Cognitive-behavioral psychotherapy: the main principle of this approach, its variations, strengths and weaknesses. Cognitive behavioral therapy

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Anxiety and depression, eating disorders and phobias, problems in couples and communication - the list of questions that cognitive behavioral therapy undertakes to answer continues to grow from year to year. Does this mean that psychology has found a universal “key to all doors”, a cure for all diseases? Or are the advantages of this type of therapy somewhat exaggerated? Let's try to figure it out.

Put your psyche back in place

In the beginning there was behaviorism. This is the name of the science of behavior (hence the second name of cognitive behavioral therapy - cognitive behavioral therapy, or CBT for short). The first to raise the banner of behaviorism was the American psychologist John Watson at the beginning of the twentieth century. His theory was a response to the European fascination with Freudian psychoanalysis. The birth of psychoanalysis coincided with a period of pessimism, decadent moods and expectations of the end of the world. This was also reflected in the teachings of Freud, who argued that the source of our main problems is outside the mind - in the unconscious, and therefore it is extremely difficult to cope with them. The American approach, on the contrary, assumed some simplification, healthy practicality and optimism. John Watson believed that we need to focus on human behavior, on how we react to external stimuli. And - work to improve these very reactions. However, this approach was successful not only in America. One of the fathers of behaviorism is considered to be the Russian physiologist Ivan Petrovich Pavlov, who received a Nobel Prize and studied reflexes until 1936.

Between the external stimulus and the reaction to it there is a very important authority - in fact, the person himself who reacts. More precisely, his consciousness

It soon became clear that in its desire for simplicity, behaviorism threw out the baby with the bathwater - essentially, reducing a person to a set of reactions and putting the psyche as such out of the picture. And scientific thought moved in the opposite direction. In the 1950–1960s, psychologists Albert Ellis and Aaron Beck “returned the psyche to its place,” rightly pointing out that between the external stimulus and the reaction to it there is a very important authority - in fact, the person himself who reacts. More precisely, his consciousness. If psychoanalysis places the origins of the main problems in the unconscious, inaccessible to us, then Beck and Ellis suggested that we are talking about incorrect “cognitions” - errors of consciousness. Finding them, although not easy, is much easier than penetrating the dark depths of the unconscious. The work of Aaron Beck and Albert Ellis is considered today the foundation of cognitive behavioral therapy.

Errors of consciousness

Errors of consciousness can be different. One simple example is the tendency to view any event as having something to do with you personally. Let’s say your boss was gloomy today and greeted you through gritted teeth. “He hates me and is probably about to fire me” is a fairly typical reaction in this case. But it’s not necessarily true. We do not take into account circumstances that we simply do not know about. What if the boss’s child is sick? What if he quarreled with his wife? Or have you just been criticized at a meeting with shareholders? However, one cannot, of course, exclude the possibility that the boss really has something against you. But even in this case, repeating “What a horror, everything is lost” is also a mistake of consciousness. It is much more productive to ask yourself whether you can change something in the situation and what benefits might come from leaving your current job.

One of the errors of consciousness is the tendency to perceive all events as relevant to us personally.

This example clearly illustrates the “scope” of CBT, which does not seek to understand the mystery that was happening behind the door of our parents’ bedroom, but helps to understand specific situation. And this approach turned out to be very effective: “Such scientific evidence base does not have any type of psychotherapy,” emphasizes psychotherapist Yakov Kochetkov. He is referring to a study by psychologist Stefan G. Hofmann that supported the effectiveness of CBT methods. 1: A large-scale analysis of 269 articles, each of which in turn reviewed hundreds of publications.

Costs of Efficiency

“Cognitive-behavioral psychotherapy and psychoanalysis are traditionally considered the two main areas of modern psychotherapy. Thus, in Germany, in order to obtain a state certificate as a psychotherapist with the right to pay through insurance companies, you must have basic training in one of them. Gestalt therapy, psychodrama, systemic family psychotherapy, despite their popularity, are still recognized only as types of additional specialization,” note psychologists Alla Kholmogorova and Natalya Garanyan 2. In almost all developed countries, psychotherapeutic assistance and cognitive behavioral psychotherapy are almost synonymous for insurers. For insurance companies, the main arguments are scientifically proven effectiveness, wide range application and relatively short duration of therapy.

Related to the last circumstance funny story. Aaron Beck said that when he started practicing CBT, he almost went broke. Traditionally, psychotherapy took a long time, but after just a few sessions, many clients told Aaron Beck that their problems had been successfully resolved, and therefore they did not see the point in further work. A psychotherapist's earnings have dropped sharply.

Questions for David Clark, cognitive psychotherapist

You are considered one of the pioneers of cognitive behavioral therapy. What path did she take?

I think we were able to improve a lot. We have improved the system for measuring the effectiveness of therapy and were able to understand which components are most important. It was possible to expand the scope of CBT – after all, it was initially considered only as a method of working with depression.

This therapy is attractive to authorities and insurance companies economically – a relatively short course brings a noticeable effect. What are the benefits for clients?

Exactly the same! She gives quickly positive result, allowing you to avoid spending money on going to a therapist for many years. Imagine, 5-6 sessions in many cases are enough for a noticeable effect. Moreover, often the most significant changes occur at the beginning of therapeutic work. This applies, for example, to depression, in some cases - anxiety disorders. This does not mean that the work is already done, but the patient begins to experience relief in a very short term, and this is extremely important. In general, CBT is a very focused therapy. She does not set the goal of improving the condition in general; she works with the specific problems of a particular client, be it stress, depression or something else.

How to choose a therapist who works using the CBT method?

Find someone who has completed a certified, internationally recognized training program. Moreover, one that provides supervision: the work of a therapist with an experienced colleague. You can't become a therapist by just reading a book and deciding you're ready. Our research shows that supervised therapists are much more successful. Russian colleagues who began to practice CBT had to regularly travel to the West, because they could not undergo supervision in Russia. But now the best of them are ready to become supervisors themselves and help spread our method.

Method of use

The duration of the CBT course may vary. “It is used both short-term (15–20 sessions in the treatment of anxiety disorders) and long-term (1–2 years in the case of personality disorders),” point out Alla Kholmogorova and Natalya Garanyan. But on average this is significantly less than, for example, a course of classical psychoanalysis. Which can be perceived not only as a plus, but also as a minus.

CBT is often accused of being superficial, likening it to a painkiller pill that relieves symptoms without addressing the causes of the disease. “Modern cognitive therapy begins with working with symptoms,” explains Yakov Kochetkov. – But working with deep-seated beliefs also plays a big role. We just don't think it's necessary to work with them for many years. The usual course is 15-20 meetings, not two weeks. And about half of the course is working with symptoms, and half is working with causes. In addition, working with symptoms also affects deep-seated beliefs.”

The exposure method consists of controlled exposure of the client to the very factors that are the source of problems

This work, by the way, includes not only conversations with a therapist, but also the exposure method. It consists in the controlled influence on the client of the very factors that serve as the source of problems. For example, if a person has a fear of heights, then during the course of therapy he will have to climb onto the balcony of a high-rise building more than once. First - together with a therapist, and then independently, and each time to a higher floor.

Another myth stems, apparently, from the very name of therapy: since it works with consciousness, then the therapist is a rational coach who does not show empathy and is not able to understand what concerns personal relationships. This is not true. Cognitive therapy for couples, for example, in Germany is recognized as so effective that it has the status of a state program.

In the treatment of phobias, exposure to heights is used: in reality or using computer simulation PHOTO Getty Images

Many methods in one

“CBT is not universal, it does not displace or replace other methods of psychotherapy,” says Yakov Kochetkov. “Rather, it successfully builds on the findings of other methods, each time testing their effectiveness through scientific research.”

CBT is not one, but many therapies. And today there are CBT methods for almost every disorder. For example, schema therapy was invented for personality disorders. “CBT is now successfully used in cases of psychosis and bipolar disorders, continues Yakov Kochetkov. – There are ideas borrowed from psychodynamic therapy. And recently, the authoritative journal The Lancet published an article about the use of CBT for patients with schizophrenia who refused to take medications. And even in this case, this method gives good results.”

All this does not mean that CBT has finally established itself as “psychotherapy No. 1”. She has many critics. However, if quick relief is needed in a specific situation, then 9 out of 10 experts in Western countries would recommend contacting a cognitive behavioral psychotherapist.

1 S. Hofmann et al. "The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses." Online publication in the journal Cognitive Therapy and Research dated 07/31/2012.

2 A. Kholmogorova, N. Garanyan “Cognitive-behavioral psychotherapy” (in the collection “Main directions of modern psychotherapy”, Cogito Center, 2000).

Cognitive behavioral therapy (CBT) deals with the adjustment of thoughts and feelings that determine actions and influence a person's lifestyle. It is based on the principle that an external influence (situation) causes a certain thought, which is experienced and embodied in specific actions, that is, thoughts and feelings shape the behavior of the individual.

Therefore, in order to change your negative behavior, which often leads to serious life problems, you must first change your thinking pattern.

For example, a person is terrified of open space (agoraphobia), when he sees a crowd he experiences fear, and it seems to him that something bad will definitely happen to him. He reacts inadequately to what is happening and endows people with qualities that are not at all inherent to them. He himself becomes withdrawn and avoids communication. This leads to mental disorder and depression develops.

In this case, cognitive methods and techniques can help. behavioral psychotherapy that will teach you to overcome panic fear in front of a large crowd of people. In other words, if you cannot change the situation, you can and should change your attitude towards it.

CBT came out of the depths of cognitive and behavioral psychotherapy, combines all the main provisions of these techniques and sets specific goals that need to be solved during the treatment process.

These include:

• Relief of symptoms of mental disorder;
• Persistent remission after a course of therapy;
• Low probability of repeated manifestation (relapse) of the disease;
• Effectiveness of medicines;
• Correction of erroneous cognitive (mental) and behavioral attitudes;
• Resolution of personal problems that caused mental illness.

1. Find out how his thinking affects his emotions and behavior;
2. Critically perceive and be able to analyze your negative thoughts and feelings;
3. Learn to replace negative beliefs and attitudes with positive ones;
4. Based on the new thinking developed, adjust your behavior;
5. Solve the problem of your social adaptation.

It is effective, in particular, in the treatment of alcoholism and drug addiction, if after drug therapy the body is cleared of toxic poisoning. During the rehabilitation course, which takes 3-4 months, patients learn to cope with their destructive thinking and correct their behavioral attitudes.

It is important to know! Cognitive-behavioral psychotherapy will be effective only when the patient himself desires it and establishes trusting contact with the psychotherapist.

Basic methods of cognitive behavioral therapy

The most significant CBT techniques are:

• Cognitive therapy. If a person is insecure and perceives his life as a streak of failures, it is necessary to consolidate in his mind positive thoughts about himself, which should restore him to confidence in his abilities and hope that everything will work out for him.
• Rational emotive therapy. Aimed at making the patient aware of the fact that his thoughts and actions need to be coordinated with real life, and not soar in your dreams. This will protect you from inevitable stress and teach you to make the right decisions in various life situations.
• Reciprocal inhibition. Inhibitors are substances that slow down the flow of various processes, in our case we are talking about psychophysical reactions in the human body. Fear, for example, can be suppressed by anger. During the session, the patient can imagine that he can suppress his anxiety, for example, by complete relaxation. This leads to the extinction of the pathological phobia. Many special techniques of this method are based on this.
• Autogenic training and relaxation. Used as auxiliary technique during CBT sessions.
• Self-control. Based on the method of operant conditioning. It is understood that the desired behavior in certain conditions must be reinforced. It is relevant for difficulties in life situations, for example, study or work, when various kinds of addictions or neuroses arise. They help raise self-esteem, control unmotivated outbursts of rage, and extinguish neurotic manifestations.
• Introspection. Keeping a behavior diary is one of the ways to “stop” to interrupt obsessive thoughts.
• Self-instructions. The patient must set himself tasks that must be adhered to in order to positively solve his problems.
• The “Stop Tap” method or the self-control triad. Internal “stop!” negative thoughts, relaxation, positive representation, mental consolidation.
• Assessing feelings. Feelings are “scaled” using a 10-point or other system. This allows the patient to determine, for example, the level of their anxiety or, conversely, confidence, where they are on the “scale of feelings”. Helps you objectively assess your emotions and take steps to reduce (increase) their presence on a mental and sensitive level.
• Study of threatening consequences or “what if”. Helps expand limited horizons. When asking, “What if something terrible happens?” the patient should not overestimate the role of this “terrible”, which leads to pessimism, but find an optimistic answer.
• Advantages and disadvantages. The patient, with the help of a psychologist, analyzes the advantages and disadvantages of his mental attitudes and finds ways to perceive them in a balanced way, this allows him to solve the problem.
• Paradoxical intention. The technique was developed by Austrian psychiatrist Viktor Frankl. Its essence is that if a person is very afraid of something, he needs to return to this situation in his feelings. For example, a person suffers from a fear of insomnia; he should be advised not to try to fall asleep, but to stay awake as long as possible. And this desire to “not fall asleep” ultimately causes sleep.
• Anxiety control training. It is used when a person in stressful situations cannot control himself or make a decision quickly.

Techniques of cognitive behavioral therapy in the treatment of neuroses

1. Reframing (English - frame). With the help of special questions, the psychologist forces the client to change the negative “frameworks” of his thinking and behavior and replace them with positive ones.
2. Thought Diary. The patient writes down his thoughts to understand what worries him and affects his thoughts and well-being throughout the day.
3. Empirical verification. Includes several methods to help you find correct solution and forget negative thoughts and arguments.
4. Examples fiction . The choice of a positive judgment is clearly explained.
5. Positive imagination. Helps get rid of negative ideas.
6. Role reversal. The patient imagines that he is comforting his friend who finds himself in his situation. What could he advise him in this case?
7. Flood, implosion, paradoxical intention, induced anger. Used when working with children's phobias.

Treatment of depression using cognitive behavioral psychotherapy

This has a serious impact on the psyche; not only the patient himself suffers, but also his loved ones. Today, more than 20% of the population in developed countries suffers from depression. It significantly reduces the ability to work, and the likelihood of suicide is high.

Symptoms depressive state many, they manifest themselves mentally (dark thoughts, lack of concentration, difficulty making decisions, etc.), emotional (sadness, depressed mood, anxiety), physiological (sleep disturbance, loss of appetite, decreased sexuality) and behavioral (passivity, avoidance contacts, alcoholism or drug addiction as temporary relief) level.

If such symptoms are observed for at least 2 weeks, we can confidently speak about the development of depression. For some, the disease proceeds unnoticed, for others it becomes chronic and lasts for years. IN severe cases The patient is admitted to a hospital where he is treated with antidepressants. After drug therapy, the help of a psychotherapist is necessary; methods of psychodynamic, trance, and existential psychotherapy are used.

Cognitive-behavioral psychotherapy for depression has proven positive. All symptoms of depression are studied, and with the help special exercises the patient can get rid of them. One of effective techniques CBT is cognitive reconstruction.

The patient, with the help of a psychotherapist, works with his negative thoughts, which are reflected in behavior, speaks them out loud, analyzes them and, as necessary, changes his attitude to what was said. In this way he ascertains the truth of his values.

The technique includes whole line techniques, the most common are the following exercises:

• Inoculation (grafting) of stress. The patient is taught skills (coping skills) that should help in the fight against stress. First you need to understand the situation, then develop certain skills to deal with it, then you should consolidate them through certain exercises. The “vaccination” obtained in this way helps the patient cope with strong experiences and disturbing events in his life.
• Suspension of thinking. A person is fixated on his irrational thoughts, they interfere with adequately perceiving reality, serve as a cause for anxiety, and as a result, stressful situation. The psychotherapist invites the patient to reproduce them in his internal monologue, then loudly says: “Stop!” Such a verbal barrier abruptly ends the process of negative judgments. This technique, repeated several times during therapeutic sessions, develops a conditioned reflex to “wrong” ideas, the old thinking stereotype is corrected, and new attitudes towards a rational type of judgment appear.

It is important to know! There is no treatment for depression that suits everyone equally. What works for one may not work at all for another. To find an acceptable method for yourself, you don’t need to get hung up on one just because it helped someone close or familiar.

It can be carried out in different directions. One of the most relevant and developing trends today is cognitive behavioral therapy.

This method is based on the acceptance that the causes of problems must be sought in oneself, in own thoughts and assessment of others, as well as oneself. Emotional reactions of a negative nature appear as a response to a certain situation only because in the deep consciousness of a person there is a certain internal assessment. To solve a problem, you will need to change your assessment of a difficult situation.

Differences between behavior therapy and other areas of psychology

Any type of psychotherapy is aimed at changing the patient's personality. This is deep work that requires a lot of dedication from the psychotherapist. Exists a large number of areas of psychotherapy, each of which has its own characteristics:

Gestalt therapy puts the patient’s “I” in the first place, calling on him to satisfy his needs and desires at the moment they arise by any socially acceptable means. It is believed that various kinds of psychological problems arise in a person when he does not follow his desires, but tries to live up to the ideal imposed on him by the people around him;

Psychoanalysis evaluates the patient's dreams, as well as the associations that various objects, people and situations evoke;

Art therapy allows you to resolve psychological problems through the influence of artistic methods. The patient is offered to draw, sculpt, etc.

There are also other directions, but only behavioral therapy will allow a person to discover irrational logic and warnings in the deep consciousness.

align="justify">Inner beliefs are questioned and given a new assessment. To achieve such results, the therapist asks the patient many different questions, some of them tricky, others funny or simply idiotic.

As a result of cognitive behavioral therapy, the psychologist's patient gets the opportunity to look at his internal beliefs from the outside and understand the absurdity of some of them. Revising your assessment of the world around you, people and yourself allows you to get rid of such psychological disorders, such as depression and anxiety, and increase self-esteem and self-confidence.

Methods used in cognitive behavioral psychotherapy

All therapy sessions this method take place in the form of a conversation, during which the patient is asked to conduct experiments and answer a number of questions. This can be individual therapy or group sessions, which are more like training aimed at improving psychological state patient now and in the future.

Cognitive behavioral therapy for mental disorders is carried out using the following methods:

1. Cognitive restructuring can reduce the patient's anxiety. This is achieved by assessing your fears and reality. The psychotherapist's client independently fills out a table that includes the situation that frightens him. Then he is asked to predict several worst options developments of events. When this stage is completed, it is necessary to recall similar situations from the past and describe their real outcome. For greater clarity, fears are assigned a probability coefficient as a percentage, after which the patient can see that his worst fears were not justified.

2. Socratic (Socratic) dialogue can be used not only during psychotherapy, but also in any other conversation. This method was used by Socrates during classes with his students. First you need to agree with your opponent, then question his rightness, and then argue your thoughts. Skillful use of this method allows you to resolve any controversial situation.

3. The cognitive continuum allows you to work with polar thinking. Relatively speaking, patients are sure that there is only white and black, but during the session it turns out that there are many shades of gray.

4. ABC analysis. Every situation that happens to us in life (A) leads to the emergence of thoughts and internal conversation (B). Depending on internal beliefs, reaction (C) occurs. In the A→B→C scheme, our beliefs play the main role; the thoughts that arise in response to a situation, leading to negative or positive emotions, depend on them.

Also, psychotherapists who practice the cognitive-behavioral method of correcting mental disorders use other methods in their work. This area is actively developing, new works, developments and techniques are appearing.

Cognitive-behavioral (cognitive-behavioral psychotherapy) therapy is such A complex approach and other psychological difficulties, which combines elements and techniques of behavioral therapy supported by cognitive assessment and reframing.

So, if we are talking about the therapy itself, then first it is worth touching on the main problems of the cognitive-behavioral approach. This direction studies a person’s perception of a particular situation based on his thinking.

And the way of thinking, in turn, depends on how a person was “taught to think.” In a word, if we briefly outline the approach of the supporters of the mentioned direction, we can recall folk wisdom: “Don’t judge by yourself.” A person perceives other people, interactions with them, and life in general, based on their ways of thinking. And these methods are inherent. And if they are ineffective, pessimistic, inadequate or destructive, then, accordingly, they will provoke the same behavior.

Let's look at examples. A woman complains that she cannot arrange her personal life. At the same time, her mother, who herself suffered a personal tragedy, constantly inspires her daughter that “all men are unreliable, they only need one thing.” Naturally, when meeting another young man, the described client is already looking for a “trick”, trying to “figure out” how the next chosen one will let her down. And what happens? IN Once again“finds a flaw.” The perception of the world and the said companion is initially destructive; naturally, it cannot lead to constructive relationships.

In a word, if a person is used to seeing himself as “poor and unhappy,” then he will behave that way. If a girl has been taught from childhood that she is fat, ugly and useless to anyone, she feels and behaves this way. If a boy has been told that he is stupid and will “end his life in the trash heap,” he is afraid to try because internally he is already ready to accept defeat.

And these are very serious things that can be called subconscious attitudes and which very often become a serious obstacle to achieving goals, career advancement, family happiness and many other positive things that fill the world around us.

Returning to the first example, let’s assume that with the help of other methods, she herself discovered that her behavior model comes from someone else’s negative experience. But who can we learn correct and constructive behavior from? How to stop “seeing a catch even where there isn’t one yet?” Cognitive behavioral therapy is not aimed at analyzing the problem itself and working through it, but at changing the quality of productive thinking. In a word, they try to teach the client to “think in a new way”, to look at familiar things from a different, positive side.

Remember how in the film “Office Romance”, to the remark about the impossibility of “getting to know” the main character, he replied that there was no need to “bite” him. This is probably the most shining example. Learning to see positive sides and prospects, which, in turn, teach us to look for ways to develop our personality. Otherwise, we look for excuses for ourselves.

Who works in a similar vein?

The main behavioral therapies include:

The main principle of the cognitive-behaviouristic approach

The most important question that remains for consideration is precisely the principle of teaching the aforementioned constructive thinking. The original model of G. Eysenck was reduced to the method of treating mental disorders by direct positive reinforcement.

For example, in patients with severe behavioral disturbances, the “token method” was introduced. For the fact that the patient dressed, cleaned or washed himself, he was given a token that could be exchanged for goodies. However, such a direct behavioral approach was sharply criticized by many specialists, since it did not take into account the patient’s personal experiences and the construction of strong, fixed behavioral patterns was actually similar to training.

However, since the 20s of the last century, a number of researchers have proven the importance of cognitive processing of the surrounding reality. That is, a person does not just answer simple action in response to a stimulus, he builds his own model and develops his attitude towards the surrounding reality. And this attitude can already be regarded by the environment as constructive or destructive.

Therefore, clean behavioral therapy difficult to meet; techniques based on stimulus-response practice are more often used. However, they are necessarily accompanied by a process of rethinking and building an attitude towards what is happening, that is, a cognitive process, giving rise to cognitive behavioral therapy in various variations.

We can talk about several basic approaches that rely on more or less explicit use of such techniques:

As an example of a pure technique that uses a stimulus and learning that changes the attitude towards this stimulus, we can offer Wolpe’s fear inhibition technique. The mentioned technique takes place in three stages:

• highlighting frightening stimuli (for example, a trip to the subway, because there is a closed space, a lot of people, a depressing environment, etc.);
• teaching the method muscle relaxation, which immerses a person in a state of complete peace and bliss;
• gradual introduction of a frightening stimulus against the background of practiced relaxation. For example, at first the patient is simply shown pictures of the subway, monitoring his condition. Then they offer to imagine themselves in it, making sure that external manifestations: pulse, sweating and other signs did not indicate a state of stress, and the client continued to carry out relaxation activities. And at the final stage, the client and the psychotherapist can descend into the already real metro, without obvious critical conditions person.

There is also the opposite approach, when a person is deliberately placed in a situation of significant confrontation, so that the massive experience of his worst fears provokes a “breakthrough” and a sharp change in entrenched methods.

It is worth noting that such methods require great motivation and stress resistance. For example, a client who is inclined to attribute his failures to his state of health is placed in a situation where he is directly told that he is “sick with illness.” It is believed that such an obvious “simplification” of the situation and its escalation can cause an internal protest, which will turn all activities and attitudes towards them upside down.

A. Bandura was a proponent of several other interesting approaches. The mentioned approaches were based on three principles:

• social learning;
• observation;

For example, based on the concept of social learning, the client is asked to act in a difficult situation for him. This allows you to simulate possible options behavior. Moreover, modeling can have a negative and positive outcome. And the video recording allows you to look at your reactions from the outside. Thus, fears about the situation in real life are removed.

For example, a situation of fear of a leader and the inability to defend one’s rights and present one’s successes can be played out in various variations. For example, what exactly scares you about a boss: he will scold you, he will fire you. Okay, it happened, what next? Change of job. Are you comfortable in the office now? No. Exit? Change of job. That is, in the worst case, and in the current situation, there is only one way out. The tension decreases somewhat, since the “worst case” turns out to be equivalent to the current one. What if everything goes wrong? And here the client begins to model.

The work can be carried out in a group, so the client also tracks the models of other people, tries them on himself, notices his own fears and mistakes. Ultimately, a well-developed model of behavior must be formed. Which will allow the client to undergo with greater benefit and less stress similar situations in real life.

Strengths and weaknesses of this approach

Let us note once again that in these cases we do not get to the bottom of the reasons for the development of such a behavioral reaction, which would be necessary to identify when working in another technique, we do not identify his childhood fears and complexes, we do not change attitudes towards his parents, we do not replenish missing sensations by working through basic needs. We just work with specific skills.

This is the main plus and minus of this approach. Acute traumatic events are often so distorted by our psyche to enable simple survival and maintain mental balance that it is very difficult for many patients to make deep changes. And this results, firstly, in the duration of therapy, and secondly, it is often difficult for clients who come with a certain problem to understand how this relates to their childhood fears or other experiences.

In a word, if a person finds it difficult or scary to communicate with leaders, he doesn’t quite understand why he needs to sort out his difficult relationship with his dominant and cruel father. It is much clearer to work through simulated, but such “really understandable” and “possibly encountered” situations. Moreover, the time of therapy itself is usually several times shorter.

However, many clients subsequently realize that it is not just a matter of communication, for example, with a manager, but the problem is more general: “when I am in any way dependent or subordinate, I am nothing.” And this “backfires” both in the personal and in the larger public sphere, then he comes to another form of therapy, for example, psychoanalysis or symboldrama. But perhaps this is the meaning of existence different approaches: the client chooses the one that is most acceptable and productive to him at the moment.