From the author: Keiselman (Dorozhkin) V.R. Cotherapy: group phenomena, methods, effects. – St. Petersburg: “Rech”, 2007. – 192 pp. On the issue of the effectiveness of psychotherapy The problem of studying the effectiveness of psychotherapy arose at the dawn of the development of therapeutic practice. This problem has been and is being raised by most working psychologists and psychotherapists. First of all, the category of such therapists includes those who are interested in obtaining fairly formalized criteria for ending psychotherapy. A number of works by domestic and foreign psychotherapists are devoted to the development of such criteria (V.A. Ababkov, A.A. Aleksandrov, A.F. Bondarenko, M.E. Burno, F.E. Vasilyuk, E.S. Kalmykova; Zh. Lacan; H. Thome, H. Kähele; I. Yalom), and in particular the work of Z. Freud “Finite and Infinite Analysis”. The result of S. Freud's article was the idea that the analysis can be considered complete when the patient ceases to suffer from his symptoms, and the psychoanalyst forms a fairly firm belief that the repetition of psychopathological processes in the patient will not occur. Another group of researchers of the effectiveness of psychotherapy consists of those therapists who who are interested in determining the degree of effectiveness of their own influences. The development of such “subjective” criteria is necessary for the formation of professional reflection on the effectiveness of one’s work, as well as for the formation of a stable professional identity. It goes without saying that the criteria for the end of psychotherapy and the criteria for therapeutic effectiveness are interrelated and, apparently, their development belongs to one single problem of studying the result of psychotherapy. A special group consists of psychologists who seek to refute the usefulness of any psychotherapy or refute the results of one of its forms One of these psychologists was G. Eysenck. He argued for quite a long time with psychoanalytically oriented therapists about the effectiveness of psychoanalysis as a method of psychological help. G. Eysenck tried to validate and verify the effects of psychoanalytic therapy using objective and statistical methods. He believed that since psychoanalysis is aimed at eliminating painful symptoms, then either these symptoms should disappear completely, or somatic patients undergoing psychotherapy should recover more quickly. Conducting statistical studies on large samples from the experimental and control groups, G. Eysenck did not find significant differences in the recovery of patients receiving psychotherapy and patients without psychological help (data from Alexandrov, 1997; Ivey, Ivy et al., 1999). The authority of G. Eysenck at that time was so high, and the logic of his reasoning was so convincing that it was difficult for practicing therapists to oppose weighty, convincing and, most importantly, statistically objective evidence of the effectiveness of their work. Therefore, for a long time, psychotherapists simply ignored the findings of G. Eysenck. The exception was a few research scientists, including Smith and Glass. Their research into the effectiveness of psychotherapy was methodologically based on the same principles as the work of G. Eysenck himself. Thus, in 1977, Smith and Glass conducted a meta-analysis of the results of psychological assistance, summarizing data from 375 studies on the effectiveness of psychotherapy and psychological counseling. Conclusions Smith and Glass were: recognizing the presence of improvements in patients undergoing therapy; establishing the optimal duration of the therapeutic course (medium-length courses were considered least effective - from 10 to 20 hours); accepting the cognitive-behavioral approach as the most effective method of counseling (Ivey, Ivey , 1999). G. Eysenck challenged and criticized the results obtained by Smith and Glass. In turn, the latter accused G. Eysenck of bias and bias in the selection of materials confirming his own conclusions. Controversy between themwas carried out for quite a long time and was not particularly fruitful (Ivey, Ivey, 1999). Such protracted scientific discussions were most likely associated not with the peculiarities of the researchers’ preferences among certain therapeutic methods, but, perhaps, with the very understanding of the result of psychotherapy, which they considered as a quantitative measure that can be measured objectively in certain units. This understanding of the therapeutic effect after numerous mutually contradictory studies (Ruchman, Wilson; Kammengs, Folette, etc.) had to be abandoned (data from Ivey, Ivey, 1999). The first constructive decision that radically advanced the understanding of the result of counseling and led to the development of effectiveness criteria to a qualitatively new level, was associated with the promotion of the principle of problem-therapy-result congruence (data according to Kalmykova, 1992). According to this principle, research into the effectiveness of psychotherapy should be carried out in terms of the psychotherapeutic practice that forms the object of this research. That is, in other words, the theory, methodology, conceptual apparatus of describing the problem, therapeutic process, result and interpretation of this result must coincide. Within the framework of the principle of problem-therapy-result congruence, more specific methodological consequences were formulated, for example, the following: Changes that undergoes by the patient in the process of therapeutic work, are multidimensional and nonlinear. Changes in the client’s behavior and internal states are equally important. To assess the results of psychotherapy, it is undesirable to use traditional linear psychodiagnostic tests. The use of specific situational techniques is productive. Probably, there are simply no uniform criteria for improving the psychosomatic state and behavior for all patients (data from Kalmykova, 1992). Another constructive advance in understanding the effectiveness of psychotherapy was that, in addition to taking into account the language and methodological foundations of the counseling paradigm itself, As a result of psychological assistance, they began to speak, increasingly using subjective linguistic categories (Alexandrov, 1997; Vasilyuk, 1997). Supporters of the “subjectivization” of criteria for the effectiveness of therapy began to insist on the impossibility of using “objective assessments” to record changes, “all objectivity of which is subjective” (Vasilyuk, 1997, p. 16). The shift in considering the therapeutic result from objective aspects of change to subjective ones did not eliminate, however, the very problem of analyzing and studying the effectiveness of counseling. However, now, to capture the effect of therapy, it has become possible to use person-oriented, subjective methods, based primarily on the analysis of the client’s speech/discourse. The central provisions of the concept of “subjectivity” of the therapeutic effect can be presented as follows: The effectiveness of the therapist’s influence is determined by how the client himself begins to talk about his problems. Diagnostically important for understanding the result of counseling is the relationship that the client begins to build with the therapist in the final stages of work. An important effect of psychotherapy is also how fully the client has restored and accepted his personal history (Lacan, 1998 ).Understanding the importance of subjective, semantic changes as a result of therapeutic influence required the development of specific methodological tools for its recording and study. Such tools were modified versions of the semantic differential (Petrenko, 1997), as well as more complex in calculations, but also more personally adapted methods of repertoire lattices (Francella, Bannister, 1987). These methods made it possible to study the semantic structure of the client’s consciousness, reconstruct his semantic system of constructs, and also study the subjective experience of a person. Today we can say that these methods are sufficient for ascertaining the semantic changes that have occurred with the client.Difficulties arise when trying to interpret the results of therapy from the point of view of its optimality and effectiveness. Apparently, it is necessary to correlate the results obtained using diagnostic tools with the analysis of the client’s self-reports. It is desirable that these self-reports present material devoted not only to a new understanding of their own problems and difficulties, but also to the client’s vision of the logic of therapeutic work, systematization of the changes that have occurred to him, as well as a description of established relationships with the client’s significant others. Involving client self-reports dedicated to retrospective analysis of one’s own difficulties and established new relationships with significant others, corresponds to another aspect of understanding the effectiveness of psychotherapy. This aspect is determined by taking into account the usefulness of counseling not only for the client himself, but also for those systems in which he is included as a subsystem. That is why the development of criteria for the effectiveness of psychotherapy should also include an analysis of the properties of various systems (family, professional, ethnic or cultural environment) into which the client enters as an element and to which he feels involved. This understanding of effectiveness involves the therapist bringing “the context of culture into the individual life” of the client, enriching him with the historical and cultural experience of humanity (Barabin, 1990), “revealing to the client the complexity and difficulties of the world” (Vasilyuk, 1984), discussing with him the existential problems of existence ( Yalom, 2000). Let me summarize what has been said. Today there is no single, clearly established understanding of the effectiveness of psychotherapeutic influence. The understanding of the result is specific depending on the therapeutic paradigm within which the counseling is carried out, on the program for researching this result, and on the personality of the researcher/psychotherapist himself. On the other hand, modern procedures for studying the effectiveness of various forms of counseling, one way or another, integrate the results of different approaches to effectiveness and contain both objective and subjective criteria (Yalom, 2000). Therefore, despite all the differences in views on the results of counseling, we can talk about the unification of trends in understanding these results. Today, the main difficulty is no longer the definition of the term “efficiency” itself, but its measurement and recording. This applies to individual and group forms of psychotherapy. With cotherapy, the situation is somewhat more complicated. Difficulties in studying the effects of cotherapy are multiplied by the poor development of the practice and theory of cotherapeutic counseling, as well as the lack of determination of the measure of influence on the client of each cotherapist individually. Basically, authors touching on the field of cotherapy limit themselves to listing the advantages and problematic aspects of cotherapy and talk about the pros and cons of working together (Kociunas, 2000; Psychotherapeutic Encyclopedia, 1999; Yalom, 2000; Whitaker & Malone, 1981), leaving the problem of the effectiveness of cotherapy behind side of theoretical analysis. Therefore, any practicing therapists who try to counsel couples have to develop this problem themselves, empirically selecting the optimal criteria for recording the results of their influence. I myself approach determining the effectiveness of joint influence on the client in the following way. Firstly, when determining the result of cotherapy, I rely on a three-aspect system for analyzing the interaction of therapy participants (let me remind you that this system highlights cognitive, affective and behavioral aspects). At the same time, I expand the indicated system of analysis and add two more aspects to it: educational and scientific. The latter provide additional opportunities for analyzing the effects of psychotherapy. Secondly, I consider the therapeutic result as a holistic effect, cumulatively made up of individual achievements in all five aspects I consider. At the same time, under the very effectiveness of cotherapy, II understand precisely the holistic cumulative effect that is obtained during cotherapeutic counseling of a specific client. Finally, thirdly, in my understanding of the effectiveness of cotherapy, I try to reconcile objective and subjective criteria for analyzing the result and consider these criteria not as additional, but as equal in importance and in status. So, let’s get down to specifics. The first effect of cotherapeutic counseling is an increase in the client’s meaning. Cognitive aspect of the effectiveness of cotherapeutic work I consider the cognitive effect of psychotherapy to include the increase in the client’s personal meaning (term by N.F. Kalina). This effect is probably one of the most common in psychotherapeutic practice. Moreover, any psychotherapy is aimed at the client acquiring new understanding/experience/knowledge/meaning. Such acquisitions are the goal of any psychotherapeutic process and there is not a single therapeutic paradigm in which the effect of enriching the client with new meanings would not be present. Another thing is that the content of the effect of increasing personal meaning differs from school to school and from approach to approach. In psychoanalysis, it is achieved by understanding deep, repressed unconscious desires; in Gestalt psychotherapy - through awareness of the body/process/contact/relationships and being in the present moment; in cognitive psychotherapy - through training, persuasion and revealing the meaning of internal cognitions; in psychological counseling - by informing and restructuring personal experience, etc. What is important here is not the mechanisms through which the increase in meaning occurs, but what is significant is that any communication with a psychotherapist teaches the client to comprehend life in a new way and assimilate subsequent experience. Suffice it to say that the very communication with a psychotherapist-psychologist puts a person in the position of an analyzing subject . A person gets used to analyzing his speech/life, revealing more and more new meanings and personal meanings. This can be expressed this way: in therapeutic communication, a person develops the skill of a special, “analytical” structuring of his speech, which, in turn, forms his ability to “analytically “think and “therapeutically” process the experience gained from life. The reader who has his own therapeutic practice understands well what I am talking about here. I will give a more illustrative example. I suggest that any psychologist conduct a simple experiment. Pay attention to how the speech of a random fellow traveler/interlocutor with whom you are traveling on a train/bus or simply communicating changes when he finds out who you are by profession. A person’s speech instantly becomes different. A person begins to speak more responsibly (or irresponsibly)[1]. This is due to the fact that in everyday life there are still strong ideas about psychologists as scanners/X-rays/seers who see much more and further than a person would like to say/show. These ideas give rise to internal anxiety/fear in a person, caused by the very fact “there is a psychologist in front of me now.” These same fears encourage a person to treat his speech more consciously. Another option is when, in an attempt to suppress the anxiety that has arisen, a person begins to reduce the significance of his statements, turning everything into a joke. But the fact remains a fact. For some time, the psychologist’s interlocutor actually speaks differently, more (or less) thoughtfully. However, I will continue. The most powerful therapeutic tool that affects the increase in personal meaning is interpretation. It is always associated with the discovery of new meanings and acts as a micro/macro discovery in the life of the person to whom this interpretation is given. This is its meaning - to establish a connection between the well-known, known and hidden/unconscious. Interpretation, like no other tool, influences the growth of new meanings and meanings. That is why so many rules are associated with its preparation and communication. This includes the requirement to speak with the client in the same language as him, and recommendations related to the preparationinterpretation, and factors of timeliness of the interpretation message. How to see/feel/record that the phenomenon of an increase in meaning has occurred? There is only one answer: you need to clearly track the client’s new understanding of his problem. It is desirable when this understanding coincides with the therapist’s understanding of the problem (or, in another option, The therapist must be clear about the conclusions that the client made based on the results of psychotherapeutic work). What has been said is clear. If the understanding of the results by the therapist and the client strongly diverges or, moreover, contradicts each other, then there can be no question of the completion of the therapeutic work. This is largely due to the fact that the therapist is at that stage of counseling when he already understands the client and the essence of his problems, begins to intentionally lead the client to prepared interpretations. And if in this version, the client’s conclusions are little understood by the therapist himself, seem pretentious or divorced from reality to him, then further work is required aimed at clarifying personal meanings. The above also applies to the situation when the client says that he understood everything, begins to thank the therapist, but refuses to say what exactly he understood and how he connects it with the therapeutic work. On the other hand, the opposite is also true: the psychotherapist’s interpretations, for all their “values ​​and advancement” must be accessible and understandable to the client. If the client does not understand the interpretation, “closes” to it, and stops speaking after it, then the therapist did something wrong. Perhaps he chose the wrong words, perhaps he did not feel the client “to the end” (or, in general, did not allow him to finish/speak), or did not prepare an interpretation, said it at the wrong time, in the wrong voice and with the wrong intonation. In this case, I try to adhere to a simple rule: the interpretation must be prepared by the psychotherapist and expressed by the client himself. The therapist only guides the client to an interpretation/new understanding by asking leading questions. In this case, working with the client’s resistance is largely decided by him. In conclusion, I will say that when it comes to cotherapeutic counseling, both psychotherapists are responsible for increasing the client’s meanings. If their work is divided into phenomenological and analytical strategies, then the analytical therapist is primarily responsible for this phenomenon. Now I will say a few more words about methods for measuring this effect. To capture such a component of the result of counseling as the increase in meaning, you can use various methods for studying subjective semantics. Various modifications of the semantic differential or repertory grid methods are suitable for this role (features of using repertoire methods to identify changes in the process of group psychotherapy are described in the appendix to the book by Francell, Bannister, 1987). Standardized self-reports with highlighted criteria for them are also suitable for identifying incremental meanings. analysis (compare Yal, 2000, pp.547–554). In this sense, keeping diaries by clients acts as a reliable record of therapeutic effectiveness. If you perceive the use of additional tools as a burden and unnecessary work, I recommend ending the therapeutic session with a mandatory question to the client: “What conclusions did you draw today?” Personally, I always ask this or a similar question with the goal of ultimately aligning my own understanding with the client’s understanding. Symbolic constitution as an affective aspect of effectiveness Another important component of the effectiveness of psychotherapy is the symbolic constitution of the client. By the symbolic constitution of the client in psychotherapy, I understand the process when the absence/impossibility of satisfying unconscious desires in the register of the real is compensated by the realization of these desires in the register of the symbolic, i.e. in therapeutic discourse. Constitution is achieved in the symbolic register through the embodiment of the client’s unconscious desires in speech, whenhe takes the position of satisfying these desires in the face of the Significant Other. In other words, for symbolic constitution it is necessary, firstly, the presence of a referent listener (in psychotherapy this is a therapist), secondly, the speaker’s understanding of his unconscious desires and, thirdly, that the person takes the position of satisfying desires in speech. But first things first I’ll start with an analysis of the definition itself. Several points are important in it. First. Symbolic constitution (hereinafter, SC) is associated with the register of the Symbolic (the classification of registers of the psyche I borrowed from J. Lacan). By the way, the name itself—symbolic constitution—comes from this register. So, SC occurs when the Desired in reality is difficult to achieve, or can lead to a radical change in the client’s entire lifestyle. In this situation, we can also say that the real embodiment of unconscious desires is not shown/not advisable. How often does a similar situation arise in the practice of therapy and why, in fact, is it necessary? If we remember the ambivalent nature of the human psyche and the complementary nature of the Unconscious, then SC necessary in any psychotherapeutic process when the therapist works with the psyche as a whole. We are designed so that we simultaneously love and hate, are monogamous and polygamous, and want to make any choice and prevent it, and strive for freedom and are afraid of it. At the same time, our actual life is unambiguous, it does not like compromises, does not allow duality or, especially, multiplicity. The reality of human choice is poorer than the capabilities of our essentially multidimensional psyche (therefore, the most promising computer developments are aimed at creating multiple reality). The register of the Symbolic allows us to more fully reflect the nature of the psyche. In it, we can explore any choices and possibilities, allow any results, the most contradictory to each other, and they will coexist in our mental spaces and not be mutually exclusive, but complement and enrich each other. These possibilities can be embodied in a therapeutic session in a joint discourse, as leads to the client's SC.Second. The definition says that the satisfaction of unconscious desires in the register of the real is compensated by the realization of these desires in the register of the Symbolic. Pronunciation, articulation of unconscious desires, their embodiment in therapeutic discourse is already the realization of the energy of these desires. Repeatedly uttering the Desired reduces its motivating potential. If we are talking about repressed desires, then reducing their significance through symbolic satisfaction has a significant therapeutic effect. On the other hand, as I said just above, the Symbolic register compensates for the lack of plurality of the Real register and is more adapted to the nature of the psyche. Therefore, in speech it is possible to realize the multidimensional nature of the psyche, which ensures the restoration of its integrity. This is another compensatory effect: the satisfaction of repressed desires in the Symbolic register. In this regard, we can also say that internal multiplicity and inconsistency must be resolved by internal means, and not by diversifying external ones. Third. The fact that the client can respond to unconscious, forbidden desires, constituted in the register of the Symbolic, is one of the most important results of psychotherapy. This means that when assessing the effectiveness of therapeutic work, it is necessary to use not only the previously developed “objective” and “subjective” criteria, but also take into account how fully the client has been constituted in the Symbolic register. Moreover, understanding the capabilities of the SC allows me to say that the actual implementation of any therapeutic decisions is not at all necessary. Moreover, discussing problems during counseling and psychotherapy may not lead to any real changes in the client’s life.The need for such changes was postulated in the “former” understanding of effectiveness, introduced by G. Eysenck. Today we can talk about how fully during therapy the client was given the opportunity to respond to his inner, deeply repressed essence, whether the person’s internal reality was objectified, in the space in which the SC occurred, etc. Incarnation in reality is not at all necessary. Therapy, in principle, should not lead to any changes in reality (this is rather the principle of the Eysenckian approach to understanding effectiveness). It is even possible that therapeutic practice exists so that reality remains unshakable. And here I want to give examples that prompted me to the very possibility of SC. A few years ago I drew attention to one interesting result of psychotherapy. The result of some therapeutic sessions was not the implementation of decisions made during psychotherapy, but the paradoxical strengthening of a person’s own life positions. At that time, I had a feeling of some kind of trap. The more the client talked about the need to change, the more he worked through ways of possible change, the less likely it became that he would change anything at all. I remember this case especially vividly. In one of the groups that worked for four years and met once per week, the same problem was repeatedly raised. This problem was posed by a regular participant in this group, a young married woman about thirty years old. The problem concerned her possible divorce from her husband and her persistent desire to get this divorce. It all started with the fact that at the next meeting Masha (that was the name of this girl) volunteered to be a client. She told the group that she was tired of living with her husband, that they were different people and their interests did not intersect, different goals in life, opposing views on the family and their own roles in it. She also mentioned that she had thought about her situation for a long time, analyzed all possible options and the only solution that seemed likely to her was divorce. After this word, she was silent for a long time, immersed in her inner state. The word “divorce” itself was difficult for her; it was clear how worried she was and how painful this confession was for her in the group. Nevertheless, once the words “divorce” and “breakup” were introduced, they flashed quite often in that session. Gradually, Masha began to treat them as commonplace, as an ordinary and natural matter. This was noticed. By calm acceptance, the group sanctioned the normativity of such an act, lifted the ban on it, which gave greater confidence and freedom to the client. Having acquired this opportunity, having felt its potential consequences, Masha noticeably calmed down. It turned out that for six months. Six months later, she again started talking about her breakup, but from a slightly different perspective. As she put it, the divorce was a done deal for her; she just wanted to analyze her role in it, understand her mistakes and not repeat them again. In addition, she asked new topics: what kind of person does she need, what kind of woman is she, and what kind of relationship does she need? These topics caused a certain resonance in the group, especially in its male part. The men, sensing the client’s unconscious request, actively joined the discussion. Men's presentations began at the group. For men, she had already stopped being married, had become free, and all this had just happened, right here at the session, which fueled male interest and even gave rise to a certain competition among men. This fact was interpreted, which provoked even more flirtatious behavior from the client. It became clear that she unconsciously sought to achieve a new status in the group, so that she would be perceived as a free girl. She wanted to acquire a new position and achieved it. Periodically, at intervals of four to six months, Masha announced her divorce and her criteria for choosing a man several more times, reminding the group of her freedom and desire. The position is symbolically divorced, whichMasha started working in a therapeutic group, freed her from the need for a real divorce and allowed her to survive family conflicts. She reacted in therapeutic discourse to the desire to be divorced, constituting herself in the image of a free woman. After some time, when the situation in her family became more comfortable and the urgency of the divorce decreased, she stopped going to the group. The situation in her family has returned to normal. She is married to this day. Second example. I borrow it from the world of feature films. There are a significant number of episodes in films when one of the characters threatens another. As a rule, a pistol/machine gun/gun/knife is pointed at the head or another mortally vulnerable place, and its owner hesitates and even begins to monologue. The practice of watching the overwhelming number of such episodes has already developed in us - the viewers - the intuition that the longer this monologue continues, the longer the owner of the weapon talks about how he hates his victim, how he will shoot at him, where his brains will fly, calls for remembering about life, about actions - the less likely it is that this shot will actually happen. And if it does happen, it will be past/towards/towards oneself; or, another option, by accident/by mistake/negligence (as in the movie “Pulp Fiction”), i.e. against the will of the owner of the weapon. As a rule, something gets in the way, someone saves, the person under the gun begins to act actively, or the person with the weapon changes his mind about shooting/gets angry/softens/spoke out and that’s enough for him. In such episodes it is correctly conveyed that the verbal expression of aggression eliminates or prevents/ interferes with the actual reality of the aggressive attack. If you want to act, act, don’t talk. Third example. Already from the field of everyday life. We all know that the more a person talks about his plans, describes in detail the stages of their implementation, begins to think through the distribution of the results of his work, and especially if he immerses himself in the field experiences of what he will achieve, then the internal strength for real implementation becomes less and less. There is even a superstition in everyday life that prohibits talking about something that has not yet happened. “So as not to be jinxed,” warns popular rumor. The folk saying about the prohibition of sharing the skin of an unkilled bear has the same nature. People have long felt the catch in repeatedly talking about any promising cases and, especially, about the results of these cases. On this occasion, once upon a time I even formulated advice that I called “how to stop a terrorist”: if you want to stop someone to carry out his plans, arrange for him to tell his acquaintances, relatives, and friends about them twenty times, and especially to share with them the planned results and achievements. There is a high probability that after repeatedly talking about their plans, a person simply will not want to implement them. “Burned out,” people say about this state. This is the nature of the human psyche. What can be seen from these three examples? I will give a detailed answer. By and large, we have three ways of realizing our inner desires: in the register of the Imaginary (unsatisfactory Ersatz, when constitution leads away a person from his true essence), in the register of the Symbolic and in the register of the Real. All these registers are identical from the point of view of the way of satisfying desire. What is different is only the final result and the pleasure that a person experiences when achieving it. The Symbolic register in this sense is a good alternative and a much safer analogue of the Real register. In speech, you can say everything, try out all sorts of options for the development of events and not bear the responsibility that follows real actions. By speaking out some of your internal state, your truly Desired, the human psyche is constituted in the image that is currently created in speech, it is embodied in German True, a number of conditions are necessary for SC to occur. For example, the presence of a referent listener is required (I talked about thisa little earlier).So, by pronouncing the Desired in speech, we create a symbolic effect of achieving this Desired, when everything has already been received and, in addition, there is a witness (referent listener) who sees/supports it. We symbolically satisfy our inner urge, our desire. Internal tension decreases for a while. There remains less motivation to make this Desired reality. Symbolically, we are already satisfied. Repeated repetition of the act of SC leads to the development in us of a typical method of releasing tension, when the constitution in the register of the Symbolic is fixed as the main path. I repeat that other ways can be constitution in the register of the Imaginary and constitution in the register of the Real. We can talk about the SC only when the most significant motivations and desires of a person are represented in the discourse. Like everything that really works, the SC meets the principle: “ in large quantities it is destructive, but in small quantities it is healing.” Therefore, constitution in the Symbolic register, if handled correctly, has significant therapeutic potential. I will consider the stages of SC during psychotherapy: The first stage begins from the moment the client comes to psychotherapy and begins to talk about his problems. I will immediately make one important remark. It is no coincidence that they say that the client never knows his real problem. And more radically: “psychotherapy ends when the client has learned to talk correctly about his problems” (Lacan, 1997). At the very initial stages of therapeutic communication, the client really does not understand the essence of his deep-seated problems. Although he can describe the situation in his life quite well and characterizes the experiences he experiences quite well, something is always missing. The client “pours water”, gives out “empty speech” (J. Lacan’s term), which, no matter how much a person speaks, does not bring him relief. On the contrary, very often he has a feeling of melancholy, fatigue, monotony, “the same thing.” And if the psychotherapist does not help him find the right words, these feelings will practically not go away. Maybe, perhaps, they will forget. What does the psychotherapist do at this moment? He listens attentively, occasionally asks questions that return to the essence of the matter, in general, he is on the path to understanding the client’s deep meanings. No matter how much and what the client talks about at the first stage, SC will never happen for him. The appropriate conditions have not yet been created. These conditions include: the presence of a referent listener (Significant Other), understanding of deep essential desires, the client occupying the position of satisfying these desires in the space of a psychotherapeutic session. But more on that in order. The beginning of the second stage of the SC procedure is associated with the transition of the psychotherapist into the client’s Significant Other system. Why does this happen? Why does a therapist, whom the client did not know at all until recently, suddenly become an extremely important person with whom the client rushes to consult, about whom he develops a number of complex and contradictory feelings and without whom he generally ceases to imagine his life? Psychoanalysis has long ago answered this question by introducing the concept of transference. In short, the formation of transference can be summarized as follows: by devoting the therapist to the particulars of his life, talking about people who are significant to him, remembering the most emotionally significant events, the client actualizes a whole conglomerate of the brightest emotions. Since there is only one person in the field of his story - the therapist, the client, willy-nilly, associates all these emotions with him. Transference gradually begins to develop when the client attaches more and more strongly colored and earlier emotional labels to the psychotherapist. Thus, the therapist becomes a Significant figure for the client, the so-called referent listener, and their entire dialogue acquires special importance for the client. We can say that this dialogue takes on “real weight.” In the process of development of the described phenomena, the psychotherapist continues to helpto the client in determining his essential unconscious desires, in the space of speaking about which SC is possible. Moreover, it is very important that the client gradually begins to understand his unconscious desires. The third stage of the SC procedure begins when the therapist, from an active search for the client’s inner meanings, begins to introduce the client’s unreacted unconscious desires into the space of the psychotherapeutic session. This is the most interesting moment. The introduction of the client's unconscious desires into the field of therapy occurs through the therapist appropriating the discourse of the client's complete speech and then delegating to him the meaning of this speech in his discourse. In structural psychoanalysis they say that the analyst introduces the client to his Other Self. The most vivid description of what is happening can be obtained by becoming familiar with the provocative and paradoxical techniques of work in psychotherapy (Sherman, Fredman, 1997). Among these techniques is the method of “controlled symptom amplification,” when a person is asked to develop his symptom in as much detail as possible, think through all its consequences, describe how this symptom amplification will affect his whole life, etc. At the third stage of SC, something similar happens. The therapist suggests the client to discuss those unconscious desires and those aspects of his personality that can be attributed to the client’s Other Self. If the client experiences certain difficulties in discussing these desires, then the therapist himself can begin to talk about them, authorizing their introduction into the space of the therapeutic session, making them normative. You can work with any therapeutic material. If, for example, we are talking about internal, unreacted aggression, then the person is asked questions: what kind of aggression could this be, towards whom it will be directed; what a person will experience immediately after an aggressive attack; how you will behave if you encounter resistance or counter-aggression, how you will feel; what will happen if your family/friends find out about this; what thoughts will you have after some time, etc. As a rule, the client’s utterance of a topic that is forbidden to him, his symbolic mastery of the position of a person who can commit an aggressive act, ultimately give an integrative result, when a person knows and begins to treat his aggressiveness calmly, the number of cases of unmotivated and auto-aggression decreases, and, consequently, the feeling of guilt; in general, he calms down and becomes more harmonious. In the act of SC, he splashes out the first, most subjectively terrible wave of aggressiveness, and then comes rational comprehension and awareness of what lies behind it. Similar work can be carried out if the psychotherapist identifies any other deeply repressed and suppressed desires/complimentary personality traits. Thus, The psychotherapist’s work on introducing the client’s repressed desires into the therapeutic field is carried out mainly through “inclusive questions” that actualize the client’s latent impulses. Finally, the fourth stage of the SC procedure begins when the client independently tries to master the previously forbidden positions of his Other Self. The SC itself occurs exactly at this stage. The client himself introduces his Other into the therapy space, experiments with him in discourse, masters through speech positions that were previously taboo and forbidden, and more often even unknown. He begins to enjoy constituting himself in the role of his Other, he begins to enjoy experimenting with his inner essence in the symbolic space of psychotherapy. The fourth stage is the stage when the client gains experience in using the register of the Symbolic to identify, create and integrate the multiple selves of his personality, connecting all these selves into a single integrity of real existence, when the energy of all the internal essences of a person is maximally fully connected. Moreover, if certain latent desires, which were worked with in the symbolic register, receive the effect of discharge and weakening,then, in general, the personality is potentiated and acquires a new level of energy. Let me summarize the analysis of this type of effectiveness of psychotherapy. The client’s SC is a process when the absence/impossibility of satisfying desires in the register of the Real is compensated by the realization of these desires in the register of the Symbolic. Compensation occurs through the articulation of these desires in the face of a Significant Other, which entails a response and partial/full satisfaction of repressed impulses. The Significant Other in psychotherapy is the therapist. The second role of the psychotherapist from the point of view of the SC process is to provide significant assistance in determining the client’s unconscious desires themselves. The degree and completeness of SC depends on the correct definition of these internal desires. In cotherapy, SC is primarily the responsibility of the therapist, working within the framework of an understanding, empathic strategy. It is he who is the main character in the formation of the QC process. Such a therapist is a symbolic figure of the Other for the client, while the cotherapist helps to maintain and maintain contact with reality. The cotherapist is the client's referent Subject, preserving his identity. A few words about the methods of recording this effect of psychotherapy. The SC process, as a rule, entails a feeling of pleasure in the client. Therefore, a working (but not scientific) method for recording this component of effectiveness can be the cotherapists’ own experiences, which “like a microscope for a microbiologist” (Yalom, 2000) highlight the client’s condition. A more objective method would be to conduct supervision and provide expert assessments about the process IC of the client and how completely it happened. Educational aspect of effectiveness. Self-object transfer The third aspect by which one can judge the effectiveness of long-term psychotherapy is the establishment and resolution of self-object transfer. This is probably the most non-obvious parameter for measuring effectiveness, which needs clarification. I’ll start with the concept itself. Terms “Self-object transfer” ", "I-object connection" and "I-object" were introduced by H. Kohut to describe specific phenomena that are born in psychoanalysis as a result of long-term work with a client. H. Kohut, who is one of the global reformers of classical psychoanalysis, drew attention to that the therapist’s analytical rule of abstinence traumatically frustrates the client and causes in him reactions similar to those that he once demonstrated in relation to his “cold”, “schizophrenogenic” mother. The therapist, guided by the psychoanalytic prescription, himself drives the client “into a corner” repeating their typical childhood reactions. It is clear that at the first stage, the appropriateness of such behavior by the therapist can be justified by diagnostic purposes, but the continued presence of the psychoanalyst in a “mirroring” position hinders, according to H. Kohut, the therapeutic development of the client. The meaning and main goal of psychoanalysis, from the point of view of this scientist-analyst , in providing the client with space to complete the formation of their interrupted development processes. The client always has many such processes. They are connected with the fact that at one time the child was not given enough conditions for the full development of all his personal qualities, needs, wants and feelings. One way or another, the parents frustrated the child with their prohibitions, coldness, devaluation, and other destructive manifestations of their behavior. In psychotherapy, the client again tries to build an I-object relationship with the psychotherapist. H. Kohut says that it would be correct not to continue to frustrate the client by “mirroring” or silence, but to respond empathetically to his experiences. But I’ll start in order. Analyzing models of child-parent relationships at an early age, H. Kohut noticed that most parents tend to specific responsiveness to the developing needs of the child. Parents sincerely rejoice in the successes of their baby, feel a sense of pride in him, and worry whenthe child suffers some kind of failure, they try to calm him down when he cries, help him in a difficult situation, etc. When all of the above is present in the child-parent relationship, H. Kohut says that an I-object relationship has been formed between the parents and the child, and The parents themselves become self-objects for their child. Among the functions of the self-object, H. Kohut identifies: containing the child’s failures (when the parent softens the failures, smooths them out, and prevents them from exaggerating the child’s emotions to a state of panic and horror); advance payment (when the parent believes in the child’s ability, provides him with the conditions for independently achieving goals); maintaining a sense of joy in the baby in happy moments for him (when parents sincerely rejoice with their baby, feel a sense of pride in him). When all of the listed functions are present in the relationship between parents and children, then the latter grow into harmonious personalities. Such individuals are able to independently set and achieve their own life goals, are able to experience failures and quickly recover from them, and are able to take on significant matters. In general, they have enough mental resources to live in our contradictory world. What happens when one or more functions of the Self-object are disrupted? H. Kohut says that from those children who did not have self-objects, neurotic personalities grow up, that is, those who make up the main contingent of psychotherapists. Why does this happen? It has long been known in psychoanalysis that the parental attitude towards the child becomes his self-attitude. If a child had a mother who experienced sincere joy from the first achievements of her baby, contained his failures with faith in his growing abilities and success, caressed and loved him, then it is clear that such a child will have a stable positive self-attitude as an adult. If the mother punished her baby, “did not believe” in him, considered him the same loser, incompetent, bungler, “rag” like ... daddy, grandfather, grandmother (underline as appropriate), “inflated” the slightest shortcomings of the child to the state of universal catastrophes, then such a child in adulthood there will be the same lack of faith in yourself and your strengths. At the same time, every problematic event will be perceived by him as a catastrophe that can no longer be corrected; for the slightest reasons, depression will arise, and so on and so forth. What to do? After all, clients have already matured as individuals and their past cannot be changed? This is where H. Kohut talks about the need to develop self-object transfer in psychotherapy, when all the functions of the self-object will be projected onto the psychotherapist. Does the psychotherapist need to do something special for this? ?In principle, no. The formation of self-object transfer is a natural process for the client. If the psychotherapist is empathetic and accepting to the extent that he allows the client to regress to his earlier ages, then the formation of self-object transference starts automatically. The client’s psyche will require further development of those interrupted processes that were once frustrated by “cold” parents. So, what does the therapist need to do? The psychotherapist needs to respond empathetically to the client’s experiences, help him form an I-object connection in the psychotherapeutic space, contain his fears. Then the client will be given the opportunity to further form himself, to develop his own emotionality, to collect the missing mental-energetic resource. From the above, it becomes clear that self-object transfer makes a significant contribution to the results of psychotherapy. He is important in many ways. It is this that leads to a change in the client’s personality towards its strengthening and harmonization. This is a significant effect, and I associate it with the educational aspect of the effectiveness of psychotherapy. What advantages does a cotherapeutic couple have in the formation of self-object transfer? If a cotherapeutic couple is heterosexual, then its potential in pre-forming the client is enormous. I have already mentioned several times that suchthe cotherapeutic couple symbolically recreates the family model, and the processes associated with the formation of self-object transference are qualitatively enhanced. For example, the client is given the opportunity to internalize not only the relationships of cotherapists to him, but also the relationships of cotherapists among themselves, which becomes for the client “a model of actual relationships between people” (Alexandrov, 1997). Moreover, when dividing counseling strategies into empathetic and analytical, psychotherapists it is possible to combine the potential of classical analytical work and the potential of Kohut psychoanalysis, “close in its principles to Rogerianism” (Kahn, 1997). In conclusion, I will say a few words about the methods for measuring this result of psychotherapy. These are diary self-reports of the client and supervision of the work done. Since with the therapeutic resolution of the Self-object transfer the client changes as a person, another evidence of effectiveness within this aspect will be the client’s greater adaptation, his greater social achievements and increased ability to overcome life’s difficulties. Behavioral aspects of the result of cotherapy I associate the fourth, behavioral aspect of the analysis of the effectiveness of psychotherapy with the client’s self-efficacy. Let me explain what I mean. In my opinion, the client’s self-efficacy is a necessary component of the effectiveness of the therapeutic process, which allows us to distinguish between the competencies of the therapist and the client. In psychotherapy, not everything depends on the professionalism of the therapist himself. The result of the consultative process is directly “tied” to the client and his personality traits. This is important to know and understand. Especially when we really want to help a person. A client can take out of psychotherapy exactly as much as he can take away. Within the framework of a client’s self-efficacy, I identify three independent aspects: A). The client's ability to self-constitute. Recently, many psychotherapists are beginning to recognize that certain personal qualities of the client play a significant role in the formation of the therapeutic relationship and influence the outcome of therapy (Yalom, 2000). H. Strupp conducted a series of studies in which two patients underwent therapy with the same psychotherapist, and one of the patients showed significant progress, and the therapy of the second was rated as unsuccessful. Among the client’s personal qualities that influence psychotherapy are: :Organization and strength of the client’s ego (this refers to the client’s ability to retain facts in his mind that contradict his own ideas about himself) The client’s maturity and experience Motivation for work The ability to actively participate in the proposed interpersonal process, readiness to establish relationships of a new type. H. Strupp emphasizes that experience The patient's past interpersonal relationships play an important role in achieving significant changes during the therapeutic interaction. That is, in other words, there are a number of personal qualities of the client that contribute to better effectiveness of the therapeutic process. In addition, the client himself is also responsible for the implementation of the results of therapy. It is he who carries out the activities of self-change. Moreover, such activity sometimes requires significant volitional effort and mental stress from the client (Yalom, 1997). In Russian psychology, self-creation activities are called amateur creativity (S.L. Rubinstein; V.P. Zinchenko). In acts of creative initiative, the Subject defines himself and, most importantly, embodies, objectifies, continues himself in his otherness (S.L. Rubinstein). A number of qualities of the client that ensure self-change constitute his ability to self-change. Each client has a different ability to do this. There are patients for whom self-creation activities are carried out actively, flexibly and dynamically - such clients have a high ability for self-change. They get rid of their symptoms more quickly. But there are also clients for whom transformational personal processes occur veryslowly. Such people have a lower ability to self-change and a worse prognosis. B). The client’s acquisition of the ability for self-analysis (Tome, Kahele, 1996). This is probably one of the most important results of any therapeutic assistance. The mechanism for developing the client’s ability for self-analysis is identification with the figure of the supporting therapist, which is then internalized and forms a special mental authority in the structure of the client’s Superego. The formation of this authority provides the client with an “internal analyst”, capable of providing support and giving an analytical understanding of current situations at the end of the analysis. By acquiring the figure of an “internal psychoanalyst”, the client becomes more tolerant of the thoughts and feelings of other people, he is more sophisticated in interpersonal relationships, his social intelligence develops, he understands other people better, etc. Also, the client’s ego strength increases (O. Kernberg’s term), he learns to become more aware of the unconscious aspects of his own behavior, is freed from a number of defenses, his SuperEgo becomes more tolerant and softer, etc. All of these new formations are formed in the process of long-term psychotherapy. They develop the client's general ability for self-analysis. B). Social self-expression. This accompanying effect of psychotherapy can also serve as an indicator of its success. Social self-expression manifests itself, first of all, in the formation of a client’s sense of perspective, in the ability to find new behavioral strategies (Ivey, Ivey, 1999) and is associated with a sense of one’s social significance, one’s own success, etc. (Burno, 1989). The presence of such an effect in psychological counseling as social self-expression allows us to take the formation of the client’s culturally productive personality as one of the goals of therapeutic work (Ivey, Ivey, 1999). Now I will summarize the consideration of the client’s self-efficacy. Firstly, this component of effectiveness is responsible for the real the client's embodiment of the results of therapeutic work. Secondly, it is associated with the increase in his subjectivity (term by V.A. Tatenko). A few words about this. Psychotherapy ensures an increase in the client’s subjectivity. The client transforms as a person, acquires a new way of conceptualizing and meaning experience, and becomes more mature and responsible. Then, by performing certain actions, he begins to assert a new subjectivity and is constituted in a new, changed position. Changes concern not only the client’s personality and the way of his mental functioning, but also interpersonal relationships, which, in turn, entails the consolidation of new structures of his personality formed as a result of therapeutic work. Among the methods for measuring this aspect of effectiveness, I can name the analysis of the client’s self-reports, personal tests, standardized interviews of people close to the client, as well as performing all kinds of homework. In addition to the listed methods for diagnosing the development of the client’s self-efficacy, the therapist in his work can rely on observation data of the client, and, most importantly, on the analysis of the relationships that the client begins to build with the therapist at the final stages of work. Research aspect of effectiveness. Scientific value of the results The fifth and final aspect of analyzing the effectiveness of psychotherapy is the scientific value of the results obtained. Consideration of this aspect as a component of effectiveness is dictated by the consideration that psychotherapy is not only a form of psychological assistance, but also a means of understanding the human psyche. Therefore, after each psychotherapy, I recommend summarizing its results from the point of view of obtaining new knowledge about the characteristics of people’s relationships, about new aspects of a person’s mental life, about the structural organization of the psyche, etc. In the history of counseling there are many cases when specific psychotherapy enriched the general theory of psychology not only with new methods, techniques and methods of work, but also gave validated ideas about».