Advisory assistance can be provided in different forms and types. There is a wide variety of forms of advisory practices and classifications of these forms.

Thus, according to the criterion of the object of assistance, one distinguishes between individual ("one-on-one" or "face-to-face"), group and family counseling.

Work with children and adults is differentiated according to the age criterion.

The spatial organization of counseling can be carried out in the formats of contact (face-to-face) or distant (correspondence) interaction. The latter can be carried out within the framework of telephone counseling (although to a certain extent it is also contact counseling), written counseling, and also through printed materials (popular science publications and self-help guides).

According to the criterion of duration, counseling can be urgent, short-term and long-term.

There are also several typologies of counseling, focusing on the content of the client's request and the nature of the problem situation. So, distinguish between intimate and personal, family, psychological and pedagogical and business counseling. Counseling can be a reaction to the client's situation - "crisis counseling" or an incentive for the growth and development of the client - "developmental counseling". Traditionally, counseling is spoken of in relation to a situation during or after a crisis, but it should also help people anticipate possible problems in the future, teach them to recognize the signs of an impending crisis, and equip them with the skills to suppress crises in the bud. Any successful counseling implies personal growth, however, in a crisis situation, a person is in its grip, under the pressure of circumstances, and since counseling is limited to the scope of the existing problem, the client's conceptual and behavioral arsenal can be replenished in a very small amount.

Heron (1993) identifies six categories of advisory impacts, depending on their purpose and content: authoritarian:prescriptive, informative, confrontational - and facilitating:cathartic, catalytic, supporting.

Prescribingthe impact is focused on the client's behavior outside the consultative interaction.

Informingimpact provides the client with knowledge, information and meanings.

Confrontationalimpact has as its purpose the client's awareness of any restrictive attitudes or behavior.

Catharticthe impact is used to help the client to discharge, to release suppressed painful emotions (abreaction), mainly such as grief, fear or anger.

Catalyticthe impact is focused on stimulating self-knowledge, self-governing being, learning and problem solving.

Supportivethe impact is focused on confirming the significance and value of the client's personality, his qualities, attitudes or actions.

Facilitating interventions focus on greater autonomy of clients and acceptance of responsibility for themselves (helping to alleviate mental suffering and pain that reduce strength I AM,promoting independent learning, confirming their importance as unique creatures).

The choice of this or that type and type of influence depends on the client's personality type (as well as the consultant's personality type) and the specifics of his situation. The ratio of authoritarian and facilitating types of influence is mainly related to the topic of power and control: the consultant has complete control over the client, control is shared between the consultant and the client, the client is completely autonomous.

THEORY, MODELS AND COUNSELING SCHOOLS

As indicated in the specialized literature, there are 200 to 400 approaches to the concept of counseling and models of counseling and psychotherapy. The main approaches from which counseling schools have evolved are:

1. Humanistic approaches: person-centered counseling, gestalt counseling, transactional analysis, reality therapy (counseling on realism).

2. Existential approaches: existential counseling, logotherapy.

3. Psychoanalysis.

4. Behavioral approach.

5. Cognitive and cognitive-behavioral approaches: rational-emotive behavioral counseling, cognitive counseling.

6. Affective approaches: basic therapy, revaluation counseling, bioenergy.

7. Eclectic and integrative approaches: multimodal counseling, eclectic therapy, life skills counseling.

In recent years, approaches such as hypnosis according to M. Erickson, psychosynthesis, neurolinguistic programming, problem-solving short-term psychotherapy, etc. have also become widespread.

Some authors believe that from a methodological point of view, three basic approaches should be distinguished - psychodynamic, cognitive-behavioral and humanistic, which are most fundamentally different from each other in their views on a person and the nature of his emotional and behavioral problems.

From the very beginning of the development of counseling and psychotherapy, individual specialists have noted that the similarities in different approaches to counseling are much more than differences. In 1940, at a symposium with the participation of such prominent figures as K. Rogers and S. Rosenzweig, the idea was approved that all successful types of psychotherapy have in common such factors as support, a good relationship between the counselor and the client, insight and changes in behavior.

In 1974, Frank (Frank) put forward the thesis: the effectiveness of psychotherapy is associated initially not with the use of special strategies within the framework of a particular conceptual approach, but with a number of general, or "nonspecific" factors. These factors include: building a supportive relationship, providing the client with an rationale to understand his / her problem, and sharing the client and the counselor in therapy rituals.

More recently, Grencavage and Norcross (1990) identified the following groups of non-specific, or general, factors that contribute to therapeutic change.

Client characteristics:positive expectations, hope or belief; a state of distress or incongruity; actively seeking help.

Qualities of the therapist:

professionally valuable personality traits;

building hope and positive expectations;

warmth and positive attitude;

empathic understanding;

the presence of the social status of the therapist;

valuelessness and acceptance.

Change process:

opportunity for catharsis and emotional response; mastering new elements of behavior; providing a reasonable explanation or model for understanding;

stimulation of insight (awareness);

emotional and interpersonal learning;

suggestion and persuasion;

experience of success and competence;

placebo effect";

identification with the therapist;

behavioral self-control;

relaxation of tension;

desensitization;

providing information / training.

Treatment methods:

use of techniques;

focusing on the "inner world";

strict compliance with theory;

creating a supportive environment;

interaction between two people;

explaining the roles of the client and therapist.

Although these factors are implemented in different ways within different approaches, they are all designed to strengthen the client's sense of dominance over oppressive external and internal forces through their designation, conceptualization and positive experience. This position contradicts the widespread belief among counselors and psychotherapists that only the techniques and strategies they use will lead to positive results for clients. However, in favor of the concept of general, or "non-specific" factors, the following arguments can be put forward, obtained as a result of conducted for the period 1975-1990. numerous studies.

First, it is shown that different theoretical approaches and corresponding special strategies are characterized by similar success rates. Second, it has been found that lay counselors who are not properly trained in special techniques seem to perform as effectively as well-trained professional counselors. Third, clients themselves rate the importance of “non-specific factors” higher than special techniques. Nevertheless, the role of general factors cannot be absolutized, which in any advisory approach closely interact with theoretical models and special techniques.

Since the 1960s, more and more practitioners, as special studies have shown, see themselves as adherents of an “eclectic” or “integrated” approach to counseling, rather than any single model. They believe that no one model is self-sufficient and universal, and they borrow ideas and techniques from various approaches. It is for this reason that the early 1980s. characterized by the publication of a large number of books on eclecticism and integrationism, the creation of the Journal of Integrative and Eclectic Psychotherapy and the Society for the Study of Integration in Psychotherapy, as well as educational and training programs on integrative therapy.

The term “eclectic” in counseling means that the consultant selects the best or most appropriate ideas and techniques from a range of theories and models to meet the client's needs. Differ, according to A. Lazarus (A. Lazarus, 1989), non-systematic and systematic (technical) eclecticism. Non-systematic eclecticism is characterized by the fact that consultants do not feel the need for a logically consistent explanation or empirical confirmation of the techniques they use. Systematic (technical) eclecticism is characterized by the fact that consultants are guided by their preferred theory, but in addition, they draw on techniques used in other types of counseling.

Unlike supporters of theoretical eclecticism, consultants - adherents of technical eclecticism "use procedures taken from various sources, not always harmonizing these procedures with the theories or disciplines that gave rise to them" (A. Lazarus, 1989), and consider it unnecessary to add new explanatory principles ...

Unlike eclectics, integrationists not only apply techniques used in different approaches, but also try to combine different theoretical positions. A. Lazarus views technical eclecticism as a step towards integrationism, however, he emphasizes that it is necessary to be careful in doing so.

Became more popular in the 1980s. the term “integration” refers to a more ambitious conceptualized approach in which the consultant creates a new theory or model from elements of different theories or models.

There are six different strategies for achieving integration.

1. Creation of a new independent theory (a kind of "scientific revolution").

2. Development of one of the existing theories in such a direction that all other competing or alternative theories can be assimilated into it (this strategy is considered fundamentally erroneous, since all existing theories are based on completely different views on human nature).

3. Focusing on vocabulary, phrases and concepts used in different approaches, and developing a common language for counseling and psychotherapy (this strategy is considered useful for effective communication between counselors working in different approaches).

4. Focus on consistent areas and common elements different approaches, which allows you to develop general concepts and techniques not at the level of theory, but within specific fields of application or components of counseling (for example, the concept of "therapeutic alliance" or stages of change).

5. Greater exchange in the community of practice of specific techniques and “working procedures” (for example, in the process of reviewing each other's advisory work), which allows expanding the toolkit for working with clients on a practical level.

6. Conducting special research to highlight the most effective techniques of exposure in typical cases (the so-called "technical eclecticism").

Nevertheless, to this day, many supporters of the "pure" approach (conceptual "purism") have survived, putting forward many serious arguments against eclecticism. These include, first of all, the fair statement that different approaches are based on completely different and often contradictory philosophical views (on the nature of man, the mechanisms of his affective sphere, behavior, etc.). As a result, there are different languages, interpretations and explanations of the same phenomena, the choice of different techniques of influence, and all this can lead to confusion or lack of authenticity.

Finally, it is not clear: how and in what professional language to carry out training - education and supervision - of practitioners in the absence of a unified theoretical model of counseling?

Of course, most of the practicing consultants are, as it were, between two poles - conceptual and empirical, and there are no "pure theorists" or "pragmatic technicians" among them.

In the 1990s. Within the framework of the integrating approach, the so-called "transtheoretical" constructs have become more and more widespread; approaches in which an attempt was made to develop mechanisms and procedures aimed at changing impacts that would not fit into any of the existing models.

The most striking examples of the transtheoretical approach (we can say that new conceptual models have actually been created) are: the model of a “skillful assistant” who exercises “problem management” by J. Egan (G. Egan, 1986, 1990, 1994), the model of “self-assertion” by J. Andrews (J. Andrews, 1991) and A. Ryle's cognitive analytic therapy (A. Ryle, 1990, 1992).

In social work, the model of J. Egan (G. Egan, 1994) has become widespread. He suggested that the client seeks the help of a consultant in cases when he finds it difficult to cope with his life problems, and the first task of the consultant is to help the client find and implement appropriate solutions to these problems.

J. Egan considers consulting as "problem management", ie. problem management (not a “solution”, since not all problems can be finally resolved), and identifies nine stages of client assistance, of which three are central:

1) identifying and clarifying the problem: helping the client in telling his story;

2) focusing;

revitalization;

2) the formation of goals:

development of a new scenario and set of goals;

assessment of goals;

selection of goals for specific actions;

3) taking action: developing strategies for action; choice of strategies; implementation of strategies.

Successfully completed Stage 1 ends with the establishment of trust and a clear picture of the "current scenario", i.e. the problem situation that has arisen. At the second stage, a "new scenario" is formed in the client's view, in particular, how the client's situation should look in the "improved" version. Stage 3 is associated with strategies for achieving goals and is focused on the development and implementation of the actions necessary to move from the "current scenario" to the "desired".

Further development of the transtheoretical approach was realized within the framework of Kelly's concept of integrative consulting skills (Culley, 1999). In this model, the counseling process is viewed as a series of successive stages: initial, middleand final.

Basic skills for all stagesare:

attention and listening, accuracy and specificity;

reflection skills: reformulation, paraphrasing, summing;

research (probing) skills: questions and statements.

Initial stage goals:

establishing working relationships;

clarification and identification of problems;

diagnostics and formulation of hypotheses;

contracting.

Start-up strategies and procedures:

exploring / probing: helping clients explain their concerns;

prioritization and focusing: deciding on the order of work with the client's problems and identifying the pivotal moment;

communication: acceptance and understanding.

Mid-stage goals:

reassessing problems: helping clients see themselves and their problems in a different, more hopeful perspective;

maintaining a working relationship;

revision of the contract (if necessary).

Mid-stage strategies and procedures:

confrontation (helps clients to become aware of the tricks and tricks they use to prevent change);

providing feedback: enables clients to understand how they are perceived by the consultant;

providing information (can help clients see themselves from a different perspective);

directives: aimed at changing habitual stereotypes of behavior;

self-disclosure of the consultant: a story about his own experience (rarely used);

prompt feedback: providing clients with a consultant's point of view on what is happening between him and the client "here and now".

Final stage goals:

select the appropriate change: clients need to know what changes are possible and what specific results they want to achieve;

transferring learning outcomes: applying the results of counseling to work with problems in everyday life;

implementation of change: concrete actions of clients;

termination of the consultative relationship: involves the recognition of the termination of this relationship as well as the fulfillment of the contract.

Post-stage strategies and procedures:

goal-setting: determination using special techniques (discussion, imagination, role play, etc.) together with clients of the expected results;

action planning: choosing from all the options available to clients and planning specific actions;

evaluation: evaluation of the success of clients' actions in terms of solving their problems;

completion (reviewing the work done, helping the client to understand everything that happened, working with the client to overcome the feeling of sadness that arose due to the termination of the consultative relationship).

Social and advisory assistance to people with disabilities is aimed at their adaptation in society, easing social tension, creating favorable relationships in the family, as well as ensuring interaction between the individual, family, society and the state. Social counseling assistance to people with disabilities is focused on their psychological support, intensification of efforts in solving their own problems and provides for:

• identification of persons in need of social counseling assistance;
• prevention of various kinds of social and psychological deviations;
• working with families with disabled people, organizing their leisure time;
• advisory assistance in training, vocational guidance and employment of people with disabilities;
• ensuring coordination of the activities of state institutions and public associations to address the problems of disabled people;
• legal assistance within the competence of social service bodies;
• other measures to form healthy relationships and create a favorable social environment for people with disabilities.

Advisory center. The institution of social services for the disabled, providing social counseling assistance is advisory center - an institution designed to protect the rights and interests of citizens, their adaptation in society by helping to solve social, psychological and legal problems.

Terms of use and repair of technical means of rehabilitation, prostheses and prosthetic and orthopedic products.

Terms of use of technical means of rehabilitation, prostheses and prosthetic and orthopedic products before their replacement

Terms of use technical means rehabilitation, prostheses and prosthetic and orthopedic devices before their replacement are approved by the Order of the Ministry of Health and Social Development of the Russian Federation of December 27, 2011 N 1666n "On approval of the Terms of use of technical rehabilitation aids, prostheses and prosthetic and orthopedic devices before their replacement." Appendix N 1 to the Order of the Ministry of Health and Social Development of the Russian Federation of August 21, 2008 N 438n Procedure for the implementation by the executive body of the social insurance fund of the Russian Federation of medical and technical expertise to establish the need for repair or early replacement of technical means of rehabilitation, prostheses, prosthetic and orthopedic products

1. Implementation of medical and technical expertise to establish the need for repair or early replacement of technical means of rehabilitation provided for by the federal list of rehabilitation measures, technical means of rehabilitation and services provided to a disabled person, approved by order of the Government of the Russian Federation of December 30, 2005 N 2347-r (hereinafter - technical funds) provided to persons recognized as disabled (with the exception of persons recognized as disabled due to accidents at work and occupational diseases), and to persons under the age of 18 who have been assigned the category "disabled child" (hereinafter referred to as disabled), as well as prostheses (except for dentures) and prosthetic and orthopedic products (hereinafter referred to as products) provided to certain categories of citizens from among the veterans who are not disabled (hereinafter referred to as veterans) are produced by the executive body of the Social Insurance Fund of the Russian Federation (hereinafter referred to as the authorized body).
2. Medical and technical expertise is carried out on the basis of an application by a disabled person (veteran) or a person representing his interests. An application for a medical and technical examination is submitted to the authorized body at the place of residence of the disabled (veteran) in writing. Simultaneously with the application for a medical and technical examination, a disabled person (veteran) presents a technical device (product), the need for repair or early replacement of which must be established. If it is impossible to provide a technical device (product) due to difficulty in its transportation or the state of health of a disabled person (veteran), confirmed by the conclusion of a medical organization providing medical and preventive care, the authorized body, upon the application of a disabled person (veteran) to conduct a medical and technical examination, may make a decision on conducting a medical and technical examination with a visit to the house of a disabled person (veteran).
3. The authorized body informs the disabled person (veteran) about the date and place of the medical and technical examination, in which the disabled person (veteran), at his request, has the right to take part. The disabled person (veteran) informs about the desire to take (or not to take) part in the medical and technical examination in the application for the medical and technical examination.
4. The authorized body, within 15 days from the date of receipt of an application for a medical and technical examination, makes an expert assessment of the state of operability of a technical device (product), its compliance with the required functional parameters, medical purpose and clinical and functional requirements. Documents required by the authorized body for the expert assessment cannot be requested from a disabled person (veteran).
5. Based on the results of the medical and technical examination, the authorized body establishes the feasibility of repairing the technical means (product) and prepares the conclusion of the medical and technical examination in the form provided for in Appendix No. 2, in 2 copies, one of which is issued to a disabled person (veteran).
6. The conclusion of the medical and technical expertise indicates the reasons for the malfunction of the technical means (product), as well as the types of repair. When it is established that it is impossible to repair a technical device (product) by the authorized body, in the conclusion of a medical and technical examination, it is concluded that it is necessary to replace the technical device (product) early and the reasons for its early replacement are indicated. In the conclusion of the medical and technical examination, recommendations are given on the organization that carries out the repair and the provision of new technical means (product).
7. Disputes arising from the implementation of medical and technical expertise are settled in the manner prescribed by the legislation of the Russian Federation.

Repair of technical means of rehabilitation.

Disabled persons are provided with services for the repair of technical rehabilitation equipment. Within the framework of social welfare services, disabled persons are provided with:

• the necessary means of telecommunication services;
• special telephones (including for subscribers with hearing impairments);
• collective bargaining points;
• household appliances;
• typhlo-, deaf- and other means necessary for social adaptation.

A disabled person has the right not only to receive the specified special means for self-service and care, as well as other means of rehabilitation, free of charge, but also to receive services for their repair. Maintenance and repair of technical means for the rehabilitation of disabled people. - are made out of turn with exemption from payment or on preferential terms. Order of the Ministry of Health and Social Development of the Russian Federation of 08.21.2008 N 438n "On approval of the procedure for the implementation and the form of the conclusion of a medical and technical examination to establish the need for repair or early replacement of technical means of rehabilitation, prostheses, prosthetic and orthopedic products" (Registered in the Ministry of Justice of the Russian Federation 09.16.2008 N 12293) approved the procedure for the implementation and forms of the conclusion of the medical and technical expertise to establish the need for repair or early replacement of technical means of rehabilitation, prostheses, prosthetic and orthopedic products.

The procedure for maintenance and repair of rehabilitation facilities for disabled people.

1. If a technical device or prosthetic and orthopedic product is defective, the disabled person must submit an application to the body of the Social Insurance Fund of the Russian Federation at the place of residence for a medical and technical examination of this device or product.
2. The application is submitted by the disabled person or his representative in writing. Together with the application, a tool or product is presented that must be checked for repair or early replacement.
3. Sometimes it is not possible to provide a means or product, for example, due to the complexity of transportation or the state of health of a disabled person. In this case, a disabled person needs to first obtain a conclusion from a medical institution before contacting the body of the Social Insurance Fund of the Russian Federation (for example, about the impossibility of removing a prosthesis before receiving a new one).
4. At the request of a disabled person, the body of the Social Insurance Fund of the Russian Federation may decide to conduct a medical and technical examination with a visit of a specialist expert to the disabled person's home. For example, this is useful when the wheelchair is out of order.
5. The body of the Social Insurance Fund of the Russian Federation, which received an application from a disabled person, must set a date for the medical and technical examination and notify the disabled person of the exact time and place of its holding. A disabled person has the right to take part in this examination at his will. A disabled person must inform about his desire or unwillingness to take part in the examination in the application.

The maximum period during which an application is considered and an examination is carried out is 15 days from the date of receipt of the application.

1. The expert draws up a conclusion, which assesses the state of health of a technical device or product, its compliance with the required functional parameters, medical purpose and clinical and functional requirements, the cause of breakdown or malfunction.
2. In the final part of the conclusion, the expert indicates whether the repair of a technical device or product is expedient. If the repair is impractical (that is, too expensive compared to the cost of a similar new product) or impossible, then a conclusion is made about the need for early replacement of a technical device or product.
3. The conclusion indicates the organization that can repair or manufacture a new product or product. One copy of the conclusion of the medical and technical examination, signed, is handed to the disabled person.

1

Andriyanova E.A. 1 Iorina I.G. 2

1 GOU VPO Saratov State Medical University named after IN AND. Razumovsky ", Saratov

2 GUZ "Regional ophthalmological hospital", Saratov

In the problematic field of the sociology of medicine, counseling is considered as social interaction (communication), during which the transfer and receipt of semantic and evaluative information affecting the patient's behavior, as well as his attitude to social values \u200b\u200bassociated with the value of health are carried out. The communicator in the provision of advice is a doctor and medical personnel, the recipient is the patient. The object of counseling communication is the patient's state of health, and the subject is the message that displays it. The channel is mainly oral speech. Specific for this type of communication is the specialized nature of information: for the communicator, the implicit communication code is the language of medical science, which is poorly understood by the patient. Psychophysiological, psychological and social barriers are most significant for the patient.

advisory assistance

communication

1. Andriyanova E.A. Social parameters of the formation of the professional space of medicine: dis. ... Dr. Sociol. sciences. - Saratov, 2006.

2. Golub O.Yu., Tikhonova S.V. Communication theory. - M .: Dashkov and K °, 2011 .-- 388 p.

4. Chebotareva O.A. Paternalism in Russian medicine: author. dis. ... Cand. sociol. sciences. - Volgograd, 2006 .-- 24 p.

5. Sharkov F.I. Basics of communication theory. - M .: Perspektiva, 2002 .-- 246 p.

6. Schepansky J. Elementary concepts of sociology / per. from Polish V.F. Chesnokova; ed. and entered. Art. R.V. Ryvkina. - Novosibirsk: Science. Sib. department, 1967 .-- 247 p.

Counseling is an integral part of medical and preventive care. In the problematic field of the sociology of medicine, counseling can be viewed as a social interaction, during which the transmission and receipt of semantic and evaluative information affecting the patient's behavior, as well as his attitude to social values \u200b\u200bassociated with the value of health are carried out. Considering counseling as an act of social communication allows us to single out its structure and functional features.

The purpose of the work is the consideration of counseling as a form of social communication .

Materials and research methods

The work was carried out on the basis of a communication approach.

Research results and their discussion

The term "communication" (lat. Com-mu-nicatio, from communico - making it common, connecting, communicating) was originally used to designate means of communication, transport, communications, underground urban networks. Gradually, in the language of science, the term "communication" began to denote a means of communication between any objects in the world. According to F.I. Sharkov, the term "communication" entered scientific reflection at the beginning of the 20th century to fix the system in which the impact is carried out, the process of interaction and methods of communication that allow you to create, transmit and receive a variety of information. For sociological thinking, this is a paradigmically very close concept, since all social dynamics (as a subject of sociology) is the process of interactions.

Considering counseling as social communication allows you to clearly record the roles of the participants in the interaction and its result. As you know, the main components of the communication process are:

The subjects of the communication process are the communicator (sender of the message) and the recipient (recipient);

Communication means - a code used to transmit information in symbolic form (words, pictures, graphics, etc.), as well as the channels through which the message is transmitted (letter, telephone, radio, telegraph, etc.);

The subject of communication (any phenomenon, event) and the message displaying it (article, radio broadcast, television story, etc.);

Communication effects are the consequences of communication, expressed in a change in the internal state of the subjects of the communication process, in their relationships or in their actions.

Accordingly, counseling can be considered as a process of social communication, which is realized in a series of local interactions, in which medical personnel play the role of a communicator, the patient is a recipient, the patient's health is the subject of the message, and changes in the patient's behavior that ensure a change in the quality of life are the effects of communication.

Communication between doctor and patient in the course of providing counseling is carried out in a rigid formal framework. Their emergence is due to the specific nature of medical activities, an increased degree of social responsibility of the doctor. Since the activity of a doctor presupposes the presence of highly specialized knowledge, the motives of his decisions are not transparent to the patient, and the motivation for seeking medical help is very high. The patient, desiring treatment and recovery, is not familiar with the nature of the disease, nor with the state of his own body, nor with the prediction of the outcome of the disease. As a result, the risk of possible abuse of the patient's position is too great. Therefore, from the earliest stages of professionalization of medical activity, it is clearly formalized.

Thus, an essential characteristic of counseling as social communication is its institutional nature. The communicator always acts as a representative of the Institute of Medicine, and the recipient acts as a patient. The institutional role is one of the basic elements of a social institution. So, according to J. Schepansky, the essence of a social institution can be revealed through the following characteristics:

Each institution has its own target activities;

It clearly defines functions, rights and dutiesparticipants in institutionalized interaction to achieve the set goal;

Each one fulfills its established, traditional for a given institution, social role, function within the framework of this institution, due to which all others have sufficiently reliable and reasonable expectations; social institution has certain means and institutions to achieve the goal (can be both material and ideal, symbolic);

The Institute has a certain system of sanctions, providing encouragement of desired and suppression of unwanted, deviant behavior.

The analysis of a person's acceptance of a role as a complex process, including communication, replacing identification with another person and the projection of his own tendencies of ignorance onto him, is contained in the works of A. Schutz, R.G. Turner, R. Williams and other representatives of the phenomenological school. At the same time, it was noted that the freedom of individuals in the construction of their roles depends on the nature of their position and varies from the pole of formalized bureaucratic roles with a minimum of improvisation to the pole of undefined roles (parents, friends).

Mastering the social role of a doctor is realized through professionalization - a process during which an individual who has mastered certain skills, knowledge and abilities, implements them in the course of his activities within a certain social community. The nature of the social division of labor, the status of professionals, the attributes of their activities and self-awareness constitute the main elements of the model of professionalization, typical for a particular stage in the development of society.

Today, formal regulation of the doctor-patient role uses ethical and legal mechanisms of rule-making. In general, the value-legal norms governing the roles of the doctor and the patient are expressed in the so-called ethical models of the doctor-patient relationship. They can be schematically characterized as follows:

The Hippocratic model (“do no harm”). Based on the famous "Oath", in which Hippocrates formulated the duties of a doctor to a patient. According to this model, the physician must win the patient's social trust.

Paracelsus' model ("do good"). It implies paternalism - the emotional and spiritual contact of the doctor with the patient, on the basis of which the entire treatment process is built. Paternalism built the relationship between the doctor and the patient according to the clerical model of the relationship between a spiritual mentor and a novice. The essence of the relationship between the doctor and the patient is determined by the benefit of the doctor, the good, in turn, has a divine origin, since it comes from God. The principal feature of paternalism is the asymmetry of relations, within which the doctor is assigned the role of the subject, and the patient is assigned the role of the object.

Deontological model (principle of "respect for the duty"). This model places the doctor's moral duty at the center of the doctor-patient relationship and presupposes the strictest observance of the prescriptions of the moral order, established by the medical community, society, as well as the doctor's own mind and will for mandatory execution. Bioethics (the principle of "respect for human rights and dignity").

Bioethical model. The bioethical model eliminates the asymmetry in the doctor-patient relationship through the introduction of the principle of autonomy, which has become the central moral right of the competent patient. The principle of individual autonomy is based on the unity of the rights of the doctor and the patient and presupposes their mutual dialogue, during which the right of choice and responsibility are not entirely concentrated in the hands of the doctor, but are distributed between him and the patient. In the Russian Federation, the bioethical model of the doctor-patient relationship is legally established (Article 30 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens of July 22, 1993).

It is important to note that not only doctors, but also nursing staff can be classified as communicators. First of all, these are nurses. The normative construction of the roles of a nurse duplicates the norms typical for doctors in terms of the relationship with the patient, assuming a hierarchical relationship between the doctor and the nurse.

Usually, ethical models of doctor-patient relations are considered in chronological order, as replacing each other. This is largely due to the rejection of the neutral attitude to medical paternalism, characteristic of Parsons' approach, and criticism of paternalism by Campbell, Luna, Seeger, Witch and others. At the same time, many researchers note that paternalism is inherently inherent in the Russian model of medicine. In a study by O.A. Chebotareva proves that role paternalism in medicine is not a passed stage, but plays the role of a basic model due to its psychological naturalness for a doctor and a patient.

Models of the doctor-patient relationship are likely complementary. One of them is fixed at a formal level, while others act as informal rules and guidelines. The professionalization of medicine is dynamic, the mutual transitions of professional roles into social roles and vice versa are natural. The model of the social roles of the doctor and the patient cannot be fixed completely and unambiguously.

The recipient of communication in the provision of counseling is the patient. It is obvious that the patient's social role is formalized in the course of the progression of medicalization. The social role of the patient, initially informal, is localized in space and time through the activities of healthcare institutions, and the patient's role expectations stem from the requirements of the social environment and are focused on recovery (the patient's personal interest) and the ability to fully fulfill social roles (public interest). S.A. Efimenko rightly notes that the patient's socialization begins from the first years of life and can continue both until the end of growing up and in life, is influenced by the labor, socio-political and cognitive activities of the individual and is revealed through the development of typical behavioral acts. The combination of knowledge, beliefs and practical actions forms character traits and qualities inherent in certain types of patients. The main agents of such specialized socialization are the institutions of family and medicine, which form a system of values, traditions, social norms and rules of behavior in the field of health.

The object of counseling communication is the patient's state of health, and the subject is the message that displays it. The channel is mainly oral speech. Specific for this type of communication is the specialized nature of information: for the communicator, the implicit communication code is the language of medical science, which is poorly understood by the patient. Therefore, the communicator must, during the consultation, carry out "decryption" of the message into ordinary language, taking into account the personal and socio-demographic characteristics of the recipient's perception.

We can say that the entire system of institutionalization of medicine provides understanding between the doctor and the patient. Understanding is the result of counseling and the basic effect of communication. On its basis, the patient makes a decision and changes his behavior. On the one hand, the patient is in a situation where it is difficult for him to objectively understand the meaning of what is happening to him. In his attitude to the situation, there are personal meanings that actually govern his behavior. That is why the patient cannot be considered a passive object of medical intervention. The effectiveness of treatment is far from the least dependent on whether the patient is viewed as an “organism”, or a person with social and psychological needs. The satisfaction of the patient's needs is the result of the coordination of the system of health needs and personal predispositions with a subjective assessment of the practical possibilities to realize them in a specific health care system.

In recent years, the problem of understanding is increasingly being solved with the involvement of the communicative aspect of the competence approach. Indeed, the profession of a doctor is one of the few professions of the "person-to-person" group that require perfect mastery of techniques and methods of effective communication. At the same time, the circle of professional communication partners is very large, it includes the patients themselves, their relatives, colleagues. The goal of communication is to achieve mutual understanding, which is necessary in solving not only medical and diagnostic problems, but also personal and family problem situations that can have a significant impact on the outcome of a particular disease and the quality of life of a person as a whole.

As a behavioral strategy, communicative competence is based on the ability to productively communicate with the interlocutor, avoiding conflict situations, build constructive relationships, achieve compliance when discussing with the patient the appointment of diagnostic and therapeutic interventions, the ability to provide all possible assistance in resolving his family and personal problems. In addition, the concept of communicative competence includes the possession of certain norms of communication, behavior, as a result of assimilation of various ethnic and socio-psychological standards, behavioral stereotypes, standards.

The problem of the patient's communicative competence can also be formulated within the framework of the sociology of medicine. This topic requires independent research, however, as a first approximation, it can be noted that the patient's communicative competence is formed spontaneously and is determined by the communication barriers characteristic of the patient's existing diseases.

The communication approach allows you to fix the obstacles that arise on the path of understanding, interpreting them as barriers to communication. Communication barriers are obstacles that prevent communication and interaction between the communicator and the recipient. They impede adequate reception, understanding and assimilation of messages in the process of communicating.

Psychophysiological, psychological and social barriers are of fundamental importance for the patient's communicative competence. However, it should be borne in mind that the psychophysiological barrier can act in a complex way, excluding the possibility of using certain technical means and initiating specific psychological and social barriers. To study the barriers of the patient's communicative competence, it seems justified to use empirical material and methods for studying the quality of life of a particular contingent of patients.

Counseling, considered as a form of social communication, is interpreted as a communicative goal with clear functional characteristics of all basic elements. This perspective allows you to increase its efficiency and develop flexible strategies for its optimization.

Reviewers:

Tikhonova S.V., Doctor of Philosophy, Professor of the Department of Public Relations of the Federal State Budgetary Educational Institution of Higher Professional Education "SGSEU", Saratov;

Maslyakov V.V., Doctor of Medical Sciences, Professor of the Department of Surgery, State Educational Institution of Higher Professional Education Saratov Military Medical Institute of Moscow Region, Saratov.

The work was received on May 14, 2012.

Bibliographic reference

Andriyanova E.A., Iorina I.G. CONSULTATIVE HELP AS A KIND OF SOCIAL COMMUNICATION // Fundamental research. - 2012. - No. 7-1. - S. 26-29;
URL: http://fundamental-research.ru/ru/article/view?id\u003d30031 (date accessed: 03/26/2020). We bring to your attention the journals published by the "Academy of Natural Sciences"

Sometimes we can provide our wards with the best help by referring them for consultation to specialists whose qualifications, knowledge and proximity can play a particularly important role. Seeking counseling does not necessarily indicate that the caregiver is ignorant of these issues or is trying to get rid of the caregiver. No one can know and be able to do everything in order to engage in general, universal counseling, so referral for consultation with specialists often indicates to the ward that you want to provide him with the opportunity to find the best possible help.

The counselor is obliged to refer the wards to specialists in the case when, after a series of counseling sessions, the wards do not show signs of improvement; when they have serious financial difficulties; when they should seek legal advice; when symptoms of depressive disorders and suicidal tendencies are found; when they are acting strange, eccentric, or overly aggressive; when they are in a state of extreme emotional arousal; when they cause strong antipathy or sexual desire; or show problems that are beyond your control. People with obvious signs of bulimia, drug addiction, bodily deformities, persistent manic-depressive disorders, fear of conception or HIV infection and other diseases - all need medical advice in addition to, and sometimes instead of, your counseling.

Counselors need to know about all public organizations and institutions that provide appropriate assistance, and about specialists who can provide advice to their wards. These are specialists in private practice, such as doctors, lawyers, psychiatrists, psychologists and other counselors; persons engaged in pastoral counseling and other church leaders; as well as private and public clinics and hospitals; services such as the Society for Assisting Children with Developmental Disabilities and the Society for the Blind; government services, including social welfare agencies and local employment offices; about departments of school counseling and about local institutions of public education; private employment offices; suicide and narcological dispensaries and departments; voluntary organizations such as the Red Cross and Hot Lunch Delivery to Homes for the Elderly and Disabled; and self-help groups such as Alcoholics Anonymous. For the most part, they are all listed in telephone directories; other counselors or colleagues who know the real state of affairs in your area can report them. When deciding to send your ward for counseling, do not lose sight of the church communities, which often (as needed) provide support and practical assistance to those in need.

Ideally, it would be best to refer your charges only to counselors who are both competent and Christian. Unfortunately, in many societies there are no professional Christian counselors, and those few Christians - specialists in the field of medicine, psychotherapy, psychology, pedagogy, and other fields of knowledge - cannot be called highly qualified. To solve many problems (say, school failure, neuropsychic and other diseases) it is not necessary to involve specialists from among the believing Christians. Some psychological problems lie on planes that do not intersect with Christian ideals, and unbelievers also successfully cope with them. And even in the case when your charges are struggling with deep, purely personal issues, many non-Christians, from among those who are well-disposed towards the religious values \u200b\u200bof your charges, do not at all want to shake their faith. If the help of specialists from among believing Christians is not available in your environment, you still have to make a decision (for each of your wards, such a decision must be made on an individual basis) to send your ward for a consultation to a non-Christian specialist or continue to observe him yourself, although you and I would like to hold such a consultation.

Before offering a ward to go through a consultation with a specialist, you need to find out about the available and nearest sources of help. First, sort out with public and private consultants, find out if they can really provide your ward with the necessary assistance. (Turning to those who, in your opinion, can provide help, and not receiving it, the wards may experience extremely negative experiences.) Offering specialist advice to the wards, be sure of the absolute necessity of this procedure. Make it clear to the ward that this is done in order to provide him with the best help. Someone will resist the idea of \u200b\u200bcounseling, thinking that you are insane or that his problem is too difficult for you. As you deal with these fears as they arise, try to involve the mentees in the decision to turn to another source of help when necessary.

Goal setting... The goals of any advice should be based on the needs of the client. In this context, we can talk about two main goals:

• 1) increasing the efficiency of the client's own life management;
• 2) development of the client's ability to solve problem situations and develop existing capabilities.

Counseling / assistance must necessarily include teaching the client, i.e. bringing into his life new values, alternative perspectives of the vision of life, the ability to develop solutions to his own problems and put them into practice.

Sometimes the goals of counseling are divided into goals related to rectification (correction) and goals related to growth or development. Development challenges are challenges that people face at different stages in their lives. For example, this is the transition to an independent existence, finding a partner, raising children and adapting to old age. To achieve development goals, it is necessary to both suppress negative traitsand strengthening of positive qualities. In counseling, much attention is paid to achieving a state of psychological comfort and maintaining mental health.

According to A. Maslow, complete self-actualization implies the realization of creativity, autonomy, social realization and the ability to focus on solving problems. It can be said that the ultimate goal of counseling is to teach clients to help themselves and thus teach them to be their own counselors. This is consistent with one of the leading methodological principles of social work - the concept of independent living.

As R. Kociunas notes, the issue of determining the goals of counseling is not simple, and because it depends both on the needs of the clients seeking help and on the theoretical orientation of the counselor himself. However, there are several universal goals that are more or less mentioned by theorists of different schools (Figure 14.5).

Fig. 14.5.

• 1. Promote behavior change so that the client can live more productively, experience life satisfaction, despite some unavoidable social constraints.
• 2. Develop skills to overcome difficulties when faced with new life circumstances and requirements.
• 3. Ensure effective vital decision making. There are many things that can be learned during counseling: acting independently, allocating time and energy, assessing the consequences of risk, exploring the field of values \u200b\u200bin which decisions are made, assessing the properties of your personality, overcoming emotional stress, understanding the influence of attitudes on decision making, etc. .P.
• 4. Develop the ability to establish and maintain interpersonal relationships. Communicating with people takes up a significant part of their lives and causes difficulties for many due to their low level of self-esteem or insufficient social skills. Whether it is adult family conflicts or children's relationship problems, clients' quality of life should be improved through training in better interpersonal relationships.
• 5. Facilitate the realization and increase the potential of the individual. According to Blochsr, counseling should strive for maximum client freedom (taking into account natural social constraints), as well as developing the client's ability to control his environment and his own reactions provoked by the environment.

R. May points out that when working with children, the counselor should seek to change their immediate environment in order to improve the effectiveness of assistance.

The above list of goals largely coincides with the list of typical customer requests and their expectations from the results of advisory assistance:

• - to better understand yourself or the situation;
• - change your feelings;
• - be able to make a decision;
• - to confirm the decision;
• - get support in making a decision;
• - be able to change the situation;
• - adapt to a situation that most likely will not change;
• - give relaxation to your feelings;
• - consider the possibilities and choose one of them.

Often, clients are interested in results that are not directly related to counseling: information, new skills, or practical help.

At the heart of all these requests is the idea of \u200b\u200bchange. Regardless of the nature of the request or the type of problem, there are four main strategies.

The first situation - a change in the situation itself.

Second situation - changing yourself to adapt to the situation.

The third situation is way out.

The fourth situation is finding ways to live with this situation.

At the same time, one should once again emphasize the need to increase the personal responsibility of clients for solving a problem situation and, in general, the further development of their life scenario. The client, as N. Linde notes, needs to be helped to free himself from the state of objectivity and to activate the qualities of a subject who is ready and capable of changes, making decisions and implementing them.

Typology of advice. Advisory assistance can be provided in different forms and types. There is a wide variety of forms of advisory practice and classifications of these forms for different reasons (Figure 14.6). Thus, according to the criterion of the object of assistance, one distinguishes between individual ("one-on-one" or "face-to-face"), group and family counseling.

Fig. 14.6.

Work with children and adults is differentiated according to the age criterion.

The spatial organization of counseling can be carried out in the formats of contact (face-to-face) or distant (correspondence) interaction. The latter can be carried out within the framework of telephone counseling (although to a certain extent it is also contact counseling), written counseling, and also through printed materials (popular science publications and self-help guides).

According to the criterion of duration, counseling can be urgent, short-term and long-term.

There are also several typologies of advice, focusing on the content of the client's request and the nature of the problem situation. So, distinguish between intimate, family, psychological and pedagogical and business counseling.

Counseling can be a reaction to the client's situation ("crisis counseling") or an incentive for the client's growth and development ("developmental counseling"). Traditionally, counseling is spoken of in relation to a situation during or after a crisis, but it should also help people anticipate possible future problems, teach them to recognize the signs of an impending crisis, and equip them with the skills to suppress crises in the bud.

Any successful counseling implies personal growth, however, in a crisis situation, a person is in its grip, under the pressure of circumstances, and since counseling is limited to the scope of the existing problem, the client's conceptual and behavioral arsenal can be replenished in a very small amount.

Heron (1993) distinguishes several categories of advisory impacts, depending on their goals and content (Fig. 14.7).

Prescribing the impact is focused on the client's behavior outside the consultative interaction.

Informing impact provides the client with knowledge, information and meanings.

Confrontational impact has as its purpose the client's awareness of any restrictive attitudes or behavior.

Facilitating - cathartic, catalytic, supporting.

Cathartic the purpose of the impact is to help the client to discharge, to give an outlet to repressed painful emotions (abreaction), mainly such as grief, fear or anger.

Catalytic the impact is focused on stimulating self-knowledge, self-governing being, learning and problem solving.

Supportive the impact is focused on confirming the significance and value of the client's personality, his qualities, attitudes or actions.

Facilitating types of influence are focused on greater autonomy of clients and acceptance of responsibility for themselves (helping in alleviating mental suffering and pain, reducing the power of "I", contributing to independent learning, confirming their importance as unique creatures).

The choice of this or that type and type of influence depends on the client's personality type (as well as the consultant's personality type) and the specifics of his situation. The ratio of authoritarian and facilitating influences is mainly related to the topic of power and control:

• - the consultant completely controls the client;
• - control is divided between the consultant and the client;
• - the client is completely autonomous.