Research methods of the cognitive sphere in clinical psychology. The subject and tasks of clinical psychology. Methods used to study attention

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Principles:

Qualitative analysis of the features of the course of mental activity (taking into account not only the results, but also a thorough analysis of the process of activity, errors, compensatory mechanisms, identifying the mechanism of violations).

Modeling of normal mental activity.

Accounting for the personality of the patient, his attitude to the situation of the study.

The complexity of the study, individual selection of methods.

Syndromic analysis of the obtained results.

Accurate and objective registration of symptoms, keeping a study protocol.

Identification of not only disturbed, but also preserved forms of mental activity (positive diagnostics).

The research program depends on the clinical task.

The main principle of the study is the principle of qualitative analysis of the specifics of the course of mental processes in patients. In domestic psychology, it is believed that due to the fact that mental processes are formed in vivo in the process of appropriating socio-historical experience, in the process of activity, communication - the experiment should be directed not to research and measurement of individual mental functions, but to the research of a person who performs real activity , to identify the mechanisms of violations of activity and approaches to its restoration.

The analysis of pathopsychological data should be not only qualitative, but also systemic. In pathopsychology, it is necessary to carry out an analysis not so much symptomatic as syndromic (according to Luria). An experimental pathopsychological study should be, as it were, an agent that provokes the manifestation of the originality of the patient's mental activity and his relationship to the environment and himself.

The preparatory stage takes place before the meeting of the psychologist with the future subject. Its purpose is to plan future empirical research. To do this, the psychologist solves two problems: 1) to build a research program (scheme) and 2) to obtain preliminary data about the future subject.

The purpose of the second stage of pathopsychological research is the collection of empirical data. At this stage, the psychologist interacts directly with the subject, an experiment is carried out, a conversation and observation of the patient in the process of communication and performing tasks.

An important requirement for conducting an EPI is careful record keeping. The research protocols should note the behavior of the subject, his understanding of the instructions, as well as everything related to the task.

The final stage of the study is the analysis of the obtained empirical facts, their generalization and interpretation. All empirical data obtained by the psychologist during the research are analyzed: the data of the conversation, observations and, of course, the results of all experimental tests. The analysis of experimental data should proceed similarly to clinical analysis - from symptom to syndrome.

As a result of the analysis, the pathopsychologist establishes a psychological diagnosis.

Based on the analysis of the results of the study, a conclusion is drawn up, which in writing reflects and substantiates the characteristics of the identified pathopsychological syndrome.

The conclusion according to the experimental psychological study, according to Zeigarnik, S. Ya. Rubinshtein and others, cannot be standard, since the pathopsychological study itself is generally not standard. The conclusion is essentially a product of the psychologist's creative thinking about the specific task that is significant for the clinic.

The main part of the conclusion should contain information about the nature of the cognitive activity of the subject, that is, about the features of thinking, memory, attention, the rate of his sensorimotor reactions, the presence or absence of signs of increased exhaustion found during the study. Be sure to describe the features of the personal-emotional sphere identified in the study.

Based on the analysis of experimental data, it is necessary to highlight the leading pathopsychological features, and specific data from the protocols can be used as illustrations confirming the qualification of the violation.

At the end of the conclusion, the most important data obtained during the study are summarized, characterizing the features of the violation of mental activity and the personality of the subject, that is, a reasoned qualification of the pathopsychological syndrome is given.

Arrangement of stresses: CLINICAL METHOD in psychology

CLINICAL METHOD in psychology - a more or less long-term study of personality, including both observation and the use of other, in particular experimental, methods with the aim of a more in-depth study of various aspects of the personality and the formulation of psychological. diagnosis. K. m. in psychology is used in the study of both mentally healthy people (to study the patterns of personality development), and in cases of various mental disorders. processes. When studying a healthy person, K. m. is most often used to study the patterns of development of mental health. processes in children. age (see Child psychology). In this case, a long ("longitudinal") study of the child is combined with special. psychological samples and with a thorough questioning of the child (this variant of K. m. was used, for example, by the Swiss psychologist Zh. Piaget and his collaborators in the study of the thinking of the child).

Beginning of the special the development of K. m. in psychology in the study of the sick psyche and in particular the use of experimental psychological as part of this method. the technique was put in Germany in psychiatric. clinic of E. Kraepelin (1856 - 1926). The further development of K. m. is associated with the names of E. Bleiler- in Switzerland, K. Goldstein - in the USA, etc. In Russia, the first experimental psychological. the laboratory as part of the clinic was created by V. M. Bekhterev in 1885 in Kazan. S. S. Korsakov, A. A. Tokarskii, G. I. Rossolimo, A. N. Bernstein, and L. S. Vygotsky. Favorable conditions for the development of K. m. were created by the penetration into the psychology of Sechenov's and Pavlovian ideas of nervism, on the basis of which K. m. is being developed in a number of neurological. and psychiatric. institutions (A. R. Luria, B. V. Zeigarnik, V. N. Myasishchev and etc.).

K. m. is used in defectology, for the purpose of differential diagnosis of abnormal children to be sent to special. schools, as well as in psychiatric., neurological. and neurosurgical clinics. Used by K. m. also for the purpose of forensic medical. and labor expertise.

Usually, when studying the sick psyche, K. m. is used in the system of a comprehensive study, when, along with the study of anamnestic. data and clinical observation includes neurological. and physiological. research. With such a comprehensive study, K. m. acts not only as an essential means of differential diagnosis of mental disorders. activities, but also as a way to control the progress of development of corrective or compensatory-restorative work, as well as to identify the most effective methods and techniques of such work.

Experimental psychology. the techniques used when using K. m. can be divided into several groups: techniques aimed at studying the state of the auditory, visual, kinesthetic. and the motive analysis and synthesis, violations to-rykh can be caused by defeat of this or that department of a brain; these techniques provide initial indicative data for further study, which includes: techniques aimed at analyzing cognitive activity (perception, representations, memory, thinking, speech, attention), techniques for studying the emotional-volitional sphere.

The most developed methods for studying cognitive activity (reproducing stories, explaining plot pictures, classifying objects, highlighting essential features of concepts, etc.). Methods for studying the emotional and volitional spheres have been developed to the least extent.

K. m. suggests an individualized approach to the choice of research methods, depending on the characteristics of the person being studied and the results obtained.

Lit.: Bernstein A. N., Clinical methods of psychological research of the mentally ill, 2nd ed., M., 1922; Luria A. R., Traumatic aphasia, M., 1947; his, Higher cortical functions of a person and their disturbances in local brain lesions, M., 1962; Principles of selection of children in auxiliary schools. Ed. G. M. Dulneva and A. R. Luria. Moscow, 1960. Zeigarnik B. V., Pathology of thinking, M., 1962; Rubinshtein S. Ya., Methods of experimental pathopsychology. Method. allowance, M., 1962; Kononova M. P., Guidelines for the psychological study of mentally ill children of school age, M., 1963; Rey A., Monographies de psychologie Clinique, Neuchatel - P., 1952; Contributions towards medical psychology, ed. by A. Weider, v. 1 - 2, N.Y., ; Handbuch der klinischen Psychology, hrsg. von E. Stern, Bd 1-2, Z#252;rich, 1954-55; Louttit S. M., Clinical psychology of exceptional children, 3 ed., N. Y., ; Handbook of abnormal psychology, ed. by H. J. Eysenck, N. Y., ; Meili R., Lehrbuch der psychologischen Diagnostik, 4 Aufl., Bern-Stuttg., .

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RESEARCH METHODS IN CLINICAL PSYCHOLOGY

The choice of research methods used by a clinical psychologist is determined by the tasks that arise before him in the performance of his professional duties. The diagnostic function dictates the use of psychological methods (batteries of tests, questionnaires, etc.) that can assess both the activity of individual mental functions, individual psychological characteristics, and differentiate psychological phenomena and psychopathological symptoms and syndromes. The psycho-corrective function implies the use of various scales, on the basis of which it is possible to analyze the effectiveness of psycho-corrective and psychotherapeutic methods. The selection of the necessary methods is carried out depending on the goals of the psychological examination; individual characteristics of the mental, as well as the somatic state of the subject; his age; profession and level of education; time and place of the study. All kinds of research methods in clinical psychology can be divided into three groups: 1) clinical interviewing, 2) experimental psychological research methods, 3) evaluation of the effectiveness of psycho-correctional influence. Let's dwell on them in more detail.

Clinical interview

We are aware of how difficult the unification and schematization of the creative process is, and yet interviewing can rightly be called creativity. In this regard, we are aware of the limits of our capabilities and do not pretend to find the ultimate truth. Each psychologist has the right to choose from a variety of existing ones the most suitable for him (his character, interests, preferences, level of sociability, worldview, culture, etc.) method of interviewing a client (patient). Therefore, the proposed text and the thoughts embodied in it should be considered as another possibility, another option that can satisfy the discerning reader and lead to the application of the provisions of this particular guide in practice.

If the information is capable of causing rejection, then it is up to the reader to continue searching for the most appropriate guide to clinical method in clinical psychology.

One of the main goals of clinical interviewing is to assess the individual psychological characteristics of a client or patient, to rank the identified features in terms of quality, strength and severity, and to classify them as psychological phenomena or psychopathological symptoms.

The term "interview" has entered the lexicon of clinical psychologists recently. More often they talk about a clinical questioning or conversation, the description of which in scientific works is overwhelmingly descriptive, sententious. Recommendations, as a rule, are given in an imperative tone and are aimed at forming undoubtedly important moral qualities of a diagnostician. In well-known publications and monographs, a clinical method for assessing a person’s mental state and diagnosing mental deviations in him is given without describing the actual methodology (principles and procedures) of questioning, which takes the recommendations given beyond the scope of scientific ones and available for effective reproduction. It turns out a paradoxical situation: it is possible to learn clinical examination and diagnostics only experimentally, participating as an observer-student in conversations with clients of well-known and recognized authorities in the field of diagnostics and interviewing.

Digressing from the main topic, I would like to note that, unfortunately, in the field of diagnostics there is and has a lot of fans even among professionals in diagnosing mental disorders without interviewing. That is, the diagnosis is made in absentia, without a direct meeting of the doctor with the alleged patient. This practice is becoming fashionable in our time. Diagnoses of mental illness based on an analysis of human actions known to the doctor by hearsay or from the lips of non-specialists, psychopathological interpretations of the texts of the “suspects” (letters, poems, prose, once abandoned phrases) only discredit the clinical method.

Another distinctive feature of modern practical psychology has become the belief in the omnipotence of experimental psychological methods in the diagnostic plan. A large army of psychologists is convinced that they are able to identify mental abnormalities and delimit the norm from pathology with the help of various tests. Such a widespread misconception leads to the fact that the psychologist often turns himself into a fortune-teller, into a conjurer, from whom those around him expect to demonstrate a miracle and solve miracles.

True diagnostics of both mental deviations and individual psychological characteristics of a person must necessarily combine diagnostics in the narrow sense of the term and a direct examination by a psychologist of a client (patient), i.e. interviewing.

Currently, the diagnostic process is completely at the mercy of psychiatrists. This cannot be considered fair, since the doctor, first of all, is aimed at finding a symptom, and not at the actual differentiation of a symptom and a phenomenon. In addition, due to tradition, the psychiatrist is little aware of the manifestations of healthy mental activity. It is precisely because of these features that it can be considered reasonable to involve a clinical psychologist in the diagnostic process in the form of interviews to assess the mental state of the subjects.

A clinical interview is a method of obtaining information about the individual psychological properties of a person, psychological phenomena and psychopathological symptoms and syndromes, the internal picture of the patient's illness and the structure of the client's problem, as well as a method of psychological impact on a person, produced directly on the basis of personal contact between the psychologist and the client.

The interview differs from the usual questioning in that it is aimed not only at complaints actively presented by a person, but also at revealing the hidden motives of a person’s behavior and helping him to realize the true (internal) grounds for an altered mental state. The psychological support of the client (patient) is also considered essential for the interview.

The functions of the interview in clinical psychology are: diagnostic and therapeutic. They should be carried out in parallel, since only their combination can lead to the desired result for the psychologist - the recovery and rehabilitation of the patient. In this respect, the practice of clinical questioning, ignoring the psychotherapeutic function, turns the doctor or psychologist into an extra, whose role could be successfully performed by a computer.

Clients and patients often cannot accurately describe their condition and formulate complaints and problems. That is why the ability to listen to the presentation of a person's problems is only part of the interview, the second is the ability to tactfully help him formulate his problem, make him understand the origins of psychological discomfort - crystallize the problem. “Speech is given to a person in order to better understand himself,” wrote L. Vygotsky, and this understanding through verbalization in the process of a clinical interview can be considered essential and fundamental.

The principles of a clinical interview are: unambiguity, accuracy and accessibility of wording questions; adequacy, consistency (algorithmicity); flexibility, impartiality of the survey; verifiability of the received information.

The principle of unambiguity and accuracy in the framework of a clinical interview is understood as the correct, correct and precise formulation of questions. An example of ambiguity is such a question addressed to the patient: “Do you experience a mental impact on yourself?” An affirmative answer to this question does not give the diagnostician practically anything, since it can be interpreted in various ways. The patient could mean by "impact" both ordinary human experiences, events, people around him, and, for example, "energy vampirism", the impact of aliens, etc. This question is inaccurate and ambiguous, therefore uninformative and redundant.

The principle of accessibility is based on several parameters: vocabulary (linguistic), educational, cultural, cultural, linguistic, national, ethnic and other factors. The speech addressed to the patient must be understandable to him, must coincide with his speech practice, based on many traditions. The diagnostician asked: “Do you have hallucinations?” -- may be misunderstood by a person who encounters such a scientific term for the first time. On the other hand, if a patient is asked if he does not hear voices, then his understanding of the word "voices" may be fundamentally different from the doctor's understanding of the same term. Availability is based on an accurate assessment by the diagnostician of the patient's status, the level of his knowledge; vocabulary, subcultural features, jargon practice.

One of the important parameters of the interview is the algorithmization (sequence) of the questioning, based on the knowledge of the diagnostician in the field of compatibility of psychological phenomena and psychopathological symptoms and syndromes; endogenous, psychogenic and exogenous types of response; psychotic and non-psychotic levels of mental disorders. A clinical psychologist must know hundreds of psychopathological symptoms. But if he asks about the presence of every symptom known to him, then this, on the one hand, will take a lot of time and will be tedious for both the patient and the researcher; on the other hand, it will reflect the incompetence of the diagnostician. The sequence is based on the well-known algorithm of psychogenesis: on the basis of the presentation of the first complaints by patients, the story of his relatives, acquaintances, or on the basis of direct observation of his behavior, the first group of phenomena or symptoms is formed. Further, the survey covers the identification of phenomena, symptoms and syndromes that are traditionally combined with those already identified, then the questions should be aimed at assessing the type of response (endogenous, psychogenic or exogenous), the level of disorders and etiological factors. For example, if the presence of auditory hallucinations is the first to be detected, then further questioning is built according to the following algorithm scheme: assessment of the nature of hallucinatory images (the number of "voices", their awareness and criticality, speech features, determining the location of the sound source according to the patient, the time of appearance etc.) - the degree of emotional involvement - the degree of criticality of the patient to hallucinatory manifestations - the presence of thinking disorders (delusional interpretations of "voices") and Further, depending on the qualification of the described phenomena, confirmation of exogenous, endogenous or psychogenic types of response with the help of a survey about the presence of, for example, disorders of consciousness, psychosensory disorders and other manifestations of a certain range of disorders. In addition to the above, the principle of sequence implies a detailed questioning in the longitudinal section: the order in which mental experiences appear and their connection with real circumstances. At the same time, every detail of the story is important, the context of events, experiences, interpretations is important.

The most significant are the principles of verifiability and adequacy of a psychological interview, when, in order to clarify the congruence of concepts and exclude incorrect interpretation of answers, the diagnostician asks questions like: “What do you understand by the word“ voices ”that you hear?” or “Give an example of the ‘voices’ being tested. If necessary, the patient is asked to specify the description of his own experiences.

The principle of impartiality is the basic principle of a phenomenologically oriented psychologist-diagnostician. Imposing on the patient his own idea that he has psychopathological symptoms on the basis of a biased or carelessly conducted interview can occur both due to a conscious attitude, and on the basis of ignorance of the principles of the interview or blind adherence to one of the scientific schools.

Considering the burden of responsibility, primarily moral and ethical, lying on the diagnostician in the process of psychological interview, it seems appropriate for us to cite the main ethical provisions of the American Psychological Association regarding counseling and interviewing:

1. Adhere to confidentiality: respect the rights of the client and his privacy. Do not discuss what he said during interviews with other clients. If you cannot comply with the confidentiality requirements, then you must inform the client about this before the conversation; let him decide for himself whether it is possible to go for it. If information is shared with you that contains information about a danger that threatens a client or society, then ethical regulations allow you to violate confidentiality for the sake of safety. However, one must always remember that, be that as it may, the psychologist's responsibility to the client who trusts him is always primary.

2. Realize the limits of your competence. There is a kind of intoxication that occurs after the psychologist has learned the first few techniques. Beginning psychologists immediately try to delve deeply into the souls of their friends and their clients. This is potentially dangerous. A novice psychologist should work under the supervision of a professional; Seek advice and suggestions to improve your work style. The first step to professionalism is knowing your limits.

3. Avoid asking about irrelevant details. The aspiring psychologist is mesmerized by the details and "important stories" of his clients. Sometimes he asks very intimate questions about sex life. It is common for a novice or inept psychologist to place great importance on the details of the client's life and at the same time miss what the client feels and thinks. Consulting is intended primarily for the benefit of the client, and not to increase your volume of information.

4. Treat the client the way you would like to be treated. Put yourself in the client's shoes. Everyone wants to be treated with respect, sparing his self-esteem. A deep relationship and a heart-to-heart conversation begins after the client has understood that his thoughts and experiences are close to you. A relationship of trust develops from the client's and counselor's ability to be honest.

5. Be aware of individual and cultural differences. It is safe to say that the practice of therapy and counseling, regardless of what cultural group you are dealing with, cannot be called an ethical practice at all. Are you prepared enough to work with people who are different from you?

The current situation in society allows us to talk about potentially or clearly existing conflicts in the field of communication. The clinical interview is no exception in this regard. Potential psychological difficulties in conducting interviews are possible at different levels - yesterday they covered one area; today - the second; tomorrow they may spread and a third. Without a trusting atmosphere, therapeutic empathy between a psychologist and a patient, qualified interviewing, diagnosis and psychotherapeutic effect are impossible.

Jacques Lacan's theory suggests that an interview is not just a relationship between two people physically present in a session. It is also the relationship of cultures. That is, at least four people are involved in the counseling process, and what we took for a conversation between a therapist and a client may turn out to be a process of interaction between their cultural and historical roots. The following figure illustrates the point of view of J. Lacan:

Figure 2.

Note that counseling is a more complex subject than simply giving advice to a client. Cultural affiliation must always be considered. In the figure above, the therapist and the client are what we see and hear during the interview. “But no one can get away from their cultural heritage. Some psychological theories tend to be anti-historic and underestimate the impact of cultural identity on the client. They focus mainly on the client-psychologist relationship, omitting more interesting facts of their interaction” (J. Lacan).

Schneiderman argued that "whoever seeks to erase cultural differences and create a society in which alienness does not exist, is moving towards alienation ... The moral denial of alienness is racism, one can hardly doubt it."

Empathy requires that we understand both the personal uniqueness and the “foreignness” (cultural-historical factor) of our client. Historically, empathy has focused on personal uniqueness, and the second aspect has been forgotten. For example, psychologists in the United States and Canada typically expect that all clients, regardless of their cultural background, will respond in the same way to the same treatment. Based on the concept of J. Lacan, then such therapy looks like this:

Figure 3

Thus, the cultural-historical influence is reflected in this interview, but the client and the psychologist are not aware of these problems, they are disconnected from them. In this example, the client is aware of the specifics of their cultural identity and takes it into account in their plans for the future. The psychologist, however, proceeds from a theory based on individual empathy and does not pay attention to this important circumstance. In addition, the client sees only a cultural stereotype in the counselor, “This example is by no means an exception to the rule, and many non-white clients who have tried to get counseling from an unqualified white therapist will readily confirm this” (A. Ivey).

Ideally, both - the psychologist and the client - are aware of and use the cultural-historical aspect. Empathy, on the other hand, cannot be considered a necessary and sufficient condition if one does not pay attention to the cultural aspect as well.

J. Lacan's model gives an additional impetus to building a certain level of empathy. Sometimes the client and the psychologist think that they are talking to each other, when in fact they are only passive observers of how two cultural settings interact.

In the process of a clinical interview, as experience shows and confirms the theory of J. Lacan, such components of the historical and cultural bases of a psychologist (doctor) and a client (patient) as: gender, age, religious beliefs and religion, racial characteristics (in modern conditions - - nationality); sexual orientation preferences. The effectiveness of the interview in these cases will depend on how the psychologist and the patient with different beliefs and characteristics will find a common language, what style of communication the diagnostician will offer to create an atmosphere of trust. Today we face relatively new problems in the field of therapeutic interaction. Patients conceived do not trust doctors, and doctors do not trust patients only on the basis of differences in national, religious, sexual (hetero-, homosexual) characteristics. A doctor (as well as a psychologist) should be guided by the current situation in the field of ethnocultural relations and choose a flexible communication tactic that avoids discussing acute global and non-medical problems, in particular national, religious ones, and even more so not to impose his point of view on these issues.

The described principles of the clinical interview reflect the basic knowledge, the theoretical platform on which the entire interviewing process is built. However, principles not supported by practical procedures will remain unused.

There are various methodological approaches to conducting interviews. It is believed that the duration of the first interview should be about 50 minutes. Subsequent interviews with the same client (patient) are somewhat shorter. The following model (structure) of a clinical interview can be proposed:

Stage I: Establishment of a "confidence distance". Situational support, provision of confidentiality guarantees; determining the dominant motives for conducting an interview.

Stage II: Identification of complaints (passive and active interviews), assessment of the internal picture - the concept of the disease; problem structuring,

Stage III: Evaluation of the desired outcome of the interview and therapy; determination of the patient's subjective model of health and preferred mental status.

Stage IV: Assessment of the patient's anticipatory abilities; discussion of probable outcomes of the disease (if it is detected) and therapy; anticipation training.

The above stages of a clinical psychological interview give an idea of ​​the essential points discussed during the meeting between the psychologist and the patient. This scheme can be used in each conversation, but it should be remembered that the specific weight - the time and effort allocated to one or another stage - varies depending on the order of meetings, the effectiveness of therapy, the level of observed mental disorders, and some other parameters. It is clear that during the first interview, the first three stages should be predominant, and during subsequent interviews, the fourth. Particular attention should be paid to the level of mental disorders of the patient (psychotic - non-psychotic); voluntariness or compulsory interview; criticality of the patient; intellectual features and abilities, as well as the real situation surrounding him.

The first stage of a clinical interview (“establishing a confidence distance”) can be defined as an active interview.” It is the most important and difficult. the patient does not begin with a formal one that has set the teeth on edge; “What are you complaining about?”, But with situational support. The interviewer takes the thread of the conversation into his own hands and, mentally putting himself in the place of the patient who first went to the doctor (especially if in a psychiatric hospital), having felt the drama of the situation, the fear of the applicant being recognized as mentally ill or misunderstood or put on record helps him start a conversation.

In addition, at the first stage, the psychologist must identify the dominant motives for contacting him, make a first impression of the level of criticality of the interviewee to himself and psychological manifestations. This goal is achieved with the help of questions like: “Who initiated your appeal to a specialist?”, “Is your coming to talk with me your own desire or did you do it to calm relatives (acquaintances, parents, children, bosses)? »; “Does anyone know that you were going to see a specialist?”

Even when interviewing a patient with a psychotic level of disorder, it is advisable to begin the interview by providing assurances of confidentiality. Often effective for further conversation with such patients are phrases like: “You probably know that you can refuse to talk to me as a psychologist and psychiatrist?” In the vast majority of cases, this phrase does not cause a desire to leave the doctor's office, but rather turns out to be a pleasant revelation for the patient, who begins to feel free to dispose of information about himself and at the same time becomes more open to communication.

The active role of the doctor (psychologist) is interrupted at this point and the stage of the passive interview begins. The patient (client) is given time and opportunity to present complaints in the sequence and with those details and comments that he considers necessary and important. At the same time, the doctor or psychologist plays the role of an attentive listener, only clarifying the features of the manifestations of the patient's disease. Most often, the listening technique includes the following methods (Table 1).

The questions asked by the diagnostician are aimed at assessing the internal picture and concept of the disease, i.e. identifying the patient's ideas about the causes and reasons for the occurrence of certain symptoms in him. At the same time, the problem is structured, which remains frustrating at the time of the interview.

Table 1

The main stages of diagnostic listening (according to A-Ivn)

Methodology	Description	Function during the interview
Open questions	"What?" - reveals the facts; "How?" -- feelings; "Why?" -- causes; "Is it possible?" - big picture	Used to clarify basic facts and facilitate conversation
Closed questions	Usually include the particle “li”, they can be answered briefly	Gives the opportunity to reveal special facts, shorten too long monologues
Promotion (support)	Repetition of several key phrases of the client	Encourages detailed development of specific words and meanings
reflection of feeling	Draws attention to the emotional content of the interview	Clarifies the emotional background of key facts, helps to open feelings
retelling	Repetition of the essence of words client and his thoughts, using his keywords	Activates discussion, shows level of understanding
	Succinctly repeats key facts* and feelings of the client	It is useful to repeat periodically during the interview. Required at the end of the meeting.

Here, the diagnostician asks all sorts of questions regarding analysis and mental state, based on known diagnostic algorithms. In addition to listening, the psychologist should also use elements of influence during the interview.

Methods of influence in the interview process (according to A. Ivey)

table 2

	Description	Function during the interview
Interpretation	Sets a new framework in which the client can see the situation	An attempt to enable the client to see the situation in a new way - an alternative perception of reality, which contributes to a change in attitudes, thoughts, moods and behaviors
Directive (indication)	Tells the client what action to take. It can be just a wish or a technique.	Clearly shows the client what action the psychologist expects from him.
(information)	Gives wishes, general ideas, homework, advice on how to act, think, behave.,	Moderately used tips provide the client with useful information.
Self-disclosure	The psychologist shares personal experiences and experiences, or shares the feelings of the client.	Closely related to the reception of feedback, built on "I-sentences". Helps build rapport.
Feedback	Gives the client the opportunity to understand how the psychologist perceives him, as well as those around him.	Gives specific data that helps the client understand how to understand him, how others perceive his behavior and thinking style, which creates the possibility of self-perception.
logical subsequence	Explains to the client the logical consequences of his thinking and behavior. "If...then."	Gives the client a different point of reference. This method helps people anticipate the results of their actions.
Impact Resume	Often used at the end of a conversation to formulate the psychologist's judgments. Often used in combination with a client's resume.	Clarifies what the psychologist and client achieved during the conversation. Summarizes what the therapist said. Designed to help the client transfer these generalizations from the interview to real life.

Essential at this stage of the interview is the collection of the so-called psychological and medical anamnesis - the history of life and illness. The task of the psychological anamnesis is to obtain information from the patient to assess his personality as an established system of attitudes towards himself and, in particular, attitudes towards the disease and assess how much the disease has changed this entire system. Important are the data on the course of the disease and the life path, which are designed to reveal how the disease is reflected in the subjective world of the patient, how it affects his behavior, on the entire system of personal relationships. Outwardly, the medical and psychological history as research methods are very similar - the questioning could go according to a single plan, but their purpose and the use of the data obtained are completely different (V.M. Smirnov, T.N. Reznikova).

The next (III) stage of the clinical interview is aimed at identifying the patient's ideas about the possible and desired results of the interview and therapy. The patient is asked: “Which of what you told me would you like to get rid of first of all? How did you imagine our conversation before coming to me and what do you expect from it? How do you think I could help you?"

The last question aims to identify the patient's preferred mode of therapy. After all, it is not uncommon for a patient, after presenting complaints (often diverse and subjectively severe) to a doctor, to refuse treatment, referring to the fact that he does not take any medications in principle, is skeptical about psychotherapy, or does not trust doctors at all. Such situations indicate the desired psychotherapeutic effect from the interview itself, from the opportunity to speak out, to be heard and understood.

In some cases, this turns out to be sufficient for a certain part of those who seek advice from a doctor or psychologist. Indeed, often a person comes to a doctor (especially a psychiatrist) not for a diagnosis, but in order to get confirmation of his own beliefs about his mental health and balance.

At the fourth and final stage of the clinical interview, the interviewer takes on an active role again. Based on the identified symptoms, having the patient's understanding of the concept of the disease, knowing what the patient expects from treatment, the interviewer-psychologist directs the interview into the mainstream of anticipatory training. As a rule, a neurotic is afraid to think and even discuss with anyone the possible sad outcomes of the conflict situations that exist for him, which caused him to go to the doctor and get sick.

Anticipatory training, which is based on the anticipatory concept of neurogenesis (V.D. Mendelevich), is aimed, first of all, at the patient's thinking out the most negative consequences of his illness and life. For example, when analyzing a phobic syndrome within the framework of a neurotic register, it is advisable to ask questions in the following sequence: “What exactly are you afraid of? “Something bad is about to happen. - How do you suppose and feel with whom this bad thing should happen: with you or with your loved ones? - I think with me. - What exactly do you think? - I'm afraid to die. What does death mean to you? Why is she terrible? -- I do not know. - I understand that it is an unpleasant occupation to think about death, but I ask you to think about what exactly you are afraid of in death? I will try to help you. For one person, death is non-existence, for another, it is not death itself that is terrible, but the suffering and pain associated with it; for the third, it means that children and loved ones will be helpless in the event of death, etc. What is your opinion about this? -- ...--»

Such a technique within the framework of a clinical interview performs both the function of a more accurate diagnosis of the patient's condition, penetration into the secret secrets of his illness and personality, and a therapeutic function. We call this technique anticipatory training. It can be considered a pathogenetic method for the treatment of neurotic disorders. The use of this method when interviewing patients with psychotic disorders performs one of the functions of the interview - it clarifies the diagnostic horizons to a greater extent, and this has a therapeutic effect.

The clinical interview consists of verbal (described above) and non-verbal methods, especially in the second stage. Along with questioning the patient and analyzing his answers, the doctor can recognize a lot of important information that is not dressed in verbal form.

The language of facial expressions and gestures is the foundation on which counseling and interviewing are based (Harper, Wiens, Matarazzo, A. Ivey). Non-verbal language, according to the last author, functions at three levels:

* Terms of interaction: for example, the time and place of the conversation, the design of the office, clothing and other important details, most of which affect the nature of the relationship between two people;

* Information flow: for example, important information often comes to us in the form of non-verbal communication, but much more often non-verbal communication modifies meaning and rearranges emphasis in a verbal context;

* Interpretation: Every individual, belonging to any culture, has completely different ways of interpreting non-verbal communication. What one perceives from non-verbal language may be fundamentally different from what another understands.

Extensive research in Western psychological science on the study of listening skills has shown that the standards of eye contact, torso tilt, medium timbre of the voice may be completely unsuitable in communicating with some clients. When a clinician is working with a depressed patient or someone who is talking about sensitive matters, eye contact during the interaction may be inappropriate. Sometimes it is wise to look away from the speaker.

visual contact. Without forgetting cultural differences, it should still be noted the importance of when and why an individual stops making eye contact with you. “It is the movement of the eyes that is the key to what is happening in the client's head,” says A. Ivey, “Usually, visual contact stops when a person speaks on a sensitive topic. For example, a young woman may not make eye contact when she talks about her partner's impotence, but not when she talks about her solicitousness. This may be a real sign that she would like to maintain a relationship with her lover. However, more than one conversation is required to accurately calculate the meaning of a change in non-verbal behavior or visual contact, otherwise there is a high risk of drawing erroneous conclusions.

Language of the body. Representatives of different cultures naturally differ in this parameter. Different groups put different content into the same gestures. It is believed that the most informative in body language is the change in torso tilt. The client may sit naturally and then, for no apparent reason, clasp their hands, cross their legs, or sit on the edge of a chair. Often these seemingly minor changes are indicators of conflict in the person.

intonation and tempo of speech. The intonation and pace of a person's speech can say as much about him, especially about his emotional state, as verbal information. How loudly or quietly sentences are spoken can serve as an indicator of the strength of feelings. Rapid speech is usually associated with a state of nervousness and hyperactivity; while slow speech may indicate lethargy and depression.

Following AAivy and his colleagues, we note the importance of such parameters as the construction of speech in the interview process. According to these authors, the way people construct sentences is an important key to understanding their perception of the world. For example, it is proposed to answer the question: “What will you tell the controller when he starts checking the availability of tickets, and you find yourself in a difficult situation?”: a) The ticket is torn, b) I tore the ticket, c) The car tore the ticket, or d) Something what happened?

Explaining even such an insignificant event can serve as a key to understanding how a person perceives himself and the world around him. Each of the above sentences is true, but each illustrates a different worldview. The first sentence is just a description of what happened; the second - demonstrates a person who takes responsibility and indicates an internal locus of control; the third represents external control, or "I didn't do it," and the fourth indicates a fatalistic, even mystical, outlook.

Analyzing the structure of sentences, we can come to an important conclusion regarding the psychotherapeutic process: the words that a person uses when describing events often give more information about him than the event itself. The grammatical structure of sentences is also an indicator of personal worldview.

The research and observations of Richard Bandler and John Grinder, the founders of neurolinguistic programming, focused the attention of psychologists and psychotherapists on the linguistic aspects of diagnosis and therapy. For the first time, the significance of the words used by the patient (client) and the construction of phrases in the process of understanding the structure of his mental activity, and hence personal characteristics, was noted. Scientists have noticed that people talk differently about similar phenomena. One, for example, will say that he “sees” how his spouse treats him badly; another will use the word "know"; the third is "I feel" or "feel"; the fourth - will say that the spouse does not "listen" to his opinion. Such a speech strategy indicates the predominance of certain representational systems, the presence of which must be taken into account in order to “connect” to the patient and create true mutual understanding within the interview.

According to D. Grinder and R. Bandler, there are three types of mismatches in the structure of the interviewee's speech, which can serve to study the deep structure of a person: deletion, distortion and overgeneralization. Crossing out can appear in sentences such as "I'm afraid." To questions like “Who or what are you afraid of?”, “For what reason?”, “In what situations?”, “Do you feel fear now?”, “Is this fear real or its reasons are unreal?” -- usually no responses. The task of the psychologist is to "expand" a brief statement about fear, to develop a complete representative picture of the difficulties. During this "filling in the crossed out" process, new surface structures may appear. Distortion can be defined as an unconstructive or incorrect proposal. These proposals distort the real picture of what is happening. A classic example of this would be a sentence like, "He's making me crazy," while the truth is that a person who "makes another crazy" is only responsible for his own behavior. A more correct statement would be: "I get very angry when he does this." In this case, the client takes responsibility for his behavior and begins to control the direction of his actions. Distortions often develop from strikeouts on the surface structure of a sentence. At a deeper level, a close examination of the client's life situation reveals many distortions of reality that exist in his mind. Overgeneralization occurs when the client draws far-reaching conclusions without having sufficient evidence for this. Overgeneralization is often accompanied by distortions. The words that accompany overgeneralizations are usually the following: "all people", "everyone in general", "always", "never", "the same", "always", "forever" and others.

The use of verbal and non-verbal communication contributes to a more accurate understanding of the patient's problems and allows you to create a mutually beneficial situation during the clinical interview.

Experimental-psychological (patho- and neuropsychological) research methods

Pathopsychological research methods.

Under pathopsychological studies (experiments) in modern psychology is understood the use of any diagnostic procedure in order to model an integral system of cognitive processes, motives and "personal relations" (B.V. Zeigarnik).

The main tasks of paraclinical methods in clinical psychology are the detection of changes in the functioning of individual mental functions and the identification of pathopsychological syndromes. A pathopsychological syndrome is understood as a pathogenetically determined community of symptoms, signs of mental disorders, internally interdependent and interconnected (V.M. Bleikher). Pathopsychological syndromes include a set of behavioral, motivational and cognitive features of the mental activity of patients, expressed in psychological terms (V.V. Nikolaeva, E.T. Sokolova, A.S. Pivakovskaya). It is believed that the pathopsychological syndrome reflects violations of various levels of functioning of the central nervous system. According to A.Rluriya, Yu.F.Polyakov, in the system of hierarchy of brain processes, such levels are distinguished as: and neuropsychological (which are characterized by a violation of the course of mental processes and related properties of the psyche), psychopathological (manifested by clinical symptoms and syndromes of mental pathology).

As a result of the identification of pathopsychological syndromes, it becomes possible to assess the features of the structure and course of the mental processes themselves, leading to clinical manifestations - psychopathological syndromes. The pathopsychologist directs his research to the disclosure and analysis of certain components of brain activity, its links and factors, the loss of which is the cause of the formation of symptoms observed in the clinic.

The following pathopsychological register-syndromes are distinguished (I.A. Kudryavtsev):

* schizophrenic

* affective-endogenous

* oligophrenic

* exogenous-organic

* endogenous-organic

* personality-abnormal

* psychogenic-psychotic

* psychogenic-neurotic

The schizophrenic syndrome complex consists of such personality-motivational disorders as: a change in the structure and hierarchy of motives, a disorder of mental activity that violates the purposefulness of thinking and meaning formation (reasoning, slipping, diversity, pathological polysemanticism) while maintaining the operating side, emotional disorders (simplification, dissociation of emotional manifestations, sign paradoxicality), changes in self-esteem and self-awareness (autism, sensitivity, alienation and increased reflection).

The psychopathic (personality-abnormal) symptom complex includes: emotional-volitional disorders, violations of the structure and hierarchy of motives, inadequacy of self-esteem and the level of claims, impaired thinking in the form of "relative affective dementia", impaired prediction and reliance on past experience.

The organic (exo- and endogenous) symptom complex is characterized by such signs as: a general decrease in intelligence, the collapse of existing information and knowledge, mnestic disorders affecting both long-term and operative memory, impaired attention and mental performance, impaired operational side and purposefulness of thinking, changes in emotional spheres with affective lability, violation of critical abilities and self-control.

The oligophrenic symptom complex includes such manifestations as: inability to learn and form concepts, lack of intelligence, lack of general information and knowledge, primitive and concrete thinking, inability to abstract, increased suggestibility, emotional disorders.

Identification of pathopsychological register-syndromes allows the clinical psychologist not only to fix disorders in various areas of mental activity, but also to rank them according to the mechanisms of occurrence. In addition, the correct qualification of the pathopsychological syndrome allows the clinician to verify the nosological diagnosis and direct corrective and therapeutic work in the right direction. To a greater extent, register syndromes are significant for pathopsychological studies in a psychiatric clinic, to a lesser extent - in a somatic clinic.

Paraclinical research methods in clinical psychology represent an extensive set of methods for assessing brain activity. Each of them represents the tools of any field of science. As a result, the development of all paraclinical methods and diagnostic methods is not within the competence of clinical psychologists. But the ability to select paraclinical methods necessary for a specific clinically identified pathology, to justify the need for their use, to correctly interpret the results obtained with their help is considered an integral part of the activity of a clinical psychologist.

Table 3

The main methods of pathopsychological diagnostics for violations of certain areas of mental activity

The sphere of mental activity in which violations are noted	Pathopsychological technique
Attention disorders	Schulte tables correction test Kraepelin account Munsterberg method
Memory disorders	test ten words pictogram
Perceptual disorders	sensory excitability of the Aschaffenburg, Reichardt, Lipman tests
Thinking disorders	tests for classification, exclusion, syllogisms, analogies, generalization associative experiment Everrier problem, pictogram test of discrimination of properties of concepts
Emotional disorders	Spielberger test Luscher color selection method
Intellectual Disorders	Raven test Wechsler test

Pathopsychological diagnostics uses a battery of experimental psychological test methods, with the help of which

it is possible to evaluate the functioning of both individual spheres of mental activity and integrative formations - types of temperament, character traits, personal qualities.

The choice of specific methods and methods of pathopsychological diagnostics in clinical psychology is based on the identification of cardinal psychopathological deviations in various types of mental response in certain areas of mental activity. Table 3 presents the indications for the use of certain methods of pathopsychological diagnostics.

Pathopsychological assessment of attention disorders

To confirm the clinically detected attention disorders, the most adequate pathopsychological methods are the assessment of attention according to the Schulte tables, the results of thinning the correction test and the Kraepelin count.

Schulte tables are a set of numbers (from 1 to 25) not placed in random order in the cells. The subject must show and name in a given sequence (as a rule, increasing from one to twenty-five) all the numbers. The subject is offered four or five non-identical Schulte tables in a row, in which the numbers are arranged in a different order. The psychologist records the time spent by the subject on showing and naming the entire series of numbers in each table separately. The following indicators are noted: 1) exceeding the standard (40-50 seconds) time spent on pointing and naming a series of numbers in the tables; 2) the dynamics of temporal indicators during the survey process for all five tables.

Schulte tables. one.

According to the results of this test, the following conclusions about the characteristics of the attention of the subject are possible:

Attention is concentrated enough - if the subject spends time corresponding to the standard on each of the Schulte tables.

Attention is not concentrated enough - in the event that the subject spends time exceeding the standard on each of the Schulte tables.

Attention is stable - if there are no significant time differences when counting the numbers in each of the four to five tables.

Attention is unstable - if there are significant fluctuations in the results according to the tables without a tendency to increase the time spent on each subsequent table.

Attention depleted - if there is a tendency to increase the time spent by the subject on each next table.

The Kraepelin score technique is used to study fatigue. The subject is asked to add in his mind a series of single-digit numbers written in a column. The results are evaluated by the number of numbers added in a certain period of time and errors made.

When conducting a correction test, special forms are used, on which a series of letters are shown, arranged in a random order. The instruction provides for the test subject to cross out one or two letters at the choice of the researcher. At the same time, every 30 or 60 seconds, the researcher makes marks in the place of the table where the subject's pencil is at that time, and also registers the time spent on the entire task.

The interpretation is the same as when evaluating the results according to the Schulte tables. Normative data on the correction test: 6-8 minutes with 15 errors.

The Munsterberg technique is designed to determine the selectivity of attention. It is a literal text, among which there are words. The task of the subject as quickly as possible reading the text, underline these words. You have two minutes to work. The number of selected words and the number of errors (missing or incorrectly highlighted words) are recorded.

Münsterberg technique

bsopnceevtrgschofionzshchnoeost

sukengshizhwafyuropdbloveavyfrplshd

bkyuradostwufciejdlorrgshrodshljhashshchgiernk

zhdorlvfuyuvfbcompetitionfnguvskaprpersonality

eprppvaniedptyuzbyttrdshschnprkkukom

janvtdmjgftasenplaboratorygsh

Attention disorders are not specific to any mental illness, types of mental response, levels of mental disorders. However, it is possible to note the specifics of their changes in various mental pathologies. So, they are most clearly represented in the structure of the exogenously organic type of mental response, manifesting themselves as impaired concentration and stability of attention, rapid exhaustion, and difficulties in switching attention. Similar disorders are found in neuroses. Within the framework of the endogenous type of mental response, attention disorders are not decisive (as a rule, they are either absent or secondary to other psychopathological phenomena). Despite this, there is evidence (E.Krepelin) that in schizophrenia, violations of active attention are characteristic, while passive attention is preserved. This distinguishes patients with schizophrenia from patients with exogenous organic and neurotic mental disorders.

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List of topics

1. Subject, tasks and features of modern natural science.
2. Structure and methods of natural science knowledge.
3. Physical concepts of natural sciences.
4. Astrophysical concepts of natural science and space.
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Clinical psychology is a broad specialty that has an intersectoral character and is involved in solving a set of problems in the healthcare system, public education and social assistance to the population. The work of a clinical psychologist is aimed at increasing the psychological resources and adaptive capabilities of a person, harmonizing mental development, protecting health, preventing and overcoming illnesses, and psychological rehabilitation.

Formation clinical psychology as one of the main applied branches of psychological science is inextricably linked with the development of both psychology itself and medicine, physiology, biology, anthropology; its history begins in ancient times, when psychological knowledge was born in the depths of philosophy and natural science.

Late 18th - early 19th centuries development of psychological ideas about the decomposability of mental processes into some original mental "abilities", doctors of that time began to look for the brain substratum of these "abilities". This is how the locationist theory begins, which tries to elucidate the problem of "brain-mind". Early 19th century Gall (Austrian anatomist) - an attempt to localize the moral and intellectual qualities of a person in various parts of the brain, he suggested that the development of individual sections of the cortex, furrows and the brain as a whole allegedly affects the shape of the skull and therefore the study of its surface allows diagnosing individual personality traits.

By the middle of the XIX century. (thanks to the works of M. Hall and Muller, Steinbuch and Bell, Weber, Fechner, Helmholtz), the psyche began to be recognized as a reality woven into a complex system of interaction between the stimuli of the external world and the response activity of the body, and it became possible to develop methods that could translate this reality into scientific concepts and models. At the same time, Sechenov gave a significant impetus to the development of the reflex concept after he discovered the mechanisms of central inhibition. This discovery led him to the most important conclusion about the reflex nature of the psyche.

In the middle of the XIX century. thanks to the concept of the founder of modern pathological anatomy, the German scientist Virchow, various studies of the cellular structure of the brain and cerebral cortex begin. In 1861, the French anatomist and surgeon Broca drew attention to the connection between loss of speech and damage to the lower frontal gyrus of the left hemisphere. These observations stimulated research on the localization of functions in the cerebral cortex, including those associated with stimulation of certain parts of the brain with electricity. Thanks to the work of Brock, a clinical method for studying the structure of the brain arose. In 1874, the German psychiatrist Wernicke describes 10 patients with impaired understanding of inverted speech, with localization of the lesion in the posterior sections of the superior temporal gyrus, also in the left hemisphere. The end of the 19th century was also marked by other successes of localizationists, who believed that a limited area of ​​the brain could be the "brain center" of some mental function.

The development of science in the middle of the XIX century. led to rapid changes in ideas about wildlife, about the functions of the body, including mental ones, both in the norm and in pathology. Global scientific discoveries in Europe also contributed to these changes in psychology in general and in the emerging scientific medical psychology in particular: Darwin's theory in England, which revealed the laws of evolution; the doctrine of the mechanisms of self-regulation by Bernard in France, which determined the concept of homeostasis; the achievements of the physico-chemical school in Germany, which presented the foundations of life in a new way; the discovery of the mechanism of central inhibition by Sechenov in Russia, which radically changed the overall picture of the dynamics of the processes of higher nervous activity.

The impetus for the development of psychology, and clinical psychology in particular, was the opening in Leipzig by Wundt of the world's first experimental psychological laboratory (1879). Wundt became the founder of psychology as a formal academic discipline. He founded his own scientific school, where later well-known scientists studied and worked - Kraepelin, Münsterberg, Külpe, Kirschman, Meisman, Marbe, Lipps, Kruger (Germany), Titchener (England), Violin, Angell, G. S. Hall, Whitmer (USA), Bekhterev, Chizh, Lange (Russia), - many of whom are considered the founders of clinical psychology. First of all, it should be mentioned Whitmer who introduced the concept clinical psychology. Having organized a psychological clinic for retarded and mentally ill children at the University of Pennsylvania, he developed a course of lectures on this problem. In 1907, Whitmer founded the journal Psychological Clinic, in the first issue of which he proposed a new specialization for psychologists - clinical psychology. Although Whitmer contributed to the development of clinical psychology and quite rightly used this term, in fact this direction was much broader than what he did. Whitmer's example was followed by many psychologists. Already by 1914 there were almost two dozen psychological clinics operating in the United States, similar to Whitmer's. Whitmer's followers applied his clinical approach to the diagnosis and treatment of disorders in adults.

Development of clinical psychology abroad associated with such personalities as Kraepelin, Bleyer, Kretschmer, Binet, Ribot, Freud.

More: In Germany, Kraepelin introduced a psychological experiment into a psychiatric clinic already in the early 90s. The associative experiment was widely used for diagnostic purposes by the Swiss psychiatrist Bleuler, thanks to which Bleuler singled out a new form of thinking - autistic thinking. The German psychiatrist Kretschmer developed the doctrine of the difference between progredient processes and constitutional states. In 1922, he published the first textbook entitled "Medical Psychology", which laid the methodological foundations for the application of psychology in medical practice. In France, Binet, in addition to experimental studies of thinking, studied people with outstanding abilities, as well as imagination, memory and intelligence in children. In 1896 he developed a series of personality tests. The real fame brought him a metric scale of intellectual development, developed in 1905 together with the doctor Simon with the aim of selecting mentally retarded children from a normal school. Much of the credit belongs to Ribot, the founder of modern experimental psychology in France. He called pathopsychology a natural experiment of nature itself. Many of his works were devoted to the study of diseases of memory, personality, feelings. Ribot noted that psychology should study the concrete facts of mental life in their dynamics. Ribot's ideas were further developed in the works of his student Janet. He considered clinical observation to be the main method of psychology.

A huge contribution to the development of clinical psychology was made by Freud's psychoanalysis, which arose in the early 1990s. 19th century from the medical practice of treating patients with functional mental disorders, who significantly advanced the psychological theory of the onset of mental disorders, and also opened the way for psychoanalytic treatment for psychologists and doctors.

Development of clinical psychology in Russia: associated with the names of Bekhterev, Lazursky, Pavlov

In Russia, the impetus for the development of clinical psychology was the discovery on the basis of psychiatric clinics, universities, experimental psychological laboratories at. Bekhterev (Kazan, St. Petersburg), Korsakov and Tokarsky (Moscow). Sikorsky (Kyiv), Chizh (Tartu). The staff of these laboratories developed methods for the experimental psychological study of the mentally ill, carried out developments to study the mechanisms and disorders of memory and thinking, developed and tested research methods for solving psychological, physiological, and psychiatric problems.

Companion Bekhterev Lazursky expanded the application of the experiment, extending it to the study of personality. He developed a method of natural experiment, which, along with laboratory techniques, made it possible to investigate the personality of a person, his interests and character.

Rossolimo, a well-known pediatric neuropathologist, developed his own method of experimental study of personality - the method of psychological profiles, which was of great diagnostic value for determining personality defects.

A significant contribution to research on the problem of localization of mental functions was made by Pavlov, who developed the theory of dynamic localization of functions, the formation of "dynamic stereotypes" in the cerebral cortex, and cerebral variability in the spatial confinement of excitatory and inhibitory processes. In his works, ideas about the first and second signal systems are formulated and substantiated, the concept of analyzers, their nuclear and peripheral parts is put forward and developed. The experimental study of higher nervous activity in Pavlov's laboratories, the identification of types of nervous activity (the physiological equivalent of temperament), the relationship between the first and second signal systems led to the theoretical substantiation of experimental neuroses, which Pavlov transferred to the clinic. Thus, the methodological foundation of the pathophysiological theory of neuroses (F40-F48) and their psychotherapy was laid. This direction was called Pavlovian psychotherapy, which used in practice experimental data on the emergence and inhibition of conditioned reflexes, the concepts of inhibition, irradiation, induction, and phase states.

In the first third of the 20th century in psychology (due to the gap between empirical and applied research and theoretical and methodological foundations), independent trends began to emerge that claimed to create a new psychological theory. Each of them relied on its own theoretical ideas about the nature of mental processes, had its own theory of personality in normal and pathological conditions, and developed the foundations of the psychological impact on a person. But with all the differences in views on the object and subject of medical psychology research, the volume and tasks reflected in the literature of this period, its analysis indicates the convergence of at least some positions. First of all, this concerned medical psychology itself, the recognition of its right to be singled out as an independent science at the interface between medicine and psychology. At the same time, it was obvious that the further development of many sections of modern medicine: the doctrine of psychogenic and psychosomatic diseases, psychotherapy and rehabilitation, psychohygiene and psychoprophylaxis was hardly possible without psychological science participating in the development of their theoretical foundations.

That's how I saw medical psychology at this time (1972) the leading Soviet psychiatrist Snezhnevsky: " Medical psychology is a branch of general psychology that studies the state and role of the mental sphere in the occurrence of human diseases, the features of their manifestations, course, outcome and recovery. Medical psychology in its research uses descriptive and experimental methods accepted in psychology. It, in turn, contains the following branches: a) pathopsychology, which studies disorders of mental activity by psychological methods; b) neuropsychology, which studies focal lesions of the brain using psychological methods; c) deontology; d) psychological foundations of mental hygiene - general and special; e) psychological foundations of occupational therapy; f) the psychological foundations of the organization of patient care in hospitals, outpatient clinics, sanatoriums. Other industries are possible».

Specific goals medical psychology were formulated as follows (Lebedinsky; Myasishchev, Kabanov, Karvasarsky):

The study of mental factors influencing the development of diseases, their prevention and treatment;

Studying the influence of certain diseases on the psyche;

The study of mental manifestations of various diseases in their dynamics;

The study of developmental disorders of the psyche; study of the nature of the relationship of a sick person with medical personnel and the surrounding microenvironment;

Development of principles and methods of psychological research in the clinic;

Creation and study of psychological methods of influencing the human psyche for therapeutic and prophylactic purposes.

In accordance with the specified goals as subject medical psychology considered (Karvasarsky) the features of the mental activity of the patient in their significance for the pathogenetic and differential diagnosis of the disease, the optimization of its treatment and prevention (preservation and promotion of health).

The most developed at that time were such sections of medical psychology as pathopsychology, which arose at the intersection of psychology, psychopathology and psychiatry (Zeigarnik, Polyakov, etc.), and neuropsychology, formed on the border of psychology, neurology and neurosurgery (Luria, Chomskaya, etc.). Pathopsychology, according to Zeigarnik, studies the regularities of the decay of mental activity and personality traits in comparison with the regularities of the formation and course of mental processes in the norm. The task of neuropsychology, according to the views of Luria, the founder of this branch of psychology, is to study the brain mechanisms of human mental activity using new, psychological, methods for the topical diagnosis of local brain lesions.

In addition, studies were carried out to build the most effective psychotherapeutic and rehabilitation programs.

The development of medical psychology was influenced by research on theory and practice rehabilitation. Kabanov understood the process of rehabilitation as a systemic activity aimed at restoring the personal and social status of the patient (full or partial) by a special method, the main content of which is mediating through the personality of therapeutic and restorative effects and activities.

A complex of problems related to the study of the nature, methods of treatment and prevention of the so-called psychosomatic disorders, the importance of which in the structure of the incidence of the population has been constantly increasing. Gubachev, Zaitsev, Goshtautas, Solozhenkin, Berezin and others devoted their monographic works to psychosomatic research using psychological methods.

In the 60s. brain research has revived interest in the problem of consciousness and its role in behavior. In neurophysiology, Nobel Laureate Sperry sees consciousness as an active force. In our country, neuropsychology is being developed in the works of Luria and his students - Chomskaya, Akhutina, Tsvetkova, Simernitskaya, Korsakov, Lebedinsky and others. research and continued study of violations of individual mental functions - memory, speech, intellectual processes, voluntary movements and actions in local brain lesions, analyzed the features of their recovery. Assimilation of the experience of domestic and foreign authors in the development of neuropsychological research techniques allowed Luria to create a set of methods for the clinical study of individuals with brain lesions. One of the results of the theoretical generalization of clinical experience was the concept of the three-block structure of the functional organization of the brain that he formulated. A large place in the work of Luria was occupied by questions of neurolinguistics, developed in close connection with the problems of aphasiology. These numerous studies in the field of neuropsychology created the prerequisites for the allocation of this science into an independent discipline.

Current state : In connection with the socio-political changes in Russia and the elimination of ideological barriers in the last decade, the question arose of the convergence of domestic and world psychology, which required, in particular, a revision of the concepts of "medical" and "clinical" psychology. Clinical psychology as an organization of researchers and practitioners has been represented by the American Association of Clinical Psychology since 1917, and in German-speaking countries since the middle of the 19th century. In our country, the specialty "clinical psychology" (022700) was approved by the Ministry of Education of the Russian Federation in 2000 (Order No. 686). In accordance with the state educational standard clinical psychology- a specialty of a wide profile, which has an intersectoral character and is involved in solving a set of problems in the healthcare system, public education and social assistance to the population. The activity of a clinical psychologist is aimed at increasing the mental resources and adaptive capabilities of a person, at harmonizing mental development, health protection, prevention and psychological rehabilitation.

object clinical psychology is a person with difficulties in adaptation and self-realization associated with his physical, social and spiritual condition.

Subject The professional activities of a clinical psychologist are mental processes and conditions, individual and interpersonal characteristics, socio-psychological phenomena that manifest themselves in various areas of human activity.

A clinical psychologist in the above areas performs the following activities: diagnostic, expert, corrective, preventive, rehabilitation, advisory, research and some others.

The relationship of clinical psychology with other sciences: Any science develops in interaction with other sciences and under their influence. The basic sciences for clinical psychology are general psychology and psychiatry. Psychiatry belongs to medicine, but is closely related to clinical psychology. The subject of scientific research in both clinical psychology and psychiatry is mental disorders, and clinical psychology, in addition, deals with such disorders that are not equivalent in importance to illness (for example, problems of marriage and partnership), as well as mental aspects of somatic disorders. Psychiatry, as a private field of medicine, takes more into account the somatic plane of mental disorders; in clinical psychology, the main ones are psychological aspects. A comprehensive understanding of mental disorders is only possible with comprehensive biopsychosocial models. Therefore, the developed approaches sometimes do not have pronounced differences and are often implemented in joint research.

Clinical psychology influences the development of the theory and practice of psychiatry, neurology, neurosurgery, internal medicine and other medical disciplines.

Methodology is a system of principles and methods for organizing and constructing theoretical and practical activities, united by the doctrine of this system. It has different levels: philosophical, general scientific, concrete scientific, which are interconnected and should be considered systematically. Methodology is closely related to the worldview, since its system involves a worldview interpretation of the foundations of the study and its results. The methodology of clinical psychology itself is determined by the specific scientific level and is associated with the worldview of the researcher (for example, focused on a dynamic, cognitive-behavioral, humanistic or dialectical-materialistic understanding of personality, behavior, psychopathology).

The methodology includes specific scientific methods of research: observation, experiment, modeling, etc. They, in turn, are implemented in special procedures - methods for obtaining scientific data. As a psychological discipline, clinical psychology relies on the methodology and methods of general psychology. Methods, that is, the ways of cognition, are the ways by which the subject of science is known.

Methodology in psychology is implemented through the following provisions (principles).

1. The psyche, consciousness are studied in the unity of internal and external manifestations. The relationship between the psyche and behavior, consciousness and activity in its specific, changing forms is not only an object, but also a means of psychological research.

2. The solution of a psychophysical problem affirms the unity, but not the identity, of the mental and the physical; therefore, psychological research presupposes and often includes a physiological analysis of psychological (psychophysiological) processes.

3. The methodology of psychological research should be based on a socio-historical analysis of human activity.

4. The purpose of psychological research should be to reveal specific psychological patterns (principle of individualization of research).

5. Psychological patterns are revealed in the process of development (genetic principle).

6. The principle of pedagogization of the psychological study of the child. It does not mean the rejection of experimental research in favor of pedagogical practice, but the inclusion of the principles of pedagogical work in the experiment itself.

7. The use of products of activity in the methodology of psychological research, since the conscious activity of a person materializes in them (the principle of studying a specific person in a specific situation).

According to Platonov, for medical (clinical) psychology, principles similar to those presented above are of the greatest importance: determinism, unity of consciousness and activity, reflex, historicism, development, structurality, personal approach. Probably only a few of them require explanation, in particular the last three principles.

development principle. In clinical psychology, this principle can be concretized as the etiology and pathogenesis of psychopathological disorders in their direct (development of the disease) and reverse (remission, recovery) development. Specific is a special category - the pathological development of personality.

The principle of structure. In philosophy, structure is understood as the unity of elements, their connections and integrity. In general psychology, the structures of consciousness, activity, personality, etc. are studied. Pavlov gave the following definition of the method of structural analysis: “The method of studying the human system is the same as any other system: decomposition into parts, studying the meaning of each part, studying the parts, environment and understanding on the basis of all this its general work and management of it, if it is in the means of man. The task of clinical psychology is to bring various psychopathological phenomena into a single system of particular structures and to harmonize it with the general structure of a healthy and sick person.

The principle of personal approach. In clinical psychology, a personal approach means treating the patient or the person being studied as a whole person, taking into account all its complexity and all individual characteristics. It is necessary to distinguish between personal and individual approaches. The latter is taking into account the specific features inherent in a given person in given conditions. It can be realized as a personal approach or as a study of individual psychological or somatic qualities taken separately.

Methods of medical (clinical) psychology are divided into:

Clinical and psychological methods of personality research:

2) Interview

3) Anamnestic method

4) Observation

5) Study of products of activity

Experimental-psychological methods:

1) Non-standardized (qualitative methods) - represented primarily by a set of so-called pathopsychological techniques (Zeigarnik, S. Ya. Rubinshtein, Polyakov), are distinguished by their “targeting”, focus on certain types of mental pathology, and their choice is carried out individually for a particular subject. These methods are being created to study specific types of mental disorders. Under the conditions of a psychological experiment, they are selectively used to identify the features of mental processes in accordance with the task, in particular, differential diagnosis. The psychological conclusion is based not so much on taking into account the final result (effect) of the patient’s activity, but on a qualitative, meaningful analysis of the methods of activity that are characteristic features of the process of performing work as a whole, and not individual tasks. It is important to take into account the attitude of the patient to the study, the dependence of the form of presenting the task on the state of the subject and the level of his development. Only with such a design of the experiment can the requirement for psychological research be fully realized - the identification and comparison of the structure of both altered and remaining intact forms of mental activity.

2) Standardized (quantitative) - In this case, groups of suitably selected and structured tasks are presented in the same form to each subject in order to compare the method and level of their performance by the subjects and other persons. Standardized methods can be defined as broadly understood tests, including tests for the study of mental processes, mental states and personality. In the case of standardized methods, the method of analyzing the results of each individual method is based mainly on a quantitative assessment, which is compared with the estimates obtained previously from the corresponding sample of patients and from healthy subjects. Standardized methods are inferior in their diagnostic value to non-standardized ones; their use in the clinic usually has an auxiliary value, more often as a supplement to non-standardized methods. Their use is adequate for mass examinations, if necessary, a group assessment of the subjects, for indicative express diagnostics in conditions of time pressure.

Projective Methods- addressed to the unconscious psyche. Disguised testing, the subject does not know what the study is aimed at and therefore cannot distort the results. The only proper psychological method of research. Projection is a normal psychological process of assimilation

Personality is the most complex mental construct in which many are closely intertwined. A change in even one of these factors significantly affects its relationship with other factors and the personality as a whole. A variety of approaches to the study of personality is associated with this - various aspects of the study of personality come from different concepts, they differ methodologically according to the object of which science is the study of personality.

In recent years, there has been a significant increase in interest in research on the personality characteristics of mentally ill patients, both in pathopsychology and in clinical psychiatry. This is due to a number of circumstances: firstly, personality changes have, to a certain extent, nosological specificity and can be used to resolve issues of differential diagnosis; secondly, the analysis of premorbid personality traits can be useful in establishing the possible causes of the origin of a number of diseases (and not only mental, but also, for example, peptic ulcer, diseases of the cardiovascular system); thirdly, the characterization of personality changes during the course of the disease enriches our understanding of its pathogenetic mechanisms; fourthly, taking into account the characteristics of the individual is very important for the rational construction of a complex of rehabilitation measures. Given the complexity of the concept of personality, we should immediately agree that there is no single method of its study, no matter how complete and versatile it may seem to us, which can give a holistic description of personality. With the help of experimental research, we obtain only a partial characterization of the personality, which satisfies us insofar as it evaluates certain personality manifestations that are important for solving a specific problem.

Currently, there are many experimental psychological techniques, methods, techniques aimed at studying personality. They, as already mentioned, differ in the peculiarities of the approach to the problem itself (we are talking about a fundamental, methodological difference), the diversity of the interests of researchers (personality is studied in educational psychology, in labor psychology, in social and pathological psychology, etc.) and focus on various manifestations of personality. Of course, the interests of researchers and the tasks facing them often coincide, and this explains the fact that the methods of studying personality in social psychology are adopted by pathopsychologists, the methods of pathopsychology are borrowed by specialists working in the field of labor psychology.

There is not even any clear, much less generally accepted classification of methods used to study personality. V. M. Bleikher and L. F. Burlachuk (1978) proposed the following classification of personality research methods as a conditional:
1) and methods close to it (studying biographies, clinical conversation, analysis of subjective and objective anamnesis, etc.);
2) special experimental methods (simulation of certain types of activities, situations, some instrumental techniques, etc.);
3) personal and other methods based on assessment and self-assessment;
4) projective methods.

As will be seen below, the distinction between these four groups of methods is very conditional and can be used mainly for pragmatic and didactic purposes.

K. Leonhard (1968) considered observation to be one of the most important methods for diagnosing personality, preferring it over methods such as personality questionnaires. At the same time, he attaches particular importance to the opportunity to observe a person directly, to study his behavior at work and at home, in the family, among friends and acquaintances, in a narrow circle and with a large number of people gathered. The special importance of observing facial expressions, gestures and intonations of the subject, which are often more objective criteria of personality manifestations than words, is emphasized. Observation should not be passive-contemplative. In the process of observation, the pathopsychologist analyzes the phenomena that he sees from the point of view of the patient's activity in a certain situation, and for this purpose exerts a certain influence on the situation in order to stimulate certain behavioral reactions of the subject. Observation is a deliberate and purposeful perception, due to the task of activity (MS Rogovin, 1979). In a clinical conversation, the features of the patient's biography, the features of personal reactions inherent in him, his attitude to his own character, and the behavior of the subject in specific situations are analyzed. K. Leonhard considered the latter as the most important methodological point in the analysis of personality. MS Lebedinsky (1971) paid special attention in the study of the patient's personality to the study of diaries and autobiographies compiled by him at the request of the doctor, or conducted earlier.

For the study of personality in the process of activity, special methods are used, which will be discussed below. It should only be noted that for an experienced psychologist such material is provided by any psychological methods aimed at studying cognitive activity. For example, according to the results of a test for memorizing 10 words, one can judge the presence of apathetic changes in a patient with schizophrenia (a memorization curve of the “plateau” type), an overestimated or underestimated level of claims, etc.

Significant methodological and methodological difficulties arise before the psychologist in connection with the use of personality questionnaires. Personal characteristics obtained in terms of self-assessment are of considerable interest to the pathopsychologist, but the need to compare self-assessment data with indicators that objectively represent personality is often overlooked. Of the most frequently used personality questionnaires, only the MMPI has satisfactory rating scales that allow one to judge the adequacy of the self-assessment of the subject. A disadvantage of the design of many personality questionnaires should be considered their obvious purposefulness for the subject. This primarily applies to monothematic questionnaires such as the anxiety scale.

Thus, the information obtained with the help of personality questionnaires can be adequately assessed only by comparing it with the data of an objective assessment of the personality, as well as by supplementing it with the results of personality research in the process of activity, by projective methods. The selection of methods that complement a particular personality questionnaire is largely determined by the task of the study. For example, when studying the internal picture of the disease, the position of the patient in relation to his disease is significantly refined by introducing methods of the type into the experiment.

By projective, we mean such methods of mediated study of personality, which are based on the construction of a specific, plastic situation that, due to the activity of the perception process, creates the most favorable conditions for the manifestation of tendencies, attitudes, emotional states and other personality traits (V. M. Bleikher, L. F. Burlachuk, 1976, 1978). E. T. Sokolova (1980) believes that, focused on the study of unconscious or not quite conscious forms of motivation, is practically the only psychological method of penetrating into the most intimate area of ​​the human psyche. If the majority of psychological techniques, E. T. Sokolova believes, are aimed at studying how and due to what the objective nature of a person’s reflection of the outside world is achieved, then projective techniques aim to identify peculiar “subjective deviations”, personal “interpretations”, and the latter far from always objective, not always, as a rule, personally significant.

It should be remembered that the range of projective techniques is much wider than the list of methodological techniques that are traditionally included in this group of techniques (V. M. Bleikher, L. I. Zavilyanskaya, 1970, 1976). Elements of projectivity can be found in most pathopsychological methods and techniques. Moreover, there is reason to believe that a conversation with the subject, directed in a special way, may contain elements of projectivity. In particular, this can be achieved by discussing with the patient certain life conflicts or works of art containing a deep subtext, phenomena of social life.

V. E. Renge (1976) analyzed the problems of projectivity in the aspect. At the same time, it was found that a number of methods (pictograms, a study of self-esteem, a level of claims, etc.) are based on stimulation that is ambiguous for the patient and does not limit the scope of the “choice” of answers. The possibility of obtaining a relatively large number of responses of the subject to a large extent depends on the characteristics of the conduct. An important factor in this is, according to V. E. Renge, the subject’s unawareness of the true goals of applying the techniques.

This circumstance, for example, was taken into account in the modification of the TAT method by H. K. Kiyashchenko (1965). According to our observations, the principle of projectivity is inherent in the classification technique to a large extent. In this regard, one should agree with V. E. Renge that there are no methods for studying only personal characteristics or only cognitive processes. The main role is played by the creation of the most favorable conditions for the actualization of the projectivity factor in the process of performing the task, which to a certain extent is determined not only by the knowledge and skill of the psychologist, but is also a special art.

Level of claims research
The concept was developed by psychologists of the school of K. Lewin. In particular, R. Norre's (1930) method of experimental study of the level of claims was created. The experiment found that the level of claims depends on how successfully the subject performs experimental tasks. V. N. Myasishchev (1935) distinguished two sides of the level of claims - the objective-principled and the subjective-personal. The latter is closely related to self-esteem, a sense of inferiority, a tendency to self-affirmation and the desire to see a decrease or increase in working capacity in terms of one's performance. The author pointed out that the ratio of these moments determines the level of claims of patients, especially with psychogenic diseases.

The level of claims is not an unambiguous, stable personal characteristic (B. V. Zeigarnik, 1969, 1972; V. S. Merlin, 1970). It is possible to distinguish the initial level of claims, which is determined by the degree of difficulty of tasks that a person considers feasible for himself, corresponding to his capabilities. Further, we can talk about the known dynamics of the level of claims in accordance with how the level of claims turned out to be adequate to the level of achievements. As a result of human activity (this also applies to the conditions of the experimental situation), finally, a certain level of claims typical of a given individual is established.

In shaping the level of claims, an important role is played by the compliance of the activity of the subject with his assumptions about the degree of complexity of the tasks, the fulfillment of which would bring him satisfaction. V. S. Merlin (1970) attached great importance to social factors, believing that in the same activity there are different social standards of achievement for different social categories, depending on the position, specialty, and qualifications of the individual. This factor also plays a certain role in the conditions of an experimental study of the level of claims - even the correct performance of experimental tasks with a certain self-assessment of the subject may not be perceived by him as successful. From this follows the principle of the importance of the selection of experimental tasks.

The nature of the subject's reaction to success or failure is primarily determined by how stable his self-esteem is. Analyzing the dynamics of the level of claims, V. S. Merlin found that the ease or difficulty of adapting a person to activity by changing the level of claims depends on the properties of temperament (anxiety, extra- or introversion, emotionality) and on such purely personal properties as the initial level claims, the adequacy or inadequacy of self-esteem, the degree of its stability, motives for self-affirmation.

In addition to self-assessment, in the dynamics of the level of claims, such moments as the attitude of the subject to the situation of the experiment and the researcher, the assessment of the activity of the subject by the experimenter, who registers success or failure during the experiment, the nature of the experimental tasks, play a significant role.

In the laboratory of B. V. Zeigarnik, a version of the methodology for studying the level of claims was developed (B. I. Bezhanishvili, 1967). In front of the patient, two rows are laid out with the reverse side up 24 cards. In each row (from 1 to 12 and from 1a to 12a) the cards contain questions of increasing difficulty, for example:
1. Write 3 words starting with the letter "Sh".
a. Write 5 words starting with the letter "N". 3. Write the names of 5 cities starting with the letter "L".
3 a. Write 6 names starting with the letter "B". 10. Write the names of 5 writers starting with the letter "C". 10a. Write the names of 5 famous Soviet film actors starting with the letter "L". 12. Write the names of 7 French artists.
12a. Write the names of famous Russian artists with the letter "K".

The subject is informed that in each row the cards are arranged according to the increasing degree of difficulty of the task, that in parallel in two rows there are cards of the same difficulty. Then he is offered, according to his abilities, to choose tasks of one or another complexity and complete them. The subject is warned that a certain time is allotted for each task, but they do not tell him what time. By turning on the stopwatch every time the subject takes a new card, the researcher, if desired, can tell the subject that he did not meet the allotted time and therefore the task is considered failed. This allows the researcher to artificially create "failure".

The experience is carefully recorded. Attention is drawn to how the level of the patient's claims corresponds to his capabilities (intellectual level, education) and how he reacts to success or failure.

Some patients, after successfully completing, for example, the third task, immediately take the 8th or 9th card, while others, on the contrary, are extremely careful - having correctly completed the task, they take a card either of the same degree of complexity or the next one. The same with failure - some subjects take a card of the same complexity or slightly less difficult, while others, having not completed the ninth task, go to the second or third, which indicates the extreme fragility of their level of claims. It is also possible that the patient's behavior is such that, despite failure, he continues to choose tasks that are more and more difficult. This indicates a lack of critical thinking.

N. K. Kalita (1971) found that the questions used in the variant of B. I. Bezhanishvili, aimed at identifying the general educational level, are difficult to rank. The degree of their difficulty is determined not only by the volume of life knowledge and the level of education of the subject, but also largely depends on the circle of his interests. In search of more objective criteria for establishing the degree of complexity of tasks, N.K. Kalita suggested using pictures that differ from each other in the number of elements. Here, the complexity criterion is the number of differences between the compared pictures. In addition, control examinations can establish the time spent by healthy people to complete tasks of varying degrees of complexity. Otherwise, the study of the level of claims in the modification of N.K. Kalita has not changed.

To conduct research, tasks of a different kind can also be used, in the selection of which one can relatively objectively establish their gradation in terms of complexity: Koos' cubes, one of the series of Raven's tables. For each of the tasks, it is necessary to select a parallel one, approximately equal in degree of difficulty.

The results of the study can be presented for greater clarity and facilitate their analysis in the form of a graph.

It is of interest to study the level of claims with the assessment of some quantitative indicators. Such a study may be important for an objective characterization of the degree of mental defect of the subject. An attempt to modify the methodology for studying the level of claims was made by V.K. Gerbachevsky (1969), who used all the subtests of the D. Wexler scale (WAIS) for this. However, the modification of V.K. Gerbachevsky seems to us difficult for pathopsychological research, and therefore we have somewhat modified the version of the Zeigarnik-Bezhanishvili technique. According to the instructions, the subject must choose 11 out of 24 cards containing questions of varying difficulty according to their abilities (of which the first 10 are taken into account). The response time is not regulated, that is, it is important to take into account the actual completion of tasks, however, the subject is advised to immediately say so if it is impossible to answer the question. Given the well-known increase in the difficulty of the questions contained in the cards, the answers are respectively evaluated in points, for example, the correct answer on the card No. 1 and No. 1a - 1 point, No. 2 and No. 2a - 2 points, No. 8 and No. 8a - 8 points etc. At the same time, just as according to V.K. Gerbachevsky, the value of the level of claims (total assessment of the selected cards) and the level of achievements (the sum of points scored) are determined. In addition, an average score is calculated that determines the trend of activity after a successful or unsuccessful response. For example, if the subject answered 7 out of 10 questions, the sum of points for the cards selected after a successful answer is calculated separately and divided by 7. Similarly, the average activity trend after 3 unsuccessful answers is determined. To assess the choice of cards after the last answer, the subject is offered an unaccounted 11th task.

The methodology for studying the level of claims, as practical experience shows, makes it possible to detect the personal characteristics of patients with schizophrenia, manic-depressive (circular) psychosis, epilepsy, cerebral atherosclerosis, and other organic brain lesions that occur with characterological changes.

The study of self-esteem by the method of T. Dembo - S. Ya. Rubinshtein
The technique was proposed by S. Ya. (1970) for research. It uses the technique of T. Dembo, with the help of which the subject's ideas about his happiness were discovered. S. Ya. Rubinshtein significantly changed this methodology, expanded it, introduced four reference scales instead of one (health, mental development, character and happiness). It should be noted that the use of a reference scale to characterize any personal property helps to identify the position of the subject much more than the use of alternative methods such as the polarity profile and the list of adjectives, when the subject is offered a set of definitions (confident - timid, healthy - sick) and asked to indicate his state (N. Hermann, 1967). In the method of T. Dembo - S. Ya. Rubinshtein, the subject is given the opportunity to determine his condition according to the scales chosen for self-assessment, taking into account a number of nuances that reflect the degree of severity of one or another personal property.

The technique is extremely simple. A vertical line is drawn on a sheet of paper, about which the subject is told that it means happiness, with the upper pole corresponding to a state of complete happiness, and the lower one occupied by the most unhappy people. The subject is asked to mark his place on this line with a line or a circle. The same vertical lines are drawn to express the patient's self-esteem on the scales of health, mental development, and character. Then they start a conversation with the patient, in which they find out his idea of ​​\u200b\u200bhappiness and unhappiness, health and ill health, good and bad character, etc. It turns out why the patient made a mark in a certain place on the scale to indicate his characteristics. For example, what prompted him to put a mark in this place on the health scale, whether he considers himself healthy or sick, if sick, then with what disease, whom does he consider sick.

A peculiar version of the technique is described by T. M. Gabriel (1972) using each of the scales with seven categories, for example: the most sick, very sick, more or less sick, moderately sick, more or less healthy, very healthy, most healthy. The use of scales with such gradation, according to the author's observation, provides more subtle differences in identifying the position of the subjects.

Depending on the specific task facing the researcher, other scales can be introduced into the methodology. So, when examining patients with alcoholism, we use scales of mood, family well-being and service achievements. When examining patients in a depressed state, mood scales, ideas about the future (optimistic or pessimistic), anxiety, self-confidence, etc. are introduced.

In the analysis of the results obtained, S. Ya. Rubinshtein focuses not so much on the location of the marks on the scales as on the discussion of these marks. Mentally healthy people, according to the observations of S. Ya. Rubinshtein, tend to determine their place on all scales with a point “slightly above the middle”. In mental patients, there is a tendency to refer the points of marks to the poles of the lines and the “positional” attitude towards the researcher disappears, which, according to S. Ya. .

The data obtained using this technique are of particular interest when compared with the results of the examination in this patient of the features of thinking and the emotional-volitional sphere. At the same time, a violation of self-criticism, depressive self-esteem, and euphoria can be detected. Comparison of data on self-esteem with objective indicators for a number of experimental psychological techniques to a certain extent allows us to judge the patient's inherent level of claims, the degree of its adequacy. One might think that self-esteem in some mental illnesses does not remain constant and its nature depends not only on the specificity of psychopathological manifestations, but also on the stage of the disease.

Eysenck personality questionnaire
Personal is a variant created by the author (H. J. Eysenck, 1964) in the process of reworking the Maudsley questionnaire proposed by him (1952) and, like the previous one, is aimed at studying the factors of extra- and introversion, neuroticism.

The concepts of extra- and introversion were introduced by representatives of the psychoanalytic school.

S. Jung distinguished between extra- and introverted rational (thinking and emotional) and irrational (sensory and intuitive) psychological types. According to K. Leonhard (1970), the criteria for distinguishing S. Jung were mainly reduced to the subjectivity and objectivity of thinking. N. J. Eysenck (1964) connects extra- and introversion with the degree of excitation and inhibition in the central nervous system, considering this factor, which is largely innate, as a result of the balance of the processes of excitation and inhibition. In this case, a special role is given to the influence of the state of the reticular formation on the ratio of the main nervous processes. H. J. Eysenck also points to the importance of biological factors in this: some drugs introvert a person, while antidepressants extrovert him. Typical extrovert and introvert are considered by N. J. Eysenck as individuals - the opposite edges of the continuum, to which different people approach in one way or another.

According to H. J. Eysenck, an extrovert is sociable, likes parties, has many friends, needs people to talk to them, does not like to read and study himself. He craves excitement, takes risks, acts under the influence of the moment, impulsive.

An extrovert loves tricky jokes, does not go into his pocket for a word, usually loves change. He is carefree, good-naturedly cheerful, optimistic, loves to laugh, prefers movement and action, tends to be aggressive, quick-tempered. His emotions and feelings are not strictly controlled, and he cannot always be relied upon.

In contrast to the extrovert, the introvert is calm, shy, introspective. He prefers reading books to communicating with people. Restrained and distant from everyone except close friends. Plans his actions in advance. Distrusts sudden urges. Serious about making decisions, likes everything in order. Controls his feelings, rarely acts aggressively, does not lose his temper. You can rely on an introvert. He is somewhat pessimistic, highly values ​​ethical standards.

N. J. Eysenck himself believes that the characteristic of the intro- and extrovert described by him only resembles that described by S. Jung, but is not identical to it. K. Leonhard believed that the description of H. J. Eysenck as an extrovert corresponds to the picture of a hypomanic state and believes that the extra- and introversion factor cannot be associated with temperamental traits. According to K. Leonhard, the concepts of intro- and extraversion represent their own mental sphere, and for the extravert, the world of sensations has a determining influence, and for the introvert, the world of ideas, so that one is stimulated and controlled more from the outside, and the other more from the inside.

It should be noted that the point of view of K. Leonhard largely corresponds to the views of V. N. Myasishchev (1926), who defined these personality types from the clinical and psychological point of view as expansive and impressive, and from the neurophysiological side - excitable and inhibited.

J. Gray (1968) raises the question of the identity of the parameters of the strength of the nervous system and intro- and extraversion, and the pole of weakness of the nervous system corresponds to the pole of introversion. At the same time, J. Gray considers the parameter of the strength of the nervous system in terms of activation levels - he considers a weak nervous system as a system of a higher level of reaction compared to a strong nervous system, provided that they are subjected to objectively identical physical stimuli.

J. Strelau (1970) found that extraversion is positively related to the strength of the excitation process and the mobility of nervous processes. At the same time, there is no connection between extraversion and the force of inhibition (in the typology of I.P. Pavlov, the force of inhibition is set exclusively for conditioned inhibition, in the concept of J. Strelau we are talking about “temporary” inhibition, consisting of conditioned and protective, that is, from two different types of braking). All three properties of the nervous system (strength of excitation, strength of inhibition and mobility of nervous processes), according to J. Strelau, are negatively associated with the parameter of neuroticism. All this testifies to the illegitimacy of comparing the personality typology according to N. J. Eysenck with the types of higher nervous activity according to IP Pavlov.

The factor of neuroticism (or neuroticism) testifies, according to H. J. Eysenck, to emotional and psychological stability and instability, stability - instability and is considered in connection with the congenital lability of the autonomic nervous system. In this scale of personality traits, opposite tendencies are expressed by discordance and concordance. At the same time, a person of the “external norm” turns out to be at one pole, behind which lies the susceptibility to all kinds of psychological perturbations, leading to an imbalance in neuropsychic activity. At the other extreme are individuals who are psychologically stable and adapt well to the surrounding social microenvironment.

The neuroticism factor plays an extremely important role in the diathesis-stress hypothesis of the etiopathogenesis of neuroses created by N. J. Eysenck, according to which neurosis is considered as a consequence of a constellation of stress and a predisposition to neurosis. Neuroticism reflects a predisposition to neurosis, a predisposition. With severe neuroticism, according to N. J. Eysenck, a slight stress is sufficient, and, conversely, with a low rate of neuroticism, severe stress is required for the onset of neurosis to develop neurosis.

In addition, a control scale (lie scale) was introduced into the Eysenck questionnaire. It serves to identify subjects with a "desirable reactive set", that is, with a tendency to respond to questions in such a way that the results desired for the subject are obtained.

The questionnaire was developed in 2 parallel forms (A and B), allowing for a second study after any experimental procedures. Questions compared to MMPI differ in simplicity of wording. It is important that the correlation between the scales of extraversion and neuroticism is reduced to zero.

The questionnaire consists of 57 questions, of which 24 are on the extraversion scale, 24 are on the neuroticism scale, and 9 are on the lie scale.

The study is preceded by an instruction that indicates that personality traits are being investigated, and not mental abilities. It is proposed to answer the questions without hesitation, immediately, since the first reaction of the subject to the question is important. Questions can only be answered with “yes” or “no” and cannot be skipped.

Then questions are presented either in a special notebook (this facilitates assessment, as it allows the use of a key in the form of a stencil with specially cut windows), or printed on cards with appropriately cut corners (for subsequent recording).

Here are some typical questions.

So, the following questions testify to extroversion (the corresponding answer is noted in brackets; if the answer is opposite, it is counted as an indicator of introversion):
Do you like the revival and bustle around you? (Yes).
Are you one of those people who do not go into their pocket for words? (Yes).
Do you usually keep a low profile at parties or in companies? (Not).
Do you prefer to work alone? (Not).

The maximum score on the extraversion scale in this version of the Eysenck questionnaire was 24 points. Extraversion is indicated by an indicator above 12 points. With an indicator below 12 points, they speak of introversion.

Questions typical of the neuroticism scale:
Do you feel sometimes happy and sometimes sad for no reason? (On the scale of neuroticism, only positive responses are taken into account).
Do you sometimes have a bad mood?
Are you easily swayed by mood swings?
Have you often lost sleep due to feelings of anxiety?
Neuroticism is indicated by an indicator exceeding 12 points in this scale.
Examples of questions on the lie scale:
Do you always do immediately and resignedly what you are ordered to do? (Yes).
Do you sometimes laugh at indecent jokes? (Not).
Do you brag sometimes? (Not).
Do you always reply to emails immediately after reading them? (Yes).

An indicator of 4-5 points on the lie scale is already considered critical. A high score on this scale indicates the subject's tendency to give "good" answers. This trend also manifests itself in answers to questions on other scales, however, the lie scale was conceived as a kind of indicator of demonstrativeness in the behavior of the subject.

It should be noted that the scale of lies in the Eysenck questionnaire does not always contribute to the solution of the task. The indicators for it primarily correlate with the intellectual level of the subject. Often, persons with pronounced hysterical traits and a tendency to demonstrative behavior, but with good intelligence, immediately determine the direction of the questions contained in this scale and, considering them negatively characterizing the subject, give the minimum indicators on this scale. Thus, obviously, the scale of lies is more indicative of personal primitiveness than demonstrativeness in the answers.

According to H. J. Eysenck (1964, 1968), dysthymic symptoms are observed in introverts, hysterical and psychopathic in extroverts. Patients with neurosis differ only in the index of extraversion. According to the index of neuroticism, healthy and neurotic patients (psychopaths) are at the extreme poles. Patients with schizophrenia have a low rate of neuroticism, while patients in a depressed state have a high rate. With age, there was a tendency to decrease in the indicators of neuroticism and extraversion.

These data of H. J. Eysenck need to be clarified. In particular, in cases of psychopathy, the study using a questionnaire reveals a known difference in indicators. So, schizoid and psychasthenic psychopaths, according to our observations, often show introversion. Different forms of neurosis also differ not only in terms of extraversion. Patients with hysteria are often characterized by a high rate of lies and an exaggeratedly high rate of neuroticism, often not corresponding to an objectively observed clinical picture.

In the latest versions of the Eysenck questionnaire (1968, 1975), questions were introduced on the scale of psychotism. The factor of psychotism is understood as a tendency to deviations from the mental norm, as it were, a predisposition to psychosis. The total number of questions is from 78 to 101. According to S. Eysenck and H. J. Eysenck (1969), the indicators on the psychotism scale depend on the gender and age of the subjects, they are lower in women, higher in adolescents and the elderly. They also depend on the socio-economic status of the surveyed. However, the most significant difference in the factor of psychotism turned out to be when comparing healthy subjects with sick psychoses, that is, with more severe neuroses, as well as with persons in prison.

There is also a personal questionnaire S. Eysenck (1965), adapted to examine children from the age of 7. It contains 60 age-appropriate questions interpreted on scales of extra- and introversion, neuroticism, and lying.

Questionnaire of the level of subjective control (USK) (E. F. Bazhin, E. A Golynkina, A. M. Etkind, 1993)

The technique is an original domestic adaptation of the J. Rotter locus of control scale, created in the USA in the 60s.

The theoretical basis of the methodology is the position that one of the most important psychological characteristics of a person is the degree of independence, autonomy and activity of a person in achieving goals, the development of a sense of personal responsibility for the events happening to him. Proceeding from this, there are persons who localize control over events that are significant for themselves outside (an external type of control), that is, they believe that the events occurring to them are the result of external forces - chance, other people, etc., and persons who have an internal localization of control (internal type of control) - such people explain significant events as the result of their own activities.

In contrast to the concept of J., who postulated the universality of the individual's locus of control in relation to any types of events and situations that he has to face, the authors of the USC methodology, based on the results of numerous experimental studies, showed the insufficiency and unacceptability of transsituational views on the locus of control. They proposed measuring the locus of control as a multidimensional profile, the components of which are tied to the types of social situations of varying degrees of generalization. Therefore, several scales are distinguished in the methodology - the general internality of Io, the internality in the field of achievements Id, the internality in the field of failures Ying, the internality in family relations Is, the internality in the field of industrial relations Ip, the internality in the field of interpersonal relations Im and the internality in relation to health and illness From .

The methodology consists of 44 statements, for each of which the subject must choose one of the 6 proposed answers (completely disagree, disagree, rather disagree, rather agree, agree, completely agree). For ease of processing, it is advisable to use special forms. The processing of the methodology consists in calculating the raw scores using the keys and then transferring them to the walls (from 1 to 10).

Here is the content of individual statements of the methodology:
1. Promotion depends more on luck than on a person's own abilities and efforts.
8. I often feel like I have little influence on what happens to me.
21. The life of most people depends on a combination of circumstances.
27. If I really want, I can win over almost anyone.
42. Capable people who failed to realize their potential should only blame themselves for this.

The technique is extremely widely used for solving a wide variety of practical problems in psychology, medicine, pedagogy, etc. It is shown that internals prefer non-directive methods of psychotherapy, while externals prefer directive ones (S. V. Abramowicz, S. I. Abramowicz, N. B. Robak , S. Jackson, 1971); a positive correlation of externality with anxiety was found (E. S. Butterfield, 1964; D. S. Strassberg, 1973); with mental illness, in particular, with schizophrenia (R. L. Cromwell, D. Rosenthal, D. Schacow, T. P. Zahn., 1968; T. J. Lottman, A. S. DeWolfe, 1972) and depression (S. I. Abramowicz, 1969); there are indications of a relationship between the severity of symptoms and the severity of externality (J. Shibut, 1968) and suicidal tendencies (C. Williams, J. B. Nickels, 1969), etc.

E. G. Ksenofontova (1999) developed a new version of the USK methodology, which simplifies the study for the subjects (alternative answers such as "yes" - "no" are assumed) and introduces a number of new scales ("Predisposition to self-blame") and subscales (" Internality in describing personal experience”, “Internality in judgments about life in general”, “Readiness for activities related to overcoming difficulties”, “Readiness for independent planning, implementation of activities and responsibility for it”, “Negation of activity”, “Professional and social aspect of internality”, “Professional and procedural aspect of internality”, “Competence in the field of interpersonal relations”, “Responsibility in the field of interpersonal relations”).

Methods of psychological diagnostics of the life style index (LIS)
The first Russian-language method for diagnosing types of psychological defense was adapted in the Russian Federation by employees of the laboratory of medical psychology of the V. M. Bekhterev Psychoneurological Institute (St. Petersburg) under the guidance of L. I. Wasserman (E. B. Klubova, O. F. Eryshev, N. N. Petrova, I. G. Bespalko and others) and published in 1998.

The theoretical basis of the technique is the concept of R. Plu-check -X. Kellerman, which suggests a specific network of relationships between different levels of personality: the level of emotions, protection and disposition (that is, a hereditary predisposition to mental illness). Certain defense mechanisms are designed to regulate certain emotions. There are eight main defense mechanisms (denial, repression, regression, compensation, projection, substitution, intellectualization, reactive formations) that interact with eight basic emotions (acceptance, anger, surprise, sadness, disgust, fear, expectation, joy). Defense mechanisms exhibit qualities of both polarity and similarity. The main diagnostic types are formed by their characteristic styles of defense, a person can use any combination of defense mechanisms, all defenses basically have a suppression mechanism that originally arose in order to defeat the feeling of fear.

Questionnaire for the study of accentuated personality traits
The questionnaire for the study of accentuated personality traits was developed by N. Schmieschek (1970) based on the concept of accentuated personalities by K. Leonhard (1964, 1968). According to it, there are personality traits (accentuated), which in themselves are not yet pathological, but can, under certain conditions, develop in positive and negative directions. These features are, as it were, a sharpening of some unique, individual properties inherent in each person, an extreme version of the norm. In psychopaths, these traits are especially pronounced. According to the observations of K. Leonhard, neuroses, as a rule, occur in accentuated individuals. E. Ya. Sternberg (1970) draws an analogy between the concepts of "accentuated personality" by K. Leonhard and "schizothymia" by E. Kretschmer. Identification of a group of accentuated personalities can be fruitful for developing clinical and etiopathogenesis issues in borderline psychiatry, including the study of somatopsychic correlates in some somatic diseases, in the origin of which the personality characteristics of the patient play a prominent role. According to E. Ya. Sternberg, the concept of accentuated personalities can also be useful for studying the personality traits of relatives of mentally ill people.

K. Leonhard singled out 10 main ones:
1. Hyperthymic personalities, characterized by a tendency to high mood.
2. "Stuck" personalities - with a tendency to delay, "stuck" affect and delusional (paranoid) reactions.
3. Emotive, affective-labile personalities.
4. Pedantic personality, with a predominance of features of rigidity, low mobility of nervous processes, pedantry.
5. Anxious personalities, with a predominance of anxiety traits in the character.
6. Cyclothymic personalities, with a tendency to phase mood swings.
7. Demonstrative personalities - with hysterical character traits.
8. Excitable personalities - with a tendency to increased, impulsive reactivity in the sphere of inclinations.
9. Dysthymic personality - with a tendency to mood disorders, subdepressive.
10. Exalted personalities prone to affective exaltation.

All these groups of accentuated personalities are united by K. Leonhard according to the principle of accentuation of character traits or temperament. The accentuation of character traits, “features of aspirations” include demonstrativeness (in pathology - psychopathy of a hysterical circle), pedantry (in pathology - anankastic psychopathy), a tendency to “get stuck” (in pathology - paranoid psychopaths) and excitability (in pathology - epileptoid psychopaths) . The remaining types of accentuation K. Leonhard refers to the features of temperament, they reflect the pace and depth of affective reactions.

The Shmishek questionnaire consists of 88 questions. Here are typical questions:

To identify:
Are you enterprising? (Yes).
Can you entertain society, be the soul of the company? (Yes).
To identify a tendency to "get stuck":
Do you vigorously defend your interests when injustice is done to you? (Yes).
Do you stand up for people who have been treated injustice? (Yes).
Do you persist in achieving your goal if there are many obstacles along the way? (Yes).
To identify pedantry:
Do you have doubts about the quality of its execution after the completion of some work and do you resort to checking whether everything was done correctly? (Yes).
Does it annoy you if the curtain or tablecloth hangs unevenly, do you try to fix it? (Yes).
To identify anxiety:
Were you afraid of thunderstorms and dogs in your childhood? (Yes).
Are you bothered by the need to descend into a dark cellar, to enter an empty unlit room? (Yes).
To detect cyclothymism:
Do you have transitions from a cheerful mood to a very dreary one? (Yes).
Does it happen to you that, going to bed in an excellent mood, in the morning you get up in a bad mood, which lasts for several hours? (Yes).

To identify demonstrativeness:
Have you ever sobbed while experiencing a severe nervous shock? (Yes).
Were you willing to recite poems at school? (Yes).
Do you find it difficult to speak on stage or from the pulpit in front of a large audience? (Not).

To detect excitability:
Do you get angry easily? (Yes).
Can you use your hands when you're angry with someone? (Yes).
Do you do sudden, impulsive acts while under the influence of alcohol? (Yes).

To identify dysthymia:
Are you capable of being playfully cheerful? (Not).
Do you like being in society? (Not). To identify exaltation:
Do you have states when you are filled with happiness? (Yes).
Can you fall into despair under the influence of disappointment? (Yes).

Answers to questions are entered into the registration sheet, and then, using specially prepared keys, an indicator is calculated for each type of personal accentuation. The use of appropriate coefficients makes these indicators comparable. The maximum score for each type of accentuation is 24 points. A sign of accentuation is an indicator that exceeds 12 points. The results can be expressed graphically as a personality accentuation profile. You can also calculate the average accentuation index, equal to the quotient of dividing the sum of all indicators for individual types of accentuation by 10. Shmishek's technique was also adapted for the study of children and adolescents, taking into account their age characteristics and interests (I. V. Kruk, 1975).

One of the options for the Shmishek questionnaire is the Littmann-Shmishek questionnaire (E. Littmann, K. G. Schmieschek, 1982). It includes 9 scales from the Shmishek questionnaire (exaltation scale is excluded) with the addition of extra-introversion and sincerity (lie) scales according to H. J. Eysenck. This questionnaire was adapted and standardized by us (V. M. Bleikher, N. B. Feldman, 1985). The questionnaire consists of 114 questions. The responses are evaluated using special coefficients. The results on individual scales from 1 to 6 points are considered as the norm, 7 points - as a tendency to accentuation, 8 points - as a manifestation of a clear personal accentuation.

To determine the reliability of the results, their reliability in a statistically significant group of patients, the examination was carried out according to a questionnaire and with the help of standards - maps containing a list of the main features of types of accentuation. The selection of standards was made by people close to the patient. In this case, a match was found in 95% of cases. This result indicates sufficient accuracy of the questionnaire.

The total number of accentuated personalities among healthy subjects was 39%. According to K. Leonhard, accentuation is observed in about half of healthy people.

According to a study of healthy people by the twin method (V. M. Bleikher, N. B. Feldman, 1986), a significant heritability of types of personal accentuation, their significant genetic determinism, was found.

Toronto alexithymic scale
The term "alexithymia" was introduced in 1972 by P. E. Sifheos to refer to certain personal characteristics of patients with psychosomatic disorders - the difficulty of finding suitable words to describe one's own feelings, impoverishment of fantasy, a utilitarian way of thinking, a tendency to use actions in conflict and stressful situations. In a literal translation, the term "alexithymia" means: "there are no words for feelings." In the future, this term took a strong position in the specialized literature, and the concept of alexithymia became widespread and creatively developed.

J. Ruesch (1948), P. Marty and de M. M "Uzan (1963) found that patients suffering from classic psychosomatic diseases often show difficulties in verbal and symbolic expression of emotions. Currently, alexithymia is determined by the following cognitive-affective psychological features:
1) difficulty in defining (identifying) and describing one's own feelings;
2) difficulty in distinguishing between feelings and bodily sensations;
3) a decrease in the ability to symbolize (poverty of fantasy and other manifestations, imagination);
4) focusing more on external events than on internal experiences.

As clinical experience shows, in most patients with psychosomatic disorders, alexithymic manifestations are irreversible, despite long-term and intensive psychotherapy.

In addition to patients with psychosomatic disorders, alexithymia can also occur in healthy people.

Of the numerous methods for measuring alexithymia in the Russian-speaking contingent, only one has been adapted - the Toronto alexithymia scale
(Psycho-Neurological Institute named after V. M. Bekhterev, 1994). It was created by G. J. Taylor et al. in 1985 using a concept-driven, factorial approach. In its modern form, the scale consists of 26 statements, with the help of which the subject can characterize himself, using five gradations of answers: “completely disagree”, “rather disagree”, “neither, nor the other”, “rather agree”, “completely agree”. ". Examples of scale statements:
1. When I cry, I always know why.
8. I find it difficult to find the right words for my feelings.
18. I rarely dream.
21. It is very important to be able to understand emotions.

In the course of the study, the subject is asked to choose for each of the statements the most appropriate answer for him; in this case, the numerical designation of the answer is the number of points scored by the subject on this statement in the case of the so-called positive points of the scale. The scale also contains 10 negative points; to obtain a final score in points for which the opposite score should be given for these items, held in a negative way: for example, score 1 gets 5 points, 2-4, 3-3, 4-2, 5-1. The total sum of positive and negative points is calculated.

According to the staff of the Psychoneurological Institute. V. M. Bekhtereva (D. B. Eresko, G. L. Isurina, E. V. Kaidanovskaya, B. D. Karvasarsky et al., 1994), who adapted the methodology in Russian, healthy individuals have indicators for this method of 59.3 ±1.3 points. Patients with psychosomatic diseases (patients with hypertension, bronchial asthma, peptic ulcer) had an average score of 72.09±0.82, and no significant differences were found within this group. Patients with neurosis (obsessive-phobic neurosis) had a score on a scale of 70.1±1.3, not significantly different from the group of patients with psychosomatic diseases. Thus, using the Toronto alexithymic scale, one can only diagnose a "combined" group of neuroses and; its differentiation requires further targeted clinical and psychological research.