Integrating Resources of M. Spivak’s Systemic Approach, Cognitive-Behavioral Therapy and Cultural-Historical Psychology in Addressing Challenges of Reforming Residential Institutions for Psychiatric Patients in Russia



2016, the Russian Federation started a reform of residential institutions for psy¬chiatric patients. An essential condition of its success is reintegration of patients into society, which implies development and implementation of effective psychosocial rehabilitation programs. Materials and Methods. In 2018, an integrated rehabilita¬tion program was developed and implemented for the first time in Psychoneurologi¬cal Residential Institution No. 22 in Moscow. The program integrated the principles and methods of M. Spivak’s systemic approach, cultural-historical psychology, and cognitive-behavioral therapy. The rehabilitation group included 12 patients with chronic mental disorders and disabilities who had resided in the institution for 3 to 16 years. The total duration of the program was 6 months. An expert assessment of the participants’ psychological and social competencies in the major life areas (housing and everyday life; work and employment; hygiene; interpersonal relations; hobbies and leisure) was carried out before and after the rehabilitation program, using Spivak’s diagnostic scales. Results. A study of the integrated rehabilitation program effectiveness showed a statistically significant improvement in the patients’ competencies in the major life areas. Follow-up of the dynamics within the follow¬ing 3 years upon the program completion revealed positive changes in their social adaptation. Output. A preliminary conclusion could be made that the proposed in¬tegrated rehabilitation program might be effective for shaping and training of social skills that increase the patients’ autonomy, as well as for overcoming self-limiting attitudes and avoidance strategies resulting from their negative experience of social “defeats” and institutional experience of learned helplessness. Each of the three in-tegrated approaches contributed to achieving the rehabilitation objectives. Further research with larger samples is needed.

General Information

Keywords: psychoneurological residential institutions, rehabilitation patients, psychosocial rehabilitation, cultural-historical psychology, cognitive-behavioral therapy, resocialization

Journal rubric: Empirical Researches

Article type: scientific article


Acknowledgements. The author expresses her gratitude to the trainers of the integrated rehabilitation program, all employees of Moscow residential institution 22 and students of the Counseling and Clinical Psychology Department of Moscow State University of Psychology and Education, who took part in the study, and to the participants of the program: 12 residents of the residential institution, who decided to change their lives and made great efforts to obtain their legal capacity.

For citation: Sisneva M.E. Integrating Resources of M. Spivak’s Systemic Approach, Cognitive-Behavioral Therapy and Cultural-Historical Psychology in Addressing Challenges of Reforming Residential Institutions for Psychiatric Patients in Russia. Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2021. Vol. 29, no. 3, pp. 140–158. DOI: 10.17759/cpp.2021290309.


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Information About the Authors

Maria E. Sisneva, clinical psychologist, lecturer of additional professional education programs, Moscow State Psychological and Pedagogical University (MGPPU), Member of Interdepartmental Working Group on the Development of Basic Approaches to Reforming Residential Institutions for Psychiatric Patients of the Ministry of Labor and Social Security of the Russian Federation, Moscow, Russia, ORCID:, e-mail:



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