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THE GLOBAL July 2021
Number 2
PSYCHOTHERAPIST Volume 1

JOURNAL OF POSITIVE AND TRANSCULTURAL PSYCHOTHERAPY

ISSN: 2710-1460
Published by WAPP
www.positum.org
 The Global Psychotherapist (JGP) is an interdisciplinary digital
journal devoted to Positive and Transcultural Psychotherapy
(PPT after Peseschkian, since 1977)™. This peer-reviewed semi-
annual journal publishes articles on experiences with and the
application of the humanistic-psychodynamic method of
Positive and Transcultural Psychotherapy. Topics range from
research articles on theoretical and clinical issues, systematic
reviews, innovations, case management articles, different aspects of
psychotherapeutic training and education, applications of PPT in counselling,
education, and management, letters to the editors, book reviews, etc. There is a
special section devoted to young professionals that aims to encourage young
colleagues to publish. The Journal welcomes manuscripts from different cultures and
countries.

Journal Co-Chief Editor: Olga Lytvynenko, Ukraine: [email protected]

Journal Co-Chief Editor: Erick Messias, USA: [email protected]
Editorial Office: [email protected]
English editor: Dorothea Martin [email protected]
Russian editor: Kateryna Lytvynenko [email protected]

JGP EDITORIAL BOARD:

Olga Lytvynenko, Ukraine Ali Eryilmaz, Turkey
Erick Messias, USA Roman Ciesielski, Poland
Liudmyla Serdiuk, Ukraine Andre R. Marseille, USA

JGP website: www.positum.org/ppt-journal

INTERNATIONAL ADVISORY BOARD (IAB):

Shridhar Sharma, India; Arno Remmers, Germany; Ivan Kirillov, Turkey; Maksim
Chekmarev, Russia; Todor S. Simeonov; Bulgaria; Oleksandra Nizdran-Fedorovych,
Ukraine; Polina Efremova, Russia; Ewa Dobiała, Poland; Aleksandra Zarek, Poland;
Liudmyla Moskalenko, Ukraine; Yevhen Karpenko, Ukraine; Ovidiu Damian, Romania;
Zlatoslav Arabadzhiev, Bulgaria; Denys Lavrynenko, Ukraine.

All the professional affiliations of the members of the Editorial Board and the
International Advisory Board are now posted on the relevant pages of the JGP website.

Published by: World Association for Positive and Transcultural Psychotherapy (WAPP)
Luisenstrasse 28, 65185 Wiesbaden, Germany
E-mail: [email protected]
Website: www.positum.org

Copyright © 2021, World Association for Positive and Transcultural Psychotherapy

ISSN: 2710-1460 (Online)

ISSN 2710-1460 © WAPP Publishing

 EDITORIAL:
Welcome letter by the Editorial Board……………………………………………………………………...…5

Dealing Positively with World Crises: our Contribution to World Peace

Nossrat Peseschkian…………………………………………………………………………………………………….7

RESEARCH AND INNOVATION:

Recover your Balance: Effectiveness Research of Positive Psychotherapy

Claudia Christ, Ferdinand Mitterlehner, Selina Raisch..………….…………………………………..12

Possibilities of Positive Psychotherapy in the Formation of Hardiness
Olena Chykhantsova, Olga Kuprieieva.……….………………………….……………………………………22
Frustration Reactions Spectrum During the Crisis of Puberty

Stefanka Tomcheva, Zlatoslav Arabadzhiev……….………………………….……………………………27

PREMILIARY STUDIES:
The Ability to Authentic Presence of the Therapist as a Method of Quality Follow Up
the Effectiveness of Psychotherapy
Veronika Ivanova……………………………………………………………………………………………………….36

PSYCHOTHERAPEUTIC TRAINING:
What Does Our Body Tell Us in Therapy?
Arno Remmers………………………………………………………………………………………………..…………41

SPECIAL ARTICLES:
Challenges of Psychological Therapy Work with Autistic Adults

Ewa Dobiała, Renata Stefańska-Klar, Aleksandra Rumińska, Paulina Gołaska-Ciesielska,

Maciej Duras, Weronika Janiak ………………………………………………………………………………….45

ISSN 2710-1460 © WAPP Publishing

 Групповые формы работы в психиатрическом стационаре и отношение к
пациенту [Therapeutic Group in Psychiatric Hospitals and the Attitude to the
Patient]

Владимир Перебейносов [Vladimir Perebeynosov] ………………………………………………..57

International Proverbs about Hope

Friedhelm Röder………………………………………………………………………………………………………..66

Хаос VS Продвижение: как не исчезнуть в информационном пространстве

[Chaos VS Promotion: How Not to Disappear in the Information Space]

Оксана Фортунатова [Oksana Fortunatova]………………………………………………………………69

BOOK REVIEWS:
ЗДРАВСТВУЙТЕ, ДЕТИ!: Ш. А. Амонишвили (1983)
[HELLO CHILDREN! by Amonishbvili, S.]
Reviewed by Maksim Chekmarev………………………………………………………………………………75
WE LEARN BY SHARING - A GUIDE WRITTEN BY AND FOR L&D SPECIALISTS:
Editor: Gabriela Hum (2021)

Reviewed by Diana Pop……….…………………………………………………………………………………….78

WAPP NEWS………………………………………..………………………..…………………..……………………..80

INFORMATION AND GUIDELINES FOR AUTHORS………………………………………………...……83

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5 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021

WELCOME BY THE EDITORIAL BOARD OF

THE PPT JOURNAL

“THE GLOBAL PSYCHOTHERAPIST”
Dear Reader,

It is with great pride and delight we are able to present to you the second issue of
“The Global Psychotherapist” – the International Journal of Positive
Psychotherapy. The efforts of the editorial board of The Global Psychotherapist as
well as the referees of the blind peer review system contributed to the emergence
of this issue. First, we would like to thank the researchers, referees and individuals
on the editorial board of the journal who contributed to this issue.

As is the purpose of The Global Psychotherapist – the International Journal of

Positive Psychotherapy, this issue also includes practical material and research in
the field of psychotherapy with a universal perspective. As Positive Psychotherapy,
which is an intercultural approach that focuses on the positum (whole person), can
include eclectic approaches, and is based on analytical therapies, these various
techniques are reflected in the studies included in the second issue of this journal.
During the Covid-19 pandemic, the world is going through extraordinary processes,
and we found that Prof. Dr. Nossrat Peseschkian's perspective on the principal of
hope in Positive Psychotherapy offers us a skill most significant at the time of this
second issue. Developed by Prof. Dr. Peseschkian during the 1960s and confirmed
by the Positive Psychological movement in the early 2000s, the importance and
power of Positive Psychotherapy is shown in these articles. In the same way, Röder
examines hope and its importance for mental health with proverbs and carries this
tradition to the present in this second issue.

The increase in the number of studies on the effectiveness of Positive

Psychotherapy can be seen in this second issue. Here Christ et al. impressively
demonstrates, from the points of view of psychotherapists and patients, that
Positive Psychotherapy is an important therapy method in terms of motivational
clarification, active help in solving problems and therapeutic support and
relationships. The concept of hardiness, used in today's psychology is Examined
here by Chykhantsova and Kuprieieva in terms of Positive Psychotherapy, which
provides important information to the literature. Chykhantsova and Kuprieieva
show us that capabilities such as contact, trust, hope, love, achievement, and
reliability can be important tools in increasing hardiness. Additionally, Tomcheva
and Arabazhiev examine the frustration and the general level of aggressive
tendencies of adolescents and remind us of the importance of “egocentricism”,
which is an important concept in adolescent development. One of the important
concepts of Positive Psychotherapy is intrapersonal differentiation. Ivanova shows
us the importance of authenticity and openness, which are important tools of
intrapersonal differentiation in the psychotherapy process, with an interesting and
important research in terms of Positive Psychotherapy.

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6 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021

Positive Psychotherapy sees the body as an important source of coping with conflict
and an important area where people's abilities and capacities are reflected.
Remmers deals with the body's messages in the psychotherapy process in a
theoretical and practical way. As there are special people in our lives, there are also
special clients in the psychotherapy process. Dobiała et al. discuss in detail the
nature of the disorder experienced by individuals with adult autism, its effects on
the psychotherapy process, and what needs to be done. One of the applications of
Positive Psychotherapy is positive group psychotherapy. Perebeynosov broadens
our perspective with his study on group practices. Finally, Fortunatova evaluates
and examines the issue of ethics in the psychotherapy process from a different
perspective.

When the content of the second issue is summarized, it is seen that Positive
Psychotherapy has been scientifically examined by researchers at micro and macro
levels. An interesting aspect of this issue is the examination of the relations
between the concepts dealt with in positive psychology studies and the structures
of Positive Psychotherapy. As stated at the beginning of our second issue, the
principles, concepts, and structures of Positive Psychotherapy protect individuals
and societies from crises. As a result, providing significant support to bio-medical,
psycho-social, and biopsychosocial perspectives; with the hope that The Global
Psychotherapist - International Journal of Positive Psychotherapy, which offers an
important perspective to different help professional groups such as psychological
counselors, psychologists, psychiatrists, educators, social workers, and psychiatric
nurses, will be beneficial to humanity.

“The Global Psychotherapist”,

Journal of Positive and Transcultural Psychotherapy

ISSN 2710-1460 © WAPP Publishing

 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Founder Section 7

DEALING POSITIVELY WITH WORLD CRISES:

OUR CONTRIBUTION TO WORLD PEACE
by PROF. DR. NOSSRAT PESESCHKIAN ⴕ
M.D., WIESBADEN, GERMANY

First published in
Hessisches Ärzteblatt Journal. Issue 3 (2002) in German
Translated by Dr. Dorothea Martin

Dostoyevsky said that life is like a paradise to which From a therapist's report:
we have lost the key. -"The Brothers Karamazov", Book " ... In addition to these fears of war, images came
VI, Ch. 1 This talk will show us a way to find this lost key. from the television which showed hundreds of
On 11 September 2001 a world order that we had unsuspecting people burning up in a ball of fire within
taken for granted was completely and unexpectedly seconds or being torn into a thousand pieces. Thoughts
turned upside down. of death, which we are usually so good at repressing in
This article will not discuss the facts of this event or our society, were omnipresent during those days. The
the political reasons underlying it. Instead it will try to fact that it all could be over in seconds was always on
shed light on its psychological and psychotherapeutic the table."
aspects.
"If you want to put the country in order, first put the We will limit ourselves to a few factors here:
province in order. To ask about the meaning of human life also means
If you want to put the province in order, you have to that we must ask about its origin and about its goal.
bring first order to the cities. Further questions arise in this context as to what is the
To bring order to the cities, you must bring order to nature of man? Is he good or evil? Is he free to make his
the family. own decisions? Is there fulfillment for his longing for
If you want to bring order to the family, you must happiness? Does he have any influence on the fate of
first bring order to your own family. humanity? Does everything end with his death?
If you want to bring order to your own family, you An important motivation for the approach known as
must bring order to yourself.” (Oriental Stories) positive psychotherapy may well be that I find myself in
This ancient oriental wisdom traces the a transcultural situation. I am Persian (Iranian) but have
interrelationships in which we live. We must assume been living in Europe since 1954. From this vantage
that even small changes in one area of life have an point I have become aware that many behaviors, habits
impact on the entire system. According to Confucius, and attitudes are valued differently between these two
each person is responsible for the rise and fall of cultures. This is an experience which I had already had
humanity. during my childhood in Tehran. It concerned prejudices
about religion, which I was able to observe quite
One can only recognize the value of persons and closely.
diamonds when they are taken out of their settings. As Bahàis, we always found ourselves caught in the
-Word of Wisdom tension between our Islamic, Christian and Jewish
classmates and teachers.
This stimulated me to think about the relationships

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8 THE GLOBAL PSYCHOTHERAPIST. Volume. 1. Number. 2. July 2021 NOSSRAT PESESCHKIAN

between the religions and about the relationships For interpersonal relationships, this means bringing
between people. I had experience with the families of prejudices into question by relativizing one's own
my classmates and came to understand their behavior values, loosening fixations and removing
as coming from their world views and family concepts. communication blocks.
Later I was witness to similar confrontations during my This is linked to a further process, namely the
specialization when I experienced how tense the dismantling of emotional barriers and prejudices that
relationship between psychiatrists, neurologists, exist towards foreign ways of thinking and feeling.
internists and psychotherapists was and the These cause whatever is foreign to be perceived as
vehemence with which these positions clashed. something aggressive and threatening where
understanding would be initially appropriate.

Only the Seed

Perplexity and hope
In a dream a young man entered a shop where an
• The fact is, that we can perceive a worldwide crisis
older man stood behind the counter. The young man
in our communication today which is assuming the
asked him: "What do you sell, dear sir?"
proportions of an epidemic. In marital
The wise man answered: "Everything you want." communication, partners are experiencing the pain
The young man began to list them: "Then I would of mutual misunderstanding and disregard. Families
like world unity and world peace, the abolition of suffer from an almost total lack of communication
prejudice, the elimination of poverty, more unity and between parents and children or from
love between the religions, equal rights for man and communication that is merely superficial. Similarly,
women and ..." communication between governments and their
Then the wise man interrupted him: "Excuse me, peoples exhibit a state of mutual distrust, abuse,
young man, you have misunderstood me. We don't deceit and hostility. Finally, there has been an
sell fruit, we only sell the seeds. unprecedented crisis of communication between
- after N. Peseschkian the superpowers - a state which could easily have
ended with the destruction of all life on this planet.
According to a 1997 UN report, we had wars in 59
places throughout the world. These facts make it
clear that our efforts to analyze the reasons for
These experiences and my reflections led me to inadequate communication are no more sufficient
understand people not only as isolated individuals than our efforts to develop new methods of problem
(even in psychotherapy); rather, to consider their solving or fact-finding.
relationships between one another and, because of my
• In the whole world there are a great number of
own development, their transcultural situations, which
people - I would say it is the majority - who are in
makes a person what he or she is.
favor of world peace and view it as the only way of
resolving questions about the meaning of our
Commonality and differences in different cultures human existence. However, many people maintain
(the transcultural approach) an unmistakable skepticism toward the realization
We must consider the transcultural approach, which of this idea, a mistrust and even an inner resistance
offers not only material for understanding individual against it.
conflicts, but also carries an extraordinary social At the outset I would like to share some experiences
significance as we face Problems of guest workers and which have been particularly important for me. The
of development aid, difficulties that arise in dealing following four areas are of special interest to me:
with members of other cultural systems, problems of • The contribution of the politician to world peace
transcultural marriages, prejudices and overcoming (the transcultural encounter)
them, and alternative models that come from another • The contribution of the religious leader to world
cultural framework. In this context political themes can peace (concepts of religion or world view)
also be discussed which arise out of a transcultural • The contribution of the scientist to world peace
situation.
• The contribution of the individual to world peace

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Three examples:

Behavior/Concept West East

Illness When someone is sick, he/she wants Here, if someone is ill, the bed is placed in the living
to get some rest. He/she is visited by room, as with a broken leg. The sick person is the
only a few people These visits are focus of attention and is visited by numerous family
also seen a social control. members, relatives and friends. A lack of visitors
would be considered an insult and a deprivation.
Death We ask people to refrain from Relatives, friends, acquaintances and other
condolence visits. I must come to sympathetic people visit the bereaved for 8-40 days
grips with my fate alone. I must bear and give them a feeling of security. A shared sorrow is
such great suffering alone. half a sorrow.
Depression Central Europeans and North In the Orient people develop depression because they
Americans develop depression feel overwhelmed by the narrowness of their social
because they lack contact, are obligations and relationships from which they cannot
isolated and lack emotional warmth. escape.

1. The contribution of the politician the life of the individual even into its most private and
The actions of the politician are determined by the intimate areas. Without going into a deeper content
time and culture in which he/she grew up, the degree analysis of the religions, we can say that their basic
of emotional warmth and the examples their families principles are the same despite the differences
gave them, the relationships they have been able to between them. The functional theory of sociology and
develop with their fellow human beings and the psychology teaches that the institutional structures
significance which other people have for them. built in the contexts of the religions fulfill a function.
Furthermore, the ideas of meaning that they receive The institution must fulfill a practical need of its society
from their religions and world views and which and its individuals. If it has no meaning and no function,
instruments of science and technology are available to it ceases to exist, or as is unfortunately so often the
them are also decisive. The considerations paired with case, it attempts to save itself over time through
the example of the politicians, are not limited to them. fixation and dogmatism. Here also, the dimension of
Because man, as a social being, can only shape his life time can be seen as a basic principle of its development.
together with other people, each of us has a political Religion is like a remedy that is measured according
mandate. We can delegate our tasks but not our to the nature of the human being. It can only be
responsibilities: meaningful when it is appropriate to the requirements,
Transfer to language: needs and demands of the human being and when it
It is important for all of us to maintain our mother takes into account the concepts of development (the
tongues but we should also be able to speak a language principle of time), relativity and unity. When a falsely-
which will help us communicate with others. Such a understood religion leads to disturbance, fixations,
"language" is what transcultural psychotherapy limitations to development, rigidity of intellectual
attempts to provide - a metacommunication - defenses, then it becomes meaningless. Thus
communication beyond conflicts. Feuerbach typed it as pathology rather than theology,
Marx and Engels called it the opium of the people and
Freud caricatured it as an insurance company.
Many little people in many little places who do
many little things will change the face of the earth.
Learn to tell the difference between a religious
- African Proverb
belief and an institution

2. Contribution of religious leaders 3. The contribution of the scientist

Though there is a tendency to ignore religion, there The task of religion is to give the human being
is no argument that religion, in a moral context and also values, goals and meaning (giving meaning), whereas
in the context of providing an active creed, influences
10 THE GLOBAL PSYCHOTHERAPIST. Volume. 1. Number. 2. July 2021 NOSSRAT PESESCHKIAN

science seeks for explanations and presents descriptive the same time the individual possesses the capacity of
laws (finding meaning). There are a great number of differentiation and the responsibility that goes with it.
sciences and they approach reality from different Thus he or she is not passively subordinated to nature
perspectives. Here, too, we find competition between but actively determines his or her own destiny within
individual sciences with their claims of the absoluteness the range of the available possibilities.
of their particular systems and their rivalry with other
systems. Practical Approach
These connections show us that a science's In this sense, the relationship of a politician, a
preliminary decisions, the subjects it investigates, the religious leader, a scientist or an individual can be seen
questions it presents and its methods depend on as disturbed if his/her emotionality is made desolate.
historical, societal, ideological and religious One therefore asks the person about the relationships
preconditions. It is not only through geographical within the following five categories:
connections that humanity has achieved functional How is my relationship as a politician/scientist to my
unity. This is much more due to the interdependence of own self?
the elements of the structure of its civilization. Thus, Do I take time for my own needs such as sleep, food,
fields such as politics, business, education, science, free time and further education?
philosophy, psychology and religion are interlinked by a
whole network of connections. The practical facts of the How is my relationship with my partner?
case are then that the economy is no longer the Is there good contact with my wife/husband, and
business of economists and education is no longer in with the children? Do I take time for them, trust them?
the hands of parents alone. All the fields of endeavor Do I only demand obedience and politeness from them
have come to be interrelated in some way or do I place value on an open exchange of opinions
("globalization"). with them? Do I take the family into consideration?
Our current situation, with its non-human
technological independence, necessitates working How is my relationship with my social environment?
together. How is my relationship with relatives, friends,
colleagues, compatriots or any other person at all? Am
Thoughts without content are empty, intuitions I ready for such relationships, sociable, or do I have
without concepts are blind. prejudices, fears or aggressiveness toward specific
- Immanuel Kant individuals or groups?

How is my relationship with my profession?

4. The contribution of the individual Did I choose this profession voluntarily or was I
When we ask where a person got his/her forced into it? Was there no other work that I could
idiosyncrasies, views and value judgments, we most have done? Does the work that I do interest me? Do I
likely come back to the environment in which he or she only work for the money or to afford the things I want?
grew up, namely, his/her family. The continuity of Or has my work become meaningful to me, an inner
society is maintained by the rules of the game that a need? Do I have conflicts in my job? Am I overtaxed or
person has acquired in the family and by the common under-challenged? Do I find the work fulfilling but not
values which, as group goals, hold the society together. get along with my colleagues? How can I make a
The individual stands in the midst of these contending, contribution to social development?
culturally specific, ideological-religious and scientific
concepts, which are all trying to offer meaning. The
individual will be ground down between these No future can make up for what is neglected in
competing millstones if none of them seems to be the present.
something he or she could identify with. -Attributed to Albert Schweitzer
The result is that the human being him/herself is
integrated into this unity and must accede to certain
orders, laws of nature and unavoidable regulations. At

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11 THE GLOBAL PSYCHOTHERAPIST. Volume. 1. Number. 2. July 2021 NOSSRAT PESESCHKIAN

How is my relationship to the future? Consequences

Am I satisfied or unsatisfied with the present? Do I Humanity's search for a new and effective
see possibilities for development or just being stuck? orientation will bring with it a changing relationship
Can I expect my needs to be appropriately satisfied in between cause and effect. Individuals disillusioned by
the future? What are my goals and what are the culture, society, politics and religion, who seek refuge
principles underlying my system of orientation? Did I and help in their private worlds, will in turn multiply the
work out my system of orientation for myself or did I collective problems because of these shifting relations.
just get it from others? What does life really mean for This shows us once again that none of these cultural
me? How do I work through difficulties which appear in systems is good in itself. Their qualities only reveal
various situations? Am I willing to experiment? Am I themselves in the ways in which they are effective for
willing to state my opinion openly and be judged on it, the people who live within them and to the extent to
even risking the danger of losing the good opinion of which the rules of their games allow for constructive
others? encounters with other sociocultural systems and their
members. So, there is much that the members of
various cultural systems could learn from each other -
even if they only learn to understand one another.

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Research and innovations in PPT https://doi.org/10.52982/XXXX 12

RECOVER YOUR BALANCE: EFFECTIVENESS

RESEARCH OF POSITIVE PSYCHOTHERAPY
Claudia Christ
Prof. Dr., MD, internal medicine, Master of Public Health
CEO, Master Trainer of PPT and psychotherapist at Akademie
an den Quellen (Wiesbaden, Germany)
Email: [email protected]

Ferdinand Mitterlehner
Master of Psychology, Master of Theology
CEO and psychotherapist at Akademie an den Quellen
(Wiesbaden, Germany)
Email: [email protected]

Selina Raisch
Bachelor of Psychology
Head of research and quality assurance at Akademie an den
Quellen (Wiesbaden, Germany)
Email: [email protected]

Received 07.04.2021
Accepted for publication 28.06.2021
Published 07.07.2021

Abstract
The present study examines whether Positive Psychotherapy (PPT) fulfills the three common efficacy factors of
psychotherapy postulated by Grawe et al. (1994) and in doing so takes the therapists’ assessment of the common
factors, the length of professional experience of therapists and multiple times of measurement into account. 207
outpatients (66 males, 41 females) and their therapists - who were trained in PPT - evaluated the fulfillment of
the three common factors after an individual therapy session. Results provide support for the effectiveness of
PPT: patients and therapists both assessed PPT to fulfill the three common efficacy factors. However, patients
perceived all three factors to be fulfilled to an even higher degree than therapists did. Additionally, two of the
common factors were judged to be more fulfilled when the treating therapist had more rather than less
professional experience. Lastly, patients experienced therapy as even more effective over time. The verification
of the effectiveness of Positive Psychotherapy via an explicit measurement of the common efficacy factors leads
to a gain of knowledge and has important implications for psychotherapists practicing and teaching PPT alike.
Furthermore, the present study provides new and interesting approaches for future research.
Keywords: psychotherapy research, Positive Psychotherapy, effectiveness research, common efficacy factors,
outpatient treatment
services” (e.g. Lambert, 1991, p. 1) and is held to be
Introduction
necessary to improve treatment outcomes and
Psychotherapy research is considered by many treatment guidelines of psychotherapy (Angus et al.,
authors as a “fundamental aspect of psychotherapeutic 2014). Its relevance results from the contribution that

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13 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Claudia Christ et al.

psychotherapy research makes in extending the psychotherapy as the extent to which the patient feels
knowledge of psychotherapeutic processes and understood by the therapist and can accept the
outcomes (Strauss et al., 2015) and the important therapist's support. According to the model, the
benefits and implications it has for practicing effectiveness of psychotherapy depends on the extent
psychotherapists (Grawe, 1992; McLeod, 2001; Safran to which these three common factors are activated by
et al., 2011; Taubner et al., 2014) as well as for the concrete therapeutic procedures (Grawe et al., 1994).
training of ongoing psychotherapists (Elkins, 2012; These common efficacy factors sensu Grawe et al.
Grawe, 1992). Additionally, psychotherapy research is (1994) have found general acceptance in the
also of interest to patients (McLeod, 2001), as patients’ psychotherapy research field (Mattejat, 2011) and thus,
positive valuation of therapy – including the belief that have been used in order to demonstrate or compare
psychotherapy is efficacious and likely to be of help to the effectiveness of various psychotherapeutic
them – goes along with increased motivation for approaches and treatments (e.g. Sander et al., 2012;
therapy (Rosenbaum & Horowitz, 1983). On top of that, Schramm et al., 2004; Stangier et al., 2010). In that
there has been increasing pressure from health sense, Nossrat Peseschkian and colleagues conducted a
insurances, funding bodies and other stakeholders to wide-ranging effectiveness study between 1994 and
demonstrate effectiveness of psychotherapeutic 1997 in order to show that Positive Psychotherapy (PPT)
services (McLeod, 2001; Peseschkian et al., 1999; fulfills the three common efficacy factors defined by
Presslich-Titscher & Datler, 1994). Grawe et al. (1994; Peseschkian & Remmers, 2020).
All of the above led to a rise of research on Their study was undertaken under conditions of daily
psychotherapy over the past 70 years (Fuertes & Nutt clinical practice and examined 402 patients with
Williams, 2017). This research can generally be divided different psychiatric and psychosomatic disorders that
into four phases, depending on the particular research were treated by therapists trained in PPT (Peseschkian
question under investigation (Grawe, 1992). During the & Tritt, 1998; Peseschkian et al., 1999). Using a battery
first phase research concentrated on demonstrating the of psychometric test that was decided on in
effectiveness of psychotherapy in general, while the consultation with Grawe, Peseschkian and colleagues
second phase centered on comparing psychotherapy were able to show that “PPT fulfills the […] principles
directions and thus on identifying the most effective postulated by Grawe [et al. (1994)] for the effectiveness
one. The third phase, on the other hand, took a more of psychotherapy” (Peseschkian & Remmers, 2020, p.
prescriptive approach by examining which form of 29). The importance and impact of that effectiveness
therapy was indicated for which patient. In the 1990s, study is highlighted by the award for outstanding work
process research came more and more into focus, and in the field of medical quality assurance it received
with it the question of how psychotherapy works and (Peseschkian et al., 1999). Yet, it should be noted that
what exactly makes psychotherapy effective (Grawe, the researchers at that time could only infer the
1997; Hank & Krampen, 2008; Mattejat, 2011). fulfillment of the three common efficacy factors from
Concerning that last research question, Grawe, the patients’ results on various psychometric tests since
Donati and Bernauer (1994) - based on a large empirical there was no instrument available to specifically
examination of psychotherapy effectiveness - measure the common efficacy factors postulated by
postulated that three common efficacy factors were Grawe et al. (1994).
crucial for the effectiveness of every psychotherapy: Now, over 20 years later, this has changed as
motivational clarification, active help to solve problems Krampen (2002) developed the Session Questionnaire
and therapeutic support and relationship. According to for General and Differential Individual Psychotherapy
them, motivational clarification refers to fathoming the (STEP). This instrument was designed in order to allow
threatening meaning of a particular situation or event for an economic measurement of the three common
or the implications of a patient’s goal. The second efficacy factors according to Grawe et al. (1994). The
common factor of active help to solve problems refers STEP questionnaire refers to the patient’s experience of
to the patient's concrete experience of learning how to an individual therapy session as well as the associated
deal with situations previously experienced as difficult external perception and evaluation of his or her
or anxiety-provoking (Grawe, 1997). Finally, Grawe et therapist (Krampen, 2002). The items form three
al. (1994) defined the third common factor of subscales, namely motivational clarification, active help

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14 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Claudia Christ et al.

to solve problems and therapeutic relationship, After scanning the data for potential outliers, 207
therefore covering the three common factors defined patients were included in the statistical analysis for the
by Grawe et al. (1994). As the good psychometric first time of measurement. Thus, this sample included
quality of the STEP questionnaire has been attested 66 males and 41 females between 18 and 78 years
multiple times (Beutel & Brähler, 2004; Krampen, 2016; (average age = 44). The outlier analysis of the sample
Krampen & Wald, 2001), this instrument can be used to with two measures resulted in 52 patients (11 males, 41
reliably and explicitly survey the three common efficacy females, average age = 43). As the sizes of the samples
factors. with three and four measures are both very small, these
Therefore, the present study aims at examining samples were not analyzed separately.
whether PPT fulfills the three common efficacy factors For the statistical analyses of the general
postulated by Grawe et al. (1994) when explicitly effectiveness of psychotherapy in the practice, all
surveyed via the STEP questionnaire. Additionally, the measures were analyzed together as the STEP
present research also takes the therapists’ evaluation of questionnaire is designed specifically to evaluate the
the common efficacy factors, differences in the therapy session just conducted and, therefore, multiple
professional experience of therapists and multiple measurements by the same person should also be
times of measurement into account, allowing for a considered for assessing the general effectiveness of a
more sophisticated exploration of the activation form of psychotherapy. After having excluded statistical
pattern of common efficacy factors in PPT. Following outliers, the resulting sample, including multiple
the work of Peseschkian and colleagues, in order to measures of the same person, consisted of 282 patients
maximize generalizability of results, a naturalistic (86 male, 196 female, average age = 44). On average,
setting was chosen in that the STEP questionnaire was patients had been treated in the practice for 9.9 months
administered to 210 outpatients that were treated by when they completed the STEP questionnaire.
therapists trained in PPT. Thus, this study poses a Diagnoses of patients included depression (52.9%),
continuation of the research conducted by Peseschkian stress disorders (26.8%), anxiety disorders (14.3%),
and colleagues in 1998 and 1999 and provides further psychological and behavioral factors associated with
evidence for the effectiveness of PPT. disorders or diseases classified elsewhere (15.0%),
somatoform disorders (7.5%), personality disorders
Methodology (6.8%), and others (22.1%).
2.1 Subjects and study design 2.2 Therapists
The study sample consisted of outpatients treated at A total of 21 psychotherapists participated in the
the psychotherapy practice Akademie an den Quellen in present study, all of whom worked at the
Wiesbaden, Germany, between 2014 and 2019. psychotherapy practice Akademie an den Quellen in
Patients were asked to fill out the STEP questionnaire Wiesbaden, Germany, throughout the time of the
directly following a regular therapy session. They study. All therapists were trained in psychodynamic
completed the STEP questionnaire at different stages of psychotherapy and PPT. 19 of them were
therapy, consequently, the sample was a mixture of psychotherapists in training at Wiesbadener Akademie
patients at the beginning of therapy as well as at für Psychotherapie (WIAP) where psychotherapeutic
advanced stages of therapy. Sessions to be evaluated training based on PPT is provided. The other two
were selected randomly and patients were not told psychotherapists both are lecturers at WIAP: one is
about the planned evaluation in advance in order to certified as master trainer in PPT, while the other is
prevent biases. qualified in Integrative Therapy sensu Petzold (1993),
In total, 210 patients participated in the study of an approach very similar to PPT concerning the
whom 54 completed the questionnaire twice, 17 filled fundamental structure and conception of human
it out thrice and 5 answered it four times. The average beings.
time between two measurements was 7 months. The
present study poses a clinical study in which no control 2.3 Therapy Sessions
group was planned (quasi-experimental study or non-
All patients included in the present study received
randomised design; Schramm et al., 2004).
weekly 50 minute-sessions of PPT. PPT is ‘a form of

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15 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Claudia Christ et al.

humanistic psychodynamic psychotherapy’ Because of the different amounts of items of the

(Peseschkian & Remmers, 2020, p. 11). It was three scales, the maximally achievable values vary. For
developed by Nossrat Peseschkian during the 1970s the STEP-C a total score of 35 can be reached, for the
and 1980s (ebd.). PPT is characterized by conflict- STEP-P a maximal assessment of 28 is possible and for
centeredness and resource-orientation as well as the the STEP-R the maximal score is 21.
integration of approaches from the main
psychotherapy directions (ebd.). PPT focuses on the Results
capacities of the patient and wants to help the patient 3.1 PPT fulfills the three common efficacy factors
to discover his or her potential for self-help. Disorders,
conflicts and symptoms are seen as ‘a capacity to react The statistical analysis of the dataset including all
to conflicts’ (ebd., p. 12), and are considered to be part measures revealed that in comparison to the norms
of the wholeness of the patient just like his or her published by Krampen (2002) the mean values of all
resources, capacities and potentials. subscales were in the average range (see Table 1).
When taking into account random fluctuations,
2.4 Measures however, the mean values of STEPP-P and STEPT-P
The Session Questionnaire for General and tended to be in the below average to average range. As
Differential Individual Psychotherapy [Stundenbogen the deviations from the average range are rather small
für die Allgemeine und Differentielle Psychotherapie] (see Table 1), overall, both scales can still be considered
(STEP; Krampen, 2002) constitutes an economic and to be lower average. It is noteworthy though that both
standardized questionnaire to assess the common scales concern the active help to solve problems – from
efficacy factors of psychotherapeutic processes the patients’ and the therapists’ point of view.
distinguished by Grawe et al. (1994) from the Therefore, this could imply that therapists practicing
perspective of patients and their therapists. The items and teaching PPT should pay special attention to this
of the questionnaire directly relate to the experience of common factor in order to ensure its fulfillment.
an individual therapy session by the patient, Additionally, in consideration of random
constituting the patient version (STEPP), as well as his fluctuations, the mean value of STEPP-R tended to be
or her therapist’s external perception of the session and average to above average, suggesting that patients
of the patient’s experience, forming the therapist perceive the common factor therapeutical relationship
version (STEPT). to be especially strongly fulfilled by PPT (see Table 1).
Both versions are designed as parallel in terms of All things considered, it can be stated that PPT
content and comprise 12 complementary items each. activates the three common efficacy factors
Five items measure the experienced (patient version distinguished by Grawe et al. (1994), both from the
STEPP) or perceived (therapist version STEPT) patients’ point of view and according to the therapists’
motivational clarification of the patient (STEP-C), four assessment, and is thus perceived to be effective.
items assess the experienced or perceived active help
Table 1.
to solve problems (STEP-P) and three items evaluate the
T norm values, Cronbach’s , standard deviations (SD)
therapeutic relationship (STEP-R), respectively for the
and confidence intervals (CI) for all STEP scales.
specific therapy session.
Classi-
For the STEPP the patients use a 7-step answer scale Scale T  SD 90% CI
fication
to rate how applicable the respective statements are to STEPP-C 50 .89 10 [44.56, 55.44] a
their experiences. The reliabilities for the three scales STEPT-C 45 .85 10 [40.08, 49.92] a
of the patient version lie between Cronbach’s  = 0.76 STEPP-P 45 .76 10 [38.64, 51.35] ba to a
and Cronbach’s  = 0.89. For the STEPT the therapists STEPT-P 45 .91 10 [38.44, 51.56] ba to a
assess content-analogous questions related to their STEPP-R 60 .84 10 [51.97, 68.03] a to aa
perception of the patients’ experience and behavior on STEPT-R 50 .78 10 [42.31, 57.69] a
a 7-step answer scale. The reliabilities for the three Notes. N = 282, STEPP-C/STEPT-C = patient/therapist version of
motivational clarification scale, STEPP-P/STEPT-P = patient/
scales of the therapist version range from Cronbach’s 
therapist version of active help to solve problems scale, STEPP-R/
= 0.78 to Cronbach’s  = 0.91. Thus, all scales show good STEPT-R = patient/therapist version of therapeutic relationship
internal consistencies (Field, 2013). scale, a = average, ba = below average, aa = above average.

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3.2 Patients experience therapy as more effective than Table 2.

their therapists think Means (M), standard deviations (SD), t- and p-values of
t-tests for comparison of patients’ and therapists’
Interestingly, patients’ evaluations differed assessment of the STEP scales.
significantly from the therapists’ assessments on all Patients’ Therapists’
subscales and at all times of measurement (see Table 2 assessment assessment
and Figure 1). Thus, on average, the patients Scale M SD M SD t(280) p
experienced all three common efficacy factors as STEP-C 25.06 6.04 21.67 5.49 8.53 <.001
significantly more fulfilled than their therapists STEP-P 19.20 5.23 14.43 6.06 13.13 <.001
perceived them to do. STEP-R 18.86 2.36 16.56 2.63 12.90 <.001
Although divergence in patients’ and therapists’ Notes. N = 282. STEP-C = motivational clarification scale (score range
evaluation of a therapy session is neither alarming nor = 5-35), STEP-P = active help to solve problems scale (score range =
4-28), STEP-R = therapeutic relationship scale (score range = 3-21).
unusual and is described as a generic problem of
process research by Hartmann et al. (2013), the
differences in the assessments of the STEP
questionnaire are generally not as uniform and
consistent across all scales as was the case in the pre-
sent survey. Usually, it can be observed that at times
the patients and at other times the therapists perceive
the common efficacy factors as more fulfilled and that
the direction of divergence between the scales also
differs within the same sample (Krampen, 2002).
One possible explanation for this unusually uniform
divergence in terms of higher values of the patients’
assessments evident in the present study is that the Figure 1. Comparison of mean scores of patients’ vs.
therapists have a more advanced understanding of the therapists’ assessment on STEP scales motivational
three common factors and base their assessments of clarification (STEP-C), active help to solve problems
them on their professional knowledge of how they (STEP-P) and therapeutical relationship (STEP-R).
should be fulfilled in a psychotherapy, leading to higher
expectations and, thus, a more critical evaluation. The
patients on the other hand compare the psychotherapy
3.3 Therapists’ professional experience plays a role
situation to their past personal experiences resulting in
more positive assessment. A similar explanation was As two therapists with many years of professional
suggested by Horvath (2000) concerning the divergence experience (average professional experience = 20.56
of patients’ and therapists’ assessment of the years) as well as 19 psychotherapists in training
therapeutical alliance. Fitzpatrick et al. (2005) applied (average professional experience = 3.50 years)
Horvath’s assumption to the three dimensions of task participated in the present study, the influence of
collaboration, goal collaboration and patient-therapist professional experience of the treating therapist on the
bond. Therefore, it seems plausible that this pattern assessment of the common efficacy factors could also
may also be applicable to the three common factors of be examined. The statistical analysis of the dataset
psychotherapy defined by Grawe et al. (1994). including all measures showed that the common factor
problem solving was perceived by both patients and
therapists as being significantly more fulfilled if the
treating therapist had more rather than less
professional experience. As it had been those two
scales (STEPP-P and STEPT-P) that tended to be in the
below average to average range when compared to the
norm values, another norm comparison was conducted
for therapists with much and for therapists with little
professional experience, separately. This analysis

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revealed that the patients’ and therapists’ assessment

for experienced therapists was in the average range,
even when taking into account random fluctuations.
The mean values for therapists with less professional
experience, on the contrary, tended to be below
average to average. As the analyzed dataset includes
248 measures from therapists with little professional
experience, but only 34 measures of more experienced
therapists, it seems plausible that the effect of
therapists’ professional experience led to the overall
classification of STEPP-P and STEPT-P as below average
to average, that was reported earlier. Figure 2. Comparison of patients’ and therapists’ mean
In addition, patients of therapists with many years of scores of STEP scales motivational clarification (STEP-
professional experience rated the therapeutic C), active help to solve problems (STEP-P) and
relationship to be significantly more fulfilled than therapeutical relationship (STEP-R) for therapists with
patients of less experienced therapists. The therapists much vs. little professional experience.
themselves, however, showed no significant difference
in their assessment of this common factor. With regard When comparing the results of the present study
to motivational clarification, therapists and patients with the comparative results reported in the manual of
agreed that no difference was seen in the fulfillment of the STEP questionnaire (Krampen, 2002), the findings
this common factor depending on the therapist’s are only partially corresponding.
amount of professional experience (see Table 3 and Coinciding with the present findings, Krampen’s
Figure 2). (2002) analyses also revealed significantly higher values
regarding problem solving for therapists with more
Table 3. professional experience, both from the therapists’ and
Means (M), Standard deviations (SD), t- and p-values the patient’s point of view. However, the patients’ and
of t-tests for comparison of much versus little therapists’ ratings of motivational clarification were
professional experience of the treating therapist. also higher for more experienced therapists, which was
Much Little not true for the present survey. Moreover, in the
professional professional comparative analyses the patients' assessment of the
experience experience therapeutic relationship showed no significant
Scale M SD M SD t(280) p differences depending on the professional experience
STEPP-C 26.59 5.57 24.86 6.07 1.57 .117 of the therapist, whereas this was the case in the
STEPT-C 22.71 5.37 21.54 5.49 1.16 .247 present survey. Although it should be considered that
STEPP-P 21.12 4.75 18.93 5.70 2.14 .033 the comparative analyses reported in the manual are
STEPT-P 17.94 5.06 13.92 6.07 3.70 <.001 based on rather small samples only, a more
STEPP-R 19.74 1.69 18.70 2.53 3.11 .003 differentiated and in-depth exploration of the influence
STEPT-R 16.68 3.36 16.59 2.60 0.36 .721 of therapists’ professional experience on each of the
Notes. N = 282. STEP-C = patient/therapist version of motivational
clarification scale (score range = 5-35), STEP-P = patient/therapist three common factors seems desirable and germane.
version of active help to solve problems scale (score range = 4-28), The agreement on the direction of the effects – always
STEP-R = patient/therapist version of therapeutic relationship scale in the sense of better ratings of the common factors for
(score range = 3-21). therapists with more professional experience –
however, indicates that therapeutical work can be
taught and learned.

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3.4 Patients experience therapy as even more effective Conclusions

over time
The aim of the present study was to examine the
Since for 52 patients two measurements were fulfillment of the three common efficacy factors of
conducted, it was also possible to investigate whether psychotherapy by PPT. Using the STEP questionnaire
and how the patients’ and therapists’ assessment of the (Krampen, 2002) to explicitly measure the common
three common efficacy factors of psychotherapy factors postulated by Grawe et al. (1994), the results at
developed over time. It was noteworthy that the hand provide support for the effectiveness of PPT in the
patients’ evaluation changed significantly in that they sense that patients as well as therapists perceived PPT
perceived all three common factors to be even more to fulfill the three common efficacy factors. The finding
strongly fulfilled over time. Thus, patients perceived that patients and therapists assessed active help to
therapy to be even more effective over time. However, solve problems to be fulfilled only at a lower average
no such effect was observed among the therapists: they could be resolved by taking into account the
always perceived therapy as equally effective for the professional experience of the treating therapist which
patients (see Table 4 and Figure 3). was identified as especially relevant for the fulfillment
of this common efficacy factor. The professional
Table 4. experience also played a role for patients’ evaluation of
Means (M), Standard deviations (SD), t- and p-values the therapeutic relationship. This provides evidence for
of t-tests for comparison of first versus second time of the teachability and learnability of therapeutic work,
measurement. especially concerning the active help to solve problems
First time of Second time of and the therapeutic relationship. Furthermore, patients
measurement measurement judged all three common factors to be fulfilled to an
Scale M SD M SD t(280) p even higher degree than therapists did. Lastly, it could
STEPP-C 24.83 6.25 26.04 5.61 -2.15 .036 be found that patients experienced therapy as even
STEPT-C 21.57 5.00 21.65 5.34 -0.41 .682
more effective over time while no such trend was
STEPP-P 17.87 5.78 20.19 4.92 -3.65 .001
detected in therapists’ assessments.
STEPT-P 13.14 5.99 13.92 6.05 -1.29 .204
To the authors’ knowledge this paper poses the first
STEPP-R 18.06 2.93 18.97 2.04 -2.36 .022
STEPT-R 16.33 2.39 16.25 2.65 0.23 .816
examination of the fulfillment of the three common
Notes. N = 282. STEP-C = patient/therapist version of motivational efficacy factors as measured by the STEP questionnaire
clarification scale (score range = 5-35), STEP-P = patient/therapist in PPT. Therefore, it provides important and new
version of active help to solve problems scale (score range = 4-28), support for the effectiveness of PPT. Additionally,
STEP-R = patient/therapist version of therapeutic relationship scale because of taking into account the therapist’s
(score range = 3-21).
assessment, the length of the therapist’s professional
experience and multiple times of measurement, it
allows for deeper insights into the patterns of activation
and makes it possible to identify relevant aspects of the
fulfillment of the common factors. A particularly
important finding in this context is the influence of
professional experience on the fulfillment of active help
to solve problems as this highlights the importance of
giving special consideration to this common factor in
the training of ongoing psychotherapists.
In addition to providing meaningful answers
concerning the effectiveness of PPT, the present
Figure 3. Comparison of patients’ and therapists’ mean findings also open up further questions and thus
scores of STEP scales motivational clarification (STEP- provide important and interesting approaches for
C), active help to solve problems (STEP-P) and future research. For one thing, there should be closer
therapeutical relationship (STEP-R) for first vs. second examination of what factors play a role for the
measurement. differences in assessment between patients and
therapists and whether the potential explanation

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19 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Claudia Christ et al.

suggested by the authors proves to be true. Moreover, [5] FITZPATRICK, M.R., IWAKABE, S., STALIKAS, A.
future research should try to illuminate how the (2005). Perspective divergence in the working
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The present results should always be interpreted by 375.
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challenges in practice-oriented psychotherapy

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Section: Research and innovations in PPT https://doi.org/10.52982/XXXX 22

POSSIBILITIES OF POSITIVE PSYCHOTHERAPY

IN THE FORMATION OF HARDINESS

Olena Chykhantsova
Ph.D. in Psychology, Associate Professor
Chamata Laboratory of Psychology of Personality
Basic Consultant of PPT
G. S. Kostiuk Institute of Psychology of the NAES of Ukraine
(Kyiv, Ukraine)
Email: [email protected]

Olga Kuprieieva
Ph.D in Psychology, Associate Professor,
Taras Shevchenko National University of Kyiv
Basic Consultant of PPT
(Kyiv, Ukraine)
Email: [email protected]

Received 05.04.2021
Accepted for publication 28.06.2021
Published 07.07.2021

Abstract
The main goal of this study was to explore the possibilities of Positive psychotherapy in the formation of hardiness
and to delve deeper into the relationship between hardiness and actual capabilities of the person. Data were
collected from 380 people from Ukraine, aged between 19 and 62. The respondents completed the Wiesbaden
Inventory for Positive Psychotherapy and Family Therapy (WIPPF 2.0), which was developed by N. Peseschkian in
collaboration with H. Deidenbach and the Maddi Hardiness Scale. We used Pearson’s correlation coefficient to
measure the statistical relationship between hardiness and personal capabilities. Also, we used regression analysis
to determine the prognostic indicators for hardiness. As a result of our research, we found that the capabilities of
contact, trust, hope, love, achievement, and reliability have the greatest influence on hardiness.
Keywords: hardiness, Positive Psychotherapy, personality features, primary and secondary capabilities
performance under stress (Mund, 2016). This concept is
Introduction
defined as a basic characteristic of a personality, the
In the modern scientific world, the concept of system of an individual’s attitudes and beliefs that
personal hardiness is attracting increasing attention of mediate the impact of adverse life situations on human
researchers. The problems of loss of meaning of life, consciousness and behavior (Maddi, 2013).
coping with stressful factors, especially in activity, So, S. Kobasa and S. Maddi (2002) characterized
prompts exploration for means of psychological and hardiness as being comprised of three components,
psychotherapeutic support. known as the 3C’s: 1) Commitment, 2) Control, and 3)
The concept of “hardiness” was first presented by Challenge. ‘Commitment’ is an important characteristic
Suzanne C. Kobasa (1979) as a personality style or of a person’s attitude to him/herself, the surrounding
pattern associated with continued good health and world and interactions with it, which gives strength and

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motivates him/her to self-realization, leadership, supporting clients to use their inner resources to
healthy thoughts and behavior; it allows the person to overcome challenges, understand and recognize areas
feel important and sufficiently valuable to be fully of growth, and focus instead on working towards
engaged in solving life’s problems without paying hardiness (Mead, 2021). Positive psychotherapy, with
attention to stress factors and changes. ‘Control’ over the help of reflection and self-assessment, allows
circumstances helps to find ways to influence the people to come to the awareness of their resources, the
outcome of changes from stress rather than falling into content of the conflict, the characteristics of conflict
a state of helplessness and passivity. ‘Challenge’ helps a reactions and their psychodynamic origin. The basic
person to be open to the surrounding world, other conflict is described by primary and secondary
people and society. Its essence lies in the perception by capabilities and during therapy the personal meaning
a person of his/her life events and problems as a and development of every capability are reflected
challenge and test for his/herself. The applied aspect of upon, differentiated, compiled by the human (Dobiała,
hardiness is determined by the role that its personal Winkler, 2016).
parameters play in tolerance to stressful situations According to PPT theory, everyone has two core
(Baranauskienė, Serdiuk, Chykhantsova, 2016). capabilities: the Capability of Perception and the
D. Leontiev believes that hardiness is a kind of Capability of Love. N. Pesechkian (1987) concluded that
psychological analogue of a person’s life core that these two core capabilities are what lies behind our
reflects the extent of his/her overcoming of certain further abilities. PPT seeks to explore an individual’s
stressful situations and adapting to given two core capabilities to understand better and, where
circumstances, as well as a measure of applied efforts appropriate, address imbalances to create additional
for self-improvement and overcoming unfavorable positive outcomes. Positive Psychotherapy sees human
circumstances in life (Leontev, 2002). According to S. beings as capable of helping the person, who wants to
Maddi ‘hardiness emerged as a set of attitudes or lead a meaningful and fulfilling life, to grow, mature and
beliefs about yourself in interaction with the world flourish (Dobiała, Winkler, 2016).
around you that provides the courage and motivation Consequently, in our study we try to investigate the
to do the hard work of turning stress changes from role of Positive Psychotherapy in the development of a
potential disasters into opportunities instead’(Maddi, person’s hardiness.
2004, p. 286). The object of the research – personal features of
An important factor for hardiness is an individual’s hardiness.
fundamental assumptions (Janoff-Bulman, 1992), The aim of the research – to investigate the
which are the basis of his/her picture of the world, they importance of primary and secondary capacities in the
are included in the acts of internal human choice, so formation of a person’s hardiness.
they are the basis for self-determination,
purposefulness and self-development. These Methodology
fundamental assumptions, as a unit of worldview, are a 2.1. Methods and organization of the research
criterion for value choices made by an individual in The study was conducted on the basis of the
different life circumstances and a base for certain Laboratory of Personality Psychology of Kostiuk
personal meanings (Kuprieieva et al., 2020). Institute of Psychology of the National Academy of
The important fact is that not only hardiness as Educational Science of Ukraine.
human potential, but also Positive Psychotherapy (PPT) In the empirical study we used the following
as a therapeutic approach is among the resources that methods:
ensure a person’s ability to overcome stress. According 1. Wiesbaden Inventory for Positive
to E. Messias (2020) the feature of Positive Psychotherapy and Family Therapy (WIPPF 2.0), which
Psychotherapy is a change in the focus of approaches to was developed by N. Peseschkian in collaboration with
a person from an orientation to symptoms and deficits, H. Deidenbach (Peseschkian, & Deidenbach, 1988),
to the development and support of his/her internal translated and adapted for the Ukrainian sample by
resources. In other words, Positive Psychotherapy is L. Serdiuk and S. Otenko (Serdiuk, Otenko, 2021). The
one such therapeutic model that has aimed to reorient questionnaire consists of 27 scales that allow us to
the therapeutic approach to be more focused on assess the subjective significance of one’s personality

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traits in the following three sections: 1) actual characteristics, self-reflect and show self-
capacities (secondary in relation to one’s own behavior; understanding. Primary capacities influence the
primary in relation to oneself); 2) manifested conflict corresponding experiences on mood and physical
reactions in four areas of the balance model; 3) condition, which is important in stressful situations.
subjectively perceived parameters of the relationship Among the secondary capacities, the influence on
model. All questions were rated on a four-point scale, hardiness have: punctuality (r = 0,383; р < 0,01),
ranging from strongly agree to strongly disagree.
reliability (r = 0,381; р < 0,01) and achievement (r =
Cronbach’s alpha ranged according to the different
0,358; р < 0,05). With the help of these secondary
WIPPF scales in the Ukrainian version from 0.73 to 0.86
(Serdiuk, Otenko, 2021). capacities, a person tries to control a stressful situation
2. Maddi Hardiness Scale, adapted version by and demonstrates hardiness-s.
D. Leontev and E. Rasskasova (Leontev, & Rasskasova, As a result of our research, we found that people
2006). It was designed to determine personal ability tend to express themselves in terms of socially
and willingness to act actively and flexibly in situations acceptable qualities, at the same time, real behavior
of stress and difficulties. The Scale contains a general often turns out to be the opposite. Through awareness
indicator of hardiness and three scales: commitment, of the poles, it becomes possible to increase acceptance
control, and challenge. It has 45 statements and 4 and understanding of oneself.
answer options from 1 (completely disagree) to 4 Table 1.
(completely agree). Cronbach’s alpha was 0.81. The relationships of hardiness with personal
For statistical analysis of the obtained data, the
capabilities
following methods of mathematical statistics were Hardiness
used: correlation, regression analysis. The processing of

commitment

indicator of
the obtained empirical data was carried out using the

hardiness
challenge
statistical software package SPSS 21.0 for Windows. Actual capabilities

general
control
2.2. Participants in the research Orderliness .265 .277 -.105 .331
The sample of our study consisted of 380 people, Cleanliness -.223 .253 -.157 *
.334**
including 96 men (25,26%) and 284 women (74,74%) Punctuality .358 *
.029 *
.390 *
.383**
from different regions of Ukraine, aged 19 to 62 years. Politeness -.023 .163 *
-.133 -.103
Secondary сapacities

Average age 37.7 ± 11.1. According to the way of Openness .141* .096 .046 .115
selection, the sample is random to avoid unintentional Achievement .388** .364* .347 .358*
or deliberate distortion of the facts. Reliability .311** .245* .298 .381**
**
Thrift .229 .294 .370 .328*
Results Obedience -.035 .011 .216 **
-.071
Table 1 reports the correlations among the study Justice .139* .125 .037 .122
Exactitude .223** .158* .115 .196**
variables. Pearson’s correlation coefficient results
Patience .158* .126 .140* .159*
obtained indicate that there are more correlations ** ** **
Time .164 .273 .252 .242**
Primary сapacities

between primary capacities. Therefore, we can say that Contact .483 **

.474 **
.341 **
.439**
the following primary capacities have relationships with Trust .423 **
.432 **
.368 **
.451**
hardiness as: hope (r = 0,533; р < 0,01), trust (r = 0,451; Hope .514 **
.507 **
.387 **
.533**
** ** **
р < 0,01), contact (r = 0,439; р < 0,01), and love (r = Sexuality .250 .335 .283 .330**
0,419; р < 0,01). This indicates that hardiness can be Love .420** .385** .443** .419**
**
Faith .201 .259 .325 .264
developed through the individual’s example through
Note: **. Correlation is significant at the 0.01 level (2-
relationships. Faith correlates with challenge as a
tailed). *. Correlation is significant at the 0.05 level (2-tailed).
component of hardiness (r = 0,325; р < 0,01). Sexuality
It is interesting to note that all three components of
correlates with general hardiness (r = 0,330; р < 0,01)
hardiness (commitment, control and challenge) have
and control (r = 0,335; р < 0,01). This means that the
correllations to primary capabilities as contact, trust,
respondents are aware of their capabilities and
hope and love. This means that emotions take the first

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place and they are very important for the development involve personal capabilities in interaction with the
of hardiness. This can be explained by the fact that, in parameters of an existentially difficult situation.
essence, primary capacities refer to life experience that As actual capabilities are the content of upbringing,
was acquired in connection with secondary capacities. they are formed in individuals in accordance with the
So, the development of hardiness through positive needs of society. They are socialization variables, so
psychotherapy will mean that the person can increase some abilities prevail over others. This was
demonstrated in our study. A person forms and
acceptance and understanding of himself.
develops his/her abilities depending on the micro and
We used regression analysis to determine the
macro society. As a result, our sample is characterized
prognostic indicators for hardiness. Table 2 presents by the following indicators. The strongest correlations
the calculation of results for hardiness predictors. were found between the hardiness and primary
Table 2. capacities: contact, trust, hope, and love and secondary
Prognostic model of hardiness capacities: achievement and reliability. We also
Model R R Square Adjusted R Std. Error of demonstrated, that primary and secondary capacities
Square the Estimate as predictors have a positive impact on hardiness. The
1 ,654a ,527 ,410 12,9694 primary capacity of love is in the first place of hardiness’
predictors. Depending on the physical condition,
Note: Predictors: (const) love, reliability, contact, environment and time in which a person lives, these
achievement, hope, trust. abilities are differentiated and form an unchangeable
Dependent variable: hardiness structure of essential traits. These abilities are
constantly featured in everyday life in various
As we see, the primary capacity of love is in the first situations.
place in the formation of hardiness. Basic settings are The primary abilities ensure the development of
formed on the basis of primary capacities and we need viability as internal resources of the individual.
to pay attention because they are the basis of human Depending on the physical condition, environment and
time in which a person lives, these capabilities are
screening and the development of hardiness. Thus, the
differentiated and affect the formation of hardiness.
predictors that have a positive impact on hardiness are
Our research has confirmed that PPT helps
primary and secondary capacities: reliability, contact, individuals better understand the skills and abilities
achievement, hope, trust. they have, and ones they might need to develop, to
Actual capabilities are the main tool for work in achieve a greater sense of inner balance, which is
Positive Psychotherapy, because they are the content important for the formation and development of
of the conflict, and they are the kind of value norms that hardiness.
help us build hardiness. As the aim of the research was to investigate the
importance of primary and secondary capacities as
Conclusions actual capabilities in the formation of a person’s
This study represents one of the first attempts to hardiness, so we did not set differences between
examine the role of actual capabilities (primary and primary and secondary capacities in this process. But
secondary capacities) with hardiness. This result this is in the plans for future research. Also, the further
confirms the definition of hardiness as an individual research should use a longitudinal research plan that
resource that can be enhanced when people develop will unequivocally prove that the development of actual
their capacities through Positive psychotherapy. abilities can consistently influence people's resilience,
The Wiesbaden Inventory for Positive which, as a result, will be reflected in their general state
Psychotherapy and Family Therapy is an original tool for of both physical and mental health.
the study of personality traits, primary and Secondary
Capacities. Using this Inventory we studied an impact of References
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In our study, we found that such components of [1] BARANAUSKIENĖ, I., SERDIUK, L., CHYKHANTSOVA, O. (2016).
hardiness as commitment, control and challenge Psychological characteristics of school-leavers’hardiness at their

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26 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Olena Chykhantsova and Olga Kuprieieva

professional self-determination. Social welfare: interdisciplinary [9] MESSIAS, E., PESESCHKIAN, H, CAGANDE, C. (editors) (2020).
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[2] DOBIAŁA, E., & WINKLER, P. (2016). ‘Positive psychotherapy’ Applications. Springer International Publishing, Cham.
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psychotherapy-according-to-seligman-and-positive- https://sloap.org/journals/index.php/irjeis/article/view/243
psychotherapy-according-to-peseschkian-a-comparison/ [accessed: 04.04.2021]
[accessed: 04.04.2021] [11] PESESCHKIAN, N. (2000). Positive Psychotherapy; Theory and
[3] JANOFF-BULMAN, R. (1992). Shattered assumptions. New York, Practice of a New Method. Author House UK. ISBN 978-
NY: Free Press 8120722439
[4] KOBASA, S. C. (1979). Stressful life events, personality, and [12] SERDIUK, L., OTENKO, S. (2021). The Ukrainian-language
health: an inquiry into hardiness. Journal of personality and Adaptation for the Wiesbaden Inventory for Positive
social psychology, 37(1), 1-11. DOI: 10.1037/0022-3514.37.1.1 Psychotherapy and Family Therapy (WIPPF). “The Global
[5] KUPRIEIEVA O., TRAVERSE, T., SERDIUK L., CHYKHANTSOVA O., Psychotherapist”, Vol. 1, No.1, pp. 11-14. DOI: 10.52982/lkj135
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psychological hardiness of students with disabilities. Social
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[6] LEONTEV, D., & RASSKAZOVA, E. (2006). Тест жизнестойкости The authors would like to thank Liudmyla Serdiuk,
[Test of psychological hardiness]. Moscow: Smysl.
D.Sc. (Psychology), Professor, Head of the Laboratory of
https://www.aksp.ru/work/activity/nac_strateg/resurs_centr/f
iles/soln_testgizn.pdf [accessed: 04.04.2021]
Psychology of Personality, Kostiuk Institute of
[7] MADDI, S. R. (2002). The story of hardiness: Twenty years of Psychology, NAES of Ukraine for her support, for
theorizing, research, and practice. Consulting Psychology clarifications of using the Ukrainian version of the
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10.1037/1061-4087.54.3.173 Family Therapy and for the opportunity to conduct
[8] MEAD, E. (2021). What is Positive Psychotherapy? (Benefits &
Model). URL: https://positivepsychology.com/ [accessed: research on the basis of the laboratory of personality
04.04.2021] psychology.

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Research and innovations in PPT https://doi.org/10.52982/XXXX
27

FRUSTRATION REACTIONS SPECTRUM DURING

THE CRISIS OF PUBERTY
Stefanka Tomcheva
PhD, psychologist, Master Trainer of PPT (Shumen, Bulgaria)
Psychosocial Support Studio "Selena",
Email: [email protected]

Zlatoslav Arabadzhiev
MD, PhD, Basic Consultant of Positive Psychotherapy
(Plovdiv, Bulgaria)
Email: [email protected]

Received 25.04.2021
Accepted for publication 28.06.2021
Published 07.07.2021

Abstract
In every sphere of life, whether it is education, academic or personal, adolescents feel lots of obstacles on the way
to their goals in life. Sometimes they are able to deal with them rationally but sometimes they deal with them
emotionally. If they are incapable of dealing with these obstacles, they become frustrated. To cope with
frustration, the adolescents need time to develop their social and emotional skills. This means that they should
have flexibility, optimistic thoughts and skills to control impulses. The present study willexamine the reactions of
adolescents in situations of frustration and the general level of aggressive tendencies, as well as the presence of
a link between reactions of frustration and aggressive behavior. During the period of 2018-2020 we have consulted
with 212 adolescents and their parents in our practice. Informed agreement for inclusion in the study of the
characteristics and dynamics of reactions in situations of frustration was obtained from the parents of 109
adolescents, who were all male - 57 (52.3%) aged 12-14 years and 52 (47.7%) ) aged 15 -17 years. The results
showed that the adolescents are focused on their inner world and believe that the world should be what they
want it to be. They lack enough experience to judge and accept opinions that differ from their own. They try to
hide the uncertainty in their abilities and skills, relying on protective mechanisms.
Keywords: frustration, adolescents, aggression, crisis, Positive Psychotherapy
"successfully". If this happens, the individual resolves
Introduction
the corresponding crisis, "accumulates" new
During one’s individual development, one goes "psychological experience" and moves to a higher level
through different periods. Through each of them one of personal functioning. Adequate role models and new
faces the solution of various "psychological tasks", coping strategies are being developed (Boncheva,
which require a certain resource in order to pass 2013). In each normative crisis there are: objective

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28

factors, most often changes coming from the Body

environment or physiological processes and a Beginning of puberty, the appearance of secondary
subjective factor - deficit, ways of surviving and sexual characteristics, rapid growth and change in the
resolving the crisis. body, sudden changes in mood, accompanied by a
Puberty is rightly called a crisis. During this period feeling of influx of strength and energy to helplessness.
there are significant changes in the formation of
personality, which lead to a radical change in the
behavior, interests and attitudes of adolescents.
During the crisis of puberty, one of the most
complex and controversial stages of every person's life
begins and ends. L.S. Vygotsky (1984) identifies three
phases during the crisis of puberty:
• Negative phase (pre-crisis) – Starts around the
10th - 11th year. The value system begins to
Fig. 1. Body
rearrange themselves, stereotypes are broken.
Achievement
Problems begin in the relationship between Deficiencies: Loss of interest in previous/old
parents and children. activities, decreased productivity of cognitive functions
• Real crisis - 12 - 14/13 - 15 years. This phase can and reduced performance. Striving to prove their
go through several different ways: from uniqueness by any means, incl. problematic behavior
expressed negativism towards all spheres of and rejection of norms
life, to a smooth transition to mastering new Resources: Differentiated attitude towards the
skills. The field of interests and way of thinking learning content, expanded volume and selectivity of
expands, new opportunities appear. The knowledge, preferences and abilities. Development of
adolescent defends his individuality and volitional qualities: from the basic dynamic - strength,
struggles to separate from his parents. speed and speed of reaction, through qualitative - the
• Positive phase (post-crisis). It marks the end of ability to withstand greater and longer load -
the crisis, a rather calm period, characterized by endurance, perseverance, patience, to complex and
an already-expanded horizon (prognostic differentiated volitional qualities - concentration,
thinking), a changed worldview, formed life consistency, concentration and perseverance.
values and a certain further path of The need for self-determination gives impetus to
development. increased cognitive and creative activity - curiosity,
Intense physical and physiological development experimenting with different activities, participation in
causes adolescents to look at themselves differently. different clubs and schools
According to I. Boncheva (2013, p. 102), “while in earlier
ages their main task was to adapt to the world outside
of them, now the conscious attempt to adapt the world
to their increased personal needs begins. The main
conflict is the struggle between the relatively low level
of psychosocial maturation and the increased need for
sexual identity”. And if in the beginning the challenges
that the adolescents face are the changes that the body
undergoes, then the next, much more complex
challenge is how to build their social relations in a new Fig. 2. Achievement
way (figures 1, 2, 3, 4).

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29

Contact situations, and on the other hand, the period is

Deficiencies: Stubbornness, rudeness, characterized by emotional instability, stressful and
disobedience, arbitrariness, devaluation, ignoring and / frustrating situations related to difficulties with
or sharp opposition to the authority of the adult. psychological growth.
Frequent mood swings – from irritability,
"explosiveness", aggression and negativism, to
tearfulness, indifference, indifference and apathy. The
relationship with the adults is strongly conflictual, with
an active pursuit of separation, expressed in disregard
for norms, contesting rules, rejecting and not
respecting restrictions, rebellion against sanctions.
Resources: Expansion of communication skills,
formation and development of organizational skills,
business skills, entrepreneurship, discipline, Fig. 4. Future/meaning
responsibility, expanding the range of strategies for
dealing with conflict situations. The key to growing with minimal emotional
Contrary to the content of contact with adults, the damage is the formation of psychological resilience of
desire for contact with peers develops - the circle of young people, based on confidence in their own
friends is the place to learn new models and practice strengths and skills, ability to accept and cope with
them. In the group of friends, everyone experiences and challenges, flexibility in approaches to solving problems
shares the same thing. Reflection. and overcoming difficult situations. In other words, it is
a matter of forming tolerance against frustration.
Frustration tolerance is defined as psychological
resilience to a frustrator, which is based on the ability
to adequately assess the frustrating situation and
predict a way out of it (L. S . Aseikina, 2005).
J. Wilde (2012) identifies some contradictory traits
of adolescence that influence the formation of
frustrating tolerance:
• Young people are focused on their inner
Fig. 3. Contact world and believe that the world should be what
they want it to be.
Future / meaning
• They lack enough experience to judge and
Deficiencies: Feeling a lack of meaning in life, fear
accept opinions that differ from their own.
of the future, insecurity, helplessness, hopelessness.
Strong internal contradictions between desire and • They try to hide the uncertainty in their
possibilities. abilities and skills, relying on protective
Resources: Broadening the horizons and enriching mechanisms.
and restructuring the system of values - in the field of • Adolescence is a period of high sensitivity
communication - selective attitude and evaluation of and frequent mood swings.
others, and self-esteem. They show a tendency to quickly orient themselves
During the "crisis of puberty", the susceptibility of to how it "should be" and not how it really is.
adolescents to frustration is very strong. Young people Methodology
are faced with many challenges, on the one hand there
is the flourishing of creative, cognitive and intellectual 2.1. Participants
abilities, and logical approaches to solving problem During the period of 2018-2020, we consulted with
212 adolescents and their parents in our practice.

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Informed agreement for inclusion in the study of the • High anxiety ("Things in contact with
characteristics and dynamics of reactions in situations my/our son depend on me, I can't handle it - I'm
of frustration was obtained from the parents of 109 helpless and that's a problem!") - in 60.5% of
adolescents, all male - 57 (52.3%) aged 12-14 years and the parents, with a minimal difference in age -
52 (47.7%) ) aged 15 -17 years. 31.2% for parents of young adolescents (12-14
Aim of the study: To study the reactions of years) and 29.3% for parents of adolescents
adolescents in situations of frustration and the general (15-18 years).
level of aggressive tendencies, as well as the presence • Disappointment, dissatisfaction,
of a link between reactions of frustration and aggressive discouragement ("I/we can't do it; We are
behavior. supposed to be good parents, but it doesn't
work! I don't understand what's going on!") is
2.2. Instruments
the experiences of 82.5% of parents, more for
Primary psychotherapeutic interview – 5-steps
parents of young adolescents - 47.7 %, for
model of Method of Positive and Transcultural
parents of adolescents this is 34.8%.
Psychotherapy (Peseschkian H., 2000).
Rosenzweig Picture Frustration test (Rosenzweig • Outrage, irritation, accusations
S., 1945; Bulgarian standardization К. Мечков, 1979). A (“He/she is not what we expected!; "He/she
projective test, designed to measure characteristic behaves childishly and none of our efforts
modes of responding to frustration, in which the work!) showed 63.3% of the parents,
respondent is presented with 24 cartoon drawings, respectively 22.1% of those of young
each depicting one person saying something frustrating adolescents and 41.3% from the parents of the
to the other, the second person being shown with a examined adolescents.
blank speech bubble. The respondent's task is to fill in • Insult, aggression ("I/we give him / her
each of the 24 blank speech bubbles with the first everything that a good parent is supposed to
response that comes to mind. The score is based on and we expect to get good behavior !;" He/she
nine factors, derived from combinations of three types tries to overcome with his/her behavior, but it
of aggression (obstacle-dominance, ego-defense, and will not happen - with punishments and
need-persistence) and three directions of aggression restrictions we will "cure" his/her
(extraggression, imaggression, and intraggression). stubbornness!) is observed in 38.6% of parents
Aggression questionnaire (Buss and Perry, 1992). - less in young adolescents (15, 5%) and about
The Buss–Perry Aggression Questionnaire (BP-AQ) is a 8% more in parents of older adolescents
29-item, four-factor instrument that measures physical (22.9%).
aggression, verbal aggression, anger, and hostility. On the opposite side are the experiences of young
adolescents and older adolescents. The content of the
Results problems they share could be conditionally divided into
During the first psychotherapeutic interview several main groups: Relationships with adults; peer
relationships; problems at school; dissatisfaction with
shared information whith the parents, the conflict
oneself and dissatisfaction with others (table 1):
content was found:
Table 1.
Problems through the perspective of young adolescents and adolescents.
Problems Age group 12 – 14-years old Age group 15 – 17-years old

Relationships with Conflicts with parents: "They forbid me to go out!"; Conflicts with parents: "They only demand
adults (parents and "They don't like my friends and we have fights over and oblige!" "They don't understand me!";
significant adults) them!"; "They threaten me with punishment!"; "They argue with me and limit me"; They are
"They constantly scold me and insult me!" "They always dissatisfied - with my style, with the
accuse me of being disobedient, lazy and music I listen to, with my friends ..., with

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31

irresponsible!"; "They want things to happen just myself! "" They accuse me of being lazy and
their way - They don't understand me!"; "I have no irresponsible! "" According to them, I'm not
right to want or to do anything – because I am good for anything if I don't do it the way they
young!"; "They don't buy what I want, but what want it! ”; "I have no say!"; "They don't
they have decided!"; "They don't love me!" believe me!"

Relationships with Rejection, isolation, harassment, aggression, Complex relationships with peers - betrayal,
peers ridicule treason, rejection, harassment, aggression.
Unrequited love.

Problems at school Lack of interest and resistance - "My parents chose Lack of interest, boredom; problems with
the school, let them study!"; bad grades - "They teachers, injustice in assessment, a lot of
deliberately give me bad grades!"; punishments; requirements, a lot of homework, heavy
Rebellion against the rules: "The rules are designed workload; not understanding, not accepting,
to be broken!" forcibly imposing "dumb" rules.

Dissatisfaction with Body; appearance; abilities Irritability, resentment, anger towards

themselves oneself: "Everything is out of control!";
"Everything slips away from me!" "I'm not
good for anything!"

Dissatisfaction with Others are evil, dissatisfied, vindictive, hate me, "They're always outraged, they annoy me, I'm
others insult me and gossip. disappointed, they're not fair."

To track the age specifics of frustration reactions in (category "E"). With regard to the object to which the
young adolescents and older adolescents, we used the reaction is directed, the highest values are observed in
Rosenzweig Picture - Frustration Test. the reactions fixed to self-defense (category "ED").
The reliability of the results (Cronbach's Alpha) - (Table 3).
0.77 in the age group 12 - 14 years and 0.86 in the age Compared to the normative range (K. Mechkov,
group 15 - 17 years. 1979) the reactions of both groups are normal (Code 3).
Both groups showed the highest values in external
accusatory reactions as a way to deal with frustration
Table 3.
Values of the mean values in both groups
Age E I M OD ED NP
12 – 14 Mean 11,17 4,833 7,684 5,99 10,92 6,77
years N 57 57 57 57 57 57
Std. Deviation 3,853 1,9419 2,9725 2,304 2,904 2,591
15 – 17 Mean 9,53 5,442 8,683 4,27 11,88 7,51
years N 52 52 52 52 52 52
Std. Deviation 3,884 2,1343 2,6972 1,708 2,646 2,500

Significant differences between the two groups attention to themselves. Not without significance are
were found in Rosenzweig's Picture Frustration test In the other participants in the frustrating situation, 58.0%
61.3% of 12 - 14 year olds (compared to 38.7% of 15 - of young adolescents, compared to 42.0% of older
17 year olds), anxiety, tendency to rely on rigid adolescents tend to react with acute rejection of what
stereotypes of activity and inability to assess the is happening, a desire to subordinate reality to their
situation are found. Adolescents fixate on the conflict needs, striving for dominance and intolerance to
as an event / obstacle (factor E – extrapunitive "Foreign will" (factor E - extrapunitive responses). The
responses) and through vulnerability, a desire to other factor with a greater emphasis on young
impose themselves and "have a say" try to attract adolescents is the impulsive response to circumstances

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(factor M – impunitive responses), respectively 61.1% • “I” (intropunitive responses) – a sign of self-
of 12-14 year olds react with carelessness, frivolity, criticism, focus on one's own inferiority, sense of
irresponsibility and / or underestimate the situation. guilt, remorse, sometimes self-blame and self-
Such behavior is subject to emotional breakdowns, and discreditation with the characteristic behavior of
frequent change of values and asthenic states. politeness and irrational conformism.
In the characteristic of frustration reactions in • “M” (impunitive responses) – tendency to be
adolescents (15-17 years) compared to young indifferent in situations of frustration, devaluation
adolescents (12-14 years) with a strong statistical or demonstrated indifference, which is probably
significance (60, 1% in adolescents, compared to 39.9% the selective use of psychological defence
in adolescents) proved factor "e", which on the one "reaction’s formation" in order to deal with the
hand is an indicator of claims and expectations towards fear of new frustration or to contain a repressed
the other in order to remove frustration, on the other aggressive impulse built in the adolescent's
hand means activity, tendency to delegate perceptions of subjective unacceptability of
responsibility and leadership. In the young people we aggressive behavior - 53.7% in young adolescents,
examined, the factor "e" shows significance in compared to 46.3% in older adolescents).
combination with the factors:

Table 4.
Significance of the differences in the two groups by factors of the Rosenzweig P -F Study
E' E e I M' M
Mann-Whitney U test 1028,5 1105,0 740,5 957,0 1030,5 740,5
Wilcoxon W 2406,5 2483,0 2393,5 2610,0 2408,5 2393,5
Z 2,770 2,293 4,527 3,21 2,762 4,527
Asymp. Sig. (2-tailed) ,006 ,002 ,001 ,001 ,006 ,001

Buss and Perry Aggression Questionnaire (AQ) The average values of the studied variables are
Results: higher in the group of adolescents, and significant
The questionnaire reliability (Cronbach’s Alpha) for differences between the two groups are found in all
the individual subscales varies between 0.73 and 0.79, components of aggression, except for the scale
"Hostility". (Tab. 5 and Tab. 6).
reaching 0.77 for the overall score of aggression.

Table 5.
Average value for the components of aggression
Age OA FA VA A H
12 – 14 Mean 98,74 34,49 22,77 22,89 18,84
years N 57 57 57 57 57
Std. Deviation 13,915 6,596 6,921 5,554 3,895
15 – 17 Mean 76,17 23,52 20,46 16,50 15,69
years N 52 52 52 52 52
Std. Deviation 12,269 6,210 5,465 3,739 3,644

Table 6.
Significant differences between groups on scales of aggression
OA FA VA A H
Mann-Whitney U test 337,0 362,5 803,0 518,5 1184,5
Wilcoxon W 1715,0 1740,5 2181,0 1896,5 2562,5
Z -6,948 -6,797 -4,132 -5,855 -1,808
Asymp. Sig. (2-tailed) ,001 ,001 ,001 ,001 ,071

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2-14 year olds show a willingness to use these aimed at infuriating and / or upsetting authorities
two forms of aggression to achieve their own. Young (parents, teachers, educators).
adolescents openly show their irritability, "There is no smoke without fire!" - what is the
dissatisfaction, anger and irritability. Still limited spark that ignites the aggressive behavior of a growing
cognitive abilities affect the meaning of behavior, and person?
the lack of tolerance in achieving the desired and the
strength of the impulse that guides the actions of Discussion
adolescents gives aggression a more protective The summarized information from the primary
character. Limited self-control and the emerging self- psychotherapeutic interview shows that in order to
esteem, expressed mainly in sensitivity to negative establish himself in his new social position, the young
evaluation and the accompanying emotions and man tries to go beyond his current style of contacts. His
experiences, predispose to aggressive actions. efforts are focused on finding ways to realize his
The low values in both groups on the scale "growing" opportunities, the pursuit of autonomy and
"Hostility" are an indicator that the actions of young independence (experienced as freedom), to develop his
adolescents and older adolescents are not determined individuality and to receive recognition from adults,
by prolonged and persistent negative attitudes towards whose model he repeats, and to whom he wants to
the surrounding reality (people and events), but rather show his readiness to take a place in the "world of the
are the result of an emotional state of a provocative great."
nature, such as anger. The sphere of communication with peers is very
By definition, hostility is an antagonistic emotionally charged. And if in the second normative
attitude towards people, which includes a cognitive, crisis (of the first grader) the successful outcome is the
affective and behavioral component. The affective good contact with just one person – "My friend! Peace
component is represented by a number of in the group" (I. Bontcheva, p.101), then in the crisis of
interconnected emotions such as: anger, irritation, puberty the leading motive in the behavior of the young
resentment, disgust, contempt and others. The man is to consolidate his place and to establish himself
cognitive component contains negative beliefs about in the group of peers. Friendship during the period is
the world and others - mistrust, suspicion, contempt, complex and controversial, and friends are a source of
prejudice and cynicism, The behavioral component social and emotional significance. The assessment that
includes a diverse repertoire of actions, most often he expects and receives from his peers acquires
hidden - passive-aggressive actions, unwillingness to paramount importance and displaces from the
cooperate and compromise, avoid contact adolescent's field of vision the relationship with the
(communication), cold attitude towards others, etc. significant adult, but the content of the contact retains
(Barrett et al., 2007). its strong emotional charge. The inner struggle of the
Passive - aggressive behavior is, perhaps the growing person is, on the one hand, a strong desire for
worst way to show anger - as opposed to the open and autonomy, independence and freedom, and on the
spontaneous way, to strongly relieve the tension that other hand the need to feel and receive love, patience,
usually follows the trajectory: dissatisfaction - irritation attention, trust and time (primary capabilities) to feel
- anger - rage. The adolescents and the young adults are secure and stable and to experience himself as
not yet able to understand their insidious and significant and valuable.
destructive ability, and they do not realize that their This is where the "cornerstone" in the contact
resistance and perseverance prevent the imprisoned between parents and young/older adolescents is found.
anger from being released. Examples of such behavior Shared problems show where the discrepancy is -
are: procrastination, stubbornness, suspicion, parents have expectations for success, achievement,
resentment, anger, deliberate "inability" to make the order, accuracy, courtesy, discipline, responsibility
expected or repeated failure to perform the required (secondary capabilities), and the young adolescent and
tasks. On a conscious level, the young man believes that adolescents have needs for support, help, cooperation
in this rank he defends himself and "lets them and partnership. Parents demand and blame, and / or
understand." On an unconscious level, such behavior is helplessly withdraw from active contact with their
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34

children, while adolescents either protest violently or conveyed. In many cases, adolescent anger is an
remain grimly silent and act in their own way. attempt (sometimes consciously, more often not) to
Unmet needs cause frustration. The rapid pace of declare that some basic needs have not been met or
physical and cognitive development leads to the have been unfairly ignored.
formation of new needs, and the narrowed Young people are filled with indignation and
psychological horizon of “Here and now!” determines anger when they feel they do not receive:
the framework in which the adolescent insists on • Respect - Adolescents may be outraged because
getting what he wants. in talking to their parents they feel that their
Based on the psychological features of the crisis parents think they do not deserve respect. They
during puberty, it is evident that adolescents, due to are often considered more capable than their
their vulnerability and not-strengthened self-image, parents are willing to admit.
choose demonstrative behavior - from open aggression, • Space - they need physical and emotional space
active-offensive position, striving for dominance and for curiosity and experimentation and expect
intolerance to requirements, to impulsiveness and their parents to provide it. A space in which to
poorly judged action decisions. Successful self-defense explore life, themselves, without obeying
in their experience is the activity through accusations, parental rules, guidelines and imposed images.
demands / expectations of the other to take They need space to form their own self-image.
responsibility for what is happening, rejecting and • Recognition - entering the lives of adults,
denying their own guilt and / or participation trying to adolescents do not yet have life experience. They
"equalize forces". experience for the first time what their parents
The comparative analysis allowed the have experienced many times. This makes it
demonstration of the characteristics of the frustrating difficult for parents to understand the severity of
reactions of young adolescents and older adolescents their reactions to situations that seem common.
in the field of motivational needs: destruction of the This misunderstanding leads to conflicts: the
authority of the adults, orientation towards affirmation parent does not recognize their emotions as
in the peer group, need for self-affirmation, self- appropriate to the situation, and young people
expression, defending one's own position, gaining simply have not yet learned to respond to the
recognition from the others, need of autonomy and fluctuations (rise and fall) of life in the way the
independence. In terms of the emotional sphere and parent already knows how. It is good for the
behavior: irritation, resentment, anger, suspicion parent to remember that the growing person is
vulnerability, frustration, impulsivity, resistance, desire still learning to live in a difficult period, and it is
to resolve this situation oneself, stubbornness, very important for him to know that his parents
disobedience and fighting, ego-protective behavior and recognize and accept the reality and adequacy of
demonstrativeness. his experiences.
Taking into account the age characteristics, it can
be said that in general the reactions of frustration are Conclusions
normal, but non-constructive frustration reactions
prevail, which are the probable barrier that creates 1. In general, in both groups the ego-protective
another reality in young people and determines their type of reactions dominates, followed by the
reactions and experiences - resentment, suspicion, reactions fixed to the satisfaction of needs.
isolation and aggression. In general, in both groups the 2. In the group of 12 - 14 year-olds, anxiety, the
ego-protective type of reactions dominates, followed tendency to rely on rigid stereotypes of activity
by the reactions fixed to the satisfaction of needs, and and the inability to assess the situation are
the influence of the obstacle is the weakest. found. Young adolescents fixate on the conflict
The adolescents sends messages to his parents as an event / obstacle and through
through his behavior, sometimes in the form of vulnerability, a desire to impose themselves
unpleasant, aggressive attacks, outbursts of anger, and
and "have a say", they try to attract attention
/ or oppositional behavior. Parents need to respond to
to themselves. Young adolescents tend to react
the message hidden in the behavior, not the way it is
with acute rejection of what is happening, a

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desire to subordinate reality to their needs, [3] BUSS, A. H. (1966). Instrumentality of aggression, feedback, and
frustration as determinants of physical aggression. Journal of
striving for dominance and intolerance to
Personality and Social Psychology, No. 3, 1966. pp. 153-162.
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3. In the characteristic of frustration reactions in Journal of Personality and Social Psychology, 63(3), 1992, pp.
adolescents (15-17 years) with a strong 452–459. DOI: 10.1037/0022-3514.63.3.452
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Aggression and the Picture-Frustration Study. Journal of
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Consulting Psychology, 24(5), pp. 446–452. DOI:
expectations towards the other in order to 10.1037/h0046233
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means activity, the tendency to delegate Presenting Case of Psychotherapeutic Practice. “The Global
Psychotherapist”, Vol. 1, No.1, pp. 49-52. DOI: 10.52982/lkj142
responsibility and leadership.
[7] PESESCHKIAN, N. (2006). Positive Psychotherapy; Theory and
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and believe that the world should be what they 8120722439.
want it to be. They lack enough experience to [8] ROSENZWEIG, S. (1945). The picture-association method and its
judge and accept opinions that differ from their application in a study of reactions to frustration. J. Pers., No. 14,
pp. 3-23.
own. They try to hide the uncertainty in their
[9] ROSENZWEIG, S. (1978) The Rosenzweig Picture Frustration (P-
abilities and skills, relying on protective F) Study. St. Louis: Rana House.
mechanisms. [10] WILDE, J. (2012). The Relationship between Frustration
5. The crisis of puberty is characterized by the fact Intolerance and Academic Achievement in College. International
that the adolescent acquires new opportunities Journal of Higher Education 1(2). 2012. DOI:
10.5430/ijhe.v1n2p1
and strengths that were previously absent or [11] АСЕЙКИНА, Л. [AISEIKINA, L.] (2008) Организация
were a process of development. Moving to a толерантного педагогического взаимодействия на етапе
higher stage of development, the young person довузовской подготовке иностраныйх студентов
feels that he already has much more strength, [Organization of tolerant pedagogical interaction at the stage of
pre-university training of foreign students]. Орел.
independence and will to solve the problems
[12] БОНЧЕВА, И. [BONCHEVA, I.] (2019). Психология на
that until recently were solved by adults. детското развитие [Psychology of child development].
Варна: Славена.
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возраста [Age problem]. Собр.соч. в 6 т. М.Т.4. 244-268 с.
[1] BARRETT, L. F., MESQUITA, B., OCHSNER, K. N., GROSS, J. J. [14] ВЫГОТСКИЙ, Л.C. [VYGOTSKIY, L.] (1984). Учение об
(2007). The experience of emotion. Annual Review of эмоциях [Doctrine about emotions]. Собр.соч. в 6 т. М. Т.6. 318
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[2] BUSS, A. H. (1961). The psychology of aggression. New York: [15] МЕЧКОВ, К. [MECHKOV, K.] (1979). Българска
Wiley. 307 p. стандартизация на картинно-фрустрационна проба на
Розенцвайг [Bulgarian standardization of a picture-frustration
sample of Rosenzweig].

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Preliminary studies in PPT https://doi.org/10.52982/XXXX 36

THE ABILITY TO AUTHENTIC PRESENCE OF THE

THERAPIST AS A METHOD OF QUALITY FOLLOW
UP THE EFFECTIVENESS OF PSYCHOTHERAPY
Veronika Ivanova
Ph.D, clinical psychologist,
Certified Positive Psychotherapist (Varna, Bulgaria)
Chief Assistant Professor at the Medical University of Varna
Email: [email protected]

Received 08.04.2021
Accepted for publication 28.06.2021
Published 07.07.2021

Abstract
There are disputes and a large number of methods that claim to measure efficacy in psychotherapy. Most studies focus
on the personality and skills of the therapist, fewer which examine the process of psychotherapy and how
interconnections between the therapist and the client change this process. In this study we present a method of
assessing the authenticity and the level of communication inspired by the theory of Budgatal (Budgendhal), examining
the authenticity of the client's contact after each session, together with two therapist-related factors: expression and
openness ( Reflectiveness according to Peseschkian). In the semantics of positive psychotherapy, these are the abilities
of the therapist, the ability of openness, emotional expression, and so on. The results are determined through the
correlation analysis of the authentic presence and communication scale (Alpha of Cronbach Alfa 0.6) which presents
the correlation relationship between abilities of Expression and accessibility of the therapist and the level of authenticity
in the therapeutic sharing of the client. The results show that there is a statistically significant positive correlation
(Spearman's Correlation .748 and .511, p=0,01) between the ability of openness and high levels of authenticity in
therapeutic communication and a negative correlation with the emotional expression of the therapist. In conclusion,
we can say that the level of authenticity in therapeutic communication depends on the ability of openness (frankness
according to Peseschkian) and needs the opposite of expressiveness, namely the introverted function of the emotion
capable of "the contents of the other's experiences, without taking space with excessive expression of their emotions.
Keywords: effectiveness, authentic presence, Positive Psychotherapy
theoretical concepts of the model and the actual
Introduction
behaviour of the psychotherapist conducting
If we track the development of research methods in psychotherapy is still not understood. Studies in
psychotherapy, three major dimensions stand out, psychotherapy show that the therapist’s profile and
representing research interest, efficacy, efficiency and knowledge are what determines the effect of
the research proces. Psychotherapeutic psychotherapy, rather than the therapist’s training and
communication is qualitatively different from the school to which it belongs. In this sense, to avoid
communication outside the therapy room but what is asking psychotherapy to justify scientific concepts
contained in this concept is a common, complex issue. about its action, it is possible if the focus is on
Due to our insufficient knowledge of the mechanisms speculative structures but the principle of activity, in
of psychotherapy, the relationship between the the different environmental and different profile of

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patients. The parameters are optimally objectified and ultimately without a true therapeutic Process,
according to The behaviour in the course of which yields almost no psychotherapeutic benefit.
communication of patients as, in the conditions of a Therefore, a study of levels of "presence", the degree
particular social group, personal qualities exist in the of authentic communication, as the role of the
form of phenomena of interpersonal relations. therapist is by showing expressiveness and
Empirical studies of psychotherapy are increasingly transparency, to help the group reach a more in-depth
requiring differentiated objectivization of patients, the level of "presence". The simple transmission of
role of the personality of the therapist and process information is not psychotherapy, Bugental, The Art of
levels. The latter is recognized as particularly important Psychotherapy, 1990), as a result, the patient knows a
as pure pre-measurements, i. Studies of patient lot about him/herself, but almost does not achieve
parameters before and after treatment, as well as any sustainable changes in the most important area of
one-dimensional studies of the physician’s and his/her relationship with others. Presence,
patient's parameters, are insufficiently reliable. With expressiveness, authenticity are incompatible with the
no data on the psychotherapy process, it remains psychoanalytic principles of the therapist as an
inaccurate and the specifics of the model cannot be interpreter, side observer and critic. The effect of
understood (Beebe, 1998). That is why the different psychotherapy depends very much on what level of
types of psychotherapy based on pre-measurements presence in the patient.
can give similar results (Berríos & Lucca, 2006). Formal communications
The transition from the preliminary measurements
Keeping the contact
of efficacy to diagnose the psychotherapeutic process
at the level of the dual quality units - the exact Standard relations
specification of the psychotherapeutic procedure, the
Critical circumstances
study of individual interventions from psychotherapist
and patient responses to them - is seen as a major
Intimate
achievement in evaluating research (Chattor &
Krupnick 2001, Del Prette, Zap, & Del Prette 2008,
Elliot, Shapiro, Firth-Cozens, Stiles, Hardy, Lewelin et
al., 1994). The specifications for the procedure also Fig.1 Five degrees of authentic presence and levels of
contribute significantly to the objective of the communication on the Budgel
1. Formal communication
mechanism and complex psychotherapeutic
2. Keeping the contact
approaches.
3. Standard relations
Reaching objective psychotherapeutic goals, such as 4. Critical Circumstances
adaptation and mitigation of symptoms, can only be 5. Intimacy
focused on process subjectivity. The inability of the Each item is estimated at a 5-point-scale, the group
patient to show a complete presence is the most indicators are compared to the factors:
obvious, effective way to avoids importing his/her • Expression of therapist
subjectivity into group therapy work. The • Accessibility of the therapist - ability to open
inexperienced and unskilled therapist, according to The levels of communication or as it calls them a
Budgental, 1990, may not notice that during the "presence" budget, are related to the abilities of
sharing of facts, contents and symptoms,, the patient authentic accessibility and adequate expression of the
has avoided presenting him/herself as a complete therapist. The main hypothesis of the study is related
person in the process of therapy. (Peseschkian & to the assumption that the accessibility and expression
Remmers, 2020) In this situation, even the most of the therapist are associated with the degrees of the
authentic presence of patients during the group
significant therapeutic interpretations risk the abstract
process (Budjental, 1965).
therapeutic communication, intellectual accumulation
of volume of new knowledge but without authenticity

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The first level is a level of formal communication. seem to others, social desirability is reduced at the
When coming to a new person in the group who has no expense of sincerity. The experiences become more
psychotherapeutic experience, he/she is inclined to use immediate. The patient begins to use more adjective
customs adapted from his/her culture of names, adverbs, in his experience to transmit the
communication. Such behaviour we use in quality of his experiences. Slug, exclamation, obscene
communicating with authority. Formal communication words. The posture becomes more relaxed and
focuses on the objective characteristics of people. A unprotective, with the body language corresponding to
key sign of formal communication is that accessibility the feelings. Here we have a strong expression and
and expression are restrained to limit human limited accessibility (that is, the man is swallowed by
involvement in communication with the other and are his experiences and is not so accessible to understand
a type of resistance. The patient holds everything under it).
control until he has assured the security of the middle. The fifth level is an intimacy level. The word has
This control is focused on his image. As a result, the been cleared by its meaning of sexual proximity. Means
speeches are more objective, superficial and banal, intensity and emotional proximity, suggests sharing
above all impersonal. Spontaneity is minimal and personal, secret experiences. Maximum accessibility
practically absent (Budjental, 1990). and expression, crying, laughter, deep fear,
The second level is the level of maintenance of the enthusiasm, suffering from conscious loneliness and
socket. Some patients can miss this level and pass despair, rising anger. The subjective existence of the
straight on to level 3, standard relationships, but client is energetically involved in the process of inland
others, especially in stationary conditions, need an awareness. (Budjental, 1990)
intermediate stage. They may look allocated***, ready Objective of the study: a positive and significant
to share but often restrained. Communication is in the correlation is expected between the ability of a
form of superior participation, sharing contains only therapist for openness and expression and the two high
facts. At this level of communication, there is a lot of levels of authenticity of therapeutic contact - "critical
factual information, and the psychotherapist observed circumstances" and "intimacy" and low or negative in
emotional responses and signalling readiness to pass the other three levels of authenticity. It is assumed that
on to a deeper level of communication. The therapist
the more open and expressive the therapist is, the
directs the discussion to such topics having
more likely the client is to reach the "intimate" level of
psychotherapeutic importance (Budjental, 1990).
The third level is the level of a stood talk, as sharing.
"standard" is used in the sense of common, expected.
Psychotherapeutic communication, in the most Methodology
effective part there is little dependence on standard,
This study describes data for 30 participants, all
customary conditions. This is a transitional moment,
adolescents. (X= 6.16, SD = 3.06). The following clinical
between the care of the image and internal
methods were used: observation, psychotherapy
experiences. Sincere but limited personality inclusion.
sessions with adolescents with methods of the PPT,
As a rule, such communication does not contain a
inpatient and ambulatory. Statistical methods include
conflict (Budjental, 1990).
data processing with the SPSS program. For data
The fourth level, called "critical circumstances",
analysis, there were used descriptive statistics,
under which it is significant, meaningful to man, having
correlation analysis, a frequency distribution of data
a crucial meaning. Talk at this level leads to prolonged
and reliability statistic.
changes in the thoughts, feelings, words and actions of
one or more of the participants. Typical for this level Results
are the strong up-to-date emotions, not so many
memories of them. A sign of profound input is the The results were processed with the statistical
sincere descriptions of the past and current internal program SPSS 19. The standard methods for this type
experiences and issues that the patient is experiencing. of data presentation were used - descriptive statistics,
The patient is more disturbed by its internal correlation analysis. The research includes 30 sessions
experiences than the external circumstances as they of psychotherapy. 18 women and 12 men.

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39 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Veronika Ivanova

Table 1 Table 2
Description of the sample Reliability Statistics
N Mean Std. Deviation Cronbach's Cronbach's Alpha Based on
Alpha Standardized Items N of Items
Formal 30 1.7000 .70221 .626 .635 30
Contact 30 2.0667 .86834
Standard 30 2.7000 1.26355 Correlation analysis
Critical 30 2.8000 1.15669 Correlations between the therapist related factors
Intimate 30 4.2333 .67891 (Expression of therapist Accessibility of the therapist)
Accessibility 30 4.0333 .71840 and the level of authenticity of therapeutic
Expressiveness 30 4.3667 .55605 communication.
Valid N (listwise) 30
Table 3
Correlation analysis
Formal Contact Standard Critical Intimate
Accessibility Spearman's correlation .031 -.436 .271* .748** .511**
Sig. (2-tailed) .871 .016 .147 .000 .004
N 30 30 30 30 30
Expressiveness Spearman's correlation -.271 -.062 -.054 -.312 .283
Sig. (2-tailed) .746 .763 .757 .093 .129
N 30 30 30 30 30
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).
It is seen from the table that the openness or ability but at the same time, does not predispose to low levels
to honesty the therapist correlates significantly positive of authenticity, but also supports intimacy. This can be
with the two most important levels of authenticity of explained by the fact that the fifth level of authenticity,
therapeutic communication (.748 and .511). as Bugental describes it, is a client closure, sinking into
The expression of the therapist have low correlates experiences whose power requires a calm, open but not
with all the rocks and low and insignificant with the so expensive therapist who will be able to " contain the
highest level of authenticity 5-intimacy. "anxiety of the client. Probably empathy to a client
The objective of the study was set in the whose sharing is intimate, requires more
correlational study of the study was not fully confirmed. concentration, calm silence and non-verbal support
The expected positive correlation between the that is not highly emotionally coloured.
therapist openness and the critical level of authenticity The negative correlation between the accessibility of
of therapeutic contact and customer sharing is the therapist and the contact level of communication is
confirmed. This means that the theories of the distant, an unanticipated result. In practice, contact level 2 is
passive and wrapped psychotherapist are not justified, when the client uses words to hide the real emotions,
it is the openness that is the ability to self-disassemble, the level when the client talks and talks but has not said
accessibility, trust to the client is the basis for creating important things. In the early sessions, some clients talk
a safe and secure space in which the level of a lot out of fear or fear of rejection from the therapist.
Authenticity of therapeutic sharing which allows them When accessibility is emphasized, when the therapist is
to get to intimacy and intimate moments. What is sincere and open, the time of the second level in
interesting is the result of interconnections between therapy is reduced, the words become less, but more
the emotional expressiveness of the therapist and the authentic.
reported negative correlation with most levels of In Positive Psychotherapy (Peseschkian, & Remmers,
sharing except with the intimacy, but it is negligible. An 2020) the primary abilities to which they relate both the
analysis of this result is important in terms of balance openness (frankness) and the expression of emotion
between openness and expression, the expressive are related to the emotional capacity of the therapist.
therapist occupies more space in the consulting room,

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40 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Veronika Ivanova

Thus, their relationship with the level of authenticity of [2] BEEBE, B. (1998). A procedural theory of therapeutic
therapeutic contact are not surprising. action:commentary on the symposium. Interventions that
effect change in psychotherapy. Infant Mental Health Journal,
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"Expression" factor. (2006). A naturalistic comparision of effectiveness os trianee
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[7] CHARMAN, D. (2003). Paradigms in current psychotherapy
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The level of presence depends on the accessibility of DUPREE, W. J., WHITE, M. B., OLSEN, C. S., & LAFLEUR, C. T.
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content and on the process of psychotherapy.
[10] JUNG, C. (2020). Personality types. Sofia: Lege artis. ISBN
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"bottom-up" process to collect data that relies on the Adolescents with Anorexia. “The Global Psychotherapist”, Vol.
experience of clinicians to inform therapy. (Dupree, 1, No.1, pp. 34-38. DOI: 10.52982/lkj139
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The future direction of the study is to make a on psychotherapy efficacy and effectiveness: Between Scylla
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strategies in clinical research (p. 505–546). American
empathy of the therapist, as well as the various
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with the factors inherent in the approach that help Psychotherapy: An Introduction. In: Messias E., Peseschkian
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of psychotherapy. Psychology. Springer,Cham. DOI: 10.1007/978-3-030-33264-
8_2
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COOPER, M. (2006). Effectiveness of cognitive-behavioral,
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677-83. DOI: 10.1037/0033-2909.130.4.604. PMID: 15250816.

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: PPT training https://doi.org/10.52982/XXXX 41

WHAT DOES OUR BODY TELL US IN

THERAPY?

Arno Remmers
M.D., psychotherapist, International Trainer of PPT
private lecturer and supervisor at the Wiesbaden Academy for
Psychotherapy (WIAP) (Wiesbaden, Germany)
Email: [email protected]

Received 01.04.2021
Accepted for publication 28.06.2021
Published 07.07.2021

Abstract
Verbal interaction seems to be the main instrument of treatment. In this article the the unconscious language of
the body interaction will be looked at, as it seems to be not only an important transmitter of an emotional
therapeutic atmosphere, but also valid to find out the conflict contents, relation pattern, and helps to work with
structural problems. Results about early parent-child interaction show like a mirror the specific needs of a
successful therapy relation especially in personality disorder treatment. Counter transference is based mainly on
the awareness for the own body reactions and feelings, mirroring the unconscious themes of the client. To look
as a therapist how the own body reacts with specific impulses, feelings and emotions can help to discover the
associated psychodynamic terms of conflict contents and structural needs. The interpretation of the own body
sensations can be helpful in the application of positive and psychodynamic therapies as well as in cognitive
approaches to see the body interaction like an instrument to understand the hidden agenda.
Keywords: Positive Psychotherapy, counter transference, protective factors, prevention, body language
even if the mother had better control of her anxiety and
We do not shiver because we are scared of the lion, depression after giving birth to her child (Schmid-
but we shiver, and this is what we feel as our fear. Hagenmeyer, 2008). The mother - child body language
In other words, emotions are feelings of bodily changes.“ interaction, as a protective factor for mental health,
James, 1884
was found as “the touch from the mother in the
Introduction interaction with the baby, the mother’s
supportiveness..., smiling in the interaction with
Impact of the body language, interaction, and mother, expressive language during the child’s infancy.”
initiative in early childhood This was found in research to be a strong influence on
Physical interactions between persons start as early mental health even 19 years later in adulthood, as
as in pregnancy between mother and child, influenced compared to the interaction with the mother during the
by the interaction of the mother with her environment: baby’s childhood. Early active interaction can prevent
Some researchers have even found that the prenatal depression, nearly independent of genetic factors. “The
influence of the mother’s stress during pregnancy less initiative the mother showed in the contact with
causes more emotional and behavior problems in the the three-month-old child, the more depressive the
child later in school (overview in Talge et al., 2007). children noted themselves to be at the age of 19, and
O’Connor et al. (2002) showed this prenatal influence

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42 THE GLOBAL PSYCHOTHERAPIST. Volume. 1. Number. 2. July 2021 Arno Remmers

the worse this became.., resulting in diagnoses of The physical basis and mediation of emotions is in
depression or dysthymia”. These children also had more the process of increasing enlightenment: "The
behavior symptoms between the ages of 2 and 15. The emotions are not only experiential representations of
social support for the pregnant women and new physiological processes, but function as organizers and
mothers plays an important role; the more support they integrators for important physiological processes and
had, the more responsive they are usually with their especially for our immunological defense potentials.
children. “Emotional support is the offering of empathy, "...Neuropeptides (are) the main molecular mediators
concern, affection, love, trust, acceptance, intimacy, for emotions (Pert, 1986)... Neuropeptides are most
encouragement, or caring. It is the warmth and densely localized in the limbic system. This region of the
nurturance provided by sources of social support.“ All brain is particularly significant for emotional
these capacities and attachment are expressed by body neurological analogues. ...This neuropeptide network
language, and are similarly to feel in therapy sessions. (forms) a biochemical basis for this... ...that emotional
stimuli can modulate the emergence and development
Methodology or regression of biological diseases." "Displacement of
aggressive feelings (p<0.001), humorous moods... an
Body language, personality, and therapeutic
active defensive or coping style, increased general
relations
emotionality... are highly correlated with immune
Different ways of body language are to find, related
competence versus immune failure..."
to the specific personalities with their style of
perception, and the specific evaluation of the perceived
Application
body language. Fuchs and Koch (2014) describe it
clearly: „We regard emotions as resulting from the How can we address body interaction in therapy?
circular interaction between affective qualities or As a therapist I may feel very angry or even
affordances in the environment and the subject's bodily contemptuous, but I will not give it back directly
resonance, be it in the form of sensations, postures, affectively, but rather as a "container" to take up the
expressive movements or movement tendencies. projections, transform them and place them in my
Motion and emotion are thus intrinsically connected: interventions in a curative way. If this is correct, then
one is moved by movement (perception; impression; the opposite is also true: as a therapist you may have
affection) and moved to move (action; expression; e- the feeling inside you to react very empathetically and
motion). Through its resonance, the body functions as a lovingly to the patient's offers and at the same time to
medium of emotional perception: it colors or charges act quite differently in the affective microexpression
self-experience and the environment with affective behavior. This is also verifiable and more frequent than
valences while it remains itself in the background of we think." (Krause, 1996). Krause (1996) describes the
one's own awareness. This model is then applied to paramount importance of recognizing the type of
emotional social understanding or interaffectivity feelings in psychotherapy for the success of therapy,
which is regarded as an intertwinement of two cycles of even as a prognosis factor within the first sessions. In
embodied affectivity, thus continuously modifying each addition, an active interaction with the client using the
partner's affective affordances and bodily resonance. awareness for the own feelings becomes a model for
We conclude with considerations of how embodied the clients to be aware of their own feelings and
affectivity is altered in psychopathology and can be impulses.
addressed in psychotherapy of the embodied self... The unconscious manifests itself as often between
"The special thing about feelings is that they ... affect the lines, is interpreted in a subordinate clause, an
all areas: experience, expression, instrumental behavior inappropriate break to speak, a slip of the tongue or in
and physiology. Feelings are the litmus test for the state accompanying body language characters. As the patient
of discussion of the body-soul problem. The heritability speaks, we can observe his non-verbal communication:
of feelings, of temperament, even of empathy will have Does he grasp your hand, or does he approach you,
to be reopened and we will probably have to concede a demanding your greeting? Is his hand stretched far
far greater share to it than was usual in psychoanalytic away from himself to keep distance from you, to quickly
circles (Zahn-Waxler et al., 1992)." retract his hand after the handshake? Language
pictures like: "There the ground breaks away under my

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43 THE GLOBAL PSYCHOTHERAPIST. Volume. 1. Number. 2. July 2021 Arno Remmers

feet", or "I lose the hold" contain the body language Conclusions
quite clearly. Non-verbal communication is
groundbreaking for the unconscious process that The process of therapy works unconsciously and
unfolds between you and your patient from the very later consciously with feelings as body sensations:
first minute. The body communicates not only through Feeling, sensing, perceiving, naming and writing down
facial expressions and gestures, but also through the feelings and bodily functions - this is the first step of
skin's blood circulation (the patient turns red or gets observation and distancing in a positive psychotherapy
warm), body odor (e.g. anxiety sweat that likes to be process. To differentiate the feelings and body
masked with a lot of perfume), wet hands, changes in reactions in the next step we can translate them into
breathing and pupil reactions. Even if your conscious the underlying contents of capacities, values, conflict
observation misses one or the other detail of body contents, and relationship patterns in relation to the
language, your unconscious systems of perception will patient's experience and history. To name the feelings
implicitly grasp it. In this respect, the self-observation missing from the patient, are they covered by defense
of the therapist also belongs to the observation in a very mechanisms or not able to feel, becomes an
special way. Do not only collect data, but also feel your encouragement in the situation of the patient and his
patient: What do people trigger in you in feelings, environment. Feelings signalize conflicts - their
vegetative reactions, prejudices, value judgements, resolution is possible by understanding the language of
fears, desires, fantasies, memories? the body as an expression of inner conflicts, which can
also be felt in the countertransference. To enable the
Discussion patient to experience sensations consciously and to
differentiate their content into relationships broadens
For depression, the subconscious basic conflict of the possibilities of the client.
anxiety of separation and loss was described by Gerd
Rudolf (Küchenhoff, 2017) in a way that later the
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[8] PERT, C. B. (1986). The wisdom of the receptors: neuropeptides, factors into account]. Ruprecht-Karls-Universität Heidelberg
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stress reactivity in young adulthood, taking moderating genetic

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PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Special articles https://doi.org/10.52982/XXXX 45

CHALLENGES OF PSYCHOLOGICAL THERAPY WORK

WITH AUTISTIC ADULTS
Ewa Dobiała
MD, psychotherapist & supervisor-trainee in Polish Psychiatric Association,
Basic Trainer on PPT, Mental Health Center in Leszno, Positive Psychotherapy
Center in Leszno, Institutum Investigationis Scovorodianum at the Autism
Team Foundation (Head of the Psychiatric Section, Poland), Prodeste
Foundation (Poland)
Email: [email protected]

Renata Stefańska-Klar
MA, PhD, counseling psychologist, therapist
State Higher Vocational School in Racibórz, Institute of Educational
Studies, Institutum Investigationis Scovorodianum at the Autism
Team Foundation (Head of the Psychological Section, Poland)
Email: [email protected]

Aleksandra Rumińska
MA, Doctoral School of the University of Silesia in Katowice,
Institutum Investigationis Scovorodianum at the Autism
Team Foundation (coordinator of interdisciplinary research,
Pedagogical Section, Poland)
Email: [email protected]

Paulina Gołaska-Ciesielska
MA, PhD, psychologist, therapist
Centre for Supporting Relationships in Poznań, Institutum
Investigationis Scovorodianum at the Autism Team
Foundation (Psychotherapeutic Section, Poland)
Email: [email protected]

Maciej Duras
MA, Pedagogue, therapist
Centre for Supporting Relationships in Poznań
Email: [email protected]

Weronika Janiak
MA, journalist, politologist, activist and volunteer
FIONA Foundation, Active Foundation FURIA in Poznań
Email: [email protected]

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Special articles https://doi.org/10.52982/XXXX 46

Received 19.03.2021
Accepted for publication 28.06.2021
Published 07.07.2021

Abstract
Autism spectrum disorder (ASD), as a neurodiverse developmental pattern, affects between one and two
individuals in every 100 people. Autistic individuals experience different challenges in every decade of their lives.
The difficulties in sensorimotor functioning, emotional codes, communication and cognition, albeit causing
emotional distress, form a basis for developing a unique culture. Knowledge, understanding, respect and openness
to neurodiversity are the fundamental prerequisites for Transcultural and Positive Psychotherapists and any
professional who intends to deliver psychological therapy to autistic individuals. In this paper, we discuss the
medical, psychological and sociocultural aspects of the autistic spectrum and present the basic goals of therapeutic
work with autistic adults.
Keywords: adults, autism spectrum disorder, recommendations, Positive Psychotherapy
population for a number of reasons, and it will become
Introduction
even greater with the growth of that population. Where
Due to their different developmental pattern, professionals are not sensitive to the specificity of the
autistic individuals often experience lack of autism spectrum, this work may, however, be
understanding of their unique needs by others, ineffective and a source of frustration for all parties
including psychological therapists. In the current involved.
medical and psychological sciences, there is no “gold
standard” for therapeutic intervention in autistic 1.1 General overview of adulthood
individuals. At the same time, our understanding of the Adulthood is the longest developmental stage in
autistic spectrum changes and becomes outdated very human life, spanning across several decades between
quickly. Whereas there is a plethora of therapeutic adolescence and old age, the boundaries of which are
interventions intended for autistic children and determined by biological, demographic, social and
adolescents (Greenspan & Wieder, 2014), there are cultural factors. This is because the lifespan itself as well
only a few interventions intended for autistic adults, as the ageing rate and legal norms and regulations of
making the available assistance on offer insufficient. different age-related matters affect who is considered
The number of autistic adults worldwide is difficult to to be at the age of consent to e.g. a marriage, who is
estimate. Epidemiological studies are usually subject to criminal liability or who is entitled to retire.
conducted in children and their results are extrapolated Developmental psychology has come up with many
onto the general population, which does not seem developmental stage classifications, which are often
entirely legitimate. One of the few studies conducted in discrepant in age range boundaries of adulthood. For
adults (Brugha et al., 2007) showed that in the UK, the instance, E. Erikson or R. Havighurst considered the age
prevalence of autism spectrum disorder was 1%. of 18 as the beginning of adulthood, further subdivided
Clinical experience suggests that the number of autistic into: early adulthood (18-35 years of age), middle
adults, who receive their diagnosis of autism very late, adulthood (aka midlife, 35-60 years of age), and late
e.g. after a long-term search and numerous visits to adulthood (over 60 years of age). D. Levinson
different professionals, or having discovered their own considerably extends early adulthood, placing it
neurodiversity through the diagnosis of their own between 17 and 45 years of age, with each five-year
children, increases every year. This increase is period marking its respective beginning and end seen as
particularly noticeable in women whose diagnostic a transitional phase (Brzezinska et al., 2015).
assessment requires distinct knowledge and attention Contemporary research data indicates the
from professionals who are only beginning to learn how increasingly “delayed onset of adulthood” in modern
to effectively recognise the subtle manifestations of the young people, which is reflected by their staying in full
female autism phenotype (Rynkiewicz et al., 2019). As time education for longer, having a full time, permanent
shown later in this paper, the need for psychological career later, as well as starting a family or giving birth to
and therapeutic support is already great in the autistic the first child after the age of 30 years (Brzezińska &

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Syska, 2016). Therefore, the divisions of adulthood obstacles) to continuously strive to achieve one's goals
proposed by contemporary authors need to account for despite difficulties and setbacks.
it, although it is not clear whether the key issue should Thinking of these criteria, it becomes clear that
be termed the ‘postponement’ of adulthood rather adulthood is not about one’s age. Instead, the factors
than its ‘delayed onset’. Accordingly, Bee (2004) related to individuals and the degree of their personal
suggests that early adulthood begins at the age of 20 development, as well as contextual factors creating the
and lasts until the age of 40, midlife falls between 40 field of possibility, necessity and acceptability of one’s
and 60 years of age, after which the late adulthood actions play the key role.
follows. This shift of the age at onset affects subsequent
age ranges, blurring their limits. In line with the above, 1.2. Adulthood on the autistic spectrum
Brzezińska et al. (2015) divide human life into 4 distinct When assessing psychosocial function of autistic
stages: early and late childhood (from birth to 10-12 adults with the view to determine their needs in order
years of age), adolescence (from 10-12 to 20-25 years to provide sufficient support, a number of factors which
of age) and adulthood (from 20-25 years of age to the affect their daily lives, beyond those typically associated
end of life). with their current stage of life, need to be considered.
Oleś (2015), on the other hand, postulated four These are all biological/ medical, psychological and
criteria which - if met - confirm that an individual social consequences of neurodiversity, that is, of the
progressed to adulthood. The first criterion (1) is autistic pattern of development, which need to be
accepting and carrying out adult life tasks. Traditionally, explored beyond the usual psychopathological
those would include having a job and starting a family. perspective (Stefańska-Klar, 2017a; Stefańska-Klar,
Nowadays, however, the extent of social and mental 2017b).
transformations within our culture, as well as changes
to the conditions in which those life roles are fulfilled, 1.3 Medical aspects of autism
warrant a revision of adult-like life roles and tasks. Contemporary understanding of the autism
Hence, at the moment, adults would be persons who spectrum assumes its neurobiological nature,
have determined the directions of their life pursuits, underpinned by both genetic (Sandin et al., 2014; Risch
have chosen their predominant activity (not necessarily et al., 2014) and environmental factors, which affect
of a professional nature), have identified their both prenatal and postnatal brain development. The
aspirations for the subsequent 10-20 years and are research to date failed to identify any isolated causal
capable of active and persistent attempt to live their factors. Hence, autism spectrum disorder is considered
chosen lives. Regarding starting a family, this one of the most heterogeneous neuropsychiatric
expectation is increasingly more often replaced now by disorders. Numerous cohort studies (e.g. Hviid et al.,
considering themselves ready and able to build long- 2019) have excluded the link between autism and
term relationships or abide by their choice to live alone. vaccinations, which was suggested in 1998 and has
The second criterion (2) is the ability to take since become popular. On the other hand, variations in
responsibility for oneself and others. The third criterion over 700 genes have been confirmed in autistic
(3) is achieving independence, in particular emotional individuals. However, these include only few de novo
independence, from one’s parents (carers/ protectors). mutations (Ruzzo et al., 2019). Hence, even though the
This does not necessarily mean leaving the family genes clearly play a role in autism, their phenotypic
home, which - Oleś postulates - is not the most expression in autistic individuals remains highly variable
important thing. Instead, he argues, the ability to make (Veenstra-Vanderweele et al., 2004), affected by a
autonomous choices and decisions without the need for number of prenatal, perinatal and postnatal factors
the decision-making process to be supported or (Wang et al., 2017).
approved by "an adult". The fourth criterion (4) is the The specificity of autistic cognition, sensory and
freedom of choice and the accompanying drive to fulfil motor function as well as communication pose a
one’s desires and aspirations. This takes courage (to live medical challenge throughout the lifespan of an autistic
an independent life), perseverance (to tackle adult life adult alongside comorbidities, both physical and
roles), and endurance (in the face of hardships and mental, including primary and secondary disorders.
Highly prevalent, those comorbidities contribute to the

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high variability of clinical presentations in autistic health and associated psychological wellbeing, which
adults. stems from satisfaction from a life which one perceives
Recent studies show that 50% of autistic individuals as meaningful, fruitful and conducive to their further
have at least four confirmed comorbidities (psychiatric, personal development.
neurological, endocrine, rheumatologic, The World Health Organisation (2004) defines
gastrointestinal, etc.) and that over 95% of autistic mental health as “a state of well-being in which the
children have at least one additional diagnosed individual realizes his or her own abilities, can cope with
condition (Baron-Cohen, 2020). In clinical practice, 83% the normal stresses of life, can work productively and
of autistic children have another neurodevelopmental fruitfully, and is able to make a contribution to his or her
condition, 10% have at least one mental health community”. Therefore, from a psychological
condition (anxiety disorder, depressive disorder, eating perspective, mental health is a by-product of reaching
disorder, etc.), and 16% have a concomitant one’s full potential in terms of meeting one’s needs,
neurological disorder. Sleep problems affect 50% to achieving one’s aspirations, plans and goals,
73% of autistic individuals, with prevalence depending undertaking tasks which mobilise one’s internal and
on the assumed definition of sleep or the assessment external resources, as well as positive coping with stress
tool used in a study (Hodges et al., 2020). and difficult life events. What follows is
The prevalence of mental illness and disorder acknowledgement of mental health as a sine qua non
increases significantly with age in the autistic prerequisite for achieving everything that wellbeing
population, which is believed to be attributable to depends upon i.e. good and fruitful human functioning,
childhood and adolescence microtraumas and traumas. positive adjustment to life changes and self-fulfilment
Approximately 50-70% of autistic adults have at least in terms of achieving one’s aspirations.
one diagnosed mental health condition. The risks of Research into psychological functioning of autistic
depression and schizophrenia in autistic individuals are adults supports the conclusion that it is a group
3 times and 22 times higher than in the non-autistic particularly vulnerable to stress and its consequences,
population, respectively. Even though the risk of a as well as to experiencing emotional crises of various
suicidal attempt is 5-fold higher in autistic individuals, origins. Environmental maladjustment, related to the
only 50% of those who attempt suicide have been situational stimuli or challenges and difficulties of social
previously diagnosed with depression. The prevalence life, seems an important factor (Hirvikoski & Blomqvist,
of autoimmune, endocrine or rheumatologic diseases is 2015). The inherent autistic specificity of receiving and
also significantly higher in autistic individuals compared processing sensory and semantic information, as well as
to the general population. A single population-based interpersonal and social difficulties (encompassing
prospective study indicated that the mortality risk in cognitive, emotional and practical aspects), means that
autistic population is nearly twice that of the general many situations that most neurotypical people find to
population (Mouridsen et al., 2008). be usual and manageable become considerably difficult
to cope with for the autistic individual. Some situations
1.4 Psychological difficulties of autistic adults may even put one on the verge of mental and physical
Individuals with autistic traits (whether formally safety, being exceptionally energy-consuming and
diagnosed or not) experience a range of psychological demanding significantly intense activity across different
difficulties, both specific to their condition and those domains, in order to meet the expectations, achieve the
commonly affecting other adults for a number of goal or just survive until the conclusion of a situation. It
reasons. The developmental, clinical and health should be noted that the emotional and energy
psychology provides tools to group those difficulties expenditures in question are considerably higher
translating into different counselling approaches compared to those of a neurotypical individual. When
(Czabała & Kluczyńska, 2020). Some of those problems such experience becomes regular or even permanent,
result from internal and external barriers to one’s one lives in a state of chronic fatigue, leading to periods
progression through consecutive developmental stages of exhaustion and even a subjective sense of ‘life
and/ or fulfilling their respective developmental tasks, burnout’ (Stefańska-Klar, 2020). One’s inability to cope
positive resolution of normative life crises. These may with the situation may lead to atypical consequences,
as well be difficulties in maintaining optimum mental sometimes perceived as shocking by the environment.

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These can be sudden affective-behavioural outbursts to raise their non-autistic child, feeling unable to
(meltdowns) or energetic breakdown, manifesting as a understand the child or to appropriately respond to the
prolonged inability to move, detachment from the child’s needs.
stimuli, or even falling into a deep sleep, regardless of Another group of psychological difficulties is linked
one’s physical location (shutdown). In the absence of to self-image and self-acceptance, the subjective
support and access to personal resources, exhaustion meaning of life and perceived life satisfaction, which
results in what has been termed ‘autistic burnout’, form the basis of psychological wellbeing across the
which is a state threatening to health or even life itself. lifespan. This includes all issues associated with autism
A distinctive group of psychological difficulties awareness, understanding its impact, accepting the
experienced by autistic individuals are those resulting diagnosis, self-contentment as well as a positive
from the untimely (i.e. accelerated or delayed) appraisal of one's place in the world and the quality of
achievement of subsequent stages of psychosocial and their relationships with others. As reasonably expected,
personality development. They stem from the the needs of young adults will differ from the needs of
mismatch between one’s intellectual ability, readiness those in their midlife or old age. Hence, it is important
to undertake specific developmental tasks, and one’s to identify the stage of adult life affected by the
social, communication or emotional skills. Alternatively, personality and existential difficulties of an autistic
they may originate from one’s not being ready to person (Stefańska-Klar, 2017).
assume certain roles, despite societal norms and
expectations expressed, explicitly or implicitly, by those 1.5 Social and cultural dimensions of autism: the issue
important to an individual (Stefańska-Klar, 2017). The of autistic self-identity
society may "push" an autistic person to assume roles Autistic self-identity, defined as a cognitive self-
and tasks considered age-appropriate, status- perception of an autistic individual in all possible
appropriate, or expected by socio-cultural norms. relationships with oneself and the outside world, can
Alternatively, fuelled by fear, concern or prejudice, it only start to develop once autism has become known.
may create barriers, hinder his/her activity or prevent Building self-identity requires grounding in society and
him/her from taking certain actions. What follows, as culture, followed by a construct of awareness and self-
psychological consequence, is the lack or loss of awareness, the ability to identify oneself with others
autonomy, emotional crises, depression and/or learned and compare one’s own traits with those of others. A.
helplessness. On the other hand, the effect of autism Giddens (2012) defines self-identity as “a reflexive
may cause difficulties in achieving one’s goals and project of the self, which consists in sustaining
meeting one’s own needs even for an individual who is consistent, yet continuously revised, biographical
successfully fulfilling his/her personal life plan, in the narratives, and takes place in the context of multiple
absence of, or despite barriers or obstacles. Whereas choice as filtered through abstract systems”. Autistic
such effect may be confined to an individual (personal self-identity, as the collective identity of a social
problems, personality difficulties, etc.), it often affects movement, cognitive self-perception common to and
the person’s closer and more distant social shared by groups of people with similar characteristics,
environment, such as relationships with loved ones, defined as autistic traits, is a new and dynamic reality,
within the family system, workplace, neighbourhood yet deeply rooted in culture, created by, and typical of,
etc. The autistic individuals who are in relationships, society. It fits into the model of resistance identity with
have started families and have children, experience projective characteristics, as defined by Bokszanski
problems typical of couples or families where a member (2005), because the social actors are marginalised by
of a family is autistic, be it an adult, a child/ children or the logic of domination, which leaves them feeling
both. In these circumstances, the autistic traits of one stigmatised. They are often excluded from full
or both spouses/ partners affect the issues typically participation in social life, which additionally grounds
addressed in couple counselling, family therapy and them in resistance leading to adopting rules different
psychological support for parents of autistic children, from those upheld by the part of the society which is
which should always be taken into account when excluding them. The activities aimed at a
working with this client group. For example, autistic comprehensive transformation of the social structure
parents may fear that they are not competent enough and its underpinning principles (Bokszanski, 2005),

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being one of the key objectives of autistic self-advocacy, grounds of their systemic, strategic disregard of autistic
demonstrate features in keeping with the projective people their contribution to autistic stigmatisation and
model of identity.Such activities bring about qualitative excluding autistic people from the public debate on
changes in the level of autism awareness and issues which directly affected them. The ASAN initiated
understanding. Thus, as such, they are significant from the campaign to introduce legal changes in a bid to
the praxeology perspective. This is largely a credit to prevent the Judge Rotenberg Educational Center from
self-advocacy movements, which aim to empower using the graduated electronic decelerator (GED), an
groups and individuals, help them regain their agency, electrical stimulation device designed by the centre’s
and ensure that human and civil rights are duly granted. founder, Matthew Israel. The American Food and Drug
Self-advocacy is therefore centred on such sociological Administration (FDA) only banned the GED in 2020,
categories as trust, agency, social identity, care, dignity after the United Nations had twice condemned the
and respect, representation, cooperation, and device as torture. However, the JRC still use other
subjectivity (Racław & Trawkowska, 2017). aversive treatments on their students and residents
The history of autistic self-advocacy movements (https://www.masslive.com/news/2020/03/after-fda-
dates back to 1990, when the first such identity bans-judge-rotenberg-center-from-using-electric-
movement of individuals diagnosed with autism, the shock-devices-advocates-seek-public-apology-
Autism National Committee (AUTCOM), was founded reparations.html [accessed on: 01.09.2020]).
“… to protect and advance the human rights and civil The grassroot initiatives appear essential for the
rights of all persons with autism and related differences discourse on the place of autistic individuals in the
of communication and behaviour. In the face of social society. Therefore, such autistic self-advocacy
policies of devaluation, which are expressed in the movements and third sector organisations working with
practices of segregation, medicalization, and aversive and on behalf of autistic people and their allies have
conditioning, we assert that all individuals are created been set up in Poland, too. These are the Bright Side of
equal and endowed with certain inalienable rights, and the Spectrum [Polish: Jasna Strona Spektrum] autistic
that among these are life, liberty, and the pursuit of self-advocacy organisation and autistic self-advocates
happiness” (https://www.autcom.org/about.html centred around the Mary and Max Association [Polish:
[accessed on: 30.08.2020]). Stowarzyszenie Mary i Max]. Furthermore, the Autism
Another such organisation, the Autism Network Team Foundation, an organisation for autistic people,
International (ANI) is an autistic-run self-help and their families, friends and allies, has the “Conscious
advocacy organization for autistic people created in Youth Club”, a grassroot initiative started by Jan
1992 by Jim Sinclair, Kathy Grant and Donna Williams. Gawroński, a young autistic self-advocate. All these
The organisation objectives are to help autistic people groups provide psychoeducation for autistic people,
identify positive ways of living with autism and about their families, teachers/ educators and other
functioning as autistic people in a neurotypical world, professionals. Some of those initiatives additionally aim
to give them a sense of belonging to the shared autistic at promoting positive changes in law and infrastructure
culture and, since 1996, to share and expand in order to reduce social disability of autistic individuals.
knowledge based on first-hand accounts of autistic The ASAN website reads: Autism (...) is not a disease.
people during Autreat conferences It is a neurological, developmental condition; it is
(https://www.autreat.com/History_of_ANI.html considered a disorder, and it is disabling in many and
[accessed on: 30.08.2020]). varied ways. It is lifelong. It does not harm or kill of its
In 2006, Ari Ne'eman and Scott Michael Robertson own accord. It is an edifying and meaningful component
founded the Autistic Self Advocacy Network (ASAN), an of a person’s identity, and it defines the ways in which
international organisation whose motto is: Nothing an individual experiences and understands the world
about us without us. It was founded in response to the around him or her. It is all-pervasive”
US legislation as well as inaccurate media portrayals of (https://autisticadvocacy.org/about-asan/identity-
autistic people as lacking independence, dangerous and first-language/ [accessed on: 04.09.2020]). This
in need of intensive aversion therapy. ASAN voiced their definition is quintessential for autistic self-advocacy.
opposition to Autism Speaks - an organisation claiming While it does not rule out the coexistence of autism and
to support autistic people and their families, on the disability, it points out that such coexistence is not a

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commonplace. Autism is not a functional deficit or current perception and understanding of the autistic
deficiency, which can and should be corrected. An spectrum.
autistic individual growing and developing in a friendly In the project discussed, we have been guided by the
environment will build his/her self-identity based on motto: “The person comes first” from the inception of
their personal resources and those obtained from the our work, with the primary aim of putting the patient/
environment; hence autism cannot be seen as an client, his/her emotions and needs first in all
“addition” to an individual. Furthermore, as Sabina therapeutic support, regardless of his/her cognitive and
Pawlik points out, autistic self-advocates, whose social potential, self-awareness, emotional regulation,
activity contributes to shaping the autism discourse in a health or independence. Hence, the humanistic therapy
public domain, win increasingly more control of paradigm, in which the perception of a person as a
categories that they are defined by, exposing such dark subject rather than object is central to all activities
sides as eugenics, institutional abuse and stigmatisation building on one’s strengths and protecting their
that have been an experience of many autistic vulnerabilities, regardless of one’s (neuro)diversity or
individuals (Pawlik, 2015). A pursuit to define normality disability, has become central to the recommendations
based on what is common, homogeneous and uniform postulated herein. This paradigm is consistent with the
by means of rejecting what is different, is deeply rooted social definition of disability, and the perception of
in our culture. Whatever causes upset, anxiety or disability in terms of normalisation, integration and
surprise should be investigated and explained (Brauner emancipation (Krauze, 2010). Defining autism as
& Brauner, 1988). As the investigation is limited by the neurodiversity rather than a disorder is a significant
resources and tools, uneducated communities aspect of autistic self-identity and a factor in promoting
developed their own folk stories, myths and legends. In and maintaining good mental health of autistic
those, developmentally different individuals were individuals.
labelled as “foundlings” (in Polish: podrzutki, podciepy,
niańduchy, zamienoki, znajdy, cf. Kojder-Demska, Methodology
2020), that is, children dropped off in their families by These recommendations were written as part of the
goddesses, elves, good people or other characters of "Awareness and Relationships. Improving Access to
the world of magic. This emic notion of disability still Psychological Therapies for Adults on the Autism
significantly affects the level of social acceptance of Spectrum" project carried out by the Centre for
disability or developmental differences. It is reflected in Supporting Relationships as a part of the “Accessibility
numerous superstitions regarding, for instance, Generator: Social Innovation Incubator” under the
pregnant women and babies. Babies still wear red Operational Programme “Knowledge Education
ribbons as a protection against evil and the motif of a Development”, Priority Axis IV Social Innovation and
“bad eye” is omnipresent across cultures. Some people Transnational Cooperation, Action 4.1 Social
still believe that disability can be a punishment from Innovation, co-financed by the European Union under
God for the sins of one’s ancestors, or a result of the European Social Fund. The aim was to inspire
substandard upbringing. reflection on the specificity and distinctness of
The perception of autism has also been affected by (psycho)therapeutic work with neurodiverse persons.
the development of social sciences, starting from L. The author team, all being members of the project
Kanner and H. Asperger whose work encompassed the working team, represent various domains of science
concept and diagnostic criteria of autism. Later, and clinical practice. We decided to present different
Bettelheim’s psychogenic theory of autism with its perspectives on and modes of understanding of the
central ‘refrigerator mother’ concept caused significant autism spectrum in adulthood. The descriptive
irreversible harm to autistic people and their families language of this paper was intended to be
(Rosmalen & Veer, 2020). Unfortunately, that is also supraparadigmatic, hence the terms patient/ client
true about the applied behavioural analysis using were used interchangeably to denote an autistic
aversive treatments developed by Lovaas (Kirkham, individual seeking therapeutic support, leaving behind
2017). Finally, contemporary authors such as T. the discussion of the meanings attached to those terms.
Attwood, T. Gałkowski or S. Baron-Cohen, undisputed We firmly believe that, whether termed a client or a
autism research experts, have also contributed to the patient, individuals and their needs should always be at

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the heart of design and delivery of any support services. their needs being unmet throughout the lifetime, as
Accordingly, the overarching aim of such services they are exposed to high levels of stress from an early
should always be to promote their optimum wellbeing age - in education, peer relationships, developmental
- both physical and mental - with the possibility of crises, professional career and/or family life (if one
achieving their full potential in good relationships with chooses to have a family). This highlights the urgent and
their important ones. The target audience of this paper vital need to build awareness and broaden the
are researchers and clinicians of various professions, understanding of unique cognitive, emotional and
who encounter or may encounter neurodiverse adults social aspects of autism in professionals (including
as a part of their respective roles. We are convinced therapists) and to teach them how to effectively
that therapeutic encounter of an autistic individual support autistic adults. Whatever shape or form such
differs from that of a neurotypical individual and, as awareness-building takes, it is always worth the effort.
such, it requires a separate, in-depth discussion. In line The “Awareness and Relationships: Improving
with project limitations, an autistic person is denoted Access to Psychological Therapies for Adults on the
herein as an autistic adult without concomitant Autism Spectrum" project carried out by the Centre for
intellectual disability (aka learning disability, LD). The Supporting Relationships as a part of the “Accessibility
issues of psychological therapy with autistic adults with Generator: Social Innovation Incubator” under the
concomitant LD are relevant and significant enough to Operational Programme “Knowledge Education
warrant a separate project followed by a separate Development”, Priority Axis IV Social Innovation and
article or even a book. Being aware of the need for such Transnational Cooperation, Action 4.1 Social
recommendations, it is our intention to develop them Innovation, co-financed by the European Union under
as a part of subsequent social innovation projects. the European Social Fund was an attempt to fill the gap
in the support offered to autistic adults. The aim of the
Results project was to draw particular attention to the
The following recommendations are the sum of the psychosocial situation of autistic adults without
conclusions of the working team and then of three learning disability and to inspire debate and reflection
groups of reviewers: on the quality of available support. The outcomes of the
• three independent psychotherapists experienced project included, alongside the current article, an
in working with autistic patients educational brochure containing detailed clinical
• three independent autistic people with recommendations for professionals working with
experience of psychotherapeutical process autistic adults, as well as an instructional video which
present the recommendations in an enriched, more
• three independent psychotherapists
dynamic manner (all resources will be available at
implementing the developed by authors
www.wspieranierelacji.pl and can be directly requested
recommendations in daily psychotherapeutic work
from the authors).Using the opportunities of the social
within three months.
innovation projects, the resources developed by the
project working group were reviewed by both experts
3.1 Therapy goals in autistic adults
according to knowledge (psychological therapists) and
Highly vulnerable and with a unique psychosocial
experts according to experience (autistic
profile, autistic adults and children can undoubtedly
patients/clients). This ensured that the developed
benefit from therapeutic support, which should aim at:
content was evidence-based and well-suited to the
(1) identification of one’s own physiological and
needs of its recipients, both direct (therapists) and
emotional states with their subsequent self-regulation,
indirect (autistic adults). The project was carried out
(2) increasing self-awareness,
between September 2020 and May 2021.
(3) understanding one’s own needs and wellbeing
The project working group developed a number of
and learning how to meet/ promote them,
recommendations for professionals who work (or
(4) coping with sensory hypersensitivities, and
intend to work) with autistic patients/ clients. One of
(5) acceptance of one’s neurodiversity. Autistic
those recommendations includes primary therapeutic
people are at high risk of developing mental health
goals which can/ should be considered when working
problems - depression, anxiety, strong psychosomatic
response to stress - which are typically secondary to

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with autistic adults in an effective, respectful and − Building assertiveness, especially in those who
dignified manner. These goals can specifically include: have been exposed to ‘therapeutic interventions’
− Developing the SELF, that is improving ones which disregarded their needs and their right to
awareness, building identity, strengthening self- autonomy (such individuals are exceptional
esteem, developing the philosophy of acceptance patients; sometimes a professional can also
and/or affirmation of their autism spectrum encounter an adult completely dependent on other
condition whilst developing acceptance (and/or adults - their carers - despite a clear potential and
affirmation) or other people’s uniqueness, thus capacity for more independent living).
promoting positive regard for human diversity. We emphasize those particular goals, as they have
These four elements (self-awareness, coherent been disregarded in many other proposed
self-identity, healthy self-esteem regardless of one’s interventions for autistic people (despite having a clear
ability levels, and accepting neurodiversity, both role in promoting and maintaining optimum mental
one's own and that of other people) are the most health) in favour of interventions focused on
important therapeutic goals when working with eliminating autism or fixing what is “autistically
autistic people of any age - children, adolescents, broken”. Supported by the reasoning of Polish and
and adults. international researchers and organisations, we
− Enhancing self-regulation and coping skills, encourage the shift of perspective towards a more
especially in highly emotive situations or during a humanistically-oriented view based on respect for each
sensory overload; person’s uniqueness.
− Developing emotional literacy and awareness The strategies that may help achieve the goals
(starting from identifying emotions based on bodily described earlier which can be used by professionals,
symptoms) and working towards emotional include primarily
maturity; (1) a therapeutic relationship based on trust and
− Building understanding of one's own needs positive regard,
followed by understanding the needs and emotions (2) creating the sense of safety, by means of
of others; understanding and acceptance shown to the client by
− Identifying relaxation techniques and activities the therapist, their consistent responses, attitude, and
(massage, osteopathy, manual therapy, medication, a stable, predictable setting, that a client considers
physical activity - individual or in a group setting), as important.
well as self-regulation and self-soothing strategies For many autistic people, this will also include the
(stimming, acupressure mat, weighted blanket, therapist's appearance (e.g. hairstyle, hair colour,
etc.); attire, etc.), the therapy room layout (also important in
− Developing the ability to maintain a dynamic online therapy). Any significant changes may cause
psychoemotional balance and to return to it upset, uncertainty or distraction causing difficulty
following the short-term highs/ lows; focusing on the actual conversation;
− Developing the motivation and competence to (3) session continuity and regularity (session
build relationships, become a part of a wider frequency can be changed as long as regular intervals
community and positively contribute to it in a are kept) avoiding sudden, abrupt changes.
number of accessible and mutually beneficial ways, Most autistic patients prefer more frequent sessions
while feeling the satisfaction from said contribution to discuss ongoing changes in themselves, their
and attending to the emotional needs of others; environment and the relationship between themselves
− Building on one’s strengths - exploring their and the environment, especially if these discussions
special interests and passions, while moving away seem to be helping in their daily lives. However, where
from a harmful, negative view of autistic special the therapy is not a part of the public healthcare system
interests/ passions as manifestations of disorder or subsidized by external funding with the third sector
("fixations" or "stereotyped behaviours"). provider, financial constraints will likely determine
− Supporting individuals to identify their therapy duration and session frequency;
strengths and talents and to set suitable SMART (4) therapists’ open-mindedness and willingness to
goals. explore new ideas, solutions, and techniques to meet

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the needs of a patient whose needs evolve throughout autistic life. This paper is one of the outcomes of the
the relationship and who may need different activities “Awareness and Relationships: Improving Access to
or challenges. Psychological Therapies for Adults on the Autism
This requires flexibility and creativity, but also the Spectrum” project carried out by the Centre for
therapists’ ability to learn from their patients, their Supporting Relationships as a part of the “Accessibility
motivation to be led by their clients and accompany Generator: Social Innovation Incubator” under the
them, while encouraging changes; Operational Programme “Knowledge Education
(5) providing ample opportunities for the client to test Development”, Priority Axis IV Social Innovation and
out the newly acquired skills and to put them into Transnational Cooperation, Action 4.1 Social
practice, first in the therapy room and then in life; Innovation, co-financed by the European Union under
(6) considering one’s personal development as the the European Social Fund. As the project team
overarching principle for everything that takes place as members we hope that the content of this publication,
a part of therapy. the brochure and the instructional video, which aim at
This means that, alongside the immediate or short- changing the perception of autism and improving the
term goals, there should be some long-term goals which quality and relevance of support services to enable
determine the direction of change in the clients’ comprehensive, holistic development of autistic people
behaviour and personality as well as provide the will inspire reflection, promoting updated and
general direction in their ongoing work on their own improved understanding of autism by researchers and
lives. Obviously, the clients still remain the principal practitioners working with autistic adults.
architects and creators of themselves and their lives.
The therapist is their conscious companion, sometimes References
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(2004). Autism as a paradigmatic complex genetic disorder, No. 3, additionally of substantive correction of the text;
Annual Review of Genomics and Human Genetics, 5:379-405. Paulina Gołaska-Ciesielska - project manager, author
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[39] World Health Organization (2004). Promoting mental health: Maciej Duras - member of the project's working
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Acknowledgements
Competing interests
The authors gratefully acknowledge the assistance
This article was written as part of the "Awareness
of Karolina Kalisz in translating the manuscript.
and Relationships. Improving Access to Psychological
Therapies for Adults on the Autism Spectrum" project
Author contributions carried out by the Centre for Supporting Relationships
Ewa Dobiała - coordinator of work on a scientific as a part of the “Accessibility Generator: Social
article, member of the project working team, author of Innovation Incubator” under the Operational
an abstract, subsection No. 1.2., co-author of Programme “Knowledge Education Development”,
subsection No. 2, 3 and 4, additionally substantive Priority Axis IV Social Innovation and Transnational
correction and consolidation of individual fragments of Cooperation, Action 4.1 Social Innovation, co-financed
the text. by the European Union under the European Social Fund.

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Special articles https://doi.org/10.52982/XXXX 57

ГРУППОВЫЕ ФОРМЫ РАБОТЫ В

ПСИХИАТРИЧЕСКОМ СТАЦИОНАРЕ
И ОТНОШЕНИЕ К ПАЦИЕНТУ

THERAPEUTIC GROUP IN PSYCHIATRIC HOSPITALS

AND THE ATTITUDE TO THE PATIENT

Владимир Перебейносов
Vladimir Perebeynosov
Clinical Psychologist, Basic Consultant of PPT
Private practice psychologist (Blagoveshchensk, Russia)
Email: [email protected]

Received 19.04.2021
Accepted for publication 28.06.2021
Published 07.07.2021
Аннотация
Ирвин Ялом называл психотерапевтические группы «социальным микрокосмом» (Ялом, 2007). Группы
психологической поддержки и закрытые психотерапевтические группы особенно важны для пациентов
психиатрических учреждений. В статье обосновывается ценность групповой работы в психиатрических
учреждениях; описываются основные формы группового взаимодействия; разбираются особенности
взаимодействия с пациентами в российских психиатрических стационарах. Предлагаемая концепция
помощи и работы с пациентами основана на идеях Позитивной и Транскультуральной Психотерапии
Носсрата Пезешкиана. Цель этой статьи: актуализировать для специалистов помогающих профессий
важность групповых форм работы с пациентами.
Ключевые слова: групповая психотерапия, медицинская психология, психиатрия, социализация,
Позитивная Психотерапия

Abstract
Irwin Yalom called psychotherapy groups a "social microcosm" (Yalom, 2007). Psychological support groups and
closed psychotherapy groups are particularly important for patients in psychiatric institutions. The article
substantiates the value of group work in psychiatric institutions; describes the main forms of group interaction;
analyzes the features of interaction with patients in Russian psychiatric hospitals. The proposed concept of patient
care and work is based on the ideas of Positive and Transcultural Psychotherapy by Nossrat Peseschkian. The
purpose of this article is to update the importance of group forms of work with patients for specialists of helping
professions.
Keywords: group psychotherapy, medical psychology, psychiatry, socialization, Positive Psychotherapy.
58 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Vladimir Perebeynosov

собственном опыте работы в психоневрологическом

Вступление
стационаре и взаимодействии со специалистами
Актуальность данной темы обусловлена различного профиля. Большое внимание уделялось
растущим интересом общества к психологическим идеям Позитивной и Транскультуральной
формам работы с пациентами психиатрических Психотерапии. Труды Ирвина Ялома и его
учреждений. художественное описание процесса
Психоневрологические стационары повышают психотерапевтической работы, также, внесли
количество рабочих мест для медицинских большой вклад в написание данной статьи.
психологов, а также, увеличивается количество
Результаты
специалистов, проходящих обучение в
психотерапевтических методах. На момент С точки зрения современных представлений о
написания статьи, в условиях пандемии, в гуманности и лечении, изначальная цель
большинстве медицинских учреждений запрещены функционирования психиатрических больниц была
посещения пациентов; что оставляет людей в ещё неверно поставлена. Первые психиатрические
большей изоляции без непосредственной «лечебницы» ставили перед стремились
поддержки близких людей. Исходя из этого, «изолировать» пациента; а не «вылечить» или
повышается важность групповой работы с «помочь». Как мы помним, Филипп Пинель,
пациентами. французский психиатр больницы Сальпетриер, в
К сожалению, многим медицинским психологам 1795 г. принимает решения снять цепи и оковы с
приходится сталкиваться с отсутствием душевнобольных, что уже приводило некоторых
вовлеченности врачей-психиатров, заведующих пациентов к выздоровлению. Мы не можем
отделений, среднего и младшего медицинского констатировать, что к пациентам современных
персонала к глубокому сотрудничеству. По мнению психиатрических больниц проявляют открытое
автора, это связано с отсутствием насилие. Однако его пассивные формы, мешающие
заинтересованности и понимания ценности выздоровлению, в виде стигматизации,
внутреннего мира пациентов. Зачастую, процесс ограничении прав и свобод, изоляции, грубости в
лечения сводится лишь к купированию имеющейся российской психиатрической практике встречаются
симптоматики; а отношение к пациентам, местами, повсеместно.
антитерапевтично. Высокие нагрузки на медицинский персонал,
Formal communications жёсткие протоколы, нехватка кадров усугубляют
Методология незаинтересованность медицинского персонала к
Keeping the contact
внутреннему миру пациентов.
Написание данной статьи основывается на опыте Как следствие незаинтересованности, появляется
работы в психиатрическом учреждении и изучении привычка "клеймить". То есть пытаться подогнать
опыта европейских стран. В статье состояние человека под определённые рамки, четко
«Реформирование психиатрической службы. Опыт и понятно описывающие происходящее с ним. В
США и Европы» (Цыганок, 2007) обозревается и какой-то мере это помогает врачам и учреждению,
анализируется опыт психиатирического движения в поскольку упрощает документацию и
странах Европы и США. В статье было проведено фармакотерапию. Однако, не приносит пользы
подробное изучение предписаний ВОЗ, касающихся самим пациентам. У врачей встречаются диагнозы,
психиатрической помощи. основанные на быстрой диагностике, - что особенно
Анализ теоретического и исторического часто наблюдается на врачебных комиссиях (т.н.
материала до и после реформ, введенных гипердиагностика). У психологов – это попытка
французским врачом Филиппом Пинелем, «вставить» человека в определенные шаблоны,
позволяет проследить важность гуманного и гибкого якобы описывающие то, как устроен внутренний
подхода к лечению пациентов. мир того или иного пациента, например:
Анализ и теоретическая разработка "истеричный", "эпилептоид", "шизоид",
эффективного способа помощи пациентам внутри "демонстративный", "нарциссичный" и т.д. Однако,
стационаров были основаны на наблюдении, использование данных понятий, с точки зрения

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59 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Vladimir Perebeynosov

пользы для пациента, практически не имеет смысла психиатрии в общую систему здравоохранения,
без вовлеченности во внутренний мир и интереса к интеграцию психического здоровья с первичной
индивидуальности каждой отдельной личности. медицинской помощью, развитие учреждений
По вышеперечисленным причинам, пациенты и интернатного типа.
их родственники, за последние годы, повышают 3. Рост заботы со стороны сообщества
внимание именно к негосударственным (community care). Этот подход призывает
учреждениям психиатрической помощи. По делегировать часть полномочий по оказанию
статистике частной психиатрической клиники помощи на социальные группы и организации,
«Клиника Роса», темп роста обращаемости находящиеся в зоне проживания душевнобольного.
пациентов с психическими расстройствами в К ним могут относиться сообщества пациентов или
негосударственную психиатрическую службу г. их родственников, а также НПО.
Москвы ежегодно возрастает, увеличиваясь за 4. Увеличение внимания к немедикаментозной
последние 7 лет в среднем на 20% в год (на 24%, терапии. Психотерапией стали заниматься не
81%, 28%, 4%, 7%, 20%, соответственно) (Филашихин только врачи-психиатры, но и другие специалисты. В
и Аведисова, 2010). том числе, немедицинского профиля.
Неоспоримой является важность повышения 5. Проведение законодательных реформ для
уровня образования среди врачей, а также обеспечения гражданских прав пациентов. То есть
младшего и среднего медицинского персонала. В формирование правовой основы политики в
особенности это касается изучения психологических области психического здоровья. В частности, в
аспектов психических больных. По мнению автора, задачи входят: регулирование принудительной
очень важна организация помощи медицинскому госпитализации, предоставление адекватных
персоналу в понимании собственного стиля условий лечения, борьба за свободные от
взаимодействия с пациентами; возможности дискриминации рабочие места и образование,
получения своевременной психологической развитие социальной поддержки, обеспечение
помощи и профилактики эмоционального права на неприкосновенность частной и семейной
выгорания. жизни.
6. Дестигматизация. Психические больные
3.1 Подходы к оказанию психиатрической помощи подвергаются сильной стигматизации, что приводит
к потере социального статуса, дискриминации,
Подходы к оказанию психиатрической помощи в безработице, изоляции, сокращению жизненных
разных странах Европы различаются, однако не возможностей. Для уменьшения негативных
слишком критично. Все европейские государства последствий, в рамках работы по развитию заботы
следуют предписаниям Всемирной организации со стороны сообществ, создаются программы и
здравоохранения (ВОЗ). Соответственно, можно стратегии по снижению стигмы и изменению
проследить общие направления развития стереотипов, ассоциирующихся с психиатрией.
(Колпакова и Тарасова, 2019). 7. Ориентация на повышение качества жизни
1. Деинституционализация. Подразумевает пациентов. Со временем этот принцип стал важной
закрытие государственных психиатрических концепцией современной модели медицинской
больниц или уменьшение их стационарных помощи. На первый план, вышли психологическое и
отделений, путем сокращения количества койко- физическое благополучие и социальное участие, а
мест и финансирования. Такой подход позволяет не просто уменьшение симптомов или выживание.
частному сектору и неправительственным 8. Вовлечение членов семьи и близких людей в
организациям (НПО) создавать учреждения процесс лечения пациентов. Важно, что вместе с
интернатного типа, где лечение проходит в более вовлечением, рядом идет осознание бремени,
домашней обстановке и атмосфере. которое ложится на плечи заботящихся
2. Децентрализация оказания психиатрической родственников. Им, также, стараются обеспечить
помощи. Означает перевод стационарных поддержку.
отделений для душевнобольных из В российской практике стремятся следовать
специализированных больниц в общегородские. Эта Европейскому видению и предписаниям ВОЗ.
политика, прежде всего, направлена на включение

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Однако данные предписания, зачастую, являются с другом для комплексной и полноценной помощи
формальными. Изменения, которые внедряются в пациенту. К сожалению, в российских реалиях
действующие системы, проходят без должного медицинских учреждений наблюдается отсутствие
обучения специалистов. Помимо этого, существует подобного взаимодействия. Звенья помощи либо
проблема отдаленных регионов, которые тоже разобщены друг с другом, либо медицинский
должны попадать под влияние изменений, но персонал, а особенно врач и психолог, говорят «на
зачастую, остаются без должного внимания. разных языках».
«Закон, прежде всего, заботится об уменьшении Также, как видно из предложенной схемы,
негативных последствий для государства — имеется достаточно значимым элементом является
в виду сокращение случаев инвалидности и взаимодействие пациентов между собой. Именно
нетрудоспособности, преступности, непригодности поэтому, одними из самых важных и эффективных
к военной службе и т.п.» (Колпакова и Тарасова, форм лечения, являются психотерапевтические
2019) Права пациентов, в основном, учитываются в группы.
нормативных документах о стационарном лечении, В психиатрических учреждениях, психологу
а вот что же происходит с людьми за пределами и приходится собирать психотерапевтические группы
внутри больницы — зачастую противоречит «из того, что есть». Учитывая различный срок
изначальным целям созданных предписаний. нахождения в стационаре, диагнозы, стадии,
состояние больного - приходится приспосабливать
3.2 Ценность групповой работы с пациентами в группу к тем пациентам, которые уже находятся на
психиатрических стационарах стационарном лечении.
По наблюдениям автора, нахождение в
Анализируя собственный опыт работы в атмосфере принятия и поддержки – это основной
психоневрологическом стационаре, в данной статье фактор улучшения самочувствия «здесь и сейчас»
была выведена схема наиболее эффективного среди пациентов стационара. Но, к сожалению,
взаимодействия членов терапевтического процесса приходится сталкиваться с тем, что практически
для помощи пациентам. Данная схема любые эмоциональные проявления пациентов, будь
основывается на единстве специалистов то плач или раздражение, стремление к
помогающих профессий между собой, с больным и конфронтации, настойчивость в отстаивании
с его близким окружением. собственных интересов – воспринимаются
медицинским персоналом как «ненормальные».
Будто непослушание, даже то, которое никак не
вредит благополучию самого пациента и людей его
окружающих, нужно срочно лечить. Дается посыл:
«тебе нельзя проявляться и быть самим собой - ты
патологичен». Бывает так, что слова или действия
пациентов принимаются медицинским персоналом
«на свой счет», что влечет за собой злоупотребление
властью. А зачастую, сами действия медицинского
персонала провоцируют у пациентов различные
эмоциональные и поведенческие реакции.
В качестве выхода из подобного рода
трудностей, предлагается организация
семинаров и групп психологической подготовки для
медицинского персонала по развитию понимания
Рис. 1. Эффективное взаимодействие персонала и важности гуманного отношения к пациентам и
пациентов в медицинских учреждениях создания атмосферы заботы и принятия внутри
стен медицинского учреждения. Такие обучающее
Как видно из схемы (pис. 1), практически все и психологические группы, в которых медицинский
элементы системы должны взаимодействовать друг персонал мог бы понять свой способ

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взаимодействия с пациентами, получить или советами в обществе. Они начинают

информацию и обратную связь; найти и проработать выслушивать друг друга и делиться опытом схожих
внутри себя причину, которая влияет на способ переживаний.
взаимодействия с пациентами и перестроить Так как внутриличностные конфликты
собственные формы коммуникации. формируются вследствие нарушения отношений
человека с миром, а прежде всего с людьми; то я
3.3 Классификация групп в условиях стационара периодически привношу в процесс
поддерживающих групп интервенции о групповой
Как известно, по составу участников группы могут динамике и взаимоотношениях между участниками
быть: группы. Это делается для того, чтобы наряду с
- Гомогенные. То есть, собранные по каким-либо получением и проявлением поддержки, пациенты
признакам (пол, возраст, диагноз, запрос и т.д.) имели возможность обращать внимание на способы
- Гетерогенные. Группа, в которой встречаются своего взаимодействия в группе и постепенно
различные вышеперечисленные признаки. перестраивать сложившиеся шаблоны поведения и
Предлагается выделить две основные взаимодействия.
используемые формы работы с пациентами 2. Закрытые динамические группы. Собрать в
психиатрического стационара: условиях стационара полноценную динамическую
1. Группы психологической поддержки. Могут группу, в которой пациенты были бы мотивированы,
быть использованы для пациентов, чей период могли просить о помощи, были бы критичны к
нахождения в стационаре менее двух месяцев. То своему состоянию, имели примерно одинаковый
есть тот период, которого недостаточно для срок нахождения в стационаре - очень сложно. Но
развития постепенного близкого и стабильного при удаче собрать такую группу, взаимодействие
контакта с другими участниками группы. Данные получается очень и очень продуктивным.
группы могут создаваться и на более длительный
срок, для создания атмосферы групповой 3.4 Факторы эффективности стационарных
поддержки и сопровождения пациентов на весь терапевтических групп
период лечения.
Самое главное, что формируется в группах Выделим несколько факторов большой
психологической поддержки, – это ощущение, что эффективности динамических и поддерживающих
ты не один. На протяжении длительного времени групп в условиях стационара:
приходилось наблюдать, как между несколькими а) Уровень критических переживаний. Согласно
десятками пациентов, находящихся в одном постулату позитивной психотерапии о развитии
отделении и общих палатах, не формируется первичных актуальных способностей, они могут
близкий контакт. Пациенты практически не развиваться двумя основными способами: через
общаются между собой, а при взаимодействии не пример или через отчаяние (через прикосновение к
позволяют говорить открыто о своих переживаниях. пиковым переживаниям). Как правило, пациенты,
Открытое выражение эмоций, медицинским которые по своим способностям, могут допускаться
персоналом, чаще всего, расценивается как к участию в динамической группе – это люди,
усиление симптомов. дошедшие до очень острого уровня переживаний
Группа является отличной возможностью для (вследствие чего они и попали в психиатрическое
пациентов приблизиться друг к другу в безопасной и учреждение) и при этом способные постепенно к
принимающей атмосфере. Практически все этому прикасаться. Пациенты, например, с
пациенты, уже после первой встречи группы, психотическими эпизодами или тяжелыми
становятся более сплоченными в отделении. К ним депрессиями проходят через отчаяние.
будто приходит понимание, что остальные Одновременно с этим участвуют в группе, получая
пациенты здесь «такие же, как и я», то есть пример людей и отношений, через которые можно
страдающие люди, попавшие в тяжелое положение. более полноценно развивать в себе недостающие
Пациенты начинают коммуницировать друг с способности. Именно это и является очень большим
другом, помогать в решении проблем в отделении движущим механизмом развития. Есть вероятность,

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что в стационарной динамической группе будут трудности, которые приводили к острым групповым
задействованы оба способа развития актуальных конфликтам. Поэтому, каждый случай и каждого
способностей. пациента, с точки зрения его возможности
б) Наличие времени. Как известно, для рефлексии находиться в группе, необходимо рассматривать
и контакта с собой нужно достаточно много индивидуально.
временно́го ресурса. Подразумевается время на Недостаток теплоты, заботы и поддержки со
обдумывание, проживание, нахождение со своими стороны медицинского персонала блокирует
чувствами и эмоциями, чему потенциально способность к Контакту у пациентов, вследствие
способно научить откровенное групповое ощущения недоверия. Группа, здесь, является тем
взаимодействие. «спасающим» для пациентов местом, в котором
в) Ощущение, что «Я не один». Пациентка, после есть возможность ощущать, проявлять и развивать
своего первого группового занятия по арт-терапии, Доверие. Также, в группе большой акцент делается
на индивидуальной сессии сказала, что она и не на Надежде. Так как учитывая тяжесть состояния
подозревала что переживают и думают другие больных, Надежда является важным звеном в
пациенты. Хотя, ей всегда хотелось об этом узнать. процессе помощи. Пациентам, находящимся в
г) Купирование продуктивной симптоматики отчаянии, бывает очень полезно понять причины,
лекарствами. Обеспечение медицинскими которые привели к тому, что происходит в жизни на
препаратами и контроль их приема позволяет данный момент. Понимание причин дает
человеку, прикасающемуся к тяжелым возможность сделать выбор. «Нами управляет то,
переживаниям, оставаться в контакте с самим что мы не осознаем». Дает возможность
собой. Однако, зачастую, лекарственные препараты проанализировать и сделать шаг в другом
мешают разговорной психотерапевтической работе. направлении; что добавляет Надежды на изменения
Одна из основных причин, по которой в будущем. Также, группа отлично развивает
специалистам не удается собрать Контакт и Открытость. А как известно, одна из
психотерапевтические группы в условиях основных причин формирования психопатологии и
стационара, является постановка чрезмерного фактор, сильно усугубляющий состояние – это
акцента на критериях отбора в группу. Очень неспособность пациента к выражению чувств и их
интересными выдаются критерии Ирвина Ялома для блокирование. Принятие, также, является одной из
работы со стационарными больными, описанные в важнейших способностей, развивающихся в
книге «Теория и практика групповой психотерапии» отношениях в группе.
(Ялом, 2007): Как видно из выделенных выше актуальных
1. Способность говорить. способностей, большинство из них – это первичные
2. Способность удерживать свое внимание на способности. Акцент сделан именно на них,
протяжении 80 минут. поскольку наличие психопатологии, в большинстве
3. Признание своей потребности в помощи. случаев, предполагает глубокий дефицит в
Очевидно, критерии достаточно просты. Отбирая структуре эмоциональных потребностей (например,
участников для стационарных групп и в принятии). И именно в психотерапевтической
руководствуясь данными критериями, группе возможно внести вклад в их развитие.
взаимодействие было действительно Карл Роджерс говорил о трех основных
продуктивным. Ирвин Ялом не делает акцента на принципах взаимодействия между людьми,
диагнозе. Например, во многих источниках говорят лежащих в основе лечения (Роджерс, 2001):
о том, что не нужно брать в группу пациентов с 1. Безусловное принятие. Которое совпадает со
диагнозом «умственная отсталость» (или способностями к принятию и терпению в
«расстройство интеллектуального развития» по позитивной психотерапии.
МКБ-11). В наших группах были случаи, когда 2. Конгруэнтность. Что схоже со способностью к
пациенты с расстройством интеллектуального открытости и доверию в позитивной психотерапии.
развития сами проявляли желание присоединиться 3. Эмпатия. Эмпатия предполагает способность к
к группе и вносили вклад в процесс групповой контакту.
работы. Однако, с такими пациентами также были и

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Неоспоримые принципы Карла Роджерса взаимодействие происходит на стадии слияния;

подтверждают важность именно первичных однако оно не настолько глубокое, как в закрытых
актуальных способностей. Это можно сравнить с динамических группах. Группа поддержки проводит
фундаментом, на котором строится лечение и человека на этапе переживания глубокого
адаптация пациента. психического и эмоционального кризиса.
Способность к открытости, в условиях
стационара, имеет первостепенную важность среди 3.5 Примеры из практики ведения групп в
вторичных АС. Если возможно её развивать у условиях стационара
пациентов стационара, то вероятно и освобождение
множества лежащих внутри переживаний и чувств, Предлагается кейс одной из пациенток. Елена
которые и привели человека к психопатологии. (имя изменено). 31 год. Наблюдается с диагнозом
Однако, очень важно соблюдать баланс вежливости «Параноидная шизофрения» (F20.0).
и открытости, в условиях стационарного лечения. Госпитализация, во время прохождения групповой
Зачастую приходилось наблюдать, как открытое психотерапии, 14-я. На индивидуальных
выражение эмоций (например, плача) терапевтических встречах, а также на первом
воспринималось медицинским персоналом как групповом занятии, пациентка была отгорожена, а
ухудшение состояния человека и ему лишь ее высказывания касались сверхценных идей
добавляли дозу лекарств. Поэтому, очень важно отношения других к Елене. Всю первую группу она
помочь человеку найти тот способ и место просидела отодвинутой от всех, в небольшом углу.
выражение эмоций, которое будет безопасным для На протяжении первых встреч она вела себя схожим
самого пациента и будет давать ему чувство образом, что и на индивидуальной психотерапии:
облегчения. Например, в психотерапевтических говоря о себе и пытаясь показать всю тяжесть своего
группах или на индивидуальных психологических положения, пациентка практически полностью
сеансах. отгораживалась от возможности получения
Стоит отметить, что через развитие контакта и поддержки, заботы и теплого отношения от других
первичных способностей, у пациентов стационара, участников группы. Постепенно, у участников
происходит развитие способности к Любви. Под группы начала возникать злость и желание
развитием способности к любви, в данном случае, я исправить восприятие Елены. Некоторые участники
понимаю рост теплого, принимающего и открыто выразили свою критику. Постепенно, автор
эмпатичного отношения к себе и другим. вносил интервенции по поводу ощущения
Особенность стадий взаимодействия (слияние, беспомощности, возникающего в группе и
дифференциация и отделение), в данном случае вызывающего злость и желание исправить
заключается в том, что пациентам стационара человека. А также о том, что мы периодически сами
крайне сложно их отслеживать и понимать степень бываем в настолько тяжелом положении, что
отношений с другими людьми. Некоторым отрицаем любую возможность помощи и
пациентам сложно войти в стадию слияния, так как поддержки со стороны. Группа достаточно быстро
она автоматически ассоциируется у них с ушла от попыток критики Елены. Участники стали
опасностью. Таким пациентам требуется больше больше доверять и делиться собственным опытом.
времени. На стадии дифференциации может Постепенно, по истечении 5–8 встреч, Елена
наблюдаться некоторое сопротивление к понемногу стала доверять участникам группы. Да,
отделению; попытки зацепиться за слияние с она всё еще не умела принимать заботу и
группой. Что может выражаться в частом поддержку, но, даже несмотря на короткий
возникновении чувства обиды, протеста и даже промежуток времени нахождения в группе, она
усиление остроты симптомов. Важно отметить, что в перестала выставлять жесткие стены в ответ на
условиях стационарного лечения, где в среднем теплую обратную связь. Вместо этого она начинала
срок нахождения пациентов непринудительного смеяться и пытаться перевести тему. Но она
лечения составляет 2–6 месяцев, нужны группы перестала реагировать враждебностью на желание
психологической поддержки, нежели полноценные другим ей помочь.
закрытые группы. В группах поддержки основное

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Столкновение между глубокой потребностью в Заключение

помощи и поддержке, вместе со стойкой
убежденностью в невозможности получить это для 1. В российской психиатрической практике
себя создает внутриличностный конфликт, в необходим кардинальный пересмотр как целей
котором актуальные способности к открытости, функционирования психиатрических учреждений,
доверию, принятию, контакту могут быть развиты во так и их условий. Важно, чтобы основной целью
взаимодействии в психотерапевтической группе. была не изоляция пациентов, а помощь им, переход
Постепенно, приводя к возможности сближения с к более гуманному отношению. А условия должны
другими и формированию эмоционально значимых удовлетворять потребности пациента в заботе, в
отношений. теплом отношении, в надежде и помощи.
Другая пациентка настолько полюбила группы 2. Психологическая служба психиатрических
поддержки, что ходила в них на протяжении всего учреждений, в первую очередь, должна дать
срока принудительного лечения (1,5 года). Каждую человеку возможность выстраивать новый способ
встречу она ждала с нетерпением, говоря о том, что отношений с окружающими людьми и самим собой:
это единственное, что приносит ей помощь, через индивидуальную и групповую психотерапию
интерес, чувство общности во время нахождения в пациентов, заинтересованное взаимодействие с
стационаре. Она с глубоким интересом врачами и родственниками. Это развивает
анализировала себя, собственное прошлое, слушала способности человека к дальнейшей социализации,
опыт других пациентов и делилась собственным. адаптации и интеграции в общество.
Был опыт, когда пациенты, устанавливающие 3. Для многих пациентов стационарного лечения,
близкий доверительный контакт на групповой особенно в период пандемии и изоляции, важны
психотерапии, продолжали поддерживать друг групповые формы работы с соблюдением
друга вне стен больницы, обмениваясь личными необходимых защитных мер.
контактами и помогая решать возникающие Таким образом, ведение групповой работы с
социальные проблемы. пациентами, с точки зрения метода Позитивной и
Транскультуральной Психотерапии, позволяет
достаточно комплексно и осознанно подойти к
руководству группой. В стационарных условиях есть
возможность для развития как первичных, так и
вторичных актуальных способностей. Позитивная
концепция человека позволяет разглядеть в каждом
пациенте его ресурсы и способности.

Список использованных источников

[1] КОЛПАКОВА, С., ТАРАСОВА, А. [KOLPAKOVA, S.,
TARASOVA, A.] (2019). От цепей до арт-терапии.
Эволюция психиатрической помощи [From Chains to Art
Рис. 2. Основные актуальный способности, Therapy. The Evolution of Mental Health Care]. Научно-
развивающиеся в стационарной групповой образовательный портал IQ, Международный центр
психотерапии и группах психологической поддержки экономики, управления и политики в области здоровья
НИУ ВШЭ. URL: https://iq.hse.ru/news/303803375.h.tml
Как видно из схемы (pис. 2), способность и (accessed: 20.03.2021)
потребность в контакте размещена в центре, как [2] ПЕЗЕШКИАН, Н (2006). Психосоматика и позитивная
самая значимая и необходимая во время психотерапия [Psychosomatics and positive psychotherapy],
нахождения на стационарном лечении. Именно М.: Институт позитивной психотерапии.
[3] ФИЛАШИХИН В., АВЕДИСОВА А. [FILASHIKHIN V.,
близкий открытый контакт с другими пациентами и
AVEDISOVA A] (2010). Структура обращаемости больных с
специалистами, способен развить те актуальные психическими расстройствами в частную психиатрическую
способности, которые помогут пациенту повысить службу [Referral Structure of Patients with Mental Disorders
его реабилитационный потенциал. to a Private Psychiatric Service]. Психиатрия и
психофармакотерапия. №2, pp. 4-8.

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65 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Vladimir Perebeynosov

[4] ЦЫГАНОК, Л. [TSYGANOK, L.] (2007). Реформирование Ограничения исследования

психиатрической службы. Опыт США И Европы [Reform of
the psychiatric service. The Experience Of The USA And Пандемия коронавирусной инфекции
Europe]. Независимый психиатрический журнал, № 3. существенно затруднила возможность проведения
http://test.npar.ru/journal/2007/3/reforming.htm Accessed как терапевтических групп, так и групп
27 February 2021
психологической поддержки. Однако, с другой
[5] ЯЛОМ, И. [YALOM, I.] (2007). Теория и практика групповой
психотерапии [Theory and practice of group psychotherapy].
стороны, пандемия помогла понять важность
М.: Апрель Пресс. группового взаимодействия для пациентов. В
[6] РОДЖРЕС, К. [ROGRES, C.] (2001). Становление личности. период обострения инфекции, групповой работы с
Взгляд на психотерапию [Becoming a person. A look at пациентами не проводилось, в периоды спада
psychotherapy]. М.: Эксмо-Пресс. заболеваемости, группы были только в некоторых
отделениях с очень ограниченным количеством
пациентов и применением защитных мер.

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Special articles https://doi.org/10.52982/XXXX 66

INTERNATIONAL PROVERBS ABOUT HOPE

Friedhelm Röder
MD, DM, psychiatrist, psychotherapist,
Retired senior doctor of the Vogelsbergklinik,
Psychosomatic Rehabilitation Hospital
(Grebenhain, Germany)
Email: [email protected]

Received 05.04.2021
Accepted for publication 28.06.2021
Published 07.07.2021

Abstract
The base for every treatment is hope. To understand the concept of a patient about the future and to stimulate a
process of widening the horizon proverbs about hope can be used. As a help for a therapist to use this tool a paper
seized DIN A 4 was created which offers a collection of international proverbs. Some practical hints are given how to
use the paper. Also, the paper can be used by the patient afterwards to transmute the role within the family from a
source of trouble into a source of encouragement.
Keywords: hope, fantasy, proverb, transmutation, Positive Psychotherapy
imaginations of further positive experiences with each
Introduction
other. The more desperate a patient is, the more
Due to their different developmental pattern, The important is to direct the attention on positive aspects
emotional and motivational base for every treatment is of life. And talking about hope is a subject everybody
hope [Peseschkian, Aziz 2009, p. 64]. Hoping is the understands at once. And hope is a subject each of the
combination of two abilities. On one side there is the members of the patient’s social system have an attitude
abilities to remember well doing experiences in the to, which is mostly known by the patient. So, the
past. On the other side there is the ability to imagine therapist can ask the patient about their concept of
new well doing experiences in the future. The hope. Thus, it is possible to understand the social
imagination might be similar as the previous ones or position of the patient and to discover chances to
even totally different. change it.
Treatment is a cooperation between a therapist and Talking about hope is not only important at the
a patient for the benefit of the patient following rules beginning of a therapy, but also in every situation a
which make sense to both, even if the basic ideas crisis is raising or has already overwhelmed the patient
behind this vision may differ from each other. As first with the unsolved problems. Then talking about hope is
common step they must talk about their visions of an important way to stabilize the slackened emotional
hope. Doing this they start with the relaxing part of the status and identity. And as the treatment goes on, the
concepts of hope sometimes change. Because of this it
complicated emotional situation, causing the wish or
might be usefull to return to the earlier attitude of hope
the need for treatment. Thus, the danger of a failing
and to compare it with the actual result of the latest
start of the first meeting is averted. Doing this the development.
chances for a positive start of the meeting rise at once. Hope is the ability to calculate with possibilities,
And this positive experience encourages the which are not known in the presence. So, hope is closely

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related with fantasy. To make talking about hope more Hope without strain is like a sea voyage without a
sufficient the abilities of fantasy on side of the patient ship. (Wales)
and of the therapist must be encouraged. For that He who harnesses the hope before his cart, will drive
purpose, the Positive and Transcultural Psychotherapy twice as fast as before. (Poland)
uses the technique of telling stories or proverbs. The* Even the stake hopes that it will become green again
method of offering the patient a great variety of when next spring returns. (Finland)
international proverbs about hope is an invitation to Hope is the anchor of the world. (Bantu)
enlarge the horizon of fantasy [Peseschkian 1979, p. 7]. The smaller the lizard, the bigger its hope to become
For this purpose I developed a DIN A 4-sized paper a crocodile one day. (Abyssinia)
containing proverbs about hope from many places and Hope and courage are two bright diamonds in the
cultures [Personal comments 2009-2013; Özcan, Seuß crown of success. (India)
2013; www.sprueche-liste.com; If you lose a hope which was in vain, you will gain a
www.sprueche.woxikon.de; www.sprichworte-der- lot. (Italy)
welt.de]. Some of the proverbs in this collection can be • Which proverb encourages you?
exchanged with a few from the cultural background of • What is the next step that this proverb
the patient which are familiar to him or her encourages you to take?

Application Practical hints:

Handout with international proverbs about hope:
Print this handout and give it to the patient.
Ask the patient to read this handout aloud. It usually
What kind of hope do you have when facing your
takes between two or three minutes to read it. This
problems?
allows to check the measure of the patient's ability to
“Actually, it is not difficult to reach the top of a
read, which may give information about the intellectual
mountain. You only have to walk slowly enough.”
status, and discover psychotic disorders of thinking. By
“It is better to stumble while going new ways than to
listening to the patient’s reading, it is possible to watch
just run in place on the ways you know.”
the patient's spontaneous reactions.
But how do you find your way and your speed?
After the patient has read the handout, you may
Without hope, nothing will be possible.
begin to talk with the patient about these proverbs.
But: Which hope guides to which aim? Therefore:
At the end of this therapeutic session, you may
Which kind of hope do you have?
encourage the patient to take the handout home, for
him/herself and for presentation to the family. Thus,
International proverbs:
you help the patient to change his or her role at home.
Very often a patient is defined by the family mainly as a
If hope didn’t exist, I wouldn’t be alive now.
cause for troubles and the family hopes that his visit to
(Germany)
a psychiatrist or psychotherapist will bring release for
On one hand, I still hope, but on the other hand, I
him/herself and for them. If the patient presents them
still doubt. (Germany)
with this handout, the family members learn at once
Hope is something you don’t have to buy. (Germany)
that they are included in the therapy and that they shall
Is the way ahead of you in darkness? Remember: the
be encouraged also. The patient thus transmutates his
curtain is only before your eyes, but not in your way.
or her role from a cause for troubles into a cause for
(Turkey)
hope and the patient can read the handout together
No matter how much snow is falling, it will not
with the family members and talk about their situation
remain until summer. (Turkey)
in a new and simple way. Their discussion can unbolt
When God closes the silver door, he opens the
various blockades that have existed within and between
golden one. (Turkey)
them.
If you don’t know how to go on, there are still four
solutions left. (Bulgaria)
Hope is just a swimming vest, but not a lifeboat.
(Poland)

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68 THE GLOBAL PSYCHOTHERAPIST. Volume. 1. Number. 2. July 2021 Friedhelm Röder

Conclusions References
The base for every treatment is hope. To understand [1] ÖZCAN, C., SEUSS, R. (2013). Türk Atasözleri – Türkische
the concept of a patient about the future and to stimulate Sprichwörter. Auswahl und Übersetzung mit Zeichnungen von
a process of widening the horizon proverbs about hope Ina Seeberg [Türk Atasözleri - Turkish proverbs. Selection and
can be used. translation with drawings by Ina Seeberg]. Deutscher
Taschenbuch Verlag, München, 6.Auflage.
As the therapy progresses, it is possible to return to
[2] Personal comments from friends, colleagues and patients, 2009-
this collection of proverbs and see whether the process 2013.
of learning has caused the patient to change his or her [3] PESESCHKIAN, N. (2016). Oriental Stories as Techniques in
favorite proverb. Positive Psychotherapy. Author House UK. ISBN 978-
As a help for a therapist to use this tool a paper seized 1524660871
DIN A 4 was created which offers a collection of [4] PESESCHKIAN, N., AZIZ, A. (2009). Lexikon der Positiven
international proverbs. Some practical hints are given how Psychotherapie [Lexicon of Positive Psychotherapy].
to use the paper. Also, the paper can be used by the Frankfurt/Main: Fischer Taschenbuch Verlag.
patient afterwards to transmute the role within the family [5] Sprichwörter aus aller Welt [Proverbs from around the world].
URL: www.sprichworte-der-welt.de [accessed: 04.04.21].
from a source of trouble into a source of encouragement.

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 PPT Journal “THE GLOBAL PSYCHOTHERAPIST” Volume 1. Number 2. July 2021
Section: Special articles https://doi.org/10.52982/XXXX 69

ХАОС VS ПРОДВИЖЕНИЕ: КАК НЕ ИСЧЕЗНУТЬ В

ИНФОРМАЦИОННОМ ПРОСТРАНСТВЕ

CHAOS VS PROMOTION: HOW NOT TO DISAPPEAR IN THE

INFORMATION SPACE

Оксана Фортунатова
Oksana Fortunatova
Basic Consultant of Positive Psychotherapy,
Private practice consultant (Kyiv, Ukraine)
Email: [email protected]

Received 24.03.21
Accepted for publication 28.06.2021
Published 07.07.2021
Аннотация

Данная статья посвящена тонкому и сложному вопросу конкуренции методов психотерапии, этике и
стратегии их продвижения, задачам и цели популяризации метода, а также роли в этом каждого из нас, как
носителей метода Позитивной Психотерапии. Целью статьи является привлечение внимания коллег к
такому важному и ценному делу, как проявление себя в информационном пространстве и последствия
отказа от такового.

Ключевые слова: Позитивная Психотерапия, популяризация, социальные сети, ключевой конфликт,

баланс

Abstract
This article is devoted to the delicate and complex issue of competition between methods of psychotherapy, ethics
and strategies for their promotion, the objectives and goals of popularizing the method, as well as the role in this
of each of us as carriers of the method of Positive Psychotherapy. The purpose of the article is to draw the
attention of colleagues to such an important and valuable matter as manifesting oneself in the information space
and the consequences of refusing it.
Keywords: Positive Psychotherapy, popularization, social networks, key conflict, balance.
приемы остались, въевшись в коллективное
Вступление
бессознательное настолько, что уже не
«Мы не добиваемся правды, мы добиваемся воспринимаются, как нечто, противоположное
эффекта» - говорил апологет пропаганды, не правде.
брезговавший ни серой, ни черной информацией в Причем тут мы, мирная профессия, помогающая
деле завоевания умов. Апологета сожгли, а вот его людям стать счастливее, успешнее, здоровее? Ответ

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 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Oksana Fortunatova
70

в нашем профессиональном пространстве, где Но голос психотерапевтов слаб и не звонок, и

рекламные трюки, попсовые переработки сложных люди вынуждены выбирать из того, что
теорий, противостояние и информационный мусор предлагается, а возложить всю ответственность за
преобладают. И не просто наводняют пространство, выбор на клиента опасно. «Ослабление
а создают серьезное препятствие человеку в выборе когнитивных процессов и переход на «детское»
способа преодоления проблемы. правополушарное мышление – результат стресса,
Для специалиста, решившего стать приводящий к принятию иррациональных
психотерапевтом, вопрос какой же метод выбрать – решений» (Сандомирский, 2005). Таким образом,
это не только о личном совмещении с уровнем сотни тысяч людей, находящихся в тяжелых
интеллекта, философией и инструментарием жизненных обстоятельствах, просто доверятся
метода. Это еще и вопрос – насколько метод информационному пространству.
привлекателен для клиентов и уважаем в Но является ли сегодня информационная среда
профессиональной среде. сбалансированной, объективной о методах помощи
И мы неминуемо столкнемся с качеством в душевных страданиях? Достаточно ли мы, как
информационной среды. Ключевым станет, представители научного метода психотерапии,
насколько она отражает реальность и дает проявляемся в ней? И как мы участвуем в
возможность сделать объективный и свободный противостоянии?
выбор как специалисту, так и потенциальному Но противостоянием «псевдоцелители VS
клиенту. Главный вопрос насколько все это зависит специалисты в области психических процессов»
от каждого из нас предлагается рассмотреть дело не ограничивается. Специалисты не улучшают
предметно далее. шансы клиентов на получение эффективной
Процесс цифровой трансформации общества – помощи.
данность, которой не избежать. И именно в Первое, что привлекает внимание
мировом интернет-пространстве, социальных сетях неправильностью, это оспаривание психиатрами,
формируется сейчас отношение к психологии, психотерапевтами с медицинским образованием,
психотерапии, как инструментам исцеления и роста. психотерапевтами без медицинского образования и
Только на Facebook около сотни тематических групп, психологами прав друг друга на психологические
где люди пытаются найти ответы и рекомендации. интервенции. Обычному человеку в этом споре
Крайне важно учитывать особенность почти невозможно разобраться.
постсоветского пространства и развивающихся Таким образом, второй уровень противостояния,
стран, где психологическая просвещенность в которое мы втянуты, это «психотерапевт метода VS
невелика, а лояльность к психотерапии еще меньше. иные специалисты в области психических
Потому люди преимущественно обращаются к процессов».
соцсетям за рецептом от душевной боли и от того, Но даже там, где сталкиваются только
что они там прочтут, зависит очень многое. психотерапевты, возникает не менее яркое
И на сегодня большое количество ответов – это противостояние – противостояние методов.
непрофессиональные рецепты от экстрасенсов, Давайте проследим, в какое информационное
распространителей БАДов, психологов-самоучек, и пространство вариантов попадет современный
воодушевленных собственной терапией клиентов. клиент, если попытается разобраться в методах
Но плотность этих рекомендаций преобладает психотерапии.
настолько, что создает впечатление истины. «Окей, Google!»
Именно потому, так много людей долгие годы Запрос: «лучшие методы психотерапии».
следуют им. Результатов: примерно 2 640 000 (0,52 сек.)
С одной стороны, эти советы не на пользу И первый выделенный фрагмент поиска
клиентам, но с другой стороны, они – хорошее поле категоричен: «Эффективные методы психотерапии:
работы с невежеством и непросвещённостью • Психоанализ
людей, отличный повод психотерапевту заявить и о • Аналитическая психология
возможностях метода, и о себе. • Когнитивно-поведенческая терапия
• Гештальт-терапия

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• Экзистенциальная терапия 12 недель). Решение о месте проведения и

• Десенсибилизация и переработка специалисте, который будет проводить
движением глаз» определенный вид психотерапии, принимается
Среди ссылок первых двух страниц поисковой вместе с пациентом».
выдачи представлены эти же методы, и увы, Таким образом, люди, страдающие депрессией,
отсутствуют упоминание о методе ППТ. соматоформными расстройствами и
Специалисты знают, что подобные психосоматическими заболеваниями, неврозами,
утверждения беспочвенны, а такие заявления не ПТСР и стрессовыми расстройствами должны
этичны. Но об этом не знают и не подозревают согласовывать с врачом психотерапевта, с которым
клиенты, в чьих умах прочно поселяется мысль о будут работать, и он может быть только в методе
том, к кому же можно обращаться. КПТ.
Как обычному человеку разобраться в вопросе, Дискуссия о возможности научно доказать и
какой метод психотерапии эффективен, если подтвердить эффективность метода на сегодня не
путаница начинается на самом высшем уровне? закрыта, и однозначный ответ не получен. Более
Так, Всемирная организация здравоохранения в того, сегодня идет горячая дискуссия о том, как
«Руководстве mhGAP-IG по оказанию помощи в вообще оценить эффективность психотерапии
связи с психическими и неврологическими валидно (Чушке, 2015).
расстройствами, а также расстройствами, Таким образом, мы, как представители
связанными с употреблением психоактивных Позитивной психотерапии, уже втянуты (и не по
веществ, в неспециализированных учреждениях своей воле) в несколько уровней противостояния.
здравоохранения», говоря о способах
психологического лечения дает двусмысленный Обсуждение
перечень. Среди приемов интервенции Важно помнить, что психотерапевты
упоминаются несколько методов психотерапии: постсоветского пространства и развивающихся
«Рекомендуется: Поведенческая активация, стран, в отличие от европейских, американских
Обучение приемам релаксации, Терапия, коллег, на стадии «грязных» работ в деле
направленная на решение проблем, Когнитивно- строительства рынка психотерапевтических услуг:
поведенческая терапия, Лечение методом разгребания мусора и закладки фундамента. Этот
управления непредвиденными обстоятельствами, факт напрочь лишает нас возможности почивать на
Семейное психологическое консультирование или лаврах победы разума над невежеством. Нам
психотерапия, Интерперсональная психотерапия, предстоит еще много работы.
Психотерапия, направленная на активизацию Начинать нужно с освоения маркетинга, а
мотивации». именно азов продвижения (promotion). Основа
Не удивительно, что страны дублируют продвижения – информирование. Это база, на
подобные рекомендации в своих протоколах которой возможна вся последующая надстройка:
лечения. Так, например, Украина ввела формирование престижности, поддержание
Унифицированный клинический протокол популярности, изменение стереотипа восприятия,
первичной, вторичной и третичной медицинской лояльность методу.
помощи. Реакция на тяжелый стресс и расстройства Давайте посмотрим, с какой плотностью
адаптации, ПТСР; или Унифицированный информации столкнется клиент, захотев подробнее
клинический протокол первичной, вторичной и ознакомиться с методами психотерапии из
третичной медицинской помощи. Депрессия, в вышеупомянутого перечня:
утвержденном приказом МОЗ Украины 23.02.2016 «Окей, Google!»
№ 121, обязывает врача: «предложить пациенту и «Транзактный анализ» Результатов: примерно
координировать с ним специализированные и 220000 (0,54 сек.)
высокотехнологичные виды психотерапии (терапия «Когнитивно-поведенческая терапия»
решения проблем, короткая когнитивно- Результатов: примерно 1820000 (0,58 сек.)
поведенческая психотерапия (КПТ) и «Гештальт терапия» Результатов: примерно
консультирование – в течение 6-8 сеансов около 10- 1210000 (0,57 сек.)

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«Телесно-ориентированная психотерапия» И тут уместно вспомнить о центральным

Результатов: примерно 1470000 (0,59 сек.) понятии позитивной психотерапии – ключевом
«Психоанализ» Результатов: примерно 3100000 конфликте. В понимании ППТ метода, «имея что
(0,70 сек.) сказать – нужно сказать», в противном случае эта
Теперь рассмотрим результат для ППТ: энергия становится разрушающей.
«Позитивная психотерапия» Результатов: Обратимся к четырем вариантам сочетания
примерно 193 000 искренности и вежливости, которым соответствует
«Позитивная кросс-культурная психотерапия» четыре типа нашего поведения (Кириченко, 2007) и
Результатов: примерно 49 800 (0,46 сек.) адаптируем их к обсуждаемой проблеме.
Очевидно, что такая структура – вовсе не «Искренняя вежливость»: мы спокойно
результат количества психотерапевтов в том или реагируем на утверждение о том, что некий метод
ином методе. Это результат активности. «единственно действенный», просто игнорируя это.
Очень важно помнить, что продвижение «Неискренняя вежливость»: уступаем из
метода психотерапии – это совсем иной феномен, страха, вяло отделываясь общими
нежели продвижение товаров. По сути, мы меняем формулировками. Возможная причина – неверие
взгляд на устройство человека. Согласитесь, это о либо не знание силы собственного метода.
науке более, нежели об услуге. И тут важно «Невежливая искренность»: агрессивно
понимать, что просто информировать не получится. отстаиваем свое мнение, не заботясь об аргументах,
«Переход к новой парадигме не может уповая на эмоциональный напор. «Вежливая
основываться на чисто рациональных доводах, хотя искренность»: открыто, но вежливо вступаем в
этот элемент значителен. Здесь необходимы диалог, запрашивая аргументы, источники,
волевые факторы – убеждение и вера» (Кун, 2002). выражаем свое несогласие и предоставляем свои
Убеждение и вера: Верим ли мы в наш метод? аргументы.
Верим ли мы в себя? Знаем ли мы тонкости Немаловажно задуматься, как каждый из нас
настолько, чтобы убеждать других в эффективности сегодня преимущественно реагирует на ситуацию
метода? Убеждаем ли? научной и деятельной конкуренции направлений,
В сегодняшних реалиях информирование — это вернее конфликт. Еси это молчание, игнорирование
даже не инструмент заявления о себе. Это или уходом, важно понять почему так происходит.
инструмент противостояния отрицанию метода и Ведь с точки зрения ППТ метода – это не
его возможностей. Это отстаивание права быть. эффективно. Что мы, как психотерапевты, будем
Но важно учитывать, что мы не только в предлагать клиенту, реагирующему на конфликт
атмосфере научной среды, мы в реалиях таким образом? Взращивать вежливую
конкуренции. И то, что происходит в искренность, поскольку у иных вариантов реакции
информационном пространстве сегодня, добавляет есть негативные последствия.
еще один признак – конфликт. Мы часто оперируем Нельзя не коснуться еще одного уровня
этим понятием, ведь оно ключевое для противостояния: психотерапевт против самого себя.
динамического направления. Сегодня многие коллеги, пытаясь выиграть в гонке,
«Конфликт – серьезное разногласие, присваивают себе знания уровня «могу все».
столкновение противоположных сторон, мнений, Например, заявляя о своей специализации во всех
сил» (Ефремова, 2002). известных психологии расстройствах и проблемах.
Что как не конфликт, принятие акта, который Или гарантируя применение всех популярных
навязывает пациенту определённый метод методов. Специалист 27 лет от роду заявляет о
психотерапии, значительно ограничивая права и работе в 11 методах психотерапии. Некоторые «для
возможности пациента? надежности» еще и добавляют такие способности,
Что как не конфликт, многочисленные и столь как «энерготерпевт», «нумеролог», «астролог». «У
категоричные заявления коллег из других методов: семи нянек дитя без глазу» (Too many cooks spoil the
«единственный метод, который может помочь вам broth). Глубокое изучение одного метода и
– это метод ХХХХ». специализация в определенной тематике – это
лучшая ли гарантия эффективности и узнаваемости.

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Заключение Реклама – не менее важный способ в деле

продвижения и метода и себя. Впечатляюще
Таким образом, для усиления своей бытности в масштабную работу по изучению запретов на
информационном пространстве предложены рекламу в этических кодексах психотерапевтических
следующие шаги. обществ разных стран провел психиатр,
Если многие коллеги уже пришли к психотерапевт Кирилл Кошкин, в результате
необходимости иметь сайт и размещать статьи в которой сделал однозначный вывод: запрет для
онлайн изданиях, то активность в соцсетях все еще психотерапевтов на рекламу — это миф. Реклама
остается на очень низкм уровне. Максимум должна соответсвовать этическим нормам, но она
редпринимаемых усилий заключаются в создании должна быть.
статического контента. Но большой поток запросов Подводя итог, хочется отметить самое главное -
и обмен информацией сегодня происходит в без всех этих мер в современном мире обойтись
объединениях по интересам: группах. Сегодня стоит нельзя. Мы уже втянуты в информационную битву,
относится к работе с ними, как к части своей и возможно нам не выиграть. Но есть такие битвы,
профессии: ответы на вопросы, разъяснения, где важнее не победа, а противостояние.
отсылка к своим статьям, или статьям коллег.
Достаточно найти несколько групп по своей Список использованных источников
специализации, где люди ищут ответы.
Создание своей группы или аудитории – это [1] TSCHUSCHKE, V., CRAMERI A., KOEMEDA M., SCHULTHESS
P., VON WYL, A. & WEBER, R. (2015). Rainer
более продвинутый уровень, который дает WeberPsychotherapieforschung – Grundlegende
возможность целенаправленно заявлять о себе и Überlegungen und erste Ergebnisse der naturalisti-schen
методе. И что самое важное в группе: это Psychotherapie-Studie ambulanter Behandlungen in der
регулируемое столкновение мнений и взглядов. На Schweiz (PAP-S) [Rainer Weber Psychotherapy Research -
Basic considerations and first results of the naturalistic
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psychotherapy study of outpatient treatments in Switzerland
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запроса. schulthess-agnes-von-wyl-rainer-weber.html#show_full_text
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[2] ЕФРЕМОВА, Т. [EFREMOVA, T.] (2000). Новый словарь
мастер курсах есть сотни страниц готовой к русского языка [New dictionary of the Russian language]. М.
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Они могут как сразу писаться в формате статьи, так и [3] КАРВАСАРСКИЙ, Б. [KARVASARSKY, B.] (2002).
переделываться позднее. Это полезная и творчески Психотерапия: учебник для студентов медицинских
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информационное поле предлагает говорить. Психоаналитическая диагностика. Понимание
Подкасты – сегодня очень востребованный сектор, и структуры личности в клиническом процессе
дает не меньшую возможность заявить о методе и о [Psychoanalytic diagnostics. Understanding personality
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Сегодня как никогда важно не просто владеть [8] ПЕЗЕШКИАН, Н. [PESESCHKIAN, N.] (2001): Психотерапия в
информацией, а загружать ее в пространство. И не повседневной жизни. Тренинг разрешения конфликтов
просто загружать, а помочь ей стать видимой.

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[Psychotherapy in everyday life. Conflict resolution training]: [11] Руководство mhGAP-IG по оказанию помощи в связи с
перевод с немецкого Наумовой Ю. С. СПб.: Речь. 288 с. психическими и неврологическими расстройствами, а
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[10] ПРИКАЗ МОЗ УКРАИНЫ 23.02.2016 № 121. URL: региональное бюро, Копенгаген
https://dec.gov.ua/wp- [12] САНДОМИРСКИЙ, М. [SANDOMIRSKY, M.] (2005).
content/uploads/2019/11/2014_1003_ykpmd_depresiya.pdf Психосоматика и телесная психотерапия
[accessed: 23.03.2021] [Psychosomatics and body psychotherapy]. Москва. «Класс».
416 с.

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75 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Maksim Chekmarev

BOOK REVIEW
подготовил Максим Чекмарев
MD, психиатр, психотерапевт, международный Мастер Тренер по ППТ,
директор Амурского центра по Позитивной Психотерапии, преподаватель кафедры
общественного здоровья Амурского государственного медицинского университета
[email protected]

Работая в Дальневосточном Федеральном

Университете во Владивостоке, я часто ездил
на поездах в Благовещенск. Это почти сутки
пути, в которые я брал с собой книгу.
Однажды я провёл эти сутки неотрывно за
книгой, часто начиная плакать. Соседи по купе
оглядывались, но сохраняли вежливую
дистанцию. Этой книгой была «Здравствуйте,
дети!» Шалвы Амонашвили издания 1983
года - документальные записи педагога о
большом эксперименте в грузинских школах.
Над следующей его книгой - монографией
1984 года «Воспитательная и
образовательная функция оценки учения
школьников» я тоже нашёл, где заплакать.
Шалва Амонашвили - грузинский педагог и
психолог, создатель концепции гуманной
педагогики, в этом году ему исполнилось 90
лет. С 1980-х годов его труды успели получить
международное признание. Моя мотивация
рассказать об одной из книг Амонашвили в
научном журнале, посвящённом Позитивной
и Транскультуральной Психотерапии
продиктована близостью двух концепций.
Много из того, о чём говорил и писал
Пезешкиан в области психотерапии
перекликается с идеями Амонашвили в
педагогике и наоборот. В нашем методе
только происходит формирование
методологии позитивной педагогики,
складывается понимание специфики
концепции ребёнка в образовании. В
гуманной педагогики эти философские
HELLO CHILDREN! by Amonishvili, S. основания хорошо описаны.

В качестве объекта рецензии я возьму книгу

ЗДРАВСТВУЙТЕ, ДЕТИ! Шалвы Амонашвили 2000 года «Школа
Ш. А. АМОНИШВИЛИ жизни», которая вышла с подзаголовком
«Трактат о начальной ступени образования,
Учебное пособие основанной на принципах гуманно-
«Просвещение», 1983 личностной педагогики». Она, пожалуй,
208 стр. наиболее лаконично и полно описывает не

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76 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Maksim Chekmarev

только философию, но и практику подхода, ребёнку в гуманной педагогике.

затрагивает учебный и воспитательный
1. Ребёнок есть явление (феномен).
процесса в школе как в организации.
Феноменологический подход призывает к
Книга написана уже в новом тысячелетии и восприятию ребёнка как уникального
вдруг - «трактат». В языке автора человека, который уже живёт, а не
присутствуют намеренные архаизмы. Во- готовится к жизни.
первых, Амонашвили признаётся, что они 2. Ребёнок несёт в себе жизненную миссию.
служат для передачи пафоса и даже В нём скрыт потенциал для прохождения
романтики педагогики. Ему чужда тенденция уникального жизненного пути, который
восприятия образования как услуги, оно должен быть раскрыт и актуализирован
непременно только служение, особая образованием.
деятельность, не имеющая права потерять 3. Ребёнок несёт в себе энергию духа.
ощущение себя как чего-то сакрального. Во- Библия говорит о том, что «Дух дышит, где
вторых, архаизмы помогают понять, что хочет», таким образом и ребёнок не видит
перед нами неоклассика. После границ для своей реализации, способен и
модернистского и постмодернистского стремится выйти за пределы мира,
подхода к образованию, то есть становления очерченного старшими поколениями.
его как массового и стандартизированного Три движущих силы обосновывают
явления, а затем имеющего право на бессмысленность авторитарного
плюрализм, автор предлагает задуматься о педагогического мышления и постулируют
возвращении к истокам. Что такое компоненты природосообразного
педагогическая классика? Какие ценности воспитания, которое способно учесть наличие
утверждали в образовании Квинтиллиан, следующих стремлений в душе ребёнка:
Коменский, Песталоцци, Ушинский, Корчак и 1. Стремление к развитию. Ребёнок не
Макаренко? Каждый из них предполагал, что может не развиваться, развитие
ученик - субъект обучения, личность, происходит через преодоление
раскрывающая свой потенциал. трудностей. Это естественный
врождённый процесс, который требует
Далее я предложу краткий обзор основных
создания условий, а не постоянного
положений гуманной педагогики. Вы легко
мотивированная извне. Он нарушается
сможете оценить их близость с позитивным
только при воздействии агрессивной
видением человека, что открывает
социальной среды, которой может стать и
возможность для транскультурального
семья, и школа.
плодотворного обмена между двумя
2. Стремление к взрослению. Ребёнок
школами.
рождается не для того, чтобы остаться
Описывая свой подход, опираясь на ребёнком, а для того, чтобы стать
педагогическую классику, Амонашвили взрослым. Поэтому его жизнь -
предлагает три допущения, три постулата и каждодневный выход за пределы себя.
формулирует три движущих силы. Амонашвили предлагает возвести
исполнение педагогических процессов до
Три допущения связывают педагогику и искусства, что поможет чувствовать себя
духовную традицию. Вот они: взрослым там, где он вовсе ещё не
- душа человека есть реальная сущность; взрослый, а ребёнок.
- она устремлена к вечному восхождению и 3. Стремление к свободе. Оно означает
совершенствованию; движение к самостоятельности и
автономности, которое может
- земная жизнь есть отрезок пути
превратиться из возможности в
восхождения. Здесь автор напоминает нам,
реальность при содействии взрослого,
что слово «школа» происходит от
через общение и совместную
латинского «scale» - лестница.
деятельность как с ним, так и
Три постулата описывают наше отношение к
самостоятельно.

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77 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Maksim Chekmarev

Вне всякого сомнения, такой взгляд на Даже беглый анализ основных положений
ребёнка требует новое устройство школы. гуманной педагогики позволяет определить
Современные тенденции стремятся сделать этот подход как родственный позитивной
её максимально соответствующей текущим психотерапии. В силу интереса у многих
ценностям общества. Гуманная педагогика наших коллег к формированию нового
предлагает сосредоточиться на направления - позитивной педагогики, я
непреходящих истинах и раскрытии настоятельно советую ознакомиться как с
личностного потенциала, который включает трактатом «Школа жизни», так и с иными
физическое, интеллектуальное, работами Шалвы Амонашвили.
эмоциональное и духовное развитие.

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78 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Diana Pop

BOOK REVIEW
by Diana Pop
Certified Positive Psychotherapist,
Cluj-Napoca, Romania
[email protected]

Invatam impartasind. Ghid de During the pandemic of 2020, eighteen

experiente scrise de si pentru specialists in learning and developmental from
different companies in Cluj-Napoca (Romania)
specialistii L&D, Editor: Gabriela coordinated by Gabriela Hum started to write a
Hum book.
The result?
"We learn by sharing - a guide written by and for
L&D specialists" - A great 347 pages book about
their personal experience about training and the
rules to follow in order to create a good learning
experience, how to deliver training and sustain
the changes induced by trainings in
organizations.
The volume contains five chapters, divided in
twenty sections created around the word
“learning” and organizational development. The
main accent is on the importance of learning and
development as part of the Human Resources
functions and the importance of learning and
development specialists as business partners,
points out technical aspects that are part of the
need analysis and the design of the
interventions, delivery programs, post-delivery
learning, careers one could have in learning and
development department and exciting
possibilities in this area.
It is a new entry book in the HR field and should
become the “bible” for each organization and for
everyone interested in training area.
What I’ve noticed when started to read the book
WE LEARN BY SHARING - A GUIDE was the easy accessible language used, although
is a technical book, the language used allowed
WRITTEN BY AND FOR L&D me - a non-learning and development specialist
SPECIALISTS [in Romanian] to understand and to immerse myself into this
world. From the first chapter it made me curious
about how long the process of creating a training
is and how many details are taking into
TREI publishing, 2021 consideration from the first point: the need of
348 pages training analysis.
ISBN: 9786064010124
It is a book of details but not in a boring,

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79 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021 Diana Pop

excessive way. Are those details needed to make Another thing I enjoyed is the accent from the
a difference and those details who can capture last Chapter – “Possibilities and perspectives in
attendance’s attention in order the learning L&D” on section - How to train a trainer – an
process occurs. important aspect and rarely taken into
consideration when a training is delivered. And
The feeling you get while reading this book is not the author Calin Grigorovici points out: “The
a heavy, tired one, but a feeling of curiosity training is about the participants not about the
mixed with enthusiasm, that “Ok, tell me more trainer” and the chapter is dedicated to trainer’s
about it feeling. preparation around three pillars: background,
I particularly enjoyed Chapter three – “Training pedagogy and shape.
delivery” and from the title you would expect a The entire book focuses not just on information,
“How to” section, but no, imagine this book as a methods and exercises but on people as well:
maze, you know where you enter to, you learn from the trainer to participants and the
how to get out and you will receive all the tools organization – which in Romania are timidly
in order to find the way out, but the process will beginning to have a culture of learning.
amaze you. And this is the correct word for this
Chapter: amazing! When you start to read this At the end of each chapter, the reader can find a
chapter the first sentence is: “When we prepare References section, examples of exercises, tools
a training, we start thinking about it as a journey. to be used in trainings and a practice area where
IT has a starting point where we meet our trip the reader is invited to be part of the journey.
partners, we warm up and we look on the map to
see where we need to arrive. Then we start the If you are not a learning and development
journey, and we follow some rules to make sure specialist like me, maybe your question will be:
everybody is with us, the guides. And at the end, “Why to buy this book?”
we say goodbye to each other and take with us My answer to you will be: you should buy it for
the things we learned during the journey, in order your own personal development, because we
to share them and practice them further. learn something each day and with each
The reader will be amazed how good this experience we encounter in live we can easily
sentence summarizes the entire chapter: the become trainers for our children, clients,
opening, the group rules, the warm up for the students etc. And most of the exercises and
training and the warm up for the specific subject, information found in this book can be easily used
expectations, everybody’s learning style - to in day to day practice.
make sure “everybody is with us, the guides”, The learning process is not just for organizations,
training delivery and techniques of delivery, is for everybody, every day in our life.
group dynamics and visual facilitation.

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80 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021

WAPP NEWS

- July 2021
Dear WAPP members,
Dear friends and supporters of Positive Psychotherapy worldwide,

Over the past six months, the WAPP Board of Directors and the Head Office –
with much support of our members – have implemented many innovative ideas
and developed existing projects:

✓ WAPP has launched a course monitoring system.

✓ The WAPP Board has developed an information leaflet on self-discovery.

✓ An international edition of a Textbook on “Psychodynamic Positive

Psychotherapy” is in the process of being published, and will soon be
translated into many languages.

✓ The WAPP Board of Directors has developed criteria for the admittance
of Master Course participats.

✓ WAPP president Dr. Hamid Peseschkian has been appointed to the

Council of the International Federation of Psychotherapy (IFP).

✓ Two online meetings with trainers, one of them was dedicated to self-
discovery.

✓ One online meeting with centers and organizers of PPT courses.

✓ Monthly online meetings of the WAPP Board of Directors.

✓ Preparation of international online and offline conferences.

As well as other significant news, please find below.

WAPP establishment of Committees

The World Association for Positive and Transcultural Psychotherapy (WAPP) has
formed 4 Committees to discuss and work on the following four main topics of
our organization: Governance; Membership; Training; Publications.

Our Association has grown to about 1,900 members in 36 countries this year.
The topics become more complex and wider. The WAPP Board of Directors
meets once a month by video conference to discuss a constantly enlarging
number of issues. Still, many subjects need a closer look and research – and
most important – different views and opinions.

Therefore, the Board has appointed some colleagues among our members to
help us bring our Association to the next level. 19 of the nominated members
volunteered to join the Committees. Together with the Board members they
form the following groups of 27 persons from 12 countries:

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81 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021

There will be more committees, subgroups of the committees, or working

groups for which we will be happy to find volunteers in the future.

The new possibility of meeting online over continents and time zones enables
us to consult and meet more frequently and to finally get things started.

A first meeting of all Committees took place in May, subsequent meetings of the
Committees are now frequently taking place and are very fruitful and inspiring.
Their ideas and suggestions are presented to the WAPP Board and, if approved,
are realized in close cooperation of Committees, Board, and Head Office.

We very much look forward to the new developments the work of our new
Committees will bring.

Many thanks to all of you who fill this organization with life and experience –
and special thanks to our new Committee members for your readiness and for
adding your ideas!

WAPP by-elections

Due to the resignation of a Board member a by-election was needed. The Board
was calling for an extraordinary (online) assembly meeting, which was held by
Zoom on 29 of April 2021.

Altogether we had 11 nominations for

members from 8 countries, of who 7 were
ready to candidate for the WAPP Board.
Thank you for nominating them and
showing them your trust and respect. The
election was only possible by electronic
vote and took place in April. 311 members
eligible to vote participated in the
election.

The newly elected member is Dr. Stefanka

Tomcheva from Bulgaria. More than 50
members from 3 continents participated
in the extraordinary (online) assembly on
29 April, in which the by-election results
were announced.

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82 THE GLOBAL PSYCHOTHERAPIST. Volume 1. Number 2. July 2021

Brand new website launching

WAPP has released a brand new website

(www.positum.org). It is more contemporary,
easy to navigate, and full of useful
information.

There is a special section ”Publications”

where we’ve collected all available PPT
publications: books, articles, presentations,
training and promo materials.

You can filter it by type and language.

Of course, the new website again has the

member list sorted by countries and other
features you were used to on the old website.

It also has a member login that allows WAPP

members to get more information than other
users of the site. It offers more news, training
materials, details on publications and articles.

International Training Seminar (ITS) 2021 – Registration is open

We are happy to announce the

next International Online
Conference on PPT: 9-10 October
2021. Due to the pandemic the
ITS will again take place online via
Zoom.

Registration is open – Register>>

9 October 2021 – Trainers day: only for trainers and candidate trainers - plenary
meetings, seminars, workshops on trainer and training related topics and self-
discovery groups.

10 October 2021 – Open day: plenary meetings and workshops - open for
everyone.

Seminar language will be English and partly Russian, translation for individual
presentations needs to be organized by presenter, translation to other
languages please also organize yourself. More information about the scientific
program is on our website.

We are delighted to see the growth of the WAPP community as well as the
increase of the quality of PPT trainings all over the world. Despite the COVID-
19 pandemic, WAPP remains continually active thanks to members
contributing time and expertise.

With deep gratitude

WAPP Board of Directors and Head Office

World Association for Positive and Transcultural Psychotherapy (WAPP)

WAPP Head Office • Luisenstrasse 28 • 65185 Wiesbaden • Germany
Tel. +49-6 11-450 34 40 • Email: [email protected] • Website: www.positum.org

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 INFORMATION AND GUIDELINES FOR AUTHORS

Full and up-to-date “Information and Guidelines for Authors” are on the JGP website:
https://www.positum.org/ppt-journal/

The Global Psychotherapist (JGP) is an interdisciplinary digital journal devoted to

Positive Psychotherapy (PPT after Peseschkian, since 1977)™. This peer-reviewed semi-
annual journal publishes articles on experiences with and the application of the
humanistic-psychodynamic method of Positive and Transcultural Psychotherapy.
Topics range from research articles on theoretical and clinical issues, systematic
reviews, innovations, case management articles, different aspects of
psychotherapeutic training and education, applications of PPT in counselling,
education, and management, letters to the editors, book reviews, etc. There is a
special section devoted to young professionals that aims to encourage young
colleagues to publish. The Journal welcomes manuscripts from different cultures and
countries.

The languages of articles are: English and Russian. Each article must have abstracts in
English and for Russian articles – in English and Russian.
For English language editing, authors may ask our English language editor, Dr.
Dorothea Martin (USA/Albania), for assistance. This service is free-of-charge for
authors. But, this is only for editing, not for translation – email
via [email protected].

Review Process: All manuscript submissions - except for short book reviews - will be
anonymised and sent to at least 2 independent referees for ‘double-blind’ peer-
reviews. Their reviews (also anonymised) will then be submitted back to the author.

Submissions can only be sent by an email attachment in DOC, DOCX, RTF format
to [email protected].
For article’s formatting, including information about the authors, the Editorials ask
authors to use special templates.

• For scientific sections: Template for scientific articles

• For practical sections: Template for practical articles
• Book reviews and letters are accepted in free form.
An author can publish only one paper per issue.

In exceptional circumstances, longer articles (or variations on these guidelines) may be

considered by the editors, however, authors will need a specific approval from the
Editors in advance of their submission. (We usually allow a 10%+/- margin of error on
word counts.)

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 References: The author must list references alphabetically at the end of the article, or
on a separate sheet(s), using a basic Harvard-APA Style. The list of references should
refer only to those references that appear in the text e.g. (Fairbairn, 1941) or
(Grostein, 1981; Ryle & Cowmeadow, 1992): literature reviews and wider
bibliographies are not accepted. Details of the common Harvard-APA style can be sent
to you on request or are available on various websites.

In essence, the following format is used, with exact capitalisation, italics and
punctuation.

Here are three basic examples:

[1] For journal / periodical articles (titles of journals should not be abbreviated):

FAIRBAIRN, W.R.D. (1941). A revised psychopathology of the psychoses and neuro-

psychoses. International Journal of Psychoanalysis, Vol. 22, pp. 250-279.

[2] For books:

PESESCHKIAN, N. (2016). Positive Psychosomatics: Clinical Manual of Positive

Psychotherapy, Bloomington, USA: AuthorHouse UK.

[3] For non-English resources:

ШПИГЕЛЬБЕРГ, Г. М. [SPIEGELBERG, H. M.] (2002). Феноменологическое движение.

Историческое введение [Phenomenological movement. Historical introduction]. М.:
"Логос". 608 c.

[4] For chapters within multi-authored books:

PESESCHKIAN H., REMMERS A. (2020) Positive Psychotherapy: An Introduction. In:

Messias E., Peseschkian H., Cagande C. (eds), Positive Psychiatry, Psychotherapy and
Psychology, (pp. 3-9). Springer, Cham.

Frequency and Copyright

The journal is published twice a year. The copyright of all published articles is with the
World Association of Positive and Transcultural Psychotherapy. The Editorial Board of
the Journal reserves the right to proofread the articles, submitted for publishing.

Further Information and contact details are available on the JGP website:
https://www.positum.org/ppt-journal/

ISSN 2710-1460 © WAPP Publishing

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