The article is devoted to scientific and practical contribution of A.I. Zakharov in clinical psychology and psychotherapy of children with neurotic disorders and their family members. For the first time the author introduces a general model of pathogenesis of child's neurosis in the form of interaction of the following factors: 1) constitution and neuro-somatic weakening of the body; 2) premorbid characteristics and age; 3) adverse situations; 4) trauma and internal conflict; 5) neuropsychiatric tension; 6) pathophysiology; 7) changes in personality. For the first time the functional specialization of the cerebral hemispheres is described in clinic neuroses. The mechanism of formation of various clinical forms of child's neurosis based on the dynamics of interhemispheric asymmetry is described.
The concept of childish fear is developed, which includes real and imagined, acute and chronic, situational and personal fears, as well as "normal", pathological and implanted fears. Their prevalence is investigated and standards of occurrence are offered with regards to age of both boys and girls, the phenomenon of intersection of natural and social fears of teens is described. The terms of eliminating fears are considered from the standpoint of the child, taking into account the etiology of fears (inspired, situational and personal) and the willingness of parents to rebuild family relations and change educational influences. A.I. Zakharov considers the followimng deviations of child's behavior : a normal and pathological child's attachment to parents; problems in emotional development; problems of adaptation of children to preschool and school; pathological habits, etc.
For the first time in Russia pathogenetic student-oriented individual, group and family therapy for child and adolescent neuroses is presented in a systematic manner. Particular attention is paid to the influence of grandparents upon children and grandchildren who are parents themselves, as well as to phenomenon that consolidates pathological tereotypes of relations between generations, leading to child and adolescent behavior disorders. The main methods of psychotherapy are: explaining psychotherapy, psychotherapy using arts, play therapy, infusion and hypnotherapy.
Keywords: children behavioral deviation; neurosis, children's fears; grandparents-parents-children, children psychotherapy of neuroses.
Aleksandr Ivanovich Zakharov, a well-known Russian child psychologist and psychiatrist, devoted his life to psychological and psychiatric aid to children and their parents. He was born on October 12, 1940 in Kotelnichi settlement of Kirovsk district and died on June 1, 2008. In 1962 he graduated from the Pediatric Institute in Leningrad. Throughout his professional life he worked as a psychotherapist in different institutions of Leningrad, for example, at the City Department of treatment of neurosis in children at 26th children’s out-patient clinic. For many years A.I. Zakharov was the chief specialist in psychotherapy for children and teenagers of the Chief Department of Health of Leningrad City Executive Committee. At the same time he taught at higher educational institutions of Saint Petersburg. In his last years he was professor of the chair of psychological aid of A.I. Herzen Russian State Pedagogical University.
He started his scientific research in the field of psychology and psychiatry when yet a student. His academic advisors were Prof. S.S. Libikh, Doctor of Medical Science, and Prof. V.K. Myager, Doctor of Medical Science. He presented his Ph.D. thesis on “Specific Features of Family Relations and Family Psychotherapy for Childhood Neuroses” in 1976 and his doctorate thesis on “Psychological Foundations of the Origin and Psychotherapy of Juvenile Neuroses” in 1992.
A.I. Zakharov systematized his long-term experience of work with children with behavior deviations and their children and published over 70 scientific works, including 18 monographs.
A.I. Zakharov studied the causes of neurotic disorders in children under 6 years of age and separately in children of 5—7 years of age which result in behavior deviations, which was reflected in his monograph “Prevention of Child Behavior Deviations” . For example, the causes of nervousness in children from birth till 5 years of age include problems of children’s parental fixation, problems of emotional development, and problems of children’s adaptation in pre-school institutions, pathological habits, sleep disturbances, crying and obstinacy. The causes of nervousness in senior preschool age include problems of formation of the personality, fears, enuresis, encopresis, tic disorders, stuttering, psychomotor instability syndrome. The author described both the causes and identified the ways of their prevention and psychocorrection.
Despite the extensive experience of work with children with different neurotic disorders A.I. Zakharov paid the greatest attention to neuroses in children and teenagers. The first monograph “Psychotherapy of Neuroses in Children and Teenagers” was published in 1982 by Meditsina Publishing House. Being a follower of the school of thought created by V.N. Myasishchev he was the first in Russia to present the systematized pathogenetic person-centered psychotherapy of neuroses in children and teenagers. The cornerstone was not just the child but the family as well, the specific features of its functioning with account for development of children prior to emergence of the neurosis, the parents’ personalities, specific features of child-rearing, etc.
Based on the long-term experience of work and analysis of standardized interviews with the parents of the children with neuroses A.I. Zakharov concluded that “the main pathogenic factor running like a scarlet thread through all generations (grandparents — parents — child) is the psycho-traumatic experience of interpersonal relations, the parent’s family being the chief link of transfer of this experience for the child” [1, p. 17]. The mechanism of accumulation of the changes of the neurotic circle looks as follows. For the child the family consists of seven “I’s”: four of them are two grandmothers and two grandfathers who reveal characterological disorders conditioning the pathological stereotypes of relations between them, two of them are the parents who start revealing disorders of the neurotic circle against the background of characterological disorders as they have assimilated some pathological stereotypes of relations, which is reflected in the existing family attitudes; the lest, seventh “I” is the child himself in whom the neurotic disorders grow and reach a clinically defined disorder already. The author placed the main emphasis on the parents being “the center of the psychopathological crossing” and wrote that “the parents of children with neuroses do not just involuntarily compensate but repeat many of the problems of the relations in the grandparents’ family, including denial of the children’s individuality, lack of understanding of their possibilities and needs, etc.. This is accounted for by formation of pathological attitudes and stereotypes of relations which act as assigned, programmed or even instilled in the life experience” [Ibid. P. 20].
A.I. Zakharov [1, p. 66; 5, pp. 283–347) proposed the author’s model of the general pathogenesis of neuroses in children and teenagers in the dynamics of action of the following factors: 1) constitution and neuro-somatic reduced condition; 2) premorbid specific features and age; 3) unfavourable life situation; 4) psychic trauma and inner conflict; 5) neuro-psychic tension; 6) pathophysiology; 7) personality change. The author filled all these factors with specific substance based on the long-term experience of work as a psychotherapist and systematization of the obtained data. For example, he identified the following groups of personality changes in case of neurosis in children and teenagers [5, p. 346]: reduction of the general productivity and activity due to growing asthenic disorders and self-defeating mood; growing lack of self-confidence and difficulties in forecasting the events; subjectivity in assessments with reactively conditioned inflexibility of thinking and its irrational processing; inconsistency and contradictory of acts, etc.
Then, proceeding from clinical presentations of neuroses A.I. Zakharov also considered pathophysiological disorders, such as overstrain of the excitative and inhibitory processes, “tilt” of the excitative and inhibitory processes, disruption of bilateral regulation, etc. He paid special attention to bilateral regulation and was the first to describe the functional specialization of the hemispheres in the clinical picture of neuroses. Based on the dynamics of the hemispheric asymmetry he described the following picture of formation of different clinical forms of neuroses [Ibid. P. 328–329]: the left hemisphere — anxiety of the apprehensive type; the anxiety transforms into obsession; obsessive doubts reach the degree of self-effacement, neurotic depression (moral aspect), manifestation of the defensive mechanisms of the rationalization type, anxious-suspicious type of response, and all this results in the model of subsequent clinical development of psychasthenia; the right hemisphere — anxiety of the type of diffuse feeling of worry; the anxiety transforms into the feeling of fear, suggestibility as assimilation of information assigned from the outside independent of one’s consciousness, neurotic depression with a vital shade, manifestation of defensive mechanisms of the type of suppression and amnesia, affective-excitable type of response, and all this results in the model of subsequent development of hysteric neurosis.
The author concluded that neuroses in children usually result from the left hemisphere type of upbringing contradicting the innate dominance of the activity of the right hemisphere. Manifestations of this left hemisphere type of upbringing include too early socialization of the child with overstated requirements, excessive deliberativeness with minimized proximity in dealing with the child, multitude of verbal assignments, advice, threats and requirements of behavior control, emotional restraint of the child, excessive concentration on the child’s intellectual achievements.
Considered in detail for the first time were the daytime and night fears of children, their cause-and-effect relations, their incidence in children; the norms for boys and girls of different age are proposed. The author described different fears: real and imagined, acute and chronic, situational and personal, normal and pathological. Quite interesting is identification of the so-called instilled fears in children which are the most frequent ones and are primarily instilled at the conscious and subconscious level by the adults close to the child in the course of excessively persistent and emotionally charged warning of dangers. Anxious parents also “transfer” their fears to children when discussing disasters, diseases, fires, death, etc. in their presence as a result of which the fears become impressed in the child’s psyche.
The author proposed age-related dynamics of fears with individual description of the specific features of the causes as well as manifestations of the fear. He considered the phenomenon of crossing of natural and social fears in teenage years which involves obvious dominance of natural fears at the age of 10—12 with the growing social fears at 13—15.
With a view to provision of effective psychological aid to children the author developed classification of 29 specific fears encountered in children which include fears of being attacked, animals, fairytale characters, elements, height, injections, etc. As a result the author concluded that girls are more subject to fears than boys. The normative peaks of the number of fears in boys at the age of 3, 6 and 7 are nine fears while with girls at the age of 5, 6, 7 and 11 they are 11—12 fears [4, pp. 85–86].
Attention is paid to children’s night fears and the role of the family in their origin. The author delineated frightening dreams and nightmares where the child experiences horror as an emotional-shocking, acute sensation which leaves a long-time emotional trace in the children’s memory. He gave the data showing that 37% of children aged 3—5 see nightmares and 18% of them see them repeatedly, which is often unknown to their parents. The research of over 2,000 children showed age-related distribution of fears in nightmares [3, p. 226]. The author summarized the influence of inadequate upbringing and disrupted family relations on children’s dreams [Ibid. Pp. 363–364) and on this basis made a number of conclusions: excessive exactingness and adherence to principles of adults who fail to consider the personal specific features of the child result in the fear of the discrepancy or change of the child’s “I”; the adult’s insincerity accounts for the fears of frightening characters with threatening and unpredictable behavior, etc.
A.I. Zakharov proposed individual, group and family psychotherapy for children and teenagers with behavior deviations. The conditions of fear elimination include consideration of fears from the child’s positions, account for the etiology of fears (instilled, situational, personal) and parents’ willingness to reconstruct the relations in the family and change the educational impacts. The principal methods of psychotherapy are drawing the fears and game. “When drawing the child gives expression to his or her feelings and sensations, wishes and dreams, reconstruct his or her relations in different situations and painlessly comes in touch with certain frightening, unpleasant and traumatic images” [Ibid. P. 92]. The greatest effect is achieved in children at the age of 5—12 but if the frightening event has occurred recently, one should not expect positive changes in the form of reduced intensity of the fear. In this case game psychotherapy has a better effect.
Games can be object-related and role-related, spontaneous and goal-oriented as well as mixed object and role-related where all family members, boys and girls, children of different age groups from 4—5 to 14—15 take part. A.I. Zakharov displayed creativity in applying games known to everybody: squares, blindman’s buff, fast responses, ball in a circle, etc. For example, the psychotherapy effect of the squares when applied repeatedly involves such changes as: 1) emotional discharge; 2) reduction of fear intensity in case of a sudden impact; 3) increased variability, flexibility of behavior in different situations; 4) formation of the ability of taking a quick independent decision; 5) aid in assimilation of group rules of behavior in joint activities; 6) development of agility, coordination of movements; 7) higher activity; 8) immediate contact improving interaction of the child-parent relations. Different modifications of the game are proposed: the “put out” person may “feel hurt” and run after the game participants with a sponge roller, cap with express threats; one can apply wider space, including the hall and other rooms; one can stretch a rope or draw mole hills on the floor with the need to jump from one to another, etc. Besides, modifications of the game are proposed depending on the age of the children, specific features of the system of the relations between parents and children and educational practice.
The author considered suggestion and hypnosis in treatment of neurotic disorders in children. Noteworthy is the reasonable and balanced attitude to the problem of application of suggestion and hypnosis and its effectiveness or, on the contrary, its negative result aggravating the existing neurotic symptoms. The author specially noted that suggestion does not restore the disrupted relations in the family and does not influence the inner conflict but may influence the formation of certain traits of character and raise self-confidence.
Scientists and experts continue developments of A.I. Zakharov and apply his experience in work with children with neurotic disorders and their families. Colleagues from A.I. Herzen Russian State Pedagogical University dedicate round tables and publish collections of articles describing the contemporary practical application of A.I. Zakharov’s ideas .
Thus, A.I. Zakharov is one of the best known psychotherapists and clinical psychologists in Russia who studied the etiopathogenesis of behavior deviations in children and teenagers, neurotic disorders in their development. He greatly contributed to development of the pathogenetic person-oriented psychotherapy of neuroses in children. Based on the long-term practical work with children and generalization of over 2,000 observations he convincingly proved the principal role of disrupted family relations in three generations and improper upbringing ignoring children’s specific features in formation of neuroses and behavior deviations in them.
1. Zakharov A.I. Psikhoterapiya nevrozov u detei i podrostkov [Psychotherapy of Neuroses in Children and Teenagers]. Leningrad, Meditsina Publ., 1982. 236 p.
2. Zakharov A.I. Preduprezhdenie otklonenii v povedenii rebenka. 3-e izd., ispr. [Prevention of Child’s Behavior Deviations. 3rd edition, revised]. St. Petersburg, Soyuz Publ., 1997. 234 p.
3. Zakharov A.I. Chto snitsya nashim detyam [What Our Children Dream of]. St. Petersburg, "Del'ta" Publ.; Moscow, OOO "Izdatel'stvo AST" Publ., 1997. 432 p.
4. Zakharov A.I. Dnevnye i nochnye strakhi u detei [Children’s Daytime and Night Fears]. St. Petersburg, Rech’ Publ., 2005. 320 p.
5. Zakharov A.I. Proiskhozhdenie i psikhoterapiya detskikh nevrozov [Origin and Psychotherapy of Childhood Neuroses]. St. Petersburg, KARO Publ., 2006. 672 p.
6. Sbornik statei pamyati A.I. Zakharova [Collection of articles in memory of A.I. Zakharov]. St. Petersburg, Izd-vo RGPU im. A.I. Gertsena Publ., 2011. 63 p.
Gorkovaya I.A. Prevention of behavior deviations in children within the framework of the concept of A.I. Zakharov. Med. psihol. Ross., 2015, no. 2(31), p. 1 [in Russian, in English]. Available at: http://mprj.ru ↑
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