The cultural approach in psychotherapy

In the given article the variant of cultural — historical psychology advanced by L.S. Vygotsky and his students — A.R. Luria, A.N. Leont’ev, A.V. Zaporozhets, D.B. El’konin etc. is considered. According to this concept, human mental processes are carried out with the help of the certain psychological tools. They are produced by a society and acquired by the individual due to interiorization, the “appropriation” of the social relations and their transformation into individual mental function. Applying these interiorized tools, the person obtains the ability any way to manage voluntary his/her behavior and mental processes, organizing them according to his/her own intentions.

These positions are most properly elaborated with reference to development of cognitive processes. However they are relevant to every form of human development — in particular, to the development of the personality taking place during psychotherapy. The general logic of cultural — historical psychology quite often leads researchers to a psychotherapeutic problematics even when initial research problems were connected only with educational problems.

So, psychotherapeutic aspects clearly act in G.A.Tsukerman’s researches on different age cooperation and in M. Cole’s project “The Fifth dimension”. So, as the concept of general psychology, the cultural — historical psychology should give substantiation to psychotherapeutic practice and it can cope with this problem because of having the necessary theoretical toolkit and research methods. The analysis of psychotherapeutic techniques from positions of the cultural — historical approach should answer the following questions:

• What psychological tools are offered to the client by the given system of psychotherapy, what ways of their use it forms for him?  
• How the social relations between the client and the therapist are constructed, how effectively the interiorization of tools and their “appropriation” by the client is achieved?
• To what extent the voluntariness and independence of the client in managing of his/her mental conditions and activity is provided?

Let’s consider an initial direction of psychotherapy, which in many respects became a paradigm for all the subsequent, the classical psychoanalysis. In process of psychoanalysis the reconstruction of person’s previous life experience took place. As a result the complete system of representations in which client’s symptoms obtain a logical explanation is created, acting as a reproduction of last (basically, children’s) psychological traumas. However it not the original biography, but an original individual myth which is the basic psychological tool offered to the client. As any myth, it explains an origin and organization of the world (in this case — of a private world of the client). The question on its relations to a reality is wrongful: mythological events are real not in literal, but in symbolical sense. As any myth, psychoanalytic quasihistory of client’s life is unwrapped not in linear, but in cyclic time. As Osiris dies each autumn and revives each spring, the living Oedipus complex — the love to mother, jealousy of the father, fear of castration — is reproduced at the person in his/her mutual relation with other people embodying father and mother figures.

The system of relations of the client with the analyst is under construction according to the model of the child-parent relationship. The analyst being in a role of the wise parent interprets statements and reactions of the client. The process of interiorization proceeds in the “natural” way, occupying many years, as well as development of the child. From here and long dependence of the client on the psychoanalyst (a low level of voluntariness and independence), that causes criticism of psychoanalysis by the representatives of other directions of psychotherapy.

Interpretation of psychoanalytic techniques from position of cultural — historical approach (or, if easier, cultural) does not apply for replacing the “internal” interpretation given by psychoanalysis. It only focuses attention on other aspects of therapeutic process, allowing to understand better both strong, and the weak sides of psychoanalysis.

In article the cultural approach to construction of original variant of psychotherapeutic techniques is described. Main principles of this approach are formulated as followings.

1. Psychoterapist offers to the client the certain psychological tools to overcome (to cope with) his/her problem. Advantage is given to common cultural tools (instead of those specially invented for the purposes of psychotherapy).

2. The process of interiorization “appropriation“ by the client of psychological tools is organized purposively. The psychological mechanism of their acting is opened to the client. It provides voluntariness of their subsequent application, prevents the occurrence of dependence on the therapist.

3. Choosing psychological tools the therapist pays special attention to features of culture to which the client belongs.

4. Psychotherapeutic relations are under construction not according to model of child-parent relationship, as it is psychoanalysis. It is not “friendship for money“ as sometimes is called ironically the system of relations in psychotherapy oriented on personality. In frameworks of cultural approach the psychologist acts in function of the teacher owning a direction of use of psychological tools which the client — student should master.

The universal remedies for emotional experiences’ processing are submitted in art. Therefore for the cultural approach the methods of art-therapy are most organic and natural. However for purpose of illustration simpler psychotechnique is chosen — the talisman. It was used and continues to be used by people of dangerous occupations: soldiers, pilots — testers, stuntmen etc. Its psychological function consists in creation of feeling of security, confidence — in other words in reduction of a level of anxiety (alarm). It allows using talisman in psychotherapy working with anxious clients.

Work begins with discussion of psychological function of talisman. If the client trusts in its magic power there are no bases to undermine this belief. The psychologist simply explains, that this question is outside of his competence. As a result of discussion the client comes to a conclusion that talisman helps the person to cope with excitement, anxiety (household synonyms of the term “alarm”).

Further it is found out, what things were traditionally used as talismans. It could be symbols of a religious cult (the cross, sacred image), but it could be and a medallion with a ringlet of the beloved. Thus, psychological function of talisman is emphasized. The fact that it reminds about something very significant to person and is dear for him is decisive. These memoirs also serve as the basic calming factor. Additional positive associations are determined by memoirs about the person who has presented the talisman — mother, the wife or beloved. But original psychological force talisman collects gradually as at its presence dangerous situations become safely resolved. Already it reminds of all these successfully resolved situations. Discussion of all these themes with the client is, as a matter of fact, the organization of his orientation in ways of talisman use.

The following step is a discussion of probable troubles. The client himself thinks out those problems, which can arise, and the psychologist helps him to recollect the ways fixed in culture to cope with them. The most obvious problem is the loss of talisman. In culture it is fixed two possible values of this event: talisman is not necessary any more, the person already can act without it, or (if without it the person still feels uncomfortably) talisman has spent its force and should be replaced by new one.

More serious problem: despite of presence of talisman, a serious trouble occurs. If such things happened several times then talisman loses the psychological force: because now negative associations are connected to it. The culture has provided the ritual actions directed on “updating” of talisman, on revival of positive associations and inhibition of negative (for example, repeated consecration of a cross). The client should explain, that he will feel, whether such rituals “have worked” or talisman has lost its force for him finally and demands replacement.

The psychologist shows to the client, that the offered technique is based on original “games with him/herself“, but it does not belittle its gravity. Similar “games with him/herself“ is a basis of every psychotechnique. Disclosing of the psychological mechanism of self-management with the help of external tools is the important step in a direction of interiorization of these tools, its “appropriation” by the client.

Some clients feel danger in the probable arising of talisman-dependence. But it is the way of human culture functioning: each new achievement results in occurrence of new dependence. For example, let us imagine that accidentally the electricity is switched off.

And one more fears which are extremely useful. It is possible to forget talisman at home. It even needs to be periodically forgotten, because it is the following step to interiorization, lowering dependence on talisman. It is important to learn to recollect it, not having it with you then all those calming associations which are connected to it automatically emerge in memory.

The techniques of work with talisman described in article as well as other techniques constructed on a basis of the cultural approach, was applied by the author with colleagues not in research, but in the practical purposes (at work with the hostages seized at the Moscow theatre and at school of Beslan etc.). It is marked, that the author had no opportunity to organize control group and to provide the diagnostic procedures necessary to confirm the advantages of this or another method. Therefore article is limited to an illustration of the offered approach, without discussion of a question on its advantages and lacks. It was important for the author as the convinced supporter of a cultural — historical paradigm, to show an opportunity of its use in the field of psychotherapy.