RU2486924C1 - Method of treating computer dependency - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to psychiatry, and may be used within the integrated treatment of computer dependency. With underlying psychopharmacotherapy, the 8-staged family psychotherapy is prescribed, including: 1 - making efforts to keep a family constellation and initiatives. 2 - developing the shared objectives and methods to achieve by the family members. 3 - separating the psychotherapist from the family to exercise the initiatives by re-building the family hierarchy and by establishing an immutable principle of the single authority in all matters of patient's treatment. 4 - developing the directions: including direct and paradoxical psychotherapist's prescriptions. 5 - controlling the prescriptions to be followed with the family's attention focusing on the pathological stereotypes of the family relations. 6 - preparing the family for a potential recurrence by means of paradoxical prescriptions and evoking subconscious resistance in the family members. 7 - arresting the recurrence, outpatiently as far as possibly, and encoding of assistance skills in the family members. 8 - adapting the patient and his family members to the counselee-oriented psychotherapy The family psychotherapy aims at correcting the pathological communication stereotypes by the patient's family by using a paradoxical method of graduated family crises burn out with underlying psychopharmacotherapy enabling to avoid a conflict resolution as a standard psychopathic response.EFFECT: method enables achieving an emotionless attitude to computers and games, forming a stable motivation of barriers and behaviour, and ensuring a psychological comfort and an outlook on a real life.1 ex

Description

The invention relates to medicine, namely to psychiatry, and can be used in the complex treatment of patients with non-chemical dependence, in particular in the complex treatment of patients suffering from computer dependence.

The problem of dependence, due to the epidemic nature of the spread of a number of its forms and the complexity of associated medical, social and legal problems, is currently considered as a “challenge” to modern society and social psychiatry (Dmitrieva TB, 2008). Particular attention is drawn to the problem of computer addiction. It is known that the total number of computers used in Russia is more than 31 million pieces. More than 30% of families in Russia have a computer at home. The number of Internet users in the country is about 35 million people and is growing steadily (from a speech by the Minister of Information Technology and Communications of the Russian Federation L. Reiman). The widespread prevalence of personal computers and the ease of Internet access, reflecting the realities of technological progress, pose a threat to the formation of a new epidemic of non-chemical dependence - computer, given the proven high addictive potential of this type of activity. According to the literature (Malygin V.L., 2010), the prevalence of computer addiction reaches 37.9% of the number of users. Such a widespread use of computer addiction creates significant medical and social problems, which necessitates the search for adequate methods to help patients.

The well-known "Method of treating computer addiction", developed at the psychotherapy center of Professor Malygin (found at http://www.psypodderjka.ru/content/view/82).

The basis of the method is the joint psychocorrectional work of a psychotherapist and a clinical psychologist.

The solution to the problem begins with the consultation of relatives and friends on issues of how to help a person suffering from computer addiction seek medical attention from a doctor. Together with a specialist, a tactic of behavior is developed with a person suffering from computer addiction, discusses how to build a conversation about the need to contact a specialist.

The first stage of the treatment of computer addiction is the diagnosis of the causes of the formation of computer addiction, as well as the exclusion of possible painful disorders, in particular depression. If latent depression is detected, if necessary, drug treatment is performed.

The basis for the treatment of computer addiction, within the framework of the method under consideration, is psychological correction, which is carried out individually and in special training groups. Psychological assistance is aimed at improving relationships with relatives and peers, training in self-regulation and ability to cope with difficulties, raising strong-willed qualities, increasing self-esteem, and the formation of new life hobbies.

The most important stage in the treatment of computer addiction is the involvement of a person suffering from it in processes not related to computers, so that electronic games and processes do not become a substitute for reality. It is necessary to show a person that there are many interesting entertainments besides the computer (bowling, snowboarding, mushroom picking, paintball, kayaking, football, etc.) that not only allow you to survive the thrill, but also train the body and normalize the psychological state.

Computer addiction affects relationships in the family, so during the treatment of computer addiction it is important to help relatives and friends of a person suffering from computer addiction, in particular aimed at harmonizing relations with him.

It is noteworthy that the author completely disregards the biological component of dependence, the lack of criteria for choosing treatment tactics and statistical data that make it possible to judge the effectiveness of the proposed method. It is not described how the key issue of harmonizing relations in families of patients with computer addiction is specifically addressed. No mechanism has been proposed for creating a structure in the family that prevents possible relapses of addiction and thereby ensures the persistence of the results.

The well-known "Method for the treatment of computer addiction", developed in the Benihisa Clinic (found at http://www.benihis.ru/services/lzkigr). The basis of the method is emotionally stressful psychotherapy.

Purpose of treatment: to achieve an indifferent attitude to computer games.

Treatment objectives: to form a sustainable forbidden-behavioral motivation. Provide psychological comfort and a positive outlook on real life.

Advantages (according to the authors of this method):

1. The method is not traumatic for the psyche, does not cause depressive syndrome.

2. Steady positive result in compliance with the treatment plan for computer addiction and observation.

Admission Conditions:

1. The desire to be treated for computer addiction.

2. There should be no alcohol intake for at least 24 hours before visiting the clinic.

Work form:

- An individual appointment with a doctor at the Benihisa Clinic - cost 29,200 r. (information on 25.2.12).

- An individual appointment with Dr. Eugene Benihis - the cost of 42,600 p. (the authors do not disclose the essence of the reception, i.e. the content of emotional stress therapy; it remains to be assumed that the cost of admission is a part of stress therapy - note of the authors).

Treatment includes a mandatory 2-time visit with an interval of a week, the duration of one session is 1.5 hours and observation during the year.

Some skepticism that a problem that has been formed over the years can be eliminated in 2 sessions is reinforced by a complete lack of statistics. Ignored as work with the family, which, according to many experts, is a key issue in the treatment of disease-dependent behavior, and the diagnosis and treatment of biological problems, which are an important component of the pathogenesis of the disorder. Noteworthy is the lack of a differential approach, an attempt at a template solution to a complex and voluminous problem.

The well-known "Method for the treatment of computer addiction" used in China (found at http://gizmod.ru/2009/06/04/kitajtsy_lechat_internet-zavisimost_elektroshokom).

The essence of the method is to hospitalize all patients suffering from computer addiction in a psychiatric clinic and conduct a course of electroconvulsive therapy. Another type of therapy in the clinic is “public self-criticism, as well as kneeling repentance to parents”.

The disadvantages of the method are the stereotyped approach, brutal therapy without sufficiently studied reasons, an attempt to solve the problem of dependence in isolation from the family, lack of data on effectiveness. In addition, the importance of harmonizing family relations, recognized by the authors, is solved through a primitive attempt to restore the family hierarchy without correcting the reasons for its violation and establishing feedback between family members, which are a prerequisite for the effective functioning of any complex system (including the family one). The authors of this method do not at all consider the need to correct individual problems of the patient - both psychological and biological in nature.

The well-known "Method for the treatment of diseases of dependent behavior" (Bukhanovsky A.O. et al. Dependent behavior: clinic, dynamics, systematics, treatment, prevention. A manual for doctors. Rostov-on-Don. 2002. 60 pp.), We selected as a prototype.

The essence of the method proposed by the authors is an integrated approach to therapy. Medical assistance includes biological treatment methods (complex pathogenetic therapy according to G.N. Kryzhanovsky, antioxidants, neurometabolic therapy) and psychotherapy (priority is given to a personality-oriented integrative model of psychotherapeutic effect).

Thanks to the application of the method in patients suffering from various forms of the disease of dependent behavior and treated for more than one month, the condition objectively and subjectively improved, and with treatment for more than 6 months, the severity of compulsive drive decreased significantly.

However, when applying this method, there is no positive transformation of family relationships, the rude deformation of which was described by E. Berne ("Games that people play: Psychology of human relationships; People who play games: Psychology of human fate" // - M., 2003 , 226 pp.), Which prevents the full realization of the potential of the method. It turns out to be difficult to motivate patients to unconditionally abandon pathological forms of behavior, taking medications and psychotherapeutic work. In addition, the effectiveness of psychotherapy to a large extent depends on the personality of the therapist, which leads to poor reproducibility of the results when introducing the technique.

We have not found any analogues of the method we use, which provide for complex individualized stepwise treatment of computer addiction, in the available literature.

The aim of the invention is the individualization of pathogenetically oriented therapy of computer addiction, increasing the effectiveness of diagnostic and treatment assistance, reducing the likelihood of relapse.

This goal is achieved by the fact that after the patient’s voluntary treatment and informed consent from him to provide advice, a diagnostic process is carried out, which without fail involves the use of the following main methods: clinical (conversation, observation, medical history), experimental psychological, neuroimaging and electroencephalographic.

Thus, a team consisting of a psychiatrist, psychologist, and electrophysiologist is involved in the examination. After conducting an examination and clarifying the clinical picture, the laws of its development, the predisposition to the disease (biological, social, personal), the patient is offered a comprehensive program of medical care. It includes psychopharmacotherapy (which is prescribed depending on the results of the examination and includes the use of normotimics, serotonergic antidepressants, small doses of atypical antipsychotics and complex pathogenetic therapy according to G.N. Kryzhanovsky - see "Complex use of butyrophenones, benzodiazepines and sodium salts in psychiatric practice: Methodological recommendations of the USSR Ministry of Health. "M., 1989. - 45 p.) and psychotherapy (individual and family), the purpose of which is to correct pathological stereotypes of the general Nia in the patient's family at the expense of strengthening intra-dosed crisis makes these changes are inevitable, and the development of problem-solving behavior skills. Psychotherapy is carried out from the very beginning of treatment, against the background of psychopharmacotherapy, and is carried out in 8 stages.

1. The struggle for family structure and initiative. It starts from the moment the family calls for help and aims to ensure that all family members are present at family classes and that they comply with all instructions of the psychiatrist and psychotherapist. Thus, overcoming the split and formation of coalitions, typical of family members of patients with computer addiction, a crisis of intra-family relations is initiated.

2. The development by family members of common goals and ways to achieve them. A survey is conducted of all family members about how they see family problems (including mental illness of a relative) and how to solve them. Unified approaches to solving problems are being developed, including mandatory measures to ensure the regularity of patients receiving the prescribed treatment, to control the strength of family members with impaired patient behavior and to ensure that he is restored to work or school. The specific responsibility of all family members for the implementation of these agreements and the consequences of violation of their obligations by them is determined. It serves to strengthen the intra-family crisis by counteracting the avoidance of clear agreements and responsibilities characteristic of family members of patients with computer addiction.

3. Detachment of the therapist from the family with the transfer of the initiative to its members. The therapist emphasizes that he is not a member of the family and cannot be the main one in it, raising the question of which member of the family will be the head, and striving to restore the family hierarchy with the mandatory establishment of the principle of unity of command in family relations, the responsibility of the head of the family for the outcome of treatment and the strict observance by all other family members of the instructions of the chapter regarding treatment of the patient. It serves to strengthen the intra-family crisis by counteracting the computer dependency characteristic of family members of patients with the entanglement of hierarchical relationships in the family.

4. The development of directives (direct or paradoxical prescriptions of a psychotherapist, including tasks for all family members aimed at correcting pathological stereotypes of family communication). It continues to intensify the intra-family crisis due to the fact that the implementation of the previous stereotypes of intra-family interaction becomes impossible.

5. Monitoring the execution of prescriptions with focusing the attention of family members on pathological stereotypes of family interaction and shifting attention from the patient's problems to the problems of other family members and methods for solving them. It opposes the belief typical for families of patients with computer addiction that all problems are only a consequence of the patient’s illness, and creates the conditions for the beginning of the assimilation of new, more effective rules for family interaction.

6. Preparing the family for a possible relapse of problems by the method of paradoxical prescription of relapse. In an effort to provoke a subconscious backward reaction from the patient and his family members using a paradoxical prescription, the therapist insists that relapse is inevitable in this disease, moreover, it is necessary, since only during relapse family members can check how effective the previously developed measures are to combat the disease and, accordingly, the sooner a relapse occurs, the better - to improve the quality of work. This not only reduces the chances of relapse due to subconscious resistance of family members to the implementation of this "prescription", but also makes it easier to cope with the reactions of fear and despair familiar to the patient and family members. If relapse nevertheless occurs, creates the conditions for its quick and effective relief on an outpatient basis with minimal social maladaptation of the patient.

7. Relief of relapse. Members of the medical team strive to ensure that family members themselves, calmly and confidently, with minimal consultative and psychotherapeutic help, based on the knowledge acquired in the process of psycho-education, both medically and behaviorally, if possible without hospitalization of the patient, are able to cope with the exacerbation.

8. The transition to client-centered psychotherapy with the patient and, if necessary, members of his family, carried out against the backdrop of periodic joint meetings of the whole family and ongoing supportive psychopharmacotherapy.

The invention "A method for treating computer addiction" is new, as it is unknown in the field of medicine in the treatment of this type of addiction.

The novelty of the invention lies in the fact that for the first time in each patient in comparison, the clinical and dynamic characteristics of the development of the disorder are analyzed. The study of the pathogenetic mechanisms of the development of the disease allows the implementation of pathogenetically oriented therapy of dependence. The structural-dynamic model of the development of the disease created during the diagnostic process is the basis for the development of complex therapy and prevention of the disease, the rehabilitation and rehabilitation program. The novelty of the invention also lies in the fact that for the first time a reproducible method of family psychotherapy of patients with computer addiction, consisting of 8 stages, was developed that not only reduces the severity, but also completely eliminates the pathological stereotypes of family communication. In addition, unlike the known methods, this methodology contains specific measures to establish control over medication, prevent behavioral disorders and social and labor maladaptation of patients with the introduction of responsibility for their implementation by family members, which significantly increases the effectiveness of these measures and , accordingly, the results of treatment and their resistance. Unlike all other known methods of treatment, the emphasis is on restoring the family hierarchy with the mandatory establishment of the principle of unity of command in everything related to the treatment of the patient, which greatly facilitates the achievement of regularity of the prescribed treatment for patients, the co-control of family members with impaired patient behavior and ensuring its recovery at work or school. In addition, the novelty of the invention lies in the fact that if in the prototype psychotherapy is carried out in the mode of supporting family members, here we use the paradoxical method of dosed reinforcement of the family crisis, conducted against the background of psychopharmacotherapy, which does not allow the conflict to be solved by the development of a standard psychopathic reaction, which forces the family to develop new, constructive forms of response and allows, through the use of energy of subconscious resistance of family members, to achieve faster, more pronounced x and persistent changes in family communication, providing the best treatment results. The use of receiving the prescription of relapse and preparing the family for it not only reduces the fear of family members about possible exacerbation, which in itself increases the quality and persistence of the results achieved, but also helps to increase the motivation of family members to learn problem-solving behavior skills, which is also one of the key factors of persistence of the achieved results of the therapeutic and rehabilitation process.

In addition, a full examination of the comprehensive correction of the disorder, in contrast to other known methods involving either psychological or biological effects, are important factors in the effectiveness of the proposed treatment method for the patient.

Thus, the proposed brigade method for the diagnosis and treatment of pathological cravings for computer activities contributes to the individualization of medical care, increases the effectiveness of therapy, allows the development of rehabilitation and rehabilitation programs.

The invention "A method of treating computer addiction" is industrially applicable, as it can be used in healthcare, psychiatric medical facilities.

An example of a specific application of the "Method for the treatment of computer addiction" in patients.

Patient D.V.N. (medical history 87/11), born 1992, asked for help 05/20/11.

Heredity is burdened by dependence on computer games in the paternal uncle, neurodermatitis in the mother.

Born from the first pregnancy without a pathology. Childbirth by cesarean section (weight 3750 g, height 52 cm); screamed right away. From 2 weeks on artificial feeding, due to polyallergy. From 2 to 7 years he lived with his family in the Arctic. He grew up obedient, with new people he had difficulty, behaved “cautiously” with them, and at the same time he was kind, sympathetic, and cheerful within the family. Until 4 years old he was brought up at home, after he went to DOW. Adapted easily, took part in matinees. Often, ARVI was sick, as a result of which in winter he was at home under the supervision of a nanny. From 4.5 years stuttering, dysarthria appeared - he was engaged with a speech therapist. Parenting by the type of dominant hyperprotection.

The first experience of a computer game - at 6 years old. He played irregularly, mainly in the company of his own uncle, who, according to the patient’s father, spent a lot of time at the computer. The duration of the episode was no more than 2-3 hours.

In 1999 (7 years), the family moved to Rostov-on-Don, where the patient went to a full-day boarding school in which his grandmother and mother worked. Prior to grade 9, he studied at “good” and “excellent”, with pleasure. He took an active part in the life of the school. 9th grade graduated "excellent". In his free time, he talked with friends, played, walked, spent a lot of time with his parents (hiking, skiing). In 2004 (12 years old) he had severe pneumonia, without complications. Puberty from 15 years. In the summer of 2008, he went to Baikal with his parents, worked at Rostselmash (courier for 1.5 months), according to his parents, his mood was steady.

Since 2007 (15 years), he began to play on-line role-playing game "World of Workraft". The time spent at the computer increased to 6-8 hours a day. At the same time, he felt a sense of emotional uplift, “inspiration,” which persisted outside the game. Being in such a state, he enthusiastically fantasized with enthusiasm, introducing himself as a “hero”, inventing various fantastic adventures with his own participation. Remarks and other attempts by parents to limit the time spent at the computer did not lead to a result. He played mainly in the evening and night, to the detriment of sleep. Upon awakening, I felt lethargy, drowsiness. Conversations with friends began to come down to a discussion of computer games. In 2008 (16 years), by decision of his parents, he entered the Lyceum at RAU. He didn’t converge with the group, preferred to be alone, about six months “the relationship was neutral,” after peers began to offend him, “do all kinds of dirty tricks”. He motivated his parents that "the guys are not of his circle." Then the enthusiasm for computer games intensified, he could play up to 8-10 hours in a row (mainly at night). By that time he was keen on several computer games, but World of Workraft remained the main hobby. I skipped classes (I could not attend 3 weeks, then return for a month, then skip again), deceived parents - claimed that "everything is fine in the lyceum." He was passive at home; he did not show initiative in domestic affairs. In the 10th grade, academic performance dropped sharply (satisfactory grades prevailed). On this basis, conflicts began to arise with parents. In the event of a forced inability to use a computer, I constantly thought about the game, felt a pronounced desire to return to it. He began to show pronounced reactions of the opposition, "rudeness", became more "masterful." Parents persuaded to change the lyceum to another school, but decided to stay at the lyceum. He moved to another class, where relations with peers were "tolerant." According to the results of a well-passed exam, with the support of parents, in the summer of 2009 I entered DSTU, planning to “start everything in a normal way”. I studied for about 2 months without complaints, easily. At the same time, he continued to play actively, as a result of which he did not get enough sleep (in the spring of 2010 he occasionally used energy tonics) - he began to skip classes, first episodically, then regularly; “Abandoned” his studies and in May 2010 he was expelled, about which he did not experience strong feelings. Intra-family scandals intensified and became more frequent. He played a lot. In July 2010 (17 years old), on his own initiative, he got a job as a waiter, was glad about his salary (according to his mother, was “inspired” by the money he earned, spent it easily), felt independent. He was organized in the work: he attended trainings with pleasure, tried to look presentable (he washed his clothes independently, kept an eye on his neat haircut), worked a lot, with pleasure, productively (he occupied leadership positions among colleagues). Actively communicated with friends, spent time in companies; computer use time was slightly reduced, but the daily nature of the games continued. He entered the SFU himself. In his own words, "has changed over the summer and thought that everything will be fine." In the fall of 2010, I bought an expensive computer with the money I earned, updated the wardrobe, started studying, with the intention of conscientiously attending and gaining knowledge. I liked the student group, “I was pleased with everything”, but a week later, when my parents went to rest, I began to skip classes, studied without enthusiasm, and was absent from classes. Less attention was paid to appearance. He played a lot, having a pronounced attraction to continue the computer game. I passed the winter session with the help of my parents. In the second semester, attendance improved slightly, but learning was still difficult (it was difficult to learn new material, due to knowledge gaps due to previous omissions). He claimed that he missed classes because of laziness (“I can’t organize my day”), recognizing the essential role of attraction to computer games. They turned to the Phoenix LRNC for help.

Somatic status: no features.

Neurological status: FMN is normal. The reaction of the pupils to the light is lively, friendly. Active movements in full; strength is slightly reduced in the left limbs; tendon reflexes S≤D; there are no violations of sensitivity. In the Romberg position is steady. Coordination tests are performed correctly.

Mental status. Consciousness is clear. Oriented true in all areas. Outwardly neat. Keeps alert, alert. Visual contact is not always supported. After some time, begins to behave more confidently. Mimic reactions live, adequate situations. Pantomime is active, angular movements. Answers questions in terms of the set. Speech is grammatically correct at the usual pace. He considers the inability to organize his day to be the reason for contacting the LRNC. With directed questioning, it turns out that about 3 years ago he was actively carried away by computer games, for which he could spend up to 8-12 hours a day. I could not concentrate on classes, I thought about the game. He describes the characters of the game, focusing on their uniqueness, on their achievements in their images. In judgments lightweight, superficial. At the moment, she is worried about the conflict with her parents: "I'm tired of listening to morality already." In the future, plans to get a diploma, in the near future - to get a job as a waiter. The mood background is even. To the state formally critical.

The results of additional studies.

1. EPI (05.23.11): signs of emotional infantilism.

2. REG (05.22.11): physiological asymmetry of blood supply in both pools.

3. EEG (05.22.11): Diffuse manifestations of paroxysmal activity.

4. Brain MRI (06/01/11): MRI signs of a gliosis focus of the brain stem.

5. Daily urine for hormones (05/25/11): DOPA - 77.37 nmol / day; dopamine - 360.01 nmol / day; norepinephrine - 139.81 nmol / day; adrenaline - 15.52 nmol / day.

6. The content of serotonin in the blood (05/23/11): total 1.26 μmol / l; platelet 0.96 μmol / l; free 0.3 μmol / l.

7. Blood for lithium (05/23/11): 5.87 mcg / dl.

06/02/2011 a consultation was held as part of the professor MD Soldatkina V.A., attending physician A. Dyachenko The clinical diagnosis was established: “Disease of addictive behavior (non-chemical addiction - computer addiction, primary variant)”. According to ICD-10: "Other disorders of habits and drives F63.8."

Recommended by:

1. Drug therapy:

- Depakin-chrono 500 mg per day, with a possible increase to 1000 mg;

- Seroquel - start the selection of an individual dose from 12.5 mg per day.

- Metabolic therapy: cortexin, phenibut.

2. Family psychotherapy - start simultaneously with the start of drug therapy, conduct in stages:

1 - struggle for family structure and initiative,

2 - development by family members of common goals and ways to achieve them,

3 - disconnection of the psychotherapist from the family with the transfer of initiative to its members with the restoration of the intra-family hierarchy and the mandatory establishment of the principle of unity of command in family relations in everything related to the treatment of the patient,

4 - development of directives: direct or paradoxical prescriptions of the therapist,

5 - control over the implementation of prescriptions with a focus on family members on pathological stereotypes of intra-family interaction,

6 - preparing the family for a possible relapse of the disorder by the method of paradoxical prescribing with causing subconscious resistance in family members,

7 - relief of relapse, if possible without hospitalization, with the consolidation of family members skills to assist the patient,

8 - transition to client-centered psychotherapy with the patient and members of his family.

In the process of complex therapy, the patient noted a marked reduction in the pathological attraction to a computer game. It was possible to achieve a noticeable transformation of family relationships. Several times the patient tried to resist the agreements reached, meeting an adequately tough rebuff from the family. He continued to work with a psychotherapist and take medications. All stages of family psychotherapy have been implemented, currently receiving client-centered psychotherapy (stage 8), while continuing to take medications.

The proposed method treated 38 patients suffering from computer addiction.

Follow-up monitoring of patients who received care was performed in the period from 3 months to 3 years. A stable remission, in which the patient completely abstained from computer games and other variants of pathological activity, while there was no transition to another dependence (chemical and non-chemical), was achieved in 59% of cases. It should be noted that in cases where the patient and his family fully complied with the recommendations and worked with a psychotherapist for at least six months, the effectiveness of the method reached 83%.

The technical and economic effectiveness of the “Method for the treatment of computer addiction” lies in the fact that the use of the method allows for a comprehensive, individualized, stepwise, pathogenetically oriented therapy of addiction, which increases the effectiveness of treatment and prophylactic measures and significantly reduces the risk of exacerbation of the disorder.

Claims (1)

A method of treating computer addiction, including psychopharmacotherapy and psychotherapy, characterized in that from the very beginning of treatment, against the background of psychopharmacotherapy, 8 stages of family psychotherapy are started: 1 - struggle for family structure and initiative, 2 - development by family members of common goals and ways to achieve them, 3 - disconnection of the therapist from the family with the transfer of the initiative to its members with the restoration of the family hierarchy and the mandatory establishment of the principle of unity of command in family relations in everything related to treatment patient, 4 - development of directives: direct or paradoxical prescriptions of a psychotherapist, 5 - control of the execution of prescriptions with the focus of family members on pathological stereotypes of family interaction, 6 - preparation of the family for a possible relapse of the disorder by the method of paradoxical prescription with subconscious resistance in family members, 7 - relief of relapse, if possible without hospitalization, with consolidation of family members' skills in assisting the patient, 8 - transition to client-centered psychotherapy with the patient and members of his family; in the process of family psychotherapy, pathological stereotypes of communication in the patient's family are corrected by the paradoxical method of metered-dose intensification of the intra-family crisis, conducted against the background of psychopharmacotherapy, which does not make it possible to solve this conflict by the development of a standard psychopathic reaction, and develop problem-solving behavior skills.