Abstract
Introduction. The article draws attention to the difference between psychiatric and psychotherapeutic approaches to treating and diagnosing mental disorders. These approaches rely on different definitions of norm and also treatment goals and methods. Given the lack of critical attention paid to such a difference in the literature and clinical practice, this issue merits special attention. The paper presents a generalized model for the process of psychotherapeutic diagnosis and treatment.
Theoretical Basis. The study rested upon the principle of complementarity formulated by the physicist N. Bohr in quantum mechanics for systematization of the data received in different circumstances of observation by the observers with different attitudes. Thus, the psychiatric approach and psychotherapy were considered not only as different and relatively independent but also as complementary modes of working with patients.
Discussion. The generalized model for the process of psychotherapeutic diagnosis and treatment demonstrated differences between diagnosis and treatment in psychotherapy and psychiatry. When practicing psychotherapy and training young psychotherapists, the three main kinds of psychotherapy (psychodynamic, humanistic, and cognitive behavioural) should be considered as complementary and also independent integral models. For effective treatment, clinicians must consider each patient separately within the psychiatric and psychotherapeutic approaches, switching from one perspective to another.
Conclusion. The new approach (a) can be readily used in practice to make the psychiatric and psychotherapeutic models more logical, clear, free from contradictions, and focused on the relationship and (b) contributes to the development of these models.
References
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Greenson R. The techniques and practice of psychoanalysis (Russ. ed.: Grinson R. Tekhnika i praktika psikhoanaliza. Moscow, Kogito-Tsentr Publ., 2010. 480 p.).
Bird B. Notes on transference: universal phenomenon and hardest part of analysis. In: A. H. Esman (ed.) Essential papers on transference. New York, New York University Press, 1990, pp. 331–361. DOI: 10.1177/000306517202000203
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Erikson E. Childhood and society (Russ. ed.: Erikson E. Detstvo i obshchestvo. St. Petersburg, Universitetskaya kniga Publ., 1996. 592 p.).
Nardone, D., Waclawik P. The art of rapid change. Short-term strategic therapy (Russ. ed.: Nardone D., Vatslavik P. Iskusstvo bystrykh izmenenii. Kratkosrochnaya strategicheskaya terapiya. Moscow, Institute of Psychotherapy Publ., 2006. 195 p.).
Jones E. E., Pulos S. M. Comparing the process in psychodynamic and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 1993, V. 61, no. 2, pp. 306–316. DOI: 10.1037//0022-006X.61.2.306
Milton J. Psychoanalysis and cognitive behaviour therapy – rival paradigms or common ground? The International Journal of Psychoanalysis, 2001, V. 82, Issue 3, pp. 431–447. DOI: 10.1516/DVLN-RK5E-C1YV-ME4V
Wiser S., Goldfried M. Verbal interventions in significant psychodynamic-interpersonal and cognitive-behavioral therapy sessions. Psychotherapy Research, 1996, no. 6, pp. 309–319.
Bobrov A. E. Metodologicheskie aspekty izucheniya psikhosomaticheskikh sootnoshenii i perspektivy integrativnoi meditsiny [Methodological aspects of studying psychosomatic interrelations and the future of integrative medicine]. Trudy XI mezhdunarodnogo kongressa: Psikhosomaticheskaya meditsina – 2016 [Proc. the 11th International Congress “Psychosomatic medicine 2016”]. St. Petersburg, Chelovek Publ., 2016, pp. 6–9.
Kurpatov V. I., Gladyshenko A. V. Krizis ili kollaps rossiiskoi psikhoterapii? [Russian psychotherapy: crisis vs. collapse]. Trudy XI mezhdunarodnogo kongressa: Psikhosomaticheskaya meditsina – 2016 [Proc. the 11th International Congress “Psychosomatic medicine 2016”]. St. Petersburg, Chelovek Publ., 2016, pp. 33–37.
Tiganov A. S. (ed.) Psikhiatriya. Rukovodstvo dlya vrachei v dvukh tomakh [Psychiatry: A guide for physicians in two volumes]. Moscow, Meditsina Publ., 2012, V. 1. 807 p.
Wampold B. E., Imel Z. E. The great psychotherapy debate: The evidence for what makes psychotherapy work. New York, London, Routledge, 2015. 334 p.
Prokhazka Dzh., Norkross Dzh. Sistemy psikhoterapii [Psychotherapy systems]. St. Petersburg, Praim-Evroznak Publ., 2007. 384 p.
Bugental, J. F. T. The art of the psychotherapist (Russ. ed.: B'yudzhental' D. Iskusstvo psikhoterapevta. St. Petersburg, Korvet Publ., 2011. 316 p.).
Kohut H. The restoration of the self (Russ. ed.: Kokhut Kh. Vosstanovlenie samosti. Moscow, Kogito-Tsentr Publ., 2017. 320 p.).
Stolorow, R. D., Brandchaft, B., & Atwood, G. E. Psychoanalytic treatment: An intersubjective approach (Russ. ed.: Stolorou R., Brandshaft B., Atvud D. Klinicheskii psikhoanaliz. Intersub"ektivnyi podkhod. Moscow, Kogito-Tsentr Publ., 2011. 256 p.).
Yalom I. D. The theory and practice of group psychotherapy (Russ. ed.: Yalom I. Teoriya i praktika gruppovoi psikhoterapii. St.Petersburg, Piter Publ., 2000. 640 p.).
Caligor E., Kernberg O. F., Clarkin J. Handbook of dynamic psychotherapy for higher level personality pathology. Arlington, American Psychiatric Publishing, 2007. 284 p.
Clarkin J. F., Yeomans F. E., Kernberg O. F. Transference-focused psychotherapy for borderline personality disorder: A clinical guide. Arlington, American Psychiatric Publishing, 2015. 427 p.
Bohr N. The quantum of action and the description of nature (Russ. ed.: Bor N. Kvant deistviya i opisanie prirody. Izbrannye trudy: v 2 tomakh. Moscow, Nauka Publ., 1971, V. 2, pp. 56–61).
Bohr N. Quantum physics and philosophy (Russ. ed.: Bor N. Kvantovaya fizika i filosofiya. Izbrannye nauchnye trudy: v 2 tomakh. Moscow, Nauka Publ., 1971. V. 2, pp. 526–532. DOI: 10.3367/UFNr.0067.195901c.0037).
Reshetnikov M. M. Contemporary psychotherapy: Medical and psychological model. Vestnik psikhoterapii – Bulletin of Psychotherapy, 2016, no. 60 (65), pp. 7–16 (in Russian).
Mack-Williams N. Psychoanalytic diagnosis: understanding personality structure in the clinical process (Russ. ed.: Mak-Vil'yams N. Psikhoanaliticheskaya diagnostika: ponimanie struktury lichnosti v klinicheskom protsesse. Moscow, Klass Publ., 2015. 592 p.).
Kernberg O. F. Borderline conditions and pathological narcissism. New York, Jason Aronson, 1975. 376 p.
Kernberg O. Borderline personality organization. In: M. H. Stone (ed.) Essential papers on borderline disorders. New York, New York University Press, 1986, pp. 279–320. DOI: 10.1177/000306516701500309
Freud Z. Introductory lectures on psychoanalysis (Russ. ed.: Freid Z. Vvedenie v psikhoanaliz: Lektsii. Moscow, Nauka Publ., 1989. 456 p.).
Malan D. H. Toward the validation of dynamic psychotherapy: a replication. New York, Plenum Medical Books, 1976. 298 p.
Beck J. Cognitive therapy: Basics and beyond (Russ. ed.: Kognitivnaya terapiya. Polnoe rukovodstvo. Moscow, Dialektika-Vil'yams Publ., 2017. 400 p.).
Rogers C. R. Client-centered therapy: Its current practice, implications and theory (Russ. ed.: Klient-tsentrirovannaya psikhoterapiya: teoriya, praktika i primenenie. Moscow, Psikhoterapiya Publ., 2007. 560 p.).
Siemens H. Guidance for Gestalt therapists (Russ. ed.: Prakticheskoe rukovodstvo dlya Geshtal'tterapevtov. St.Petersburg, Izdatel'stvo Pirozhkova Publ., 2008. 168 p.).
Perls F., Hefferline R., Goodman P. Gestalt therapy: Excitement and growth in the human personality (Russ. ed.: Perlz F., Khefferlin R., Gudmen P. Opyty psikhologii samopoznaniya (praktikum po geshtal'tterapii). Moscow, Gil'-Estel' Publ., 1993. 240 p.).
Zinker, J. (1994). In search of good form: Gestalt therapy with couples and families (Russ. ed.: Zinker D. V poiskakh khoroshei formy. Geshtal't-terapiya s supruzheskimi parami i sem'yami. St. Petersburg, Korvet Publ., 2015. 272 p.).
Strean H. S. Resolving resistances in psychotherapy. New York, Brunner Mazel, 1990. 316 p.
Greenson R. The techniques and practice of psychoanalysis (Russ. ed.: Grinson R. Tekhnika i praktika psikhoanaliza. Moscow, Kogito-Tsentr Publ., 2010. 480 p.).
Bird B. Notes on transference: universal phenomenon and hardest part of analysis. In: A. H. Esman (ed.) Essential papers on transference. New York, New York University Press, 1990, pp. 331–361. DOI: 10.1177/000306517202000203
Freud S. The Dynamics of transference. In: A. H. Esman (ed.) Essential papers on transference. New York, New York University Press, 1990, pp. 28–36.
Greenacre P. The role of transference: practical considerations in relation to psychoanalytic therapy. In: A. H. Esman (ed.) Essential papers on transference. New York. New York University Press, 1990, pp. 124–135. DOI: 10.1177/000306515400200406
Kernberg O. An ego-psychology-object relations theory approach to the transference. In: A. H. Esman (ed.) Essential papers on transference. New York, New York University Press, 1990, pp. 492–510.
Kernberg O. Structural derivatives of object relations. In: P. J. Buckley (ed.) Essential papers on object relations. New York, New York University Press, 1986, pp. 309–342.
Stone L. The transference-countertransference complex. In: B. Wolstein (ed.) Essential papers on transference. New York, New York University Press, 1988, pp. 270–281.
Winnicott D. W. Counter-transference. In: B. Wolstein (ed.) Essential papers on transference. New York, New York University Press, 1988, pp. 262–269. DOI: 10.1111/j.2044-8341.1960.tb01220.x
Erikson E. Childhood and society (Russ. ed.: Erikson E. Detstvo i obshchestvo. St. Petersburg, Universitetskaya kniga Publ., 1996. 592 p.).
Nardone, D., Waclawik P. The art of rapid change. Short-term strategic therapy (Russ. ed.: Nardone D., Vatslavik P. Iskusstvo bystrykh izmenenii. Kratkosrochnaya strategicheskaya terapiya. Moscow, Institute of Psychotherapy Publ., 2006. 195 p.).
Jones E. E., Pulos S. M. Comparing the process in psychodynamic and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 1993, V. 61, no. 2, pp. 306–316. DOI: 10.1037//0022-006X.61.2.306
Milton J. Psychoanalysis and cognitive behaviour therapy – rival paradigms or common ground? The International Journal of Psychoanalysis, 2001, V. 82, Issue 3, pp. 431–447. DOI: 10.1516/DVLN-RK5E-C1YV-ME4V
Wiser S., Goldfried M. Verbal interventions in significant psychodynamic-interpersonal and cognitive-behavioral therapy sessions. Psychotherapy Research, 1996, no. 6, pp. 309–319.
Bobrov A. E. Metodologicheskie aspekty izucheniya psikhosomaticheskikh sootnoshenii i perspektivy integrativnoi meditsiny [Methodological aspects of studying psychosomatic interrelations and the future of integrative medicine]. Trudy XI mezhdunarodnogo kongressa: Psikhosomaticheskaya meditsina – 2016 [Proc. the 11th International Congress “Psychosomatic medicine 2016”]. St. Petersburg, Chelovek Publ., 2016, pp. 6–9.
Kurpatov V. I., Gladyshenko A. V. Krizis ili kollaps rossiiskoi psikhoterapii? [Russian psychotherapy: crisis vs. collapse]. Trudy XI mezhdunarodnogo kongressa: Psikhosomaticheskaya meditsina – 2016 [Proc. the 11th International Congress “Psychosomatic medicine 2016”]. St. Petersburg, Chelovek Publ., 2016, pp. 33–37.