own family). life path, break with parents, retirement of parents, etc.) It is at these intervals of their existence that families are unable to solve new problems in the old ways and therefore face the need to complicate their adaptive reactions.

Basic family steps systemic psychotherapy look like this:

• Uniting the psychotherapist with the family, joining him to the structure of roles presented by the family.
• Formulating a psychotherapeutic request.
• Reconstruction of family relations.
• Completion of psychotherapy and disconnection.

Mara Selvini-Palazzoli introduced such a principle of work when a team of therapists of different sexes work with the family, while others observe their work, being behind a one-way transparent mirror. The unit of psychotherapy is the participation in all sessions of all members of the family living under one roof. The frequency of meetings was 1 per month, up to 10 sessions in total. Her method was brief and sudden, she used the method of paradoxical prescriptions, sought to bring about changes in the family by sudden decisive move. The paradoxical task (in other words, the “invariant prescription”) was developed very carefully and involved all family members in a series of actions that contradicted the rigid rules and myths that had developed in the family.

Strategic family therapy

This method of family therapy is also called "problem-solving", "short", as it is focused on solving problems. Most famous figures this direction - Jay Haley, Carl Whitaker, Clu Madanes. In their work, psychotherapists in this area do not concentrate on the personality traits of family members. This approach characterized by extreme attention to the details of the symptom and less interest in the family. This direction gained wide popularity by 1970. Representatives of this method learned many ideas from the experience of Milton Erickson. His practice is characterized by two approaches: the use indirect methods exposure and acceptance of everything that the client offers.

The essence of the strategic approach is the development of a strategy for solving problems, since changes in the family are more important than understanding the causes of violations. Strategic therapists explore the factors that make a problem sustained by existing family interactions and therefore seek to identify behaviors that reinforce the problem. Many strategic psychotherapists believe that a normally functioning family is one that avoids symptoms and is able to function according to the demands of changing circumstances.

Family Behavioral Therapy

Family behavioral therapy sees reinforcement of behavior by consequences as its main principle, which implies that the pattern of behavior resists change in all cases, except when there are more favorable consequences. Representatives of this direction are interested in the analysis of the sequence of actions. It is based on the position that satisfaction in marriage is to a much greater extent due to the absence of mutual frustrations than to the volume of pleasures delivered to each other.

One of the most commonly used techniques is behavioral parenting training. The process of psychotherapy begins with the fact that the therapist reformulates the client's ideas about the essence of the problem and possible ways to solve it. Behavioral psychotherapists are one of the few who do not invite the whole family for treatment, but only the child and one of the parents. Behavioral training of parents aims to increase their competence in raising children, recognizing and modifying patterns of emotional and behavioral response.

Most Popular the following techniques works:

• shaping - achieving the desired behavior in small portions through sequential reinforcement;
• token system - uses money or points to reward children for successful behavior;
• contract system - includes an agreement with parents to change their behavior in sync with the change in the behavior of the child;
• exchange of changes for a fee;
• interruption ( timeout ) - punishment in the form of isolation.

Family behavioral therapy is one of the most popular methods due to its simplicity and economy, although often therapeutic changes are one-sided or short-lived.

Other destinations

Family communication therapy has evolved from the Palo Alto trend. Its leading representatives are P. Vaclavik, D. Jackson and others. The goal of family communication therapy is to change modes of communication, or "conscious action to change poorly functioning patterns of interaction." At first, representatives of this direction, for example, Virginia Satir, set the goal simply to improve communication in the family, then this idea narrowed down to changing exactly those modes of communication that support the symptom. The main groups of family communication therapy techniques are: teaching family members the rules of clear communication; analysis and interpretation of communication methods in the family; manipulation of family communication different techniques and rules. This type of family therapy failed to establish itself as a highly effective method.

Of the representatives of the direction of family therapy based on experience, the most famous are Carl Whitaker ( Carl Whitaker) and August Napier ( August Napier). This method is based on experience and common sense” (Eidemiller, Justickis, “Psychology and Psychotherapy of the Family”, 1999).

Marriage Psychotherapy

Marriage psychotherapy is a form of psychotherapy that is focused on a married couple, helps her in overcoming family conflicts and crisis situations, in achieving harmony in relationships, ensuring mutual satisfaction of needs. It can work as an independent method and as a stage of family psychotherapy.

The work is carried out either with a married couple, or with one of the partners who came to see a psychotherapist. In this version of marital psychotherapy, the psychotherapist does not discuss the problems of the spouse, but only those thoughts, feelings, experiences that the applicant has problems about his (her) marriage.

At present, dynamic, behavioral and humanistic approaches are the most common in marital psychotherapy.

With a dynamic approach, marital disharmony is considered from the point of view of intrinsic motivation the behavior of both partners. The dynamics of interpersonal relations and its connection with the dynamics of mental processes are traced.

The goal of the behavioral approach in marital therapy is primarily to change the behavior of partners, while using conditioning and training methods, which provides:

Mutual management positive behavior spouses;

Acquiring the necessary social knowledge and skills, especially in the field of communication and joint problem solving;

Development and implementation of a marital agreement on the mutual change of their behavior.

The behavioral direction in marital psychotherapy is currently the most common. Its most popular forms are the conclusion of marital contracts, communication trainings, constructive dispute, problem solving techniques, etc. Currently, many specialists use an integrative approach, most often combining the methods of cognitive behavioral therapy and systemic psychotherapy.

At the heart of the contract is an agreement in which the spouses clearly define their requirements in terms of behavior and assumed circumstances. When formulating requirements, it is recommended to use the following order: general complaints, then their concretization, then positive proposals, and finally, an agreement listing the responsibilities of each of the spouses.

In a humanistic approach to psychological correction marital relations the leading ones are the ideas that openness, authenticity, tolerance, the need for self-expression, belonging to another and independent development of each person's personality are at the heart of a harmonious marriage. This approach has evolved as opposed to the dynamic approach, which is too focused on the influence of the spouse's historical past and his family of origin, and the overly manipulative behavioral approach. Here the psychotherapist creates conditions in which the spouses strive to verbalize their feelings and thereby improve mutual understanding. The principles of open marriage were formulated, creating the most favorable conditions for the personal growth of partners:

The principle of reality, "here and now";

Respect for the privacy of a partner;

Mobility in the performance of family roles;

Equality;

Authenticity - to know yourself and your price, to appreciate the right of another to live according to his ideas;

Open partnership - everyone has the right to own interests and hobbies.

Family counseling

Family counseling is one of the varieties of family psychotherapy, which has its own distinctive features and boundaries of therapeutic intervention. Family counseling has developed in parallel with family therapy, mutually enriching each other. The main goal of family counseling is to study the problem of a family member or members in order to change the interaction in it and provide opportunities personal growth.

What is the difference family counseling and family therapy? First, family counseling does not accept the concept of illness. Secondly, it puts emphasis on the analysis of the situation and aspects of role interaction in the family. Thirdly, it is intended to help in the search personal resource subjects of counseling and discussion of ways to resolve the situation.

Leading theoretical concepts family counseling are cognitive-behavioral therapy, rational-emotional therapy and others. This is due to the variety of techniques and methods that are available in his arsenal.

The basic principles and rules of family counseling come down to the following points:

Establishing contact and connecting a consultant to clients. It is achieved by maintaining a constructive distance that promotes optimal communication, as well as techniques for synchronizing the facial expressions and breathing of the counselor and the counselee, the use by the counselor of speech forms that reflect the dominant representational system of the one who reports his family problem.

Collecting information about the client's problem using meta-modeling techniques (NLP) and therapeutic metaphors. To achieve this goal, the consultant can ask clarifying questions such as: “What result do you want to achieve?”, “What do you want?”, “Try to say this without the negative “no” particle, that is, words that describe a positive result.”

Discussion of the psychotherapeutic contract, which is one of the most important tasks of family counseling. At this stage, there is a discussion of how the responsibility will be distributed between the client and his consultant. For example, the consultant is responsible for the security conditions of family counseling, for access technologies to resolve the client's problem. In turn, the client becomes responsible for his own activity, sincerity in the desire to change his role behavior, and so on. After successful completion In this phase, the participants agree on the duration of work (for example, 3-6 hours), the duration of one session and the frequency of therapeutic meetings (for example, at first once a week, later less often - once every 2-3 weeks). Finally, the terms of payment are discussed, as well as sanctions for violation of the terms of the contract by the parties.

Next, the client's problem is clarified, and the resources of the family as a whole and each of its members individually are also determined. This is facilitated by questions like: “How did you deal with difficulties in the past? What helped you in this?”, “In what situations were you strong? How did you use your power?”

Conducting the actual consultation. Here it is necessary to strengthen the confidence of clients in the success and safety of the counseling procedure: “Your desire to implement changes, your previous experience, activity and sincerity, combined with the desire of the consultant to cooperate with you, his professional qualities and work experience will be a reliable guarantee of success.” The positive and negative aspects of the prevailing stereotypes of behavior are discussed with the participants of the consultation, for example, with the help of such questions: “What, in your opinion, is the most negative in the current situation? And what is the best thing under these circumstances?” A joint search for new patterns of behavior is carried out. Consultant offers next questions: “What haven't you done yet to solve the problem? How did the people significant to you behave if they found themselves in a similar situation? Could you do this?” or “What will help you do the same thing?” The consultant can use visualization techniques: clients, being in a trance, create an image of a new situation, while fixing the emerging kinesthetic sensations.

"Environmental Check". The consultant invites family members to imagine themselves in a similar situation in 5-10 years and explore their condition.

Nearing the end of family counseling, the counselor makes an effort to "insure" the results. This is because clients sometimes need activities to help them gain confidence in learning new behaviors. They may receive some homework from the consultant and an invitation to come back for a follow-up consultation some time later to discuss the results.

Disconnection. This procedure is necessary in some cases. For example, the literature describes how Jay Haley did this with the help of a “paradoxical task”, the exact execution of which leads to the opposite result. Young couples who were consulted about expressing their feelings were asked to quarrel for an hour a day "to test their emotional response." Haley thus considered human nature, knowing that no one would knowingly harm themselves. The couple tried the task and left it, their desire to appreciate each other strengthened, and they decided to refuse the services of the “stupid consultant”, thus the “disconnection” took place.

Currently, family counseling is a widely demanded type of psychotherapeutic assistance among the Russian population. Family consultants work in psychological centers, in consultations operating in the system of the Ministry social protection and committees for the protection of the family and childhood, as well as in other institutions.

Psychotherapeutic correction of relationships in families

Family psychotherapy itself begins when the psychotherapist, having studied the family and established a family disorder, organizes an impact on the family and its individual members in order to achieve the desired changes in their lives. In this case, problems and tasks arise, which are conditionally divided into 3 groups (Eidemiller, Yustickis, 1999): right attitude families to family therapy; general issues conducting therapy; finally, the methods of family psychotherapy.

It is necessary to form a positive attitude towards the process of family psychotherapy, although it is not easy for family members - its participants, due to organizational, emotional and intellectual reasons. Therefore, the psychotherapist needs to form a strong and stable motivation to participate in psychotherapy.

As a rule, the first meeting is decisive for the rest - during it the degree of complexity of the problems faced by the psychotherapist is clarified, and the clients (family member) get the first idea about family therapy and decide whether to continue their participation in it. In general, the task of the psychotherapist during the first meeting is to help the client in short term understand that serious and long-term work is needed and that he will be required to be active and responsible for the success of psychotherapy. Therefore, a well-designed plan for the first meeting with a family member is necessary. First, the psychotherapist must become familiar with the client's problems, actualize his emotional experiences related to the family, etc., let the client see the totality of frustrations that he deals with in everyday life. The further task of the psychotherapist is to create in the client the idea that family therapy will provide an opportunity to find a solution to his problems, because the latter still has a poor idea of ​​family psychotherapy. The therapist must use the client's state of mind to create motives for participation in psychotherapy, and just as importantly, work through the motives that prevent participation, see future difficulties and find ways to solve them. Another important aspect of this meeting is to form in the client an active interest in the very content of psychotherapeutic activity in order to avoid a situation in the future when the client is passively waiting for help from the psychotherapist. Instead, it adjusts to active search solving their family problems with the help of a psychotherapist.

The family psychotherapist has to solve problems in organizing his work different kind, for example:

Work alone or invite a co-therapist?

What is the optimal duration of psychotherapy?

Where to work with the family - in the office or at her place of residence?

Should I conduct classes with the whole family at once or first with individual family members?

What is the best frequency and duration of meetings?

What problems to start with, private or family?

Should I develop a detailed plan of action or put it on the spur of the moment?

The method of organizing and conducting family psychotherapy should not be determined by the “scientific views” of the family psychotherapist. Ideally, the choice of how to organize family psychotherapy should depend on the characteristics of the family. Also, any family therapist should be equally prepared to apply the most various styles psychotherapy (and their changes) depending on the family, its individual members, its problems and family conditions. It is possible that with one family member is preferred authoritarian style, with the other - non-directive. So, the answer to all these questions facing the psychotherapist depends on the totality of conditions.

Next, the question is considered which methods of family psychotherapy are most applicable. The method of family psychotherapy is a typical set of actions with the help of which a psychotherapist solves a specific psychotherapeutic problem. Family psychotherapy during its development has acquired a large number of different techniques that have come from the experience of newly emerging schools. I will list the main types of psychotherapeutic techniques most widely used in family psychotherapy.

Directives (or instructions) are direct, specific instructions about the need for certain actions on the part of the whole family or its individual members in order for them to achieve their goals. These may be instructions to do something; do something differently than before; not to do something that was done before. In the case of the so-called paradoxical directive, its true purpose is the opposite of its proclaimed one. The effectiveness of the application of directives depends decisively on the correctness of its application, it requires a thorough study of the family, psychotherapeutic influence on the family by the example of the psychotherapist himself, and most importantly, sufficient authority of the psychotherapist.

The method of family discussion is also widely used in the practice of family psychotherapy. During it, family members discuss a wide range of issues related to her life, and ways to solve various family issues. A discussion can serve many purposes, such as correcting misconceptions about family relationships or teaching family members how to discuss. Managing a discussion requires the psychotherapist to have the necessary skills. Among the main techniques used in conducting family discussions are called effective use silence, listening, learning through questions, repetition, generalization, confrontation with a particular opinion or family member, etc.

Sometimes it turns out that family members do not have enough skills and abilities necessary for successful family life; in the course of family psychotherapy, these missing skills are formed with the help of a variety of psychotherapeutic techniques, special exercises and “trainings”: the formation of versioned thinking, playing family roles, etc. Their general principle is that a certain task is set before a family member, for example, in the form of a skill or habit that he must form, and a criterion is reported by which he judges whether he (she) managed to cope with the task.

List of used literature:

1. E. Eidemiller, V. Justickis. Psychology and psychotherapy of the family. St. Petersburg, 1999.
2. Psychotherapeutic encyclopedia (edited by B. Karvasarsky). St. Petersburg, 1998.
3. K. Madanes. Systemic family psychotherapy. M, 1999.
4. P. Papp. Family therapy and its paradoxes. M, 1998.
5. S. Minukhin, Ch. Fishman. family therapy techniques. M, 1998.

No matter how the Russian people ridiculed the latter, therapeutic techniques literally saved many marriages, and at least improved mutual understanding in families who asked for help, helped to overcome a difficult period, a crisis in family relationships and even grief.

And no matter what practitioner you are, you should pay attention, first of all, to theoretical knowledge, it is on them that modern psychological techniques. The more you learn about family psychology, the fewer irreparable mistakes you make, the more happy you yourself will be and make your family so. And then you won't need any therapists.

Lots of research done social psychologists(It is in the sphere of social problems that includes family relationships), made it possible to derive a number of psychological patterns. It is difficult to determine which of them to name in the first place, however, it is up to you to judge which is more important ...

Causes of conflict between husband and wife.

Among the most common reasons for conflict, psychologists named: the organization of life, methods of raising children, various preferences for ways to spend leisure time. It is these issues that should be discussed in advance and in as much detail as possible so that there are no surprises later. Although they will still be, you will significantly reduce their number, and, accordingly, the number of reasons for quarrels, conflicts, and misunderstandings.

Crisis stages in family development.

At some point, a turning point occurs. Something in family life changes the established way of life. This difficult period is called a crisis. On the one hand, it is useful if it leads to favorable, beneficial changes for the family. But it happens that family members do not cope with the changes due to a lack of understanding of what is happening, or due to their own personal problems.

1. The first crisis occurs at the initial stage, when the family was just born. Adaptation period, "lapping" is complicated by the bachelor habits of the spouses. The longer they lived alone, the more difficult it will be to combine the two. different lives in one. Especially if one beautiful moment one or both spouses have no desire to try to come to terms with this or that fact.
2. Then after 3 years or at the time of the birth of the child. Of course, becoming a parent is stressful for both.
3. Then the crisis comes with the advent of the second child or after 7 years. The reason for the difficulties in the distribution of roles, the new responsibilities of everyone, especially the older child does not like it if you have not prepared him properly.
4. And later critical period can be called offensive midlife crisis at the head of the family. This crisis affects only men. Women also have a crisis due to age-related changes, but much later (menopause). And only a “male” crisis can destroy a family. Women cannot be called more stable in terms of the crisis, but outwardly we try not to show the crisis, not to transfer it to the family. A man in a fit can change, behave like a teenager, abuse alcohol, engage in gambling. Of course, here are the most striking, defiant examples of male behavior. More often, the crisis manifests itself in a more smoothed form, and yet the behavior of the head of the family cannot but affect all family members.
5. The next crisis is sometimes referred to as "emptying the nest". This happens after 20 years of marriage, when all the children leave parental home, and the spouses suddenly realize that they have nothing to do. They built their whole lives around children, not each other, they always dreamed of spending more time alone, but now that this has become possible, they do not know what to do with themselves. And add to this the fear of death, deterioration of health ...

You can prepare yourself for each of these periods, despite the bleakness of the picture. But you should not wait for difficulties, focusing on them, as if waiting for them to begin. Just be prepared.

Crises in relationships with children.

• All of them are connected with the crises studied by psychologists in the development of the child himself (the crisis of one year, three years, seven, adolescence).
• The crisis also arises due to changes in the family ( divorce, the arrival of a new family member, death loved one): this includes all the problems of raising a child in an incomplete family, childhood jealousy, the struggle for the love of parents, relationships with a stepfather (stepmother), a sense of loss and inability to survive it if the relationship was especially close.

Psychological techniques for working with families.

Do not be surprised if you are familiar with the methods of work of several specialists, and they are incredibly different. The fact is that there are many theories on which specific techniques and methods of working with families are based.

Basically, the work is carried out to establish contact and mutual understanding. Training can take place in specific conditions set by the psychologist, with the help of modern technology, using your imagination. Don't be surprised by anything.

The psychologist himself, having studied your situation, can invite an assistant with whom he will demonstrate your relationship from the outside. You hardly recognize yourself. The first impulse will be to deny what is happening, blaming an outsider. Hold on at least at first.

It is possible to visit a psychologist to your home, for a deeper understanding of the problem.

Some problems are easier to solve silently, and creativity unites like nothing else. A psychologist may suggest that you even do modeling ...

As ridiculous or paradoxical as the therapist's suggestions may seem, they work. If you come to a psychologist, follow his advice.

The main question that interests everyone and everyone is what needs to be done so that your marriage is strong, happy and forever. Only the desire of the spouses to be together will be important - romance will say. Psychologists are somewhat pragmatic in matters of love and marriage. We love those who meet our needs. Respectively strong marriage will, if everyone gets from him what he always wanted. If you are just thinking about marriage, find out how much you have in common, what you expect from each other.

The most important issue to discuss together (and it's never too late for that) is your ideas about marriage, about the position of each spouse in it, a section of general duties. Practicing psychologists, family counselors noticed. Diagnosing problems in family relationships reveals basically a huge difference in the ideas of the spouses about their role and the role of the other in marriage. In other words, we do not do what is expected of us, but we think that we are the ideal wife (husband) and at the same time demand excessively (and it seems that we deserve it) from the spouse (wife). When we don't get any of our demands, we get angry, and we get even angrier when we meet with dissatisfaction. This is how small squabbles bring a marriage to the brink of divorce.

Over time, human needs change and this must be remembered. Be attentive to each other.

Myths about love and marriage.

Do not bother yourself with believing in non-existent "facts". For example, in anger, any of you can say a lot of unpleasant and very hurtful things. It begins to seem to us that a loved one has always had a bad opinion of us, we begin to doubt the strength of his feelings, the strength of marriage and attract more trouble. In this case, the myth can be formulated as follows: "if he (she) would love me, he would not dare to insult me." Relationships should be easier. Don't invent something that doesn't exist. Do not rush to conclusions. And remember, anything can happen in a relationship. Each person changes during his life and at one fine moment can throw out something that he did not expect from himself. Also, each of us changes in relationships, the relationships themselves change. Learn to trust each other. Learn to discuss problems, eliminate misunderstandings before they develop into a protracted conflict, alienation.

Families with different composition.

Everything discussed above can be attributed to the standard composition of the family. But there are families, different in composition and they have their own problems. The most common situation, when the intervention of grandparents goes beyond incomplete family. In order to compensate for the absence of a father or mother in a child - it's even great, extra hands, help never hurt. But, if these relationships prevent the mother (father) from properly raising a child, undermine the authority of a single parent, you need to learn to put a barrier between grandparents and your, albeit small, family. This is not so easy to do: moving does not always help, introducing a new family member (second marriage) is not always the best way out. Try to eliminate the influence of your parents on your child on your own, unnoticed by them. Changes may be insignificant, move forward step by step, but purposefully, towards the separation of your family, in which you are a parent, from the family, in which you are a child.

And in the end, I would like to emphasize: your family is one force, which is recharged from each, doubles and gives everyone strength, meaning and happiness. Raise your children on the same principle, and they will feel everything that modern children lack so much: a sense of security, security, immeasurable parental love, self-confidence, adequate self-esteem recognition of loved ones, satisfaction with life in general. Adhering to this position, and together you will overcome not only external, incoming problems, but also internal ones, no matter how sophisticated they are.

Family psychotherapy deals with the elimination and prevention of violations of the emotional atmosphere in the family. This highly specialized direction in psychology is a technique that mainly focuses on analysis and per se. More precisely, it is help to any individual within the framework of his relatives, family, and also through them.

The target for therapy can be not only a family in the stage of its “destruction”, but also any other family that is experiencing a crisis moment in one or another area of ​​their relationships. At the same time, it should be noted that the leading moment is not an external influence. And the general search for internal family resources that can serve as the basis for the formation of the necessary community, focusing the attention of family members on solving mutual problems.

Depending on the type of goal used, this technique can change dramatically. Most often we are talking about the creation topical issue for all family members and their involvement in the process of solving the problem, lowering emotional stress in the family, the search for a common compromise solution to conflicts, and the like.

Systemic family therapy

In the concept of "family psychotherapy" Eidemiller once made his amendments, thereby expanding the scope this method. From his point of view, this technique is not only an influence on a particular individual, but a way of influencing the family as an open living system in order to improve and optimize its functioning. The technique itself was formed and developed relatively recently, along with cybernetics, which is the reason for its systems approach. Along with other narrowly focused techniques in psychiatry, systemic family therapy is the "youngest". This technique, being aimed at working with internal relations in a team and resolving emerging interpersonal conflicts, considers as a basis the systemic structure of the family as a team and the features of family relationships for this particular case.

Thus, we can say that the goals of family psychotherapy are expressed in a number of specific strategic points:
1. Support and optimization of the family microclimate.
2. Formation among family members of the feeling that their individuality and needs are respected by others.
3. Help in overcoming the position, from the point of view of which all family problems are the result of the decisions and behavior of one particular family member.
4. Nurturing empathy among the participants. The ability to feel and empathize with others.
5. Formation among family members of a more tolerant attitude towards the conditional head of the family and his decisions.
6. Optimization of the skills and abilities of all participants in the system of collective, family problem solving.
7. Education in the family of a balanced ratio of individuality and independence of each on a par with cohesion and a sense of duty, responsibility to the family.

Methods of family psychotherapy

In the course of working with a particular family, a specialist can use completely various methods family psychotherapy. In many ways, this depends not only on the specifics of the problem or even the characteristics of the family itself, but also on the stage that is currently being carried out in therapy. Thus, the phasing of this technique in psychiatry properly structures the treatment process in general, determines a certain approach, the choice of a particular method, and even the duration of therapy.
For example, the first and initial stage of all therapy is the so-called "diagnostic stage". Throughout it, the doctor tries to join the entire family team, literally gradually merge into it, so that, by setting and testing various hypotheses, he ultimately makes a general diagnosis.
In the future, there is a stage of conflict resolution, during which the psychotherapist first of all discovers a certain source, which is the cause of the emerging conflict. Its elimination is achieved through the regulation of emotional responses on the part of all family participants in the formed conflict. This state is achieved through the communication of all family members with a psychotherapist, who establishes contact with them in advance in order to be able to act as a kind of "intermediary". Thus, literally transmitting signals between family members, the specialist introduces them to forming a common language understandable to all.
At the next stage, which is considered the stage of restoration or reconstruction, there is already a general, collective discussion by the family of the existing problems, as well as the adoption of options for solving them. Various trainings are also used to help all participants develop the necessary positive lines of behavior and the ability to adequately communicate and respect each other.
The last maintenance stage uses more than simple techniques, whose task is to consolidate or adjust the skills acquired during therapy. The results are also evaluated and further necessary consultation is carried out.

Group family therapy

Of course, in this direction often there are individual sessions, but in essence, family therapy is designed to conduct a simultaneous session with several couples, up to seven. Of course, it is necessary to select couples for a one-time session that are similar in age, social status, education, mentality. One of the positive aspects that group family therapy has is the increased efficiency of mastering various communication skills. In addition, participants better master the possibilities of softer and more adequate communication, learn to listen to the interlocutor.
For the most part, the techniques that are used in group sessions practically do not differ from individual ones. The difference is that during group lessons each couple has the opportunity to learn from the experience gained by observing other participants in the treatment. In addition, such experience has a positive effect on the processes of communication and communication, and also allows you to consider alternative methods of approach to problem solving.
Before starting a full-fledged therapy, as a rule, specialists share common group for two. In one of them, only men participate, and in the second, respectively, women. This tactic is due to the fact that it allows you to prepare both parties for further treatment and thereby reduce the risk of excessive manifestation of habitual protective reactions. This is due to the fact that very often people come to sessions of psychotherapeutic treatment only because of their unwillingness to fully open up to their partner and others. Unfortunately, there are such cases. When, after each treatment session, the spouses, upon returning home on the same day, repeat their quarrel. In this regard, techniques that widely use the foundations of bioheverism, aimed at organizing and optimizing skills, are very popular. positive thinking and adequate, constructive dialogue.

Family Therapy Techniques

The concept of “family psychotherapy techniques” usually means a number of techniques and techniques that are aimed at understanding and positively modifying the family structure, which will further improve its internal microclimate and relationships as such.
For example, there are so-called "sociometric" techniques. They are quite simple and relevant from the point of view of the need to analyze the life of the family in all social spheres. And also make some changes to the structure. Among other things, sociometric techniques also make it possible to reduce the possible resistance of the family system to interference in its usual structure, which is carried out by a specialist. Also apply behavioral techniques, largely based on the principles of biohevirism and the development of positive lines and patterns of behavior, as well as other "paradoxical" methods.
In any case, therapy cannot take place without intervention "from outside", that is, without the participation of a specialist. With any approach, not only analysis and constructive solution with the help of a psychotherapist, but also requires Active participation in this process all family members.

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 patient with schizophrenia.

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 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 clinical manifestations and features of the 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 the misdiagnosis of the disease, especially as a result of the excessive expansion of the boundaries of schizophrenia, ignoring the data of studies of the nervous system, the results obtained from psychological assessment 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, latent family conflicts may aggravate during this period. 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 provide Negative influence on the state of a 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 clarify Negative consequences such tactics that 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 the 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 reproducible transculturally 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 parents is an additional stressor for a patient with schizophrenia, creating the cognitive dissonance and contributing to an increase in psychopathological symptoms, which, in turn, increase emotional expression in parents, thereby completing 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 see their family often. doctor. Come to terms with the fact mental illness 85% of mothers see the benefits of treatment mainly in the rare admission of the patient to the 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 father of the patient, 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 more desired assessment patient 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. Such tactics can be especially recommended for beginning 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 skills 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 direction of problem-oriented therapy may consider various strategies problem solving through role play.

You can work with groups of family members using " colloquial forms psychotherapy”, providing for relatives of patients necessary information. 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.