Psychology and sociology /6.Сlinical psychology

Zinchenko A.V.

is a graduate student of Institute of psychology named after G.S.Kostyuka The National academy of pedagogical sciences of Ukraine, doctor-psychologist of the Kiev city clinical psychonevrological hospital № 1, center «Epilepsy», Ukraine

INFLUENCE OF PSYCHOTHERAPY MEASURES ON DEGREE OF SATISFACTION WITH SOCIAL SITUATION BY PATIENTS WITH EPILEPSY

Epilepsy belongs to those diseases which cause alienation, distancy, and after all, stigmatization, and sometimes and discrimination from the side of society. Patient’s reaction to the stigmatization of society can become his self stigmatization (I.Y. Gurovich [1], M.M.Kabanov [2], B.C. Yastrebov [3]), that make worse the process of social adaptation of patients with epilepsy.

In base of received theoretical and empirical facts do us there were completed certain directions of psychological help in social adaptation of patients with epilepsy, directed on minimization of negative behaviors displays, adaptation, to variable reality, caused by illness, strengthening of faith for itself and effect of treatment, increase of self-appraisal and self-relation.

In view of the results of theoretical research and our own empiric information, we assumed that such complexes of psychological qualities, which are the determinative factors of disadaptation of personality, can be formed in the structure of personality of patient. A psycho correct effect will be expressed in the change of indexes on all levels of psychological mechanisms of social adaptation of personality with epilepsy.

Application of psychotherapy at epilepsy differs complication and labor intensiveness, predefined the particularity of psychical sphere of patients and many-sided nature of problem of epilepsy, by the variety of its clinical forms and displays. The task of psychologists is minimization of negative influence of disease on forming personality, family relations, character of mutual relations, with people around, and in general on the behavior of patients, which predetermines their social desadaptation.

In directions of psychosocial help to patients with epilepsy in the process of social adaptation we selected three stages: 1 stage - is diagnostic, which aim is a clinical, psychological and social estimation of the condition of sick person. The 2 stage - is informative, which aim is informative support of patients and their relations. 3 stage – psychotherapy, which aim is a direct psychosocial and psychotherapy help persons which were included to the having a special purpose group. The methods of psychotherapy were elected in order to the certain psychological mechanisms of social adaptation patients and varied according to every special case of desadaptation and deprivation of social necessities.

Providing the process of psycho correction influences took place with a concordance with general principles, developed in researches through this question, and varied in connection with certain case of practical work. Thus we stuck to the principle of combination general and partial in the process of psychological help.

A forming experiment was conducted on the base of a 19 stationary department of the Kiev city clinical psycho neurological hospital №1, the center «Epilepsy». Grounds for participating in research was a voluntarily consent of patients of clinic and absence of considerable intellectual disorders. All by a forming experiment 60 persons which made a having a special purpose group with the medium-and-low level of social adaptation were overcame. The patients of experimental group (EG=30 of persons) and their relatives got the proper social- psychological help for the improvement of their social adaptation, the patients of control group (CG=30 of persons) were limited to only diagnostic part of the program inculcated in a department.

The diagnostic assessment levels of social adaptation and psychological indexes personality of patient was conducted individually. The capture of clinical anamnesis data took place by the study of hospital, conversations, and charts with the doctor - epileptologist.

Using methods of psychotherapy and reabilitation influences in the process of social adaptation of patients with epilepsy expedient at the relative intact of personal structure, intellectual possibilities, that at the intact of potential possibilities for enough valuable readaptation. Therefore psychological help to patients in the process of social adaptation founded on the basic assessment of information about psychological diagnostics, which included the state of higher psychical functions (intellect, memory, attention), psychological protection, emotionally volitional states, in particular - aggression, and others like that.

At the estimation level of social-psychological adaptation of patients we were oriented on a criterion, the ground choice of which was done in previous sections: absence of external and internal conflicts, productive activity, possibility of free expression creative ability, satisfaction by the level of social status, by itself and by the life, accordance expectations of people around one and others like that. By indexes of successful adaptation to the terms of labor certain high productivity, satisfaction by a labor collective, desire and possibility to execute post duties. Coming from the assessment levels of adaptation, to the experimental group entered 12 patients with the middle level of adaptation and 18 – with low; to control a group: 14 persons with the middle level of adaptation and 16 – with low.

We will demonstrate results of questionnaire which was got by content-analysis which was conducted on the forming stage of experiment (tabl.1). In a questionnaire patients was suggested to specify their social information (education, studies, work), family welfare (a presence of isolation in family), feeling of social stigmatization (discrimination), own relation to illness and by a 10-pointed scale to estimate the degree of own satisfaction social status, financial position, family position, work, housings terms, social contacts. Seven positions allowed get the maximal index of social adapted, which counts 70 points. After an experiment we asked probed in a questionnaire to estimate a 12 point only: indexes of social satisfaction.

The results of questionnaire patients show, that the own estimation degree of satisfaction social situation of illness straight depended on the support of relatives, presence of work or studies. Those, who has work, stable profit (regardless of his source: payment, help of relatives, shallow business), family welfare, highly enough estimate and satisfaction by social status, contacts. Yes, for patients with epilepsy, which took part in experimental research, in rating of satisfaction the first places are occupied by «family position» (middle point 6,2) in an experimental group and «social status» (6,1p.) in a control group. Lowest indexes of satisfaction by work (3,7p. and 3,9p. accordingly) and financial position (3,4p. and 3,8p. accordingly). Not very height patients with epilepsy estimate satisfaction by education (4,7p. and 4,9p.). The high-quality analysis of questionnaires shows that among patients not many have higher education. Through illness some are forced to cut studies short, but hope stays on his continuation, especially for youths people (to 30 years).

A table 1

Degree of satisfaction by social situation patients with epilepsy of experimental and control group before and after the experiment.

N=60

Positions of questionnaire	EG		CG
	Before experiment	After experiment	Before experiment	After experiment
Social status	5,3	6,9	6,1	6,0
financial position	3,4	3,7	3,8	3,9
Family status	6,2	7,9	5,8	5,6
Education	4,7	5,7	4,9	5,6
Work	3,7	4,8	3,9	4,4
Living conditions	5,3	5,5	5,2	5,0
Social contacts( friends, colleagues, acquaintances	5,4	6,8	5,9	6,3
general index	34	41,3	35,6	36,8

The quantitative analysis (tabl.1) of data in control and experimental groups shows, that introduction of psychotherapy measures in the conditions of permanent establishment and outside it, increase the subjective assessment of the social prosperity for patients: a general index in an experimental group after an experiment was increased from 34p. to 41,3p. (from 70 maximal). In a control group this index of substantial changes did not get (35,6p. and 36,8p. accordingly).

By assessments of doctors for the patients of experimental group after the introduction measures diminished asteno-depressive and hypochondria personality disorders. Affect tension weakens also, self-control increases, the level of social introversion goes down; a faith appears in treatment, for itself, in the possibilities.

The patients talk about importance of such support, specify on the increase of confidence in itself, their possibilities, social fears and experiencing go down. Self stigmatization disappears. After introduction series of psychotherapy sessions patients specify on the increase of their social activity which affects progress in studies and work.

We will illustrate the row of examples.

Patient Sh., 33 years, has a 2 group of disability. Does not work, living on his pension. Diagnosis: epilepsy symptomatically (toxically genesis) with the expressed changes of personality, moderate intellectual reduction, simple partly and the second time generalized convulsive attacks of middle frequency. Treated oneself repeatedly with a positive dynamics. Presently generalized convulsive attacks exceptionally in the night-time of days with frequency 1 one time per a month. Simple partly - 1 time on 1-2 months. The reception of medications is regular. Lives alone. Reserved, anxious, not contactable. Feel like hypochondria. Non - aggressive. Individual sessions were conducted with the use of rational therapy and cognitive - behaviors. With satisfaction joined in group work on art-therapeutic employments, showed goodwill, support other. In conversations much talked about illness. Clearing up row of aspects flow of illness was promoted in the decline of hypochondria. Exercises on development of confidence promoted a relation. Took part in initiative groups, labor psychotherapy (with satisfaction of helped under shallow repair of furniture’s). After an extract from hospital once or twice visited psychotherapy sessions. In a questionnaire at the repeated cut increased marks in the assessment of own social status (from 4 to 6) and satisfaction by social contacts (from 3 to 6). Argument an increase because began to earn additionally with different work, in department during group sessions get new acquaintances which lasted out of hospital. An alcohol does not use. Accepts medications regularly.

Patient G. 37 years, education is middle, has a 3 group of disability. Works as warehouse porter. Has secondary education. Married, has daughter 8 months. On a stationary account from 2001 year. Diagnosis: symptomatic epilepsy with polymorphic attacks. Expressed changes of personality , moderate intellectual reduction. On a background treatment was decline of second time generalized convulsive attacks took place with the loss of consciousness to 2-4 on a year. Partly with a focal component remained with periodicity 2-3 on a month. Thought is in a slow rate. Obtrusive, egocentric, anxious, sense of distance is reduced.

Felt dissatisfaction in the assessment of education (1p.), work (3p.), by financial position (5p.). Thus considers the social status sufficient, fully content with family welfare (10p.), glad daughter. Considers family relations the mortgage of the prosperity. After the conducted work (rational therapy, including to the initiative group, art-therapy) the row of behaviors destructions is corrected (a stubborn persistence, egoistically, disrespect, to people around him).

Thus, it is possible to assert that psychological help to patients with epilepsy is the necessary part of medical process. General psychotherapy measures at epilepsy are carried out as purposeful individual conversations. A dialog includes for itself the structural discussion of the state of patient. Conversation with epileptic sick must carry informative character selective and always completed the short optimistically painted formulation, which behaves to the general feel of patient, his mood. It costs to repeat these words repeatedly at all conversations with a patient. Table of contents and subject of psychotherapy conversations must answer the requirements of patient in sympathy and support. Sure cheerful tone must prevail in the words of psychologist, as positive emotions clarify consciousness and take off informative barriers. Slow comprehensibility of information by patient’s epilepsy, viscidity their psychical structures are required repeating of information messages, simultaneously not forgetting a patient about cheering.

Position of psychologist must not be a too directive, although exactly the receptions of rational psychotherapy appear most effective. It is better to occupy position of the interested in relation to a patient. Patients with epilepsy sensible to the affect states people around them, which represents them deep requirement in a flavor. Polite and understanding from the side of psychologist must resist the even increased aggressiveness of patients. The observance of this condition provides the mutual understanding with a patient.

The results of psychotherapy reinforcements are reflected usually not at once, but exactly they allow promoting the positive psychological feel of patients, confidence, heaving up quality their social life.

Statistical proving of efficiency of the programs of psychological help to patients with epilepsy and positive reports of sick and their relatives testify to the necessity of this type of help to patient which will allow them to feel the valuable member of society, actively joining in social connection, relations, activity.

LITERATURE

1. Gurovich I.Y. Social'naya I klinicheskaya psikhiatriya./ Gl.red. I.Ya.gurovich – Tom 16. Vypusk 1 Cocial'naya of I klinicheskaya psikhiatriya. Izdanie Rossiyskogo obschestva psikhiatrov, Moskovskogo of nauchno-issledovatel'skogo instituta psikhiatrii of MZ of RF, M., 2006. – 112 p.

2. Kabanov M.V., Lichko A.E., Smirnov V.M. Psikhologicheskaya diagnostika I korrekciya in klinike. L.: 1983. – 312 p.

3. Yastrebov V.S. Vnebol'nichnaya pomosch' osnovnoe zveno psikhiatricheskoy sluzhby / V. S. Yastrebov // of Soc. and klinich. psikhiatriya. - 1998. – T . 8 № 2. – P. 63 – 67