Интеграция ресурсов системного подхода М. Спивака, когнитивно-бихевиоральной терапии и культурно-исторической психологии в решении задач реформирования психоневрологических интернатов в России

Abstract

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.