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Сессии 8-121. Возложить на пациента бóльшую ответственность за определение повестки дня. 2. Делегировать пациенту ответственность за разработку и выполнение домашних заданий. 3. Выявление и обсуждение базовых убеждений. Проверка валидности убеждений. Заключительные сессии 13-15 (вплоть до 20) 1. Готовить пациента к завершению терапии. 2. Делать упор на том, что и по завершении терапии пациент должен практиковаться в применении поведенческих и когнитивных техник. Объяснять пациенту, что психотерапия — это обучающий процесс, который продолжается всю жизнь. 3. Обговорить с пациентом, какие проблемы он предвидит в будущем и как он может разрешить их. Литература. Adler, A. What life should mean to you (A. Porter, Ed.). New York: Capricorn, 1958. (Originally published, 1931.) Akiskal, H. S., Bitar, A. H., Puzantian, V. R., Rosenthal, T. L., and Walker, P. W. The nosological status of neurotic depression. Archives of General Psychiatry, 1978, 35, 756-766. Alexander, F. 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Journal of Nervous and Mental Disease, 1970, 150, 466-478. Koranyi, E. K. Physical health and illness in psychiatric outpatient department populations. Canadian Psychiatric Association Journal, 1972, 17, 109-113. Kovacs, M., Beck, А. Т., and Weissman, A. The Use of Suicidal Motives in the Psychotherapy of Attempted Suicides. American Journal of Psychotherapy,1975, 29, 363-368. Kovacs, M., Rush, A. J., Beck, А. Т., and Hollon, S. D. Comparative efficacy of cognitive therapy and pharmacotherapy in treatment of depressed outpatients: A 12-month follow-up. Unpublished manuscript, University of Pittsburgh, 1978. Kuhn, T. S. The structure of scientific revolutions. Chicago: University of Chicago Press, 1962. Lazarus, A. Behavior therapy and beyond. New York: McGraw-Hill, 1972. Lazarus, A., and Fay, A. I can if I want to. New York: William Morrow and Co., Inc., 1975. Lazarus, R. Psychological stress and the coping process. New York: McGraw-Hill, 1966. Leff, M. J., Roatch, J. 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Experimental analysis of a cognitive-behavior therapy for depression. Cognitive Therapy and Research, 1977, 1, 59-72. Weimer, W. В., and Palermo, D. S. (Eds.). Cognition and the symbolic processes. Hillsdale, N. J.: Lawrence Erlbaum, 1974. Wolfe, J., and Fodor, I. A cognitive-behavioral approach to modifying assertive behavior in women. The Counseling Psychologist, 1975, 5, 45-52. Yalom, I. D. The theory and practice of group psychotherapy. New York: Basic Books 1970. Yessler, P. G., Gibbs, J. J., and Becker, H. A. Communication of suicidal ideas. Archives of General Psychiatry,1961, 5, 12-29. [1] Бустер (англ. booster) — вспомогательное устройство для увеличения силы тяги и скорости действия основного механизма. — Примеч. пер. [2] Курсив наш. [3] Исчерпывающее изложение общих принципов и частных процедур когнитивной терапии содержится в Приложении. Эта форма, включающая раздел «Личные и профессиональные качества терапевта», может быть использована и в качестве руководства по проведению интервью, и для оценки проведенных интервью. [4] Симптомом-мишенью можно считать любой компонент депрессии, вызывающий страдания у пациента и мешающий его нормальному функционированию. Разнообразные симптомы-мишени могут быть сведены в следующие категории (более подробное описание категорий содержится в работе Beck, 1967, pp. 10-43). [5] Заметьте, что пациент исходит из иррационального убеждения, которое звучит примерно так: «Если у меня не получается достигнуть совершенства во всех начинаниях — значит я неумеха и неудачник». Однако терапевт не спешит корректировать заблуждения пациента — эта задача будет поставлена позже, когда состояние пациента улучшится. Сейчас же терапевт ставит своей целью внести коррективы в восприятие пациента. [6] Подготовив себя таким образом к каждому из «препятствий», пациентка смогла — мысленно — доехать до спортивного клуба. Затем терапевт попросил ее еще раз мысленно проделать всю последовательность шагов. Через некоторое время пациентка возобновила занятия аэробикой. Терапевт проинструктировал ее, что в случае возникновения каких-то проблем она должна попытаться решить их на месте, а затем рассказать о них на сессии. [7] В ответ на это возражение Эллис (личное письмо, 1978) пишет: «РЭТ [рационально-эмотивная терапия] не исключает построения "прочной базы данных" и проверки обоснованности выводов пациента. Хотя такая задача впрямую не ставится перед РЭТ-терапевтом, никто не запрещает ему заняться сбором фактических данных. Во многих случаях я выстроил бы диалог с пациентом, следуя той же модели, из какой исходит ваш терапевт; в других случаях я, вероятно, предпочел бы обсудить с пациентом его самооценку или склонность к катастрофическому восприятию ситуаций — и в ходе этого обсуждения собрал бы ту же самую "базу данных". Я допускаю также, что терапевт может подвести пациента к самоприятию и отказу от катастрофического истолкования действительности с помощью совершенно иной информации, отличной от той, которую собирал ваш терапевт. Рационально-эмотивная модель не регламентирует способы опроса пациента и пути обсуждения проблем». [8] В тех случаях, когда пациент не в состоянии вычленить наиболее беспокоящие симптомы или более или менее вразумительно обозначить свои проблемы, терапевт может воспользоваться «Шкалой депрессии» (Beck, 1967, 1978). Практически каждый пункт данного опросника может открыть доступ к искаженным или дисфункциональным представлениям пациента. [9] В английском языке слово vile означает «подлый», «отвратительный». — Примеч. пер. [10] Survey, Question, Read, Recite and Review,что буквально переводится как «просмотр, вопросы, чтение, пересказ, обзор». — Примеч. пер. [11] На живом организме (лат.). — Примеч. пер. [12] Пятнадцать фунтов составляют приблизительно 6,8 килограмма. — Примеч. пер.
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