Existential psychology - what is the existential approach in psychology? Existential-humanistic psychotherapy. How it works

Existential psychotherapy, as defined by I. Yalom, is a dynamic therapeutic approach that focuses on the basic problems of the existence of the individual. Like any other dynamic approach (Freudian, neo-Freudian), existential therapy is based on a dynamic model of the functioning of the psyche, according to which at different levels of the psyche (consciousness and the unconscious), conflicting forces, thoughts and emotions are present in the individual, and behavior (both adaptive and psychopathological) represents is the result of their interaction. Such forces in the existential approach are confrontations of the individual with the ultimate givens of existence: death, freedom, isolation and meaninglessness. It is assumed that a person's awareness of these ultimate givens gives rise to suffering, fears and causes anxiety, which, in turn, triggers psychological defenses. Accordingly, it is customary to speak of four existential conflicts:

1. between the realization of the inevitability of death and the desire to continue living;
2. between the awareness of one's own freedom and the need to be responsible for one's life;
3. between awareness of one's own global loneliness and the desire to be part of a larger whole;
4. between the need for some structure, the meaning of life and the realization of the indifference (indifference) of the Universe, which does not offer specific meanings.

Every existential conflict causes anxiety. Moreover, anxiety can either remain normal or develop into a neurotic one. Let us illustrate this point with the example of anxiety arising from human existential vulnerability in relation to death. Anxiety is considered normal if people use the existential threat of death to their advantage as a learning experience and continue to develop. Particularly striking are the cases when, having learned about a fatal illness, a person begins to live his life more meaningfully, productively and creatively. Evidence of neurotic anxiety are psychological defenses. Thus, for example, a terminally ill person experiencing neurotic anxiety may unjustifiably risk his life by displaying manic heroism. Neurotic anxiety also implies repression and is destructive rather than constructive. It should be noted that Existential counselors working with anxiety do not try to remove it completely, but rather reduce it to a comfortable level and then use the existing anxiety to increase the client's awareness and vitality..

First existential conflict - this is a conflict between the fear of non-being and the desire to be: the awareness of the inevitability of death and the desire to continue to live. The task of the counselor in resolving the first existential conflict is to lead the client to a deeper awareness of death that will lead to a higher appreciation of life, open up prospects for personal growth, and make it possible to live an authentic life.

The word "existence" ("existence") comes from lat. еxistere - stand out, appear. By R. May's definition, being means potentiality, a source of potential, and implies that someone is in the process of becoming something. The feeling of "being in the world" in people is associated with the entire experience of their existence (conscious and unconscious) and is presented in three interconnected forms:

1. "Inner world", eigenwelt - a unique individual world of each person, which determines the development of self-consciousness and self-awareness, forms one's own attitude towards things and people, and also underlies the comprehension of the meaning of life.
2. "Joint world", mitwelt - social world, the world of communication and relationships. The picture of being in a “joint world” is made up of communication and mutual influence of people on each other. The significance of relationships with another person depends on the attitude towards him (on how valuable, important, attractive he is for a partner). In the same way, the extent to which people are involved in the life of a group determines how important these groups are to them.
3. « External world", umwelt - the natural world (the laws of nature and the environment). The natural world includes biological needs, aspirations, daily instincts and life cycles of the organism and is perceived as real.

The polarity of being is non-being, nothingness, emptiness. The most obvious form of non-existence is death. However, a decrease in life potential also leads to a feeling of emptiness, due to anxiety and conformity, as well as a lack of a clear self-awareness. In addition, destructive hostility and physical illness can threaten being.

The fear of death is of great importance in the inner experience of a person, and the attitude towards death affects his life and psychological development. I. Yalom put forward two theses, each of which is of fundamental importance for existential psychotherapeutic and counseling practice:

1. Life and death are interdependent; they exist simultaneously, not sequentially; death, constantly penetrating the limits of life, has a huge impact on our experience and behavior.
2. Death is the primary source of anxiety and thus is of fundamental importance as a cause of psychopathology.

Awareness of death can serve as a positive impulse, the strongest catalyst for major life changes. However, the realization of death is always painful and disturbing, so people tend to erect various psychological defenses. Already young children, in order to isolate themselves from the anxiety of death, develop defense mechanisms based on denial. They either believe that death is temporary (it only suspends life or is like a dream); either deeply convinced of their individual invulnerability and the existence of a magical savior; or believe that children do not die. Most children between the ages of 5 and 9 years deny death by personifying it in terrifying images that represent an external danger and that can be influenced (delay, propitiate, outwit, conquer). Older children (9-10 years old) make fun of death and thereby try to reduce their fear of death. In adolescents, denial and protection from the fear of death is manifested in the exploits of recklessness, and in some cases in thoughts of suicide or delinquent behavior. Modern teenagers oppose this fear with their virtual personality, playing computer games and feeling like the masters of death.

Existential counseling of children and adolescents on issues of life and death is a separate and rather complex topic. Such counseling is focused primarily on reconciliation of children and adolescents with the inevitability of death. A good find, in our opinion, is the creation of special therapeutic fairy tales, stories and metaphors that help young clients cope with the fear of death and begin to function normally.

Over the years, teenage fear is pushed aside by the two main life tasks of young adults - building a career and creating a family. Further, in the so-called middle age, the fear of death returns and takes possession of people with renewed vigor and never leaves them. It is not easy to live constantly aware of one's own mortality, it is impossible to live numb with horror, so people come up with ways to alleviate the fear of death. I. Yalom singled out two main mechanisms of protection against anxiety associated with death in adults:

1. Belief in one's exclusivity, one's own immortality and inviolability. In a "recycled" form, these defenses manifest themselves in various forms of clinical phenomena:

• manic heroism. An example would be a terminally ill person who obsessively seeks external danger in order to save himself from a greater danger coming from within;
• workaholism. For workaholics, time is an enemy not only because it is akin to mortality, but also because it threatens to undermine one of the pillars of the illusion of exclusivity: belief in eternal ascent. They are involved in a furious struggle with time and behave as if imminent death was approaching them, and they would strive to have time to do as much as possible;
• selfishness, narcissism. Severe narcissistic character disorder is always accompanied by interpersonal problems. Unconditional love and total acceptance are expected from others, while indifference, indifference and a demonstration of superiority are provided in return. Without going into a detailed description of the narcissistic personality, we only note that such clients seem to want to stop time and remain forever in infancy under magical parental protection.
• aggression and control. Some evidence of deep unconscious fears of death may be choice of professions associated with death (military, doctor, priest, undertaker, killer). With the feeling of having power and expanding the sphere of control, only conscious fears weaken, while deeper ones continue to operate.

2. Faith in a savior, a personal protector who will come to the rescue at the last moment. Such saviors can be not only people (parent, spouse, well-known doctor, traditional healer, healer or leader), but also, for example, some high cause. This defense mechanism assumes that a person overcomes the fear of death by offering his freedom and life itself on the altar of some higher figure or personified idea. He creates in his imagination "a kind of god-like figure, so that he can then bask in the rays of illusory security emanating from his own creation." People with hypertrophied faith in the ultimate savior are characterized by: self-depreciation/devaluation of themselves, fear of losing love, passivity, dependence, self-sacrifice, rejection of their adulthood, depression after the collapse of the system of ideas. Any of these options, being accentuated, can result in a certain clinical syndrome. In case of predominance of self-sacrifice, the patient can be characterized as "masochistic". Of course, in an effort to isolate themselves from the anxiety of death, people use not one, but many intertwined defenses.

Consultant self-disclosure can be carried out in various forms:

• telling the client about one's own attempts to come to terms with extreme existential anxieties;
• conveying to the client the thoughts and feelings experienced by the consultant "here and now" about the client's problems;
• “permission to endure” - the client is informed that the topic of death, typical and encouraged, is a necessary topic in the relationship between the psychologist and the client.

Let's illustrate the psychologist's self-disclosure option with a small example from the transcript of the consultation of a 5-year-old boy who survived the death of his mother:

I remember how a neighbor's boy brought me a cage with a bird at the end of winter. It was a snowman. “Bullfinches love the cold, because their tummies are bright red, like the cheeks of children who walk in the cold,” the young man explained and gave me a bird. I was happy, the most beautiful bird in the world lived in my house.
Winter is over, spring has passed, hot summer has come. Once, returning home from a walk, I saw that the door in the cage was open, but inside it was empty.
- Where is the bullfinch? I asked my mother.
“He is no more,” my mother said sadly, “it is very hot in summer, he could get sick, so I let him go free.
That same night I had a dream that early in the morning someone was knocking on my window. I come closer and see my bullfinch. I carefully open the window, gently take it in my hands and carefully, embracing it with two palms, carry it to the cage ...
And at that moment I wake up, gently squeezing the corner of the pillow between my palms. In the hands instead of a bullfinch - a corner of the pillow! My grief knew no bounds. Tears didn't fall, they flowed like a stream.
- What happened? Mom asked softly.
I told her my dream, and then my mother told me the truth:
- The bullfinch died, and his soul flew high into the sky, where it's cool ... It's good there ... And we will remember the bird and enjoy life.
She said and cried. We sat embracing for a long time, and each cried about something of his own.

Identification of psychological defense mechanisms. For the client, they make explicit information about the psychological defense mechanisms that he uses. At the same time, they help him in realizing their naivety.

Work with reminders of the fragility (transience) of existence. The consultant can use any ordinary event (or tactfully provoke a situation) that helps tune the client to the signs of mortality:

• discussion of birthdays and anniversaries;
• paying attention to everyday signs of aging: loss of stamina, senile plaques on the skin, decreased joint mobility, wrinkles, etc.;
• looking at old photographs and finding outward resemblance to parents at an age when they were already perceived as old people;
• discussion of disturbing TV shows, movies, books;
• careful monitoring of disturbing dreams and fantasies of death.

An example of the analysis of a disturbing dream is the following case from the practice of online counseling.

Client letter:

My husband and son and I are driving outside the city. A cell phone call and they tell me that my father has died. I'm at a loss - he died 4.5 years ago! They say to me: “There was a mistake, but now for sure” ...
We return to the city, and I keep thinking, how could this be a mistake? We arrive, an unfamiliar room, big table in the middle of the room - people sit around the table and talk quietly. No tears, it seems that everyone is also at a loss. We sit down too.
An unfamiliar tall thin man in a black long coat comes in and sits on a chair behind my left shoulder, I turn and invite him to sit down at the table, he refuses.
Then someone says aloud: “Maybe what needs to be transferred there?” And everyone turns to this man. He replies: “No, nothing is needed, only you can pass the spoon.”
In a circle they begin to pass a spoon, it reaches me, and I see that this is a spoon from our dacha, aluminum, conspicuous. I give it to the man and he leaves.
Then we drive, sort of like a hospital. Somehow the village wooden house with a covered courtyard, the gates are closed. There is a dirt road in front of the house, as usual in our villages. We are on the opposite side of the road from the house. And that stranger in the black coat is right there.
Suddenly the door in the gate opens, and my father is standing there. I run to him, at that moment I forget that he really died a long time ago. I am overwhelmed only with joy that I see him, that then a long time ago everything really turned out to be a mistake. I’m running, but I can’t cross this road in any way ...
Father smiles, raises his hand and waves to me (waves from side to side). And then the doorway begins to flood the light, bright, white, and this light simply absorbs the father. Doors are closing. I turn around and try to talk to people, but they ignore me. And I understand that no one but me saw anything.
I wake up. I had no fear either during sleep, or later, when I woke up. And now the actual question. We are going next Saturday to go to this dacha for the last time this year, to close the season, so to speak. Do I need to bring this unfortunate spoon and take it to my father's grave? Or is this the simplest explanation of everything and the spoon has nothing to do with it at all?

Hypotheses of the psychologist expressed in the response letter:

1. "Life-death." Everything has its time! The unconscious may be telling you not to die prematurely. A) The man in black, who stands behind his left shoulder (the Angel of Death) does not sit at a common table with the living. B) He disappears after getting what he came for. And he came, mind you, not for the soul, but with a spoon. C) And reappears to prevent crossing the road in the village that separates the world of the living and the dead.
2. "Echoes" of experiences. Amusing substitutions sometimes occur in dreams, when new (not yet conscious) experiences are replaced by understandable, already experienced ones. For example, the death of a father can symbolize the onset of winter, since nature “dies” during this period. Repeated farewell - the next completion of the summer season. “Give away a spoon” can mean “to be left without what is used in the process of eating”, in this case - gifts from a summer cottage.
3. Feelings of guilt (most likely to the father). It can be expressed in the struggle between conscious and unconscious messages. Conscious attitudes impose this very feeling of guilt (for example, we rarely go to the cemetery or did not erect a monument). Unconscious experiences, on the contrary, protect mental health (the father who smiles in his sleep and disappears into the white light).

Client response:

... with the first interpretation of my dream, you directly hit my thoughts. Lately, the idea of ​​suicide has just stuck in my head, and very firmly. Everything is thought out very thoroughly, to the smallest detail. A method has been chosen that causes a minimum of concern to loved ones. Morally matured completely. Some last drop was missing, explaining this decision for others. After all, not many people understand that Bulgakov is right that the only way to know freedom is death. This last drop still does not drip, and urgent matters roll in constantly. Well, I think, okay, this issue must be resolved, and then - freedom!
And now ... now I understand that this last drop, apparently, is delayed for a reason ... apparently, it is not yet time for freedom ... something else, probably, needs to be done in this life ... There are no irreplaceable , this is 100%, but, apparently, there is something that it will be more difficult for others to do instead of me ...
Now here's what I thought. I believe in the connection of the worlds and believe that the body is a temporary appearance given for some deeds, to achieve some goals. That's just what? So the philosophical question about the meaning of life has surfaced. So, WE WILL LIVE!

• The use of special structured exercises to deepen the awareness of mortality. Structured exercises can be referred to as "existential shock therapy”, and therefore their use suggests that the psychologist himself should not be afraid of the topic of death.

Exercise "Segment of my life"

A client suffering from anxiety, fatigue or irritation is offered: “Draw a segment on a blank sheet of paper. One end represents your birth, the other represents your death. Place a cross where you are now. Ponder on this for about five minutes."

Exercise "Funeral"

The client is asked to close their eyes and dive into themselves. Next, any relaxation technique is used that allows the client to enter a trance state. After that, the consultant helps the client survive his own funeral.

The exercise is especially effective in working with clients who have experienced the death of loved ones. It allows the client to fantasize about their own death and helps them approach a deeper awareness of death, which in turn leads to a higher appreciation of life and opens up opportunities for personal growth.

Exercise "Challenge"

The group is divided into threes and given the task to talk. The names of the group members are written on separate pieces of paper; the sheets are placed in a vessel, then they are blindly taken out one at a time and the names written on them are called out. The one whose name is called interrupts the conversation and turns his back on the others.

Many participants report that as a result of this exercise they have increased awareness of the randomness and fragility of existence.

Exercise "Life Cycles"

The group experience of the “life cycle” helps the participants to focus on the main issues of each stage of life. During the period of time devoted to old age and death, they are invited to live the life of old people for whole days: walk and dress like old people, powder their hair and try to play specific old people they know well; visit the local cemetery; walk alone in the city / forest, imagining how they lose consciousness, die, how they are discovered by friends and how they are buried.

• Encouraging the client to communicate with terminally ill people and observe their behavior.
• Encouraging the client to have greater control over those aspects of life that he can influence.

Second existential conflict is a conflict between the awareness of freedom and the need to be responsible for one's life. Respectively, the task of the consultant in resolving the second existential conflict is to help the client realize personal freedom and help him take responsibility for his feelings, thoughts, decisions, actions, life.

Let's start the presentation of the material on the resolution of the second existential conflict with an example. In September 2011, on one of the central TV channels of Ukraine, the second season of the program "From a boy to a lady" began. The essence of the project is to re-educate deviant women (alcoholics, prostitutes, sociopaths, etc.) and turn them into real ladies. Each of the future participants during the casting not only declared, but also openly demonstrated that she does only what she wants, and for her there is no concept of “should”. In other words, each participant in the show stated her personal freedom - freedom, which, unfortunately, she used not for personal growth, but turned to her own detriment.

We will interpret the life situation of the project participants from the standpoint of existential psychotherapy. The twentieth century is known to have been characterized by the destruction of traditional belief systems, religions, rituals and rules; rapid disintegration of structures and values; an upbringing that allowed a lot of things. A new generation of people has grown up for whom the emphasis has been shifted from “should” to “want”. Many people have learned to desire, but have failed to learn how to desire, how to exercise their will, how to make decisions and be responsible for those decisions. The test of freedom turned out to be too much of a burden for modern people and, accordingly, caused anxiety, to overcome which people again and again found psychological defenses. The participants in the TV show "From Tomboy to Lady" were a vivid example of how people find destructive ways to protect themselves from responsibility for their lives.

The following are psychological defenses and ways to evade responsibility in situations where freedom-related concerns are relevant to clients:

• Compulsiveness, as a kind of obsession with a force alien to the Ego (“not I”) that dominates a person, eliminates his personal choice and deprives him of his own freedom.
• Transfer of responsibility other people, including consultants, or external circumstances.
• Denial of responsibility by portraying oneself as an innocent victim or by losing control (temporarily entering an irrational "out of one's mind") state.
• Avoidance of autonomous behavior.
• Pathological expression of desires, manifestation of will and decision-making.

The word "responsibility" has many meanings. For existential consultants, it means, first of all, the authorship of one's "I", one's destiny, one's feelings and actions, as well as one's life's troubles and sufferings. And as noted by the outstanding French existentialist J. P. Sartre, no real therapy is possible for a patient who does not accept such responsibility and stubbornly blames others - people or forces - for his dysphoria. Moreover, existential counselors explain to their clients that people are fully responsible not only for their actions, but also for their inability to act; not only for what they do, but for what they choose to ignore.

Based on the foregoing, the position of the psychologist and general principle psychological assistance to people who protect themselves from the anxieties associated with taking responsibility. The counselor should always act on the basis of the understanding that the client himself created his own trouble, and, accordingly, in response to the client's complaints about his life situation, ask how he created this situation.

Existential psychotechnics in the context of this issue includes:

• Identification of psychological defenses and ways to evade responsibility. The client is explained the essence of psychological defenses and put "face to face" with responsibility for their own actions. For example, if a client asked for help in connection with feelings of isolation and loneliness, and during the consultation he himself demonstrates his superiority, contempt or neglect in relation to others, then the consultant can always comment on such attacks with the replica: “And you are alone.” Or, for example, if a client complains about the hardships of city life, the counselor might confront the client with freedom of choice: "Why don't you move to the countryside?"

Existential counselors have borrowed much from Gestalt therapists in their work on identifying ways to evade responsibility, in particular, focusing on the client's speech. For example, instead of "it happened" the client is asked to say "I did it"; instead of "I can't" - "I don't want to". Developing the theme of the client taking responsibility for every word, every gesture, feeling, thought, existential consultants actively use other gestalt games, including:

Exercise "I take responsibility"

The client is invited to add to each statement: "... and I take responsibility for this." For example: "I am aware that I am moving my leg ... and I take responsibility for it." "My voice is very quiet...and I take responsibility for it." "Now I don't know what to say... and I take responsibility for not knowing."

Exercise "Conversation with internal symptoms"

The client is encouraged to be mindful of inner sensations and take responsibility for both themselves and the symptoms of the body.

We will illustrate this exercise with the following example from the practice of F. Perls. The patient was faced with a painful dilemma and, while discussing it, he felt a lump in his stomach, Perls suggested that he talk to this lump: “Place the lump on another chair and talk to him. You will play your role and the role of a coma. Give him a voice. What does he say to you? Thus, the client is invited to take responsibility for both sides of the conflict, so that he realizes that nothing "happens" to us by itself, that we are the authors of everything: every gesture, every movement, every thought.

Identification of avoidance of responsibility "here and now". Depending on the situation, the counselor either exposes the client's attempts to involve himself in scenario games; or does not allow the client to take responsibility for what happens during or outside of counseling.

Facing realistic limits. The consultant helps the client to realize that not all life events are subject to the will and desires of a person, there are circumstances that the client cannot influence, but can only change his attitude towards them. In the practice of existential counseling, the exercise "Classification of events" can be useful.

Exercise "Classification of events"

The client is invited to write on separate cards all the events that led to the occurrence of his problem. Then the consultant asks him to divide these cards into three groups: 1) events that I cannot influence; 2) events that I can partially influence; 3) events that I can influence. Then each group, each event is discussed.

After that, the client is told that in fact there is no second group in life, and it is proposed to distribute the cards of the second group between the other two. The client is asked to explain his decision.

Next, the consultant helps the client:
- change the attitude towards those events that cannot be influenced (it is possible to use the method of ABC-emotions from rational-emotive therapy);
- take greater responsibility for circumstances that can be influenced.

• Confronting existential guilt. Psychologists consider one of the functions of anxiety to be a call to conscience. Such anxiety is fueled, among other things, by the feeling of guilt due to the failure to realize the potential. For example, the source of the existential guilt of a client whose loved one has died can be real mistakes (when a person objectively did something “wrong” in relation to the deceased or, on the contrary, did not do something important for him). In this case, psychological assistance in working with existential guilt consists in helping the sufferer to realize the significance of guilt, changing their attitude towards it, and extracting positive experience from it. In order to consolidate the result, it is possible to suggest keeping a “Guilt Diary”.

Diary of Guilt

In fairness, let's say that in existential psychotechnics, however, as in many other areas of psychotherapy (for example, gestalt therapy, implosive therapy, bioenergetics, psychodrama), consultants work more with the client's inability to feel, considering it to be the ancestor of his inability to desire. I. Yalom noted that the psychotherapy of clients with blocked “feeling” is slow and laborious, and the consultant must be persistent, repeatedly asking the client the question: “What do you feel?”; "What do you want?"

• Decision making facilitation. If the client fully experiences the desire, he will have to make a decision, make a choice. Decision is the bridge between desire and action. However, it is not uncommon for existential counselors to encounter a situation where clients block decision making, getting stuck in “What if…” doubts.

In such cases, psychologists help clients explore the ramifications of each "what if..." question and analyze the feelings that arise from it. If necessary, consultants can assist clients in developing a solution and in evaluating options. However, it is important that the client at the same time feel their own strength and resources.

Third existential conflict is a conflict between awareness of one's own global loneliness (isolation) and the desire to establish contacts, seek protection and exist as part of a larger whole. The task of the counselor in resolving the existential conflict associated with feelings of isolation is to help the client move out of the state of interpersonal fusion and learn to interact with others while maintaining and cultivating their own individuality.

I would like to note right away that the theme of isolation, in contrast to the theme of death and freedom, often pops up in everyday therapy and different approaches are used to resolve it. Existential counselors identify three types of isolation: interpersonal, intrapersonal, and existential.

Interpersonal isolation, usually experienced as loneliness, is isolation from other individuals. It can be caused by many factors: geographic isolation, lack of appropriate social skills, conflicting feelings about intimacy, the presence of psychopathology, one's own choice or necessity.

Intrapersonal isolation is the process by which a person separates parts of himself from each other or does not recognize any of his parts. Such isolation occurs when a person stifles their own feelings or aspirations, accepts the “need” and “follows” their own desires, does not trust their own judgments, or blocks their own potential from themselves. Intrapersonal isolation implies pathology by definition.

Existential isolation is the fundamental form of isolation, namely the "separation between the individual and the world". At the core of existential isolation is a confrontation with death and freedom. It is the knowledge of "my death" and the authorship of "my life" that makes a person fully aware that no one can die with or instead of someone, and means to abandon the belief that there is someone else who creates and guards you. It is also important that existential isolation, which causes intense anxiety in a person, can be masked and often kept within tolerable limits, for example, through interpersonal attachment.

Psychological defenses against isolation-related anxiety include:

• manipulation other people to protect themselves and the use of others for self-affirmation.
• Merging with another person, with a group or business, with nature or with the universe. Fusion as a response to existential isolation provides a framework through which many clinical syndromes (addiction, masochism, sadism, sexual disorders, etc.) can be understood. because pain destroys loneliness.
• Compulsive sexuality. Sexually compulsive people treat their partners more like objects than people. They don't take time to get close to anyone.

Existential psychotechnics in situations of isolation anxiety includes:

• Identification of psychological defenses and interpersonal pathology. The counselor helps the client to recognize and understand what he is doing with other people in order to cope with the fear of being alone. A definite marker of the client's interpersonal pathology can be the ideal of a need-free relationship. For example, does the client enter into relationships exclusively with those who can be useful to him? Is his love about receiving rather than giving? Is he trying, in the fullest sense, to get to know the other person? Does he keep himself partially out of the relationship? Does he really hear the other person? Does he use the other to build relationships with someone else? Does he care about the growth of the other?
• Client encountering isolation can happen in different ways, for example, to him:
  - it is proposed to experience isolation (to cut oneself off from the outside world for a while and be alone) in doses and with a support system suitable for this person. As a rule, after such an experiment, the client becomes more aware of both the fear of loneliness, and his courage and hidden resources.
  - it is recommended to master the practice of meditation as a way that allows a person in a state of reduced general anxiety (that is, in an anxiety-reducing state of muscle relaxation, a certain posture and breathing, clearing the mind) to meet and overcome the anxiety associated with isolation.

In our practice, work with aphorisms about loneliness is often used. The client is invited to blindly draw out a card with an aphorism and reflect on what they have read.

• Positive client-consultant relationship. Existential counselors are of the opinion that it is healing in itself for the client to meet with a psychologist and that the personal relationship between the counselor and the client is as important as cognitive merit. According to I. Yalom, an effective consultant:

• responds to its customers in a sincere manner;
• establishes a relationship that the patient feels safe and accepting;
• shows warmth and a high degree of empathy;
• able to "be with" the client and "grasp the meaning" of the client.

Moreover, it is important to note that in this context we are not talking about consultative "techniques" of empathy, sincerity, non-judgmental attitude, etc. We are talking about real relationships that imply genuine concern for the client and contribute to his personal growth.

Summing up, we would like to emphasize that a positive client-consultant relationship helps the client:

• identify interpersonal pathology that may interfere with maintaining relationships now and in the future. Clients often misrepresent some aspects of their relationship with consultants. Counselors can raise clients' awareness of such misrepresentations, in particular to raise awareness of the impact of misrepresentations on relationships with others;
• know the boundaries of the relationship. The client learns what he can get from others, but also, and this is much more important, what he cannot get from others.
• to assert themselves, because it is extremely important for clients that someone they respect and who really knows all their strengths and weak sides, accepts them;
• resist existential isolation;
• understand that they alone are responsible for their own lives.

Fourth existential conflict - this is a conflict between people's need for the meaning of life and the lack of "ready-made" recipes for meaningful being. The realization that the world does not exist in order to determine (systematize, streamline) the life of an individual, or even at all, is indifferent to a person, causes great anxiety and activates defense mechanisms.

According to existential consultants, it is important for a person to feel the meaning of life, whether it is cosmic or earthly. The cosmic meaning implies a certain plan that exists outside and above the personality and necessarily implies some kind of magical or spiritual ordering of the universe. The earthly meaning or "meaning of my life" includes a goal: a person who has sense of meaning, perceives life as having some purpose or function that needs to be fulfilled, some leading task or tasks for applying itself. (The terms "meaning" and "purpose" are used interchangeably in existential counseling.)

It is assumed that a person who has a sense of cosmic meaning also experiences a corresponding sense of earthly meaning, that is, his personal meaning consists in the embodiment of cosmic meaning or harmonization with it. For example, if a deeply believing Christian is sure that human life is part of a divinely predetermined plan, then, accordingly, the meaning of his life is to understand and fulfill God's will. If the idea that human life should be devoted to the goal of imitation of God as perfection is accentuated on the cosmic meaning, then the goal of life is the pursuit of perfection.

Of course, people are extremely comforted by the belief in the existence of some higher integral plan, in which each individual plays his own special role. However, due to the weakening of the influence of religious beliefs modern people are increasingly faced with the need to find a secular personal meaning in life. Existential counselors believe that such meanings can be self-transcendence (altruism, dedication, creativity), hedonistic decision and self-actualization.

Self-transcendence is associated with a person’s deep desire to transcend himself and strive for something or someone outside or “above” himself, while hedonism and self-actualization express concern for one’s own “I”. And although each of these meanings fills a person with a sense of the fullness of life, V. Frankl believed that excessive concern with self-expression and self-actualization comes into conflict with the true meaning of life. The same idea was supported by A. Maslow, who believed that a fully actualized personality is not too busy with self-expression. In his opinion, such a person has a strong sense of self and cares about others rather than using them as a means of self-expression or to fill a personal void.

It was previously said that the loss of meaning causes great anxiety and activates defense mechanisms. V. Frankl distinguished two stages of the meaninglessness syndrome - existential vacuum (existential frustration) and existential (noogenic) neurosis. The existential vacuum manifests itself in a number of interrelated phenomena: the experience of emptiness, the prevailing feeling of boredom, dissatisfaction with life, a negative emotional background, the lack of clear ideas about the direction of one's own life and the rejection of the goals and meanings of other people.

Existential neurosis is characterized by the occurrence of non-specific clinical symptoms and manifests itself in the forms of depression, obsession, deviant behavior, hypertrophied sexuality or recklessness, in all these cases, combined with a blocked will to meaning. Other non-specific consequences of existential frustration include such manifestations of disadaptation as neuroses, suicides, alcohol and drug addiction.

Psychological defenses against anxiety associated with meaninglessness have a common feature - immersion in activities that distract from understanding life:

• Compulsive activity characterized by manic persistence in any activity. For example, in getting pleasure, making money, gaining power, recognition, status;
• Crusaders(ideological adventurism) is characterized by a strong tendency to seek out spectacular and important enterprises for oneself, in order to then plunge into them headlong. For example, "professional demonstrators" who seize on any excuse to "take to the streets", almost regardless of the content of the speech.
• Nihilism characterized by a belief in the absence of meaning and activity aimed at devaluing or discrediting activities that make sense to others, such as love or service.

It is important to note that psychological assistance to clients experiencing anxiety associated with a lack of meaning in life is fundamentally different from the therapeutic strategies offered for working with other end factors. In his work “Existential Psychotherapy”, I. Yalom emphasizes that “death, freedom and isolation must be met directly. However, when it comes to meaninglessness, the effective therapist must help the client<…>make the decision of involvement rather than sinking into the problem of meaninglessness.” Thus, The task of the consultant in resolving the existential conflict associated with a sense of meaninglessness is to help the client to become more actively involved in life and help overcome / eliminate obstacles along the way.

The main existential psychotechnics in situations of anxiety associated with a sense of loss / lack of meaning in life include:

• Identification of psychological defenses. The counselor helps the client become more aware of the types of defenses they use against meaninglessness anxiety and the consequences and costs of defending them.
• Redefining the Problem. The essence of this existential technique is to help the client realize: a) that there is no “ready-made” meaning in life that could be found; b) that people are responsible for creating their own meaning. Let's highlight several ways to refocus the problem:

• the psychologist increases the client's receptivity to the role of the meaning of life and helps to identify and appreciate the "best" parts of the client's personality. To do this, the consultant is explicitly and implicitly interested in the views of the client, deeply studies his love for another person, asks about long-term hopes and goals, explores creative interests and aspirations;
• the psychologist helps the client look away from himself and switch his attention to other people. (This technique was proposed by V. Frankl and is called "dereflection").
• the psychologist helps to rethink the tragic events of the client's life in the context of new meanings, lessons, achievements, etc. Let's illustrate this method an example from the practice of V. Frankl.

Frankl was approached by an elderly general practitioner who had been depressed since losing his wife two years ago. Frankl asked him, "What would happen, doctor, if you were the first to die and your wife had to outlive you?" “Oh,” he said, it would be terrible for her, how she would suffer! Then Frankl responded: "You see, doctor, she escaped this suffering, and it was you who delivered her from them, but you must pay for this by experiencing and mourning her." The doctor did not answer a word, shook hands with Frankl and calmly left his office.

• the psychologist helps the client in "programming" the meaning by expanding consciousness (more complete coverage of the details and events of life) and stimulating creative imagination.

• Assisting the client in his more active participation in life. The psychologist helps the client explore areas and find forms of "engagement" in life. In our opinion, one of the ways to stimulate the vital activity of the client is the use of therapeutic metaphors, both with indirect and direct impact. Here are two examples from R. Tkach's book "The Use of Metaphor in Grief Therapy".

A metaphor with indirect impact as an example of a consultant's self-disclosure.

... I dream that I am standing in the middle of a fenced-in plot of land.
- What is this land? And why am I here? - I ask an unknown person.
- This is your cottage, - a friendly voice is heard.
- But here there are only weeds and thorns - either I am indignant, or I am horrified in response.
- It's not scary. Thorns and weeds can be dealt with, they just need to be pulled out, - the voice gently soothes me.
- But there's nothing here. Absolute Void! I continue to argue.
- That's good. Any Emptiness ceases to be empty if it is filled with something, the voice teaches me.
- What can I fill it with? I sincerely ask.
- This is your Void, fill it with whatever you want! - the voice instructs me to say goodbye.
And I begin to fill the Void. First, I pull out the weeds and thorns. Then along the fence I plant fruit trees, bushes and flowers. Then I start building the house. I've been working tirelessly for several months, maybe more. I work with great enthusiasm and faith in my soul that EVERYTHING will work out for me ...
In the morning my house is ready. I am laying a path to it ... and with the words: “This is the Road to a NEW LIFE!” I wake up to a new day.

A metaphor with direct impact as an example of the simultaneous use of existential, positive and behavioral therapy.

Quite often, in order to help the client streamline his life, determine plans for the future and ways to implement them, I tell the parable “Your Cross”:

“One man lived in the world, and he carried a cross on his shoulders. It seemed to him that his cross was very heavy, uncomfortable and ugly. Therefore, he often raised his eyes to the sky and prayed: “Lord! Change my cross."
And then one day the heavens opened, a ladder came down to him and he heard: "Get up, we'll talk." The man picked up his cross and began to climb the stairs. When he finally reached heaven, he turned to the Lord with a request:
- Let me change my cross.
- Well, - the Lord answered, go to the vault and choose any one you like.
A man entered the vault, looked and was surprised that there were no crosses here: small, and large, and medium, and heavy, and light, and beautiful, and ordinary. For a long time a man walked around the vault, looking for the smallest, lightest and most beautiful cross, and finally found it. He went to the Lord and said, "God, can I have this one?"
The Lord smiled back and said, “You can. This is your life. You chose the cross with which you came to me.”

After which, after a therapeutic pause, I ask: “What is the moral of this parable?” After carefully listening to the answer, and if necessary, directing it towards healthy adaptation, I suggest that the client imagine that he is a character in a parable.

Then on a white sheet of paper, from the bottom left corner to the center up, I draw a staircase with 5-6 steps and ask the client to write down above each step his thoughts about how he lived after death loved one up to this day.

Then, at the top of the stairs, I draw a large square (or circle) and ask the client to make and write down a wish in it, how he would like to live on: “Now imagine that you can make any wish, and it will surely come true. There can be only one desire, but the most important thing is for you. Write it down in this square."

Next, I draw 5-6 steps down (from the center to the right bottom corner) and tell the client something like this: “Imagine that you have already received a blessing to fulfill your desire. And now, in order for your dream to come true, you need to make some effort. Write above the steps on the right what you need to do to make your dream come true.

The work ends with me asking the client where he would like to start the path to fulfilling his dream, how he imagines it, and what he will do in the near future (this week, tomorrow, today).

Bibliography

1. Bugental J. The Science of Being Alive: Dialogues between Therapist and Patients in Humanistic Therapy. - M.: Independent firm "Class", 1998.
2. Leontiev D. A. Psychology of meaning. - M.: Meaning, 1999.
3. Maslow A. New frontiers of human nature. M.: Meaning, 1999.
4. Mey R. Existential psychology. - M.: April Press, EKSMO-Press, 2001.
5. Tkach R. M. Fairy tale therapy for children's problems. - St. Petersburg: Speech, 2008.
6. Tkach R. M. The use of metaphor in the therapy of grief. - K .: University "Ukraine", 2011.
7. Frankl V. Psychotherapy and Existentialism.
8. Frankl V. Man in search of meaning. Moscow: Progress, 1990.
9. Yalom I. Looking into the sun. Life without fear of death. - M.: Eksmo, 2009.
10. Yalom I. Existential psychotherapy. - M.: Rimis, 2008.

Tkach R.M. ,

Chapter from the textbook "Counseling psychology".

Recall that I. Yalom defined existential psychotherapy as a psychodynamic approach. It should immediately be noted that there are two important differences between existential and analytic psychodynamics. First, existential conflicts and existential anxiety arise from the inevitable confrontation of people with the ultimate givens of being: death, freedom, isolation, and meaninglessness.

Second, existential dynamics do not imply the adoption of an evolutionary or "archaeological" model in which "first" is synonymous with "profound." When existential therapists and their patients do in-depth research, they do not focus on day-to-day anxieties, but reflect on underlying existential issues. In addition, existential approaches can also be used to address issues related to freedom, responsibility, love, and creativity. [AND. Yalom writes that psychotherapeutic approaches "reflect and are shaped by the pathology they treat."]

In connection with the above, existential psychotherapy is mainly focused on long-term work. However, elements of an existential approach (for example, an emphasis on responsibility and authenticity) can also be included in relatively short-term psychotherapy (for example, associated with work with post-traumatic conditions).

Existential psychotherapy can be carried out both in individual and in group form. Usually the group consists of 9-12 people. The advantages of the group form are that patients and psychotherapists have a wider opportunity to observe the distortions that occur in interpersonal communication, inappropriate behavior and correct them. group dynamics in existential therapy aims to identify and demonstrate how the behavior of each member of the group:

1) is considered by others;

2) makes others feel;

3) creates an opinion about him in others;

4) affects their opinion of themselves.

The greatest attention in both individual and group forms of existential psychotherapy is paid to the quality psychotherapist-patient relationship. These relationships are considered not from the point of view of transference, but from the standpoint of the situation that has developed in patients to date, and the fears that torment patients at the moment.

Existential therapists describe their relationship with patients using words such as presence, authenticity and devotion. Individual existential counseling involves two real people. An existential psychotherapist is not a ghostly "reflector", but a living person who seeks to understand and feel the patient's being. R. May believes that any psychotherapist is existential, who, despite his knowledge and skills, can relate to the patient in the same way as, in the words of L. Binswanger, "one existence relates to another."

Existential psychotherapists do not impose their own thoughts and feelings on patients and do not use countertransference. This is due to the fact that patients can resort to various ways of provocative connection of psychotherapists, which allows them not to address their own problems. Yalom talks about the importance of implicit injections. We are talking about those moments of psychotherapy when the therapist shows not only professional, but also sincere, human participation in the problems of patients, thereby sometimes turning a standard session into a friendly meeting. In his case study (“Every Day Brings a Little Closer”), Yalom looks at these situations from both the perspective of the therapist and the perspective of the patient. So, he was amazed to find out what great importance one of his patients gave such small personal details as warm looks and compliments about how she looks. He writes that in order to establish and maintain a good relationship with a patient, a psychotherapist needs not only complete involvement in the situation, but also such qualities as indifference, wisdom, and the ability to get involved in the psychotherapeutic process as much as possible. The therapist helps the patient “by being trustworthy and interested; affectionately present next to this person; believing that their joint efforts will eventually lead to correction and healing.

The main goal of the psychotherapist is to establish an authentic relationship in the interests of the patient, so the question psychotherapist's self-disclosure is one of the main in existential psychotherapy. Existential psychotherapists can reveal themselves in two ways.

First, they may tell their patients about their own attempts to come to terms with extreme existential anxieties and maintain the best human qualities. Yalom believes that he made a mistake by resorting to self-disclosure too rarely. As he notes in The Theory and Practice of Group Psychotherapy (Yalom, 2000), whenever he shared a significant portion of his own self with patients, they invariably benefited from it.

Second, they may use the psychotherapy process itself rather than focusing on the content of the session. It is the use of thoughts and feelings about what is happening "here and now" in order to improve the therapist-patient relationship.

During a number of psychotherapeutic sessions, patient A. demonstrated behavior that she herself regarded as natural and spontaneous, while other members of the group rated it as infantile. She in every possible way showed activity and readiness to work on herself and help others, described her feelings and emotions in detail and colorfully, and willingly supported any topics of the group discussion. At the same time, all this was of a semi-playful, semi-serious character, which made it possible at the same time to provide some material for analysis, and to avoid a deeper immersion in it. The psychotherapist, suggesting that such "games" may be associated with a fear of approaching death, asked why she was trying to be an adult experienced woman, then a little girl. Her response shocked the whole group: “When I was little, it seemed to me that my grandmother was standing between me and something bad in life. Then my grandmother died and my mother took her place. Then, when my mother died, my older sister was between me and the bad. And now, when my sister lives far away, I suddenly realized that there is no longer a barrier between me and the bad, I stand face to face with him, and for my children I myself am such a barrier.

In addition, the key processes of therapeutic change, according to Yalom, are will, acceptance of responsibility, attitude towards the therapist and involvement in life. Let's consider them on the example of working with each of the basic alarms.

Working with death awareness

The study of people who have been extreme situations who survived the experience of clinical death, as well as chronic patients, irrefutably indicates that a deepening awareness of death can lead to a higher appreciation of life. The situation of proximity to death causes a wide variety of reactions in people. Many try to deny this fact. Others fall into panic, apathy or fruitless reflection (“Why me?”, “What have I done wrong in my life and how can I fix it?”). Still others begin to take revenge on all healthy people or just those who can outlive them. Other people activate the means of psychological protection, distorting reality, but thanks to this, they more or less calmly perceive information regarding death.

Therefore, it is important to prepare any person for this in advance and teach him to use his illnesses as an opportunity for personal growth. Awareness of the uniqueness and finiteness of human life leads to "the unbearable lightness of being" - a reassessment of values, acceptance in the present moment, a deeper and more complete experience of art, establishing close and sincere contacts with all people, and not just with relatives and friends, understanding the relativity of human fears and desires, establishing closer contact with nature. Therefore, deepening the awareness of death can also cause a radical shift in patients who are not terminally ill.

Participant E. began one of the personal growth groups by voicing the problem of relations that had deteriorated outside the group with participant S., with whom E. had a fairly strong friendship for some time. According to E., this was due to the alienation and antipathy that arose in S. in connection with the pressure of some of their mutual acquaintances, with whom E. is in a tense relationship. The group, which consisted mainly of psychology students, willingly took up the study of the problem posed, quickly discovering that in almost all E.'s relationships with women, the same scenario is observed - the inability to maintain warm friendly relations for a long time. This topic, both in a broader context (female rivalry) and in relation to E., caused quite strong emotional reactions in the group. Throughout the discussion, E. several times silently flowed tears, but she answered the attention of those around them with a request “not to pay attention”, since they flow “just like that”, behind them “nothing is worth” and with her “last times like this happen often." The facilitator suggested that the next time they flow and there are emotions associated with them that E can talk about in the group, let her give a sign - for example, stamp her foot. And after a few minutes he asked the question: “E., what is happening in your life now?” The ensuing explosion of emotions of fear, resentment, sadness shocked the whole group: it turned out that for about a month E. had been waiting every hour for news of the death of the only remaining close person, a mother suffering from severe cancer. The group, which had been actively trying to help E.

to solve the problem she had declared, she experienced shock, a sense of guilt and tried, by virtue of the available opportunities, to support her. Awareness of the every minute proximity of death led to the fact that almost at the very end of the group, already when summing up its results, one of the participants, Zh., told that she might have an oncological disease and that because of fear and unwillingness to live she does nothing for his further diagnosis and therapy. The succession of stories about close or similar experiences that followed did not persuade her to seek medical attention at that time. However, in the next group, she spoke about her "secret" trip to the hospital and the feelings of both relief and disappointment that followed. This allowed the group to focus not only on the discussion of the problems of death, but also on the meaning of life and the responsibility for bringing this meaning to life.

Yalom recommends proceeding from the following position - the anxiety associated with death is inversely proportional to life satisfaction. Increasing awareness of the inevitability of death can increase anxiety, but the therapist should seek not to anesthetize patients' anxiety, but to help them come to terms with it and use it constructively.

The Permission to Endure Technique is to let patients know that discussion of death-related issues is highly valued in counseling. This can be done by showing interest in self-disclosure of patients in the field, as well as by encouraging their self-disclosure. In addition, psychotherapists should not encourage patients to deny death. On the contrary, it is necessary to actively contribute to keeping these issues “in the public eye”. To do this, the therapist himself must be resistant to his own anxiety associated with death.

While listening to one patient talk about the importance and responsibility of the work he is doing, the therapist suddenly asked him to stop and listen, and then say what he heard. “The ticking of the clock that hangs on your wall,” the patient answered in bewilderment. "That's right," the psychotherapist confirmed. - Only this is not just a clock: they measure time. The time allotted for today's meeting. And also the time that is generally allotted to us for life. It is different for everyone and depends on genetics, lifestyle, will to live and many other factors. But in one it is similar - it cannot be calculated and reversed. Now think about whether the importance and prestige of the work you are doing are really those significant things for which you are ready to spend so much of your personal time?

Technique for working with defense mechanisms consists in identifying inadequate defense mechanisms and their negative consequences. Psychotherapists try to help patients accept that they will not live forever, rather than deny death. Existential psychotherapists require tact, perseverance, and timing to help patients identify and change their childishly naive views of death.

Dream work technique is that existential psychotherapists encourage patients to talk about their dreams. Since dreams (especially nightmares) may have unrepressed and unedited subliminal themes, death themes are often present. Therefore, the discussion and analysis of dreams is carried out taking into account the existential conflicts taking place in patients at the moment. However, patients are not always ready to deal with the material presented in their dreams.

Yalom (Yalom, 1997, pp. 240-280) cites the case of Marvin, an elderly man of 64 years old. One of his nightmares was as follows: “Two men, very tall, pale and thin. In complete silence, they glide across the dark field. They are dressed in all black. Wearing high black chimney sweep hats, long black coats, black leggings and boots, they resemble Victorian undertakers or lackeys. Suddenly, they come to a stroller where a little girl is lying wrapped in black swaddling clothes. Without saying a word, one of the men starts pushing the wheelchair. After driving a short distance, he stops, walks around the carriage and with his black cane, which now has a white-hot tip, unfolds the swaddling clothes and slowly inserts the white tip into the baby's vagina.

Yalom gave the following interpretation of this dream: “I am old. I am at the end of my life path. I have no children and I face death full of fear. I'm suffocating in the dark. I choke on this silence of death. I think I know the way. I'm trying to pierce this blackness with my sexual talisman. But that's not enough."

Subsequently, when Yalom asked Marvin to tell what associations he had in connection with his dream, he did not say anything. When Marvin was then asked how he processed all the images of death that he had imagined, Marvin preferred to view his nightmare in terms of sex rather than death.

reminder technique fragility (transience) of existence . Psychotherapists can help patients identify and manage death anxiety by “tuning in” patients to the signs of mortality that are part of normal life (for example, the death of a loved one can be a powerful reminder of personal mortality; the death of a parent means it’s the next person’s turn). generations; the death of children can cause a feeling of powerlessness in connection with the realization of cosmic indifference). In addition, a serious illness can bring patients face to face with their own vulnerability.

Also, the awareness of mortality reminds of itself in the transitional periods of life. Highest value have the transition from adolescence to adulthood, the establishment of permanent relationships and the assumption of corresponding obligations, the departure of children from home, marital separation and divorce. In middle age, many patients begin to become more aware of death, realizing that now they are not growing up, but getting old. In addition, the loss of a job or the sudden emergence of the danger of a career crash can deepen the awareness of death.

In everyday life, a person is constantly faced with reminders of the passage of time. The physical signs of aging, such as graying of hair, wrinkles, skin blemishes, reduced joint flexibility and stamina, decreased vision, all destroy the illusion of permanent youth. Meeting friends from childhood and adolescence shows that everyone is getting older. Often, birthdays and various anniversaries generate existential pain along with or instead of joy, as these dates are milestones in the aging process.

A technique for using aids to deepen awareness of death consists of asking the patient to write their own obituary or fill out a questionnaire with questions about death anxiety. In addition, therapists may invite patients to fantasize about their death, imagining where, when, and how they will meet it and how their funeral will take place. Yalom describes two ways to get patients to interact with death: observing terminally ill people and including a terminally ill cancer patient in a patient group.

Close to this technique is the technique decreased sensitivity to death. Psychotherapists can help patients cope with the horror of death by repeatedly forcing them to experience this fear in reduced doses. Yalom notes that when working with groups of cancer patients, he has often seen that the fear of death in these patients is gradually reduced just by getting more detailed information.

An interesting example semantic reappraisal of death leads V. Frankl. He was approached by an elderly doctor who had been depressed for two years about the death of his wife. “How could I help him? What should I tell him? Now, I didn't say anything, but instead posed the question, "What would happen, doctor, if you died first and your wife had to outlive you?" “Oh,” he said, “it would be terrible for her, how she would suffer!” Then I answered: "You see, doctor, she escaped this suffering, and it was you who delivered her from them, but you must pay for this with the fact that you survived and mourn her." He did not answer a word, but shook my hand and calmly left my office.

Working with responsibility and freedom

When patients have extreme anxiety about freedom, psychotherapists focus on raising patients' awareness of their responsibility for their lives and on helping patients to take on that responsibility.

Technique for determining types of protection and ways of avoiding liability is that psychotherapists can help patients understand the functions of certain behaviors (eg, compulsiveness) as evasion of responsibility for choice. In addition, psychotherapists can analyze with patients their responsibility for their own misfortunes and, if necessary, bring patients face to face with this responsibility.

Vera Gulch and Maurice Temerlin, based on the analysis of audio recordings of psychotherapy sessions, have assembled a collection of confronting interviews aimed at increasing awareness of responsibility. They give an example of one man bitterly and passively complaining that his wife was refusing to have sexual contact with him. The therapist clarified the implicit choice by remarking, "But you must like it, since you've been married so long!" In another case, a housewife complained: "I can't cope with my child, all he does is sit and watch TV all day." The therapist made the implicit choice explicit with the following remark: "And you are too small and helpless to turn off the TV." The impulsive, obsessive man yelled, "Stop me, I'm afraid I'll kill myself." The therapist said, “Should I stop you? If you really want to commit suicide - really die - no one can stop you but yourself. One therapist, in conversation with a passive, oral-addicted man who believed that the reason for his discord with life was an unrequited love for an older woman, began to sing: "Poor little lamb, he's lost."

The essence of this technique is that when the patient complains about an unfavorable situation in his life, the therapist is interested in how the patient created this situation. In addition, the therapist may focus on how the client is using "avoidance language" (for example, often people say "I can't" instead of "I don't want to").

Evasion Identification Technique focuses on the psychotherapist-patient relationship. Psychotherapists confront patients with their attempts to shift responsibility for what happens within or outside of psychotherapy to psychotherapists. For this, it is very important for the psychotherapist to realize his own feelings regarding patients, helping to identify emotional reactions in patients.

Many clients who seek psychotherapeutic help expect the therapist to do all the necessary therapeutic work for them. The motivations for such expectations can be very diverse, ranging from “You are better off, you are stronger, you have a more favorable situation” and ending with “You studied this, this is your profession, I pay you money for this.” Influencing in this way various feelings of the psychotherapist (guilt, conscience, conscientiousness, etc.), the patient shifts the burden of responsibility for the changes taking place with him onto the shoulders of the psychotherapist.

In a student study group, participant A. responded to all attempts of help and support both from the facilitator and from other group members with approximately the same words: “I don’t know ... Maybe this is so ... At least , you you see it…” Feeling that the position of such passive confrontation had become habitual for her, and avoiding a provocative slipping into teaching, the psychotherapist told her an anecdote: “Late in the evening, a woman walks along a dark deserted street. Suddenly he hears heavy man steps behind him. Without turning around, she quickens her pace. Steps also become more frequent. She runs - the pursuer runs after her. In the end, she runs into some courtyard and realizes that there is no way out. Then she boldly turns to the pursuer and loudly shouts: “Well, what do you want from me?”, To which the pursuer calmly replies: “I don’t know, this is your dream.” Despite the fact that the patient reacted aggressively to this anecdote, later his last phrase served as a good "marker" for identifying deviations. As soon as A. began to demand something from the psychotherapist and the group or to blame them for anything, she was immediately reminded: "But this is your dream."

A technique for confronting the limitations of reality. Since objectively unfavorable situations periodically arise in the life of any person, this technique is aimed at changing the patient's point of view. This change takes several forms.

First, the psychotherapist can help identify those areas of life that the patient can continue to influence despite the limitations that have arisen. So, for example, no one can change the fact of a serious illness, but it depends only on a person whether to take the position of a passive victim in relation to this fact or try to find aristos - “the best in this situation” (classic examples are “a real person” A Maresiev, circus artist V. Dikul, etc.).

Secondly, psychotherapists can change the existing attitude in relation to those restrictions that cannot be changed. It is about both accepting the injustice that exists in life, and reframing like “if you can’t change the situation, change your attitude towards it.”

V. Frankl illustrated this kind of change with the following anecdote: “During the First World War, a Jewish military doctor was sitting in a trench with his non-Jewish friend, an aristocratic colonel, when massive shelling began. Teasing him, the colonel said: "You are afraid, aren't you? This is further proof of the superiority of the Aryan race over the Semitic." like me, you would have fled a long time ago.

Existential Guilt Confrontation Technique . As already noted, in existential psychotherapy, one of the functions of anxiety is considered to be an appeal to conscience. And one of the sources of anxiety is guilt, due to the unsuccessful realization of potential.

In order to start psychological work with existential guilt in a group format, a modification of the parable from F. Kafka's Trial is well suited.

One person learned that somewhere there is a Castle in which the Law reigns, wisely distributing happiness and misfortune "justly". As expected, he sets off on a journey and, having worn out the prescribed amount of clothes and trampled down the prescribed number of shoes, finally finds him. The guard, in front of one of the countless gates, greets the traveler, but immediately announces that he cannot let him through at the moment. When a person tries to look into the bowels of the Castle himself, the guard warns: “If you are impatient, try to enter, do not listen to my prohibition. But know that my power is great. But I'm only the most insignificant of the guards. There, from rest to rest, guards stand one more powerful than the other. And with each of them you have to fight.

Then the man decided to wait until he was either allowed to enter, or someone else would come, ready to fight the terrible and powerful guards. Sometimes he had long conversations with the first guard on the different topics. Periodically, he tried to bribe the guard with various bribes. He took them, but still did not miss, explaining his actions as follows: "I do this so that you do not lose hope."

In the end, the man grew old and, feeling that he was dying, asked the guard to fulfill his last request - to answer the question: “After all, all people strive for the Law, how did it happen that for all these long years no one except me demanded that missed it?" Then the guard shouted back (since the man could not hear well): “No one enters here, these gates were intended for you alone! Now I'll go and lock them up."

There is a difference between guilt for bad choices made in the past and guilt for not making new choices. As long as patients continue to behave in the present as they did in the past, they cannot forgive themselves for past choices.

This is well illustrated by a Buddhist parable. Once two monks were walking along a narrow mountain road and at one of the turns they met a girl standing in front of a huge puddle. The first monk calmly passed by, and the second silently approached her, took her on his shoulder, carried her over the puddle and went on. Already in the evening, approaching the walls of the monastery, the first monk broke the traditional silence: "Our charter forbids touching women." To which the second monk replied: “I have only been dogging her for three minutes, and you have been carrying her for an hour already.”

A technique for releasing the ability to desire. It is impossible to experience desires without contact with your feelings. Therefore, in order to understand the true desires of a person, existential psychotherapists work with repressed and repressed affects that block desires. At the same time, unlike other methods of psychotherapy, they try to avoid dramatic global breakthroughs, since their (breakthroughs) impact is usually short-lived. Instead, within the context of authentic relationships, existential psychotherapists are constantly trying to answer the question "How do you feel?" and "What do you want?", thus exploring the source and nature of the patients' blocks and the underlying feelings that the patients are trying to express.

Decision Facilitation Technique is that existential psychotherapists encourage patients to realize that every action is preceded by a decision. Since alternatives are excluded when making a decision, decisions are a kind of borderline situations in which people create themselves. Many patients paralyze their ability to make decisions with questions that begin with "Yes, but..." or "What if..." (eg, "What if I lose my job and can't find another?"). Psychotherapists can help patients explore the ramifications of each "what if..." question and analyze the feelings that are induced by those questions. Psychotherapists can encourage patients to actively make decisions in such a way that decision making will activate their own strength and resources.

In a situation where the patient is faced with the need to make a decision, but tries by all means to shift this decision to the psychotherapist, the therapist can tell another oriental parable. One day, a woman who lived in a remote village and had the reputation of being the wisest there, learned that Khoja Nasreddin would pass through this village. Fearing for her authority, she decided to test his wisdom. When he entered the village, she approached him with a small bird clutched in her hand and asked in a loud voice: “Tell me, is the bird in my hand alive or dead?” It was a very tricky question, because if he answered that she was alive, she would tighten her fist and the bird would suffocate. If Khoja had answered that the bird was dead, the woman would have unclenched her hand and the bird had flown away. “Everything is in your hands, woman,” Nasreddin answered her.

When necessary, existential psychotherapists help patients to exercise their will. The therapist's approval allows patients to learn to trust their own will and gain confidence that they have the right to act.

Yalom recommends bringing the following messages to patients with suppressed will as often as possible: “Only I can change the world that I created”, “There is no danger in change”, “In order to get what I really want, I must change”, “I able to change."

Working with insulation

Technique for confronting patients with isolation. The therapist can help the patient understand that ultimately every person is born, lives and dies alone. This is quite painful, as it destroys all romantic patterns of human relationships extolled by culture. However, like death, awareness of total loneliness significantly affects the quality of life and relationships. [Not without reason, in The Art of Love, E. Fromm defines the ability to be alone as a condition for the ability to love.] By exploring their loneliness, patients learn to determine what they can and cannot get from relationships.

So, giving an assessment of the conducted groups, many participants note the important fact for them that, thanks to the groups, they escaped from their everyday environment for a while.

In addition, the psychotherapist can offer the patient the following experiment - to isolate himself from the outside world for a while and stay in isolation. After conducting this experiment, patients become more aware of both the horror of loneliness, and the extent of their hidden resources and the degree of their courage.

Protection Mechanism Identification Technique consists in identifying the defenses that patients use to cope with the contradiction between the need for belonging and the fact of existential isolation.

One of the groups, which was devoted to the problem of building family relationships, was attended by several people with compulsive behavior, manifested in increased amorousness, chronic unrequited love, frequent changes in love objects, and the formation of dependency relationships with them. All attempts to study the deep processes behind this have been shattered by intellectual defenses. To demonstrate that defense mechanisms against loneliness are behind such behavior, the therapist told the following parable.

“There lived a lonely and unhappy man. And one day his loneliness and despair reached such a degree that he cried out to God: "Lord, send me a beautiful woman!" His cry was so strong that God heard and paid attention to him. God asked: "Why not a cross?" The man got angry: "I'm not tired of life, I want to find beautiful woman and friend". The man received everything, but soon became even more miserable. This woman became a pain in his heart and a stone on his neck. And then he again prayed: "Lord, give me a sword." God again asked: "Maybe is it a cross after all?" But the man shouted: "This woman is worse than any cross. Send me only a sword!"

God sent a sword, a man killed a woman, was captured and sentenced to be crucified. And on the cross, praying to God, he laughed out loud: "Forgive me, Lord! I did not listen to You, and yet You asked whether to send me a cross from the very beginning. If I had obeyed, I would have got rid of all this unnecessary fuss "".

Technique for identifying interpersonal pathology. Taking ideal freedom from needs or "I-Thou" relationships as a criterion, it is possible to identify ways in which patients avoid real relationships with others. To what extent do patients treat other people as objects that serve to satisfy their desires and needs? How capable are they of love? How well do they know how to listen to interlocutors and reveal themselves? How do they keep people at a distance? Psychotherapists can teach patients the ABC of the language of intimacy, which gives them the skills to accept and express feelings.

Using the psychotherapist-patient relationship to identify pathology. Existential psychotherapists believe that focusing solely on the transference interferes with therapy because it eliminates the authentic therapist-patient relationship. This is due to the fact that, firstly, the analytic paradigm eliminates the reality of the relationship itself, considering them as a kind of key to understanding past experience, and secondly, it provides the psychotherapist with a rational basis for self-defense. In turn, the inability to self-disclosure blocks the ability to sincerely and empathically understand the inner world of another. Self-disclosure of a psychotherapist (similar to that described by R. Mayagape - love devoted to the good of another) allows the patient to take step by step towards his own disclosure.

Healing relationships. Existential psychotherapists seek to develop real relationships with patients. Although the therapist-patient relationship is temporary, the experience of intimacy can be permanent. The psychotherapist-patient relationship can promote self-assertion of patients, since it is extremely important for them that someone they respect and who really knows all their strengths and weaknesses, accepts them. Psychotherapists who have managed to develop deep relationships with their patients can help them confront existential isolation. In addition, it helps patients realize their responsibility for life and the relationships that develop in it.

Dealing with meaninglessness

problem redefining technique. When patients complain that "life doesn't make any sense," they seem to be admitting that life has a meaning that they can't find. This point of view is close to the logotherapeutic position. However, according to other existential approaches, people give meaning rather than receive it. Therefore, existential psychotherapists raise patients' awareness that there is no objective inherent meaning in life, but that people are responsible for creating their own meaning. Often what falls into the category of meaninglessness is best studied in connection with other ultimate anxieties associated with death, freedom, and isolation. An example of this technique of redefining the problem of meaninglessness can also be found in an oriental parable. So, one legend tells that one day Khoja Nasreddin died and went to heaven in a wonderful garden, where an obedient genie fulfilled all his desires. Very soon, Hodge got bored with this and decided to do some work. However, the genie forbade him to do so. Then, after a while, Nasreddin began to ask to go somewhere else, even to hell. "Where do you think you are?" The genie laughed.

A technique for identifying types of defenses against mindlessness anxiety. Existential psychotherapists help patients become more aware of the types of defense they use against the anxiety of meaninglessness. First of all, this is due to the clarification of such issues as to what extent the desire for money, pleasure, power, recognition, status is rooted in their inability to confront the existential problem associated with meaninglessness. How seriously does a person take life? Defense against meaninglessness may be one of the reasons why patients take life lightly, thereby creating problems that they consciously or subconsciously seek to avoid.

Techniques for helping patients become more involved in life lies in the fact that the psychotherapist proceeds from the assumption of the innate desire of the patient to always participate in life. This technique may involve psychotherapists inviting patients to establish and maintain authentic relationships in the course of psychotherapy, which is already a significant contribution to the therapeutic process. Psychotherapists can explore a wide range of patients' hopes and goals, their belief systems, their ability to love, and their attempts to creatively express themselves.

Note that working with meaninglessness differs from working with other ultimate foundations. In cases of death, freedom, and isolation, the therapist organizes the process in such a way that the patient meets them face to face. However, when it comes to meaninglessness, the therapist helps to turn away from the issue by making a decision about involvement in life.

Existential therapy has the following goals: 1) to become honest with yourself; 2) expand your vision of personal perspectives and the world around you in general; and 3) clarify what gives meaning to the present and future life. The key concepts of therapy are: self-awareness, self-determination and responsibility, loneliness and interconnection with others, the search for authenticity and meaning, existential anxiety, death and non-existence.

The main tasks of the existential group are:
- expanding the boundaries of consciousness and self-understanding;
- taking responsibility for your life;
- developing the ability to love others and allow yourself to be loved;
- development of the ability to enjoy life without guilt;
- development of the ability to freely choose and take risks, accepting the inevitability of experiencing anxiety and guilt;
- development of a sense of being;
- increasing the meaning of life "
- development of the ability to navigate in the real time of life (Kochyunas, 2000).

Group dynamics aims to reveal how the behavior of each member of the group is viewed by others, causes others to feel certain feelings, creates an opinion in others about him and influences their opinion of themselves. The patient can choose:
- expand your consciousness or limit your vision of yourself;
- create and search for the meaning of your life or lead an empty and meaningless existence;
- to determine the course of his life himself or to allow other people or circumstances to determine it instead of him;
- go in search of your identity or let it dissolve in opportunism;
- use your potential or do nothing;
- establish meaningful relationships with others, or isolate themselves;
- take a certain risk and experience the anxiety that accompanies change, or choose the safety of addiction;
- to accept the inevitability of one's death or to isolate oneself from this knowledge, since it generates anxiety (Corey, 2003).

When establishing indications for therapy, the following limitations should be considered:
- It is not suitable for patients who are not interested in research deep foundations of its existence.
- It is not suitable for those patients who are looking for a specific way to get rid of their symptoms or solve their problems and do not see the value of an existential approach.
- The existential therapist offers the patient the support to face the true foundations of his life. He cannot help someone who sees him as a leader or a strict parent.
- An existential therapist must be a mature person who strives to
fullness of life experiences, who have undergone intensive supervision and
trainings. A specialist with a vague idea of ​​this approach deceives himself and his patients and can be dangerous for them (Corey, 2003).

The therapist must help patients discover and use freedom of choice and take responsibility for the choices they make. His main role is to be fully present and accessible to the members of the group, as well as to understand his subjective being in the world. He is required to create personal relationships, reveal himself and confront the group carefully.

The group leader must:
- be in a group real person rather than trying to play the role of a therapist;
- remember the principle here and now”, asking yourself and the participant the question: “What is happening now? What do we feel? What are we thinking about? What do we do with it?
- avoid using psychological terms;
- notice and draw the attention of the participants to the contradictory, paradoxical positions they occupy in the life of the group;
- share your doubts with the participants. insecurity, anxiety, mood changes;
- find a place for humor in difficult situations, without slipping to the superficial level.

R. Kociunas (2002) identifies the following functions of the leader of an existential group:
- Structuring the life of the group - fixing the beginning and end of the lesson, sub-
holding productive and blocking unproductive actions of participants,
protecting them from destructive mutual attacks.
- Reflection of group processes - focusing the attention of participants on
what happens in the group, on the contradictions between words and actions, on the "pits" in the life of the group, etc.
- Direction group work- help in the transition from superficial statements to deep feelings, from impersonal, abstract questions to a discussion of personal problems, from conversations to actions.
- Modeling - the therapist should serve as an example of authentic life in
group.
- Linking individual parts of life in a group in order to bring situations that have arisen to completion.

The therapist can structure the group around one of the existential themes, such as anxiety or guilt, freedom or responsibility. At the same time, he shares with the group the feelings that arise here and now. The following questions may be helpful:
- Do you like the way your life is going?
- If not, what do you do with it?
What aspects of your life satisfy you the most?
What is stopping you from doing what you want?

The formation of responsibility occurs in a group form and includes the adoption of the following beliefs.
- The realization that life is sometimes arranged dishonestly and unfairly.
- The realization that, ultimately, some part of life's suffering and death cannot be avoided.
- The realization that no matter how close to other people, I still have to cope with life alone. A meeting with the basic questions of my life and death, thanks to which I can now live my life more honestly and less involved in trivialities.
- The realization that I am ultimately responsible for how I live my life, no matter how much support and guidance I receive from others (Yalom 2000).

The effectiveness of therapy is evaluated primarily on specific facts from the lives of patients; the assessment of positive changes by their immediate environment is taken into account. Therapeutic changes in the group occur in the following areas:
- preference begins to be given to the anxiety of independent choice, rather than a sense of security (often - in a state of dependence on others);
- there is a desire to define oneself, and not to be a reflection of other people's expectations;
- there is an understanding that, although far from everything in life can be changed, there is always the opportunity to change one's attitude to the unchanging;
- one's own limitations are accepted without hurting the sense of one's own worth, which finds expression in the formula: in order to be valuable, it is not necessary to be perfect;
- there comes a new awareness of "hindrances" to life in the present: bogging down in the past, excessive planning for the future, the desire to do a lot at the same time.

A.E. Alekseychik (1990, 2008) developed a method of intensive therapeutic life, combining existential orientation and Gestalt therapy and psychodrama techniques. This technique is characterized by directiveness, careful preliminary study of the scenario of classes, intensification and dramatization of the inclusion of participants in the work of the group. The main principles of the methodology:
- Realism - the implementation of the rules of "acceptance of fate" and "payment for everything."
- Syntheticity - level-by-level study of peak experiences of participants based on various representative systems using a wide arsenal of techniques.
- Intensification of experiences - identification of the experiences being worked out and "burning out the superfluous".
- Reliance on safe mental processes and compensatory mechanisms.
- Dramatization - techniques of "hovering over the abyss", repeated switching
polar experiences of the participants, dramatic detailing and shaping
the formation of associative links of the created psychotherapeutic situation with real problems and relationships between the participants.
- The truth of information, achieved by the methods of "materialization" and reduced "measurement" of experiences.
- Clear definition of therapeutic goals: dynamic, open self-assessment in points of therapeutic effect.

Group therapy for patients with suicidal tendencies is carried out in crisis groups. The group crisis therapy (GCT) developed by us (Starshenbaum, 2005) is a highly specific form of crisis therapy that satisfies the increased need of a crisis individual for psychological support and practical help from others. Unlike other forms group therapy GCT is aimed at resolving the current situation, which has a vital significance for the patient, which determines the short-term, intensity and problem orientation of the HCT. The focus of the crisis group is
there are, as a rule, relationships in real life that are highly significant for patients, and not interactions that occur between members of the “here and now” group. Group crisis therapy has several advantages over individual crisis therapy. The group enables the patient to overcome dependent expectations centered on the therapist. Attempts to increase self-acceptance and self-esteem of a crisis individual with the help of individual conversations, as a rule, turn out to be ineffective, since the psychotherapist's arguments are often perceived as due to the performance of his professional duty. The statements of “comrades in misfortune”, emotionally colored and supported by mutual assistance relations, turn out to be more effective. The group reflects the patient's unconscious negative features of communication, which are not always shown by him in individual communication with a psychotherapist, provides confrontation with unacceptable behavior. Finally, the group provides the patient with the opportunity to help other members, while experiencing feelings of competence and worthiness, which are extremely useful for coping with the crisis.

The indications for GCT are as follows:
1) the presence of suicidal tendencies or a high probability of their resumption when the crisis situation worsens;
2) a pronounced need for psychological support and practical assistance, the establishment of highly significant relationships to replace the lost ones, the need to create a therapeutic and life optimistic perspective, to develop and test new ways of adaptation;
3) willingness to discuss their problems in the group, to consider and accept the opinion of group members with the aim of therapeutic restructuring necessary to resolve the crisis and prevent its recurrence in the future.

The final indications for GCT are established on the basis of observation of the patient's behavior in the first group session and acquaintance with his subjective experiences associated with his participation in the group. Insufficient consideration of this provision can lead to a negative effect of group tension on the patient's condition and an increase in suicidal experiences. Moreover, in a crisis group, the suicidal behavior of one of the participants can relatively easily actualize similar tendencies in other members of the group. In this regard, during the preliminary conversation with the patient, it is stipulated that his first participation in the group's classes is trial, and the discussion of the question of the methods of his further treatment will take place after this lesson.

Some patients view their participation in the group only as an opportunity for
time to get distracted from the traumatic situation, “recover strength”, so that later
continue trying in the same ways that have already shown their ineffectiveness.

Such unrealistic treatment settings often become the topic of group discussion when new members are added to the group. In order to develop an optimistic therapeutic perspective, the patient is introduced to a book of reviews of former group members in which they describe the process of resolving their crisis situation with the help of a therapeutic group. After the final determination of the indications for GCT, a conversation is held with the patient, during which the possibilities of using the help of the crisis group are discussed.

Composition of the group. The size of the crisis group is limited to 10 participants. The group usually includes two patients with a high suicidal risk, since mutual identification facilitates public self-disclosure and discussion of their suicidal experiences. However, more than two such patients create an intractable problem for the group, requiring too much time and attention to the detriment of the rest of the group, creating a painful pessimistic atmosphere that is fraught with the actualization of suicidal experiences in other patients.

The low group activity of crisis patients is overcome by the fact that a patient with affective or hysterical type psychopathy with mild situational decompensation is included in the group as a subleader - a conductor of the psychotherapist's emotional influence. It is taken into account that two such patients can compete with each other, suppressing the activity of the others and disorganizing the work of the group.

The composition of the group is heterogeneous in age and gender, which removes the idea of ​​the age and gender uniqueness of their own crisis problems, and expands the possibility of interaction. The older ones take care of the younger ones, men and women reinforce the mutual need for recognition of their sexual attractiveness, while non-adaptive sex-role attitudes are identified and corrected. The urgency of crisis problems, the extent to which they are involved, make it possible to intensify psychotherapeutic effects as much as possible. Group classes are held up to five times a week and last 1.5–2 hours. Taking into account the fact that the usual time for a patient to resolve a crisis is 4-6 weeks, the course of GPC is on average one month. During such a period, it becomes possible to unite the group on the basis of common crisis problems.

The role of group cohesion in a crisis group differs from its role in an interpersonally oriented group, where it is used for empathy training and emerges in the process of this training. In a crisis group, the cohesion of participants develops in the course of mutual support and is used to resolve their crisis situations.

In this regard, communication of group members outside of class is encouraged, in contrast to the analytical group, where it is prohibited.

The group is open-terminal, that is, one or two patients drop out of it on a weekly basis due to the end of the therapy period (“limb”) and, accordingly, it is replenished with new participants (“openness”). The openness of the group, while creating certain difficulties for its cohesion, allows at the same time to solve a number of important therapeutic problems. Thus, persons who are at the later stages of emerging from the crisis, their successful example encourage newcomers to treatment, contribute to the creation of their optimistic treatment prospects. In addition, in an open crisis group, cognitive restructuring is easier to carry out through mutual enrichment with life experience, exchange different ways adaptation. In the open-ended group, the more experienced patients teach the new recruits techniques for coping with the crisis.

The GCT is carried out in stages for each member of the group: crisis support, crisis intervention, training in adaptation skills. At the same time, in the course of one session, depending on the condition of the patients, methods are usually used that correspond to various stages of crisis therapy. At the stage of crisis support, the emotional inclusion of the patient in the group plays an important role, which provides him with empathic support from the members of the group, contributes to the elimination of his feelings of hopelessness and despair, as well as the idea of ​​the uniqueness and intolerance of his own suffering. For lonely helpless people who experience an exceptionally high need for psychological support and practical assistance in a state of crisis, including outside group lessons, the crisis group becomes the last chance for survival.

In the first sessions, the disclosure and sympathetic sharing of the patient's suicidal experiences by group members who have or have recently had such experiences are carried out. As a result, the response to these experiences is significantly facilitated, which leads to a decrease in affective tension. In order to mobilize personal protection, anti-suicidal factors are actualized. Among group members, there are often patients in whom the onset of a crisis is largely due to excessive sensitivity and vulnerability, combined with excessive demands on oneself. In such cases, the topic of discussion becomes a suicidal attitude to blame yourself for all the troubles, as well as experiencing your own guilt and insolvency. In these patients, the key to overcoming the crisis is to achieve "self-acceptance", which is facilitated by the use of mutual support from group members.

During the first stage of the GCT, the patient receives much-needed psychological support and practical help from other group members who fill the empty world of the crisis individual. By their achievements in therapy, they clearly show him the possibility of overcoming the crisis. As a result, the localization and formulation of the crisis problem is facilitated, after which the transition to the second stage of the GCT begins.

The crisis intervention stage is dedicated to finding the best way to resolve the crisis. It should be noted that due to the exchange of life experience between members of the group, the repertoire of adaptation skills of patients with GKT is enriched more significantly than with individual interaction. In a group, the patient will better accept the advice of treatment partners and, supported by them, will more boldly try out new ways of adapting. In the process of problematic discussions, the patient recognizes a non-adaptive attitude that prevents him from using necessary ways resolution of a crisis situation. One of the most frequent topics discussed in the crisis group is the attitude to preserve "by all means" family or love relationships that have become psycho-traumatic or even suicidal. Achievement by patients of this life purpose they are hindered by the unrealistic ideals of a life partner formed in their childhood - for example, as a guardian and at the same time obedient.

The stage of adaptation skills training begins after the patient has made a certain decision to change his position in the conflict and needs to expand his adaptive capabilities. At this stage, testing and consolidation of new ways of solving the problem and correction of a number of non-adaptive personality traits are carried out, such as the need for extremely close emotional relationships, the dominance of love relationships in the value system, the insufficient role of the professional sphere, the low ability to compensate in situations of frustration, etc. .

Since the testing of new ways of adaptation is carried out at the final stage of the GCT, when the suicidal risk is minimized, the decrease in self-esteem during possible failures does not lead to an increase in the feeling of personal failure, but only contributes to a realistic assessment of one's own capabilities and strengthens the therapeutic motivation for further training in adaptation skills. The main methods of therapy at this stage are communicative training using problematic discussions, role-playing training, psychodrama and autogenic training. Playing the role of a significant other helps the patient to better understand the motives of the partner's behavior and, based on this, build relationships with him. Training in better performance of one's own role helps to change the patient's communication style to a more adaptive one. In the process of role-playing training, the skills of gender-role behavior are also developed, the idea of ​​​​one's own sexual attractiveness is reinforced.

The problem orientation of the GKT requires focusing the lesson on a crisis situation, so the psychotherapist's position is to a certain extent directive. The psychotherapist in the crisis group often resorts to direct questions, suggests topics for discussion and ways to solve problems, and when suicidal tendencies become actual in any member of the group, he directly controls his behavior.

It should be noted that, while creating a number of valuable opportunities for stopping the crisis and preventing suicidal tendencies in the future, GKT at the same time significantly complicates the work of the psychotherapist. The pronounced need of crisis patients for psychological support, summing up when they are combined into a group, can lead to an emotional overload of the psychotherapist. In addition, he must simultaneously focus individual crisis situations of group members in conditions of their frequent change, take into account the possibility of imperceptibly adding crisis problems of other group members to the patient's own problems, and prevent the spread of depressive and auto-aggressive tendencies in the group. In order to reduce these difficulties, joint management of a crisis group with a cotherapist is practiced, whose functions are as follows. At the first stage of the GCT, the cotherapist, together with the leading psychotherapist, participates in creating an atmosphere of unconditional acceptance of the personality and experiences of patients. At the second stage of the GCT, the cotherapist ensures that the group members are included in the discussion, control over their condition and provide the necessary psychological assistance in case of deterioration. At the third stage of the GCT, the cotherapist, in the process of role-playing games, acts as an assistant director and commentator, plays the roles of the patient or persons from his immediate environment, and also conducts classes autogenic training aimed at improving emotional self-control.

Existential psychotherapy is a collective concept for designating psychotherapeutic approaches that emphasize "free will", free development of the personality, awareness of a person's responsibility for the formation of his own inner world and the choice of a life path. The existential approach is more look to psychotherapy than a separate therapeutic approach. An existentialist-oriented psychotherapist can use any method or approach that is compatible with existentialist perspectives.

To a certain extent, all psychotherapeutic approaches of existential psychotherapy are genetically related to the existential direction in philosophy - the philosophy of existence, which arose in the 20th century as a result of upheavals and disappointments caused by two world wars.

The central concept of the doctrine is existence (human existence) as an undivided integrity of an object and a subject; the main manifestations of human existence are care, fear, determination, conscience, love. All manifestations are determined through death - a person sees his existence in borderline and extreme states (struggle, suffering, death). Comprehending his existence, a person gains freedom, which is the choice of his essence.

Philosophical basis

The philosophical basis of existential therapy is, as already mentioned, the phenomenological approach, the purpose of which is to refuse to accept all conceptions of reality in order to reach that which cannot be doubted - pure phenomena. The phenomenological approach is associated with the name of Edmund Husserl. From it comes the philosophy of Martin Heidegger.

Heidegger argued that people, unlike objects, exist in interactive unity with reality. They are a source of activity rather than fixed objects, and are in constant dialogue with their environment. At any given moment, the individual is a creative combination of past experience and present situation. As a result, it never stays constant for a minute. Heidegger would consider that belief in a fixed personality structure, including various labels of borderline, passive, or narcissistic personality, is an inauthentic way of relating to oneself and others. People don't "have" a personality; they are constantly creating and re-creating it through their own choices and actions.

Jean-Paul Sartre suggested that when people are faced with the need to be responsible for themselves and for their choices, they begin to experience anxiety. The concept of a fixed identity reduces anxiety. Treating yourself as a good person replaces the study of your behavior and the possibility of choosing on the basis of correctness and virtue. If you define yourself as a borderline person, you no longer need to hold yourself accountable for your impulsive actions. We all need a fixed identity, such as “doctor” or “honest man,” to avoid feeling anxious about making choices. However, what really matters is not who we are, but what we do, that is, what style of behavior we choose.

Every time a person makes a choice, he opens up new possibilities both in himself and in the world around him. For example, if you behave cruelly towards someone, then you expose your negative sides, and, possibly, the negative aspects of this person. If you are caring, you can let your potential positive qualities come out.

Thus, people are beings through which reality manifests itself. Human actions make it possible to clearly express what was previously only potential or "hidden" in reality. Most important view knowledge is the knowledge of "how" (that is, it is related to actions). For example, learning to play the guitar reveals not only the creative potential of the player, but also the musical potential of the instrument. Mental knowledge of facts is less useful. Therapy should teach to be a man, and not to gain knowledge about yourself, that is, about your past. People need to learn to listen to themselves and match the nature of their developing personality (Todd J., Bogart A.K., 2001).

Principles of Existential Therapy

Existential psychotherapy, like the very concept of "existentialism", includes many different directions and currents, but it is based on some general ideas and principles.

The ultimate goal of existential therapy is to enable the client to understand their own goals in life and make authentic choices. In all cases, therapy helps them to “remove their limitations” and also contributes to their development. Clients must openly face themselves and what they have been avoiding - their anxiety and, ultimately, their extremeness. Often, in order to control anxiety, people give up their deepest potentials. To choose to fulfill one's potential is to take risks, but there will be neither wealth nor joy in life unless people learn to face the possibility of loss, tragedy, and finally death.

The first thing the client needs to do is to expand the ability of awareness, that is, to comprehend: the potential that he refuses; means used to maintain failure; a reality he can choose; anxiety associated with this choice. To help the client succeed in this, the therapist uses two main tools - empathy and authenticity.

Empathy is used as a form of phenomenological method. The therapist tries to respond to the client without prejudice. An empathic and neo-judgmental attitude can help the client discover their inner world.

Another important tool is the therapist's own authenticity. If the goal of therapy is to achieve the authenticity of the client, then the therapist must model this authenticity. In order to become authentic, the client needs to learn that he does not have to play any role, does not have to strive to be perfect or the way he wants to be seen. He also does not need to give up aspects of his own experience and can take risks. The therapist should model these qualities and try to become a real person in therapy.

In existential therapy, being real or authentic means sharing with the client your immediate impressions and opinions about him. In essence, this is providing the client with direct personal feedback.

Existential Psychotherapy Techniques

Although existential psychotherapists use a number of techniques found in other approaches, especially psychoanalysis, forms of existential therapy have a number of features that distinguish it from other approaches. May notes six such features (May R., 1958).
1. Existential psychotherapists use a wide range of techniques. These techniques are flexible and versatile, as May puts it, “vary from patient to patient and from one stage to another during the treatment of the same patient” depending on what is needed “to best reveal the existence of this particular patient at a given moment. his personal history" and "what the best way capable of illuminating his being-in-the-world.”

2. Existential psychotherapists, especially those with psychoanalytic training, use psychological processes such as transference, repression, resistance, but always with regard to their meaning in the existential situation of the patient's current life.

3. Emphasis is placed on the presence or reality of the therapist-patient relationship, in which the therapist is "concerned not with the actual problems, but with understanding and experiencing, as far as possible, the patient's being" by penetrating and participating in the patient's field. This view is also shared by representatives of other psychotherapeutic schools, who consider the patient as an entity that requires understanding, and not as an object that needs to be analyzed. “Any psychotherapist is existential to the extent that, taking into account his technical training and received knowledge about transference and other psychological processes, he has the ability to treat the patient as "one existence interacting with another", in the words of Binswanger". The patient is not a subject, but an "existential partner", and the relationship is an encounter, or "co-being", with each other in genuine presence.The task of the psychotherapist is not to influence the patient, but to establish a meaningful relationship as a mutual experience.

4. The therapist tries to avoid behaviors that can slow down or destroy the existence of full presence in the relationship. Since a full encounter with another person often generates anxiety, the therapist may defend himself by viewing the other as "just the patient," as an object, or by focusing on behavioral mechanisms. A way to block presence can be the use of techniques.

5. The goal of therapy is for the patient to experience his existence as real. He needs to become fully aware of his existence, which includes the realization of potentialities and the beginning of activities in accordance with them. The interpretation of mechanisms or processes as part of existential therapy will always take place in the context of a person's awareness of his own existence. The task of therapy is not only to show the patient where, when and why he failed to realize his full human potential, but also to make him experience it as acutely as possible. The moment is extremely important, since one of the features of the neurotic process in our time is the loss of the meaning of being, when, in an attempt to objectively evaluate oneself, a person begins to perceive himself as an object or mechanism. Simply giving the individual new ideas about the self as a mechanism is only to perpetuate the neurosis, and a therapy that does this only reflects and continues the fragmentation of the culture that leads to the neurosis. Such therapy can bring about the elimination of symptoms and anxiety, but at the expense of the patient's adjustment to the culture and the limitation of his existence at the cost of forfeiting freedom.

6. Existential therapy helps the patient develop a commitment or commitment orientation. This attitude involves decisions and actions, but not for one's own benefit. Rather, they are commitments to a moment in the patient's own existence. Such commitments are a necessary condition for the acquisition of knowledge. The patient cannot afford to gain insight or knowledge until he is ready to make decisions, takes a position in life and makes preliminary decisions.

S. Patterson and E. Watkins (2003) consider it possible to add a seventh characteristic to this list: in the therapeutic situation, existential psychotherapy focuses on the here-and-now situation. The past and the future are involved only insofar as they enter into the current experience. The here-and-now includes not only the patient's experiences outside of therapy, but also his relationship with the therapist. It is possible to examine the patient's personal history, but not with the aim of explaining it in terms of any school of psychotherapy. Rather, it is understood as a modification of the general structure of being-in-the-world of a given patient (Binswanger L., 1964).

These aspects, or emphases, of existential psychotherapy, Patterson and Watkins note, are hardly sufficient as a basis for practice. The concepts behind them are of paramount importance; it is important that the object that is the focus of existential therapy - that is, existence as it is, and not individual symptoms - differs from the object of most traditional approaches. However, it is necessary that these concepts be put into practice by certain methods, and it can be assumed that if a theory such as existentialism differs markedly from other theories in its concepts and principles, then other methods should be used. At the same time, at present, there is no detailed, systematic description of the nature and procedures of existential psychotherapy, and it seems necessary, especially considering that these procedures may differ from those adopted in other approaches.

Psychotherapists who have been influenced by existentialism are not faced with the problem of methods. If they believe that techniques are secondary and should not violate the authenticity of the relationship, they will not be afraid of excessive passion for techniques and analyze the mechanisms of their action. But in this case, they will not demonstrate the mechanisms of action of their techniques and will deprive the other person of the opportunity to understand or master these methods and procedures. However, methods and procedures must exist, and attention must be paid to them, otherwise the approach will be considered completely intuitive (Patterson S, Watkins E., 2003).

1. Introduction
2. Existential psychotherapy (encyclopedic reference)
3. Five Fundamental Postulates of Existential Psychotherapy
4. The Goal of Existential Therapy
5. Theory and therapy of neuroses

Introduction

Each time has its own neuroses and each time needs its own psychotherapy. Today, in fact, we are dealing not with the frustration of sexual needs, as in Freud's time, but with the frustration of existential needs. Today's patient no longer suffers so much from a sense of inferiority, as in Adler's time, but from a deep sense of loss of meaning, which is connected with a feeling of emptiness - that's why we speak of an existential vacuum.

existential psychotherapy

A collective concept for designating psychotherapeutic approaches that emphasize "free will", free development of the personality, awareness of a person's responsibility for the formation of his own inner world and the choice of a life path. The term comes from the late Latin existentia existence. To a certain extent, all psychotherapeutic approaches of existential psychotherapy have a genetic affinity with the existential direction in philosophy, the philosophy of existence, which arose in the twentieth century as a result of upheavals and disappointments caused by two world wars. The ideological source of existentialism was Kierkegaard's teaching of phenomenology, philosophy of life. The central concept of the doctrine is existence (human existence) as an undivided integrity of an object and a subject; the main manifestations of human existence are care, fear, determination, conscience, love. All manifestations are determined through death, a person sees his existence in borderline and extreme states (struggle, suffering, death). Comprehending his existence, a person gains freedom, which is the choice of his essence. In a narrow sense, the term existential psychotherapy is usually referred to when referring to Frankl's existential analysis. In a broader sense, existential psychotherapy refers to humanistic direction in psychotherapy in general.

In 1963, the president of the Association for Existential Psychotherapy, James Bugenthal, put forward five fundamental postulates:

1. Man, as a whole being, surpasses the sum of his constituents (in other words, man cannot be explained as a result of the scientific study of his partial functions).
2. Human existence unfolds in the context of human relations (in other words, a person cannot be explained by his partial functions, in which interpersonal experience is not taken into account).
3. A person is conscious of himself (and cannot be understood by psychology that does not take into account his continuous, multi-level self-awareness).
4. Man has a choice (man is not a passive observer of the process of his existence: he creates his own experience).
5. A person is intentional (a person is turned to the future; in his life there is a goal, values ​​and meaning).

The main feature of existential psychotherapy is its focus on a person as being-in-the-world, i.e. on his life, and not on the person as an isolated mental integrity (by the way, many existential therapists avoid using the concept of "personality"). The very concept of "existence" in literal translation means "emergence", "appearance", "becoming". This accurately reflects the essence of all existentialism, not only in psychology and psychotherapy, but also in philosophy, art, literature, etc. The main thing in it is not a person as a static set of characterological and personal qualities, forms of behavior, psychodynamic mechanisms, but as a being constantly arising, becoming, i.e. existing. The main goal of existential therapy is to help a person better understand his life, better understand the opportunities it provides and the limits of these opportunities. At the same time, existential therapy does not pretend to change the client, to restructure his personality; all attention is focused on understanding the process of a particular life, in its daily occurrence of contradictions and paradoxes. If a person sees reality not distorted, he gets rid of illusions and self-deception, sees his calling and his goals in life more clearly, sees the meaning in everyday worries, finds the courage to be free and responsible for this freedom. In other words, existential therapy does not so much heal as it teaches the discipline of life. It can also be called the harmonization of human life. Although this is only the most general definition of the goals of existential psychotherapy, it is clear that it is more like a philosophical study of a person’s life than a psychological analysis of a person. It is for this reason that existential psychotherapy is initially interconnected with philosophy. It seems that it is the only psychotherapeutic school whose methods have a fairly clear philosophical justification. Among Western philosophers of exceptional importance for existential psychotherapeutic practice, one can distinguish the founder of existential philosophy, the Danish thinker S. Kierkegaard, the classic of modern existential philosophy, the German philosopher M. Heidegger, the German philosophers M. Buber, K. Jaspers, P. Tillich, the French philosopher J.-P. Sartre, although this is not an exhaustive list of names. Among the Russian philosophers, whose works are important for existential therapy, one can name first of all V. Rozanov, S. Trubetskoy, S. Frank, N. Berdyaev, L. Shestov. Existential therapy borrowed many of its concepts from the existential-philosophical dictionary of existence, being-in-the-world (Dasein), the feeling of being, the authenticity and inauthenticity of being, etc. The first attempt to combine philosophy and psychiatry was made by the Swiss psychiatrist and psychoanalyst Ludwig Binswanger in the 30s th years of our century, proposing the concept of existential analysis (Daseinanalyse). He can be considered the founder of existential therapy. Although he himself was not involved in practical psychotherapy, he determined the principles of a phenomenological description of the patient's inner world, from which existential therapy begins. The first truly psychotherapeutic existential concept was proposed by another Swiss psychiatrist Medard Boss in the 40-50s of our century. His version of existential analysis was in form psychoanalytic therapy, but reformed on the basis of Heideggerian philosophy. While maintaining the analytical conceptual apparatus and methods, they, nevertheless, were interpreted in an existential or, as M. Boss said, in an ontological context. Daseinanalysis as one of the areas of existential psychotherapy continues to develop today. A very fruitful and original existential psychotherapeutic school is the logotherapy of the Austrian psychotherapist Viktor Frankl. It considers the human desire for meaning as a cornerstone in human life. Logotherapy itself is a system of ways to help a person overcome the existential emptiness, with the loss of the meaning of existence. For the development of existential therapy, its American branch is very important, although existential therapy is not very popular in the USA. First of all, we should mention the famous American psychologist, one of the fathers of the movement humanistic psychology Rollo Maya. He was the first, relying on the European existential and phenomenological tradition, to formulate the prerequisites and main characteristics of the therapist's existential attitude in psychotherapy (he denied the existence of existential therapy as an independent direction in psychotherapy). Closely related to his concept is the humanistic-existential psychotherapy of James Bugental, in which he tries to combine the principles of humanistic and existential psychology (although they often contradict each other). Modern ideas about existential therapy are developed by the so-called English School, whose most prominent representatives are Emmy van Deirtzen and Ernesto Spinellia. What distinguishes existential therapy from other psychotherapeutic schools? First of all, this is the understanding of a person as being-in-the-world or as a continuous process of life, in which the self of a person and his world as a context of life are inextricably linked. Thus, if we want to truly understand a person, we must first of all examine his life, manifested in his relationship with the world. There are 4 main dimensions of human existence (being-in-the-world): physical, social, psychological (personal) and spiritual (transpersonal). In each of these dimensions, a person "meets" the world and, experiencing it, forms his own basic prerequisites (settings) of life. To understand a person means to understand how he exists simultaneously in these basic dimensions of life as the most complex bio-socio-psycho-spiritual organism. Another fundamental feature of existential therapy is the desire to understand a person through the prism of his internal ontological characteristics or universal existential factors. These are factors that affect the life of every person. We distinguish 7 such universal characteristics of a person:

1. sense of being;
2. freedom, its limitations and responsibility for it;
3. human limb or death;
4. existential anxiety;
5. existential guilt;
6. life in time;
7. meaning and meaninglessness.

In the process of psychotherapy, the client's attitudes are examined in relation to these universal circumstances of life, in which the roots of our psychological difficulties and problems are hidden. Existential therapy connects psychological health and the possibility of psychological disorders, respectively, with a genuine and inauthentic way of being. To live an authentic life, according to J. Buzhental, means to be fully aware of the present moment of life; choose how to live this moment; and take responsibility for your choices. In reality, this is quite difficult, so most of their lives people live an inauthentic life, i.e. they tend to conformism, refuse the risk associated with the choice, they try to shift responsibility for their lives onto others. Therefore, almost all people throughout their lives constantly face various difficulties, problems, sometimes reaching the degree of pronounced disorders. In existential therapy, therapeutic changes are associated primarily with the expansion of the client's consciousness, with the emergence of a new understanding of one's life and the problems that arise in it. What to do with this new understanding is the business and responsibility of the client himself. On the other hand, the real results of therapy should be manifested not only in internal changes, but also necessarily in real decisions and actions. Nevertheless, these actions should be deliberate, taking into account their possible negative consequences, rather conscious than spontaneous. therapeutic changes. But this is more a manifestation of realism, not pessimism. Existential therapy advocates a realistic view of life and the acceptance of many circumstances as given, inevitable. All people can be clients of existential therapy without exception. There is only one requirement - the active involvement of the person himself in the process of researching his life, the desire to look as openly and honestly as possible, comprehensively look at his not always successful life. On the other hand, it is existential therapy that can be most effective in providing psychotherapeutic assistance to people who find themselves in life crises, faced with exceptional life circumstances. This is an experience of meaninglessness, emptiness of life, apathy and depression, suicidal intentions, drastic changes in quality and lifestyle (loss of a job, retirement, loneliness, deterioration in the quality of life, personal and professional failures, divorce, etc.). etc.), loss of loved ones and experiencing loss, facing death (accidents, incurable diseases), etc. Existential therapy as an adjunct can be useful in chronic or acute somatic diseases, in working with mental patients to better understanding and greater acceptance of the changed realities of life. The task of traditional psychotherapy is to manifest in the mind the deep phenomena of spiritual life. In contrast, logotherapy seeks to turn consciousness towards truly spiritual beings. Logotherapy as a practice of existential analysis is intended, first of all, to bring a person to awareness of his own responsibility, since awareness of responsibility is the basis of human existence. Since being human means being aware and responsible, existential analysis is a psychotherapy based on the principle of awareness of responsibility. In an explicit or implicit form, this question is inherent in the very nature of man. Doubts about the meaning of life, therefore, can never be regarded as manifestations of mental pathology; these doubts to a much greater extent reflect truly human experiences, they are a sign of the most human in man. Thus, it is quite possible to imagine highly organized animals, even among insects, say, bees or ants, which in many ways surpassed man in terms of organizing their communities. But it is impossible to imagine that such creatures would think about the meaning of their own existence, thus doubting it. Only man is given to discover the problematic nature of his existence and to feel all the ambiguity of being. This ability to doubt the significance of one's own existence distinguishes a person among animals much more than such achievements as upright walking, speech or conceptual thinking. The problem of the meaning of life in its extreme version can literally take possession of a person. It becomes especially urgent, for example, in adolescence, when growing up young people in their spiritual quest suddenly discover all the ambiguity of human existence. Once a science teacher in high school explained to high school students that the life of any organism, including humans, is ultimately nothing but a process of oxidation and combustion. Suddenly, one of his students jumped up and threw the teacher a full of excitement question: "If this is so, then what is the meaning of life?" This young man has already clearly realized the truth that a person exists in a different plane of being than, say, a candle that stands on the table and burns out until it goes out completely. The existence of a candle can be explained as a combustion process. Man, on the other hand, has a fundamentally different form of being. Human existence takes the form of historical being, which, unlike the life of animals, is always included in the historical space (“structured” space, according to L. Binswanger) and is inseparable from the system of laws and relations underlying this space. And this system of relations is always governed by meaning, although it may not be explicitly expressed, and perhaps not at all expressible.

Theory and therapy of neuroses

Before we start talking about what logotherapy actually is, it is worth saying what it is not: it is not a panacea. The choice of method in a particular case can be reduced to an equation with two unknowns, where the first variable is the originality and uniqueness of the patient's personality, and the second variable is no less peculiar and unique personality of the therapist. In other words, just as any method cannot be applied in different occasions with the same hope of success, and no therapist can use different methods with the same efficiency. And what is true of psychotherapy in general is true of logotherapy in particular. “Logotherapy is not a therapy that competes with other methods, but it may well compete with them due to the additional factor that it includes.” What this additional factor can form is revealed to us by N. Petrilovich, who expressed the opinion that the opposite of logotherapy to all other systems of psychotherapy manifests itself not at the level of neuroses, but when it goes beyond it, into the space of specifically human manifestations. For example, psychoanalysis essentially sees neurosis as the result of psychodynamic processes and accordingly tries to treat it by setting in motion new psychodynamic processes, such as transference. Behavioral therapy, associated with learning theory, sees neurosis as a product of learning or conditioning processes and, accordingly, tries to influence the neurosis by organizing a kind of relearning, reconditioning. In contrast, logotherapy enters the human dimension, including in its instrumentation those specifically human manifestations that it encounters there. Specifically, we are talking about two fundamental anthropological characteristics of human existence, namely: firstly, about its self-transcendence, and secondly, about the ability to self-detachment, which is equally characteristic of human being. It should therefore be clear that only psychotherapy that dares to go beyond psychodynamics and behavioral research and penetrate into the dimension of specifically human manifestations in short, specifically human manifestations in short, only a rehumanized psychotherapy, will be able to understand the signs of the times and respond to requests. time. In other words, it should be clear that even in order to diagnose "existential frustration" or, even more so, "noogenic neurosis", we must consider a person as a being constantly in search of meaning through self-transcendence. As for the therapy itself, not the diagnosis, but in particular the therapy of not noogenic, but psychogenic neuroses, we must, in order to exhaust all possibilities, turn to the ability to self-detachment, which is equally characteristic of a person, not the last of the manifestations of which is the ability to humor. Thus, a humanized, humanized, rehumanized psychotherapy is possible if we take into account self-transcendence and use self-withdrawal. However, neither one nor the other is possible if we see man as an animal. The animal is not concerned with the meaning of life, and the animal cannot laugh. We do not want to say by this that man is only a man and is not at the same time an animal. The human dimension is superior to the animal dimension, which means that it includes this lower dimension as well. The statement that a person has specifically human manifestations and at the same time the recognition of the existence of subhuman manifestations in him do not contradict each other, because the human and subhuman are in relation to each other, so to speak, hierarchical inclusion, and by no means mutual exclusion. Mobilization of the ability to self-detachment in the context The treatment of psychogenic neuroses is achieved using the logotherapeutic technique of paradoxical intention, and the second fundamental anthropological fact, the phenomenon of self-transcendence, underlies another logotherapeutic technique, the technique of dereflection. To understand these two therapeutic methods, it is necessary to start with the logotherapeutic theory of neuroses. In this theory, we distinguish three pathogenic response patterns. The first can be described as follows: Causes Reinforces Symptom Phobia Increases A certain symptom causes the patient to fear that it may happen again, and along with this, a fear of anticipation (phobia) arises, which leads to the fact that the symptom actually appears again, which only reinforces the patient's initial fears. Under certain conditions, the fear itself may be that which the patient is afraid of repeating. Our patients themselves spontaneously told us "about the fear of fear." How do they motivate this fear? As a rule, they are afraid of fainting, heart attack or apoplexy. And how do they react to their fear of fear? Flight. For example, they try not to leave the house. In essence, agoraphobia is an example of this first neurotic phobia-like response pattern. But what is the "pathogenicity" of this response pattern? In a report given in New York on February 26, 1960, at the invitation of the American Association for the Development of Psychotherapy, we formulated it as follows: "Phobias and obsessive-compulsive disorder are caused, in particular, by the desire to avoid situations that give rise to anxiety." It is our position that flight from own fear by avoiding a fearful situation, plays a decisive role in fixing a neurotic response pattern like a phobia, and at the same time constantly finds confirmation from behavioral psychotherapy. In general, it cannot be denied that logotherapy anticipated much that was later placed by behavioral therapy on a solid experimental basis. After all, back in 1947 we defended the following point of view: “As is known, in a certain sense and with some right, the mechanism of neurosis can be regarded as a conditioned reflex. All predominantly analytically oriented psychotherapeutic methods are mainly aimed at clarifying in the mind the primary conditions for the emergence of a conditioned reflex, namely, the external and internal situation at the first appearance of a neurotic symptom. We, however, are of the opinion that neurosis as such is explicit, fixed neurosis is generated not only by primary conditions, but also by (secondary) fixation. The conditioned reflex, which we consider here a neurotic symptom, is fixed through the fear of expectation! Well, if we want, so to speak, to “open” the entrenched reflex, it is important first of all to eliminate the fear of waiting in a way based on the principle of paradoxical intention. The second pathogenic response pattern is observed not in phobias, but in cases of obsessive-compulsive disorder neuroses. The patient is under the yoke of obsessive ideas that have taken possession of him, trying to suppress them. This opposition, however, only reinforces the initial pressure. The circle closes again, and the patient finds himself inside this vicious circle. Unlike a phobia, however, obsessive-compulsive disorder is characterized not by flight but by struggle, the struggle against obsessive ideas. And here it is impossible to avoid the question of what motivates the patient, induces him to this struggle. As it turns out, the patient is either afraid that the obsessive ideas will not be limited to neurosis, that they signal a psychosis, or he is afraid that the obsessive ideas of a criminal content will make him actually harm someone else or himself. One way or another, the patient suffering from obsessive-compulsive disorder does not experience fear of fear itself, but fear of himself. The task of the paradoxical intention is to break open, tear, turn inside out both of these circular mechanisms. This can be done by depriving the patient of the fear of reinforcement. It should be borne in mind that the patient with a phobia is afraid of something that might happen to him, while the patient with obsessive-compulsive disorder is also afraid of what he himself can do. We will take both into account by defining the paradoxical intention as follows: the patient is required to want the realization of that (in the case of a phobia) or, accordingly, to realize himself (in the case of obsessive-compulsive disorder), which he so fears. As we can see, the paradoxical intention represents an inversion of the intention that characterizes both pathogenic response patterns, namely, avoiding fear and coercion by escaping from the first and fighting the latter. The first attempt to experimentally prove the effectiveness of the paradoxical intention was made in line with behavior therapy. Professors of the McGill University Psychiatric Clinic L. Sollom, B. L. Ledwidge were selected from among patients with obsessional neurosis of a couple with equally pronounced symptoms, and one of them was subjected to treatment by the method of paradoxical intention, and the other was left without treatment as a control case. It was indeed found that the symptoms disappeared only in patients who underwent treatment, and this happened within a few weeks. In this case, in no case did new symptoms appear in place of the previous ones. The paradoxical intention should be formulated in the most humorous way possible. Humor is one of the essential human manifestations; it gives a person the opportunity to take a distance in relation to anything, including himself, and thereby gain complete control over himself. The mobilization of this essential human capacity for distancing is, in fact, our goal when we use paradoxical intention. Because it is related to humor, Konrad Lorenz's admonition that "we don't take humor seriously enough yet" can be considered outdated. Literature

1. Psychotherapeutic Encyclopedia; Under the general editorship of B.D. Karvasarsky. St. Petersburg, 1990
2. existential psychotherapy; Yalom I.D. Moscow, 1999
3. Man in search of meaning; Frankl Yu, Moscow, 1990