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cialur-ekonomikuri statusi (Anderson et al.,1992; Klag et al., 1991).

hipertenziis mizezia frustraciebi, romelic gamowveulia mniSvnelovani, ZiriTadi cxovrebiseuli miznebis miRwevis fuWi mcdelobiT; is ar ukavSirdeba genetikur faqtors. analogiurad, qronikuli stresi, romelsac socialur-ekonomikurad araxelsayrel pirobebSi myofi qalebi ganicdian, Seicavs naadrevi mSobiarobisa da mcirewoniani bavSvis gaCenis safrTxes (Lobel, 1994; Lobel et al.,1992). amgvarad, siRaribisa da rasobrivi crurwmenebis pirobebSi dabadebuli bavSvebi, SesaZloa, cxovrebas gacilebiT meti riskis pirobebSi iwyeben, vidre maTi privilegirebuli Tanatolebi. E

saidan viciT
xangrZlivi ekonomikuri siduxWiris damangreveli Sedegebi gamokvlevaTa did nawilSi, romelic aCvenebs, rom dabali Semosavali dakavSirebulia janmrTelobis cud mdgomareobasTan, Semosavali mxolod erTxel izomeboda. miRebuli korelaciebi, SesaZloa, ver afiqsireben mravalwliani siRaribis kumulaciur efeqts da, aseve, SeiZleba sapirispiro mizez-Sedegobriv kavSirs asaxavdnen _ cudi janmrTeloba iwvevs siRaribes. bolodroindelma gamokvlevam, romelSic ekonomikuri siduxWire 1000-ze met respondentTan sami aTeuli wlis manZilze izomeboda, cxadad aCvena, rom xangrZlivi ekonomikuri siduxWire

fizikuri, fsiqologiuri da kognituri funqcionirebis gauaresebas iwvevs (Lynch et al., 1997). ekonomikuri siduxWire ganisazRvreba, rogorc siRaribis federalur donesTan SedarebiT 200%-ze naklebi ojaxis Semosavlis qona. 1994 wlis gamokvlevebiT dadginda, rom ekonomikuri siduxWiris periodebi mozrdilma adamianebma, ZiriTadad, 19651983 wlebSi ganicades da rom yvelaze meti problema maT yoveldRiuri cxovrebis iseT ZiriTad aqtivobebTan hqondaT, rogoricaa: saWmlis momzadeba, sayidlebi da fizikuri sisufTavis SenarCuneba. msgavsi efeqtebi fsiqologiur da kognitur funqcionirebaSic gamovlinda. ekonomikuri siduxWiris periodis armqone adamianebTan SedarebiT siRaribis mdgomareobaSi samjer namyofi adamianebi samjer ufro xSirad ganicdidnen klinikuri depresiis simptomebs, xuTjer ufro xSirad fasdebodnen, rogorc cinikurad mtrulad ganwyobilni da optimizms moklebulebi da oTxjer ufro xSirad uCiodnen sirTuleebs kognitur funqcionirebaSi. imis dasamtkiceblad, rom es Sedegebi gamowveulia ekonomikuri siduxWiriT da ara _ sawyisi cudi janmrTelobiT, mkvlevrebma warmoadgines monacemebi im monawileTa Sesaxeb, romelTa janmrTelobis mdgomareoba 1965 wlis sawyisi gazomvebis dros Sefasebuli iyo, rogorc kargi an Zalian kargi. mkvlevrebma daaskvnes, rom bolodroindeli ekonomikuri da politikuri strategia zrdis araTanabar Semosavlebis ricxvs da sul

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stresi Tqvens cxovrebaSi

ufro met bavSvs aiZulebs, icxovros xangrZliv siRaribeSi, rac tovebs `fizikur, fsiqologiur da kognitur anabeWds, riTac yoveldRiuri cxovrebis xarisxi qveiTdeba~ (gv. 1895). am gamokvlevis monacemTa gacnobis Semdeg gakvirvebas aRar unda iwvevdes is, rom qronikul stress SeuZlia bavSvis inteleqtualur ganviTarebazec iqonios gavlena. ganvixiloT gamokvleva, romelSic adgendnen stresis dones 6dan 16 wlamde bavSvebis jgufSi da, amasTan, zomavdnen maT inteleqts IQ testis meSveobiT (ix. Tavi 10). monacemebis mixedviT, gamovlinda uaryofiTi korelacia stressa da verbalur gaazrebas Soris IQ testSi: saSualod, rac ufro maRalia stresis done am bavSvebis cxovrebaSi, miT uaresia maTi Sedegebi am parametris mixedviT (Plante & Sykora, 1994). rogorc xedavT, qronikuli stresis maRal dones mavne zegavlena aqvs bavSvebis kognitur aqtivobaze. es monacemebi imasac gvafiqrebinebs, rom stresis zogierTi mavne efeqti socialuri gadawyvetilebebiT unda ganeitraldes.

nebebsa da janmrTelobis problemebs Soris: rac ufro xSir da intensiur usiamovnebebs aRniSnavdnen adamianebi, miT uaresi iyo maTi fizikuri da fsiqikuri janmrTelobis mdgomareoba (Lazarus,1981; 1984b). yoveldRiuri usiamovnebebis klebas kargad yofnis gancdis gaZliereba mohyveba (Chamberlain & Zika, 1990). mkvlevrebma aCvenes, rom yoveldRiuri usiamovnebebi uaryofiT moqmedebas cxovrebis sakmaod adreuli etapebidan iwyeben.

saidan viciT
sabavSvo baRis aRsazrdelebis mier gancdili yoveldRiuri usiamovnebebi mkvlevrebma sTxoves sabavSvo baRis 74 aRsazrdels, aReweraT TavianTi yoveldRiuri usiamovnebebi. am informaciis mosapoveblad mkvlevrebi ekiTxebodnen bavSvebs, moxda Tu ara bolo erTi Tvis manZilze iseTi ram maT cxovrebaSi, rogoricaa `raRacis dakargva~, an `vinmeze gabrazeba~. mas Semdeg, rac ganisazRvra, moxda Tu ara TiToeuli es movlena, bavSvebs ekiTxebodnen, imoqmeda Tu ara maTze am movlenam cudad. ase rom, yoveldRiuri usiamovnebebis sazomSi aisaxeboda, Tu ramdenad ganicdida bavSvi TiToeuli am movlenisagan gamowveul stress. bavSvebze yoveldRiuri stresebis zegavlenis dasadgenad, mkvlevrebma sTxoves bavSvebis mSoblebs da aRmzrdelebs, daefiqsirebinaT, Tu ramdenad cudad iqceodnen bavSvebi. Sedegebma aCvena dadebiTi korelacia yoveldRiur usiamovnebebsa da qcevis problemebs Soris: saSualod, bavSvebi, romelTa cxovreba ufro metad iyo datvirTuli usiamovnebebiT, qcevaSi ufro met agresiasa da destruqcias avlendnen (Creasey et al.,1995). xSirad bavSvobas umankoebis xanad miviCnevT. Tumca, es gamokvleva aCvenebs, rom zogierTi bavSvi ukve ganicdis stresis garkveul dones, rac uaryofiT SedegebTanaa dakavSirebuli. stresorebis ganxilvisas fokusirebas, ZiriTadad, yoveldRiur usiamovnebebze vaxdendiT,

yoveldRiuri usiamovnebebi
dagveTanxmebiT, rom sayvarel adamianTan urTierTobis gawyvetas, miwisZvras an diskriminaciul crurwmenas namdvilad SeuZlia stresis gamowveva, magram ras ityviT ufro sust stresorebze, romlebsac yoveldRiurad ganicdiT? ra SegemTxvaT guSin? albaT, arc ganqorwindiT da arc avtokatastrofaSi sikvdils gadaurCiT. ufro savaraudoa, rom dagekargaT rveulebi, an saxelmZRvanelo. SesaZloa, dagagviandaT mniSvnelovan Sexvedraze an dagajarimes manqanis akrZalul adgilze dayenebisaTvis, an kidev, xmaurianma mezobelma Zili dagifrTxoT. es yvelaferi ganmeorebadi yoveldRiuri stresorebia, romlebsac adamianTa umetesoba TiTqmis mudmivad ganicdis. dRiurebis gamokvlevam, romelSic saSualo klasis warmomadgeneli saSualo asakis TeTrkaniani qalebi da mamakacebi iniSnavdnen dRis manZilze momxdar usiamovnebebs erTi wlis ganmavlobaSi (Zireul cxovrebiseul cvlilebaTa da fizikur simptomTa CanawerebTan erTad), gamoavlina sruliad aSkara kavSiri usiamov-

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Tavi 13 / emocia, stresi da janmrTeloba

magram isic unda iTqvas, rom mravali adamianisaTvis yoveldRiuri usiamovnebebi yoveldRiuri dadebiTi gancdebiT balansirdeba (Lazarus & Lazarus, 1994). dadebiTi da uaryofiTi gancdebis fardobiTi balansi SeiZleba gavlenas axdendes janmrTelobis mdgomareobaze. magaliTad, erTerT gamokvlevaSi 96 mamakacs pozitiuri da negatiuri movlenebis yoveldRiur angariSs sTxovdnen. am mamakacebs yoveldRiurad imunuri reaqciis siZlieresac umowmebdnen. Sedegebma aCvena, rom sasurveli cxovrebiseuli movlenebi kavSirSi iyo ufro Zlier imunur reaqciasTan, xolo arasasurveli movlenebi _ ufro sust reaqciasTan (Stone et al., 1994). amrigad, Tu gvinda cxovrebis Semdgomi mimdinareobis winaswarmetyveleba, yoveldRiur usiamovnebebis gaTvaliswineba araa sakmarisi; saWiroa, vicodeT is yoveldRiuri siamovnebebic, rasac cxovreba gvTavazobs. Cven ukve mimovixileT adamianTa cxovrebaSi stresis mravali wyaro. fsiqologebi sakmaod didi xnis winaTac xvdebodnen, rom am sxvadasxva tipis stresorTa gavlena, didwilad, damokidebulia imaze, Tu ramdenad efeqturad SeuZlia adamians, Tavi gaarTvas maT. axla ganvixiloT, ramdenad warmatebulad Tu warumateblad umklavdebian adamianebi stress.

cifikur intervenciebs. dabolos, ganvixilavT zogierT individualur gansxvavebas stresTan gamklavebis unarSi.

stresis Sefaseba
stresul situaciebTan gamklavebisas pirveli nabijia imis gansazRvra, Tu ramdenad stresulni arian isini sinamdvileSi. kognituri Sefaseba stresoris kognituri interpretacia da raodenobrivi Sefasebaa. kognituri Sefaseba centralur rols asrulebs situaciis gansazRvraSi: ras moiTxovs is Cemgan, ramdenad didia safrTxe, ra resursebs vflob masTan gasamklaveblad (Lazarus,1993; Lazarus & Lazarus, 1994). zogierTi iseTi stresori, rogoricaa, magaliTad, sxeulis dazianeba, sakuTari almodebuli saxlis naxva, TiTqmis yvelas mier ganicdeba, rogorc safrTxe, Tumca, bevri sxva stresori SesaZlebelia sxvadasxvagvarad ganisazRvros, imisda mixedviT, Tu rogoria Tqveni piradi cxovrebiseuli viTareba, konkretuli moTxovnis mimarTeba Tqvens ZiriTad miznebTan, moTxovnebTan gamklavebis SesaZleblobebi da sakuTari SesaZleblobebis Sefaseba. situacia, romelic mwvave distress iwvevs erT adamianSi, SeiZleba sruliadECveulebrivi ram iyos meorisaTvis. SeecadeT, miaqcioT yuradReba da gaiazroT cxovrebiseuli movlenebi, romlebsac gansxvavebulad xedavT Tqven da Tqveni megobrebi da ojaxis wevrebi: zogierTi situacia TqvenSi, magram ara Tqvens megobrebsa da ojaxis wevrebSi, stress iwvevs. sxva movlenebi maTSi iwvevs stress, TqvenSi ki ara. ratom? riCard lazarusi, romlis kognituri Sefasebis zogadi Teoria wavumZRvareT emociebis ganxilvas, moTxovnaTa kognitur SefasebaSi or stadias ganasxvavebs. pirveladi Sefaseba aRwers moTxovnis seriozulobis sawyis Sefasebas. es Sefaseba iwyeba kiTxvebiT: _ `ra xdeba?~ da `es CemTvis kargia, stresulia Tu CemTan araviTari kavSiri aqvs?~ Tu pasuxi meore kiTxvaze aris `stresulia~, Tqven afasebT stresoris potenciur zemoqmedebas da arkvevT, ziani ukve arsebobs, Tu is mxolod savaraudoa da saWiroa Tu ara qcevis ganxorcieleba (ix. cxrili 13.2). Tu gadawyvetT, rom raRac unda iRonoT, iwyeba meoradi Sefaseba. afasebT stresul viTarebasTan gasamklaveblad Tqvens xelT arsebul pirovnul da socialur resursebs da gansazRvravT saWiro

stresis daZleva
Tu cxovrebaSi stresebi gardauvalia da Tu qronikul stress SeuZlia cxovrebis dangreva da adamianis ganadgureba, aucilebelia, viswavloT stresis marTva. daZleva exeba garegan da Sinagan moTxovnebTan gamklavebis process, rodesac es moTxovnebi, individis aRqmis Tanaxmad, eWvqveS ayeneben, an aRematebian mis resursebs (Lazarus & Folkman, 1984). daZleva SeiZleba moicavdes qceviT, emociur an motivaciur reaqciebsa da azrebs. am qveTavs imis aRweriT daviwyebT, Tu rogor zemoqmedebs kognituri Sefaseba imaze, rac ganicdeba, rogorc stresori. Semdeg ganvixilavT daZlevis reaqciaTa tipebs; aRvwerT rogorc daZlevis zogad principebs, ise spedaZleva (Coping) _ im garegan da Sinagan moTxovnebTan gamklavebis procesi, romelic aRiqmeba, rogorc safrTxis, an muqaris Semcveli, an dauZleveli.

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stresi Tqvens cxovrebaSi

cxrili

13.2

mtkice gadawyvetilebis gamotanis/ kognituri Sefasebis safexurebi


safexuri
1. 2. gamowvevis Sefaseba alternativebis mimoxilva

sakvanZo kiTxvebi
riski seriozulia, Tuki ar Sevicvlebi? es alternativa misaRebi saSualebaa gamowvevasTan dasapirispireblad? sakmarisad ganvixile Cems xelT arsebuli alternativebi? romeli alternativaa saukeTeso? akmayofilebs saukeTeso alternativa arsebiT moTxovnebs? ganvaxorcielo saukeTeso alternativa da sxvebsac gavumxilo? riski seriozulia, Tuki ar Sevicvlebi? riski seriozulia, Tuki Sevicvlebi?

an fizikur stresorze. Tu karg fizikur formaSi xarT, maSin ukeT gaumklavdebiT stresors, vidre maSin, roca ar xarT karg formaSi. SegiZliaT naxoT, Tu ramdenad Seesabameba kognituri Sefaseba Semamsubuqebeli cvladis gansazRvrebasac. is, Tu rogor SeafasebT stresors, momavalSi gansazRvravs imas, Tu ra tipis daZlevis reaqciebis gamoyeneba dagWirdebaT. axla ganvixiloT daZlevis reaqciebis zogadi tipebi.

daZlevis reaqciaTa tipebi


warmoidgineT, rom mniSvnelovani gamocdis dro axlovdeba. Tqven ifiqreT amis Sesaxeb, SeafaseT situacia da sruliad darwmunebuli xarT, rom es stresuli situaciaa. risi gakeTeba SegiZliaT? mniSvnelovania imis aRniSvna, rom daZleva SeiZleba win uswrebdes potenciurad stresul movlenas anticipatoruli daZlevis formiT (Folkman, 1984). rogor unda gaumklavdeT mosalodneli gamocdiT gamowveul stress? rogor unda uTxraT mSoblebs, rom skolidan gagricxes, an Seyvarebuls, rom igi aRar giyvarT? stresuli situaciis anticipacia (anu winaswar warmosaxva) uamrav azrsa da grZnobas aRZravs, romelic Tavad SeiZleba iyos stresis gamomwvevi. ase xdeba intervius, sityviT gamosvlis, an ucnob adamianTan Sexvedrisas. saWiroa icodeT, rogor gaarTvaT Tavi stresul situacias. ganasxvaveben daZlevis or ZiriTad gzas imisda mixedviT, Tu ra aris mizani: problemasTan uSaulo dapirispireba _ problemaze mimarTuli daZleva Tu stresiT gamowveuli diskomfortis Semcireba _ emociaze fokusirebuli daZleva (Billings & Moos,1982; Lazarusrus & Folkman,1984). am ori ZiriTadi midgomis ramdenime qvekategoria mocemulia cxrilSi 13.3. daviwyoT problemaze mimarTuli daZleviT. `wavavloT xars rqebSi xeli,~ _ Cveulebriv, ase aRiwereba problemuri situaciisTvis mzadyofnis strategia. es midgoma moicavs yvela strategias, romelic gamiznulia stresorebTan Ria qceviT uSualod dasapirispireblad; aseve, problemis racionalurad gadaWris aqtivobebs. xuligans an gaumklavdebiT, an gaeqceviT; ecdebiT mis mosyidvas qrTamiT, an sxva ramiT; Tqven koncentrirdebiT gadasawyvet problemaze, an stresis gamomwvev faqtorze; Tqven acnobierebT,

3.

alternativebis awondawona

4.

fiqri valdebulebis aRebaze arCeul poziciaze myarad dgoma uaryofiTi ukukavSiris miuxedavad

5. 6.

Tavi 13 / emocia, stresi da janmrTeloba

moqmedebis SesaZleblobebs. Sefaseba grZeldeba manam, sanam xdeba gamklavebis reaqciebis mosinjva. Tu pirveli reaqciebi araefeqturia da stresi narCundeba, iwyeba axali reaqciebi da fasdeba maTi efeqturobac. kognituri Sefaseba stresis Semamsubuqebeli cvladis magaliTia. stresis Semamsubuqebeli cvladebi is cvladebia, romlebic cvlian stresoris zemoqmedebas konkretuli tipis stresul reaqciaze. Semamsubuqebeli cvladebi filtravs, an saxes ucvlis stresorebis Cveul zemoqmedebas individis reaqciebze. magaliTad, Tqveni daRlilobis done da zogadi janmrTelobis statusi Semamsubuqebeli cvladebia, romlebic gavlenas axdenen imaze, Tu rogori iqneba Tqveni reaqcia mocemul fsiqologiur
stresis Semamsubuqebeli cvladebi (Stress moderator variables) _ cvladebi, romlebic cvlian mimarTebas stresorsa da mocemuli tipis stresul reaqcias Soris. anticipatoruli daZleva (Anticipatory coping) _ potenciurad saSiS movlenamde ganxorcielebuli mcdelobebi, gadailaxos, Semcirdes, an asatani gaxdes Seusabamoba aRqmul moTxovnebsa da xelT arsebul resursebs Soris.

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cxrili

13.3
daZlevis strategiebis taqsonomia
magaliTi

daZlevis strategiis tipi


problemaze mimarTuli daZleva stresoris Secvla, an misdami sakuTari damokidebulebis Secvla uSualo moqmedebebiT an/da problemis gadaWris aqtivobebiT

brZola (safrTxis ganadgureba, moSoreba, an Sesusteba)gaqceva (safrTxisgan distancireba)brZolisa Tu gaqcevis variantebis SerCvea (molaparakeba, garigeba, kompromisi)momavali stresis prevencia (sakuTari winaaRmdegobis gawevis unaris gazrda, an anticipirebuli stresoris Zalis Semcireba).

emociaze mimarTuli daZleva me-s cvlileba imgvari moqmedebebiT, romlebic ukeT agrZnobinebs adamians Tavs stresoris cvlilebis gareSe. somatikaze mimarTuli aqtivobebi (SfoTvis sawinaaRmdego medikamentebis, relaqsaciis, bio-ukukavSiris gamoyeneba)kognitur sferoze mimarTuli aqtivobebi (dagegmili garTobebi, fantaziebi, fiqrebi sakuTar Tavze)Terapia damatebiTi SiSis gamomwvevi cnobieri, an aracnobieri procesebis dasaregulireblad.

rom saWiroa moqmedeba, afasebT situacias da sakuTar resursebs da axorcielebT reaqcias, romelic adekvaturia muqaris gasaneitraleblad an Sesamcireblad. problemis gadaWris amgvari mcdelobebi sasargebloa kontrolirebadi stresorebis, anu stresorebis samarTavad, romelTa Secvla, an Semcireba SesaZlebelia aseTi moqmedebiT. aseTi stresorebis magaliTebia avtoritaruli ufrosi, an aradamakmayofilebeli niSnebi. emociaze fokusirebuli midgoma ukeTesia arakontrolirebadi stresorebis zegavlenis samarTavad. davuSvaT, pasuxismgebeli xarT alcheimeriT daavadebuli mSoblis movlaze. msgavs situaciaSi ar arsebobs `xuligani~, romlis garemodan mocilebasac SeZlebdiT; Tqven ver geqnebaT garegani stresuli situaciis Secvlis gzebis povnis SesaZlebloba. amis nacvlad SeecdebiT, SecvaloT Tqveni grZnobebi da azrebi mis Sesaxeb imiT, rom alcheimeriT daavadebulebze mzrunvelTa mxardaWeris jgufebSi gaerTiandebiT, an relaqsaciis teqnikas daeuflebiT. es midgoma isev daZlevis strategias ganekuTvneba, radgan acnobierebT, rom Tqvens kargad yofnas safrTxe emuqreba da am safrTxis Semcirebas cdilobT. daZleva aris viTareba, romelSic, rac ufro met gansxvavebul strategias flobT, miT ukeTesia (Taylor & Clark, 1986). daZleva rom warmatebuli iyos, Tqveni resursebi aRqmul moTxovnas unda Seesabamebodes. amrigad, daZlevis mravalfe-

rovani strategiebis floba adapturia, radgan, savaraudod, ufro advilad moaxerxebT am Sesabamisobis miRwevas da stresul movlenasTan gamklavebas. metic, imis codna, rom daZlevis sxvadasxvagvar strategiebs flobT, dagexmarebaT, gazardoT TqvenSi realuri unari, daakmayofiloT garemodan wamosuli moTxovnebi (Bandura,1986). TviTdarwmunebas mravali stresoris Zlieri zegavlenisagan SeuZlia Tqveni dacva, radgan rwmena imisa, rom mzadyofnaSi gaqvT daZlevis resursebi, aRkveTs stresul, qaotur reaqcias: _ `ra gavakeTo?!~ aqamde Cven stresorebis daZlevisadmi zogad midgomebs ganvixilavdiT, axla ki warmatebuli daZlevis specifikur kognitur da socialur midgomebs gavecnobiT.

kognituri strategiebis modificireba


stresTan adaptaciis Zlieri saSualeba stresorebis Tqveneuli Sefasebebisa da maTi daZlevis Sesaxeb TavdacviTi kogniciebis Secvlaa. Tqven sxvagvarad unda gaiazroT mocemuli situacia, Tqveni roli masSi da is kauzaluri atribuciebi, romlebsac arasasurveli Sedegis asaxsnelad akeTebT. stresis fsiqikuri daZlevis ori gza arsebobs: sakuTriv stresorTa bunebis gadafaseba da stresze sakuTar reaqciaTa Sesaxeb codnis restruqturireba. Cven ukve visaubreT imis Sesaxeb, rom adamianebi maT cxovrebaSi stresis gancdas, nawistresi Tqvens cxovrebaSi

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lobriv, cxovrebiseuli movlenebis Sefasebis Sesabamisad akontroleben (Lazarus & Lazarus, 1994). garkveuli stresorebis Sesaxeb gansxvavebulad fiqris swavla, maTTvis saxelis Secvla, an maTi warmosaxva naklebad saSiS (an, Tundac, sasacilo) konteqstSi warmoadgens kognituri gadafasebis formas, rasac stresis Semcireba SeuZlia. RelavT imis gamo, rom sityviT unda gamoxvideT didi, mkacri auditoriis winaSe? stresoris gadafasebis erT-erTi teqnika aseTia: _ warmoidgineT, rom Tqveni potenciuri kritikosebi darbazSi SiSvlebi sxedan, rac namdvilad Seamcirebs maT SiSismomgvrel Zalas. SfoTavT imis gamo, rom morcxvobas ver daZlevT wveulebaze, romelsac aucileblad unda daeswroT? xom ar mogeZebnaT vinme Tqvenze metad morcxvi da saubris dawyebiT simorcxvis daZlevaSi daxmarebodiT? Tqven, aseve, SegiZliaT stresis marTva imiT, rom SecvaloT is, rasac sakuTar Tavs eubnebiT mis Sesaxeb da SecvaloT masTan mopyrobis xerxi. kognitur-bihevioristma fsiqoTerapevtma donald maiCenbaumma (Donald Meichenbaum, 1977,1985,1993) SemogvTavaza samfaziani procesi, romelic amgvar stresis inokulacias (acras) iTvaliswinebs. I fazaSi adamianebi sakuTari realuri qcevis ukeT gacnobierebas cdiloben: ra iwvevs mas da ra

Tavi 13 / emocia, stresi da janmrTeloba

Sedegebi moaqvs. amis gakeTebis saukeTeso xerxi yoveldRiuri Canawerebis warmoebaa. es Canawerebi adamianebs sakuTari problemebis mizezebisa da Sedegebis terminebiT axlebur gaazrebaSi exmareba da aZliereben maTi kontrolis gancdas. SeiZleba aRmoaCinoT, magaliTad, rom Tqveni niSnebi cudia (stresori), radgan yovelTvis cota dros itovebT davalebis kargad Sesasruleblad; II fazaSi adamianebi axali qcevebis identificirebas iwyeben, romlebic aRkveTen araadaptaciur, TviTdestruqciul qcevebs. albaT, fiqsirebuli `samecadino dro~ unda gamoyoT, an Ramis satelefono zarebi 10 wuTamde daiyvanoT; III fazaSi, adapturi qcevebis ganxorcielebis Semdeg, individebi afaseben TavianTi axali qcevis Sedegebs, aqamde ganxorcielebuli damakninebeli Sinagani dialogis gareSe. nacvlad imisa, rom uTxran sakuTar Tavs: `gamimarTla, rom profesorma swored maSin gamiZaxa, roca teqsti wakiTxuli mqonda~, isini amboben: `mixaria, rom momzadebuli viyavi profesoris SekiTxvisaTvis. araCveulebrivia, rodesac mas Wkvianurad SegiZlia upasuxo~. es samfaziani midgoma reaqciebisa da sakuTari Tavis Sesaxeb gamonaTqvamebis inicirebas gulisxmobs, romlebic SeuTavsebelia aqamde ganxorcielebul damakninebel azrebTan. am gzis arCevis Semdeg adamianebi acnobiereben, rom icvlebian da mxolod sakuTar Tavs unda umadlodnen am cvlilebas, romelic momavali warmatebebis sawindaria. 13.4 cxrilSi mocemulia sakuTari Tavis Sesaxeb axali tipis gamonaTqvamebis magaliTebi, romlebic stresul situaciebTan gamklavebaSi gvexmareba. stresis inokulaciis treningi warmatebiT gamoiyeneba sxvadasxva sferoSi.

saidan viciT
stresis inokulaciis treningi tkivilis samarTavad am gamokvlevaSi monawileoba 60 sportsmenma mamakacma miiRo, romelTac sportuli travmis gamo muxlis qirurgiuli operacia CautardaT. sportsmenTa naxevari samkurnalo jgufSi moxvda, sadac reabi-

cxrili

13.4

sakuTari Tavisadmi mimarTvis magaliTebi, romlebic xels uwyoben stresis daZlevas


momzadeba me SemiZlia SevimuSavo misi daZlevis gegma. ubralod mosafiqrebelia, ra SemiZlia gavakeTo amisaTvis. es nerviulobaze ukeTesi gamosavalia. ar aris saWiro uaryofiTi mimarTva sakuTari Tavisadmi, iazrovne racionalurad. konfrontacia erTbaSad erTi nabiji; me SemiZlia am situaciis marTva. es SfoTva aris is, rasac eqimi miwinaswarmetyvelebda. es aris Sexseneba Cemi daZlevis meqanizmebis gasavarjiSeblad. dawynardi; Tavs vakontroleb, nela, Rrmad isunTqe. daZleva rodesac SiSi geufleba, Seisvene. yuradReba awmyoze SeaCere, ra maqvs gasakeTebeli? nu ecdebi SiSis mTlianad gaqrobas, SeinarCune marTvad doneze. amaze uaresic SeiZleboda momxdariyo. ubralod, sxva rameze ifiqre. TviTganmtkiceba gamomivida, me SevZeli amis gakeTeba. iseTi cudic ar yofila, rogorsac movelodi. marTla kmayofili var Cemi miRwevebiT.

litaciis Cveulebriv programas stresis inokulaciis treningi daemata. treningi fokusirebuli iyo gamojanmrTelebis periodis SfoTvisa da tkivilis saxeobebze da xels uwyobda mamakacebs zemoT aRwerili kognituri restruqturizaciis teqnikebis gamoyenebaSi. danarCenma ocdaaTma mamakacma mxolod reabilitaciis standartuli kursi gaiara. samocive monawiles sTxoves, moewodebinaT tkivilis gancdis subieqturi Sefasebebi mkurnalobis dawyebamde da Semdeg aTive fizioTerapiuli sesiis win. miuxedavad imisa, rom samkurnalo da sakontrolo jgufebi didad ar gansxvavdebodnen erTmaneTisgan mkurnalobis dawyebamde an pirveli testuri sesiis dros, danarCeni cxra Terapiuli sesiis ganmavlobaSi inokulaciis jgufis cdis pirebi gacilebiT nakleb tkivils aRniSnavdnen, vidre sakontrolo jgufis cdis pirebi (Ross & Berger,1996).

me-4 Tavidan, albaT, gaxsovT, rogor aris tkivilis gancda ganpirobebuli rogorc fiziologiuri, ise fsiqologiuri faqtorebiT. gankurnebis procesSi myof sportsmenebze Catarebuli qvemoT mocemuli eqsperimenti gviCvenebs, Tu rogor SeiZleba daZlevis teqnikebis gamoyeneba tkivilis fsiqologiuri komponentebis zogierTi aspeqtis gasakontroleblad. warmatebuli daZlevis kidev erTi ZiriTadi komponentia Tqven mier stresorze gacnobierebuli kontrolis daweseba, rwmena imisa, rom SegiZliaT cvlilebis Setana romelime movlenis, an gancdis msvlelobaSi (Vaughan, 1993). Tu gjeraT, rom SegiZliaT daavadebis mimdinareobaze, an daavadebis yoveldRiur simptomebze zemoqmedeba, albaT, kargad axerxebT am daavadebasTan gamklavebas (Affleck et al., 1987), magram Tu fiqrobT, rom stresis wyaro meore pirovnebaa, romlis qcevaze gavlenas ver axdenT, an situaciaa, romelsac ver SecvliT, izrdeba imis albaToba, rom am qronikul viTarebas fsiqologiurad ver gaumklavdebiT (Bulman & Wortman, 1977). individebi, romelTac SeuZliaT stresis cnobieri kontroli iseTi fataluri daavadebis SemTxvevaSic ki, rogoric Sidsia, amiT TavianT fsiqikur da fizikur janmrTelobas argeben (Thompson et al., 1994). sanam samomavloT gamoyenebad kontrolis am strategiebs daimaxsovrebT, stresis daZlevis bolo aspeqti _ socialuri ganzomileba ganvixiloT.

socialuri mxardaWera, rogorc stresis daZlevis resursi


socialuri mxardaWera sxvebisTvis gaweuli daxmarebaa, romelic amcnobs adamians, rom igi uyvarT, masze zrunaven, afaseben da rom igi sxva adamianebTan urTierTobisa da urTierTvaldebulebebis qselSia CarTuli (Cohen & Syme, 1985).Dsocioemociuri mxardaWeris am formebis garda garSemomyof adamianebs SeuZliaT materialuri (fuli, transporti, bina) da informaciuli mxardaWeris (rCeva, pirovnuli
gacnobierebuli kontroli (Perceived control) _ pirovnebis rwmena, rom SeuZlia movlenis, an gancdis msvlelobis, an Sedegebis Secvla; xSirad sasargebloa stresorebTan gamklavebisas.

stresi Tqvens cxovrebaSi

535

arakatastrofuli qronikulad daavadebuli pacientebi kiboTi daavadebuli pacienebi

socialuri daxmarebis

yvelaze efeqturi

60 50 40

mkvlevrebi cdiloben imis dadgenas, Tu ra tipis mxardaWeraa yvelaze sasargeblo sxvadasxva specifikuri movlenis dros (Helgeson & Cohen,1996; Kuijer et al., 2000).

30 20 10 0 emociuri informaciuli materialuri

saidan viciT
mxardaWeris tipi

mxardaWeris wyaroebisa da tipebis urTierTSedareba Seli teilori kolegebTan erTad Seiswavlida sxvadasxva tipis socialuri mxardaWeris efeqturobas kiboTi daavadebulebTan (Dakof & Taylor, 1990; Taylor, 1986). avadmyofebi gansxvavebulad afasebdnen sxvadasxva saxis mxardaWeris sargeblianobas. isini sasargeblod Tvlidnen mxolod meuRleebis, da ara eqimebis, an momvlelebis `gverdiT yofnas~. meore mxriv, avadmyofebisTvis mniSvnelovani iyo informaciis an rCevis miReba kiboTi daavadebuli sxva pacientebisagan, an eqimebisagan da ara -_ ojaxisgan da megobrebisagan. ganurCevlad imisa, Tu visgan _ iqnebodnen es eqimebi, megobrebi Tu ojaxis wevrebi _ modioda Tavsmoxveuli naZaladevi xalisi da daavadebis simZimis daknineba, avadmyofebi Tvlidnen, rom maT es arafers argebda.

suraTi

13.10

socialuri mxardaWeris Rirebuleba


aRqmuli socialuri mxardaWera, rogorc diagnozis funqcia (Martin, et. al., 1994, kiboTi daavadebuli pacientebis monacemebi aRebulia Dakof&Taylor, 1990).

Tavi 13 / emocia, stresi da janmrTeloba

ukukavSiri, informacia) uzrunvelyofa. nebismieri adamiani, visTanac gaqvT mniSvnelovani socialuri urTierToba _ iqneba es ojaxis wevri, megobari, TanamSromeli Tu mezobeli _ SesaZloa, saWiroebis SemTxvevaSi, Tqveni socialuri mxardaWeris qselis nawili iyos. mravali gamokvleva miuTiTebs stresisadmi mowyvladobis SemcirebaSi socialuri mxardaWeris Zalaze (Cohen & McKay, 1983). rodesac adamianebs hyavT xalxi, visac SeuZliaT mimarTon, isini ukeT axerxeben rogorc sakuTar yoveldRiur problemebTan, ise samsaxurebriv stresebTan, umuSevrobasTan, ojaxis rRvevasTan, seriozul daavadebebTan da sxva katastrofebTan gamklavebas (Gottlieb, 1981; Pilisuk & Parks, 1986). socialuri mxardaWeris pozitiuri efeqtebi scildeba stresuli movlenebis daregulirebas; maT SeuZliaT diagnostirebuli daavadebisagan gankurnebis gaumjobeseba da daavadebiT gamowveuli sikvdilis riskis Semcireba (House et al.,1988 Kulik & Mahler, 1989). erT-erT gamokvlevaSi Tirkmlis mZime daavadebis mqone avadmyofTa sikvdilianobis koeficienti Seiswavleboda (Christensen et al., 1994). miRebuli Sedegebis mixedviT, ojaxis mxardaWeris sazomze miRebuli qulis erTi erTeuliT mateba sikvdilis albaTobis 13%-ian klebas ukavSirdeba.Q
socialuri mxardaWera ( Social support) _ sxva adamianebis mier pirovnebisTvis stresTan gamklavebis mizniT gaweuli materialuri, socioemociuri da informaciuli mxardaWera.

536

13.10 suraTze mocemulia socialuri mxardaWeris tipebis Sedareba efeqturobis mixedviT kibos da iseTi arakatastrofuli daavadebebis mqone pacientebTan, rogoricaa: qronikuli Tavis tkivili an gaRizianebuli kuW-nawlavis sindromi (Martini et al., 1994). monacemebi kidev erTxel mowmobs, rom socialuri mxardaWeris optimaluri tipi stresis sxvadasxva wyarosTvis gansxvavebulia. SegiZliaT moifiqroT mizezebi, Tu ratom unda iyos emociuri mxardaWera ufro sasargeblo kiboTi daavadebulTaTvis, vidre arc ise mZime daavadebebis mqone avadmyofebisaTvis? mkvlevrebi, agreTve, cdiloben gansazRvron, Tu rodis iwveven mxardaWeris wyaroebi realurad SfoTvis gazrdas. magaliTad, Tu vinme daJinebiT gTavazobT eqimTan daniSnul Sexvedraze an kolejSi gasaubrebaze wamoyolas maSin, roca

Tqven marto wasvla girCevniaT, amis gamo SeiZleba damatebiTi SfoTva ganicadoT (Coyne et al., 1988); aseve, mZime daavadebis mqone avadmyofebma, SesaZloa, ver gaamarTlon maT socialur wreSi Semavali adamianebis molodinebi.

saidan viciT
molodinebi da qronikul daavadebasTan adaptacia mkvlevrebi amowmebdnen, Tu ra gavlenas axdens avadmyofebis mier garSemomyof adamianTa molodinebis aRqma daavadebasTan maT adaptaciaze. avadmyofebs Tirkmlebis daavadebis bolo stadia hqondaT, yvelas sWirdeboda dializi. mkvlevrebi sTxovdnen maT, rom skalaze (`srulebiT ar veTanxmebi~-dan `srulebiT veTanxmebi~-mde) SeefasebinaT iseTi debulebebi, rogoricaa, magaliTad, `xandaxan vgrZnob, rom Cemi ojaxi da megobrebi moelian Cemgan, rom gacilebiT ukeT moverevi Cems daavadebas, vidre es realurad SemiZlia~ da `zogjer vfiqrob, rom Cemi ojaxi da megobrebi moelian Cemgan sakuTar mkurnalobaze meti pasuxismgeblobis aRebas, vidre es realurad SemiZlia~. mkvlevrebi, aseve, zomavdnen, Tu ramdenad kargad axerxebdnen pacientebi avadmyofobis daZlevas. Sedegebma aCvena Zlieri dadebiTi korelacia molodinebsa da distresis xarisxs Soris. magaliTad, pacientebTan, romlebic sakuTari ojaxisa da megobrebis molodinebs aRiqvamdnen, rogorc gadaWarbebuls, ufro mosalodneli iyo Civili depresiisa da cxovrebis dabali xarisxis Sesaxeb (Hatchett et al.,1997).

saWiroebis SemTxvevaSi sxvebi Tqvens gverdiT aRmoCndebian maSinac ki, Tu stresis gancdisas faqtobrivad arc ki mimarTavT maT daxmarebisaTvis. erT-erTi yvelaze mniSvnelovani Setyobineba `fsiqologia da cxovrebidan~ isaa, rom yovelTvis unda imuSaoT, rogorc socialuri mxardaWeris qselis Semadgenelma rgolma da arasodes misceT Tavs ufleba, iyoT socialurad izolirebuli. stresze msjelobisas Cven araerTxel aRvniSneT stresis gavlena fizikur da fsiqologiur keTildReobaze. axla uSualod ganvixilavT, Tu rogor iyeneben fsiqologebi avadmyofobisa da janmrTelobis sakiTxebis Sesaxeb gamokvlevebiT miRebul codnas.

Sejameba
stress iwvevs stresorebi _ stimulebi, romlebic organizmisagan garkveul reaqcias moiTxoven. stresi iwvevs fiziologiur pasuxebs, romlebic amzadeben organizms moqmedebisaTvis. rodesac amgvari pasuxebi zedmetia, safrTxe eqmneba imunur sistemas, ramac SesaZloa gamoiwvios fsiqosomaturi daavadebebi. sxvadasxva saxis stresors, rogoricaa: cxovrebiseuli cvlilebebi, yoveldRiuri usiamovnebebi, matravmirebeli movlenebi, sxvadasxva saxis fsiqologiuri efeqti aqvs. stresis daZleva xSirad maSin iwyeba, rodesac adamianebi moTxovnis gansazRvris mizniT afaseben situacias. safrTxis mimarT adamianebi iyeneben stresis daZlevis problemaze orientirebul, an emociaze orientirebul gzebs. maT, aseve, SeuZliaT, stresTan gamklaveba stresoris xelaxali SefasebiT, an stresze reaqciebis Sesaxeb codnis restruqturizaciiT. stresis inokulaciis (acris) treningi kogniciaTa restruqturizaciis erT-erTi programaa. adamianebi ukeTesad axerxeben stresis daZlevas, rodesac grZnoben, rom akontroleben situacias. socialuri mxardaWera saukeTesoa maSin, rodesac is individis moTxovnebs Tanxvdeba. socialuri interaqcia, SesaZloa, uaryofiTi iyos, rodesac adamianebi grZnoben, rom maT ar SeuZliaT arsebuli molodinebis gamarTleba.

rogorc Cans, pacientebis megobrebi da ojaxis wevrebi yvelafers akeTebdnen maTTvis mxardaWeris uzrunvelsayofad, Tumca, maTi molodinebi pacientebisadmi zrdida am ukanasknelTa distress. efeqturi socialuri mxardaWeris qselis nawilad yofna niSnavs Tqvens rwmenas, rom

537

stresi Tqvens cxovrebaSi

janmrTelobis fsiqologia
ra wvlili SeaqvT fsiqikur procesebs cudad da kargad yofnis gancdaSi? Cven ukve warmogidgineT sakmarisi sabuTi imisa, rom pasuxi am kiTxvaze aris: _ `sakmaod didi~. janmrTelobisaTvis fsiqologiuri da socialuri faqtorebis mniSvnelobis aRiarebam xeli Seuwyo axali sferos _ janmrTelobis fsiqologiis _ ganviTarebas. janmrTelobis fsiqologia fsiqologiis dargia, romelic mowodebulia imis dasadgenad, Tu rogor inarCuneben adamianebi janmrTelobas; ratom xdebian isini avad da rogor reagireben avadmyofobaze (Taylor, 1986,1990). janmrTeloba gulismobs sxeulisa da gonebis zogad mdgomareobas, romelic aRiwereba siZlierisa da energiulobis terminebiT. es ar aris ubralod daavadebis an dazianebis ararseboba, aramed am SemTxvevaSi saqme imas ufro exeba, Tu ramdenad kargad funqcionireben sxeulis Semadgeneli nawilebi erTad. janmrTelobis fsiqologiis Sesaxeb msjelobas daviwyebT imis aRweriT, Tu rogor scildeba avadmyofobis tradiciul dasavlur models is filosofiuri mimdinareoba, romelic safuZvlad udevs mocemul sferos. Semdeg ganvixilavT janmrTelobis fsiqologiis wvlils daavadebisa da disfunqciis prevenciasa da mkurnalobaSi.

Tavi 13 / emocia, stresi da janmrTeloba

janmrTelobis biofsiqosocialuri modeli


janmrTelobis fsiqologia janmrTelobis biofsiqosocialuri modeliT xelmZRvanelobs. am midgomis safuZvlebs mraval aradasavlur kulturaSi vxvdebiT. sanam biofsiqosocialuri modelis gansazRvrebas CamovayalibebdeT, ganvixiloT zogierTi aradasavluri tradicia.

xarisxis gaumjobesebisaTvis. winamdebare Tavi venesuelis varaos kulturisTvis damaxasiaTebeli gankurnebis ritualis magaliTiT daviwyeT. rogorc aRvwereT, mkurnali mowveuli iyo avadmyofi biWis sxeulSi Casaxlebuli sulebis gansadevnad. mkurnalma Seasrula tradiciuli gankurnebis ceremonia. mSoblebma biWis gamojanmrTeleba mkurnalis moqmedebebs miaweres (Briggs,1996). msgavsi rwmenis arsebobas SeiZleba sxva kulturebSic SexvdeT. magaliTad, navajoSi daavadebas, avadmyofobasa da kargad yofnas socialur harmonias da gonebasa da sxeuls Soris urTierTqmedebebs miawerdnen. huazos cneba navajoSi niSnavs harmonias, sulier simSvides, saTnoebas, idealur ojaxur urTierTobebs, mSvenierebas xelovnebasa da xelobaSi, sxeulisa da sulis sijansaRes. avadmyofoba ganixileba, rogorc borotebiT gamowveuli nebismieri disharmoniis Sedegi, romelic isadgurebs adamianSi tabus darRvevis, jadoqrobis, zedmeti damyolobis, boroti ocnebebis gamo. tradiciuli gankurnebis ceremonia gulisxmobs avadmyofobis gandevnasa da janmrTelobis aRdgenas ara marto Samanis mkurnalobiT, aramed ojaxis yvela wevris erToblivi ZalisxmeviT, romlebic avadmyofTan erTad cdiloben huazos mdgomareobis dabrunebas. tomis nebismieri wevri avadmyofobas miiCnevs ara avadmyofis pirad pasuxismgeblobad (da danaSaulad), aramed ganixilavs, rogorc ufro zogadi disharmoniis niSans, romelic unda aRikveTos Temuri gankurnebis ritualebiT. es kulturuli orientacia garantias iZleva, rom Zlieri socialuri mxardaWeris qseli avtomaturad daexmareba pacients.
janmrTelobis fsiqologia (Health psychology ) _ fsiqologiis dargi, romelic mowodebulia imis dasadgenad, Tu rogor inarCuneben adamianebi janmrTelobas, ratom xdebian isini avad da rogor reagireben avadmyofobaze. janmrTeloba (Health) _ sxeulisa da gonebis zogadi mdgomareoba, romelic aRiwereba simtkicisa da energiulobis terminebiT. es ar aris ubralod daavadebis, an dazianebis ararseboba. huazo (Hozho) _ navajos (Navajo) kulturaSi arsebuli cneba, romelic niSnavs harmonias, sulier simSvides, saTnoebas, idealur ojaxur urTierTobebs, mSvenierebas xelovnebasa da xelobaSi da sxeulisa da sulis sijansaRes.

janmrTelobis dacvis tradiciuli praqtika


fsiqologiuri principebi avadmyofobis mkurnalobasa da janmrTelobis SenarCunebaSi yvela droSi gamoiyeneboda. bevr kulturaSi esmiT sazogadoebrivi janmrTelobisa da relaqsaciis ritualebis mniSvneloba cxovrebis

538

fsiqologi janmrTelobas ganixilavs, rogorc dinamikur mravalganzomilebian movlenas. optimaluri janmrTeloba, anu kargad yofna (wellness) moicavs Tqveni cxovrebis fizikur, inteleqtualur, emociur, sulier, socialur da garemos aspeqtebs. rodesac daavadebis prevenciis, an adreul etapze misi gamovlenis mizniT garkveul qmedebebs axorcielebT, Tqven janmrTelobis sakeTildReod iqceviT. janmrTelobis fsiqologiis zogad mizans warmoadgens fsiqologiuri codnis gamoyeneba kargad yofnasa da janmrTelobasTan dakavSirebuli pozitiuri qcevis xelSewyobisaTvis. ganvixiloT aRniSnul mizanTan dakavSirebuli Teoriebi da kvlevebi.

janmrTelobis profilaqtika
biofsiqosocialuri modelisken
Cven axlaxan vnaxeT, rom aradasavlur kulturebSi gankurnebis praqtika xSirad sxeulsa da gonebas Soris kavSiris arsebobas gulisxmobs. amis sapirispirod, Tanamedrove mecnieruli azrovneba, ZiriTadad, biosamedicino models eyrdnoba, romelic sxeulisa da gonebis dualisturi koncefciiT xelmZRvanelobs. am modelis Tanaxmad, medicina fizikur sxeuls sulisagan damoukideblad mkurnalobs. goneba mniSvnelovania mxolod emociebisa da rwmenebisaTvis da cota ram Tu SeuZlia gaakeTos sxeulis realobisaTvis; Tumca, droTa ganmavlobaSi mecnierebma daiwyes urTierTqmedebaTa tipebis aRnusxva, romelTa SemTxvevaSic ar muSaobs xisti biosamedicino modeli. Tqven ukve naxeT zogierTi maTgani: karg da cud cxovrebiseul movlenebs SeuZliaT gavlena moaxdinon imunuri sistemis funqcionirebaze; adamianebi metnaklebad moqnilebi arian stresis uaryofiT SedegebTan mimarTebaSi; adekvaturma socialurma mxardaWeram SeiZleba Seamciros sikvdilis albaToba. amgvari gaazrebis Sedegad Camoyalibda biofsiqosocialuri modelis sami komponenti: `bio~ miuTiTebs biologiuri avadmyofobis realur arsebobaze, `fsiqo~ da `socialuri~ ki _ janmrTelobis fsiqologiur da socialur komponentebze. biofsiqosocialuri modeli fizikur janmrTelobas gonebis mdgomareobasa da garemomcvel samyarosTan akavSirebs. janmrTelobis cneba janmrTelobis profilaqtika niSnavs zogadi strategiebisa da konkretuli taqtikis ganviTarebas, romelic miznad isaxavs adamianTa avad gaxdomis riskis gamoricxvas, an Semcirebas. XXI saukuneSi avadmyofobis prevencia XX saukunis dasawyisisgan gansxvavebul amocanebs ayenebs (Matarazzo, 1984). 1900-ian wlebSi sikvdilis upirveles mizezs infeqciuri daavadebebi warmoadgenda. am periodSi praqtikosma eqimebma wamoiwyes pirveli revolucia amerikul sazogadoebrivi janmrTelobis dacvis sistemaSi. kvlevebis, sazogadoebrivi ganaTlebis, vaqcinebis ganviTarebisa da sazogadoebrivi janmrTelobis standartebis cvlilebebis (rogoricaa narCenebis kontroli da kanalizacia) saSualebiT maT TandaTanobiT SeZles sikvdilianobis
biofsiqosocialuri modeli (Biopsychosocial model) _ janmrTelobisa da avadmyofobis modeli, romlis mixedviT, nervuli sistemis, imunuri sistemis, qceviTi stilis, kognituri procesebisa da garemo faqtorebis urTierTkavSirma SeiZleba adamiani avad gaxdomis riskis winaSe daayenos. kargad yofna (Wellness) _ optimaluri janmrTeloba, romelic aerTianebs fizikur, inteleqtualur, emociur, sulier, socialur da garemos sxvadasxva sferoSi sruli da aqtiuri funqcionirebis unars. janmrTelobis profilaqtika (Health promotion) _ zogadi strategiebisa da konkretuli taqtikis ganviTareba, romelic miznad isaxavs adamianTa avad gaxdomis riskis gamoricxvas, an Semcirebas.

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cxrili

13.5

sikvdilis ZiriTadi mizezebi aSS-Si, 1998 weli


rangi sikvdilianobis procenti 31.0 23.2 6.8 4.8 4.2 1.9 3.9 2.8 1.3 1.1 1.1 sikvdilis mizezi sikvdilis mizezebis xelSemwyobi faqtorebi DS DS DS S A A S D A A

1 2 3 4 5

6 7 8 9 10

gulis daavadeba kibo dambla filtvebis obstruqciuli daavadebebi yvela saxis ubeduri SemTxveva mxolod avtoavariebi pnevmonia da gripi diabeti TviTmkvleloba Tirkmlebis daavadebebi RviZlis qronikuli daavadeba da cirozi

* D=kveba; S =moweva; A =alkoholi

didi raodenobiT miReba, mgzavroba usafrTxoebis Rvedebis gareSe, stresebiT savse cxovreba _ yvelaferi es garkveul rols asrulebs iseTi daavadebebis CamoyalibebaSi, rogorebicaa: kibo, gulis daavadebebi, dambla, agreTve, ubeduri SemTxvevebisa da TviTmkvlelobebisas. civilizaciis aRniSnul daavadebebTan dakavSirebuli qcevebis SecvliT mravali daavadebisa da naadrevi sikvdilis prevencia gaxdeba SesaZlebeli. am codnaze dayrdnobiT advilia garkveuli rekomendaciebis mocema, magram ufro sasurvelia, rom janmrTeloba iseTi kargi Cvevebis SemuSavebiT SeinarCunoT, romlebic CamoTvlilia 13.6 cxrilSi. bevri maTgani, albaT, ukve nacnobia TqvenTvis. miuxedavad amisa, janmrTelobis fsiqologebi gamoiyeneben fsiqologiur principebs imis albaTobis gasazrdelad, rom Tqven marTla gaakeTebT imas, rac TqvenTvis kargia. amis demonstrirebis mizniT axla ganvixiloT ori konkretuli Tema: moweva da Sidsi.

mniSvnelovnad Semcireba iseTi daavadebebis SemTxvevaSi, rogoricaa: gripi, tuberkulozi, poliomieliti, wiTela da yvavili. Tu mkvlevrebs cxovrebis xarisxis gaumjobesebSi surT wvlilis Setana, cxovrebis stilTan dakavSirebuli faqtorebiT gamowveuli sikvdilianobis Semcirebas unda ecadon (ix. cxrili 13.5). sigaretis moweva, Warbi wona, cximisa da qolesterinis didi raodenobiT Semcveli sakvebisa da alkoholiani sasmelebis
Tavi 13 / emocia, stresi da janmrTeloba

moweva
SeuZlebelia imis warmodgena, rom nebismierma, vinc ki waikiTxa es wigni, ar icoda, rom Tambaqos moweva Zalian saxifaToa. yovelwliurad daaxloebiT 400 000 adamiani kvdeba mowevasTan dakavSirebuli daavadebebiT. aSS-Si yovelwliurad kiboTi gardacvalebis SemTxvevaTa 30%ze meti swored Tambaqos moxmarebiTaa gamowveuli (Skaar et al., 1997). miuxedavad amisa, 60 milioni adamiani aSS-Si jer kidev mwevelia. mwevelTa 70% ambobs, rom surs mowevisTvis Tavis danebeba, magram ver axerxebs (daavadebaTa kontrolisa da prevenciis centri, 1997). janmrTelobis fsiqologebs ainteresebT orive sakiTxi: (1) ratom iwyeben adamianebi mowevas _ amiT fsiqologebi SeZleben mis prevencias da (2) rogor daexmaron adamianebs mowevisaTvis Tavis danebebaSi _ riTic adamianebi SeZleben miiRon `eqsmwevelad~ gadaqcevasTan dakavSirebuli mniSvnelovani sargebeli. analizi imisa, Tu ratom iwyebs zogierTi adamiani Tambaqos mowevas, pirovnul Tvisebebsa da socialur faqtorebze fokusirdeba. individTa erT-erT tips, romelTanac Tambaqos moweva asocirdeba SegrZnebaTa maZieblebi uwodes (Zuckerman,1988); ufro mosalodnelia, rom aseTma individebma sarisko qmedebebi ganaxorcielon.

cxrili

13.6

aTi nabiji pirovnuli keTildReobisaken


1. regularulad ivarjiSeT. 2. miiReT noyieri, balansirebuli sakvebi (mdidari bostneuliT, xiliT, marcvleuliT, naklebi cximiTa da qolesteriniT). 3. SeinarCuneT optimaluri wona. 4. iZineT 7-8 saaTi Ramis ganmavlobaSi, daisveneT yoveldRe. 5. mgzavrobisas isargebleT usafrTxoebis RvedebiT da velosipedis CafxutiT. 6. ar moswioT sigareti da ar miiRoT narkotikebi. 7. zomierad, an saerTod ar miiRoT alkoholi. 8. iqonieT mxolod daculi, usafrTxo sqesobrivi urTierTobebi. 9. regularulad gaiareT samedicinostomatologiuri Semowmebebi; daicaviT samedicino reJimi. 10. CamoiyalibeT optimisturi damokidebuleba da SeiZineT megobrebi.

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erT-erT gamokvlevaSi qalebisa da mamakacebis pirovnuli Tvisebebis Sefasebis monacemebi, romlebic XX saukunis 60-ian wlebSi (1964-1967) miiRes, Seadares XX saukunis 80-iani wlebis bolos (1987-1991) maT `mweveli-aramwevelis~ qcevas. qalebi da mamakacebi, romlebic 60-ian wlebSi sakuTar Tavs axasiaTebdnen, rogorc SegrZnebebis maZieblebs, 20-25 wlis Semdeg ufro mosalodneli iyo, rom mwevelebi yofiliyvnen (Lipkus et al., 1994). savaraudoa, rom pirovnuli faqtorebi mWidrod ukavSirdeba zogierTi jgufis wevrebis Sefasebebs; anu, miuxedavad imisa, an swored imitom, rom moweva mavnebelia janmrTelobisaTvis, is `magaria~ (Leary et al., 1994). es gansakuTrebiT mozardebSi SeiZleba iyos ase. janmrTelobis fsiqologebi Tvlian, rom mowevis warmatebuli prevencia mowevis Sefasebis Secvlas _ `magaridan~ `cudisken~ _ gulisxmobs. ukeTesia, Tu saerTod ar daiwyebT mowevas, magram rogor SeiZleba daexmaros TambaqosaTvis Tavis danebebis swavlaSi Catarebuli kvlevebi maT, vinc ukve eweva? miuxedavad imisa, rom bevrma adamianma uSedegod scada mowevisTvis Tavis danebeba, daaxloebiT 35 milionma amerikelma samudamod mainc daaneba Tavi mowevas. 90%-ma es damoukideblad, specialuri samkurnalo programebis gareSe SeZlo. mkvlevrebma gansazRvres is etapebi, romelsac adamianebi gadian, rac TambaqosaTvis Tavis danebebis mzard mzadyofnas mowmobs (DiClemente et al., 1991; Prochaska et al., 1993): gansjis wina periodi _ mweveli jer ar fiqrobs mowevisTvis Tavis danebebaze; gansja _ mweveli fiqrobs mowevisTvis Tavis danebebaze, Tumca, jer ar axorcielebs cvlilebebs qcevaSi; momzadeba _ mweveli ukve mzad aris, rom Tavi daanebos mowevas; moqmedeba _ mweveli axorcielebs gansazRvrul qmedebebs dasaxuli qceviTi miznebis misaRwevad; SenarCuneba _ axla mweveli ukve aramwevelia da cdilobs am mdgomareobis SenarCunebas. mocemuli analizi gvafiqrebinebs, rom yvela mweveli fsiqologiurad erTnairi ar aris mowevisTvis Tavis danebebis sakiTxSi. intervencia imgvarad unda iyos dagegmili, rom manamde zrdides mwevelis mzadyofnis, sanam is fsiqo-

logiurad mzad iqneba janmrTelobis sakeTildReo qcevis gansaxorcieleblad. mowevis Sewyvetaze mimarTuli warmatebuli mkurnaloba mwevelis rogorc fiziologiuri, ise fsiqologiuri moTxovnilebebis dakmayofilebas moiTxovs (Tsoh et al., 1997; U.S. Department of health and Human Services, 2000). fiziologiur doneze mwevelebi saukeTesod eqvemdebarebian nikotinis Semcvleli Terapiis iseT efeqtur formas, rogoricaa nikotinis plastiri da nikotinis saReWi rezinebi. fsiqologiur doneze mwevelebma unda gaiazron, rom arsebobs uamravi eqsmweveli da rom TambaqosaTvis Tavis danebeba SesaZlebelia. garda amisa, mwevelma unda daiswavlos Zlieri ltolvis daZlevis strategiebi, romelic Tan axlavs TambaqosaTvis Tavis danebebis mcdelobebs. mkurnaloba xSirad moicavs Cven mier adre aRweril daZlevis kognitur xerxebs, romlebic saSualebas aZleven adamians, Seamsubuqos masze mravali stresoris zemoqmedeba. mowevasTan dakavSirebiT adamianebs aswavlian, Tu rogor moZebnon Tavis daRwevis gzebi situaciebidan, romlebmac SeiZleba kvlav gauRviZon mowevis Jini.

Sidsi
Sidsi _ es aris SeZenili imunodeficitis sindromi . miuxedavad imisa, rom aTasobiT adamiani kvdeba am saSineli daavadebiT, mravali adamiani cxovrobs aiv infeqciiT. aiv (adamianis imunodeficitis virusi) aris virusi, romelic anadgurebs sisxlis TeTr ujredebs (T limfocitebs), riTac azianebs imunur sistemas da asustebs sxeulis unars, SeebrZolos sxva daavadebebs. individi mowyvladi xdeba mTeli rigi sxva virusuli da baqteriuli infeqciebis mimarT, ramac SeiZleba sicocxlisaTvis iseTi saSiSi daavadebebi gamoiwvios, rogoricaa: kibo, meningiti da pnevmonia. virusiT Tavdapirveli
Sidsi (AIDS) _ SeZenili imunodeficitis sindromis abreviatura, sindromi gamowveulia virusiT, romelic azianebs imunur sistemas da asustebs organizmis unars, SeebrZolos infeqcias. aiv (HIV)_ adamianis imunodeficitis virusi, romelic azianebs sisxlis TeTr ujredebs (limfocitebs), riTac asustebs organizmis imunur sistemas; aiv infeqcia iwvevs Sidss.

janmrTelobis fsiqologia

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fsiqologia XXI saukuneSi

janmrTeli adamianebi 2010 wlisaTvis


Tu Tqven aSS-Si cxovrobT, Tqveni mTavroba momdevno aTi wlis gegmas gTavazobT: aSS-is janmrTelobisa da mosaxleobis momsaxurebis departamentma Seqmna programa saxelwodebiT _ `janmrTeli adamianebi 2010~, sadac mocemulia konkretuli rekomendaciebi pirovnuli da sazogadoebrivi janmrTelobisaTvis aucilebeli qcevebis Sesaxeb. programas ori zogadi mizani aqvs: (1) gansxvavebebis Semcireba janmrTelobis statusebs Soris mosaxleobis sxvadasxva fenaSi _ moxucebSi, umciresobebsa da bavSvebSi da (2) janmrTeli cxovrebis xangrZlivobis gazrda. fsiqologebi orive miznis ganxorcielebaSi Seitanen TavianT wvlils. rac Seexeba pirvel mizans, fsiqikuri janmrTeloba Setanilia `janmrTelobis statusis~ kategoriaSi. ukve ramdenime welia fsiqologebi did energias xarjaven sazogadoebis sxvadasxva jgufebSi fsiqikuri janmrTelobis dacvis gaumjobesebaze. meore mizani uSualod exeba kvalifikacias, rasac fsiqologebi janmrTelobis profilaqtikis sagnad miiCneven. programa `janmrTeli adamianebi 2010~-is mizania, rom adamianebma Secvalon janmrTelobasTan dakavSirebuli qcevebi. rogorc vnaxeT, es janmrTelobis fsiqologiis kvlevebis mniSvnelovani sakiTxia. es sakiTxi rom gavagrZeloT, ganvixiloT ori konkretuli mizani programidan `janmrTeli adamianebi 2010~: samuSao saaTebSi fizikuri aqtivobiT dakavebul mozrdilTa raodenobis Semcireba 40%dan 20%-mde; im mozrdilTa raodenobis gazrda 15%-dan 30%-mde, romlebic regularulad saSualo xarisxis fizikuri aqtivobiT arian dakavebulni (30 wuTi, TiTqmis yoveldRe). TqvenTvis, albaT, cnobilia, Tu ratom girCevT es programa regularulad varjiSs, anu janmrTelobis mTavari gaumjobeseba miiRweva iseTi varjiSebiT, rogoricaa: velosipediT siaruli, curva, sirbili da Cqari siarulic ki. es aqtivobebi iwveven gulisa da respiratoruli sistemis mdgomareobis gaumjobesebas, kunTebis tonusis gaZlierebas da bevri sxva sargebelic moaqvT janmrTelobisaTvis. rogor SeiZleba janmrTelobis fsiqologiis codna daexmaros adamians dadebiTi efeqtebis miRebaSi? mkvlevrebi swavloben, Tu vin da ratom mimarTavs regularul varjiSs da cdiloben gansazRvron is programebi Tu strategiebi, romlebic yvelaze metad exmarebian adamianebs varjiSis daiwyebasa da gagrZelebaSi (Dishman & Buckworth, 1997). faqtobrivad, varjiSis dawyebisTvis mzadyofnas igive modeli miesadageba, romelic mowevisaTvis Tavis danebebisTvis mzadyofnis SemTxvevaSi moqmedebs (Myers & Roth,1997). gansjis wina etapze adamianTa yuradReba, ZiriTadad, koncentrirebulia im winaaRmdegobebze, romlebic xels uSlian varjiSis dawyebas (magaliTad, drois ukmarisoba, varjiSisas partnioris ararseboba), vidre im sargeblobaze, romelic moaqvs varjiSs (magaliTad, exmareba relaqsaciaSi, aumjobesebs garegnobas). rogorc ki individebi treningis Semdgom _ gansjisa da SenarCunebis _ etapebze gadadian, yuradRebis koncentracia winaaRmdegobidan sargeblobaze gadainacvlebs. rogor unda moaxerxoT gansjis wina etapis daZleva, Tu Tqven jer kidev ar varjiSobT regularulad? mkvlevrebi miuTiTeben, rom adamianebs SeuZliaT iseTi strategiebis daswavla, romlebic saSualebas miscemT maT, daZlion varjiSis xelisSemSleli dabrkolebebi (Simkin & Gross, 1994). Tqven SegiZliaT zustad iseve ganixiloT varjiSis dawyeba, rogorc nebismieri sxva situacia, romelic stresis dasaZlevad Tqvengan kognitur Sefasebas moiTxovs. ecadeT dagegmoT cxovreba ise, rom varjiSi ganixilebodes, rogorc jansaRi garToba. Tqven, aseve, unda icodeT, rom Tqveni kolejis bevr students aqvs `Cavardnebi~ rogorc kvebis, ise varjiSis TvalsazrisiT: rodesac akademiuri stresis periodebi gaivlis, isini cudi kvebidan da minimaluri varjiSidan jansaR qcevas ubrundebian (Griffin et al.,1993). rogor unda CamoayaliboT Tqveni azrebi ise, rom Tavi aaridoT amgvar paterns? scadeT daexmaroT programas `janmrTeli adamianebi 2010~ dasaxuli miznebis miRwevaSi. www.health.gov/healthypeople es `janmrTeli adamianebi 2010~-is veb-gverdis misamarTia, sadac SegiZliaT gaecnoT programis 467 konkretul mizans.

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inficirebidan simptomebis gamovlenamde periodi (sainkubacio periodi) SeiZleba xuTi weliwadi an meti iyos. miuxedavad imisa, rom aiv virusiT inficirebulTa did nawils ar aqvs Sidsis samedicino diagnozi, maT mudmivi stresis qveS cxovreba uwevT, rom nebismier dros am saxifaTo daavadebam SeiZleba uecrad iCinos Tavi. dResdReobiT ukve arsebobs mkurnaloba, romelic SesaZlebels xdis Sidsis sruli siZlieriT Semotevis gadavadebas, magram ar arsebobs arc Sidsisgan gankurnebis saSualeba da arc misi gavrcelebis Tavidan asacilebeli vaqcina. aiv virusiT inficireba ar xdeba haeriT. inficirebisTvis aucilebelia sisxlTan uSualo kontaqti. zogadad, aiv virusi erTi adamianidan meores SeiZleba gadaedos ori gziT: (1) sqesobrivi kontaqtis dros sisxlis an spermis gacvliT da (2) wamlis ineqciisaTvis gankuTvnili intravenuli nemsebisa da Spricebis saziarod sargeblobisas. virusi, aseve, SeiZleba gadavides sisxlis gadasxmiT da im samedicino procedurebiT, romlis drosac janmrTel adamians SemTxveviT gadausxamen inficirebul sisxls, an gadaunergaven organoebs. hemofiliiT daavadebulma mravalma adamianma Sidsi swored am gziT SeiZina, Tumca, yvela adamians emuqreba SidsiT daavadebis safrTxe. Sidsis virusiT inficirebisagan Tavis dacvis erTaderTi gza im cxovrebiseuli Cvevebis Secvlaa, romlebic riskis winaSe ayeneben adamians. es niSnavs permanentuli cvlilebebis Setanas seqsualuri qcevis paternebsa da wamlebTan dakavSirebuli piradi moxmarebis sagnebis gamoyenebaSi. janmrTelobis fsiqologi tomas koatsi (Thomas Coates) im multidisciplinaruli kvlevis gundis wevria, romelic mTel rig fsiqologiur principebs iyenebs Sidsis Semdgomi gavrcelebis Tavidan asacileblad (Catania et al,. 1994; Coates, 1990; Ekstrand&Coates, 1990; Kegeles et a,,. 1996). gundis muSaoba moicavs gamoyenebiTi fsiqologiis mraval iseT aspeqts, rogoricaa: fsiqologiuri risk-faqtorebis Sefaseba, bihevioraluri intervenciebis ganviTareba, Temis liderebis treningi adamianebis ukeT ganaTlebis mizniT janmrTeli sqesobrivi da wamlebis moxmarebis qcevasTan dakavSirebiT, daxmareba sareklamo da sainformacio kampaniebis SeqmnaSi da cvlilebebis sistematuri Sefaseba

Sesabamis damokidebulebebSi, Rirebulebebsa da qcevebSi. Sidsis sawinaaRmdego warmatebuli intervenciisaTvis saWiroa sami komponenti (Fisher et al,. 1994, 1996; Yzer et al., 1998): informacia _ adamianebs unda miewodebodeT informacia imis Sesaxeb, Tu rogor gadadis Sidsi da rogor SeiZleba misi Tavidan acileba; maT unda miiRon konsultacia usafrTxo seqsis (magaliTad, sqesobrivi kontaqtis dros prezervativis gamoyenebis Sesaxeb) da steriluri SpricebiT sargeblobis Taobaze; motivacia _ adamianebi unda iyvnen motivirebulni Sidsis prevenciis ganxorcielebisaTvis; qceviTi unar-Cvevebi _ adamianebs unda aswavlon miRebuli codnis praqtikaSi gamoyeneba. ratomaa aucilebeli samive komponenti? adamianebi SeiZleba iyvnen Zlier motivirebulni, magram ar iyvnen informirebulni da, piriqiT, maT SeiZleba hqondeT sakmarisi codna da motivacia, magram ar hqondeT saWiro unar-Cvevebi. magaliTad, maT SeiZleba ar icodnen, rogor daZlion socialuri barieri da mosTxovon partniors prezervativis gamoyeneba (Leary et al., 1994). fsiqologiurma Carevam SeiZleba adamians roluri TamaSis gamocdileba, an sxva qceviTi unar-Cvevebi SesZinos am barieris mniSvnelobis Semcirebis mimarTulebiT.

mkurnaloba
mkurnaloba fokusirebulia avadmyofobis daregulirebasa da gamojanmrTelebaSi adamianis daxmarebaze. Cven ganvixilavT mkurnalobis sam aspeqts. Tavdapirvelad ganvixilavT fsiqologis rols pacientTa mxardaWeraSi, rac jandacvis specialistis daniSnuli reJimis Sesrulebis aucileblobaSi mis darwmunebas gulisxmobs. Semdeg ganvixilavT im xerxebs, romlebic saSualebas aZleven adamianebs, zustad gamoiyenon fsiqologiuri teqnikebi sxeulis reaqciebis gasakontroleblad. bolos ganvixilavT magaliTebs, romlebSic gonebas mniSvnelovani wvlilis Setana SeuZlia sxeulis gankurnebaSi.

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pacientis mier samkurnalo reJimis dacva


pacientebs xSirad uniSnaven mkurnalobis garkveul reJims. es SeiZleba moicavdes samkurnalo kursebs, cvlilebebs kvebaSi, woliTi reJimis periodebs da varjiSebs; aseve, iseT damatebiT procedurebs, rogoricaa: ganmeorebiTi Semowmeba, sareabilitacio treningi da qimioTerapia. mkurnalobis reJimis darRveva erT-erTi seriozuli problemaa janmrTelobis dacvis sferoSi (Clark & Becker, 1998). pacientTa daumorCileblobis xarisxi mkurnalobis zogierTi reJimis SemTxvevaSi SeiZleba 50%-s aWarbebdes. Tanamedrove kvlevebi fokusirebulia im individualuri gansxvavebebis dadgenaze, romelTac zogierTi individi mihyavs mkurnalobis reJimisadmi morCilebamde, zogierTi ki _ ara. warmodgenil paterns. sust makontroleblebTan SedarebiT, Zlier makontroleblebs sakuTar avadmyofobaze arasakmarisi kontrolis gancda hqondaT da naklebadac eqvemdebarebodnen eqimis mier daniSnul mkurnalobis reJims (Christensen et al., 1997). am kvlevis wakiTxvamde SeiZleba fiqrobdiT, rom is, vinc Zalian koncentrirebulia sakuTar avadmyofobaze, ukeT mouvlis sakuTar Tavs. amis nacvlad, miRebuli monacemebi gviCvenebs, rom avadmyofobaze Zalian Zlieri fokusirebiT adamians SeiZleba avadmyofoba ufro uaresad eCvenebodes, vidre sinamdvileSia da, amdenad, mkurnalobis uimedobis amgvari gancda saWiro qmedebebis ganxorcielebis Zalas arTmevdes. kvlevebma aCvena, rom janmrTelobis dacvis specialistebs SeuZliaT zomebis miReba pacientis reJimisadmi daqvemdebarebis gasaumjobeseblad. pacientebi ufro kmayofilebi arian sakuTari janmrTelobis dacviT, roca sjeraT, rom mkurnalobis efeqturoba aRemateba maT safasurs; aseve, metia albaToba, rom individi mihyveba mkurnalobis reJims, rodesac mkurnali eqimi mas informacias gasagebad awvdis; rwmundeba, rom pacientma gaigo misi naTqvami, Tavazianad moqmedebs, mzrunvelobasa da mxardaWeras avlens. garda amisa, janmrTelobis specialistebma unda gaiTvaliswinon kulturuli da socialuri normebis roli mkurnalobis procesSi da, saWiroebis SemTxvevaSi, CarTon masSi ojaxis wevrebi da megobrebi. zogierTi eqimi, romelic kritikulad afasebs sakuTari profesiis moZvelebul damokidebulebas biosamedicino modelze, amtkicebs, rom eqimebs unda aswavlon samedicino daxmarebis gaweva mkurnalobis mizniT (Siegel, 1988). fsiqologiur kvlevebze dayrdnobiT, pacientis damyolobis ganviTarebis strategiebi, aseve, gamoiyeneba eqimipacientis TanamSromlobis deficitis dasaZlevad (Putnametal.,1994; Zimbardo & Leippe, 1991).

saidan viciT
pacientTa damyoloba hemodializisadmi mkvlevrebma Seiswavles, Tu ramdenad mniSvnelovania yuradRebis makontrolebeli stili pacientis mier reJimis damyolobisTvis. avadmyofobisas zogierTi adamiani gansakuTrebul yuradRebas aqcevs avadmyofobis yvela aspeqts; aseT individebs Zlier makontroleblebs uwodeben, romelTagan gansxvavebiT, susti makontroleblebi naklebad axdenen yuradRebis fokusirebas avadmyofobaze. erTi SexedviT, SesaZloa, saSiSad ar mogeCvenoT Zlier makontroleblad yofna, Tumca, yuradRebis fokusis Zlieri Seviwrovebis gamo, Zlier makontroleblebs aqvT sakuTari avadmyofobis gazviadebulad Sefasebis tendencia. amis gamo maT sakuTar avadmyofobaze arasakmarisi kontrolis gancda aqvT, ramac mkvlevrebis azriT, SeiZleba gaarTulos maTi mkurnalobis reJimisadmi damyoloba. aRniSnul kvlevaSi mkvlevrebi afasebdnen pacientebs rogorc yuradRebis makontrolebeli stilis, ise maT mier aRqmuli kontrolisa da mkurnalobis reJimisadmi damyolobis mixedviT. kvlevis Sedegebi Seesabameboda mkvlevarTa mier

Tavi 13 / emocia, stresi da janmrTeloba

gonebis CarTva sxeulis gankurnvaSi


sul ufro xSirad mkurnaloba, romelsac unda daeqvemdebaron pacientebi, fsiqologiur komponentebs moicavs. axla ukve bevr mkvlevars miaCnia, rom fsiqologiur strategiebs SeuZliaT

544

janmrTelobis gaumjobeseba. magaliTad, bevri adamiani stresze daZabulobiT reagirebs, rac kunTebis daZabvasa da sisxlis wnevis momatebas iwvevs. sabednierod, mravali winaaRmdegoba datvirTvaze SeiZleba gakontroldes iseTi fsiqologiuri teqnikebiT, rogoricaa relaqsacia da bioukukavSiri. meditaciis saSualebiT relaqsacias uZvelesi fesvebi aqvs msoflios mraval kulturaSi. aRmosavlur kulturebSi saukuneebis manZilze mimarTavdnen gonebis damSvidebisa da sxeulis daZabulobis moxsnis xerxebs. dResdReobiT iaponiidan da indoeTidan Semosuli Zenis disciplinisa (aq igulisxmeba cxovrebis Zeniseuli wesi da ara Zeni, rogorc filosofiuri moZRvreba an saswavlo disciplina) da iogas varjiSebi yoveldRiuri cxovrebis nawils warmoadgenen bevri adamianisaTvis rogorc am qveynebSi, ise, gansakuTrebiT, dasavleTSi. sruli relaqsacia Zliermoqmed antistresul reaqcias warmoadgens. organizmis relaqsaciuri reaqcia aris mdgomareoba, rodesac mcirdeba kunTebis daZabuloba, Tavis tvinis qerqis aqtivoba, guliscema da sisxlis wneva, neldeba sunTqva (Benson & Stuart, 1992; Friedman et al., 1996), iklebs eleqtruli aqtivoba tvinSi da mcirdeba garemomcveli samyarodan centralur nervul sistemaSi Semavali stimulebis raodenoba. agznebadobis amgvari dabali donis dros xdeba stresidan gamosvla. relaqsaciuri reaqciis Sesaqmnelad aucilebelia oTxi piroba: (1) wynari garemo, (2) daxuWuli Tvalebi, (3) komfortuli poza da (4) raime sityvisa Tu frazis gonebaSi

relaqsaciuri reaqcia ( Relaxation response ) _ mdgomareoba, rodesac mcirdeba kunTebis daZabuloba, Tavis tvinis qerqis aqtivoba, guliscema da sisxlis wneva, neldeba sunTqva. bioukukavSiri (Biofeedback) _ TviTregulaciis teqnika, romlis drosac individi aracnobieri biologiuri procesebis nebismier kontrols axorcielebs.

janmrTelobis fsiqologia

mravaljeradi gameoreba. pirveli sami mdgomareoba amcirebs nervul sistemaSi Semaval signals, xolo meoTxe _ asustebs mis Sinagan stimulacias. bioukukavSiri TviTregulaciis teqnikaa, romelic sxvadasxva daniSnulebiT gamoiyeneba, magaliTad, sisxlis wnevis kontrolis, Sublis kunTebis relaqsaciisa (wneviT gamowveuli Tavis tkivilisas) da Zlieri gawiTlebis SemcirebisTvisac ki. am teqnikis Semqmnelis, fsiqolog nil mileris (Neal Miller, 1978) mixedviT, bioukukavSiri aris procedura, romliTac adamiani igebs, Cveulebriv, sust an Sinagan reaqciebs mkafio garegani signalebis mowodebiT. pacients SesaZlebloba eZleva, `dainaxos~ sakuTari sxeulis reaqciebi, romelTa monitoringi da gaZliereba saTanado xelsawyoebiT xdeba. es ukanasknelni sxeulis reaqciebs sxvadasxva intensivobis sinaTlis an bgeriT signalebad gardaqmnian; amis Semdeg pacientis amocanas garegani signalebis donis kontroli warmoadgens. ganvixiloT bioukukavSiris gamoyenebis erTerTi magaliTi. odesme SegimCneviaT, rom, rodesac modunebuli xarT, xelebi Tbili gaqvT, xolo rodesac SfoTavT, xelebi gicivdebaT? faqtobrivad, xelebis temperatura imis niSania, rom sxeuli stresis zemoqmedebis qveSaa. bioukukavSiris seansze kvlevis monawileebs eZlevaT ukukavSiri xelis mtevnisa da TiTebis temperaturis Sesaxeb da sTxoven, scadon misi gazrda. magaliTad, erT kvlevaSi monawileebs SeeZloT, daenaxaT TavianTi TiTebis temperaturis ricxobrivi maCvenebeli. bioukukavSiris kursis Semdeg maT SeeZloT TiTis saSualo temperaturis 79,8F-dan 87.4F-mde (Roberts & McGrady, 1996) gazrda. ratom xdeba es? kvlevam aCvena, rom kanis gaTbobis gamosawvev bioukukavSiris trenings SeuZlia ganapirobos sisxlis wnevis uwyveti Semcireba (Paron et al., 1996). mkvlevrebi zustad ver gansazRvraven im fiziologiur

545

meqanizms, romlis saSualebiTac kanis temperaturis bioukukavSiris treningi amcirebs sisxlis wnevas. isini, aseve, ganagrZoben imis kvlevas, Tu ratom moqmedebs treningi zogierT individze, zogierTze ki _ ara (Lal et al., 1998; Roberts & McGrady, 1996). miuxedavad amisa, Tu maRali wneva SegawuxebT, medikamentozur mkurnalobasTan erTad bioukukavSiris kursis mosinjvac SegiZliaT.

wlis ganmavlobaSi yovelkvireul mxardamWer Terapiul jgufSi monawileobda. es pacientebi sakuTar gamocdilebaze, kibos sxvadasxva aspeqtebis daZlevis Taobaze sasaubrod ikribebodnen, sadac keTilganwyobil garemoSi sakuTari SiSebisa da sxva Zlieri emociebis daufaravad gamovlenis saSualeba hqondaT. marTalia, aTi wlis Semdeg ganmeorebiTi Sexvedrisas, mTeli SerCevidan mxolod sami iyo cocxali, magram mniSvnelovani gansxvaveba dadasturda sicocxlis xangrZlivobis TvalsazrisiT im pacientebs Soris, romlebic damatebiT gadiodnen fsiqologiur mkurnalobas da romlebic mxolod samedicino daxmarebas iRebdnen. jgufur TerapiaSi monawile pacientTa sicocxlis saSualo xangrZlivoba 36.6 Tve iyo, sakontrolo jgufis pacientebisaTvis ki _ 18.9 Tve. kargad kontrolirebuli kvlevis es Sedegebi gviCvenebs, rom fsiqologiurma mkurnalobam SeiZleba gavlena moaxdinos daavadebis mimdinareobasa da sicocxlis xangrZlivobaze (Spiegel et al., 1989). am saxis kvlevebi gvaZlevs imeds, rom mxardamWeri jgufebis garemos kiboTi daavadebuli pacientebisaTvis sicocxlis gaxangrZliveba SeuZlia (Walker et al., 1999). mniSvnelovani dakvirveba am SemTxvevaSi isaa, rom mkurnalobis fsiqologiuri da biologiuri midgomebi erTad unda muSaobdnen. janmrTelobis bevr fsiqologs miaCnia, rom samedicino mkurnaloba, tradiciul mkurnalobasTan erTad, fsiqologiur daxmarebasac unda gulisxmobdes. dabolos, kidev erTi SeniSvna mkurnalobasTan dakavSirebiT. gqoniaT Tu ara odesme imdenad samarcxvino saidumlo, rom veravisTvis gagimxeliaT? Tu es asea, Turme am saidumloze saubars SeuZlia sagrZnoblad gaaumjobesos Tqveni janmrTelobis mdgomareoba. es aris daskvna janmrTelobis fsiqologis jeims penebakeris (James Pennebaker, 1990,1997 et al., 1998) mravalricxovani kvlevebidan. penebakerma aCvena, rom pirovnul travmebTan, warumateblobebTan da samarcxvino, an danaSaulis gancdis gamomwvev gamocdilebasTan dakavSirebuli gandevnili azrebi da grZnobebi damangrevlad moqmedebs

fsiqologiuri faqtorebis gavlena janmrTelobaze


ramdenad SeuZlia fsiqologiur faqtorebs _ sxeulze gonebis zegavlenas _ seriozul daavadebaze zemoqmedeba? sabednierod, janmrTelobis fsiqologiaSi Catarebuli kvlevebi sakmaod optimistur suraTs gvaZleven. ganvixiloT klasikuri kvleva, romelic aCvenebs, Tu ramdenad SeuZlia fsiqologiur procesebs kibos mimdinareobis Semsubuqeba.

Tavi 13 / emocia, stresi da janmrTeloba

saidan viciT
socialuri mxardaWera da kiboTi daavadebul adamianTa sicocxlis xangrZlivoba mkerdis kiboTi daavadebul, metastazebis mqone 86 pacients tradiciuli mkurnaloba utardeboda, 50 aseTive avadmyofisagan Semdgari eqsperimentuli jgufi ki tradiciul mkurnalobasTan erTad, erTi

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adamianis fsiqikur da fizikur janmrTelobaze. amgvari Sekaveba fsiqologiurad mZime gadasamuSavebelia da, droTa ganmavlobaSi, aryevs sxeulis Tavdacvis unars, winaaRmdegoba gauwios avadmyofobas. sxva adamianebisadmi ndoba aneitralebs Sekavebis uaryofiT efeqts. Tavis nebaze miSvebis gancdas Tan sdevs fizikuri da fsiqologiuri janmrTelobis gaumjobeseba kvirebis da Tveebis Semdeg. ganvixiloT emociuri gantvirTvis zemoqmedeba revmatiuli arTritis mqone adamianTa mdgomareobaze.

saidan viciT
emociuri gantvirTvis dadebiTi gavlena janmrTelobaze kvlevaSi revmatiuli arTritiT daavadebuli 72 adamiani monawileobda. es daavadeba iwvevs periferiuli saxsrebis qronikul anTebas, romelsac Tan axlavs tkivili da Sromis unaris dakargva. mkvlevrebi varaudobdnen, rom emociuri gantvirTvis seansebs SeiZleboda xeli Seewyo am daavadebasTan dakavSirebuli stresis SemcirebisTvis da, aqedan gamomdinare, yoveldRiuri funqcionirebis zogierTi problemis SemsubuqebisTvis. pacientebis naxevari gantvirTvis jgufs miakuTvnes; isini yoveldRe, oTxi dRis ganmavlobaSi, 15 wT-iT magnitifonze iwerdnen sakuTar, stresul movlenebTan dakavSirebul yvelaze Rrma grZnobebs. sakontrolo jgufi zustad igive dros andomebda neitraluri davalebis Sesrulebas _ mravalferovani peizaJis aRweras. erTi SexedviT, gantvirTvis jgufis pacientebi odnav uaresad grZnobdnen Tavs _ davalebam mravali uaryofiTi emocia aRZra. Tumca, mkurnalobidan sami Tvis Semdeg, gantvirTvis jgufis wevrebi, Sesabamisad, ufro nakleb fizikur disfunqcias ganicdidnen _ nakleb problemebs, magaliTad siarulSi da saxsrebis moxvraSi, vidre sakontrolo jgufis wevrebi (Kelley et al.,1997).

gantvirTvis jgufis pacientebisaTvis SedarebiT martivma moqmedebam grZnobebis gamosavlenad _ ganmartoebiT magnitofonTan, odnav gaaumjobesa maTi fizikuri funqcionireba.

`profesiuli gamofitva~ da janmrTelobis dacvis sistema


janmrTelobis fsiqologiis bolo amocanas warmoadgens rekomendaciebis SemuSaveba, romlebic janmrTelobis dacvis sitemis mowyobas exeba. mkvlevrebma, magaliTad, Seiswavles janmrTelobis dacvis muSakis saqmianobasTan dakavSirebuli stresi. janmrTelobis dacvis yvelaze energiul TanamSromelsac ki uviTardeba emociuri stresi mTeli rigi pirovnuli, fizikuri da socialuri problemebis mqone uamrav adamianTan intensiurad muSaobis Sedegad. emociuri stresis gansakuTrebul tips, romelsac janmrTelobisa da socialuri dacvis muSakebi ganicdian, kristina maslaCma (Christina Maslach), am farTod gavrcelebuli problemis wamyvanma mkvlevarma, gamofitva uwoda. profesiuli gamofitva warmoadgens sindroms, romelic emociur gamofitvas, depersonalizacias da pirovnuli

547

janmrTelobis fsiqologia

fsiqologia Cvens cxovrebaSi

axdens Tu ara gavlenas pirovnuli Tvisebebi janmrTelobaze


SegxvedriaT warmatebaze orientirebuli adamiani, romelic arafrad agdebs dabrkolebebs? misi klaselebis umravlesoba aRiarebs, rom gulis Seteva mas 20 wlamde daemarTeba. gavxarT am pirovnebas? rogorc iciT, zogi adamiani savse cxovrebiT cxovrobs, sxvebi ufro nel temps amjobineben. SeiZleba dagainteresoT, ramdenad zemoqmedebs individualuri gansxvavebebi janmrTelobaze. erTmniS vnelovnad mowmobs, rom pasuxi am kiTxvaze dadebiTia. ganvixiloT ramdenime maTgani. 1950-ian wlebSi maier fridmani (Meyer Friedman) da rei rouzmeni (Ray Rosenman) miuTiTebdnen imaze, rasac adamianebi jer kidev antikuri xanidan varaudobdnen: arsebobs kavSiri pirovnuli maxasiaTeblebis erTobliobasa da avad gaxdomis SesaZleblobas, gansakuTrebiT, gulis koronarul daavadebebs Soris (Friedman & Rosenman, 1974). am mkvlevrebma daadgines ori qceviTi paterni, romlebsac tipi A da tipi B uwodes. A tipis qceviTi paterni aris qcevisa da emociebis rTuli paterni, romelic ukidures metoqeobas, agresiulobas, mouTmenlobas, sulswrafobasa da mtrul ganwyobas gulisxmobs. A tipis adamianebi xSirad ukmayofiloni arian sakuTari cxovrebis ZiriTadi mxareebiT, uaRresad konkurenciulni da ambiciurni da, ZiriTadad, martoxelebi arian; B tipis qceviTi paterni aris yvelaferi is, rac ar aris A tipi, anu am tipis individebi naklebad mtrulad ganwyobilni arian, ar uyvarT konkurencia da a.S. fridmani da rouzmeni amtkicebdnen, rom adamianebs, romlebic A tipis qceviT paterns avlenen, sxvebTan SedarebiT gacilebiT ufro xSirad awuxebT gulis daavadebebi (Friedman & Rosenman, 1974; Jenkins, 1976). gamokvlevebSi didi yuradReba eTmoba individebs, romlebic xasiaTdebian A tipis qceviTi paterniT. gamokvlevebis mixedviT aRmoCnda, rom A tipis qceva gulis daavadebebTan erTad bevr sxva Tanmdev avadmyofobasTanaa dakavSirebuli (Suls & Marco, 1990; Vahtera et al., 2000). amJamad kvlevebi A tipis qceviTi paternis im specifikuri elementebis gamovlenazea fokusirebuli, romlebic yvelaze xSirad ayeneben adamianebs safrTxis winaSe. pirovnuli maxasiaTeblebidan yvelaze meti `toqsikurobiT~ mtruli

Tavi 13 / emocia, stresi da janmrTeloba

realizaciis Semcirebas gulisxmobs, rasac xSirad ganicdian im profesiis warmomadgenlebi,


A tipis qceviTi paterni (Type A behavior pattern) _ qcevisa da emociebis rTuli paterni, romelic moicavs gadaWarbebulad gamoxatul Sejibrs, agresias, mouTmenlobasa da mtrul damokidebulebas. mtruli damokidebuleba zrdis gulis koronarul daavadebaTa risks. B tipis qceviTi paterni (Type B behavior pattern) _AA tipis qceviT paternTan SedarebiT, qcevisa da emociaTa naklebad konkurenciuli, naklebad agresiuli da naklebad mtruli paterni. C tipis qceviTi paterni (Type C behavior pattern) _ qcevaTa erToblioba, romelic saSualebas gvaZlevs viwinaswarmetyveloT, romel individebs aqvT kiboTi daavadebis meti albaToba, an visTan ufro swrafad ganviTardeba es avadmyofoba. es qceviTi paterni gulisxmobs pasiur Seguebas da TavSewirvas.

548

romelTac moeTxovebaT Zalze intensiuri urTierToba pacientebTan, klientebTan an sazogadoebasTan. praqtikosi eqimebi TandaTanobiT kargaven pacientebis mimarT mzrunvelobisa da TanagrZnobis gancdis unars da maT SeiZleba sakmaod ugulod da, zogjer, arahumanuradac ki moeqcnen, ris gamoc Tavs cudad grZnoben da ganicdian sakuTar warumateblobas. gamofitva samsaxuris xSiri gacdeniTa da kadrebis denadobiT, samuSaos Sesrulebis gauaresebiT, TanamSromlebTan cudi urTierTobebiT, ojaxSi problemebiTa da janmrTelobis cudi mdgomareobiT vlindeba (Leiter & Maslach, 1988; Maslach, 1982; Maslach & Hlorian, 1988; Schaufeli et al., 1993). dRes muSa-mosamsaxureTa Soris gamofitvis sindromma arnaxul dones miaRwia, rac organizaciuli Semcirebis, samuSaos restruqturizaciisa da fuladi mogebisadmi da ara _ TanamSromelTa motivaciisa

ganwyoba gamoirCeva (Carmelli & Swan, 1996; Fredrickson et al., 2000; Smith, 1992). mtrulma ganwyobam SeiZleba janmrTelobaze zemoqmedeba moaxdinos rogorc fiziologiurad _ iwvevs ra sxeulis stresuli reaqciebis qronikul zeagznebadobas, ise fsiqologiurad _ iwvevs ra mtrulad ganwyobil adamianebSi janmrTelobis mdgomareobis gauaresebas da socialuri mxardaWerisagan Tavis aridebas. sasixaruloa is faqti, rom bihevioraluri Terapia A tipis qceviTi paternis Sesasusteblad, umravles SemTxvevaSi warmatebuli iyo (Friedman et al., 1986; Thoresen & Powell,1992). Tu sakuTar TavSi mtrul ganwyobas aRmoaCenT, sakuTari janmrTelobis dasacavad am tipis Carevas unda mimarToT. zemoT aRniSnuli tipi A da misi sawinaaRmdego tipi B mkvlevrebma qcevasa da gulis koronarul daavadebebs Soris kavSiris asaxsnelad Seqmnes. cota xnis win mkvlevrebma miuTiTes, rom kidev erTi, C ti-

pis qcevaTa paterni, saSualebas mogvcems viwinaswarmetyveloT, romel individebs aqvT kiboTi daavadebis meti albaToba, an visTan ufro swrafad ganviTardeba es avadmyofoba (Eysenck, 1994; Temoshok & Dreher,1992). qcevis C tipi gulisxmobs iseTi Tvisebebis arsebobas, rogorebicaa: gulisxmiereba, simtkice, an sakuTari Tavis msxverplad gaReba, TanamSromloba da sxvaTa gulis mogeba, moridebuloba, moTmineba, avtoritetebisadmi morCileba da uaryofiTi emociebis, gansakuTrebiT, brazis argamovlena (Temoshok, 1990 p.209). C tipis qceviT paterns ar Seesatyviseba `mebrZoli suli~, romelmac SeiZleba xeli Seuwyos kibos, an sxva romelime seriozuli avadmyofobis mimdinareobis Senelebas. `mebrZoli sulis~ zemoqmedeba mkvlevrebma aRmoaCines SidsiT daavadebul pacientebTan (Reed et al., 1994). individebi, romlebic sakuTari sikvdilis gardauvalobas ar eguebodnen, ufro metxans cocxlobdnen, vidre isini, vinc beds Seegua.

zogadad, C tipis individebisaTvis damaxasiaTebeli `pasiuri miReba~ avadmyofobisadmi saukeTeso midgoma ar aris. davubrundeT optimizmis cnebas, romelic me-12 TavSi ganvixileT. Cven vnaxeT, rom optimistebi warumateblobas garegan mizezebsa da arastabilur cvalebad movlenebs miaweren (Seligman, 1991). daZlevis es stili Zlier gavlenas axdens optimistTa keTildReobaze. mkvlevrebma daamtkices optimizmis gavlena imunuri sistemis moqmedebaze (Segerstrom et al., 1998). optimist adamianebs avadmyofobis naklebi fizikuri simptomebi aqvT, ufro swrafad axerxeben garkveuli avadmyofobebisgan gamojanmrTelebas, zogadad ufro janmrTelebi arian da ufro metxans cxovroben (Peterson et al., 1998). dadebiTi samomavlo perspeqtivebi sxeulze qronikuli stresis zemoqmedebis SemcirebaSi dagexmarebaT da sasargeblo qcevebis ganxorcielebis albaTobas gazrdis.

da erTgulebisadmi gansakuTrebuli dainteresebis Sedegia. amdenad, gamofitva mxolod muSamosamsaxureTa da janmrTelobaze mzrunvelTa problema ar aris, is organizaciul gaumarTaobazec miuTiTebs, rac organizaciuli miznebis, Rirebulebebis, samuSaos moculobis da waxalisebis struqturis gadasinjvas moiTxovs (Leiter & Maslach, 2000; Maslach & Leiter, 1997). ra rekomendaciebis mocema SeiZleba? gamofitvis gamovlenasa da xarisxze moqmedebs mTeli rigi socialuri da situaciuri faqtorebisa, romlebic arapirdapirad moicaven misi Tavidan acilebisa an Semcirebis gzebsac (Leiter & Maslach,2000; Prosser et al., 1997). magaliTad, eqimi-pacientis urTierTobis xarisxze mniSvnelovnad moqmedebs eqimis mier miRebul pacientTa raodenoba; rac ufro didia pacientTa raodenoba, miT metia kognituri, sensoruli da emociuri

profesiuli gamofitva (Job burnout) _ sindromi, romelic gulisxmobs emociur gamofitvas, depersonalizacias da pirovnuli realizaciis Semcirebas, romelsac xSirad ganicdian isini, romlebic Zlieri stresis pirobebSi muSaoben.

janmrTelobis fsiqologia

gadatvirTva. am urTierTobis xarisxze moqmedi kidev erTi faqtoria pacientebTan uSualo kontaqtis odenoba. pacientebTan mudmiv uSualo kontaqtSi muSaobis xangrZlivobas ukavSirdeba gamofitvis siZliere. es gansakuTrebiT exeba SemTxvevebs, rodesac kontaqti rTuli da damTrgunvelia, magaliTad, kontaqti momakvdav pacientebTan (Catalan et al., 1996). aseTi gaxangrZlivebuli kontaqtebiT gamowveuli emociuri daZabulobis Semcireba mTeli rigi saSualebebiTaa SesaZlebeli, anu eqimebs SeuZliaT, ise Secvalon TavianTi samuSao ganrigi, rom droebiT ganeridon amgvar stresul situaciebs.

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maT SeuZliaT individualur kontaqts jgufuri daxmareba arCion da SeuZliaT yvela Sansis gamoyeneba gaweuli ZalisxmevisaTvis pozitiuri ukukavSiris misaRebad.

rCevebi janmrTelobasTan dakavSirebiT


dadga saboloo rCevis mocemis dro. nacvlad stresis an avadmyofobis molodinisa da Semdeg masze reagirebisa, dasaxeT miznebi da dagegmeT cxovreba ise, rom janmrTelobisaTvis mtkice safuZveli SeqmnaT. cxra safexuri meti bednierebisa da ukeTesi fsiqikuri janmrTelobisaken dagexmarebaT ufro aqtiurad marToT sakuTari cxovreba da SeqmnaT ufro pozitiuri fsiqologiuri garemo rogorc TqvenTvis, ise sxvebisaTvis. aRniSnuli nabijebi warmoidgineT, rogorc wlis ganmavlobaSi gansaxorcielebeli programa: 1. arasodes TqvaT cudi sakuTar Tavze. iseT faqtorebSi eZebeT Tqveni ubedurebis mizezebi, romelTa Secvla SesaZlebelia momavali moqmedebiT. sakuTar TavTan da sxvebTan gamoiyeneT mxolod konstruqciuli kritika _ Tu ra unda gakeTdes gansxvavebulad Semdeg sasurveli Sedegis misaRebad; 2. SeadareT sakuTari reaqciebi, azrebi da grZnobebi Tqveni megobrebis, TanamSromlebis da ojaxis wevrebisas, raTa SeamowmoT sakuTari adeqvaturoba da pasuxebis relevanturoba Sesabamisi socialuri normebis mimarT; 3. gyavdeT ramdenime axlo megobari, romlebsac sakuTar grZnobebs, sixaruls da mwuxarebas gauziarebT. izruneT socialur mxardaWeris qselTa SenarCunebasa da gafarToebaze; 4. SeimuSaveT drois balansirebuli gancda, rac gagiadvilebT im moTxovnebze koncentracias, romlebsac giyenebT davaleba, situacia da sakuTari Tavi. iyaviT orientirebuli momavalze, rodesac raRacis gakeTebaa saWiro. iyaviT orientirebuli awmyoze, rodesac mizani miRweulia da siamovnebis miRebis droa da warsulze orientirebuli imisaTvis, rom ar mowydeT Tqvens fesvebs;

5. yovelTvis miiReT qeba miRwevebisa da warmatebebisTvis (da gauziareT Tqveni dadebiTi grZnobebi sxvebs). aRricxuli gqondeT yvela is Tviseba, romelic erTaderTad da ganumeoreblad gaqcevT da romelic SegiZliaT SesTavazoT sxvebs. magaliTad, morcxvma adamianma SeiZleba kargi samsaxuri gauwios molaparakes, Tu misi yuradRebiani msmeneli gaxdeba. gacnobierebuli gqondeT Tqveni pirovnuli siZlieris wyaro da Tqvens xelT arsebuli daZlevis saSualebebi; 6. rodesac grZnobT, rom emociebze kontrols kargavT, ganerideT situacias fizikuri wasvliT; sakuTari Tavi sxvis adgilze warmoidgineT konfliqtur situaciaSi. amJamad gadaulaxavi problemebis gadaWris gzebis aRmosaCenad warmosaxva momavlisken mimarTeT, an esaubreT gulisxmier mosaubres. mieciT Tqvens Tavs emociebis gancdisa da gamoxatvis saSualeba; 7. gaxsovdeT, zogjer warumatebloba da imedgacrueba gicavT kidec siyalbisagan. SeiZleba miganiSnebdnen, rom Tqveni miznebi sazianoa TqvenTvis, an SeiZleba dagifaron momavali dacemisagan. iswavleT Secdomebze. miiReT warumatebloba aRiarebiT `me davuSvi Secdoma~ da ganagrZeT gza. nebismieri ubeduri SemTxveva, warumatebloba, an imedis gacrueba, potenciurad, gardaqmnis, Secvlis mSvenieri SesaZleblobaa. 8. Tu aRmoaCenT, rom ver exmarebiT sakuTar Tavs, an sxvas sulier tanjvasTan gamklavebaSi, mimarTeT kvalificiuri specialistis rCevas. zogjer fsiqologiurad miCneuli problema, sinamdvileSi, SeiZleba fizikuri iyos da piriqiT; 9. danergeT jansaRi gasarTobebi. gamoyaviT dro dasvenebisTvis, meditaciisaTvis, masaJisaTvis, franis gaSvebisaTvis; iseTi aqtivobebisaTvis, romlebic SegiZliaT akeToT martom da romelTa saSualebiTac SegiZliaT ukeT CawvdeT da daafasoT sakuTari Tavi. maS ase, rogor grZnobT Tavs? Tu arsebul stresorebs cud gunebaze dayeneba SeuZliaT, imedi gvaqvs, Tqven SeZlebT kognituri gadafasebis gamoyenebas maTi zemoqmedebis Semcirebis

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Tavi 13 / emocia, stresi da janmrTeloba

mizniT. Tu avad xarT, imedi gvaqvs, SeZlebT fsiqikis unaris gamoyenebas gankurnebis daCqarebis mizniT. yovelTvis saTanadod SeafaseT am gansxvavebul `grZnobaTa~ Zala, raTa akontroloT sakuTari cxovreba. gamoiyeneT es Zala.

Sejameba
aradasavlur kulturebSi gonebaze fsiqologiuri zemoqmedebis gamoyenebis xangrZlivi tradicia arsebobs. janmrTelobis biofsiqosocialur modelSi asaxulia samive komponentis _ biologiuris, fsiqologiuris da socialuris _ wvlili janmrTelobaSi. janmrTelobis fsiqologebi iseTi fsiqologiuri meTodebis

gamoyenebas cdiloben, romlebic adamianebs daarwmuneben Tavi aaridon arajansaR qcevebs, magaliTad, Tambaqos mowevas. mkvlevrebma, aseve, ganaviTares SidsTan brZolis qceviTi cvlilebebis kompleqsuri programebi. mkurnalobisadmi janmrTelobis fsiqologiis midgoma gulisxmobs imis analizs, Tu ratom eqvemdebarebian, an ar eqvemdebarebian adamianebi mkurnalobis reJims. kvlevebiT, aseve, dadginda sxvadasxva xerxebi, romliTac SeiZleba gonebis Zalis gamoyeneba sxeulze zemoqmedebis mosaxdenad. janmrTelobis dacvis samsaxuri iseTi unda iyos, rom eqimebma SeZlon, Tavi aaridon gamofitvas da darCnen sakuTari saqmiTa da klientebiT gatacebulni.

sakvanZo sakiTxebi
emocia
emocia aris cvlilebaTa rTuli paterni, romelic moicavs fiziologiur agznebas, kognitur Sefasebas da qceviT da eqspresiul reaqciebs. rogorc evoluciis Sedegi, bazisuri emociuri reaqciebi yvela adamianisTvis saerToa. sxvadasxva kulturebs emociebis gamoxatvis marTebulobis gansxvavebuli standartebi aqvT. klasikuri Teoriebi emociuri pasuxis iseT aspeqtze amaxvileben yuradRebas, rogoricaa, magaliTad, periferiuli sxeulebrivi reaqciebi, an centraluri nervuli sistemis procesebi. SedarebiT Tanamedrove Teoriebi xazs usvamen agznebis Sefasebas. emociebi asruleben motivaciur, socialur da kognitur funqciebs. kognituri Sefaseba stresis ZiriTadi Semamsubuqebeli cvladia. daZlevis strategiebi an problemaze fokusirdebian (uSualo moqmedebebiT), an emociis daregulirebas cdiloben (arapirdapiri gziT, an Tavis aridebiT). stresTan gasamklaveblad SeiZleba kognituri gadafasebisa da gadastruqturebis gamoyeneba. socialuri mxardaWera, aseve, stresis mniSvnelovani Semasustebelia manam, sanam pirobebs Seesabameba.
sakvanZo sakiTxebi

stresi Tqvens cxovrebaSi


stresi SeiZleba gamoiwvios uaryofiTma, an dadebiTma movlenebma. stresTa umravlesobis safuZvelia cvlileba da garemos biologiur, fizikur da socialur moTxovnebTan adaptaciis saWiroeba. fiziologiuri reaqciebi stresze regulirdeba hipoTalamusis, hormonaluri da nervuli sistemebis rTuli urTierTqmedebiT. stresoris tipisa da droSi misi moqmedebis mixedviT, stresma, SesaZloa, gamoiwvios msubuqi aSliloba, an seriozuli problemebi Seuqmnas janmrTelobas.

janmrTelobis fsiqologia
janmrTelobis fsiqologia avadmyofobis mkurnalobasa da prevencias eZRvneba. janmrTelobisa da avadmyofobis biofsiqosocialuri modeli adgens kav-

551 551

Sirebs avadmyofobis fizikur, emociur da garemo faqtorebs Soris. avadmyofobis prevencia XXI saukuneSi mimarTulia cxovrebis wesis ganmsazRvrel iseT faqtorebze, rogorebicaa: moweva, kveba, varjiSi da Sidsis gadadebis safrTxe. avadmyofobis fsiqosocialuri mkurnaloba pacientis mkurnalobas sxva ganzomilebas matebs. individebi, romlebic xasiaTdebian, rogorc tipi A, tipi B da tipi C, optimisturi qceviTi paterniT avadmyofobis albaTobas gansxvavebulad ganicdian. janmrTelobis dacvis TanamSromlebi gamofitvis riskis qveS imyofebian, rac SeiZleba Semcirdes maT mxardamWer

garemoSi saTanado situaciuri cvlilebebis ganxorcielebiT. ZiriTadi

cnebebi

emocia amigdala jems-langes emociis Teoria kenon-bardis emociis Teoria kognituri Sefaseba emociis kognituri Sefasebis Teoria ierks-dodsonis kanoni stresi stresori mwvave stresi qronikuli stresi brZola an gaqcevis reaqcia dacvisa da zrunvis reaqcia zogadi adaptaciuri sindromi fsiqosomaturi darRvevebi cxovrebiseuli cvlilebis erTeulebi

posttravmuli stresis aSliloba rezidualuri (narCeni) stresis paterni daZleva stresis Semamsubuqebeli cvladebi anticipatoruli daZleva gacnobierebuli kontroli socialuri mxardaWera janmrTelobis fsiqologia janmrTeloba huazo biofsiqosocialuri modeli kargad yofna janmrTelobis profilaqtika Sidsi aiv relaqsaciuri reaqcia bioukukavSiri profesiuli gamofitva A tipis qceviTi paterni B tipis qceviTi paterni C tipis qceviTi paterni

Tavi 13 / emocia, stresi da janmrTeloba

mW

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pirovneba

14
pirovnebis tipisa da niSnis Teoriebi

tipebiT kategorizacia niSnebiT aRwera niSnebi da memkvidreoba winaswarmetyveleben Tu ara niSnebi qcevas pirovnebis tipisa da niSnis Teoriebis Sefaseba
fsiqologia Cvens cxovrebaSi: ratom aris zogi adamiani morcxvi fsiqodinamikuri Teoriebi

froidis Teoriss fsiqoanalizi froidis Teoriis Sefaseba post-froidistuli Teoriebi


humanisturi Teoriebi

humanisturi Teoriebis niSnebi humanisturi Teoriebis Sefaseba


socialuri daswavlis da kognituri Teoriebi

miSelis kognitur-afeqturi pirovnebis Teoria banduras kognitur-socialuri daswavlis Teoria kentoris socialuri inteleqtis Teoria socialuri daswavlisa da kognituri Teoriebis Sefaseba
me-s (self) Teoriebi me-s koncefciaTa dinamikuri aspeqtebi TviTSefaseba da TviTprezentacia me-s kulturuli konstruqcia me-s Teoriebis Sefaseba fsiqologia XXI saukuneSi: me internetSi pirovnebis Teoriebis Sedareba pirovnebis Sefaseba

obieqturi testebi proeqciuli testebi


sakvanZo sakiTxebi

ZiriTadi cnebebi

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ainteresebT, kargi mSobeli iqnebiT Tu ara? Tqven rom frenologiis _ me-19 saukuneSi popularuli erT-erTi Teoriis mimdevari iyoT, nebismieri, visac SeeZleboda Tqveni Tavis qalis moyvanilobis xeliT mosinjva, SeZlebda am kiTxvaze pasuxis gacemas. im Teoriis mixedviT, romelsac frenologia eyrdnoboda, tvinis Zlierad ganviTarebuli organoebi Signidan awvebian Tavis qalas da amozneqilobebs qmnian. tvinis yovel organos ukavSirdeboda iseTi niSnebi, rogoricaa: mSobliuri siyvaruli, megobroba da brZolisunarianoba. am organoebTan asocirebuli kopis zomis SefasebiT adamiani dauyovnebliv sakmaod bevrs Seityobda sakuTari Tavisa Tu sxva adamianis Sesaxeb. qvemoT mocemulia mSobliuri siyvarulis gamovlinebis aRwera wignidan rogor amovikiTxoT xasiaTi: frenologiisa da fiziognomiis axali ilustrirebuli saxelmZRvanelo~ (saavtoro uflebebi daculia samuel uelsis mier, 1869):
mSobliuri siyvarulis anu filoprogenitivobis organo moTavsebulia naTxemis Sua nawilis (2. suraTi 23) da kefis gamozneqilobidan daaxloebiT erTi duimiT zemoT (gv. 42).

Tavi 14 / pirovneba

ipoveT Sesabamisi adgili sakuTar Tavis qalaze? rogoria is Tqveni megobrebis Tavis qalebTan SedarebiT? ai, ras ambobs zemoT dasaxelebuli saxelmZRvanelo imaze, Tu rogori mSobeli iqnebiT Tqven, Tqveni mSobliuri siyvarulis organos zomaze dayrdnobiT: Zalian didi Tqveni siyvaruli bavSvebisa
da Sinauri cxovelebis mimarT Rrmaa. rogorc mSobeli, Tqven gaakerpebT Tqvens STamomavlobas da, SesaZlebelia, gaaTamamoT kidevac ganebivrebiTa da mavne waqezebiT, an dajerebis nacvlad mbrZaneblobis uflebis micemiT. Tu Tqven Svilebi gyavT, mudmiv SfoTvas ganicdiT maTTan

554

dakavSirebiT, gansakuTrebiT maSin, rodesac isini Tqven gverdiT ar arian, xolo erT-erTi maTganis sikvdili TiTqmis gausaZlisi dartyma iqneboda TqvenTvis; didi Tqven gaqvT unari, Zalian giyvardeT Tqveni Svilebi, bevri gaakeToT da SeswiroT maTi gulisaTvis, magram Tqven ar iqnebiT gadaWarbebulad mzrunveli da, zogadad, ar igrZnobT Svilebisadmi Tu Sinauri cxovelebisadmi Zalian Zlier mizidulobas; saSualo zomis Tqven sakmaod indiferentuli xarT Tqveni sakuTari Svilebis mimarTac ki, Tu saerTod gyavT isini, da civi yvela sxvis mimarT; cotas atana SegiZliaT maTgan da ar gaqvT miznad maTi siyvarulis mopoveba. Tqven ar gaRelvebT Sinauri cxovelebi; mcire zomis Tqven midrekilni xarT, iyoT civi da indiferentuli sakuTari Svilebis mimarT da gamoxatoT aSkara antipatia sxvisi Svilebis mimarT (gv. 160-161).

Tu Tqven ver xvdebiT, ratom unda iyos kavSiri Tqveni Tavis qalis formasa da mSobliuri siyvarulis unars Soris, maSin gagexardebaT imis gageba, rom frenologia savsebiT diskreditirebul iqna, Tumca, is impulsi, rasac is eyrdnoboda, dResac arsebobs da sakmaod Zlieria. fsiqologebi eZeben martiv, magram efeqtur gzebs adamianTa kategorizaciisaTvis; maT surT, rom am kategorizaciebma maT imis winaswarmetyvelebis saSualeba misces, Tu rogori reaqcia eqnebaT da rogor moiqcevian es adamianebi sxvadasxva situaciaSi. es aris pirovnebis Teoriebis arsebiTi mizani gansazRvron adamianTa Soris gansxvavebebi, rac maT cxovrebiseuli mimarTulebebis winaswarmetyvelebis saSualebas miscems. mdidari cxovrebiseuli gamocdilebidan, albaT, Zlieri intuicia gaqvT Camoyalibebuli imasTan dakavSirebiT, Tu rogor funqcionirebs pirovneba. rogoria Tqveni pirovnebis Teoria? gaixseneT vinme, visac WeSmaritad endobiT; axla _ is, visac piradad icnobT da TqvenTvis misabaZi magaliTia. warmoidgineT im adamianis Tvisebebi, visTanac mTeli darCenili sicocxlis gatarebas isurvebdiT da Semdeg imisa, visac dasanaxadac ver itanT. TiToeul SemTxvevaSi pirveli, rac dauyovnebliv mogvdis TavSi, es iseTi pirovnuli Tvisebebia, rogoricaa: patiosneba, sandooba, keTilSobileba, agresiuloba, uxasiaToba an pesimizmi. jer kidev bavSvobaSi, albaT, SeimuSaveT da iyenebdiT pirovnebis Sefasebis sakuTar sistemas; cdilobdiT, gangesazRvraT, vin iqneboda axal klasSi Tqveni megobari Tu mteri; SeimuSavebdiT mSoblebTan da maswavleblebTan gamklavebis teqnikebs imisda mixedviT, Tu rogor amoikiTxavdiT maT pirovnebas. fsiqologebi pirovnebas mravalnairad gansazRvraven, magram yvela gansazRvrebisaTvis saerToa ori ZiriTadi cneba: unikaloba da qcevis maxasiaTebeli paternebi. Cven ganvsazRvravT pirovnebas, rogorc unikaluri fsiqologiuri Tvisebebis rTul erTobliobas, romelic gansxvavebul situaciebSi da sxvadasxva dros gavlenas axdens individis qcevis damaxasiaTebel paternebze. pirovnebis Teoriebi warmoadgenen hipoTetur debulebebs individualuri pirovnebebis struqturisa da funqcionirebis Sesaxeb. isini gvexmarebian fsiqologiis miznebidan ori mTavari amocanis gadaWraSi: (1) pirovnebis struq-

pirovneba (Personality) _ individis unikaluri fsiqologiuri Tvisebebi, romlebic droTa ganmavlobaSi gavlenas axdens damaxasiaTebeli qceviTi (rogorc Ria, ise faruli) paternebis speqtrze gansxvavebul situaciebSi.

555

pirovnebis tipisa da niSnis Teoriebi

turis, warmoSobisa da pirovnebasTan kavSirSi myofi movlenebis gagebasa da (2) qcevisa da cxovrebiseuli movlenebis winaswarmetyvelebaSi imaze dayrdnobiT, rac viciT pirovnebis Sesaxeb. gansxvavebuli Teoriebi gansxvavebul winaswarmetyvelebebs akeTeben imis Taobaze, Tu rogor pasuxoben da rogor eguebian adamianebi konkretul pirobebs. sanam zogierTi mTavari Teoriuli midgomis ganxilvas SevudgebodeT, unda davsvaT kiTxva: _ ratom arsebobs amdeni gansxvavebuli (da xSirad urTierTsawinaaRmdego) Teoria? pirovnebisadmi midgomebSi Teoretikosebi gansxvavdebian amosavali wertilis da monacemTa wyaroebis mixedviT, aseve imiT, Tu rogor cdiloben gansxvavebuli saxis fenomenebis axsnas. zogi dainteresebulia konkretuli pirovnebis struqturiT, zogi ki _ imiT, Tu rogor ganviTarda es pirovneba da rogor gaagrZelebs igi zrdas. zogs ainteresebs, ras akeTeben adamianebi, specifikur qcevebsa Tu mniSvnelovan cxovrebiseul movlenebTan dakavSirebiT maSin, rodesac sxvebi swavloben imas, Tu ras grZnoben adamianebi am dros. dabolos, zogi Teoria cdilobs axsnas

fsiqologiuri problemebis mqone adamianebis pirovneba, sxvebi ki yuradRebas janmrTel individebze amaxvileben. ase rom, yoveli Teoria raimes gvaswavlis pirovnebis Sesaxeb, erTad ki maT bevris ramis moTxroba SeuZliaT adamianis bunebis Sesaxeb. am TavSi Cveni mizani iqneba, mogawodoT zogadi midgoma, Tu rogor unda gesmodeT pirovnebasTan Tqveni yoveldRiuri gamocdileba. Tumca, sanam daviwyebdeT, daufiqrdiT Semdeg kiTxvebs: Tqveni pirovnebis rogor portrets Seqmnidnen fsiqologebi, Tqven rom SeeswavleT? romel adreul gamocdilebas gamoyofdnen isini, rogorc Tqvens dRevandel qcevasa da azrovnebaSi wvlilis Semtans? Tqveni awmyo cxovrebis romeli pirobebi axdens Zlier gavlenas Tqvens azrebsa da qcevaze? ra gansxvavebaa Tqvensa da mraval sxva pirovnebas Soris, romlebic imave situaciaSi xvdebian, rogorSic Tqven? es Tavi dagexmarebaT am SekiTxvebze ufro zusti pasuxebis formulirebaSi. Semdgom ramdenime qveTavSi pirovnebisadmi Semdeg Teoriul midgomebs ganvixilavT: tipisa da niSnis, fsiqodinamikurs, humanisturs, socialuri daswavlis, kognitursa da me-s (self-is) analizs. am Tavs Sefasebis im zogierTi teqnikis aRweriT davasrulebT, romlebsac fsiqologebi pirovnebis gagebisa da aRwerisaTvis iyeneben.

fsiqologebma tipebsa da niSnebs Soris am gansxvavebaTa asaxvisaTvis Seqmnes.

tipebis kategorizacia
Cven yovelTvis vaxdenT adamianebis kategorizacias ganmasxvavebeli maxasiaTeblebis mixedviT. esenia: kolejis klasi, akademiuri specializacia, sqesi da rasa. pirovnebis zogi Teoretikosi adamianebs gansxvavebul, araurTierTgadamfarav kategoriebad ajgufebs, romlebsac pirovnebis tipebi ewodeba. pirovnebis tipebi sul an araferi~ fenomenebia da ar gamoixateba ama Tu im xarisxiT: Tu adamiani erT tips miekuTvneba, is SeuZlebelia miekuTvnebodes nebismier sxva tips arsebul sistemaSi. bevr adamians moswons pirovnebis tipebis gamoyeneba yoveldRiur cxovrebaSi, radgan isini gviadvileben sxva adamianebis Secnobis rTul process. erT-erTi yvelaze adreuli tipebis Teoria Cvens welTaRricxvamde mexuTe saukunes ekuTvnis. misi avtoria hipokrate, berZeni eqimi, romelmac medicinas hipokrates fici SesZina. misi Teoriis mixedviT, adamianis sxeuli Seicavs oTx ZiriTad siTxes anu humors, romelTaganac TiToeuli asocirebulia garkveul temperamentTan, emociebisa da qcevis paternTan. individis pirovneba damokidebulia imaze, Tu romeli humori Warbobs

pirovnebis tipisa da niSnis Teoriebi


ori yvelaze Zveli mcdeloba pirovnebis aRwerisa aris: adamianebis klasificireba calkeuli tipebis SezRudul raodenobad da im xarisxis gazomva, ra xarisxiTac isini SeiZleba aRiweros gansxvavebuli niSnebiT. rogorc Cans, adamianebs aqvT bunebrivi tendencia, sakuTari da sxvebis qceva sxvadasxva kategoriebs miakuTvnon. modiT, ganvixiloT Teoriebi, romlebic
pirovnebis tipebi (Personality types) _ pirovnuli maxasiaTeblebis calkeuli paternebi, romlebic gamoiyeneba adamianebis kategoriebisadmi mikuTvnebisaTvis; ara xarisxobrivi, aramed Tvisebrivi gansxvavebebi, romlebic adamianebis gansasxvaveblad ixmareba.

556

Tavi 14 / pirovneba

mis sxeulSi. hipokratem daawyvila sxeulis humorebi pirovnebis temperamentebTan Semdegi sqemis mixedviT: sisxli _ sangvinikuri temperamenti: mxiaruli da aqtiuri; flegma _ flegmaturi temperamenti: apaTiuri da modunebuli; Savi naRveli _ melanqoliuri temperamenti: naRvliani da Sefiqrianebuli; yviTeli naRveli _ qolerikuli temperamenti: gaRizianebadi da agznebadi. hipokrates Teoriis saukuneebis ganmavlobaSi sjerodaT, Sua saukuneebis CaTvliT, Tumca man ver gauZlo Tanamedrove mecnierebis moTxovnebs (miuxedavad amisa, Cven vnaxavT hipokrates temperamentebis Tanamedrove gamoZaxils hans aizenkis niSnis TeoriaSi). Cvens droSi uiliam Seldonma (William Sheldon, 1942) Seqmna tipis Teoria, romelic sxeulis agebulebas ukavSirebda temperaments; Teoria, romelic jer kidev popularulia da popularul sainformacio saSualebebSi aisaxeba. man adamianebi sam kategoriad dayo maTi sxeulebrivi agebulebis mixedviT. es kategoriebia: endomorfuli (msuqani, rbili, mrgvali), mezomorfuli (kunTiani, oTxkuTxedi, Zlieri) da eqtomorfuli (gamxdari, grZeli, susti). Seldonis azriT, endomorfebi arian relaqsirebuli, socialurni da uyvarT Wama. mezomorfebi arian sxeulebrivad ganviTarebuli adamianebi, aRsavse energiiT, gambedaobiT da axasiaTebT asertiuli1 tendenciebi. eqtomorfebi arian gonebrivad ganviTarebuli, artistuli da introverti adamianebi; maTTvis ufro damaxasiaTebelia fiqri cxovrebis Sesaxeb, vidre cxovrebiT sargebloba an masze aqtiuri zemoqmedeba. garkveuli drois ganmavlobaSi Seldonis Teoria imdenad gavleniani iyo, rom gadaRebul iqna SeerTebuli Statebis ieilisa da ueslis msgavsi kolejebis aTasobiT studentis SiSveli pozis~ foto, raTa mkvlevrebs SesaZlebloba hqonodaT, SeeswavlaT sxeulis tipsa da cxovrebiseul faqtorebs Soris kavSiri. Tumca, hipokrates bevrad ufro adreuli Teoriis msgavsad, Seldonis sxeulis tipebis Teoriac Zalian dabali Rirebulebis aRmoCnda individis qcevis winaswarmetyvelebis TvalsazrisiT (Tyler, 1965).
1

assertive dadebiTi, Tavdajerebuli.

ufro mogvianebiT, frenk saloueim (Frank Sulloway, 1996) SemogvTavaza dabadebis rigze damyarebuli, Tanamedrove tipebis Teoria. Tqven pirveli (an erTaderTi) Svili xarT Tqvens ojaxSi Tu mogvianebiT dabadebuli? imdenad, ramdenadac dabadebis rigis mixedviT adamians mxolod erTi pozicia SeiZleba hqondes, saloueis Teoria akmayofilebs tipis Teoriis kriteriumebs (uCveulo ojaxuri kombinaciebis mqone adamianebisaTvis magaliTad, rodesac or bavSvs Soris Zalian didi asakobrivi sxvaobaa salouei mainc gvawvdis individebis kategorizaciis gzebs). dabadebis rigze damyarebul winaswarmetyvelebebSi salouei efuZneba darvinis ideas, rom organizmebi xdebian gansxvavebulni, raTa ipovon is niSa, romelic maT gadarCenis saSualebas miscems. saloueis mixedviT, pirvelad dabadebulebs ukve gamzadebuli niSa aqvT _ maT Tavidanve aqvT Tavisi mSoblebis siyvaruli da yuradReba; isini cdiloben amis SenarCunebas mSoblebTan identifikaciisa da maTdami damorCilebis gziT. amis sapirispirod, ufro gvian dabadebul bavSvebs sWirdebaT gansxvavebuli niSis moZebna iseTis, sadac isini ase gamokveTilad ar mihyvebian Tavisi mSoblebis magaliTs. amis Sedegad, mogvianebiT dabadebulebs salouei axasiaTebs, rogorc ajanyebisaTvis dabadebulebs~; isini cdiloben, warmatebas miaRwion iseT sferoebSi, sadac ufros debs Tu Zmebs ara aqvT ukve mopovebuli upiratesoba. gvian dabadebulebi tipurad aviTareben Riaobas gamocdilebisadmi gamosadeg strategias yvelasaTvis, visac surs cxovrebaSi axali da warmatebuli niSis povna~. (gv. 353). im winaswarmetyvelebis Sesamowmeblad, rom gvian dabadebulni siaxleebs miesalmebian maSin, rodesac pirvelebi status-qvos amjobineben, saloueim Seiswavla mecnieruli, istoriuli da kulturuli revoluciebi, Semdeg ki gansazRvra im mravali istoriuli da Tanamedrove figuris dabadebis rigi, vinc mxars uWerda Tu ewinaaRmdegeboda am revoluciebs. 14.1 suraTze naCvenebia, Tu ra xarisxiT uWerdnen mxars mecnierebaSi arsebul 23 liberalur Teorias pirvelad da mogvianebiT dabadebuli mecnierebi. rogorc xedavT, yvela zomis ojaxis SemTxvevaSi, mosalodneli iyo, rom gvian dabadebulebi ufro dauWerdnen mxars inovaciur Teorias, vidre pirvelad dabadebulni. gyavT

pirovnebis tipisa da niSnis Teoriebi

557

suraTi

14.1

dabadebis rigi da mecnieruli inovaciebis mxardaWera


frenk saloueim gamoikvlia 23 inovaciuri Teoria da gansazRvra 1218 mecnieris dabadebis rigi, romlebmac miiRes an uaryves es Teoriebi. nebismieri zomis ojaxisaTvis, gvian dabadebulni ufro iRebdnen inovaciur Teorias, vidre pirvelad dabadebulni.

Tu ara Zmebi da debi? SegiZliaT Tu ara ipovoT aseTi magaliTi Tqvens sakuTar ojaxSi? icnobT Tu ara adamianebs, visac miakuTvnebdiT garkveul tips~? moicavs Tu ara tipi~ yvelafers, rac ki unda vicodeT pirovnebis Sesaxeb? xSirad tipis Teoriebi TiTqos ugulvebelyofen adamianTa pirovnebebis ufro faqiz aspeqtebs. modiT, gavecnoT Teoriebs, romlebic ufro meti moqnilobis SesaZleblobas iZlevian, radgan adamianebs ganasxvaveben niSnebis da ara tipebis mixedviT.
niSani (Trait) _ myari pirovnuli Tvisebebi an atributebi, romlebic gavlenas axdenen qcevaze gansxvavebul situaciebSi.

niSnebiT aRwera
tipis Teoriebis daSvebis mixedviT, adamianebi Seesatyvisebian arsebul calkeul, wyvetil kategoriebs. aseTi kategoriebia, magaliTad, pirvelad da mogvianebiT dabadebulebi. amis sapirispirod, niSnis Teoriebi gvTavazoben uwyvet ganzomilebebs, rogoricaa inteleqti, an keTilganwyoba. niSnebi aris uwyveti Tvisebebi an atributebi, romlebic winaswar ganawyoben individebs, rom isini Tanamimdevrulad moiqcnen gansxvavebul situaciebSi. magaliTad, SesaZlebelia erT dRes Tqven patiosneba gamoamJRavnoT dakarguli safulis dabrunebiT da meore dRes imiT, rom ar moityuoT gamocdaze. niSnis

558

Tavi 14 / pirovneba

suraTi

14.2

morcxvoba rogorc niSani


niSnebma SeiZleba imoqmedon, rogorc intervenciulma cvladebma, romlebic akavSireben erTi SexedviT erTmaneTTan daukavSirebel stimulebsa da maTze pasuxebis erTobliobas.

Teoriis zogierTi momxre niSnebs gansazRvravs, rogorc predispoziciebs, romlebic qcevas iwveven, Tumca ufro konservatiuli mecnierebi niSnebs iyeneben mxolod rogorc aRweriT ganzomilebebs, romlebic ubralod ajameben dakvirvebis obieqtad arsebuli qcevis paternebs. modiT, gavecnoT niSnis cnobil Teoriebs.

olportis niSnis Teoria


gordon olporti (Gordon Allport, 1937, 1961, 1966) ganixilavda niSnebs, rogorc pirovnebis samSeneblo masalas da individualobis Camoyalibebis wyaros. olportis mixedviT, niSnebi uzrunvelyofen qcevis SeTanxmebulobas (koherentulobas), radgan isini akavSireben da erTgvarovans xdian pirovnebis reaqciebs mravalgvarovan stimulebze. niSnebma SeiZleba imoqmedon, rogorc intervenciulma cvladebma, romlebic akavSireben erTi SexedviT erTmaneTTan daukavSirebel stimulebsa da maTze pasuxebis erTobliobas (ix. sur. 14.2). olportma gamoyo sami saxis niSnebi: kardinaluri, centraluri da meoradi. kardinaluria niSnebi, romelTa garSemoc agebs adamiani Tavis cxovrebas. deda terezasaTvis kardinaluri niSani sxvisi keTildReobisaTvis sakuTari Tavis Sewirva iqneboda. yvela adamians ar uviTardeba aseTi yovlismomcveli kardinaluri niSnebi, samagierod, centraluri niSnebi, rogoricaa, magaliTad, patiosneba an optimizmi, pirovnebis mTavar maxasiaTeblebs warmoadgenen. meoradi niSnebi specifiuri pirovnuli Tvisebebia, romlebic individis qcevis winaswarmetyvelebaSi gvexmareba, magram naklebad gamosadegia individis pirovnebis gagebisaTvis. meoradi niSnebis magaliTebia is, Tu rogor sakvebsa da tansacmels aniWebs adamiani upiratesobas. olports ainteresebda am sami tipis niSnebis unikaluri kombinaciebis aRmoCena, rac yovel

adamians ganumeorebel mTlianobad aqcevda, amitom igi mxars uWerda calkeul/erTeul SemTxvevaTa Seswavlis meTodis gamoyenebas (case study) . individis qcevis mTavar ganmsazRvrelad olports pirovnebis struqtura ufro esaxeboda, vidre garemo pirobebi. erTi da igive cecxli adnobs karaqs da xarSavs kvercxs~ am frazas igi iyenebda imis saCveneblad, rom erTsa da imave stimuls gansxvavebuli moqmedeba aqvs sxvadasxva individze. mravali Tanamedrove niSnis Teoria olportiseul tradicias mihyveba.

universaluri niSnebis ganzomilebebis gansazRvra


1936 wels gordon olportma da misma kolegam h. s. odbertma Caatares leqsikonis kvleva da inglisur enaSi individualuri gansxvavebebis aRmweri 18 000-ze meti zedsarTavi saxeli aRmoaCines. mas Semdeg mkvlevrebi cdiloben, gansazRvron niSnebis aseTi usazRvro sityvaTa maragis safuZvlad myofi Zireuli ganzomilebebi. isini cdiloben, daadginon, Tu ramdeni ganzomileba arsebobs da maTgan romlebi miscemen fsiqologebs yvela individis gamosadegi, universaluri daxasiaTebis Seqmnis saSualebas. reimond ketelma (Raymond Cattell, 1979) niSanTa bazisuri ganzomilebebis amomwuravi erTobliobis dadgena scada, risTvisac amosaval wertilad olportisa da odbertis zedsarTavi saxelebis sia gamoiyena. kvlevis Sedegad ketelma ivarauda, rom pirovnebas gansazRvravs 16 faqtori da maT ganmsazRvreli niSnebi uwoda, radgan, misi azriT, isini warmoadgenen im ganmsazRvrel wyaros, romelic dgas zedapirze arsebuli qcevebis ukan da romelsac Cven pirovnebad aRviqvamT. ketelis 16 faqtori moicavda iseT mniSvnelovan qceviT dapirispirebebs

pirovnebis tipisa da niSnis Teoriebi

559

dadgenili pirovnebis tipebisgan erT-erTs, Tumca, aizenkis niSnis Teoria am kategoriebSi individualuri varirebis saSualebas iZleva. individi SeiZleba yvelgan aRmoCndes wreze, Zalian introvertirebulidan Zalian eqstravertirebulamde da Zalian labiluridan (nevrotulidan) Zalian stabiluramde. wreze CamoTvlili niSnebi adamianebs swored am ori ganzomilebis kombinaciebiT aRweren. magaliTad, Zalian eqstravertirebuli da met-naklebad labiluri adamiani mosalodnelia, rom impulsuri iyos.

xuTfaqtoriani modeli
kvlevebi TvalnaTliv adastureben aizenkis Teoriis mraval aspeqts, Tumca, ukanasknel wlebSi miRweul iqna konsensusi, rom pirovnebis struqturas yvelaze kargad xuTi faqtori axasiaTebs, romlebic arasrulad emTxveva aizenkis sam ganzomilebas (Wiggins & Pincus, 1992). miuxedavad imisa, rom pirovnebis yvela mkvlevari ar emxroba am xuT faqtors (Block, 1995; Eysenck, 1992; Pervin, 1994), dResdReobiT swored isini warmoadgenen kriteriums niSnis struqturis Sesaxeb diskusiaTa umravlesobaSi. xuTfaqtoriani modelis Seqmna asaxavs mcdelobas, aRmoCenil iqnes raime struqtura niSanTa im did siaSi, romelic amoiRes leqsikonidan olportma da odbertma (1996). niSnebi dayvanil iqna sinonimebis daaxloebiT 200 klasteramde, romlebic gamoiyeneboda niSnebis bipolaruli ganzomilebebis Sesaqmnelad; ganzomilebebisa, romlebsac aqvT maRali da dabali polusebi, rogoricaa pasuxismgebliani da upasuxismgeblo. Semdeg adamianebs sTxovdnen, SeefasebinaT sakuTari Tavi da sxva adamianebi bipolarul ganzomilebebze da es Sefasebebi statistikuri damuSavebis procedurebs eqvemdebareboda imis gansasazRvrad, Tu rogor iyo erTmaneTTan dakavSirebuli sinonimuri klasterebi. am meTodis gamoyenebiT ramdenime damoukidebeli kvleviTi jgufi erTsa da imave daskvnamde mivida: im niSnebis safuZvlad, romlebsac adamianebi gamoiyeneben sakuTari Tavis da sxvebis aRsawerad, arsebobs mxolod xuTi bazisuri ganzomileba (Norman, 1963, 1967; Tupes & Christal, 1961).

suraTi

14.3

pirovnebis aRweris wris oTxi kvadrati aizenkis mixedviT


eqstraversiisa da neiroticizmis ori ganzomileba gvaZlevs wriul gamosaxulebas. aizenkma am gamosaxulebis yoveli kvadrati hipokrates mier gansazRvruli oTxi pirovnebis tipisagan erTs daukavSira. miuxedavad amisa, misi Teoria am kategoriebis farglebSi individualuri varirebis saSualebas iZleva.

560

(opoziciebs), rogoricaa, magaliTad, TavSekavebuli _ komunikabeluri, mimndobi eWviani, modunebuli daZabuli. miuxedavad amisa, Tanamedrove niSnis Teoriis mimdevrebi amtkiceben, rom pirovnebebs Soris yvelaze mniSvnelovan gansxvavebebs 16-ze kidev ufro naklebi ganzomileba asaxavs. hans aizenkma (Hans Eysenck, 1973, 1990) pirovnebis testirebis monacemebidan mxolod sami ZiriTadi, moculobiTi ganzomileba gamoyo: eqstraversia (SigniT orientirebuli gareT orientirebulis sapirispirod), neiroticizmi (emociurad stabiluri emociurad labiluris sapirispirod) da fsiqoticizmi (gulisxmieri da yuradRebiani agresiulisa da antisocialuris sapirispirod). rogorc naCvenebia suraTze 14.3 , aizenkma moaxdina ori ganzomilebis eqstraversiisa da neiroticizmis kombinireba, raTa maTi wreze demonstracia SeZleboda. misi azriT, wris TiToeuli seqtori warmoadgens hipokrates mier

Tavi 14 / pirovneba

cxrili

14.1
xuTfaqtoriani modeli

faqtori

bipolaruli gansazRvreba

eqstraversia

laparakis moyvaruli, energiuli da asertiuli wynaris, TavSekavebulisa da morcxvis sapirispirod TanamgrZnobi, keTili da mosiyvarule civis, kapasisa da sastikis sapirispirod organizebuli, pasuxismgebliani da frTxili uyuradRebos, frivolurisa da upasuxismgeblos sapirispirod stabiluri, mSvidi da kmayofili SfoTianis, arastabilurisa da temperamentianis sapirispirod kreatuli, inteleqtualuri da gonebagaxsnili martivis, zedapirulisa da ugunuris sapirispirod

TanxmobisaTvis mzaoba patiosneba

neiroticizmi

gamocdilebisadmi Riaoba

niSnebi da memkvidreoba
Tqven, albaT, gagigiaT, rom adamianebi aseT frazebs amboben xolme: jimi artistulia, Tavisi dedis msgavsad~, an, meri misi babuasaviT jiutia~, an, SesaZloa, frustrirebulad gigrZvniaT Tavi, radganac Tqvens da-ZmaSi gamaRizianebeli Tvisebebi swored isinia, romlebis gamosworebac sakuTar TavSi gsurT. modiT, ganvixiloT pirovnuli niSnebis memkvidreobiTobis damadasturebeli TvalsaCino magaliTebi. gaixseneT, rom bihevioristuli genetika aris mecniereba, romelic Seiswvlis, Tu ra xarisxiT gadaecema pirovnuli niSnebi da qceviTi paternebi memkvidreobiT. pirovnebaze genetikis

xuTfaqtoriani modeli ( Five-factor model ) _ pirovnebis yovlismomcveli aRweriTi sistema, romelic asaxavs urTierTobas zogad niSnebs, Teoriul cnebebsa da pirovnebis skalebs Soris; araformalurad ewodeba didi xuTeuli.

pirovnebis tipisa da niSnis Teoriebi

xuTi ganzomileba Zalian farToa, radgan TiToeuli erT did kategoriaSi aTavsebs bevr niSans, romelTac unikaluri erTmniSvnelovani konotacia, magram saerTo Tema aqvT. pirovnebis am xuT ganzomilebas amJamad xuTfaqtoriani modeli ewodeba, an, araformalurad, didi xuTeuli (the Big Five) (McCrae & Costa, 1999). xuTi faqtori Sejamebulia cxrilSi 14.1. Tqven erTxel kidev SeniSnavT, rom TiToeuli ganzomileba bipolarulia _ ganzomilebis saxelwodebis mniSvnelobis tolfasi terminebi aRweren maRal poluss, xolo misi sawinaaRmdego terminebi ki _ dabals. xuTfaqtoriani modelis ganzomilebebi 1960ian wlebSi Segrovebuli masalidan warmoiSva, sadac gamoiyeneboda zedsarTavi saxelebis ramdenime gansxvavebuli nakrebi, mravali gansxvavebuli SerCeva da SefasebiTi davaleba. mas Semdeg Zalian msgavsi ganzomilebebi aRmoaCines pirovnebis kiTxvarebSi, intervius kiTxvarebsa da sxva monacemebSi (Costa & McCrae, 1992a; Digman , 1990; Wiggins & Pincus , 1992). xuTfaqtoriani modelis universalurobis demon-

strirebisaTvis mkvlevrebi gascdnen Tavis kvlevebSi inglisur enas: xuTfaqtoriani struqtura gameorda ramdenime enaSi germanulis, portugaliuris, ivriTis, Cinuris, koreulis da iaponuris CaTvliT (McCrae & Costa, 1997). xuTi faqtori ar aris mowodebuli, rom Seanacvlos mravali specifikuri niSnis termini, romelsac mniSvnelobis sakuTari niuansi da elferi aqvs. ufro sworad rom vTqvaT, is gamokveTs taqsonomias _ klasifikaciis sistemas, romelic saSualebas gvaZlevs, aRvweroT yvela Cveni nacnobi adamiani ise, rom gamovxatoT is mniSvnelovani ganzomilebebi, romlebiTac isini gansxvavdebian. mniSvnelovania, xazi gavusvaT imas, rom xuTfaqtoriani modeli, didwilad, aRweriTia. faqtorebi Seiqmna niSnebis terminTa klasterebis statistikuri analizis Sedegad da ara Teoriis safuZvelze, romelic ambobda: es aris faqtorebi, romlebic unda arsebobdes~ (Ozer & Reise, 1994). xuTfaqtoriani modelis momxreebma daiwyes am Teoriuli dasabuTebis Zieba. magaliTad, maT scades, xuTi ganzomileba interaqciaTa im Tanmimdevrul tipebTan daekavSirebinaT, romlebic adamianebs hqondaT erTmaneTTan da gare samyarosTan kacobriobis evoluciis manZilze (Costa & McCrae, 1992a; McCrae et al., 2000). evoluciuri safuZveli dagvexmareboda, agvexsna xuTi faqtoris universaluroba gansxvavebul kulturebSi. Tu es axsna sworia, SesaZlebelia, evoluciis mier Camoyalibebuli adamianuri gamocdilebis sxva aspeqtebis msgavsad, niSnebi erTi Taobidan meores gadaeces. ganvixiloT es debuleba.

561

gavlenis gansasazRvrad mkvlevrebi swavloben pirovnul niSnebs erTi ojaxis wevrebisa, romlebsac msgavsi genebis gansxvavebuli proporciebi aqvT da erTsa da imave an gansxvavebul garemoSi gaizardnen. magaliTad, Tu pirovnuli niSani socialuroba genetikurad gadaecema, maSin is ufro maRal korelaciaSi unda iyos identur, monozigotur tyupebSi (romelTa genebic 100%-iT emTxveva), vidre araidentur, dizigotur tyupebSi an sxva da-ZmaSi (romelTa genebic saSualod 50%-iT emTxveva). memkvidreobiTobis kvlevebi gviCvenebs, rom TiTqmis yvela pirovnuli niSani ganicdis genetikuri faqtorebis gavlenas (Lehlin et al., 1998). msgavs Sedegebs iZleva iseTi kvlevebic, sadac mravali gansxvavebuli gazomvis teqnika gamoiyeneba, miuxedavad imisa, zomaven isini ufro farTo niSnebs, rogoricaa eqstraversia da neiroticizmi, Tu specifikur niSnebs, rogoricaa TviTkontroli an socialuroba. ganvixiloT erTi sanimuSo kvleva:

nierTa jgufma germanidan da poloneTidan Seagrova pirovnuli niSnebis monacemebi 660 monozigoturi da 304 dizigoturi tyupis wyvilebze. monacemebi miRebul iqna rogorc TviTangariSis (anu tyupebi avsebdnen im tipis pirovnebis kiTxvarebs, romelTac mogvianebiT SevexebiT am TavSi), ise axlobelTa Sefasebebis (anu megobrebi da ojaxis wevrebi adgendnen erTi an meore tyupiscalis Sefasebebs) meSveobiT. zogadad, adrindel kvlevebSi mxolod TviTangariSis monacemebs iyenebdnen. memkvidreobiTobis kvlevebis kritikosebi Tvlidnen, rom monozigotur da dizigotur tyupebs SesaZlebelia hqondeT gadaxrebi, rodesac isini sakuTar Tavs adareben Tavis tyupiscals, an sxva individs. axlobelTa Sefasebebis CarTva amcirebs imis albaTobas, rom memkvidreobiTobis maRali maCveneblebi tyupebis TviTangariSis pirdapiri Sedegia. faqtobrivad, yvela SemTxvevaSi monozigoturi tyupebis pirovnebebi Sefasebul iqna, rogorc ufro msgavsi, vidre dizigoturi tyupebisa. TviTSefasebebma gamoavlina tyupTa Soris korelaciebis aseTi maCveneblebi: 0.52 (monozigoturi) da 0.23 (dizigoturi). rogorc TviTangariSis, ise axlobelTa monacemebis gamoyenebiT mkvlevrebma aCvenes mniSvnelovani memkvidreobiTi maCveneblebi xuTfaqtoriani modeliT gansazRvruli yoveli faqtoris mxriv (Remann et al., 1997). kvlav SexedeT cxrils 14.1. xuTi faqtoris romeli polusebia TqvenTvis yvelaze Sesabamisi? SegiZliaT ipovoT msgavseba Tqvensa da Tqvens mSoblebs Soris? mkvlevrebi kvlav muSaoben memkvidreobiTobis kvlevebis gaumjobesebaze. magaliTad, radganac tyupebi da sxva da-Zma, rogorc wesi, erTad izrdebian, maT saerTo ojaxuri garemo aqvT, ramac SesaZloa maTi pirovnebebis korelacia gamoiwvios. naSvilebi bavSvebis kvlevebi ki gamoiyeneba imisaTvis, rom gaizomos gansxvaveba bavSvebis niSnebis korelaciebisa maTi biologiuri mSoblebis niSnebTan da aRmzrdeli mSoblebis niSnebTan. naSvilebi bavSvebis kvlevebis monacemebidan, aseve, naTelia is, Tu raoden

Tavi 14 / pirovneba

saidan viciT
xuTi faqtoris memkvidreobiToba Tqven axlaxan pirovnebis xuTfaqtorian models gaecaniT. mkvlevrebma yuradReba miaqcies sakiTxs: arsebobs Tu ara am modeliT gansazRvruli faqtorebis genetikuri safuZveli. erT-erT kvlevaSi mec-

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mniSvnelovania pirovnul niSnebSi genetikuri faqtoris wvlili (Bouchard, 1994).

winaswarmetyveleben Tu ara niSnebi qcevas


warmoidgineT, rom gTxoves, amoirCioT raime pirovnuli niSnis aRmniSvneli termini, romelic, Tqveni rwmeniT, gansakuTrebiT kargad SegesabamebaT. magaliTad, Tqven SegiZliaT gviTxraT, rom Tqven Zalian keTilganwyobili xarT. ra viciT Cven axla? Tu pirovnebis Teoriebi gvaZleven saSualebas, viwinaswarmetyveloT qceva, ra prognozi SegviZlia gavakeToT im codniT, rom Tqvens Tavs afasebT, rogorc Zalian keTilganwyobils? rogor SegviZlia ganvsazRvroT Tqveni mosazrebis validuroba? modiT, gamovikvlioT es sakiTxi. erTi idea, romelic SesaZloa gagiCndeT, Semdegia: codna imisa, rom pirovneba SeiZleba daxasiaTebul iqnes konkretuli niSniT, saSualebas mogcemT, iwinaswarmetyveloT misi qceva gansxvavebul situaciebSi. amgvarad, Cven Tqvengan moveliT keTilganwyobil qcevas yvela situaciaSi, Tumca, 1920-ian wlebSi ramdenime mkvlevari, romlebmac miznad daisaxes niSnebTan dakavSirebul qcevaze dakvirveba gansxvavebul situaciebSi, gancvifrebuli iyo, radgan mcire TvalsaCinoeba aRmoaCines situaciebis mixedviT qcevis konsistenturobis mxriv. magaliTad, skolis moswavleebSi mxolod susti korelacia iqna aRmoCenili patiosnebis niSanTan savaraudod dakavSirebul or iseT qcevas Soris, rogoricaa tyuilis Tqma da TaRliToba gamocdis Cabarebisas (Hartshorne & May, 1928). msgavsi Sedegebi miiRes sxva mkvlevrebmac, romlebic iseTi niSnebis kros-situaciur Tanmimdevrulobas (konsistenturobas) swavlobdnen, rogorebicaa introversia an punqtualoba (Dudycha, 1936; Newcomb, 1929). Tu niSnebTan dakavSirebuli qceva ar aris kros-situaciurad konsistenturi, anu, Tu adamianebis qceva icvleba gansxvavebul situaciebSi, ratom aRiqvamT Tqvens sakuTar da sxvebis pirovnebebs, rogorc SedarebiT mdgrads? kidev ufro damabnevelia, rom pirovnebis Sefaseba im damkvirveblis mier, romelic individs erTi situaciidan icnobs, korelaciaSia im damkvir-

konsistentobis paradoqsi (Consistency pradox) _ movlena, romlis drosac pirovnebis Sefasebebi sxvadasxva dros da gansxvavebuli damkvirveblebis mier konsistenturia, maSin, rodesac adamianis qcevis Sefasebebi sxvadasxva situaciebSi ar aris konsistenturi.

pirovnebis tipisa da niSnis Teoriebi

veblis SefasebasTan, romelic icnobs mas sxva situaciidan. movlenas, rodesac pirovnebis Sefasebebi sxvadasxva dros da gansxvavebuli damkvirveblebis mier konsistenturia, xolo adamianis qcevis Sefasebebi sxvadasxva situaciebSi ar aris konsistenturi, konsistentobis paradoqss (Consistency paradox) uwodeben (Mischel, 1968). konsistentobis paradoqsis aRmoCenas kvlevaTa didi raodenoba mohyva (mimoxilvisTvis ix. Cervone & Shoda, 1999). droTa ganmavlobaSi miRweul iqna konsensusi, rom qceviTi arakonsistentoba gamovlinda didwilad imis gamo, rom situaciebi arasworad iyo kategorizebuli: paradoqsi qreba, rodesac mecnierebi marTebulad daaxarisxeben situaciaTa fsiqologiur maxasiaTeblebis (Mischel & Shoda, 1995, 1999). magaliTad, dauSviT, rom Tqven gsurT qceviTi konsistentobis Sefaseba imis gansazRvriT, iqceva Tu ara Tqveni megobari umetesad erTnairad yvela wveulebaze, romelsac igi eswreba. mosalodnelia, aRmoaCinoT, rom misi qceva mniSvnelovnad cvalebadobs, Tu Tqveni analizis done mxolod wveulebebia~. saWiroa, gansazRvroT, Tu romeli fsiqologiurad relevanturi maxasiaTeblebi yofen wveulebebs gansxvavebul kategoriebad. SesaZloa, Tqveni megobari uxerxulad grZnobs Tavs iseT situaciebSi, sadac misgan ucxoebisaTvis piradi informaciis gaziarebas moelian. Sedegad, zogierT wveulebaze (sadac misgan piradi informaciis gaziarebas moelian) is SeiZleba Zalian arakeTilganwyobilad gamoiyurebodes, xolo sxva wveulebebze (sadac amas misgan ar moelian) _ sakmaod keTilganwyobilad. amave dros, sxva iseTma situaciebma, romlebic misgan gulaxdilobas moiTxovs, rogoricaa interviu samsaxurSi miRebisas, SeiZleba, aseve, gamoiwvion negatiuri qceva. amdenad, konsistentoba gamoixateba imiT, Tu ra gziT gamoiwveven situaciis maxasiaTeblebi adamianebis gansxvavebul reaqciebs.

563

fsiqologia Cvens cxovrebaSi

ratom aris zogi adamiani morcxvi?


ukanaskneli drois kvlevebma gviCvena, rom kolejis studentebis 50%-ze meti sakuTar Tavs amJamad morcxv~ individad miiCnevs (Carducci & Zimbardo, 1995). maTi umetesoba ambobs, rom morcxvoba aris arasasurveli mdgomareoba, romelsac uaryofiTi pirovnuli da socialuri Sedegebi ufro meti aqvs, vidre dadebiTi efeqtebi. studentebis sxva jgufi ambobs, rom isini situaciurad morcxvebi~ arian da ara dispoziciurad morcxvebi~, rogorc studentebis zemoxsenebuli umetesoba. isini grZnoben, rom TiTqosda~ morcxvoben garkveul situaciebSi, romlebic axalia, ucnauria an socialur zewolas Seicavs. aseTi situaciebia paemani ucnobTan, martoxelebis barebi, aseve, rodesac adamians moeTxoveba, sazogadoebis winaSe momzadebis gareSe imoqmedos. simorcxvis mkvlevrebi gaocdnen, rodesac zrdasrul adamianebSi aRmoaCines, rom aramorcxvi~ adamiani iSviaTi, araCveulebrivi saxeobaa SeerTebul StatebSi da yvela sxva gamokvleul qveyanaSi (Zimbardo, 1991). simorcxve SeiZleba ganisazRvros, rogorc diskomforti da/an Sekaveba iseT interpersonalur situaciebSi, romlebic xels uSlis adamianis interpersonaluri an profesiuli miznebis miRwevas. morcxvoba SeiZleba iyos qronikuli da dispoziciuri, anu warmoadgendes centralur niSans adamianis TviTgansazRvraSi. is SeiZleba iyos mcire TavSekavebuloba da socialuri ucnauroba, romelic bevr CvenTagans ugrZvnia axal situaciebSi, magram mas SeuZlia gadaizardos ukiduresobaSi _ adamianebis mimarT sruliad Semakavebel SiSSi (socialur fobias me-15 TavSi ganvixilavT). bevri morcxvi adamiani introvertirebulicaa. isini upiratesobas aniWeben ganmartovebul, arasocialur moqmedebebsa da garemos. arseboben morcxvi eqstravertebi~, romlebic sazogadoebaSi komunikabelurni, magram pirovnulad morcxvebi arian, amjobineben socialur aqtivobebSi CarTvas, aqvT socialuri unarebi amis efeqturad ganxorcielebisaTvis, magram eWvi eparebaT imaSi, rom namdvilad imsaxureben sxvebis mowonebasa da pativiscemas (Pilkonis & Zimbardo, 1979). maS ratom aris zogi adamiani morcxvi maSin, rodesac sxvebi ar arian? erTi SesaZlebeli axsnaa buneba. kvlevebi mowmobs, rom bavSvebis daaxloebiT 10% ibadeba morcxvi~ (Kagan, 1994). aseTi bavSvebi dabadebidan uCveulod frTxilni da Caketilni arian ucxo xalxTan da ucnob situaciebTan Sejaxebis dros. Semavsebeli (komplementaruli) axsna yuradRebas aRzrdaze amaxvilebs. bavSvobaSi zog adamians dascinian, masxrad igdeben, an raime Secdomis gamo isini sazogadoebrivi gakicxvis sagani xdebian; sxvebi izrdebian iseT ojaxebSi, sadac siyvarulis damsaxureba~ damokidebulia imaze, miaRwevs Tu ara bavSvi warmatebas garegnobisa da kargi qcevis SejibrSi. mesame axsna kulturas efuZneba. Seswavlili cxra qveynidan simorcxve yvelaze maRalia zog aziur qveyanaSi, gansakuTrebiT iaponiasa da taivanSi, da yvelaze dabalia israelSi (Zimbardo, 1991). es gansxvaveba, garkveulwilad, miewereba imas, rom am aziur

Tavi 14 / pirovneba

modiT, ganvixiloT kvleva, romelSic mravalferovani situaciebis fsiqologiur maxasiaTeblebs swavlobdnen. kvlevaSi ganixileboda is aqtivobebi, romlebsac bavSvebi sazafxulo banakSi axorcieleben.
simorcxve (Shyness) _ individis diskomforti da/an Sekaveba iseT interpersonalur situaciebSi, romlebic xels uSlis interpersonaluri an profesiuli miznebis miRwevas.

saidan viciT
konsistentoba verbalur agresiaSi es kvleva Catarda 6-dan 12-wlamde bavSvebis jgufze, romlebic socialuri adaptaciis problemebis mqone bavSvebisaTvis mowyobil sazafxulo banakSi gaagzavnes. mkvlevrebs surdaT enaxaT, Tu ramdenad

564

zustad SeeZloT maT im situaciaTa winaswarmetyveleba, romlebSic calkeuli bavSvebi agresiul qcevas gamoavlendnen. am winaswarmetyvelebaTa `gasakeTeblad~ mkvlevrebma Seagroves monacemebi banakis sxvadasxva situaciebis arsebiTi maxasiaTeblebis Sesaxeb, moTxovnis im tipebis mixedviT, romlebsac isini bavSvs uyenebdnen: kognituri (moiTxovs logikuri azrovnebis unars), socialuri (moiTxovs sxvebis winaSe saubris unars), TviTregulatoruli (moi-

Txovs frustraciis atanis unars), fizikuri siZliere (moiTxovs fizikur siZlieres, amtanobas) da motoruli koordinacia (moiTxovs xelisa da sxeulis moZraobebis koordinaciis unars). magaliTad, curva moiTxovs fizikur siZlieresa da koordinacias, magram SedarebiT mcire TviTregulacias. amis sapirispirod, Tevzaoba motorul koordinaciasTan erTad moiTxovs maRali donis TviTregulacias.

565

pirovnebis tipisa da niSnis Teoriebi

qveynebSi kultura ganapirobebs avtoritetisadmi damorCilebas da sircxvilis gancdas, Tu adamianma socialuri Secdoma dauSva; xolo israelSi, amis sapirispirod, Tu adamiani riskze midis, es kulturulad waxalisebulia da danaSaulis gancda eqsternalizirebulia (Pines & Zimbardo, 1978). meoTxe axsna nawilobriv exmaureba bolo dros SeerTebul StatebSi simorcxvis prevalentobis zrdas: axalgazrdebi intensiurad arian CarTulni eleqtronul teqnologiebTan muSaobaSi. didi drois gatareba, rogorc wesi, simartoveSi, televizoris yurebaSi, videoTamaSebSi, internetis Tvalierebasa da eleqtronuli fostis gzavnaSi socialur izolacias iwvevs da amcirebs yoveldRiur pirispir kontaqts. internetis intensiur gamoyenebas aqvs potenciali, adamianebs Tavi agrZnobinos martoxelad, izolirebulad da ufro morcxvad (Kraut et al., 1998; Nie & Erbring, 2000). rodesac simorcxve sul ufro Zlierdeba, is adamianis cxovrebis axal da axal aspeqtebSi iWreba, amcirebs socialur siamovnebebs da maqsimumamde mihyavs socia-

luri diskomforti da izolacia. arsebobs ramdenime martivi koncefcia da taqtika, romelTa Sesaxeb fiqrsa da gamoyenebis cdasac v Ta v a z o b T m o r c x v s t u dentebs (ix. Zimbardo, 1991): gaacnobiereT, rom marto Tqven ar xarT morcxvi; yvela sxva adamiani Tavisi morcxvobiT ufro Tqveni msgavsia, vidre Tqvengan gansxvavebuli; simorcxve SeiZleba maSinac ki Seicvalos, rodesac masSi genetikuri komponentia CarTuli, magram es moiTxovs Tavdadebasa da Secvlis ganzraxvas iseve, rogorc nebismieri xangrZlivad arsebuli Cveva, romlis Secvlac gsurT; ivarjiSeT gaRimebaSi da mxedvelobiTi kontaqtis damyarebaSi adamianTa umravlesobasTan, visac xvdebiT; ilaparakeT laRad, xmamaRali da mkafio xmiT, gansakuTrebiT maSin, rodesac Tqvens saxels eubnebiT vinmes an informaciis miReba gsurT; iyaviT pirveli, vinc SekiTxvas dasvams an komentars gaakeTebs axal socialur situaciaSi. saTqmelad momzadebuli gqondeT raime saintereso da TqviT es pirvelma; yvela afasebs adamians, vinc yinuls gaalRobs~, da

aRaravin ifiqrebs, rom Tqven morcxvi xarT; nu daimdablebT Tavs, aramed ifiqreT imaze, Tu ra SeiZleba gaakeToT Semdeg, rom TqvenTvis sasurveli Sedegi miiRoT; yuradReba gaamaxvileT i m a z e , r o m s x v e b s Ta v i komfortulad agrZnobinoT. gansakuTrebiT swored is sxva morcxvi adamianebi moZebneT. es Seamcirebs Tqvens TviTcnobirebas, rogorc morcxvi pirovnebis; gaivarjiSeT meditaciaSi, relaqsaciasa da idealuri scenaris gonebriv vizualizaciaSi, sanam aRmoCndebiT situaciaSi, romelic, Cveulebriv, aZlierebs Tqvens simorcxves. Tu Tqven morcxvi xarT, vimedovnebT, rom gaiziarebT am rCevebs. studentebi, romlebmac gaiTvaliswines es rCevebi, ganTavisufldnen morcxvobis tyveobidan da axali TavisuflebebiT~ savse cxovrebaSi Seabijes. es aris martivi fsiqologiis cxovrebaSi gamoyenebis erT-erTi upiratesoba. Tuki Tqven morcxvi ar xarT, SegiZliaT waaxalisoT Tqveni morcxvi megobrebi da ojaxis wevrebi, raTa maT am gziT Secvalon Tavisi cxovreba ( Henderson & Zimbardo , 1998).

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yuradReba miaqcieT im erTeulebs, sadamdec mividnen mkvlevrebi, raTa situaciebis relevanturi maxasiaTeblebi gamoeyvanaT. aseTi taqsonomia maT aZlevs iseTi gansxvavebebis gamovlenis saSualebas, rogoricaa sonias uWirs gamklaveba iseT situaciebTan, romlebsac maRali kognituri moTxovna aqvT. swored amitom xdeba is verbalurad agresiuli aseT situaciebSi~. Cven aRmovaCenT konsistentobas, rodesac pirovnebis (is ver umklavdeba kognitur moTxovnebs~) da situaciis (es situacia Seicavs kognitur moTxovnas~) swori aRwera gvaqvs. debatebma konsistentobis Sesaxeb aiZula niSnis Teoretikosebi, ufro zustad ganesazRvraT niSnebi _ dazustebiT gamoeyoT, Tu qcevis romeli jgufebi unda iyos dakavSirebuli pirovnul niSnebTan da romel situaciebSi. niSani SeiZleba gamoxatul iqnes gansxvavebuli qcevis meSveobiT gansxvavebul situaciebSi da gansxvavebul asakSi, magram, ramdenadac niSnis Teoria winaswarmetyvelebs imas, Tu ra gziT iwvevs situaciebis fsiqologiuri maxasiaTeblebi qceviT gamovlinebebs, es paterni logikurad gamarTulia. amgvarad, Tu Tqven aRwerT sakuTar Tavs, rogorc Zalian keTilganwyobil pirovnebas, es ar niSnavs imas, rom Tqvengan keTilganwyobil~ qcevas unda velodoT Tqveni cxovrebis yvela momentSi. Cveni molodiniT, Tqveni keTilganwyobileba gansxvavebuli iqneba sxvadasxvagvar situaciebSi maTi fsiqologiuri maxasiaTeblebis mixedviT. magaliTad, Tqven, SesaZloa, Zalian Tbili iyoT axloblebis

mimarT, magram oficialuri _ Tqveni profesorebis mimarT.

tipisa da niSnis Teoriebis Sefaseba


Cven vnaxeT, rom tipisa da niSnis Teoriebi mkvlevrebs SesaZleblobas aZlevs, mogvcen gansxvavebuli pirovnebebis lakonuri aRwera, Tumca, es Teoriebi gakritikebul iqna, radgan isini zogadad ar xsnian imas, Tu rogor warmoiqmneba qceva an rogor viTardeba pirovneba. isini mxolod gansazRvraven da aRweren maxasiaTeblebs, romlebic korelaciaSia qcevasTan. miuxedavad imisa, rom Tanamedrove niSnis Teoriis warmomadgenlebi cdiloben, Seexon am sakiTxebs, niSnis Teoriebi, rogorc wesi, aRweren amJamad arsebuli pirovnebis struqturis statikur , an, ukidures SemTxvevaSi, stabilizebul xats. amis sapirispirod, pirovnebis fsiqodinamikuri Teoriebi, romlebsac Cven axla ganvixilavT, xazs usvamen individis SigniT arsebul konfliqtur Zalebs, romlebic adamianis cvlilebasa da ganviTarebas iwveven.

Tavi 14 / pirovneba

Sejameba
tipis Teoriebi adamianebs aragadamfarav kategoriebad (rogoricaa pirvelad dabadebulni da Semdeg dabadebulni) yofen, raTa gakeTdes winaswarmetyveleba maTi pirovnebebis Sesaxeb.

amis sapirispirod, niSnis Teoriebi axdenen pirovnebis konceptualizacias uwyveti ganzomilebebis Sesabamisad. Tanamedrove mecnierebis azriT, arsebobs xuTi universaluri faqtori, romelic kros-kulturulad asaxavs pirovnebis ZiriTad ganzomilebebs: eqstraversia, TanxmobisaTvis mzaoba, patiosneba, neiroticizmi da gamocdilebisadmi Riaoba. qceviTi genetikis kvlevis mixedviT, pirovnuli niSnebi maRali xarisxis memkvidreobiTobiT xasiaTdeba. dResdReobiT mecnierebi aRiareben, rom qcevis konsistentobis kvleva moiTxovs rogorc pirovnebis, aseve situaciis fsiqologiuri maxasiaTeblebis zust aRweras.

fsiqodinamikuri Teoriebi
pirovnebis yvela fsiqodinamikuri TeoriisaTvis saerToa daSveba, rom Zlieri Sinagani Zalebi ayalibeben pirovnebas da qcevis motivirebas axdenen. zigmund froids (Sigmund Freud), fsiqodinamikuri Teoriebis fuZemdebels, misi biografi ernest jonsi fsiqikis darvins~ uwodebs (1953). froidis pirovnebis Teoria gabedulad cdilobs axsnas pirovnebis ganviTarebis sawyisi wyaroebi da mimarTuleba, fsiqikis buneba, paTologiuri pirovneba da Terapiis meSveobiT pirovnebis Secvlis gzebi. aq yuradRebas mxolod normalur pirovnebaze gavamaxvilebT. froidis Sexedulebebi fsiqopaTologiasa da mkurnalobaze me-15 da me-16 TavebSi iqneba ganxiluli, ris Semdegac am Teoriebis kritikasa da gadamuSavebis mcdelobebs aRvwerT.

motivacia aracnobier donezec moqmedebs. am midgomis fsiqodinamikuri buneba momdinareobs misi aqcentidan qcevis am Sida wyaroebze, iseve, rogorc am Sida Zalebs Soris konfliqtebze. froidisaTvis yovelgvar qcevas aqvs motivi, mas ar iwvevs SemTxveviTi movlenebi; yvela moqmedeba gansazRvrulia motivebiT. nebismier adamianur moqmedebas aqvs mizezi da mizani, romelic SeiZleba aRmoCenil iqnes azrebis asociaciebis, sizmrebis, Secdomebisa da Sinagan vnebebze metyveli sxva qceviTi miniSnebebis analizis Sedegad. pirovnebis Sesaxeb froidis hipoTezebis pirveladi monacemebi miRebul iqna Terapiis procesSi myof individualur pacientebze warmoebuli klinikuri dakvirvebebidan da SemTxvevebis siRrmiseuli Seswavlidan. fsiqikuri aSlilobebis mqone adamianebis intensiuri Seswavlis Sedegad man ganaviTara normaluri pirovnebis Teoria. modiT, ganvixiloT froidis Teoriis zogierTi yvelaze mniSvnelovani aspeqti.

froidis fsiqoanalizi
fsiqoanalitikuri Teoriis mixedviT, pirovnebis birTvs adamianis fsiqikaSi arsebuli movlenebi (intrafsiqikuri movlenebi) qmnis, romlebic qcevis motivs warmoadgenen. xSirad adamianebi acnobiereben am motivebs, Tumca, zogi
pirovnebis fsiqodinamikuri Teoriebi (Psychodynamic personality theories) _ pirovnebis Teoriebi, romlebic iziareben daSvebas, rom pirovnebis formireba da misi qcevis motivireba xdeba Zlieri Sinagani Zalebis mier.

ltolvebi da fsiqoseqsualuri ganviTareba


nevrologiaSi samedicino praqtikam froidi miiyvana Teoriul daSvebamde, rom im qcevebs, romelTac is Tavis pacientebSi akvirdeboda, saerTo biologiuri safuZveli hqondaT. adamianuri moqmedebebis motivaciis wyarod man yvela individSi arsebuli fsiqikuri energia miiCnia. man dauSva, rom yvela adamians unda hqonoda Tandayolili instinqtebi anu ltolvebi (drives),

fsiqodinamikuri Teoriebi

567

romlebic warmoadgenda sxeulSi arsebuli organoebis mier Seqmnil daZabulobis sistemebs. aqtivaciis dros energiis es wyaroebi SeiZleba gamovlindes mravali gansxvavebuli gziT. froidma Tavdapirvelad ori bazisuri ltolvis arseboba dauSva. erTi, misi azriT, dakavSirebuli iyo TviTSenaxvasTan (iseT moTxovnilebebTan, rogoricaa SimSili da wyurvili); meores man uwoda erosi, Zala, dakavSirebuli seqsualur impulsebTan da saxeobis SenarCunebasTan. am ori ltolvidan froids ufro metad seqsualuri impulsebi ainteresebda. man Zalze gaafarTova adamianis seqsualuri survilebis cneba da Sig CarTo ara marto seqsualuri kavSiris survili, aramed yvela sxva siamovnebis miRebis an sxvebTan fizikuri kontaqtis damyarebis mcdelobac. igi iyenebda termins libido (libido) seqsualuri impulsebis energiis wyaros gansasazRvrad. libido aris fsiqikuri energia, romelic migvmarTavs yvela saxis SegrZnebiTi (sensualuri) siamovnebisaken. seqsualuri impulsebi dauyovnebliv dakmayofilebas moiTxoven, iqneba es pirdapiri moqmedebebis Tu fantaziebisa da sizmrebis msgavsi arapirdapiri saSualebebis gziT. froidis mixedviT, erosi, rogorc farTod gansazRvruli seqsualuri ltolva, ar Cndeba
libido (Libido) _ fsiqikuri energia, romelic mimarTavs individs yvela tipis SegrZnebiTi, gansakuTrebiT ki, seqsualuri siamovnebisaken

moulodnelad pubertatis (sqesobrivi momwifebis) dros, aramed moqmedebs dabadebidan. igi amtkicebda, rom erosi TvalsaCinod vlindeba im siamovnebaSi, romelsac Cvilebi iReben genitaliebis da sxva mgrZnobiare areebis, anu erogenuli zonebis fizikuri stimulaciiT. froidis fsiqoseqsualuri ganviTarebis xuTi safexuri moyvanilia cxrilSi 14.2. is Tvlida, rom seqsualuri siamovnebis fizikuri wyaro icvleba am mowesrigebuli progresiiT. fsiqoseqsualuri ganviTarebis erT-erTi mTavari winaaRmdegoba, yovel SemTxvevaSi biWebisaTvis, aRmocendeba falosur stadiaze, 4-5 wlis asakSi, rodesac bavSvma unda gadalaxos oidiposis kompleqsi . froidma am kompleqss miTiuri personaJis, oidiposis saxelwodeba misca, romelmac SemTxveviT mokla sakuTari mama da colad SeirTo sakuTari deda. froidis azriT, yvela patara biWs aqvs Tandayolili impulsi, ganixilos mama, rogorc seqsualuri metoqe dedis yuradRebisaTvis brZolaSi. radgan patara biWs ar ZaluZs mamis Secvla, oidiposis kompleqsi zogadad gadawydeba, rodesac bavSvi axdens identifikacias mamis siZlieresTan (froidi araTanmimdevruli iyo patara gogonebis gamocdilebis Teoriul axsnaSi). froidis mixedviT, rogorc zedmeti dajildoeba, ise zedmeti frustracia fsiqoseqsualuri ganviTarebis romelime adreul stadiaze, fiqsacias _ ganviTarebis momdevno stadiaze normalurad gadasvlis uunarobas iwvevs. rogorc

cxrili

14.2
ffsiqoseqsualuri ganviTarebis stadiebi froidis mixedviT

stadia
oraluri

asaki
0-1

erogenuli zonebi
piri, tuCebi, ena anusi

mTavari ganviTarebadi mizani am stadiaze fiqsirebuli bavSvebis (konfliqtis potenciuri wyaro) zogierTi maxasiaTebeli zrdasrulobaSi
ZuZuTi kvebis Sewyveta oraluri qceva, rogoricaa moweva, zedmeti kveba, inertuloba da miamitoba akuratuloba (meToduroba), Zunwoba, jiutoba, an sapirispiro pativmoyvareoba, ugunuroba, an sapirispiro arc erTi: Cveulebriv, fiqsacia am safexurze ar xdeba zrdasrulebma, vinc normalurad moaxdina adreuli stadiebis integrireba, unda ganaviTaron sxvebis mimarT gulwrfeli interesi da mowifuli seqsualoba.

Tavi 14 / pirovneba

analuri

2-3

tualetis varjiSi/ qoTanze miCveva oidiposis kompleqsi dacviTi meqanizmebis ganviTareba mowifuli seqsualuri urTierToba

falosuri latenturi

4-5 6-12

genitaliebi ar arsebobs specifikuri are genitaliebi

genitaluri

13-18

568

naCvenebia cxrilSi 14.2, sxvadasxva stadiebze fiqsaciam zrdasrulobaSi SeiZleba warmoqmnas mravalferovani pirovnuli maxasiaTeblebi. fiqsaciis cneba xsnis imas, Tu ratom aniWebda froidi adreul gamocdilebebs aseT mniSvnelobas pirovnebis mTlianobaSi. igi Tvlida, rom fsiqoseqsualuri ganviTarebis adreul safexurebze miRebul gamocdilebas udidesi gavlena hqonda pirovnebis Camoyalibebaze da zrdasrulis qceviT paternebze.

fsiqikuri determinizmi
fiqsaciis cneba pirvel warmodgenas gviqmnis froidis mosazrebaze, rom adreuli konfliqtebi Semdgomi qcevis gansazRvras uwyobs xels. fsiqikuri determinizmi warmoadgens daSvebas, rom yvela fsiqikuri da qceviTi reaqcia (simptomi) gansazRvrulia adreuli gamocdilebiT. froidis azriT, simptomebi ar aris SemTxveviTi movlenebi, piriqiT, isini mniSvnelovnad aris dakavSirebuli cxovrebis mniSvnelovan movlenebTan. fsiqikuri determinizmis rwmenam miiyvana froidi iqamde, rom man gansakuTrebiT gamoyo aracnobieri _ sacavi informaciisa, romelic xelmiuwvdomelia cnobierebisaTvis. sxva avtorebs ganxiluli hqondaT aracnobieris konstruqti, magram froidma adamianuri fiqrebis, grZnobebis da moqmedebebis aracnobieri determinantis cneba adamianis cxovrebis centrSi moaTavsa. misi azriT, qceva SeiZleba motivirebul iqnes ltolvebiT, romelTa Sesaxebac adamianma araferi icis. Tqven SeiZleba moqmedebdeT mizezis codnis gareSe, an Tqveni moqmedebebis WeSmariti mizezis wvdomis SesaZleblobis gareSe. arsebobs Tqveni qcevis manifestirebuli Sinaarsi _ ras ambobT, ras
fiqsacia ( Fixation ) _ mdgomareoba, rodesac adamiani rCeba mijaWvuli iseT obieqtebsa Tu moqmedebebze, romlebic fsiqoseqsualuri ganviTarebis adreul safexurs ufro Seesabameba. fsiqikuri determinizmi (Psychic determinism) _ daSveba, rom fsiqikuri da qceviTi reaqciebi gansazRvrulia adrindeli gamocdilebiT. aracnobieri ( Unconscious) _ fsiqikis sfero, sadac inaxeba cnobierebidan gandevnili, represirebuli survilebi da primitiuli impulsebi

akeTebT da ras aRiqvamT, romlis Sesaxebac Tqven sruli codna gaqvT, magram arsebobs, aseve, faruli, latenturi Sinaarsic. nevrotuli (SfoTviT gamowveuli) simptomebis, sizmrebis, werilobiTi da metyvelebiTi mcdari qmedebebis mniSvneloba azrovnebisa da informaciis gadamuSavebis aracnobier doneze unda veZioT. dRes bevri fsiqologi aracnobieris am cnebas froidis yvelaze mniSvnelovan wvlilad miiCnevs fsiqologiis mecnierebaSi. agreTve, Tanamedrove literaturisa da dramaturgiis bevri nimuSi ikvlevs aracnobieri procesebis gavlenas adamianis qcevaze. froidis mixedviT, CvenSi arsebuli impulsebi, romlebic CvenTvis miuRebelia, mainc cdiloben gamoxatvis gzis povnas. froidiseuli mcdari qmedeba xdeba, rodesac Cveni saubari an qceva gascems aracnobier survils. magaliTad, am wignis erT-erTi avtori valdebuli iyo, samadlobelo baraTi daewera, Tumca is ar iyo didad kmayofili megobris saxlSi gatarebuli SabaT-kviriT; igi apirebda, daewera: mixaria, rom aseTi magari dro gavatareT erTad~. miuxedavad amisa, sakmaod usiamovno satelefono saubris dros megobarma Seatyobina, rom sinamdvileSi mas dauweria: mixaria, rom aseTi nagavi dro gavatareT erTad~.2 xedavT, Tu rogor SeuZlia magari~-s nagavi~-T Secvlas aracnobieri survili gamoxatos? aracnobieri motivaciis cneba axal ganzomilebas matebs pirovnebas, ramdenadac uSvebs fsiqikuri funqcionirebis ufro did sirTules. Cven ganvixileT froidis Teoriis zogierTi ZiriTadi aspeqti. axla vnaxoT, Tu ra wvlili SeaqvT maT pirovnebis struqturaSi.

froidis TeoriaSi pirovnuli gansxvavebebi im gansxvavebuli gzebidan warmoiqmneba, romlebiTac adamianebi umklavdebian Tavis ZiriTad ltolvebs. am gansxvavebebis asaxsnelad froidma warmogvidgina uwyveti brZola pirovnebis or antagonistur nawils _ idsa da superegos _ Soris, romelsac aSualebs me-s mesame aspeqti _ ego. miuxedavad imisa, rom am sam aspeqts ise ganvixilavT, TiTqos isini
`I m glad we got to spend a junk of time together~ nacvlad `Im glad we got to spend a chunk of time together~.
2

569

fsiqodinamikuri Teoriebi

pirovnebis struqtura

gancalkevebuli arsebebi iyvnen, gaxsovdeT, rom froidisTvis isini mxolod gansxvavebul fsiqikur procesebs warmoadgendnen; igi ar gansazRvravda gansakuTrebul mdebareobebs tvinSi idisaTvis, egosaTvis da superegosaTvis. idi aris ZiriTadi ltolvebis sacavi. is iracionalurad operirebs, moqmedebs impulsurad da ubiZgebs gamoxatvisaken da dauyovnebeli siamovnebisaken imis gaTvaliswinebis gareSe, aris Tu ara is, rac mas surs realurad SesaZlebeli, socialurad sasurveli anda moralurad misaRebi. ids marTavs siamovnebis principi, siamovnebis umarTavi Zieba, gansakuTrebiT seqsualuri, fizikuri da emociuri siamovnebisa, romelic unda iyos gancdili aq da amJamad, Semdgom Sedegebze zrunvis gareSe. superego warmoadgens individis mier sazogadoebisagan naswavli Rirebulebebis sacavs, moraluri damokidebulebebis CaTvliT. superego, uxeSad rom vTqvaT, sindisis zogad cnebas Seesabameba. is viTardeba, rodesac bavSvi sakuTar Rirebulebebad iRebs mSoblebis da sxva ufrosebis akrZalvebs socialurad arasasurvel qcevasTan dakavSirebiT. es aris unda-s da ar unda-s Sinagani xma. superego, aseve, moicavs egos ideals, individis warmodgenas iseT pirovnebaze, rogoradac Camoyalibebas igi unda cdilobdes. amdenad, superego xSirad konfliqtSia idTan. ids unda imis gakeTeba, rac
idi (Id) _ pirovnebis primitiuli, aracnobieri nawili, romelic iracionalurad funqcionirebs da impulsurad moqmedebs siamovnebis misaRwevad. superego (Superego) _ pirovnebis aspeqti, romelic warmoadgens sazogadoebrivi Rirebulebebis, standartebisa da moralis internalizacias. ego (Ego) _ pirovnebis aspeqti, romelic monawileobs TviTdacvaSi da mimarTavs instinqtur ltolvebsa da impulsebs Sesabamis arxebSi. represia anu gandevna (Repression) _ ZiriTadi dacvis meqanizmi, romliTac mtkivneuli an danaSaulis gancdis gamomwvevi azrebi, grZnobebi an mogonebebi ganidevneba cnobierebidan. egos dacvis meqanizmebi (Ego defence mechanisms) _ fsiqikuri strategiebi (cnobieri an aracnobieri), romlebsac ego iyenebs cxovrebis normaluri mimdinareobisas gancdili konfliqtebisagan TavdacvisaTvis.

siamovnebas mianiWebs maSin, rodesac superego daJinebiT iTxovs imis gakeTebas, rac sworia. ego aris me-s realobaze dafuZnebuli aspeqti, romelic gansjis, agvarebs konfliqtebs idis impulsebsa da superegos moTxovnebs Soris. ego warmoadgens individis pirad Sexedulebebs fizikur da socialur realobaze, mis cnobier warmodgenebs qcevis mizezebsa da Sedegebze. egos saqmianobis nawilia iseTi moqmedebebis arCeva, romlebic daakmayofilebs idis impulsebs arasasurveli samomavlo Sedegebis gamowvevis gareSe. egos marTavs realobis principi, romelic racionalur arCevans siamovnebis miRebis moTxovnebze maRla ayenebs. amgvarad, ego Seakavebs gamocdaze motyuebis impulss, am tyuilSi gamoWeris SemTxvevaSi samomavlo Sedegze zrunvis gamo, da is Caanacvlebs am impulss momavalSi ufro kargad swavlis, an maswavleblis simpaTiis gamowvevis gadawyvetilebiT. rodesac idi da superego konfliqtSi imyofebian, ego iseT kompromiss poulobs, romelic nawilobriv daakmayofilebs orives; Tumca, rodesac idis da superegos zewola Zlierdeba, egosaTvis ufro Zneli xdeba optimaluri kompromisebis gamoZebna.

represia (gandevna) da egos dacva


xandaxan idsa da superegos Soris kompromisi idis gegmebis srul CaSlas gulisxmobs. ukiduresi, eqstremaluri survilebi ganidevnebian cnobieridan aracnobierSi. represia, anu gandevna fsiqologiuri procesia, romelic icavs individs gamoxatvisaTvis miuRebeli da/an saxifaTo impulsebis, ideebisa Tu mogonebebis gamo gancdilis ukiduresi SfoTvisa an danaSaulis gancdisagan. egom araferi icis rogorc gandevnili fsiqikuri Sinaarsis, aseve im procesis Sesaxeb, romliTac represia inaxavs informacias cnobieris farglebs gareT. represia ganixileba erT-erT ZiriTad saSualebad im mravalTa Soris, romlebiTac ego icavs Tavs muqaris Semcveli impulsebisa da ideebis mozRvavebisagan. egos dacvis meqanizmebi aris fsiqikuri strategiebi, romlebsac ego idis gamoxatvis maZiebel impulsebsa da superegos mier am impulsebis uaryofis moTxovnebs Soris arsebuli yoveldRiuri konfliqtebisagan Tavis dasacavad

570

Tavi 14 / pirovneba

iyenebs (ix. cxrili 14.3). fsiqoanalitikur TeoriaSi iTvleba, rom am meqanizmebs sasicocxlo mniSvneloba aqvT individis fsiqologiur gamklavebaSi Zlier Sinagan konfliqtebTan. maTi gamoyenebiT pirovnebas SeuZlia SeinarCunos sakuTari me-s sasiamovno, mosaxerxebeli xati da, aseve, misaRebi socialuri xati. magaliTad, Tu bavSvs Zlieri siZulvilis grZnoba aqvs mamis mimarT, romelic, Tu gamoxatvis gzas naxavs, saxifaTo iqneba, gandevna moagvarebs amas, SeiZleba sZlios mas. Semdgom es mtruli impulsi cnobierad aRar iTxovs dakmayofilebas da misi arsebobac ki ar aris aRiarebuli. Tumca, miuxedavad imisa, rom impulsi ar Cans da misi xmac ar ismis, is ar gaqra; es grZnobebi kvlavac TamaSoben rols pirovnebis funqcionirebaSi. magaliTad, mamasTan Zlieri identifikaciiT bavSvma SeiZleba aimaRlos TviTRirebulebis gancda da Seamciros aracnobieri SiSi, rom masSi mtrul ganzraxvas aRmoaCenen. froidis TeoriaSi SfoTva aris intensiuri emociuri pasuxi, aRZruli maSin, rodesac gandevnili konfliqti apirebs cnobierSi amosvlas. SfoTva xifaTis niSania: _ gandevna ar muSaobs! inTeba wiTeli Suqi! saWiroa meti

dacva! droa, amoqmeddes dacvis meore xazi, egos erTi an meti dacvis meqanizmi, romlebic Seamcireben SfoTvas da gandevnian arasasiamovno impulsebs ukan aracnobierSi. magaliTad, dedam, romelsac ar moswons Tavisi vaJiSvili da ar surs masze zrunva, SeiZleba gamoiyenos reaqciis formacia, romelic mis miuRebel impulss sawinaaRmdegoSi gadaiyvans: me ar mZuls Cemi bavSvi~ gaxdeba me miyvars Cemi bavSvi. xedavT, rogori siyvaruliT vzrunav masze?~ dacvis aseTi xerxebi SfoTvis SemsubuqebaSi gadamwyvet, gamklavebis funqcias asruleben. Tu dacviTi meqanizmebi gvicaven SfoTvisagan, ratom aris, rom maT mainc SeiZleba uaryofiTi Sedegebi mogvitanon? ramdenad gamosadegic ar unda iyvnen isini, egos dacvis meqanizmebi imTaviTve Tavis motyuebaa. maTi gadaWarbebuli gamoyenebis SemTxvevaSi isini ufro met problemebs iwveven, vidre wyveten. fsiqologiurad arajansaRia didi droisa da fsiqikuri energiis daxarjva miuRebeli impulsebis lavirebaSi, dafarvasa da sxva arxisken warmarTvaSi SfoTvis
SfoTva (Anxiety) _ intensiuri emociuri reaqcia, gamowveuli winarecnobieri aRqmiT imisa, rom represirebuli konfliqti apirebs cnobierebaSi amosvlas.

cxrili

14.3
egos dacvis mTavari meqanizmi
me-s dacva arasasiamovno realobisagan mis aRqmaze uaris TqmiT Sekavebuli grZnobebis (rogoricaa, magaliTad, mtruloba) gadatana imaze nakleb saxifaTo obieqtze, romelmac Tavidan gamoiwvia emocia; frustrirebuli survilebis dakmayofileba warmosaxul miRwevebSi (gavrcelebuli formaa ocneba~); TviTRirebulebis grZnobis gaZliereba sxva (cnobil) adamianTan an sazogadoebasTan identifikaciiT;

realobis uaryofa Canacvleba fantazia identifikacia izolacia

proeqcia racionalizacia reaqciis formacia regresia represia sublimacia

sakuTari sirTuleebisaTvis bralis sxvebze gadatana an sakuTari akrZaluli~ survilebis sxvebisaTvis mikuTvneba; imis damtkicebis mcdeloba, rom sakuTari qceva racionaluria~ da gamarTlebadi da, amdenad, sakuTarsa da sxvebis mowonebas imsaxurebs; saxifaTo survilebis gamoxatvis SeCereba sawinaaRmdego damokidebulebisa da qcevis tipebis ganxorcielebiT da maTi rogorc `barierebis~ gamoyenebiT; ganviTarebis adreul doneze dabruneba, rac gulisxmobs ufro bavSvur pasuxebsa da, rogorc wesi, aspiraciis ufro dabal dones; mtkivneuli an saxifaTo azrebis gandevna cnobieridan, maTi aracnobierSi Senaxva. es iTvleba yvelaze Zireul dacvis meqanizmad; frustrirebuli seqsualuri survilebis dakmayofileba an maTgan ganTavisufleba kulturaSi socialurad miRebuli CanacvlebiTi araseqsualuri moqmedebebiT.

fsiqodinamikuri Teoriebi

saziano situaciidan emociuri muxtis moSoreba an SeuTavsebeli damokidebulebis danawevreba logikurad dakavSirebul nawilebad (SeCereba konfliqturi damokidebulebebisa, romlebic arasodes warmogvidgeboda, rogorc erTdrouli an erTmaneTTan dakavSirebuli). aseve uwodeben danawevrebas;

571

Semcirebis mizniT. aseTi qmedeba cota energias tovebs produqtuli cxovrebisaTvis da damakmayofilebeli adamianuri urTierTobebisTvis. zogierTi fsiqikuri daavadeba SfoTvis SemcirebisaTvis dacvis meqnizmebis gadaWarbebuli gamoyenebis Sedegia, rogorc fsiqikuri aSlilobebisadmi miZRvnil TavSi vnaxavT.

froidis Teoriis Sefaseba


Cven didi adgili davuTmeT fsiqoanalitikuri Teoriis aRweras, radgan froidis ideebs uzarmazari gavlena hqonda imaze, Tu ras fiqrobs mravali fsiqologi pirovnebis normaluri da paTologiuri aspeqtebis Sesaxeb, Tumca, froidis cnebebs ufro meti kritikosi hyavs fsiqologTa Soris, vidre momxre. ras efuZneba maTi kritika? pirvel rigSi, fsiqoanalitikuri cnebebi bundovania da ar aris operaciulad gansazRvruli; rTulia Teoriis didi nawilis mecnierulad Sefaseba, radgan SeuZlebelia zogierTi misi centraluri hipoTezis uaryofa da, amdenad, froidis Teoria saeWvo xdeba. rogor unda iyos pirdapiri gziT Seswavlili cnebebi libido, pirovnebis struqtura da infantiluri seqsualuri impulsebis represia? meore, amave sakiTxTan dakavSirebuli kritika isaa, rom froidis Teoria warmoadgens karg monaTxrobs, magram cud mecnierebas. is sandod ver winaswarmetyvelebs, ra moxdeba; is retrospeqtulad gamoiyeneba mas Semdeg, rac movlenebi moxda. pirovnebis gagebisaTvis fsiqoanalitikuri Teoriis gamoyeneba, rogorc wesi, moicavs istoriul rekonstruqcias da ara _ SesaZlebeli moqmedebebis da winaswarmetyvelebadi Sedegebis mecnierul konstruqcias. garda amisa, mimdinare qcevis istoriuli warmoSobis gadaWarbebuli xazgasmiT es Teoria ar uTmobs yuradRebas amJamindel stimulebs, romlebic SeiZleba iwvevdnen da inarCunebdnen qcevas. arsebobs froidis Teoriis kidev sami mTavari kritika: pirveli _ is ganviTarebis Teoriaa, magram arasodes moicavda bavSvebze dakvirvebebsa da kvlevebs; meore _ travmatuli gamocdilebis (rogoricaa bavSvebis Seuracxyofa) Sesaxeb mogonebebis reinterpretaciiT da maTTvis fantaziebis darqmeviT (rac efuZneba bavSvis mSobel-

Tan seqsualuri kontaqtis survils) mas minimumamde dahyavs am gamocdilebis mniSvneloba; mesame _ am Teorias androcentruli (mamakaczecentrirebuli) gadaxra aqvs, radganac is normad kacis models iyenebs da arc ki cdilobs, gansazRvros, Tu ra gansxvaveba SeiZleba arsebobdes qalebis SemTxvevaSi. miuxedavad zemoTqmulisa, froidis Teoriis zogierTi aspeqti axlac aRiarebulia, ramdenadac isini modificirda da gaumjobesda empiriuli kvlevebis Sedegad. magaliTad, me-6 TavSi vnaxeT, rom Tanamedrove mecnierebi sistematurad ikvleven aracnobieris cnebas (Baars & McGovern, 1996; Westen, 1998). es kvlevebi aCvenebs, rom Cveni yoveldRiuri gamocdilebis did nawils Cveni cnobierebis miRma myofi procesebi ayalibeben. es Sedegebi adasturebs froidis zogad koncefcias, magram asustebs kavSirs aracnobier procesebsa da fsiqopaTologias Soris: _ aracnobieri codna sulac ar gamoiwvevs SfoTvas an tanjvas. aseve, mkvlevrebma daadastures fsiqikis zogierTi Cvevis arseboba, romlebsac froidma dacvis meqanizmebi uwoda (Hentschel et al., 1993; Singer, 1990).

saidan viciT
individualuri gansxvavebebi dacvis meqanizmebis gamoyenebaSi zemoT davuSviT, rom mosalodnelia, individebma gamoiyenon dacvis meqanizmebi maSin, rodesac isini SfoTvas ganicdian. mkvlevrebma es hipoTeza mravalferovani meTodebiT Seamowmes. erT-erTi mkvlevari swavlobda im xarisxs, romliTac axalgazrda mozrdili (23 wlis) adamianebis jgufma miaRwia zrdasrulobis stabilur identobas (gaixseneT me-11 Tavidan, rom erik eriksonis mixedviT, identobis gansazRvra aris krizisi~, romelic adamianebma mozardobis dasrulebisaTvis unda gadalaxon). am jgufis zogierT individs miRweuli hqonda identuroba, zogi ki jer kidev krizisis mdgomareobaSi iyo. Tu es krizisi SfoTvas iwvevs, Cveni molodini unda yofiliyo, rom krizisSi myofi jgufi ufro xSirad gamoiyenebda dacvis meqaniz-

572

Tavi 14 / pirovneba

mebs. am hipoTezis Sesamowmeblad, mkvlevari sTxovda axalgazrdebs, SeeTxzaT moTxrobebi Tematuri apercefciis testis baraTebze dayrdnobiT (ix. Tavi 12). cdis pirTa monaTxrobebi gaaanalizes iseTi dacvis meqanizmebis aRmosaCenad, rogoricaa uaryofa da proeqcia (ix. cxrili 14.3). analizma daadastura hipoTeza: _ im individebis SemTxvevaSi, visac jer miRweuli ar hqonda identoba, TvalsaCino iyo meti midrekileba dacvis meqanizmebis gamoyenebisaken (Cramer, 1997). me-13 TavSi aRwerili stresis daZlevis zogierTi stili dacvis meqanizmebis zogad kategoriaSi xvdeba. Tqven SeiZleba gaixsenoT, rom pirovnul travmebTan, danaSaulis an sircxvilis gamocdilebasTan dakavSirebuli azrebisa da grZnobebis Sekavebam SeiZleba gamanadgurebeli zemoqmedeba moaxdinos fsiqikur da fizikur janmrTelobaze (Pennebaker, 1990; Petrie et al., 1998). es aRmoCenebi exmaureba froidis mosazrebebs, rom represirebul fsiqikur masalas SeuZlia fsiqikuri distresis gamowveva. froidis Teoria normaluri da paTologiuri pirovnebis funqcionirebis Sesaxeb yvelaze ufro rTuli, yovlismomcveli da daumarcxebeli xedvaa maSinac ki, rodesac misi winaswarmetyvelebebi mcdaria. yvela sxva Teoriis msgavsad, froidis Teorias saukeTesod epyrobian, rogorc Teorias, romelic unda dadasturdes, an ar dadasturdes misi Semadgeneli elementebis mixedviT. froidi inarCunebs gavlenas Tanamedrove fsiqologiaze, radgan zogi misi idea farTodaa miRebuli, sxvebi ki uaryofil iqna. misi Teoriis zogierTi adreuli revizia misi studentebis wreSi daiwyo. vnaxoT, Tu rogor cdilobdnen isini froidis mosazrebebis Sesworebas.

koreqtivebi pirovnebis fsiqoanalitikur xedvaSi. zogadad, am post-froidianelebma Semdegi cvlilebebi Semoitanes: maT meti aqcenti gaakeTes egos funqciebze, egos dacvebis, me-s ganviTarebis, cnobieri azrovnebis procesebisa da pirovnebis Zalauflebis CaTvliT; maTi azriT, socialuri cvladebi (kultura, ojaxi da Tanatolebi) ufro did rols TamaSoben pirovnebis CamoyalibebaSi; isini nakleb aqcents akeTeben zogadi seqsualuri impulsebis, anu libidos energiis mniSvnelobaze; maT pirovnebis ganviTareba bavSvobis miRma mTeli sicocxlis manZilze ganavrces. Cven mimovixilavT alfred adleris, karen hornis da karl iungis Teoriebis sakvanZo debulebebs. alfred adlerma (Alfred Adler, 1929) uaryo erosisa da siamovnebis principis mniSvneloba. adleris azriT, umweo, sxvebze damokidebuli patara bavSvis msgavsad, yvela adamiani ganicdis inferiorobis (anu arasrulfasovnebis) grZnobas. is amtkicebda, rom yvelas cxovrebaSi dominirebs am grZnobis daZlevis gzebis Zieba. adamianebi axdenen am grZnobis kompensacias adekvaturobis grZnobis miRweviT an, ufro xSirad, gadaWarbebiT kompensacias superiorobis (anu Warbi TviTSefasebis ) miRwevis mcdelobiT. pirovneba struqturirebulia am miswrafebis irgvliv; adamianebi cxovrebis stils inferiorobis bazisuri, yovlismomcveli grZnobis daZlevis konkretul gzebze dayrdnobiT aviTareben. pirovnebis konfliqti Cndeba eqsternaluri garemoebebis zewolasa da adekvaturobisaken internalur miswrafebas Soris SeuTavseblobis gamo da ara adamianis SigniT SejibrebaSi myofi impulsebis gamo. karen horni (Karen Horney) fsiqoanalitikur skolaSi aRizarda, magram ramdenime mimarTulebiT ganudga orTodoqsul froidistul Teorias. igi daupirispirda froidis falocentristul aqcents penisis mniSvnelobaze da Seqmna Teoria, romlis mixedviTac mamakacuri Suri orsulobis, dedobis, mkerdisa da ZuZuTi kvebis mimarT biWebisa da kacebis aracnobieris dinamikur Zalas warmoadgens. am saSvilosnos Surs~ mihyavs mamakacebi qalebis gaufasurebisken da

post-froidistuli Teoriebi
zogierTma maTganma, vinc froidis Semdeg movida kvleviT asparezze, SeinarCuna pirovnebis miseuli xedva, rogorc brZolis velisa, romelzec aracnobieri sawyisi impulsebi ebrZvian socialur Rirebulebebs, Tumca, froidis inteleqtualuri STamomavlebidan bevrma Seitana

fsiqodinamikuri Teoriebi

573

kreatul muSaobaze mimarTuli aracnobieri impulsebiT gadaWarbebuli kompensaciisaken. hornim, aseve, froidze metad gausva xazi kulturul faqtorebs da yuradReba gaamaxvila amJamindeli xasiaTis struqturaze da ara _ infantilur seqsualobaze (Horney, 1937, 1939). vinaidan hornim humanisturi Teoriebis ganviTarebazec moaxdina gavlena, mis ideebs Semdeg qveTavSi davubrundebiT. karl iungma (Carl Jung, 1959) didad gaafarTova aracnobieris cneba. misTvis aracnobieri ar iyo SezRuduli individis unikaluri cxovrebiseuli gamocdilebiT, aramed, aseve, aRsavse iyo Zireuli fsiqologiuri WeSmaritebebiT, romelsac mTeli adamianuri rasa iziarebs, koleqtiuri aracnobieriT. koleqtiuri aracnobieri xsnis Tqven mier primitiuli miTebis,
Tavi 14 / pirovneba

xelovnebis formebisa da simboloebis intuitur gagebas, romlebic yofis universalur arqetipebs warmoadgenen. arqetipi aris konkretuli gamocdilebis an obieqtis primitiuli simboluri warmodgena, reprezentacia. yoveli arqetipi asocirebulia mis Sesaxeb grZnobisa da fiqris, an misi gansakuTrebuli gziT gancdis instinqtur tendenciasTan. iungma mravali arqetipi moiyvana istoriidan da miTologiidan: mze RmerTi, gmiri, dedamiwa. animusi iyo mamrobiTi arqetipi maSin, rodesac anima _ mdedrobiTi da yvela qali da kaci ganicdida orive arqetips gansxvavebuli xarisxiT. me-s arqetipia mandala, anu jadosnuri wre, romelic simbolurad asaxavs erTianobisa da mTlianobisken swrafvas (Jung, 1973). iungs janmrTeli, integrirebuli pirovneba warmoedgina, rogorc iseTi urTierTsawinaaRmdego Zalebis balansireba, rogoricaa maskulinuri agresia da femininuri mgrZnobiaroba. pirovnebis, rogorc dinamikur balansSi myofi kompensatoruli Sinagani Zalebis konstelaciis, xedvas analitikuri fsiqologia ewoda. garda amisa, iungma uaryo libidos pirveladi mniSvneloba, romelic esoden centraluri iyo froidis TeoriisaTvis. man daamata ori Tanabrad Zlieri aracnobieri instinqti: qmnis, kreatulobis moTxovnileba da koherentul, mTlian individad Camoyalibebis moTxovnileba. Semdeg qveTavSi humanisturi Teoriebis Sesaxeb vnaxavT am meore moTxovnilebis paralels TviTaqtualizaciis cnebaSi.

Sejameba
froidis fsiqoanalitikuri Teoria yuradRebas amaxvilebs ideaze, rom yvela qceva motivirebulia da motivacia xSirad aracnobier doneze operirebs. libido warmoadgens motivaciis mniSvnelovan wyaros. pirovnebis ganviTarebasTan erTad seqsualuri energia gamoixateba erogenuli zonebis TanmimdevrobiT. im pacientebis SeswavliT, romelTa simptomebi adreuli cxovrebis movlenebs asaxavdnen, froidma Camoayaliba fsiqikuri determinizmis Teoria. misi Teoriis mixedviT, superegos moraluri winamZRoloba da egos realuri bazisi cdiloben, Seamciron idis Seupovari miswrafeba

koleqtiuri aracnobieri (Collective unconscious) _ individis aracnobieris nawili, romelic Tandayolilia, evoluciuradaa Camoyalibebuli da saerToa saxeobis yvela warmomadgenlisaTvis. arqetipi (Archetype) _ konkretuli gamocdilebisa Tu obieqtis universaluri, Tandayolili, primitiuli da simboluri warmodgena. analitikuri fsiqologia (Analytic pshycology) _ fsiqologiis mimarTuleba, romelic pirovnebas ganixilavs, rogorc dinamikur balansSi myofi kompensatoruli Sinagani Zalebis konstelacias.

574

seqsualuri, emociuri da fizikuri siamovnebisaken. egos dacvis meqanizmebi SesaZleblobas aZleven pirovnebas, daZlios Zlieri Sinagani konfliqtebiT gamowveuli SfoTva. miuxedavad imisa, rom froidis Teoriis bevrma aspeqtma ver gauZlo kritikas, aracnobierisa da dacvis meqanizmebis msgavsma cnebebma aRiareba pova mraval fsiqologs Soris. froidis mimdevrebma, rogorebic arian: adleri, horni da iungi, misi Teoriis ramdenime Sesworeba da damateba SemogvTavazes.

humanisturi Teoriebi
pirovnebisadmi humanisturi midgoma xasiaTdeba individis piradi da cnobieri gamocdilebis integraciisa da zrdis potencialis mimarT interesiT. yvela humanisturi Teoriis ZiriTadi niSania yuradRebis gamaxvileba TviTaqtualizaciisaken swrafvaze; TviTaqtualizacia ki mudmivi swrafvaa sakuTari arsebuli potencialis realizaciisaken _ unarebis da niWis srulad ganviTarebisaken. am qveTavSi naxavT, Tu rogor Camoayalibes humanisturi Teoriis mimdevrebma TviTaqtualizaciis es cneba. garda amisa, TqvenTvis naTeli gaxdeba, Tu ra damatebiTi niSnebi ganasxvaveben humanistur Teoriebs pirovnebis Teoriebis sxva tipebisagan.

humanisturi Teoriebis niSnebi


pirovnebis humanisturi Teoriis mimdevrebis azriT, rogorebic arian karl rojersi, abraham maslou da karen horni, qcevis motivacia momdinareobs pirovnebis unikaluri (rogorc Tandayolili, ise SeZenili) tendenciebidan, ganviTardes da Seicvalos TviTaqtualizaciis miznisaken mimavali dadebiTi mimarTulebebiT. gaixseneT me-12 Tavidan, rom masloum TviTaqtualizacia Tavisi moTxovnilebebis ierarqiis kenweroSi moaTavsa. TviTganxorcielebisaken swrafva konstruqtuli warmmarTveli Zalaa, romelic zogadad yovel adamians dadebiTi qcevisaken da me-s srulyofisaken mimarTavs. TviTaqtualizaciisken swrafva xandaxan konfliqtSi modis sakuTari da sxvebis mowonebis moTxovnilebasTan, gansakuTrebiT maSin, ro-

TviTaqtualizacia (Self-actualization) _ pirovnebis fsiqologiis cneba, romelic exeba adamianis mudmiv swrafvas sakuTari potencialis realizaciisaken da Tandayolili niWisa da unarebis ganviTarebisaken. upirobo dadebiTi ganwyoba (Unconditional positive regard) _ individis sruli siyvaruli da mimRebloba sxva adamianis mier, magaliTad, bavSvisa mSoblis mier, yvelanairi pirobis gareSe.

575

humanisturi Teoriebi

desac adamiani grZnobs, rom mowonebis damsaxurebisTvis garkveul movaleobebsa Tu pirobebs unda akmayofilebdes. magaliTad, karl rojersi (Carl Rogers, 1947, 1951, 1977) xazs usvams upirobo dadebiTi ganwyobis mniSvnelobas bavSvebis aRzrdis dros. igi Tvlida, rom bavSvebma unda igrZnon, rom isini yovelTvis eyvarebaT da moewonebaT, miuxedavad maTi Secdomebisa da cudi qcevisa; rom maT ar sWirdebaT Tavisi mSoblebis siyvarulis damsaxureba. misi rekomendaciiT, rodesac bavSvi cudad iqceva, mSoblebma xazi unda gausvan, rom maT qceva ar moswonT da ara _ TviTon bavSvi. upirobo dadebiTi ganwyoba mniSvnelovania zrdasrul asakSic, radganac nerviuloba imis Sesaxeb, movwonvarT sxvebs Tu ara, xels uSlis TviTaqtualizacias. rogorc mozrdil adamians, Tqven gWirdebaT gasceT da miiRoT upirobo dadebiTi ganwyoba im adamianebisagan, visTanac axlos xarT. rac yvelaze mniSvnelovania, saWiroa grZnobdeT upirobo dadebiT TviTpativiscemas, anu sakuTari Tavis mimReblobas, miuxedavad im sisusteebisa, romelTa Secvlas SeiZleba cdilobT. miuxedavad imisa, rom mas xSirad ar miageben saTanado pativs, karen horni kidev erTi centraluri Teoretikosia, romlis ideebmac ganapiroba humanisturi fsiqologiis dafuZneba (Frager & Fadiman, 1998). horni darwmunda, rom adamianebs aqvT namdvili me~, romelic aqtualizaciisaTvis xelSemwyob iseT garemo pirobebs moiTxovs, rogoricaa: siTbos atmosfero, sxvebis keTilganwyoba da mSoblebis siyvaruli bavSvis, rogorc konkretuli individis~ mimarT (Horney, 1945, 1950). rodesac ar arsebobs aRzrdis aseTi xelSemwyobi pirobebi, bavSvi aviTarebs bazisur SfoTvas, romelic akavebs realuri grZnobebis gamoxatvis spontanurobas da xels uSlis sxvebTan efeqtur urTierTobas. Tavisi bazisuri

576

SfoTvis dasaZlevad individebi interpersonaluri an intrafsiqikur dacvebs mimarTaven. interpersonaluri dacvebi warmoqmnian moZraobas sxvebisken (rac gamoixateba gadaWarbebuli TanxmobisaTvis mzaobisa da TviTSekavebiTi moqmedebebis meSveobiT), sxvebis winaaRmdeg (rac gamoixateba agresiuli, ampartavani, an narcisistuli gadawyvetilebebiT) an sxvebisagan (rac gamoixateba gankerZoebulobis meSveobiT). intrafsiqikuri dacvebi muSaoben, raTa Camoayalibon ararealuri idealizebuli me-s xati, romelsac Sedegad mosdevs didebis Zieba~ am xatis gasamarTleblad da siamayis sistema, romelic eqvemdebareba qcevis rigidul wesebs, raTa Seesabamebodes am grandiozul TviTSefasebas. aseTi adamianebi xSirad unda-s tiraniis~ qveS cxovroben da sakuTari Tavis mimarT wayenebuli aqvT iseTi movaleobebi, rogoricaa: me srulyofili, keTilSobili, mimzidveli, mamaci unda viyo~ da a.S. hornis azriT, humanisturi Terapiis mizani iyo, daxmareboda individs TviTrealizaciis miRwevaSi da xeli Seewyo adamianis bunebaSi Tandayolili konstruqciuli ZalebisaTvis, romlebic exmarebian TviTganxorcielebisaken swrafvas. TviTaqtualizacia, anu namdvili me-s mimarTulebiT progresis aqcentireba warmoadgens maslous, rojersisa da hornis Teoriebis mniSvnelovan aspeqts. garda amisa, humanisturi Teoriebi aRweril iqna, rogorc holisturi, dispoziciuri, fenomenologiuri da egzistencialuri. vnaxoT, ra aris amis mizezi. humanisturi Teoriebi holisturia, radgan adamianebis calkeul qmedebebs mTliani pirovnebebis terminebiT xsnian. adamianebi ar ganixilebian, rogorc jami calkeuli niSnebisa, romlebic saTiTaod axdenen sxvadasxvagvar gavlenas qcevaze. maslous azriT, adamianebi arsebiTad motivirebulni arian moTxovnilebebis ierarqiis ufro maRali doneebisaken (rac ganxilul iqna me-12 TavSi), Tu ufro dabal doneze aRmocenebulma defeqtebma ar CamoqaCes isini dabla. humanisturi Teoriebi dispoziciuria, radgan isini adamianis Tandayolil Tvisebebze fokusirdeba, romlebic mTavar gavlenas axdenen qcevis mimarTulebaze. situaciuri faqtorebi ganixileba, rogorc sirTuleebi da barierebi (rogorc Zafebi, romlebic qvemoT aCereben mibmul buStebs). rodesac aqtualizaciis tendencia

gaTavisufldeba uaryofiTi situaciuri pirobebisagan, man aqtiurad unda warmarTos adamianebi sasargeblo, dadebiTad moqmedi situaciebis arCevisaken. Tumca, humanisturi Teoriebi ar aris dispoziciuri im gagebiT, romliTac _ niSnis anda fsiqodinamikuri Teoriebi. am ukanaskneli Sexedulebebis mixedviT, pirovnuli dispoziciebi qcevaSi kvlav da kvlav warmoCenili ganmeorebadi Temebia. humanisturi dispoziciebi specifikurad mimarTulia kreatulobisa da zrdisaken. yovel jerze, rodesac humanisturi dispozicia xorcieldeba, pirovneba odnav icvleba, ase rom, dispozicia arasodes gamoixateba orjer, erTi da imave saxiT. droTa ganmavlobaSi humanistur dispoziciebs mihyavT individi TviTaqtualizaciisaken, am motivebis yvelaze wminda gamohumanisturi Teoriebi fenomenologiuria, radgan isini xazs usvamen individis Tvalsazriss da realobis subieqtur xedvas da ara damkvirveblisa Tu Terapevtis obieqtur mosazrebas. ase rom, humanisturi fsiqologi yovelTvis cdilobs yoveli adamianis unikaluri Sexedulebis danaxvas. es xedva awmyoze orientirebuli xedvacaa; warsuli gavlenebi mniSvnelovania mxolod im TvalsazrisiT, rom maT adamiani dRevandel situaciamde moiyvanes, xolo momavali warmoadgens misaRwev miznebs. amdenad, fsiqodinamikuri Teoriebisgan gansxvavebiT, humanisturi Teoriebi ar Tvlian, rom adamianebis awmyo qcevas aracnobierad warmarTavs warsuli gamocdileba. dabolos, iseTi mecnieris azriT, rogoricaa rolo mei (Rollo May, 1975), humanistur Teoriebs aqvT egzistencialuri aspeqti; isini yuradRebas amaxvileben maRal fsiqikur procesebze, romlebic xsnian mimdinare gamocdilebas da saSualebas aZleven individs Seesabamebodes, an daTrgunul iqnes yofierebis yoveldRiuri problemebiT. es egzistencialuri perspeqtiva momdinareobs rogorc literaturuli, ise filosofiuri tradiciebidan, romlebic mas farTo mimzidvelobas aniWeben mravali Tanamedrove mecnierisa da klinicistisTvis (Schneider & May, 1995). pirovnebis optimisturi humanisturi xedva sasiamovno siaxle iyo mravali fsiqologisaTvis, romlebic froidiseuli medicinis momwaro dietaze~ aRizardnen. humanisturi midgomebi fokusirdeba gaumjobesebaze an imaze, rom cxovreba ufro advilad mosanelebeli, misaRebi

Tavi 14 / pirovneba

gaxdes, da ara mtkivneuli mogonebebis gamoqeqvaze, romlebic xandaxan umjobesia gandevnili darCes. humanisturi Tvalsazrisi xazs usvams yoveli adamianis SesaZleblobas, moaxdinos Tavisi sruli potencialis realizacia.

humanisturi Teoriebis Sefaseba


froidis Teorias xSirad akritikebdnen zedmetad pesimisturi SexedulebisaTvis, rom adamianis buneba viTardeba konfliqtebidan, travmebidan da SfoTvebidan. humanisturi Teoriebi jansaRi pirovnebis gansadideblad gaCnda, romelic bednierebisaken da TviTaqtualizaciisaken miiltvis. Znelia, gaakritiko Teoriebi, romlebic waaxaliseben da afaseben adamianebs, Tundac maTi Secdomebis gamo. da mainc, kritikosebi Civian, rom humanisturi Teoriebi bundovani da Znelad misawvdomia kvlevisaTvis. isini svamen kiTxvas: dazustebiT ra aris TviTaqtualizacia? es Tandayolili tendenciaa Tu kulturuli konteqstiTaa Seqmnili?~ humanisturi Teoriebi ar amaxvileben yuradRebas individebis konkretul maxasiaTeblebze; isini ufro metad warmoadgenen Teoriebs adamianis bunebis da im Tvisebebis Sesaxeb, romlebic yvela adamianisTvis saerToa, vidre Teoriebs individualuri pirovnebis Sesaxeb, an adamianTa Soris gansxvavebebis safuZvlebis Sesaxeb. sxva fsiqologebi aRniSnaven, rom me-s, rogorc gamocdilebisa da qmedebis wyaros, rolis xazgasmiT humanisturi Teoriebi uaryofen garemos mniSvnelovan cvladebs, romlebic aseve axdenen qcevaze gavlenas. am SezRudvebis miuxedavad, humanisturi tradiciidan nawilobriv momdinareobs Tanamedrove kvlevis erTi tipi, romelic uSualod koncentrirdeba individualur moTxrobebze, anu cxovrebis istoriebze (Baumeister, 1994; McAdams, 1996; Rosenwald & Ochberg, 1992). fsiqobiografiis Sesadgenad individis cxovrebis detalebis gagebaSi fsiqologiuri Teoriis gamoyenebis tradiciis sawyiss SeiZleba froidis mier leonardo da vinCis analizSi mivakvlioT (Freud, 1910/957; ix. Elms, 1988, froidis naSromis kritikisaTvis). fsiqobiografia ganisazRvreba, rogorc fsiqologiuri (gansakuTrebiT, pirov-

fsiqobiografia (Psychobiography) _ fsiqologiuri (gansakuTrebiT pirovnebis) Teoriis gamoyeneba individis cxovrebiseuli mimarTulebis aRwerisa da axsnisaTvis.

humanisturi Teoriebi

nebis) Teoriis sistematuri gamoyeneba cxovrebis Tanmimdevrul da gasageb ambad gardaqmnisaTvis~ (McAdams, 1988, gv. 2). ganvixiloT didi mxatvris, pablo pikasos Sesaxeb arsebuli informacia: pikasom bavSvobaSi ramdenime travma ganicada, seriozuli miwisZvrisa da umcrosi dis sikvdilis CaTvliT. fsiqobiografiam SeiZleba pikasos udidesi mxatvruli Semoqmedebis garkveuli nawilis axna scados, rogorc am adreul travmebze misi pasuxebis samudamo danaleqi (Gardner, 1993). rodesac ganTqmuli an istoriuli figura fsiqobiografiis sagani xdeba, mkvlevarma SeiZleba gamoqveynebul Sromebs, dRiurebs da werilebs mimarTos, rogorc sando monacemebis wyaroebs. ufro Cveulebrivi individebis SemTxvevaSi, mkvlevrebma SeiZleba pirdapir gamokiTxon cxovrebis gamocdilebebis Sesaxeb; magaliTad, cdis pirs SeiZleba sTxovon, isaubros ukanaskneli Zlieri gamocdilebis Sesaxeb: ras fiqrobdiT da grZnobdiT? ra SeuZlia am epizods mogviTxros imis Sesaxeb, Tu vin xarT Tqven, vin iyaviT, vin SeiZleba iyoT, an rogor ganviTardiT droTa ganmavlobaSi?~ (McAdams & de St. Aubin, 1992, gv. 1010). damaxasiaTebeli Temebi, romlebic TxrobiTi angariSebis seriebSi vlindeba, mxars uWers adreuli humanistebis mier wamoyenebul pirovnebis holistur da fenomenologiur versiebs _ adamianebi Tavis identobas calkeuli moTxrobebis cxovrebis ambad gaerTianebis gziT ageben. piradi angariSebi fanjaraa, romlidanac SeiZleba davinaxoT, Tu ra warmodgena aqvT adamianebs sakuTari Tavisa da interpersonaluri urTierTobebis Sesaxeb (Harvey et al., 1990; Shotter, 1984). humanisturi Teoriebis mimdevrebi aqcents akeTebdnen TiToeuli individis swrafvaze TviTaqtualizaciisaken, Tumca, aRiarebdnen, rom adamianebis warmateba am miznis miRwevaSi, nawilobriv, gansazRvrulia maTi garemos realiebiT. axla ganvixilavT Teoriebs, romlebic uSualod exebian individebis qcevas, romelic maTi garemos gavleniT yalibdeba.

577

Sejameba
humanisturi Teoriis mimdevrebi, rogorebic arian maslou, rojersi da horni, Tvlidnen, rom qceva motivirebulia pozitiuri gziT ganviTarebisa da cvlilebis bazisuri surviliT, rac TviTaqtualizaciisaken moZraobas gulisxmobs. pirovnebis humanisturi Teoriebi holisturia, dispoziciuri, fenomenologiuri da egzistencialuri. kritikosebis azriT, humanisturi Teoriebis zogi centraluri cneba cudad aris gansazRvruli; es Teoriebi ar iTvaliswinebs adamianebis cxovrebaze garemos gavlenas. Tanamedrove mecnierebi agrZeleben humanistur tradicias im xerxebze fokusirebiT, romlebiTac individebi qmnian Tanmimdevrul mTlian suraTs Tavisi cxovrebis mravali epizodisagan.

socialuri daswavlis da kognituri Teoriebi


Cven mier aqamde ganxiluli yvela TeoriisaTvis saerToa aqcenti hipoTetur Sinagan meqanizmebze _ niSnebze, instinqtebze, impulsebze, TviTaqtualizaciisaken swrafvaze, romlebic biZgs aZleven qcevas da warmoqmnian funqcionirebadi pirovnebis baziss. miuxedavad amisa, rac aklia am Teoriebis umetesobas, esaa myari kavSiri pirovnebasa da konkretul qcevas Soris. magaliTad, fsiqodinamikuri da humanisturi Teoriebi gvawvdian monacemebs mTliani pirovnebis Sesaxeb, magram ar winaswarmetyveleben specifikur qmedebebs. pirovnebis Teoriis kidev erTi mimarTuleba imis safuZvelze warmoiSva, rom yuradReba gamaxvilda qcevaSi individualur gansxvavebebze. gaixseneT me-7 Tavidan, rom adamianis qcevis didi nawili SeiZleba garemos pirobebze dayrdnobiT viwinaswarmetyveloT. daswavlis Teoriis mimdevari fsiqologebi miuTiTeben garemos pirobebze, romlebic akontroleben qcevas. pirovneba ganixileba, rogorc Ria da faruli pasuxebis jami, romlebic didi albaTobiT gamowveulia individis moqmedebaTa ganmtkicebebis istoriiT. daswavlis Teoriis mixedviT, adamianebi gansxvavdebian, radgan maT gansxvavebuli ganmtkicebebis istoria aqvT.

ganvixiloT pirovnebis bihevioristuli koncefcia, romelic ielis universitetis fsiqologebis gundma Seqmna jon dolardisa da nil mileris meTaurobiT (John Dollard, Neal Miller, 1950). dolardma da milerma Semoitanes iseTi cnebebi, rogorebicaa: daswavlili ltolvebi, pasuxebis Sekaveba da daswavlili qcevis paternebi. froidis msgavsad, maT xazi gausves daZabulobis da daZabulobis Semcirebis ganmamtkicebeli (siamovnebis momgvreli) Sedegebis motivaciuri Zalebis rols. organizmebi moqmedeben, raTa Seamciron daukmayofilebeli moTxovnilebebiT gamowveuli daZabuloba. is qceva, romelic warmatebiT amcirebs aseT daZabulobebs, meordeba da droTa ganmavlobaSi daswavlil Cvevad gadaiqceva, romelic ganmtkicebulia ganmeorebiTi daZabulobis SemcirebiT. dolardma da milerma, aseve, aCvenes, rom adamianma SeiZleba iswavlos socialuri imitaciis (mibaZvis) gziT, anu sxvebis qcevaze dakvirvebiT ise, rom sapasuxo qmedebis faqtobrivad ganxorcielebis aucilebloba ar iqmneba. warmoidgineT, rom patara biWi xedavs, rom mis ufros das kanfets aZleven, rodesac is mirbis saxlSi dabrunebuli mamis Sesaxvedrad; umcrosma Zmam SeiZleba imave qcevis ganxorcieleba daiwyos. imitaciis ideam gaafarTova is gzebi, romlebiTac, fsiqologebis warmodgeniT, daiswavleba efeqturi an destruqciuli qceva. pirovneba warmogvidgeba, rogorc am daswavlil qcevaTa jami. Tanamedrove socialuri daswavlisa da kognituri Teoriebi xSirad iziareben dolar-

578

Tavi 14 / pirovneba

miSelis kognitur-afeqturi pirovnebis Teoria


uolter miSelma (Walter Mischel) ganaviTara pirovnebis kognituri bazisis gavlenis Teoria. miSeli aRniSnavs, rom adamianebi aqtiurad monawileoben garemosTan Tavisi interaqciebis kognitur organizaciaSi. misi midgoma xazs usvams imas, Tu ramdenad mniSvnelovania imis gageba, rogor Cndeba qceva, rogorc adamianebsa da situaciebs Soris interaqciebis funqcia (Mischel & Shoda, 1995, 1999). ganvixiloT magaliTi: jonis pirovnebis unikaloba yvelaze naTlad SeiZleba davinaxoT imaSi, rom

saidan viciT
qcevis paternebi am proeqtis erTi kvleva qcevis konsistentobis ganxilvisas aRvwereT. kidev erTi kvleva Seiswavlis bavSvebis reaqciebs gansxvavebul fsiqologiur situaciebze. es situaciebia: (1) sxva bavSvis mier dadebiTi socialuri kontaqtis wamowyeba, an (2) ufrosis mier gafrTxileba raime moqmedebis Sewyvetis Taobaze. bavSvebis reaqciebi kodirebul iqna iseT kategori-

socialuri daswavlis da kognituri Teoriebi

disa da mileris mosazrebas, rom qcevaze gavlenas axdens garemos pirobebi, Tumca, es Teoriebi erTi nabijiT win midian da xazs usvamen kognituri da bihevioraluri procesebis mniSvnelobas, riTic moqmed sxeuls moazrovne gonebas, fsiqikas ubruneben. isini, vinc pirovnebis kognituri Teoriebi Seqmna, aRniSnaven, rom arsebobs mniSvnelovani individualuri gansxvavebebi imaSi, Tu rogor fiqroben da gansazRvraven adamianebi nebismier eqsternalur (garegan) situacias. kognituri Teoriebi yuradRebas amaxvileben im fsiqikur procesebze, romelTa meSveobiTac adamianebi Tavis SegrZnebebs da aRqmebs realobis Sesaxeb organizebul STabeWdilebad gardaqmnian. humanisturi Teoriebis msgavsad, kognituri Teoriebi xazs usvamen, rom Tqven monawileobT sakuTari pirovnebis SeqmnaSi. magaliTad, Tqven, ZiriTadad, aqtiurad irCevT Tqvens garemos da ara mxolod pasiurad reagirebT masze. Tqven afasebT alternativebs da irCevT iseT garemos, romelSic moqmedebT da Tqvenze moqmedeben; Tqven irCevT situaciebs, romlebisganac moeliT, rom isini TqvenTvis ganmamtkicebeli iqneba da cdilobT, Tavidan aiciloT isini, romlebic ar gakmayofileben da bundovania. magaliTad, Tqven xSirad arCevT, kidev erTxel mixvideT im restoranSi, sadac adre gemrieli kerZi miirTviT da yovelTvis ar cdilobT axali adgilis mosinjvas. modiT, axla davaxasiaToT am midgomis ufro konkretuli magaliTebi. Cven ganvixilavT uolter miSelis, albert bandurasa da nensi kentoris Teoriebs.

is yovelTvis Zalian keTilganwyobilia, rodesac vinmes pirvelad xvdeba da, aseve, imaSic, rom savaraudoa, is sakmaod uxeSi da arakeTilganwyobili gaxdes, rodesac am adamianTan meti drois gatareba uwevs. meore mxriv, jimi unikaluria imiT, rom is, rogorc wesi, morcxvi da mSvidia im adamianebTan, visac kargad ar icnobs, magram Zalian komunikabeluri xdeba, rogorc ki maT kargad gaicnobs (Shoda et al., 1993a, gv. 1023). Cven rom gvecada jonisa da jimis keTilganwyobis gaSualeba, albaT, daaxloebiT msgavs maCveneblebs miviRebdiT am niSnis mixedviT, magram am SemTxvevaSi ver daviWerdiT mniSvnelovan gansxvavebas maT qcevaSi. miSelis mixedviT (1973; Mischel & Shoda, 1995), is, Tu rogor vpasuxobT garemos specifikur movlenaze, damokidebulia 14.4 cxrilSi gansazRvrul cvladebze. xedavT, Tu ra gavlena eqneboda yovel CamoTvlil cvlads imaze, Tu ra gziT imoqmedebda adamiani konkretul situaciaSi? Cven mogawodeT magaliTebi TiToeul cvladze. scadeT, warmoidginoT situacia, romelSic Tqven cxrilSi moyvanili personaJebisgan gansxvavebulad moiqceodiT, radgan Tqven maTgan erTi konkretuli cvladis mixedviT gansxvavdebiT. SeiZleba gainteresebT, Tu ra gansazRvravs am cvladebis bunebas konkretuli individisTvis. miSelis azriT, isini warmoadgenen am adamianis dakvirvebebis, aseve misi sxva adamianebTan da fizikuri garemos usulo aspeqtebTan interaqciebis istoriis Sedegs (Mischel, 1973).

579

cxrili

14.4
gansazRvreba is gza, romliTac Tqven axdenT Tqveni Tavis, sxva adamianebis, movlenebis da situaciebis Sesaxeb informaciis kategorizacias. Tqveni rwmenebi socialuri samyaros Sesaxeb da konkretul situaciebSi mocemuli qmedebebis mosalodneli Sedegebis Sesaxeb. Tqveni Sexeduleba imis Sesaxeb, Tu ramdenad gaqvT raime Sedegebis miRebis unari. Tqveni grZnobebi da emociebi, fiziologiuri pasuxebis CaTvliT. Sedegebi da afeqturi mdgomareobebi, romlebic TqvenTvis Rirebulia, an ar aris Rirebuli; Tqveni miznebi da cxovrebis gegmebi. qcevebi, romelTa Sesruleba Tqven SegiZliaT da gegmebi kognituri da qceviTi Sedegebis misaRebad. magaliTi rogorc ki bobi vinmes Sexvdeba, is cdilobs, daadginos, ramdenad mdidaria es adamiani. gregi patiJebs megobrebs kinoSi, magram arasodes elis, rom isini `ki~-s ityvian.

pirovnebis cvladebi miSelis pirovnebis kognitur-afeqtur TeoriaSi


cvladi kodirebebi

molodinebi da rwmenebi

afeqtebi miznebi da Rirebulebebi kompetenciebi da TviTregulatoruli gegmebi

sindi Zalian advilad wiTldeba. piters surs, kolejSi Tavisi klasis prezidenti iyos.

iani laparakobs inglisurad, frangulad, rusulad da iaponurad da varaudobs, rom gaeroSi imuSavebs.

ebad, rogoricaa: prosocialurad laparakobda~, an daemorCila, an dauTmo~. garda amisa, zafxulis bolos banakis konsultantebs sTxoves, bavSvebi daexasiTebinaT, rogorc agresiuli~, Caketili~, an keTilganwyobili~. ra informacia gamoiyenes maT am Sefasebebis gasakeTeblad? magaliTisaTvis, ganvixiloT damorCilebis an daTmobis qceva. bavSvebi, romlebic banakidan wamosvlisas daaxasiaTes, rogorc keTilganwyobili, morCilebi iyvnen im situaciaSi, rodesac maT ufrosi aZlevda gafrTxilebas, xolo bavSvebi, romlebic banakidan wamosvlisas daaxasiaTes, rogorc Caketili, morCilebi iyvnen im situaciaSi, rodesac maT Tanatolebi aRizianebdnen, an dascinodnen (Shoda et al., 1993b).

580

miSelma da misma kolegebma gvaCvenes qcevis paternebis mniSvneloba sazafxulo banakSi bavSvebis gamocdilebebis savele kvlevebiT. am Sedegebidan gamomdinare, bavSvebis damorCilebis saSualo maCveneblebis codna bevrs verafers gvetyvis maTi pirovnebis Sesaxeb. Tqven unda icodeT, ra situaciaSi moxda damorCileba imisaTvis, rom gaigoT, Tu ratom miiRo erTma bavSvma keTilganwyobilis Sefaseba da meorem _ Caketilis. miSeli xazgasmiT aRniSnavs, rom

Tavi 14 / pirovneba

Cveni warmodgenebi sxva adamianebis pirovnuli maxasiaTeblebis Sesaxeb modis ara saSualos aRebidan, aramed dakvirvebidan, Tu rogor iwvevs gansxvavebuli situaciebi gansxvavebul qcevas (Shoda & Mischel, 1993).

banduras kognitur-socialuri daswavlis Teoria


pirovnebisadmi socialuri daswavlis midgomis wamyvani mkvlevaria albert bandura (Albert Bandura, 1986, 1999). is cnobilia Teoriuli naSromebiTa da bavSvebisa da zrdasrulebis farTo

suraTi

14.4

reciprokuli determinizmi
reciprokuli determinizmis mixedviT individi, misi qceva da garemo erTmaneTTan urTierTqmedeben, raTa gavlena moaxdinon da Secvalon sxva komponentebi.

kvlevebiT (gaixseneT me-7 Tavidan bavSvebis agresiuli qcevis kvlevebi). am midgomaSi gaerTianebulia daswavlis principebi da socialur garemoSi adamianur interaqciebze aqcenti. socialuri daswavlis kuTxiT adamianebs ar marTavs Sinagani Zalebi, magram, amave dros, isini arc garemos gavlenis qveS myofi ususuri marionetebi arian. socialuri daswavlis midgoma xazs usvams kognitur procesebs, romlebic CarTulia qcevis sxvadasxva paternebis CamoyalibebaSi da, Sesabamisad, pirovnuli Tvisebebis SeZenasa da maTi SenarCunebis procesSi. banduras Teoria miuTiTebs individualuri faqtorebis, qcevis da garemos stimulebis rTul urTierTqmedebaze. yovel maTgans SeuZlia sxvebze zemoqmedeba an maTi Secvla. cvlilebis mimarTuleba iSviaTad aris calmxrivi _ is reciprokulia. Tqvens qcevaze SeiZleba gavlena moaxdinos Tqvenma damokidebulebebma (atitudebma), rwmenebma, Sexedulebebma an ganmtkicebebis winamorbedma istoriam, iseve, rogorc garemoSi arsebulma stimulebma. iman, rasac Tqven akeTebT, SeiZleba gavlena moaxdinos garemoze, xolo garemom da Tqvens qcevaze mowodebulma ukukavSirma SeiZleba Tqveni pirovnebis mniSvnelovan aspeqtebze imoqmedos. es mniSvnelovani cneba _ reciprokuli determinizmi _ gulisxmobs, rom Tqven unda

reciprokuli determinizmi (Reciprocal determinism) _ albert banduras socialuri daswavlis Teoriis cneba, romelic ukavSirdeba mosazrebas, rom individs, mis qcevas da garemos stimulebs Soris arsebobs rTuli reciprokuli urTierTqmedeba da rom TiToeuli am komponentebidan moqmedebs sxvebze. TviTefeqturoba (Self-efficacy) _ rwmenebis (mosazrebebis) erToblioba, rom adamians SeuZlia adekvaturad moqceva konkretul situaciaSi.

socialuri daswavlis da kognituri Teoriebi

gamoikvlioT yvela komponenti, Tu gsurT mTlianad gaigoT adamianis qceva, pirovneba da socialuri ekologia (Bandura, 1999; ix. sur. 14.4). amgvarad, magaliTad, Tu Tqven Warbi wona gaqvT, SeiZleba ar airCioT msubuqi aTletikiT dakaveba, magram, Tu sacurao auzis maxloblad cxovrobT, SeiZleba curva arCioT; Tu Tqven komunikabeluri xarT, gaesaubrebiT auzTan myof adamianebs da amiT ufro socialur atmosferos SeqmniT, rac, Tavis mxriv, garemos ufro sasiamovnos gaxdis. es erTi magaliTia adamians, adgilsa da qcevas Soris reciprokuli determinizmisa. me-7 Tavidan SeiZleba gagaxsendeT, rom banduras socialuri daswavlis Teoria xazs usvams dakvirvebiT swavlas, rogorc process, romliTac adamiani cvlis Tavis qcevas sxva adamianis qcevaze dakvirvebis safuZvelze. dakvirvebiT swavlis meSveobiT bavSvebi da mozrdilebi Tavisi socialuri garemos Sesaxeb informaciis udides speqtrs iZenen. dakvirvebiT swavlis meSveobiT Tqven swavlobT, Tu ra aris Sesabamisi, adekvaturi, ra jildovdeba da ras mohyveba dasja an ignorireba. vinaidan Tqven SegiZliaT mexsierebis gamoyeneba da garegan movlenebze fiqri, Tqven SegiZliaT, iwinaswarmetyveloT Tqveni qmedebebis SesaZlebeli Sedegebi maTi realurad ganxorcielebis gareSe. Tqven SegiZliaT SeiZinoT unarebi, damokidebulebebi da rwmenebi ubralod imaze dakvirvebiT, Tu ras akeTeben sxvebi da ra Sedegebi mohyveba amas. banduras Teoriis Camoyalibebis procesSi (1997) misi erT-erTi centraluri cneba TviTefeqturoba gaxda. TviTefeqturoba aris rwmena imisa, rom adamians SeuZlia konkretul situaciaSi adekvaturad moqceva. Tqveni TviTefeqturobis SegrZneba mravalgzis axdens gavlenas Tqvens aRqmebze, motivaciasa da qcevaze. Tqven arc ki cdilobT raimes gakeTebas an SesaZleblobis gamoyenebas, rodesac elodebiT, rom

581

araefeqturi iqnebiT. Tqven eridebiT situaciebs, rodesac Tavs adekvaturad ar grZnobT. maSinac ki, rodesac, realobaSi Tqven gaqvT unari da survilic, SeiZleba ar SeasruloT moTxovnili qmedeba, an ar gaagrZeloT davalebis warmatebiT Sesrulebis mcdeloba, Tu fiqrobT, rom gakliaT is, rac amisaTvis saWiroa. faqtobrivi Sesrulebebis miRma TviTefeqturobis SefasebisaTvis arsebobs informaciis kidev sami wyaro: sxvisi gamocdileba _ Tqveni dakvirveba sxvebis moqmedebaze; darwmuneba _ sxvebma SeiZleba dagarwmunon, rom Tqven SegiZliaT raimes gakeTeba, an Tqven SeiZleba sakuTari Tavi daarwmunoT amaSi; Tqveni emociuri agznebis monitoringi, rodesac fiqrobT davalebis Sesaxeb an rodesac iwyebT mis Sesrulebas; magaliTad, SfoTva migvaniSnebs efeqturobis dabal molodinze; Relva migvaniSnebs warmatebis molodinze. TviTefeqturobis Sefaseba gavlenas axdens imaze, Tu ra Zalisxmevas xarjavT da ramden xans cdilobT warmatebis miRwevas, Tu cxovrebiseuli situaciebis farTo speqtrSi sirTuleebi aRmocendeba (Bandura, 1997; Cervone, 2000; Schwarzer, 1992). magaliTad, is, Tu ramdenad energiulad da Seupovrad swavlobT am Tavs, SeiZleba ufro metad damokidebuli iyos Tqveni TviTefeqturobis gancdaze, vidre realur unarze (Zimmerman et al., 1992). warmatebis an warumateblobis molodinebze SeiZleba imoqmedos ganxorcielebuli qcevis efeqturobis Sesaxeb mowodebulma ukukavSirma, magram am molodinebs, aseve, SeuZliaT Seqmnan winaswargansazRvruli ukukavSiri da amdenad iqcnen TviTSesrulebad winaswarmetyvelebad. modiT, es aRmoCena akademiur miRwevas mivusadagoT.
Tavi 14 / pirovneba

bavSvebis, ise maTi mSoblebis TviTefeqturobis donis gavlena bavSvebis akademiur miRwevebze. TviTefeqturobis gasazomad bavSvebic da mSoblebic aRniSnavdnen Tavis Tanxmobas debulebaTa seriebze. bavSvebisaTvis debulebebi exeboda maT mosazrebebs saskolo muSaobasTan gamklavebis sakuTari unarebis Sesaxeb; aseve, maT mosazrebebs, Tu ramdenad aqvT unari, moaxdinon TavianTi garemos struqturireba swavlis gasaadvileblad, magaliTad, ramdenad kargad gamogdiT maswavleblebisTvis daxmarebis Txovna, rodesac saskolo samuSaos Sesruleba giZneldebaT?~ mozrdilebisTvis debulebebi ukavSirdeboda maT unarebs, moexdinaT TavianT bavSvebSi saskolo samuSaosadmi interesisa da misi Sesrulebis motivacia, magaliTad, ra SegiZliaT gaakeToT, raTa daexmaroT Tqvens bavSvebs saskolo samuSaoze bejiTad muSaobaSi?~ mkvlevrebs bavSvebis maswavleblebma maTi akademiuri miRwevebis Sefaseba miawodes. Sedegebma aCvena rogorc mSoblebis, ise bavSvebis TviTefeqturobis rwmenebis mniSvnelovani gavlena miRwevebze. kerZod, mSoblebis rwmenas, rom maT aqvT unari, SeunarCunon bavSvebs mimarTuleba, wvlili Sehqonda bavSvebis rwmenaSi, rom maT didi miRwevebi eqnebodaT; Tavis mxriv, bavSvebis rwmenebi zusti aRmoCnda _ TviTefeqturobis Zlieri rwmenebi korelaciaSi iyo faqtobriv maRal miRwevebTan.

saidan viciT
TviTefeqturoba da bavSvebis akademiuri miRwevebi banduram da misma kolegebma (1996) ikvlies 11-dan 14 wlamde 279 bavSvi romis maxloblad dasaxlebuli punqtidan. am kvlevis mizani iyo, eCvenebina rogorc

582

am kvlevidan Cans, Tu ramdenad mniSvnelovania gvjerodes, rom SegviZlia warmatebis miRweva. kerZod, Tu Tqven gegmavT, gaxdeT mSobeli, an Tu ukve gyavT Svilebi, unda ifiqroT imaze, Tu rogor ganaviTaroT Tqvens SvilebSi gancda, rom maT efeqturi kontroli aqvT sakuTar swavlaze. banduras TviTefeqturobis Teoria, aseve, aRiarebs garemos mniSvnelobas. warumateblobis Tu warmatebis molodinebi da Sesatyvisi gadawyvetilebebi mcdelobis Sewyvetis Tu Seupovrad gagrZelebis Sesaxeb SeiZleba efuZnebodes imis aRqmas, Tu rogoria garemo _ xelSemwyobi Tu araxelSemwyobi da, aseve,

suraTi

14.5

banduras TviTefeqturobis modeli


am modelis mixedviT, efeqturobis molodinebi moTavsebulia adamiansa da mis qcevas Soris, Sedegis molodinebi ki _ qcevasa da mis mosalodnel Sedegebs Soris.

sakuTari adekvaturobis Tu araadekvaturobis aRqmas. aseT molodinebs Sedegze dafuZnebul molodinebs uwodeben. suraTi 14.5 gviCvenebs, Tu rogor eTanxmeba erTmaneTs banduras Teoriis nawilebi. qceviTi Sedegebi damokidebulia adamianebis mier rogorc sakuTari unarebis, aseve garemos aRqmaze.

Tu ra gamocdileba SemoaqvT socialuri da pirovnuli problemebis gadawyvetis amocanebSi; miznebis ganxorcielebis strategiebi. adamianebs aqvT problemebis gadawyvetis gansxvavebuli damaxasiaTebeli strategiebi. xedavT, Tu rogor urTierTqmedebs es sami ganzomileba, raTa warmoiqmnas qcevis gansxvavebuli paternebi, romelTac Tqven aRiqvamT, rogorc pirovnebas? Tqven SeiZleba icnobT or adamians, romelTac erTnairi zogadi cxovrebis mizani aqvT _ SeiZleba orivesTvis Rirebulebas warmoadgens kargi niSnebis miReba, magram imis mixedviT, Tu ra ician maT da rogor SeuZliaT am codnis gamoyeneba, maTi myisieri gadawyvetilebebi qcevis Sesaxeb SeiZleba Zalian gansxvavebuli iyos. erT maTgans, SesaZloa, swavlis naTeli (eqsplicituri) strategiebi aswavles, meore ki Zlivs axerxebs amas specialuri daxmarebis gareSe. socialuri inteleqtis Teoria axal xedvas gvawvdis imis Sesaxeb, Tu rogor winaswargansazRvravs pirovneba konsistentobas: drois mocemul periodSi konsistentoba SeiZleba aRmovaCinoT adamianebis miznebSi, codnasa da strategiebSi. modiT, ganvixiloT konkretuli garemoebebi, romlebSic adamianebis gansxvavebuli miznebi iwveven gansxvavebul Sedegebs: _ mkvlevrebma aCvenes, rom siaxlovis miznebs gavlena aqvT urTierTobebisgan miRebul dakmayofilebaze.
socialuri inteleqti (Social intelligence) _ pirovnebis Teoria, romelic exeba im gamocdilebas, romelic adamianebs SemoaqvT cxovrebiseuli amocanebis sakuTar gancdaSi.

kentoris socialuri inteleqtis Teoria


winamorbed kognitur da socialur Teoriebze dayrdnobiT nensi kentorma (Nancy Cantor) da misma kolegebma pirovnebis socialuri inteleqtis Teoria Camoayalibes (Cantor & Kihlstrom, 1987; Kihlstrom & Cantor, 2000). socialuri inteleqti exeba im gamocdilebas, romelic adamianebs SemoaqvT cxovrebiseuli amocanebis sakuTar gancdaSi. Teoria gansazRvravs individualuri gansxvavebebis sam tips: cxovrebiseuli miznebis arCevani. adamianebi gasxvavdebian imisda mixedviT, Tu cxovrebis romeli miznebi Tu amocanebia maTTvis yvelaze mniSvnelovani. magaliTad, kolejis studentebi xSirad Relaven kargi niSnebis miRebis~, an megobrebis SeZenis da SenarCunebis~ Sesaxeb. aris Tu ara am miznebidan erT-erTi TqvenTvis ufro mniSvnelovani, vidre meore? adamianebis miznebi droTa ganmavlobaSi SeiZleba Seicvalos. Tqveni aTi wlis winandeli miznebi, albaT, gansxvavdeba rogorc dRevandeli, ise momavali miznebisagan; socialuri interaqciebis Sesabamisi codna. adamianebi gansxvavdebian imis mixedviT,

socialuri daswavlis da kognituri Teoriebi

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saidan viciT
siaxlovis miznebi sasiyvarulo urTierTobebSi rodesac zogi adamiani sasiyvarulo urTierTobas iwyebs, misi umTavresi mizania siaxlovis Seqmna _ maT surT, aRmoCndnen iseT garemoSi, sadac SeZleben urTierTdamokidebulebis gamovlenas da TviTgaxsnas; sxva adamianebi ki dainteresebulni arian imiT, rom hqondeT urTierTobebi, magram maTTvis es urTierTobebi sasurveli moqmedebebisken (magaliTad, wveulebebisken, sqesobrivi urTierTobebisken) mimaval gzas ufro warmoadgens, vidre siaxlovisken. siaxlovis miznis siZliereSi am gansxvavebebis Sesafaseblad mkvlevrebma sTxoves 60 students, epasuxaT iseTi debulebebisTvis, rogoricaa: sasiyvarulo urTierTobaSi vcdilob Cemi yvelaze siRrmiseuli azrebisa da grZnobebis gaziarebas~ (Sanderson & Cantor, 1997). studentebma iseTi faqtebic aRniSnes, rogoricaa, magaliTad, dro, romelsac isini realurad atarebdnen Tavis partniorebTan gansxvavebul situaciebSi, iseve, rogorc sakuTari dakmayofileba urTierTobebiT. monacemebma naTeli suraTi aCvena: im adamianebis dakmayofileba urTierTobebisgan, romlebsac ufro Zlieri siaxlovis miznebi hqondaT, naklebad iyo damokidebuli im drois xangrZlivobaze, romlis gatarebac maT realurad SeeZloT Tavis partniorebTan. maTi Sefaseba urTierTobebisgan miRebuli dakmayofilebisa SedarebiT maRali iyo, miuxedavad imisa, bevr dros atarebdnen isini erTad Tu cotas. SedarebisaTvis, ufro susti siaxlovis miznebis mqone individebis dakmayofileba urTierTobebisagan SedarebiT dabali iyo, rodesac isini cota dros atarebdnen partniorebTan. xedavT, rogor gamomdinareobs es paterni individis miznebisagan? ufro Zlieri siaxlovis miznebis mqone adamianebi Zlierad motivirebulni arian, rom rac SeiZleba meti miiRon

im droisgan, romlis gatarebac SeuZliaT Tavis partniorebTan. SedarebisaTvis, ufro susti siaxlovis miznebis mqoneT, SesaZloa, ar SeeZloT sakmarisi koncentracia, raTa uxvi interaqciebis gareSe SeenarCunebinaT damakmayofilebeli urTierToba. am SemTxvevaSi, Tqven SegiZliaT amoicnoT pirovneba im konsistenturobiT, romliTac adamianebi axlo urTierTobebSi iqcevian.

socialuri daswavlisa da kognituri Teoriebis Sefaseba


socialuri daswavlisa da kognituri Teoriebis winaaRmdeg gamoTqmuli kritikis erT-erTi Tvalsazrisi isaa, rom isini xSirad ugulebelyofen emociebs, rogorc pirovnebis mniSvnelovan komponents. fsiqodinamikur TeoriebSi SfoTvis msgavsi emociebi centralur rols TamaSoben. socialuri daswavlisa da kognitur TeoriebSi emociebi ganixileba mxolod, rogorc azrebisa da qcevis Tanmdevi produqti, an ubralod gaerTianebulia sxva tipis azrebTan, nacvlad imisa, rom maT damoukidebeli mniSvneloba mieweros. maTTvis, visi azriTac emociebi centraluria pirovnebis funqcionirebaSi, es seriozuli naklia. kognitur Teoriebs imis gamoc akritikeben, rom isini srulad ar aRiareben aracnobieri motivaciis gavlenas qcevasa da emociebze. kritikis meore Tvalsazrisi pirovnuli konstruqtebisa da kompetenciebis Seqmnis gzis axsnebis bundovanebazea fokusirebuli. kognituri Teoriis mimdevrebs xSirad bevri araferi hqondaT saTqmeli zrdasruli pirovnebis ganviTarebiTi warmomavlobis Sesaxeb; maTi aqcenti individis mier qcevis awmyo garemoebebis aRqmaze Crdilavs individis istorias. es kritika kelis (Kelly) Teoriazea mimarTuli, romelic aRweril iqna ufro, rogorc konceptualuri sistema, vidre, rogorc Teoria, radgan is fokusirebulia struqturaze da procesebze da TiTqmis arafers ambobs pirovnuli konstruqtebis Sinaarsze. am kritikis miuxedavad, pirovnebis kognitur Teoriebs mTavari wvlili ekuTvniT Tanamedrove azrovnebaSi: kelis Teoriam gavlena moaxdina didi raodenobiT kognitur Terapevtebze. miSelis mier situaciis maxasiaTeblebis gacnobierebam moitana ori komponentis interaqciis

584

Tavi 14 / pirovneba

ukeTesi gageba: imisa, Tu ra Semoaqvs adamians qceviT garemoSi imasTan, rasac iwvevs adamianSi qceviTi garemo; banduras ideebma gamoiwvia maswavleblebis mier moswavleebis ganaTlebis gaumjobeseba da daexmara maT warmatebisaTvis mieRwiaT janmrTelobis, biznesis da sportis sferoSi; dabolos, kentoris Teoriam pirovnebis konsistentobis Zieba cxovrebiseuli miznebisa da socialuri strategiebis doneze gadaiyvana. mogawodaT Tu ara pirovnebis am kogniturma Teoriebma axali ideebi Tqveni sakuTari pirovnebis da qcevis Sesaxeb? Tqven nel-nela naxavT, Tu rogor daiwyebT sakuTari Tavis gansazRvras nawilobriv garemosTan interaqciebze dayrdnobiT. axla SevudgebiT im Teoriebis ganxilvas, romlebic kidev ufro Sors wagiyvanen Tqveni Tavis gansazRvraSi.

Sejameba
socialuri daswavlis da kognituri Teoriebi iziareben mosazrebas, rom adamianebis moqmedebebze gavlenas axdenen garemos SemTxveviTi maxasiaTeblebi: uolter miSelis azriT, garemos specifikur movlenebs adamianebi pasuxoben sakuTar kodirebebze, molodinebze da Sexedulebebze, emociebze, miznebsa da Rirebulebebze, unarebsa da TviTmaregulirebel gegmebze dayrdnobiT; albert banduram warmoadgina adamianis, garemos da qcevis reciprokuli urTierTqmedebis Teoria. TviTefeqturoba udides rols TamaSobs adamianebis mier ganxorcielebuli qcevebis gansazRvraSi; nensi kentoris Teoriis mixedviT, adamianebi gansxvavdebian cxovrebis miznebis arCevis, Tavisi codnisa da im strategiebis mixedviT, romlebsac TavianTi miznebis misaRwevad iyeneben.

megobrebisaTvis da ojaxisaTvis konsistenturi, myari me-s warmoCenas? ra gavlena aqvs dadebiT da uaryofiT gamocdilebas imaze, Tu ras fiqrobT sakuTari me-s Sesaxeb? am kiTxvebis ganxilvas mokle istoriuli mimoxilviT daviwyebT. me-s analizis Tavgamodebuli adreuli damcvelia uiliam jemsi (William James, 1890). jemsma megamocdilebis sami komponenti gamoyo: materialuri me (sxeulebrivi me, garSemomyofi fizikuri sagnebis darad), socialuri me (Tqveni codna imis Sesaxeb Tu rogor gxedaven sxvebi) da sulieri me (me, romelic Tvalyurs adevnebs pirad azrebsa da grZnobebs). jemss sjeroda, rom yvelaferi, rasac adamiani ukavSirebs Tavis identobas, garkveuli azriT misi me-s nawili xdeba. amiT aixsneba, Tu ratom aqvT adamianebs TavdacviTi reaqcia, rodesac akritikeben maT megobrebs an ojaxis wevrebs _ maTi me-s nawilebs. me-s koncefcia, aseve, centraluri iyo fsiqodinamikuri TeoriebisaTvis. me-insaiti fsiqoanalitikuri mkurnalobis mniSvnelovani nawili iyo froidis TeoriaSi; iungi ki xazs usvamda imas, rom me-s srulyofili ganviTarebisaTvis adamianma misi cnobieri da aracnobieri cxovrebis yvela aspeqtis miReba da integracia unda moaxdinos. rogor ganixilaven me-s Tanamedrove TeoriaSi? Cven jer aRvwerT me-s kognitur aspeqtebs: me-s koncefciebs da SesaZlebel me-ebs; Semdeg ganvixilavT, Tu ra gzebiT warudgenen adamianebi samyaros Tavis me-s; dabolos, SevexebiT mniSvnelovan sakiTxs, Tu rogor gansxvavdeba me-ze Sexedulebebi kulturebis mixedviT.

me-s koncefciaTa dinamikuri aspeqtebi


me-s (SELF) Teotiebi

me-s (SELF) Teoriebi


mivadeqiT pirovnebis Teoriebs, romlebic yvelaze metad uSualod pirovnulia: isini pirdapir exebian imas, Tu rogor marTavs TiToeuli individi mis me-s. ra aris Tqveni me-s koncefcia? ras fiqrobT, Tanmimdevrulad reagirebs Tu ara samyaroze Tqveni me? cdilobT Tu ara Tqveni

me-s koncefcia warmoadgens dinamikur fsiqikur struqturas, romelic axdens intrapersonaluri da interpersonaluri qcevebisa da procesebis motivirebas, interpretirebas, organizebas, mediacias da regulacias. me-s koncefcia mraval komponents moicavs. maT Sorisaa: _ Tqveni mogonebebi sakuTari Tavis Sesaxeb; mosazrebebi Tqveni niSan-Tvisebebis, motivebis, Rirebuleme-s koncefcia (Self-concept) _ adamianis unarebis da atributebis Sesaxeb misi fsiqikuri modeli.

585

Tavi 14 / pirovneba

bebis da unarebis Sesaxeb; idealuri me, rogoric yvelaze metad gsurT, rom gaxdeT; SesaZlebeli me-ebi, rogoradac gaxdomas SesaZleblad ganixilavT; Tqveni Tavis dadebiTi, an uaryofiTi Sefasebebi (TviTSefaseba) da warmodgenebi imis Sesaxeb, Tu ras fiqroben Tqvenze sxvebi (Brown, 1009; McGuire & McGuire, 1988). me-8 TavSi ganvixileT sqemebi, rogorc codnis paketebi~, romlebic garemos struqturis Sesaxeb kompleqsur ganzogadebebs ganasaxiereben. Tqveni me-s koncefcia Seicavs sqemebs me-s Sesaxeb _ me-sqemebs, romlebic saSualebas gaZlevT, sakuTari Tavis Sesaxeb informaciis organizeba moaxdinoT, iseve, rogorc sxva sqemebi gaZleven saSualebas, marToT Tqveni gamocdilebis sxva aspeqtebi (Markus, 1977), Tumca, me-sqemebi ara mxolod imaze axdenen gavlenas, Tu rogor gadaamuSavebT sakuTari Tavis Sesaxeb informacias. kvleva gviCvenebs, rom es sqemebi, romlebsac xSirad iyenebT sakuTari qcevis interpretaciisaTvis, imazec axdens gavlenas, Tu rogor gadaamuSavebT sxva adamianebis Sesaxeb informacias (Cantor & Kihlstrom, 1987; Markus & Smith, 1981). amgvarad, sxva adamianebis moqmedebebis interpretacias Tqven imis safuZvelze axdenT, rac iciT da risic gjeraT sakuTari Tavis Sesaxeb. me-s kognituri aRqmis kidev erTi mniSvnelovani komponenti SeiZleba iyos sxva SesaZlebeli me-ebi, romlebsac Tqvens amJamindel me-s koncefcias adarebT. hezel markusma (Hazel Markus) da misma kolegebma SesaZlebeli me-ebi gansazRvres, rogorc idealuri me-ebi, rogorebic Zalian gvinda gavxdeT. esenia, aseve, me-ebi, rogorebic SegviZlia, rom gavxdeT da me-ebi,
SesaZlebeli me-ebi (Possible selves) _ idealuri me-ebi, rogoric adamians surs gaxdes, me-ebi, rogorebic adamians SeuZlia gaxdes da me-ebi, rogoradac gaxdomis adamians eSinia; me -s kognituri aRqmis komponentebi.

rogoradac gaxdomisa gveSinia~ (Markus & Nurius, 1986, gv. 954). SesaZlebel me-ebs wvlili SeaqvT qcevis motivirebaSi _ isini biZgs aZleven moqmedebas da, amave dros, iZlevian imis ganxilvis SesaZleblobas, Tu ra mimarTulebebi SeuZlia aiRos Tqvenma me-m _ ukeTesi Tu uaresi. ganvixiloT individebis mosazrebebi mSoblobisaTvis mzaobis Sesaxeb.

saidan viciT
SesaZlebeli me, rogorc mSobeli mkvlevrebis jgufma Seqmna Sefasebis instrumenti, romelic gamiznuli iyo im xarisxis gazomvisaTvis, romliTac axalgazrda mozrdil adamianebs SeeZloT sakuTari Tavis mSoblad warmodgena (Bloom, et al., 1999). kvlevaSi monawile 683-ma kolejis studentma gasca pasuxi srulebiT ar Semesabameba - Zalian Semesabameba~ skalis mixedviT iseT debulebebs, rogoricaa momavalSi iseT adamianad vxedav Tavs, romelic SesaZloa daqorwindes, magram ar moisurvebs Svilebis yolas~. im mizniT, rom studentebi ver mimxvdariyvnen kvlevis mizans, mSoblobis Sesabamisi debulebebi gabneuli iyo ufro grZel kiTxvarSi. kiTxvaris Sevsebis Semdeg TiToeul students eniWeboda mSoblis SesaZlebeli me-s qula (parent possible-self score - PPS). saSualod, qalebi da mamakacebi ar gasxvavdebodnen am qulebis mixedviT, Tumca, mkvlevrebma gamoyves rogorc qalebis, ise mamakacebis qvejgufebi, romlebmac gansakuTrebiT maRali da gansakuTrebiT dabali qulebi miiRes. am qvejgu-

586

febis adamianebma Sefasebebi misces bavSvebis videoCanawerebs, sadac bavSvebis qceva bednieridan nerviulamde icvleboda. maRali PPS-is mqone studentebma, Sesabamisad, ufro dadebiTad Seafases bavSvebi, vidre dabali PPS-is mqone studentebma.

SegiZliaT gamoZebnoT mizezebi, ris gamoc adamianis unars, warmoidginos Tavisi Tavi mSoblad, SesaZlebelia gavlena hqondes am adamianis mier bavSvis qcevis interpretaciaze?

TviTSefaseba da TviTprezentacia
Cven ukve aRvniSneT, rom zogierT adamians uaryofiTi me -s koncefcia aqvs, romelic SeiZleba aseve davaxasiaToT, rogorc dabali TviTSefaseba. adamianis TviTSefaseba warmoadgens me-s generalizebul Sefasebas. TviTSefasebas SeuZlia Zlieri gavlenis moxdena azrebze, guneba-ganwyobilebasa da qcevaze. dabali TviTSefaseba, nawilobriv, SeiZleba daxasiaTdes, rogorc me-s Sesaxeb naklebi darwmunebuloba. rodesac maRali da dabali TviTSefasebis mqone individebs sTxoves, SeefasebinaT sakuTari Tavi ramdenime niSnis ganzomilebebis mixedviT (magaliTad, logikuri, inteleqtualuri da mimzidveli), rogorc mosalodneli iyo, dabali TviTSefasebis mqone individebma sakuTar Tavs mTlianobaSi ufro dabali Sefasebebi misces (Baumgardner, 1990), Tumca, rodesac maT Tavisi Sefasebebis zeda da qveda sazRvrebis Camoyalibebac sTxoves, dabali TviTSefasebis monawileebma ufro farTo diapazoni miuTiTes _ maT me-s naklebad zusti gancda hqondaT, vidre maRali TviTSefasebis mqone monawileebs. ase rom, dabali TviTSefasebis fenomenis nawili SesaZlebelia iyos grZnoba, rom Tqven ubralod bevri ar iciT Tqveni me-s Sesaxeb, rac aZnelebs imis winaswarmetyvelebas, miaRwevs Tu ara adamiani warmatebas cxovrebiseul miswrafebebSi.
TviTSefaseba (Self-esteem) _ me-s mimarT ganzogadebuli SefasebiTi damokidebuleba, romelic gavlenas axdens rogorc guneba-ganwyobilebaze, aseve qcevaze da romelic Zlier zemoqmedebs individualuri da socialuri qcevebis speqtrze.

TvalsaCinoa, rom adamianebis umetesoba Zalian cdilobs TviTSefasebis da me-s koncefciis integrirebulobis SenarCunebas (Steele, 1988). adamianebi TviTgaumjobesebis mraval formas mimarTaven (Banaji & Prentice, 1994). magaliTad, rodesac Tqven eWvi geparebaT davalebis Sesrulebis sakuTar unarSi, SesaZlebelia, TviTuunarobis (self-handicapping) qcevas mimarToT. Tqven Segnebulad uwevT sabotaJs sakuTar qmedebas! am strategiis mizania, warumateblobis SemTxvevaSi gqondeT gamzadebuli sapatio mizezi, romelic ar gulisxmobs unaris naklebobas (Higgins et al., 1990; Jones & Berglas, 1978). ase rom, Tu geSiniaT imis gageba, iciT Tu ara is, rac saWiroa mniSvnelovani gamocdis CabarebisaTvis, SeiZleba mecadineobis nacvlad megobrebTan gaataroT dro. am gziT Tu Tqven warmatebas ar miaRwevT, SegeZlebaT amis mcire Zalisxmevaze gadabraleba, imis gamorkvevis gareSe, gqondaT Tu ara sinamdvileSi warmatebis miRwevis unari.

saidan viciT
TviTuunaroba kolejis studentebSi orma mkvlevarma sTxova kolejis studentebs, daefiqsirebinaT TavianTi pozicia (veTanxmebi/ar veTanxmebi~) TviTuunarobis gamzomvel debulebebTan mimarTebaSi: _ me bevrad mets gavakeTebdi, Tu mets vecdebodi~; mgoni, ufro metad xasiaTs
me-s (SELF) Teotiebi

587

daqvemdebarebuli adamiani var, vidre sxvebis umetesoba~; vcdilob, saqmeebi ukanasknel wuTamde gadavdo~. pirveli gamocdis win studentebs hkiTxes, Tu ra niSani iqneboda maTTvis sasurveli. gamocdis Semdeg maT mcdari pasuxebi _ sasurvelze~ naxevari quliT ufro dabali niSani _ Seatyobines (magaliTad, Tu maT 4" isurves, uTxres, rom maT 4_~ miiRes). am momentSi mkvlevrebma Seafases studentebis TviTSefaseba. Tu TviTuunaroba icavs TviTSefasebas, unda gvqonoda molodini, rom maRali TviTuunarobis mqone adamianebis TviTSefaseba nakleb zians ganicdida, rodesac maT aradamakmayofilebeli niSnebi miiRes. es zustad is paternia, romelic gamoavlines kvlevis mamrobiTi sqesis minawileebma: maRali TviTuunaroba dakavSirebuli iyo maRal TviTSefasebasTan, Tumca, qal studentebSi ar gamovlinda raime korelacia TviTuunarobasa da TviTSefasebas Soris. mkvlevrebis mosazrebiT, mamakacebs me-s xifaTisagan dacvis ufro Zlieri tendencia aqvT (Rhodewalt & Hill, 1995).

cxrili

14.5

varjiSis saSualo xangrZlivoba maRali da dabali TviTSefasebis mqone adamianebisaTvis


TviTSefaseba sajarod damkvirveblis gareSe

maRali dabali

123 257 -134

448 387 +61

SeniSvna: xangrZlivoba gazomilia wamebSi.

sakiTxebi gvexmareba, avxsnaT maRali da dabali TviTSefasebis mqone individebs Soris qceviTi gansxvavebebi (Baumeister et al., 1989). maRali TviTSefasebis adamianebi samyaros sakuTar Tavs warudgenen, rogorc ambiciur, agresiul, riskze wamsvlel adamians; dabali TviTSefasebis adamianebi ki _ rogorc frTxils da windaxeduls. mniSvnelovania, rom es pozicia gankuTvnilia sajarod wardgenisTvis, anu misi e.w. momxmarebeli~ sazogadoeba unda iyos.

saidan viciT

Tavi 14 / pirovneba

ganixileT am kvlevis Sedegebi Tqvens sakuTar qcevasTan mimarTebaSi. mimarTavT Tu ara Tqven TviTuunarobas? im SemTxvevaSic ki, Tu es icavs Tqvens TviTSefasebas (gansakuTrebiT Tu Tqven mamakaci xarT), es mainc aisaxeba Tqvens niSnebze (sxvaTa Soris, mas Semdeg, rac kvleva dasrulda, mkvlevrebi dawvrilebiT gaesaubrnen monawileebs, rac motyuebis miznis axsnasa da namdvili niSnebis miwodebas moicavda). TviTuunarobis fenomeni, aseve, migviTiTebs, rom TviTSefasebis mniSvnelovani aspeqtebi TviTprezentaciasTanaa dakavSirebuli. TviTuunaroba ufro metad aris mosalodneli maSin, rodesac adamianebma ician, rom Sedegebi sajarod xelmisawvdomi iqneba (Self, 1990). asea Tu ise, rogor unda ifiqros vinmem cudad Tqven Sesaxeb, rodesac winaaRmdegoba, romelic Tqven SegxvdaT, esoden TvalsaCinoa? TviTprezentaciis msgavsi
TviTuunaroba (self-handicapping) _ warumateblobis molodinis SemTxvevaSi iseTi qceviTi reaqciebisa da qcevis axsnis ganviTarebis procesi, romlebic minimumde daiyvans unarebis deficits, rogorc warumateblobis SesaZlebel mizezs.

TviTSefasebis sajaro saxe maRali da dabali TviTSefasebis monawileebs TamaSSi gavarjiSebis SesaZlebloba imdeni xniT miecaT, ramdenic maT surdaT. amis Semdeg maT ori wuTis ganmavlobaSi unda eTamaSaT. monawileebis nawili eqsperimentatoris dakvirvebis qveS varjiSobda, meore nawili ki _ damkvirveblis gareSe. orive SemTxvevaSi gaizoma dro, romelic maT gavarjiSebaSi gaatares (gazomva moxda Riad eqsperimentatoris daswrebis SemTxvevaSi da SeumCnevlad _ misi aryofnis SemTxvevaSi). Sedegebi naCvenebia cxrilSi 14.5. sajaroobis SemTxvevaSi, maRali TviTSefasebis individebi daaxloebiT imis naxevar dros varjiSobdnen, rasac dabali TviTSefasebis mqone monawileebi. damkvirveblis gareSe varjiSis SemTxvevaSi Sedegi Sebrunebuli iyo _ isini ufro didxans varjiSobdnen, vidre dabali TviTSefasebis individebi (Tice & Baumeister, 1990).

588

es Sedegi gasagebia TviTprezentaciis TvalsazrisiT. maRali TviTSefasebis adamianebs SeiZleba surdeT ise gamoCndnen, TiTqos warmatebas Zalian mcire momzadebis Sedegadac ki aRweven (Cemnair adamians ar sWirdeba varjiSi!~) da Tuki isini warmatebas ver miaRweven, SeiZleba kvlavac mimarTon TviTuunarobas (Tqven xom naxeT, ra cota vivarjiSe!~).

me-s kulturuli konstruqcia


aqamde Cveni msjeloba me -s relevantur konstruqtebs exeboda, rogoricaa TviTSefaseba da SesaZlebeli me-ebi, romlebic sakmaod farTod gamoiyeneba adamianebSi. me-s mkvlevrebma imis Seswavlac daiwyes, Tu ra gavlenas axdens me-s koncefciasa da me-s ganviTarebaze gansxvavebuli kulturuli zewola. Tu Tqven dasavlur kulturaSi gaizardeT, Cven mier aqamde ganxiluli kvleva ar SegiqmnidaT diskomforts: Teoriebi da konstruqtebi Seesabameba imas, Tu rogor moiazreben dasavluri kulturebi me-s, Tumca, im tipis kultura, saidanac aRmocendeba dasavluri me _ individualisturi kultura _ umciresobas warmoadgens msoflios mosaxleobis gaTvaliswinebiT, romlis daaxloebiT 70% koleqtivistur kulturebs moicavs. individualisturi kulturebi xazs usvamen individis moTxovnilebebs maSin, rodesac koleqtivisturi kulturebi jgufis moTxovnilebebzea fokusirebuli (Triandis, 1994, 1995). es yovlismomcveli aqcenti mniSvnelovnad moqmedebs imaze, Tu rogor moiazrebs am kulturebis yoveli wevri Tavis me-s. hezel markusi da Sinobu kitaiama (1991; Kitayama et al., 1995; Markus et al., 1997) amtkicebdnen, rom yoveli kultura me-s gansxvavebul gagebas (construals) aZlevs safuZvels: individualisturi kulturebi mxars uWeren damoukidebeli me-s gagebas _ damoukideblobis kulturuli miznis miRweva moiTxovs sakuTari Tavis ganmartebas, rogorc individisa, romlis qceva organizebulia da, ZiriTadad, adamianis sakuTar, da ara sxvebis, azrebTan, grZnobebTan da qmedebebTan mimarTebaSi xdeba mniSvnelovani~ (Markus & Kitayama, 1991, gv. 226). koleqtivisturi kulturebi mxars uWeren urTierTdamokidebuli me-s gagebas _ urTierTdamokidebulebis gancda iwvevs sakuTari Tavis

danaxvas, rogorc garemomcveli socialuri urTierTobis nawilisa da imis aRiarebas, rom adamianis qceva gansazRvrulia, damokidebulia da didwilad organizebulia imiT, Tu ras aRiqvams moqmedi piri sxvebis azrebad, grZnobebad da moqmedebebad~ (Markus & Kitayama, 1991, gv. 227). mkvlevrebma mravalgzis daadastures am gansxvavebebis realuroba da Sedegebi. me -s erT-erT kros-kulturul kvlevaSi gamoiyenes gazomvis instrumenti saxelwodebiT oci debulebis testi (Twenty Statements Test - TST) (Kuhn & McPartland, 1954). am testis Catarebisas monawileebs sTxoven 20 gansxvavebuli pasuxi gascen SekiTxvas _ vin var me?~ rogorc naCvenebia cxrilSi 14.6, am SekiTxvaze pasuxebi, rogorc wesi, eqvs gansxvavebul kategoriad iyofa. cxrilSi, aseve, warmodgenilia kvlevis
damoukidebeli me-s gageba (Independent construals of self) _ me-s konceptualizacia, rogorc individisa, romlis qceva, upirveles yovlisa, organizebulia adamianis sakuTar, da ara sxvebis, azrebTan, grZnobebTan da qmedebebTan mimarTebaSi. urTierTdamokidebuli me-s gageba (Interdependent construals of self) _ me-s konceptualizacia, rogorc garemomcveli socialuri urTierTobis nawilisa; imis aRiareba, rom adamianis qceva gansazRvrulia, damokidebulia da didwilad organizebulia imiT, Tu ras aRiqvams moqmedi piri sxvebis azrebad, grZnobebad da moqmedebebad.

me-s (SELF) Teotiebi

589

cxrili

14.6

oci debulebis testis ( TST) pasuxebis kros-kulturuli Sedareba _ pasuxebis procenti TiToeul kategoriaSi
indielebi kategoria socialuri identoba ideologiuri rwmenebi interesebi ambiciebi me-Sefasebebi magaliTi me var studentime var Svili me mjera, rom yvela adamiani kargia me mwams RmerTis me miyvars fortepianoze dakvrame siamovnebas maniWebs axali adgilebis monaxuleba me minda gavxde eqimime minda meti viswavlo fsiqologiaSi me patiosani da Sromismoyvare var me maRali adamiani var me vRelav momavlis Taobaze me xmauriani megobrebi myavs me myavs ZaRli mamr. 34 2 7 11 35 11 mdedr. 28 2 16 15 33 6 amerikelebi mamr. 26 2 6 2 64 1 mdedr. 26 1 5 2 65 0

sxva

Sedegebi, sadac TST-s Sesrulebas sTxovdnen daaxloebiT 300 students SeerTebuli Statebidan da indoeTidan (Dhawan et al., 1995). udidesi gansxvavebaa cxrilSi im raodenobis mixedviT, romliTac adamianebi me-Sefasebebs akeTebdnen. amerikelebi ufro xSirad akeTebdnen amas, rac Seesabameba maTi me-s damoukidebel gancdas; indoelma studentebma gamoTqves bevrad ufro naklebi me-Sefasebebi da, Tavisi urTierTdamokidebuli me-s gancdis Sesabamisad, airCies ramdenadme ufro meti debulebebi socialuri identobis Sesaxeb. miaqcieT yuradReba, rom qalebsa da mamakacebs Soris gansxvavebebi jamSi sakmaod mcirea _ kultura ufro metad mniSvnelovania. daufiqrdiT, Tu rogor moqmedebs koleqtivisturi kulturebis me-s koncefciebze dasavluri kulturis Semotana. erT kvlevaSi Sedarebulia kenielebis TST-s pasuxebi, romlebic praqtikulad ar ganicdian dasavluri kulturis gavlenas _ samburus da maasais mwyemsebis tomebis warmomadgenlebis _ im kenielebis pasuxebTan, vinc gadasaxlda dasavluri tipis dedaqalaq nairobiSi. aRmoCnda, rom tomis wevrTa pasuxebis daaxloebiT 82%, nairobiSi momuSaveTa pasuxebis mxolod 58% da nairobis universitetis studentTa pasuxebSi mxolod 17% TST-ze socialur pasuxebs warmoadgenda (Ma & Schoeneman, 1997). am paternidan gamomdinare, rodesac qveyanas Semoaqvs dasavluri produqtebi, man SeiZleba mes dasavluri gagebac Semoitanos.

es kvlevebi gviCvenebs, rom kulturebi, romlebsac adamianebi miekuTvnebian, did gavlenas axdens imaze, Tu rogor esmiT maT Tavisi me. Tqven ukve waikiTxeT am gagebis Sedegebis Sesaxeb zemoT moyvanil TavebSi. magaliTad, me-11 Tavidan gaigeT, rom kultura gavlenas axdens moralur msjelobebze (Miller & Bersoff, 1992), me-13 Tavidan ki is, rom kultura zemoqmedebas axdens emociur gamoxatulebebze (Stephan et al., 1996). Tqven mogvianebiT kvlav SexvdebiT am gansxvavebas amave saxelmZRvaneloSi, rodesac SevexebiT sakiTxs, moqmedebs Tu ara me-s gageba siyvarulis Sesaxeb mosazrebebze (ix. me-17 Tavi). axla ki gaecaniT kvlevas, romelic gansakuTrebiT mniSvnelovania me-s Sesaxeb TeoriebTan dakavSirebiT.

saidan viciT
kultura, TviTgaumjobeseba da TviTkritika zemoT movitaneT magaliTi, rom adamianebi dasavlur kulturebSi TviTgaumjobesebas _ TviTSefasebaSi dadebiTi cvlilebebis Setanas cdiloben, Tumca es, rogorc wesi, ar Sedis koleqtivisturi kulturis warmomadgenlis dRis wesrigSi. amis nacvlad, urTierTdamokidebuli me-s

590

Tavi 14 / pirovneba

gagebis arseboba SeiZleba dakavSirebul iqnes TviTkritikasTan. individi cdilobs koleqtivis gaumjobesebas sakuTari individualuri miRwevebis mimarT kritikuli damokidebulebiT. am ideebis Sesamowmeblad mkvlevrebis jgufma sTxova iaponel studentebs _ koleqtivisturi kulturis warmomadgenlebs da amerikel studentebs _ individualisturi kulturis warmomadgenlebs, aReweraT rac SeiZleba meti situacia, rodesac maTi TviTSefaseba gaizarda an Semcirda. warmatebis situaciebi aRwerili iyo iseTi debulebebiT, rogoricaa: rodesac gamocdaSi an diplomis dacvisas saukeTeso Sefaseba miviRe~; warumateblobis situaciebs ki iseTi debulebebi aRwerdnen, rogoricaa: rodesac beisbolis Cems sayvarel gunds an msaxiobs sajarod akritikeben~. momdevno fazaSi studentebis sam axal jgufs _ 63 iaponel students kiotodan da 88 iaponel students, romlebic droebiT swavloben oregonis universitetSi (iujini) da 102 kavkasiuri TeTri rasis students oregonis universitetidan _ sTxoves, waekiTxaT situaciebis aRwerebi da ecadaT sakuTari Tavis am situaciebSi warmodgena; Semdeg ki mieTiTebinaT, imoqmedebda Tu ara situacia maT TviTSefasebaze da Tu ki, ra mimarTulebiT (anu Semcirdeboda, Tu gaizrdeboda). Semdeg maT es moqmedebis xarisxi oTxsafexurian skalaze (romelzec 1 niSnavda sustad~, xolo 4 _ Zlierad~) unda SeefasebinaT. eqsperimentis Sedegebi warmodgenilia suraTze 14.6. pirvel rigSi, miaqcieT yuradReba, rom iaponeli studentebi rogorc iaponiaSi, ise amerikaSi ufro metad aRniSnavdnen TviTSefasebis Semcirebas. es aRmoCena Seesatyviseba im gansxvavebas, romelic damoukidebeli me-s da urTierTdamokidebuli me-s gagebebs Soris gavakeTeT. meore, TviTkritikis efeqti ufro didia iaponel studentebSi, xolo TviTgaumjobesebisa _ amerikel studentebSi maSin, rodesac situacia warmoiqneba anu, rogorc mkvlevrebi amboben, situacia damzadebulia~ maT mSobliur qveyanaSi. es niSnavs, rom proeqtis pirvel fazaSi amerikeli

studentebis mier aRwerili situaciebi yvelaze kargad uwyobda xels amerikelebis TviTgaumjobesebas; analogiurad, iaponeli studentebis mier aRwerili situaciebi yvelaze kargad uwyobda xels iaponelebis TviTkritikas. dabolos, SeerTebul StatebSi mcxovrebi iaponeli studentebi ramdenadme nakleb TviTkritikulni iyvnen, vidre maTi iaponiaSi mcxovrebi Tanamemamuleebi. aq SeiZleba aisaxebodes amerikuli kulturis gavlena iaponelebze maTi amerikaSi yofnis dros an im studentebis TviTSerCeva, romlebic fiqrobdnen, rom SesabamisobaSi movidodnen amerikis kulturasTan aSS-Si yofnis dros (Kitayama et al., 1997).
damzadebulia iaponiaSi damzadebulia aSS-Si T vi T S ef as eb i s S ed ar eb i T i zrda 0.6 0.4 0.2 0 -0.2 -0.4 -0.6 iaponia (kioto) iaponia (iujini) respondentis kultura aSS (iujini)

suraTi

14.6

kultura TviTgaumjobeseba da TviTkritika


proeqtis pirvel fazaSi amerikelma da iaponelma studentebma aRweres warmatebis da warumateblobis situaciebi. TiToeul kulturaSi warmoSobil situaciebs uwodes `amerikaSi damzadebuli~ da `iaponiaSi damzadebuli~ situaciebi. meore fazaSi studentebma orive kulturidan, iseve, rogorc studentebma iaponiidan, romlebic imyofebian amerikaSi, Seafases, Tu rogor imoqmedebda maT TviTSefasebaze am situaciebSi moxvedra. saSualod, iaponeli studentebi ufro orientirebulni iyvnen TviTkritikaze, TviTSefasebaSi uaryofiTi cvlilebebiT, maSin, rodesac amerikeli studentebi ufro orientirebulni iyvnen TviTgaumjobesebaze, TviTSefasebaSi dadebiTi cvlilebebiT. Sedegebi, ufro mniSvnelovani iyo, rodesac situaciebi Sesabamis qveyanaSi warmoiSoboda. svetebSi moyvanili ricxvebi warmoadgenen im studentebis procents, romlebmac dominanturi tendencia gamoavlines (magaliTad, iaponeli studentebis 86%-ma gamoavlina TviTkritika, rodesac pasuxobda `iaponiaSi damzadebul~ situaciebs maSin, rodesac amerikeli studentebis 87%-ma gamoavlina TviTgaumjobeseba, rodesac `amerikaSi damzadebul~ situaciebs pasuxobda).

me-s (SELF) Teotiebi

591

fsiqologia XXI saukuneSi

me internetSi

yvelaze rTuli SekiTxva, romelsac adamianebi sakuTar Tavs usvamen internetSi Sesvlis win, Semdegia _ vin unda viyo me dRes? internetSi cxovrebis erT-erTi yvelaze kargad dokumentirebuli aspeqtia is, rom adaminebi TavisTvis axal identobebs igoneben ( McKenna & Bargh, 2000; Reid, 1998 ) . r o d e s a c adamiani CeTis oTaxSi Sedis, man SeiZleba gadawyvitos, rom urCevnia kaci iyos da ara _qali, Savkaniani da ara _ TeTri, 40 wlis da ara _ 18is, an warmatebuli aRmasrulebeli struqturis muSaki da ara _ kolejis meorekurseli studenti. mravali adamianis cxovrebaSi internets Zalian naTlad Semoaqvs SesaZlebeli me-ebis koncefcia. modiT, yuradReba gavamaxviloT am internetis me-ebis zogierT dadebiT Sedegze. mravali adamiani Tvlis, rom realur~ cxovrebaSi sakmaod SezRudulia TviTgamoxatvaSi: ganmeorebadi interaqciebi ojaxTan, megobrebTan, ufrosebTan da TanamSromlebTan moiTxovs misgan konsistenturi iyos, rac SeiZleba ar Seesabamebodes im pirovnebas, romelic mas surs, rom iyos. adamianebisaTvis sakmaod Znelia gamocdilebis axal sferoebSi gadasvla, maTi yoveldRiuri socialuri konteqstis zewolis gaTvaliswinebiT. interneti asustebs am socialur konteqsts (McKenna & Bargh, 2000). adamianebs SeuZliaT inter-

netis anonimurobis gamoyeneba, r a Ta gamoxaton axali interesebi an gamoikvlion axali ideebi im SiSis gareSe, romelic realuri samyarosaTvis damaxasiaTebeli SedegebiT aris gamowveuli. radikaluri cvlilebebis gareSe (magaliTad, imis gancxadebis gareSe, rom igi qalia da ara mamakaci) adamians SeuZlia, gamocados SesaZlebeli me-ebi, romlebic SeiZleba ufro axlos iyos mis idealur me -sTan. metic, internetis anonimuroba SesaZleblobas aZlevs adamianebs, ufro meti gamoamJRavnon sakuTari me-s Sesaxeb, vidre isini sxva pirobebSi moisurvebdnen. gaixseneT me-13 Tavidan, rom adamianebi dadebiT Sedegebs iReben janmrTelobis TvalsazrisiT, rodesac isini emociurad ixsnebian ( Pennebaker, 1990). interneti aseTi gamomJRavnebebis farTo SesaZleblobebs gvTavazobs. adamianebs SeuZliaT ipovon specializebuli CeTis oTaxebi an jgufebi, romlebic Riad marTaven forumebs, sadac Tavisufladaa SesaZlebeli sakuTari Tavis nebismierad warmoCena da socialur mxardaWeris miRebac. mkvlevrebma faqtobrivad daadastures is, rom adamianebis unars, gamoxaton sakuTari Tavis faruli aspeqtebi, SeuZlia gamoiwvios TviTmimReblobis gazrda. erT kvlevaSi moiZies informacia adamianebisgan, romlebic internetis iseT jgufebSi monawileobdnen, romlebic gaTvaliswinebuli

592

Tavi 14 / pirovneba

iyo marginalizebuli seqsualuri identobis pirebisaTvis, rogorebic arian homoseqsualebi. mkvlevrebma moaxerxes anonimuri monacemebis Segroveba am jgufebis aqtiuri monawileebisagan (McKenna & Bargh, 1998 ). monacemebidan gamomdinare, am jgufebSi monawileobam gazarda TviTmimRebloba. faqtobrivad, respondentebis 37%-ma jgufSi monawileobis Sedegad sxvebs marginalizebuli identobis saidumloeba gauziares. Cven yuradRebas vamaxvilebdiT internetis dadebiT aspeqtebze: adamianebis unarze, gaaRrmavon me-s gaazreba da CaerTon TviTgaxsnaSi, rasac janmrTelobasTan da TviTmimReblobasTan dakavSirebuli Sedegebi mohyveba, magram, ra Tqma unda, arsebobs garkveuli saSiSroebebic. anonimurobam SeiZleba adamianebi sakuTari cxovrebis iseT fragmentaciamde miiyvanos, romelic disadaptaciis qcevas gamoiwvevs (Reid, 1998). Cven adrec aRvniSneT, rom zogi mkvlevari morcxvobis prevalentobis zrdas internetis xelmisawvdomobas miawers da mainc, imedia, rom adamianebis umetesoba sargebels naxavs im SesaZleblobebisgan, romlebsac, gazviadebis gareSe, iZleva interneti TviTgamokvlevis TvalsazrisiT.

Tu Tqven dasavlur kulturaSi gaizardeT, SeiZleba es Sedegebi TqvenTvis Znelad gasagebi iyos. ratom unda iyos adamianebisaTvis sakuTari TviTSefasebis gakritikeba ufro bunebrivi, vidre gaumjobeseba? pasuxi, ra Tqma unda, isaa, rom me am TviTSefasebaSi ar aris imave mniSvneblobis matarebeli. koleqtivisturi kulturis warmomadgenlebisTvis mniSvnelovania is, Tu rogor ukavSirdeba me koleqtivs. momdevno ramdenime dReSi Tqven SegiZliaT SeecadoT ganicadoT me-s orive gageba, Tu daakvirdebiT imas, rogor moqmedebs Tqvens garSemo mimdinare movlenebi Tqvens me-ze, rogorc individze da Tqvens me-ze, rogorc ufro farTo socialuri struqturis wevrze.

me-s Teoriebis Sefaseba


me-s Teoriebi warmatebiT afiqsireben adamianebis koncefciebs sakuTari pirovnebis Sesaxeb da imas, Tu rogor surT maT sxvebis mier iyvnen aRqmuli. ufro metic, me-s kros-kulturul gagebaTa kvlevam didi gavlena iqonia imaze, Tu rogor afaseben fsiqologebi Tavisi Teoriebis universalobas. miuxedavad amisa, is, vinc akritikebs me-s Teoriis pirovnebisadmi midgomas, gmobs imas, rom am midgomas sazRvrebi ar aqvs. ramdenadac amdeni ram aris me-s da me-s koncefciis relevanturi, yovelTvis ar aris naTeli, romeli faqtorebia yvelaze mniSvnelovani qcevis winaswarmetyvelebisaTvis. garda amisa, me -s xazgasma, rogorc socialuri konstruqtisa, srulad ar Seesabameba im faqts, rom pirovnebis zogierTi aspeqti SeiZleba memkvidreobiT gadaeces. iseve, rogorc Cven mier aRweril sxva TeoriebSi, me-s Teoriebi aRweren mxolod zogierT rames, magram ara yvelafers iqidan, rac Tqven pirovnebad gesaxebaT.

SesaZlebel me-ebs, raTa Seadaron, rogorebi arian axla da rogorebi SeiZleba iyvnen momavalSi. TviTSefaseba warmoadgens me-s zogad Sefasebas; mas SeuZlia Zlierad imoqmedos azrebze, guneba-ganwobilebasa da qcevaze. adamianebi TviTuunarobas TviTSefasebis dasacavad mimarTaven. kros-kulturul kvlevaSiAyuradReba gamaxvilda imaze, Tu rogor ubiZgebs individualisturi da koleqtivisturi kulturebi me-s gansxvavebuli gagebis warmoqmnas. individualisturi kulturebis warmomadgenlebs axasiaTebT damoukidebeli me-s, xolo koleqtivisturi kulturebis warmomadgenlebs _ urTierTdamokidebuli me-s gageba. es gagebebi moqmedeben imaze, Tu rogor afaseben Tavis Tavs adamianebi da rogor aregulireben Tavis TviTSefasebas. me-s Teoriebis kritikosebis azriT, isini yovelTvis ar iZlevian qcevis winaswarmetyvelebis SesaZleblobas da sakmarisad ar aRiareben pirovnebis genetikur aspeqtebs.

pirovnebis Teoriebis Sedareba


ar arsebobs pirovnebis erTiani, unificirebuli Teoria, romelsac fsiqologebis umetesoba daeTanxmeboda. mravalferovani Teoriebis ganxilvisas araerTxel gamovlinda maT Soris ramdenime gansxvaveba, rac ZiriTad daSvebebSi mdgomareobs. sasargeblo iqneboda Segvejamebina xuTi yvelaze mniSvnelovani gansxvaveba pirovnebis Sesaxeb daSvebebSi da is midgomebi, romlebic safuZvlad udevs yovel am daSvebas: 1. memkvidreoba Tu garemo. rogorc naxeT qveTavSi fsiqologia da cxovreba, am gansxvavebas, aseve, buneba Tu aRzrda ewodeba. ra ufro mniSvnelovania pirovnebis ganviTarebisaTvis: genetikuri da biologiuri faqtorebi Tu garemos gavlenebi? pirovnebis niSnis Teoriebi iyofoda am sakiTxTan dakavSirebiT. froidis Teoria Zlieradaa damokidebuli memkvidreobiTobaze; humanisturi, socialuri daswavlis, kognituri da me-s Teoriebi xazs usvamen garemos, rogorc qcevis determinants, an garemosTan urTierTqmedebas, rogorc pirov-

Sejameba
me-s koncefciebi warmoadgens mexsierebis struqturebs, romlebic moicaven sqemebs me-s Sesaxeb da marTaven imas, Tu rogor gadaamuSaveben adamianebi informacias sakuTari Tavis da sxvebis Sesaxeb. rogorc Cans, adamianebs TviTSemowmeba urCevniaT maSinac ki, rodesac Semowmebuli me-s koncefcia uaryofiTia. adamianebi iyeneben

pirovnebis Teoriebis Sedareba

593

nebis ganviTarebisa da pirovnebaTa Soris gansxvavebebis wyaros; 2. daswavlis procesebi Tu qcevis Tandayolili wesebi. romel mosazrebas unda mieniWos upiratesoba: imas, rom pirovneba icvleba daswavlis gziT, Tu rom pirovnebis ganviTareba mihyveba Sinagan gegmas? pirovnebis niSnis Teoriebi kvlav sxvadasxva azrs emxroba am kiTxvasTan dakavSirebiT. froidis Teoria mxars uWers Sinagani determinaciis Tvalsazriss maSin, rodesac humanistebi ayalibeben optimistur azrs, rom gamocdileba cvlis adamianebs. socialuri daswavlis, kognituri da me-s Teoriebi aSkarad mxars uWeren im Tvalsazriss, rom qceva da pirovneba icvleba daswavlili gamocdilebis Sedegad; 3. aqcenti warsulze, awmyosa Tu momavalze. pirovnebis niSnis Teoriebi xazs usvamen warsul mizezebs, Tandayolilsa Tu daswavlils; froidis Teoria aqcents akeTebs adreul bavSvobaSi momxdar warsul movlenebze; socialuri daswavlis Teoriebi fokusirebulia warsul ganmtkicebebze da awmyo SemTxveviTobebze; humanisturi Teoriebi mniSvnelobas aniWebs awmyo realobas an momavlis miznebs, xolo kognituri da me-s Teoriebi fokusirebulia warsulsa da awmyoze (da momavalzec, Tu CarTulia miznis dadgena). 4. cnobieri Tu aracnobieri. froidis Teoria mniSvnelobas aniWebs aracnobier procesebs, humanisturi, socialuri dawavlis da kognituri Teoriebi ki _ cnobier procesebs. pirovnebis niSnis Teoria mcire yuradRebas uTmobs am gansxvavebas, me-s Teoriebs ki am mxriv gamokveTili pozicia ar gaaCniaT;
Tavi 14 / pirovneba

dinamikuri Teoriebi amateben Zlier Zravas da sawvavs, raTa es manqana amuSavdes. humanisturi Teoriebi adamians mZRolis adgilze aTavseben. socialuri daswavlis Teoriebi uzrunvelyofen saWes, mimarTulebis signalebsa da sxva saregulacio mowyobilobas. kognituri Teoriebi amateben Sexsenebebs, rom fsiqikuri ruka, romelsac mZRoli irCevs mogzaurobisaTvis, gavlenas axdens imaze, Tu rogor aris dagegmili, organizebuli da damaxsovrebuli mogzauroba. dabolos, me-s Teoriebi axseneben mZRols, rom gaiTvaliswinos is STabeWdileba, romelsac misi manqanis tarebis unari gavlenas axdens mis mgzavrebsa da fexiT mosiaruleebze. imisTvis, rom davasruloT pirovnebis Sesaxeb mimoxilva, axla ganvixiloT is, Tu rogor xdeba pirovnebis Sefaseba. Cven aRvwerT zogierT gzas, romliTac fsiqologebi iZieben informacias pirovnebis im maxasiaTeblebis speqtris Sesaxeb, romelic yovel individs unikalobas aniWebs.

Sejameba
pirovnebis Teoriebi gansxvavdeba imiT, Tu rogor aqcents akeTeben isini memkvidreobiTobaze garemosTan SedarebiT; daswavlis procesebze qcevis Tandayolil wesebTan SedarebiT; warsul mizezebze, awmyo qcevaze Tu momaval miznebze; cnobierebaze aracnobierTan SedarebiT da dispoziciebze situaciebTan SedarebiT. yoveli Teoria gansxvavebul midgomas iZleva pirovnebis Secnobis TvalsazrisiT.

pirovnebis Sefaseba
dafiqrdiT im maxasiaTeblebze, romlebiTac Tqveni saukeTeso megobrebisgan gansxvavdebiT. fsiqologebs ainteresebT gansxvavebuli Tvisebebi, romlebic axasiaTebs erT individs, asxvavebs erT adamians sxvebisagan an asxvavebs erT jgufSi myof adamianebs sxva jgufis wevrebisagan (magaliTad, morcxv adamians Tamamisagan anda paranoiduls _ normalurisagan). pirovnebis gagebisa da aRweris am mcdelobebs safuZvlad ori daSveba udevs: pirveli is, rom arsebobs individebis pirovnuli maxasiaTeblebi,

5. Sinagani dispozicia Tu garemos situacia. socialuri daswavlis Teoriebi xazs usvamen situaciur faqtorebs; niSnis Teoriebi win wamosweven dispoziciur faqtorebs, xolo sxvebi uSveben interaqcias pirovnebiseul da situaciur cvladebs Soris. pirovnebis Teoriis yovel tips gansxvavebuli wvlili Seaqvs pirovnebis SemecnebaSi. niSnis Teoriebi gvawvdian nusxas, romelic aRwers pirovnebis nawilebsa da struqturebs. fsiqo-

594

romlebic maT qcevas koherentulobas aniWebs da, meore, rom es maxasiaTeblebi SeiZleba Sefasdes an gaizomos. es daSvebebi xorcSesxmulia pirovnebis testebSi, romlebic SeiZleba obieqtur da subieqtur testebad davyoT.

yeneba Cveulebriv, praqtikulad janmrTel mosaxleobasTan muSaobisas.

MMPI
MMPI Seiqmna minesotas universitetSi 1930ian wlebSi fsiqolog starke heTeueisa da fsiqiatr j. r. makkinlis mier (Hathaway & McKinley, 1940, 1943). misi ZiriTadi mizania individebis diagnostireba fsiqiatriuli kategoriebis mixedviT. pirveli testi 550 debulebisagan Sedgeboda, romelTac individebi axarisxebdnen, rogorc maTTvis marTebuls an mcdars, an pasuxobdnen _ `ar SemiZlia pasuxis gacema~. am debulebaTa erTobliobidan SemuSavda skalebi, romlebic fsiqiatriul dawesebulebebSi pacientebis mier gamovlenili problemebis saxeobebs Seesabameboda. MMPI-s skalebi ar hgavda sxva arsebul pirovnebis testebs, radganac isini empiriuli strategiis gamoyenebiT SemuSavda da ara intuitiuri, Teoriuli midgomiT, romelic im dros dominirebda (gaixseneT Cveni adrindeli diskusia testis Teoriuli da empiriuli konstruqciis Sesaxeb). debulebebi mxolod im SemTxvevaSi rCeboda skalaze, Tu isini aSkarad ganasxvavebdnen or jgufs, magaliTad, Sizofreniul pacientebs da normalur sakontrolo jgufs. TiToeul debulebas unda eCvenebina misi validuroba imiT, rom mas TiToeuli jgufis wevrebi erTnairad upasuxebdnen, xolo ori jgufis wevrebi _ gansxvavebulad. amgvarad, debulebebi SerCeuli iyo ara Teoriul safuZvelze (imis mixedviT, Tu rogor mniSvnelobas atarebdnen isini eqspertebisTvis), aramed empiriul safuZvelze (imis mixedviT, ganasxvavebdnen Tu ara isini or jgufs). MMPI-is aqvs 10 klinikuri skala. TiToeuli Seqmnilia imisTvis, rom gansakuTrebuli klinikuri jgufebi (rogoricaa SizofreniiT daavadebuli individebi) ganvasxvavoT normaluri sakontrolo jgufisagan. testi, aseve, Seicavs validurobis skalebs, romlebic gamoavlens iseT saeWvo pasuxebs, rogoricaa: aSkara sicrue, uyuradReboba, Tavdacva, anda aragulwrfeloba. MMPI-is interpretaciisas, is, vinc tests atarebs, pirvel rigSi, amowmebs validurobis skalebs, raTa darwmundes, rom testze miRebuli pasuxebi validuria da Semdeg uyurebs danarCen

obieqturi testebi
pirovnebis obieqtur testebSi Sefasebis micema (qulebis miniWeba) da maTi gamoyeneba SedarebiT martivia da kargad gansazRvrul wesebs emorCileba. zogierT obieqtur testSi Sefaseba da interpretaciac ki kompiuteruli programebiT xorcieldeba. saboloo Sefaseba, rogorc wesi, erTniSna ricxvia, romelic erTaderTi ganzomilebis gaswvriv (rogoricaa adaptacia-disadaptacia) Tavsdeba, an sxvadasxva niSnebis qulaTa erTobliobis gaswvriv (rogoricaa: impulsuroba, damokidebuleba an eqstraversia). es monacemebi SedarebaSi mohyavT normatiuli SerCevis monacemebTan. TviTangariSis kiTxvari aris obieqturi testi, romelSic individebi pasuxoben kiTxvaTa seriebs maTi azrebis, grZnobebisa da moqmedebebis Sesaxeb. erT-erTi pirveli TviTangariSis kiTxvari, vudvorTsis pirovnuli monacemebis furceli _ Woodworth Personal Data Sheet (Seqmnili 1917 wels) Seicavda amis msgavs kiTxvebs: RamiT xSirad geSiniaT xolme?~ (DuBois, 1970). dResdReobiT pirovnebis kiTxvaris Sevsebisas adamiani kiTxulobs debulebaTa seriebs da aRniSnavs, Tu ramdenad Seesabameba, an ramdenad damaxasiaTebelia misTvis TiToeuli maTgani. yvelaze xSirad gamoiyeneba minesotas multifazuri pirovnebis kiTxvari _ Minnesota Multiphasic Personality Inventory, anu MMPI (Dahlstrom et al., 1975). is mraval klinikur dawesebulebaSi gamoiyeneba pacientebis diagnostirebis damxmare instrumentad da maTi mkurnalobis mimarTulebis misacemad. am kiTxvaris maxasiaTeblebisa da misi gamoyenebis ganxilvis Semdeg mokled SevexebiT NEO pirovnebis kiTxvars (NEO Personality Inventory - NEO-PI), romelic farTod gamoipirovnebis kiTxvari (Personality inventory) TviTangariSis meTodika, romelic gamoiyeneba pirovnebis Sesafaseblad da moicavs debulebaTa CamonaTvals pirovnebis azrebis, grZnobebisa da qcevebis Sesaxeb.

595

pirovnebis Sefaseba

cxrili

14.6

MMPI- 2 klinikuri skalebi


ipoqondria (Hs): paTologiuri SfoTva sxeulebrivi funqciebis Sesaxeb depresia (D): pesimizmi, uimedoba, moqmedebisa da azrovnebis Seneleba konversiuli isteria (Hy): mentaluri problemebis aracnobieri gamoyeneba konfliqtebisa Tu pasuxismgeblobis Tavidan acilebis mizniT asocialuri fsiqopaTia (Pd): socialuri normebis ignorireba; zedapiruli emociebi; gamocdilebidan sargeblis miRebis unaris arqona maskulinoba-feminuroba (Mf): mamakacebsa da qalebs Soris gansxvavebebi paranoiduloba (Pa): iWvneuloba, gandidebis an devnis mania fsiqasTenia (Pt): obsesiebi; kompulsiebi; SiSebi; danaSaulis gancda; gadauwyveteloba Sizofrenia (Sc): ucnauroba, uCveuli azrebi an qceva; sakuTar TavSi Caketva; halucinaciebi; iluziebi hipomania (Ma): emociuri agznebuloba; ideebis araTanmimdevruloba; moWarbebuli aqtivoba

596

maCveneblebs. maCveneblebis paterni _ romelia yvelaze maRali, rogor gansxvavdeba isini erTmaneTisgan _ qmnis MMPI-is profils~. individualuri profilebi dardeba konkretuli jgufebisaTvis damaxasiaTebel iseT profilebs, rogoricaa, magaliTad, kriminalebi da azartuli moTamaSeebi. 1980-ian wlebSi MMPI Zireulad gadasijes da axla mas MMPI-2 ewodeba (Butcher et al., 1989; Butcher & Williams, 1992; Greene, 1991). MMPI-2-s axasiaTebs ganaxlebuli ena, misi Sinaarsi ukeTesad asaxavs Tanamedrove problemebs da monacemebi normebisaTvis axal populaciebSi Segrovda. garda amisa, MMPI-2-Si damatebulia 15 axali Sinaarsobrivi skala, romelic gamoiyvanes, nawilobriv, Teoriuli meTodis gamoyenebiT. 15 klinikurad relevanturi Temidan (rogoricaa SfoTva an ojaxuri problemebi) TiToeulisaTvis debulebebi SeirCa or safuZvelze dayrdnobiT _ iyo Tu ara isini Teoriulad dakavSirebuli TemasTan da qmnidnen Tu ara statistikurad homogenur skalas, rac niSnavda imas, rom TiToeuli skala zomavs erTaderT, unificirebul cnebas. MMPI-2-is

klinikuri da Sinaarsobrivi skalebi mocemulia cxrilebSi 14.7 da 14.8. Tqven SeamCnevT, rom klinikuri skalebis umetesoba zomavs ramdenime urTierTdakavSirebul cnebas da rom Sinaarsobrivi skalebis saxelwodebebi martivi da naTelia. MMPI-2-is upiratesobebia misi Catarebis simartive, ekonomiuroba da misi vargisianoba fsiqopaTologiis diagnostirebisas (Butcher & Rouse, 1996). garda amisa, debulebaTa erToblioba mravali mizniT SeiZleba iqnes gamoyenebuli. magaliTad, Tqven SegiZliaT SeadginoT kreatulobis skala individebis kreatuli da arakreatuli jgufebis moZebniTa da MMPI-dan im debulebebis gansazRvriT, romlebsac maT gansxvavebulad upasuxes. wlebis ganmavlobaSi fsiqologebma am gziT asobiT specialuri daniSnulebis skala Seadgines da gansazRvres maTi validuroba. mkvlevrebisaTvis MMPI-is erTerTi yvelaze mimzidveli maxasiaTebelia misi profilebis uzarmazari arqivi, Segrovebuli 50-ze meti wlis manZilze. radganac yvela es adamiani standartizebulad iqna Semowmebuli erTsa da imave debulebebze, isini SeiZleba SevadaroT rogorc tradiciuli klinikuri skalebis mixedviT, ise specialuri daniSnulebis skalebis mixedviT (Cveni axali kreatulobis~ skalis msgavsad). MMPI-is es arqivebi mkvlevrebs saSualebas aZlevs, Seamowmon hipoTezebi MMPIze, romlebic mravali wliT adre iyo Cata-

cxrili

14.8
antisocialuri qmedebebi tipi A (adamiani, romelic uzomod bevrs muSaobs) dabali TviTSefaseba/ TviTpativiscema socialuri diskomforti ojaxuri problemebi

MMPI- 2 Sinaarsobrivi skalebi


SfoTva SiSebi obsesiuroba (akviatebuli azrebi) depresia janmrTelobasTan dakavSirebuli sazrunavebi ucnauri azrebi gabrazeba /risxva

Tavi 14 / pirovneba

muSaobis dros winaaRmdegobebi mkurnalobis uaryofiTi indikatorebi (uaryofiTi damokidebuleba eqimebisa da mkurnalobis mimarT) antisocialuri qmedebebi

cinizmi

rebuli, SesaZloa, bevrad adre, vidre gaCndeboda warmodgena gasazomi konstruqtis Sesaxeb. MMPI-2-sac aqvs Tavisi kritika. magaliTad, misi klinikuri skalebi heterogenurobis gamo (isini erTdroulad ramdenime parametrs zomaven) gaakritikes. aseve, mkvlevrebi Tvlian, rom cvlilebebi, romlebic Sevida Sesworebul MMPI-2-Si sawyis MMPI-sTan SedarebiT, ar aris sakmarisi pirovnebis Teoriis winsvlis asaxvisaTvis; testi kvlav axlos dgas Tavis empiriul warmoSobasTan (Helmes & Reddon, 1993). SesaZlebelia, MMPI-2 gaakritikon im SemTxvevaSic, rodesac adamianebi sxvadasxva mizniT cdiloben mis gamoyenebas. magaliTad, MMPI-2is depresiis skala aRwevs validurobis misaReb dones (Boone, 1994); amis sapirispirod, wamaldamokidebulebis (substance abuse) winaswarmetyvelebisadmi miZRvnili skalebi ar aris iseTi validuri, rogorc ufro specifikuri Sefasebis instrumentebi (Svanum et al., 1994). rogorc nebismieri Sefasebis instrumentis SemTxvevaSi, mkvlevrebma didi sifrTxiliT unda Seafason MMPI-isa da MMPI-2-is gamoyenebis sandooba da validuroba yovel konkretul SemTxvevaSi (Greene et al., 1997). pirovnebis es kiTxvarebi Seqmnili iyo klinikuri problemebis mqone individebis SefasebisaTvis. momdevno or qveTavSi Cven aRvwerT zogadad pirovnebis (ara pacientebis) SefasebisaTvis ufro Sesabamis instrumentebs.

NEO PI
NEO pirovnebis kiTxvari (NEO Personality Inventory _ NEO PI) aseve Seiqmna pirovnebis maxasiaTeblebis Sesafaseblad araklinikuri mozrdilebis populaciaSi. is zomavs pirovnebis xuTfaqtorian models, romelic zemoT ganvixileT. Tu NEO PI CagitardaT, Tqven miiRebdiT profilis furcels, romelic giCvenebdaT Tqvens standartizebul maCveneblebs did normatiul SerCevasTan mimarTebaSi xuTi ZiriTadi ganzomilebidan TiToeulze: neiroticizmi, eqstraversia, Riaoba, TanxmobisaTvis mzaoba da patiosneba (Costa & McCrae, 1985). NEO PI-is gadasinjuli versia afasebs 30 calkeul niSans, romelic organizebulia xuTi ZiriTadi faqtoris mixedviT (Costa & McCrae, 1992b). magaliTad, neiroticizmis ganzomileba dayofilia eqvs calkeul

proeqciuli testebi
rodesme Tu SegixedavT RrublisaTvis da saxe an cxovelis konturi daginaxavT? Tu Tqvens megobrebs sTxovdiT, SeexedaT, maT SeiZleba daenaxaT dayrdnobili SiSveli figura an

597

pirovnebis Sefaseba

skalad: SfoTva, mtruloba, depresia, morcxvoba, impulsuroba da mowyvladoba. bevrma kvlevam aCvena, rom NEO PI-is ganzomilebebi homogenuria, axasiaTebT maRali sandooba da kargi konstruqtuli da kriteriumis mixedviT validoba (Costa & McCrae , 1992a; Furnham et al. , 1997). NEO PI gamoiyeneba cxovrebis manZilze pirovnebis stabilobisa da cvalebadobis Sesaswavlad iseve, rogorc pirovnuli maxasiaTeblebis mimarTebis sakvlevad fizikur janmrTelobasTan da mravalferovan cxovrebiseul movlenebTan, rogoricaa warmatebuli kariera, anda adreuli gasvla pensiaze. xuTfaqtorian modelze dafuZnebuli axali kiTxvari, didi xuTeulis kiTxvari _ Big Five Questionnaire (BFQ) Seiqmna im mizniT, rom gansxvavebul kulturebs Soris validuroba yofiliyo. skala italiaSi SeimuSaves, magram mas msgavsi fsiqometruli maCveneblebi aqvs amerikuli da espanuri populaciebisaTvis da Sesabamisi normebi franguli, germanuli, Cexuri, ungruli da polonuri TargmanebisaTvisac dgindeba (Barbaranelli et al., 1997; Caprara et al., 1993). miuxedavad imisa, rom BFQ maRal korelaciaSia NEO PI-sTan, is mniSvnelovanwilad gansxvavdeba misgan. faqtori 1 masSi figurirebs, rogorc energia~ an aqtivoba~ da ara eqstraversia~ (damTmobobis socialur aspeqtebTan gadafarvis Sesamcireblad). BFQ Seicavs skalebs imis Sesamowmeblad, xom ar ixreba respondentis pasuxebi socialurad sasurveli pasuxebisaken. is NEO PI-ze martivia, radganac mxolod ori calkeuli skala aqvs TiToeuli faqtorisaTvis. magaliTad, energia~ Sedgeba dinamizmisa~ da dominantobis~ skalebisagan; pirveli intrapersonaluria, meore ki _ interpersonaluri. ramdenadac fsiqologia sul ufro globaluri xdeba, Sefasebis aseTi instrumentebi, romlebic erTnairad kargad muSaoben enobrivi da erovnuli barierebis miuxedavad, arsebiTia mniSvnelovani kros-kulturuli kvlevebis warmoebisaTvis pirovnebisa da socialur fsiqologiaSi.

Tavi 14 / pirovneba

drakoni. msgavs fenomens eyrdnobian fsiqologebi pirovnebis SefasebisaTvis proeqciuli testebis gamoyenebisas. rogorc axlaxan vnaxeT, obieqtur testebs oridan erTi forma aqvT: isini an respondentebs debulebebis seriebs sTavazoben da sTxoven maT, martivi pasuxi gascen (rogoricaa WeSmaritia~, mcdaria~, an ar SemiZlia pasuxis gacema~), an sakuTari Tavis Sefasebas sTxoven garkveuli ganzomilebebis mixedviT (rogoricaa mSfoTvare-mSvidi~). amgvarad, respondenti iZulebulia, airCios winaswargansazRvruli pasuxebidan erT-erTi. amis sapirispirod, proeqciuli testebi ar Seicaven pasuxebis winaswargansazRvrul diapazons. proeqciul testSi pirovnebas warudgenen stimulebis seriebs, romlebic ganzrax bundovani/orazrovania. aseTia, magaliTad, abstraqtuli nimuSebi, dausrulebeli suraTebi, an naxatebi, romelTa interpretaciac mravalnairad aris SesaZlebeli. adamians SeiZleba sTxovon, aRweros abstraqciebi, daasrulos suraTebi an moyves naxatebis Sesaxeb istoriebi. proeqciuli testebi pirvelad fsiqoanalitikosebma gamoiyenes, romlebic imedovnebdnen, rom aseTi testebi maTi pacientebis aracnobier pirovnul dinamikas gamoavlendnen. vinaidan stimulebi bundovania/orazrovania, maTze gacemuli pasuxebi, nawilobriv, gansazRvrulia imiT, rac adamians Semoaqvs situaciaSi, saxeldobr, Sinagani grZnobebi, piradi motivebi da konfliqtebi cxovrebis gamocdilebidan. es pirovnuli, idiosinkratuli (damaxasiaTebeli, ganmasxvavebeli) aspeqtebi, romlebic proecirebulia stimulebze, pirovnebis Semfasebels mravalferovani interpretaciis gakeTebis saSualebas aZlevs. proeqciuli testebi Sefasebis im instrumentTa ricxvs miekuTvneba, romlebsac yvelaze xSirad iyeneben praqtikosi fsiqologebi (Butcher & Rouse, 1996; Lubin et al., 1984; Piotrowski et al., 1985); aseve, isini ufro xSirad gamoiyeneba SeerTebuli Statebis farglebs gareT, magaliTad, holanproeqciuli testi (Projective tests) _ pirovnebis Sefasebis meTodi, romelSic individs uCveneben orazrovani/abstraqtuli stimulebis erTobliobas da sTxoven maTi mniSvnelobis interpretacias; iTvleba, rom individis pasuxebi avlens mis Sinagan grZnobebs, motivebsa da konfliqtebs.

diaSi, hong-kongsa da iaponiaSi, vidre MMPI-is msgavsi obieqturi testebi (Piotrowski et al., 1993). xSirad ver xerxdeba obieqturi testebis adekvaturi Targmani da adekvaturi standartizeba araamerikul populaciebze. proeqciuli testebi naklebad mgrZnobiarea enobrivi cvlilebebis mimarT, Tumca, radganac isini ase gavrcelebulia, kritikosebi xSirad eWvoben, rom maT aravalidurad gamoiyeneben. ori yvelaze metad gavrcelebuli testis _ rorSaxis testisa (Rorschach test) da Tematuri apercefciis testis (Thematic Apperception Test -TAT) ganxilvisas Cven validurobis am sakiTxebs SevexebiT.

rorSaxis testi
rorSaxis testSi, romelic 1921 wels SeimuSava Sveicarelma fsiqiatrma herman rorSaxma (Hermann Rorschach) bundovani stimulebi warmodgenilia simetriuli melnis laqebis saxiT (Rorschach, 1942). zogi maTgani Sav-TeTria da zogi _ feradi (ix. sur. 14.7). testis msvlelobisas respondents uCveneben laqas da ekiTxebian: ra SeiZleba es iyos~? respondentebs arwmuneben, rom ar arsebobs swori an mcdari pasuxebi (Exner, 1974). mkvlevrebi zedmiwevniT afiqsireben, ras amboben adamianebi, ramdeni dro sWirdebaT pasuxis gasacemad, mTlianad ra dro exarjeba respondents TiTo laqaze da rogor uWiravs mas baraTi. Semdeg, meore fazaSi, romelsac gamokiTxva ewodeba, respondents axseneben wina pasuxebs da sTxoven, detalurad daamuSavos isini.

suraTi

14.7

melnis laqa, msgavsi imisa, romelsac iyeneben rorSaxis testSi


ras xedavT? am laqis Tqveneburi interpretacia asaxavs Tu ara raimes Tqveni xasiaTidan?

598

pasuxebi sami ZiriTadi maxasiaTeblis mixedviT fasdeba: (1) lokacia, anu pasuxSi aRniSnuli baraTis nawili _ mTlian stimuls exeba respondenti Tu mis nawils da aRniSnuli detalebis zomebi; (2) pasuxis Sinaarsi _ danaxuli obieqtis da moqmedebebis buneba da (3) determinantebi _ baraTis romelma aspeqtebma (rogoricaa, feri da Crdilebi) misca biZgi pasuxs. Semfaseblebma, aseve, SeiZleba aRniSnon, rogori iyo pasuxebi: originaluri da unikaluri, Tu popularuli da konformuli. Tqven SesaZlebelia ifiqroT, rom melnis bundovani laqebi biZgs miscemen iseTi pasuxebis mravalferovnebas, romlebic interpretacias ar eqvemdebarebian. sinamdvileSi, mkvlevrebma Seqmnes rorSaxis pasuxebis yovlismomcveli Sefasebis sistema, romelic gansxvavebul testis Camtareblebs Soris mniSvnelovani Sedarebis gakeTebis saSualebas iZleva (Exner, 1991, 1993; Exner & Weiner, 1994). Sefasebis es sistema azustebs Sinaarsobrivi pasuxebis iseT zogad kategoriebs, rogoricaa mTliani adamiani (pasuxi moicavs, an gulisxmobs adamianis figuris formas) da sisxli (pasuxi moicavs adamianis, an cxovelis sisxls). pasuxebis nimuSebi warmatebiT daukavSires rogorc normaluri pirovnebis maxasiaTeblebs, fsiqopaTologias. da mainc, Sefasebis sistemasTan da rorSaxis testTan dakavSirebiT mainc rCeba garkveuli winaaRmdegoba (Exner, 1996; Meyer, 2000; Wood et al., 1996a, 1996b).

suraTi

14.8

Tat testis nimuSi


rilia adamianebi, romlebic cxovrobdnen movaleobebis mixedviT da Tu ambebi moyolil iqna seriozulad da dalagebulad. gaixseneT me-12 Tavidan, rom TAT xSirad gamoiyeneboda individualuri gansxvavebebis gamosavlenad iseT dominantur moTxovnilebebSi, rogoricaa Zalauflebis, afilaciis da miRwevis moTxovnileba (McClelland, 1961). kvlevis aTwleulebis ganmavlobaSi TAT damkvidrda, rogorc miRwevis moTxovnilebis validuri sazomi (Sprangler, 1992). Cven SemogTavazebT ramdenime daskvniT SeniSvnas pirovnebis Sefasebis sakiTxTan dakavSirebiT. dainaxeT Tu ara kavSiri am pirovnebis Sefasebis instrumentebsa da zemoT ganxilul pirovnebis Teoriebs Soris? Cveni daskvna iyo, rom Teoriebis TiToeuli tipi saukeTesod aSuqebda adamianuri gamocdilebis gansxvavebul aspeqtebs. pirovnebis testebis Sesaxebac msgavsi daskvnis gamotana SegviZlia _ yovel maTgans aqvs potenciali, mogvawodos individis pirovnebaSi unikaluri Cawvdomis SesaZlebloba. klinicistebi pirovnebis Sefasebisas yvelaze xSirad testebis kombinacias iyeneben; rorSaxi da MMPI, magaliTad, SeiZleba komplementarulad ganvixiloT (Butcher & Rouse, 1996; Lubin et al., 1984; Piotrowski et al., 1985). xSirad pirobebi iseTia,

TAT (Thematic Apperception Test) Tematuri apercefciis testi


henri mareis (Henry Murrey) mier 1938 wels Seqmnil Tematuri apercefciis testSi respondentebs uCveneben orazrovani scenebis suraTebs da sTxoven, Seqmnan am scenebis Sesaxeb istoriebi, romlebic aRwers, Tu ra adamianebi moqmedeben da fiqroben am scenebSi, ram gamoiwvia TiToeuli movlena da rogor dasruldeba yoveli situacia (ix. sur. 14.8). pirovneba, romelic atarebs TAT-s, afasebs rogorc istoriebis struqturasa da Sinaarss, ise ambis momyoli individis qcevas, raTa aRmoaCinos respondentis zogierTi ZiriTadi problema, motivacia da pirovnuli maxasiaTebeli. magaliTad, eqsperimentatorma SesaZloa Seafasos pirovneba, rogorc patiosani, Tu mis mier moyolil ambavSi aRwe-

pirovnebis Sefaseba

599

rom profilebi, romlebic miiReba obieqtur, kompiuterul analizze dayrdnobiTac ki, saSualebas iZleva, gakeTdes specifikuri Sedegebis zusti winaswarmetyveleba. sxva pirobebSi klinikurma eqspertizam da daxelovnebulma intuiciam unda Seavson obieqturi normebi. praqtikaSi saukeTeso winaswarmetyveleba maSin xdeba, rodesac kombinirebulia sxvadasxva midgomis Zlieri mxareebi. Tavis dasawyisSi vTqviT, rom pirovnebas ver gavzomavT mis Tavze gamoburculobebis SegrZnebiT, Tumca, Cven, aseve, gTxoveT, gefiqraT garkveul sakiTxebze: Tu fsiqologebi Tqven Segiswavlidnen, Tqveni pirovnebis rogor portrets daxatavdnen isini? romel adreul gamocdilebebs gamoyofdnen, rogorc Tqvens qcevasa da fiqrebze gavlenis mqones? ra pirobebi zemoqmedebs Zlierad Tqvens azrebsa da qcevaze amJamindel cxovrebaSi? ra gangasxvavebT sxva individebisgan, romlebic mraval Tqvens msgavs situaciaSi funqcionireben? axla xvdebiT, rom pirovnebis Teoriebis yoveli tipi iZleva zogad

CarCos, romlis farglebSic SegiZliaT am kiTxvebze pasuxebis Camoyalibeba. dauSviT, rom axla marTlac dadga is dro, rodesac Tqveni fsiqologiuri portreti unda daxatoT. saidan daiwyebdiT?

Sejameba
pirovnebis obieqturi testebi moicaven Catarebisa da Sefasebis SedarebiT standartul da gansazRvrul teqnikas. MMPI-2-s Tanamedrove ena da Sinaarsi axasiaTebs, rac klinikuri Teoriisa da Sefasebis winsvlas asaxavs. NEO-PI da BFQ zomaven normaluri pirovnebis funqcionirebis aspeqtebs. proeqciuli testebi individebs warudgenen bundovan stimulebs, raTa gamoavlinon Sinagani gancdebi, motivebi da konfliqtebi. mkvlevrebma gamoimuSaves rorSaxis melnis laqebze pasuxebis Sefasebis yovlismomcveli sistema. TAT warmoadgens miRwevis moTxovnilebis validur sazoms.

sakvanZo sakiTxebi
pirovnebis tipis da pirovnebis niSnis Teoriebi
zogierTi mecnieri axdens adamianebis kategorizacias sul an araferi~ tipebis mixedviT, romlebic konkretul damaxasiaTebel qcevas ukavSirdeba. sxva mecnierebi pirovnebis Semadgenel agurebad miiCneven pirovnul niSnebs _ uwyveti ganzomilebebis gaswvriv arsebul maxasiaTeblebs. xuTfaqtoriani modeli warmoadgens pirovnebis aRweriT sistemas, romelic asaxavs urTierTobas zogad pirovnul niSnebs, Teoriul koncefciebsa da pirovnebis skalebs Soris. tyupebisa da naSvilebi bavSvebis kvlevebi naTelyofen, rom pirovnuli niSnebi nawilobriv memkvidreobiTia. adamianebi amJRavneben qceviT konsistentobas, rodesac situaciebi ganisazRvreba relevanturi fsiqologiuri maxasiaTeblebis mixedviT. froidis Teoriis bazisuri cnebebi moicavs fsiqikur energias, rogorc qcevisTvis biZgis mimcems da warmmarTvels; adreul gamocdilebebs, rogorc pirovnebis mTavar msazRvrelebs mTeli sicocxlis manZilze; fsiqikur determinizms da Zlier aracnobier procesebs. pirovnebis struqtura Sedgeba idisagan, superegosagan da maTi Semarigebeli egosagan. miuRebeli impulsebi represirdeba da viTardeba egos dacvis meqanizmebi SfoTvis Sesamcireblad da TviTSefasebis SesanarCuneblad.

Tavi 14 / pirovneba

fsiqodinamikuri Teoriebi
froidis fsiqodinamikuri Teoria adamianuri motivaciis wyarod instinqtur biologiur energias miiCnevs.

600 600

postfroidistebma, rogorebic arian adleri, horni da iungi, ufro metad gaamaxviles yuradReba egos funqcionirebaze da socialur cvladebze da naklebad _ seqsualur ltolvebze. maT pirovnebis ganviTareba mTeli cxovrebis manZilze mimdinare procesad miaCniaT.

me-s (self-is) Teoriebi


me-s Teoriebi fokusirebulia me -s koncefciis mniSvnelobaze pirovnebis sruli SecnobisaTvis. me-s koncefcia aris dinamikuri mentaluri struqtura, romelic axdens pirovnuli da interpersonaluri qcevisa da procesebis motivacias, interpretacias, organizebas, mediacias da regulacias. mravali individualuri gansxvaveba aisaxeba Cveul xerxebSi, romlebiTac adamianebi warmoadgenen sakuTar Tavs socialur situaciebSi. kros-kulturuli kvlevidan gamomdinare, individua listuri kulturebi xels uwyoben damoukidebeli me-s gagebas, xolo koleqtivisturi kulturebi _ urTierTdamokidebuli me-s gagebas.

humanisturi Teoriebi
humanisturi Teoriebi fokusirebulia TviTaqtualizaciaze _ individis potencialis zrdaze. es Teoriebi holisturi, dispozociuri, fenomenologiuri da egzistencialuria. humanisturi tradiciis Tanamedrove Teoriebi fokusirebulia individis cxovrebiseul ambebze.

klinikuri problemebis diagnostikisaTvis gamoiyeneba. NEO-PI da BFQ pirovnebis ufro axali obieqturi testebia, romlebic zomaven pirovnebis xuT ZiriTad ganzomilebas. pirovnebis proeqciul testebSi adamianebs sTxoven, upasuxon bundovan stimulebs. ori mniSvnelovani proeqciuli testia rorSaxis testi da TAT.

ZiriTadi cnebebi
analitikuri fsiqologia SfoTva arqetipi koleqtiuri aracnobieri konsistentobis paradoqsi ego egos dacvis meqanizmebi xuTfaqtoriani modeli fiqsacia idi damoukidebeli me-s gageba urTierTdamokidebuli me-s gageba libido pirovneba pirovnebis kiTxvari pirovnebis tipebi SesaZlebeli me-ebi proeqciuli testi fsiqikuri determinizmi fsiqobiografia pirovnebis fsiqodina-mikuri Teoriebi reciprokuli determinizmi represia TviTaqtualizacia me-s koncefcia TviTefeqturoba TviTpativiscema TviTmavnebloba morcxvoba socialuri inteleqti superego niSnebi upirobo dadebiTi pativiscema aracnobieri

socialuri daswavlis da kognituri Teoriebi


socialuri daswavlis Teoriis mimdevrebi qcevaSi da pirovnebebs Soris individualur gansxvavebebs ganixilaven, rogorc gansxvavebuli ganmtkicebebis gamocdilebis Sedegs. kognituri Teoriis mimdevrebi xazs usvamen aRqmasa da garemos subieqtur interpretaciaSi individualur gansxvavebebs. uolter miSelma ikvlia qcevis safuZvlebi, rogorc adamianebsa da situaciebs Soris urTierTobebi. albert banduram aRwera reciprokuli determinizmi adamianebs, garemos da qcevas Soris. nensi kentoris Teoriam xazi gausva miznebis, codnis da strategiebis gavlenas adamianebis qcevaze.

pirovnebis Teoriebis Sedareba


pirovnebis Teoriebi SeiZleba erTmaneTs davupirispiroT im mxriv, Tu rogor aqcents akeTeben isini memkvidreobiTobaze garemosTan SedarebiT; daswavlis procesebze qcevis Tandayolil wesebTan SedarebiT; warsul mizezebze, awmyo qcevaze Tu momaval miznebze; cnobierebze aracnobierTan SedarebiT da dispoziciebze situaciebTan SedarebiT. TiToeul Teorias gansxvavebuli wvlili Seaqvs pirovnebis SecnobaSi.

pirovnebis Sefaseba
pirovnebis maxasiaTeblebi fasdeba rogorc obieqturi, ise _ proeqciuli testebiT. yvelaze gavrcelebuli obieqturi testi, MMPI-2,

601 601

sakvanZo sakiTxebi

fsiqologiuri

aSlilobebi

15
fsiqologiuri aSlilobebis buneba

ra aris paTologiuri obieqturobis problema istoriuli perspeqtivebi fsiqopaTologiis etiologia

fsiqologiuri aSlilobebis klasifikacia

klasifikaciis miznebi DSM-IV-TR


fsiqologia Cvens cxovrebaSi: marTla gvicavs Tu ara Seuracxadoba fsiqologiuri aSlilobebis ZiriTadi tipebi

SfoTviTi aSlilobebi SfoTviTi aSlilobebi: mizezebi guneba-ganwyobilebis aSlilobebi guneba-ganwyobilebis aSlilobebi: mizezebi depresia: sqesTa Soris gansxvavebani suicidi pirovnuli aSlilobebi disociaciuri aSlilobebi
fsiqologia XXI saukuneSi: marTla arsebobs Tu ara internetomania Sizofreniuli aSlilobebi

Sizofreniis ZiriTadi tipebi Sizofreniis mizezebi


fsiqikuri daavadebis daRi (stigma) sakvanZo sakiTxebi

602

ZiriTadi cnebebi

ra reaqcia gqondaT axalgazrda qalis sityvebs rom kiTxulobdiT winamdebare saxelmZRvanelos avtorebisadmi miwerili werilidan? Tu Tqveni reaqcia Cvensas hgavs, maSin es misi mdgomareobiT gamowveuli sevdis, fsiqikuri daavadebiT gamowveul mraval problemasTan gamklavebis misi dabejiTebuli surviliT

aRtacebis, risxvis, vinc mas avadmyofis iarliys awebebs imis gamo, rom xandaxan gansxvavebul qcevas axorcielebs, da mdgomareobis gasaumjobesebeli medikamentebisa da Terapiis arsebobiT gamowveuli imedis narevi iqneboda. es mxolod mwiri CamonaTvalia im emociebisa, romelic euflebaT klinikaSi da kvlevebiT dakavebul

fsiqologiuri aSlilobebis buneba

inda mogiTxroT, Tu rogoria Cvens droSi funqcionalur Sizofrenikad yofna da rasTan uxdebaT Sejaxeba Cemnairi fsiqikuri daavadebis mqone adamianebs. me 30 wlis var, marto vcxovrob da naxevar ganakveTze vmuSaob, radganac Tan kolejSi vswavlob. Cemi avadmyofobis gamo, ar maqvs meddad muSaobis ufleba, miuxedavad imisa, rom kolejSi vswavlob da pacientebis movlis gamocdilebac maqvs. kolejSi momsaxurebis sferoSi vspecializdebi, raTa sxvebs problemebis mogvarebaSi davexmaro, radganac, rodesac pirvelad gavxdi avad, Zalian cudad viyavi da amitomac kargad vici, ra aris es, rogori tanjvaa es. sakmaod normalurad vcxovrob da veravin amCnevs, rom fsiqikurad var avad, sanam me TviTon ar vityvi xolme amis Sesaxeb... Cemi dac (ara tyupiscali) ukve 12 weliwadia avad aris da uars ambobs wamlebis miRebaze, radgan uaryofs, rom es daavadeba aqvs. me 5 welia avad var. avadmyofobis pirvel wels, rodesac vkiTxulobdi wigns arasodes Segpirebivar vardebis baRnars~, davrwmundi, rom marTlac avad viyavi. Semdeg gamovkeTdi antifsiqoturi medikamentebis wyalobiT. Cemi azriT, pacientsac da sazogadoebasac ganaTleba sWirdeba fsiqikur daavadebebSi, radganac adamianebi dagvcinian da arasworad

gveqcevian, zogjer arasworadac esmiT Cveni gadamwyvet momentebSi. aseve reagireben ojaxi, meuRle, megobrebi Tu socialuri samsaxurebi Cvennairi adamianebis maTTvis jer kidev ucnob Taviseburebebze. zogierT Cvenganze wamlebi kargad moqmedebs. SemiZlia mogiyveT im gansxvavebis Sesaxeb, romelic arsebobs Cemi avadmyofobis gamo xmaursa da realur xmaurs Soris, radganac me vkiTxulobdi amis Sesaxeb da Seviswavle Cemi Tavi. viyeneb saRi azris wess. Zalian vcdilob, rom davimaxsovro, Tu rogorebi arian adamianebi da rogoria samyaro realurad, sinamdvileSi. avadmyofoba amokrefs xolme Zalze sulelur da momabezrebel absurdebs. wamlebi Zlierad moqmedebs Cemze da Cems organizmze, amitom ar maqvs ise bevri Semawuxebeli avadmyofuri simptomebi... wamlebis miRebamde halucinaciebi da absurdebi nebismier sferos SeiZleboda miswvdomoda da survilisamebr Seecvala isini. wamlebis moqmedebis dawyebamde vgrZnobdi, rom es mTel tvins eufleboda da vyvirodi, vtirodi da mindoda Cemi gonebisa da cxovrebis dabruneba... nebismiers, visac cxovrebaSi raimes miRweva surs, sakuTari Tavis damkvidrebis SesaZlebloba esaWiroeba. avadmyofi adamianis garda, me pirovnebac var.

603

fsiqologebsa da fsiqiatrebs, rodesac isini fsiqikuri aSlilobebis bunebis Secnobasa da mkurnalobas cdiloben. winamdebare Tavi fsiqologiuri aSlilobebis bunebasa da mizezebs Seexeba: ras warmoadgens fsiqologiuri aSliloba, ratom viTardeba da rogor aris SesaZlebeli misi ganviTarebis mizezebis axsna. Semdegi Tavi am codnazea agebuli da masSi aRwerilia is strategiebi, romelic gamoiyeneba fsiqikuri daavadebebis mkurnalobisa da profilaqtikisTvis. kvleva aCvenebs, rom aSS-Si axalgazrdebisa da Suaxnis moqalaqeTa 50%-s mTeli cxovrebis manZilze erTxel mainc aReniSneba fsiqologiuri aSliloba (Kessler et al., 1994). amrigad, mravali Tqvengani, vinc waikiTxavs am wigns, sasargeblo codnas miiRebs fsiqopaTologiis Sesaxeb, Tumca, calkeuli faqtebiT SeuZlebelia im seriozuli zegavlenis aRwera, romelsac fsiqologiuri aSliloba individebisa da ojaxebis yoveldRiur cxovrebaze axdens. mocemul TavSi, ganvixilavT ra fsiqologiuri aSlilobebis kategoriebs, SevecdebiT im realuri adamianebis aRweras, romelTac yoveldRe uwevT am aSlilobiT cxovreba; gagiziarebT maT sityvebsa da gamocdilebas, rogorc es Tavis dasawyisSi gavakeTeT. daviwyoT paTologiis cnebis ganxilviT.

giuri funqcionirebis im diapazons, romelic ganixileba, rogorc arajanmrTeli, an paTologiuri da romelsac xSirad fsiqopaTologias an fsiqologiur aSlilobas uwodeben. fsiqopaTologiuri funqcionireba moicavs emociuri, qceviTi, an azrovnebiTi procesebis darRvevebs, rasac Tan sdevs pirovnuli distresi, an rac blokavs, aferxebs mniSvnelovani miznebis miRwevis SesaZleblobas. paTofsiqologia1 fsiqologiuri kvlevebis is sferoa, romelic yvelaze uSualod Seexeba azrovnebis, ganwyobilebisa da qcevis individualuri paTologiebis bunebis Secnobas. am qveTavs paTologiuri~-s gansazRvrebis ufro detaluri ganxilviT daviwyebT, Semdeg ki obieqturobis problemas SevexebiT. bolos ki Tvals gavadevnebT, Tu rogor viTardeboda es gansazRvreba kacobriobis istoriis aswleulebis manZilze.

ra aris paTologiuri
ras niSnavs, rodesac vambobT, rom mocemuli pirovneba paTologiuria, anu fsiqologiuri aSlilobisgan itanjeba? rogor wyveten fsiqologebi da klinikaSi momuSave sxva praqtikosebi, Tu ra aris paTologiuri? aris ki yovelTvis naTeli, Tu rodis, ra momentSi gadainacvlebs qceva normaluris kategoriidan paTologiuris kategoriaSi? mocemuli individis fsiqologiuri aSlilobis Sesaxeb daskvna, Cveulebisamebr, individis qcevis Sefasebas efuZneba. am daskvnas garkveuli specialuri avtoritetisa da Zalauflebis mqone adamianebi akeTeben. am fenomenis aRsawerad gamoyenebuli terminebi, rogoricaa fsiqikuri aSliloba, fsiqikuri daavadeba Tu paTologia, damokidebulia konkretul Tvalsazrisze, Semfaseblis codnasa da mis kulturul gamocdilebaze, situaciasa da im
fsiqopaTologiuri funqcionireba (Psychopatological functioning) _ darRvevebi emociur, qceviT an azrovnebis procesebSi, rasac Tan sdevs pirovnuli distresi an mniSvnelovani miznebis miRwevis SesaZleblobebis blokireba. paTofsiqologia (Abnormal psychology) _ fsiqologiuri kvlevis sfero, romelic fokusirdeba gonebis, guneba-ganwyobilebisa da qcevis individualuri paTologiebis bunebis Secnobaze.

fsiqologiuri aSlilobebis buneba


Tavi 15 / fsiqologiuri aSlilobebi

rodesme ginerviuliaT zedmetad? yofilxarT daTrgunuli an SeSfoTebuli yovelgvari realuri mizezis gareSe? SegSinebiaT iseTi ramis, ris Sesaxebac danamdvilebiT icodiT, rom ar iyo saSiSi? gifiqriaT TviTmkvlelobaze? migimarTavT alkoholisTvis an narkotikebisTvis problemisgan Tavis dasaRwevad? TiTqmis yvela Cvengani erT-erT kiTxvaze mainc gascemda dadebiT pasuxs, rac imaze miuTiTebs, rom TiTqmis yvela Cvengans ganucdia fsiqologiuri aSlilobis simptomebi. winamdebare Tavi Seexeba fsiqoloAbnormal Psychology iTargmna, rogorc paTofsiqologia~, romelSic moiazreba fsiqologiuri aSlilobebi da qcevis darRvevebi (mTargmnelis SeniSvna).
1

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ekargebodes qcevaze. bavSvi, romelic yovelgvari TvalsaCino mizezis gareSe muSts urtyams fanjaras, araprognozirebad qcevas axorcielebs; 5. araSablonuroba da statistikuri iSviaToba. individis mier ganxorcielebuli qceva statistikur iSviaTobas warmoadgens da misaRebi an sasurveli qcevis socialur standartebs arRvevs. Tumca, mxolod statistikur uCveulobas ar mivyavarT paTologiuris fsiqologiur daskvnamde. magaliTad, geniosebis inteleqtis done ukiduresad iSviaTia, magram es sasurveladac aris miCneuli. meore mxriv, ukiduresad dabali inteleqti, aseve, iSviaTobaa, magram es arasasurvelad iTvleba; amitom xSirad mas paTologiuris kategorias miakuTvneben; 6. damkvirveblis diskomforti. individi diskomforts uqmnis sxvebs imiT, rom garkveulad afrTxobs an distress badebs maTSi. Sua quCaSi mimavali, sakuTar TavTan xmamaRal kamaTSi CarTuli qali damkvirveblis diskomforts iwvevs mZRolSi, romelic misTvis gverdis avlas cdilobs; 7. zneobrivi da idealuri standartebis rRveva. individi arRvevs molodins imis Taobaze, Tu rogor unda moiqces socialuri normebis gaTvaliswinebiT. am kriteriumis mixedviT, adamianebs SeiZleba paTologiuri vuwodoT, Tu maT ar surT muSaoba anda ar swamT RmerTis. paTologiuris es kriteriumi relevanturia samarTlebriv situaciebSic. am Temas eZRvneba CanarTi fsiqologia Cvens cxovrebaSi~. SegiZliaT dainaxoT, Tu ratom ar aris paTologiuris es kriteriumebi myisierad aSkara yvela damkvirveblisTvis? ganvixiloT mxolod bolo kriteriumi. fsiqikurad avad xarT, Tu ar gsurT muSaoba maSinac ki, rodesac es paTologiurad iTvleba sazogadoebis normebis mixedviT? an ganvixiloT ufro seriozuli simptomi. Cvens kulturaSi cudia~, Tu halucinaciebi gvaqvs, radganac isini fsiqikuri darRvevis niSnebad aRiqmeba, magram es kargia~ im kulturebSi, sadac halucinaciebi interpretirdeba, rogorc spiritualuri Zalebdan momdinare mistikuri xilvebi. sworia es daskvna? winamdebare Tavis bolos

pirovnebis statusze, romlis Sesaxebac keTdeba daskvna. ganvixiloT Svidi kriteriumi, romelic qcevisaTvis paTologiuris~ statusis misaniWeblad SeiZleba gamoviyenoT (DSM-IV-TR, 2000; Rosenhan & Seligman, 1989). 1. distresi an uunaroba. individi ganicdis pirovnul distress, an axorcielebs usargeblo qcevas, rasac Tan sdevs fizikuri an fsiqologiuri gauaresebis riski, an qcevis Tavisuflad, nebismierad ganxorcielebis SesaZleblobis dakargva. magaliTad, mamakacs, romelic ver gadis saxlidan oflis mosvlis gareSe, ar SeeZleba mimdinare cxovrebiseuli miznebis miRweva; 2. araadekvaturoba. individis qceva abrkolebs miznis miRwevas, ar emsaxureba pirovnul keTildReobas, an Zalian aferxebs sxvaTa miznebsa da sazogadoebis moTxovnilebebs. individi, romelic imdenad svams, rom ar SeuZlia samuSaos SenarCuneba, an romelic safrTxis winaSe ayenebs sxvebs Tavisi problemiT, araadekvatur qcevas axorcielebs; 3. araracionaluroba/iracionaluroba. individi moqmedebs an laparakobs sxvebisTvis gaugebrad, an araracionalurad. adamiani, romelic pasuxobs obieqtur realobaSi ararsebul xmebs, araracionalurad, anu iracionalurad iqceva; 4. araprognozirebadoba. individi araprognozirebadad, an araTanmimdevrulad iqceva situaciidan situaciaSi, TiTqos kontroli

605

optimaluri fsiqikuri janmrTeloba

minimaluri fsiqikuri janmrTeloba

individualuri, jgufuri da garemos faqtorebi erTad efeqturad muSaobs da uzrunvelyofs: subieqtur kargad yofnas; optimalur ganviTarebas da gonebrivi SesaZleblobebis gamoyenebas; marTlmsajulebasTan Tavsebadi miznebis miRwevas; fundamenturi Tanasworobis mdgomareobebs. suraTi

individualuri, jgufuri da garemos faqtorebi erTmaneTTan konfliqtSi modian da iwveven: subieqtur distress; gonebrivi SesaZleblobebis gauaresebas an arasakmaris ganviTarebas; warumateblobas miznis miRwevaSi; destruqciul qcevas; usamarTlobis ganmtkicebas.

15.1

fsiqikuri janmrTelobis kontiniumi


vinaidan normasa da paTologias Soris gansxvaveba fardobiTi ufroa, vidre absoluturi, sasargebloa fsiqikuri janmrTelobis, rogorc kontiniumis ganxilva. erT boloSi moTavsebulia qcevebi, romlebic gansazRvravs optimalur fsiqikur janmrTelobas; meore boloSi ki _ qcevebi, romlebic minimalur fsiqikur janmrTelobas aRweren. maT Soris moTavsebulia TandaTanobiT mzardi araadapturi qcevebi.

606

ganvixilavT zogierT uaryofiT Sedegsa da safrTxes, romelic aseTi sazogadoebis mier regulirebad msjelobebsa da maTze dafuZnebul gadawyvetilebebs ukavSirdeba. Cven ufro meti darwmunebulobiT mivakuTvnebT qcevas paTologiuris kategorias, rodesac gvaqvs da dasabuTebulia erTze meti indikatori. rac ufro ukiduresad da mkveTrad aris gamoxatuli indikatorebi, miT ufro metad darwmunebulni SeiZleba viyoT, rom isini paTologiur mdgomareobaze miuTiTeben. arc erTi am kriteriumTagani ar aris aucilebeli piroba, romelic saerTo iqneboda paTologiuris yvela SemTxvevisTvis. magaliTad, saqmis ganxilvisas, romelic stenfordis damamTavrebeli kursis studentis mier Cadenil mkvlelobas Seexeboda, aRweraSi ar iyo arc danaSaulis grZnoba da arc sindisis qenjna; am studentma ki CaquCiT mokla maTematikis profesori da Semdeg misi kabinetis karze gaakeTa warwera: dRes ar aris miRebis saaTebi~. pirovnuli tanjvis ararsebo-

bisda miuxedavad, ar unda viyoymanoT, rodesac am ukidures qcevas paTologiuris kategoriaSi movaTavsebT. isic marTalia, rom arc erTi calke aRebuli kriteriumi TavisTavad ar aris sakmarisi piroba imisaTvis, rom paTologiuri qcevis yvela SemTxveva ganvasxvavoT normis farglebSi arsebuli qcevis variaciebisgan. normalursa da paTologiurs Soris gansxvaveba ar aris imdenad qcevis or damoukidebel tips Soris arsebuli gansvla (gansxvaveba), ramdenadac is xarisxi, ra xarisxiTac pirovnebis qmedeba Tanxvdeba paTologiuris SeTanxmebul kriteriumTa erTobliobas. umjobesia, fsiqikuri aSliloba ganvixiloT, rogorc kontiniumi fsiqikur janmrTelobasa da fsiqikur daavadebas Soris, rogorc naCvenebia suraTze 15.1. ramdenad misaRebia TqvenTvis paTologiuris Sesaxeb es mosazrebebi? miuxedavad imisa, rom kriteriumebi sakmarisad mkafiodaa gamokveTili, fsiqologebs mainc afiqrebT obieqturobis problema.

obieqturobis problema
gadawyvetileba imis Sesaxeb, rom mocemul individs fsiqologiurad aSlili, an paTologiuri vuwodoT, yovelTvis qcevis Sesaxeb msjelobas warmoadgens. mravali mkvlevris mizania am msjelobebisTvis obieqturobis miniWeba, yovelgvari mikerZoebis gareSe. zogierTi fsiqologiuri aSlilobisaTvis, rogoricaa, magaliTad, depresia an Sizofrenia, diagnozi xSirad akmayofilebs obieqturobis standartebs. sxva SemTxvevebi ufro metad problemuria. rogorc vnaxeT fsiqologiis Seswavlisas, qcevis mniSvneloba erTdroulad ganpirobebulia misi SinaarsiTa da misi konteqstiT. erTi da igive moqmedeba sxvadasxva garemoSi sruliad gansxvavebuli mniSvnelobebis matarebelia. vTqvaT, mamakaci kocnis mamakacs. es SeiZleba iyos homoseqsualistTa urTierTobis maniSnebeli aSS-Si, misalmebis rituali safrangeTSi an mafiis sasikvdilo kocna~ siciliaze. qcevis mniSvneloba yovelTvis damokidebulia konteqstze. vnaxoT, ratom aris obieqturoba aseTi mniSvnelovani sakiTxi. istoria savsea iseTi situaciebis magaliTebiT, romelSic paTologiuris Sesaxeb daskvna individTa moraluri, an politikuri Zalauflebis SenarCunebas emsaxureboda. magaliTisaTvis ganvixiloT 1851 wels samedicino JurnalSi gamoqveynebuli statia negroiduli rasis daavadebebi da fizikuri Taviseburebebi~. doqtori samuel qarTraiTi (Dr. Samuel Cartwright) luizianas samedicino asociaciis mier iyo daniSnuli afrikuli warmoSobis amerikeli monebis ucnauri~ praqtikis kvlevis komitetis Tavmjdomared. kvlevis Sedegad dagrovil iqna monobis praqtikis gasamarTlebeli utyuari mecnieruli mtkicebulebani~. aRmoCenil iqna zogierTi daavadeba~, romelic manamde ucnobi iyo TeTrkanianTa rasisaTvis. erT-erTi aRmoCena is iyo, rom Savkanianebi TiTqosda daavadebulni iyvnen sensoruli daavadebiT, rac maT dasjisas tkivilisadmi ugrZnobs xdida~ (amitom ar unda daezogaT isini). komitetma, aseve, aRmoaCina daavadeba drapetomania (drapetomania), anu Tavisuflebis Ziebis mania _ fsiqikuri aSliloba, romelic batonisgan gaqcevas aiZulebda zogierT monas. saWiro iyo gaqceuli monebis daWera,

suraTi

15.2

saidan viciT
Seracxadad darCena Seuracxad~ adgilze rozenhanma da Svidma Seracxadma adamianma sxvadasxva fsiqiatriul saavadmyofoSi moaxerxes pacientis statusiT moxvedra erTi simptomis _ halucinaciebis

fsiqologiuri aSlilobebis buneba

raTa saTanadod emkurnalaT daavadebisaTvis (Chorever, 1891). SedarebiT axlo warsulSi sabWoTa kavSiris liderebs wesad hqondaT politikuri disidentebis, maTi miuRebeli devianturi ideologiis gamo (sur. 15.2) fsiqikurad aSlilad gamocxadeba da maTi moSorebul fsiqiatriul saavadmyofoebSi xangrZlivi periodiT gagzavna. Tu individs erTxel miawebeben paTologiuris~ iarliys, adamianebs aqvT tendencia, rom Semdgom mis mier ganxorcielebul qcevasac am daskvnis Sesabamisi interpretacia miscen. devid rozenhanma ( David Rozenhan) da misma kolegebma aCvenes, rom SeiZleba SeuZlebeli iyos Seracxadad~ yofna Seuracxad adgilze~.

607

_ simulirebiT. rvave fsevdopacients miRebisas paranoiduli Sizofreniis an maniakalur-depresiuli aSlilobis diagnozi dausves. miRebis Semdeg isini sruliad normalurad iqceodnen, Tumca, rozenhanis dakvirvebis mixedviT, rodesac Seracxadi adamiani Seuracxad adgilze xvdeba, ufro metad mosalodnelia, rom isic Seuracxadad miiCnion; misi nebismieri qcevis xelaxali interpretireba konteqstis Sesabamisad xdeba. fsevdopacientebi racionalurad rom uxsnidnen saavadmyofos TanamSromlebs TavianT situacias, maT inteleqtualuri~ dacvis gamoyenebas miawerdnen, dakvirvebebis Canawerebis warmoebas ki Caweris sindromad~ miiCnevdnen. fsevdopacientebma TiTqmis sami kvira gaatares palatebSi da arc erTi CauTvliaT saavadmyofos TanamSromlebs Seracxadad. rodesac maT sabolood daixsnes Tavi (mxolod meuRleebisa da kolegebis daxmarebiT), saavadmyofodan gawerisas maTi diagnozi isev Sizofrenia~ iyo, Tumca, remisiis periodSi~; amrigad, maTi simptomebi aRar iyo aqtualuri.

individebi TavianT qcevas paTologiurad, an garemosadmi mcired Seguebulad miiCneven. amgvarad, am msjelobas mivyavarT mosazrebamde, rom SeuZlebelia arsebobdes paTologiuris sruliad obieqturi Sefaseba. fsiqologiuri aSlilobis TiToeuli tipis aRwerisas unda SeecadoT imis gagebas, Tu ratom sjeraT klinicistebs, rom simptomTa erToblioba, romliTac warmodgenilia qceviTi paterni, individisTvis ufro seriozuli movlenaa, vidre ubralod socialuri normebis darRveva. fsiqologiuri aSlilobebis konteqstze Seqmnili warmodgenis dasasruleblad axla paTologiuris cnebisa da paTologiuri qcevis mkurnalobis zogierT istoriul moments SevexebiT. amis Semdeg ki im zogad mizezobriv faqtorebs mivubrundebiT, romelTac mkvlevrebi paTologiuris gamomwvev Zalebad miiCneven.

istoriuli perspeqtivebi
istoriis manZilze adamianebs eSinodaT fsiqologiuri aSlilobebis, radgan eSmaks ukavSirebdnen maT. am SiSis gamo isini agresiulad epyrobodnen avadmyofebs da gadamwyvet zomebs iRebdnen yvela im qcevis aRmosafxvrelad, romelsac ucnaurad, an paTologiurad miiCnevdnen. adamianebi, romlebic aseT qcevebs axorcielebdnen, sapyrobileebSi xvdebodnen da ganwirulni iyvnen radikaluri samedicino mkurnalobisTvis. fsiqikur avadmyofobasa da eSmaks Soris kavSiris arsebobis Sesaxeb crurwmenebi iseTive Zvelia, rogorc kacobriobis istoria. arqeologebs aRmoCenili aqvT preistoriuli gaxvretili Tavis qalebi. es aRmoCenebi, SesaZloa, miuTiTebdes Cvens winaprebSi arsebul rwmenaze, rom aseTi naxvretebi individSi Casaxlebul demonebs gaqcevis saSualebas aZlevda. Semdgom, Sua saukuneebSi arsebuli Selocvebi mowodebuli iyo isteriis Sesamsubuqeblad, romlis simptomebi iyo paralizeba an tkivilebi, Tavbrusxvevebi, koWloba da sibrmave. Tavdapirvelad fiqrobdnen, rom isteriiT mxolod qalebi avaddebodnen, daavadebis mizezs ki eSmakis kontrolis, zegavlenis qveS moqceuli moxetiale saSvilosno warmoadgenda (Veith, 1965). miaqcieT yuradReba, rogor Cans qvemoT warmodgenil Se-

608

rozenhanis kvlevebma aCvena, Tu rogoraa damokidebuli paTologiebis Sesaxeb mosazreba Tavad qcevis miRma arsebul faqtorebze. fsiqiatr tomas szaszis (Thomas Szasz) TvalsazrisiT, fsiqikuri daavadeba arc ki arsebobs _ es miTia~ (1961, 1977, 1995). igi amtkicebs, rom fsiqikuri daavadebis arsebobis damadastureblad gamoyenebuli simptomebi mxolod da mxolod samedicino iarliyebia, romelic socialur problemebSi _ devianturi (normidan gadaxrili) adamianebis mier socialuri normebis darRvevaSi _ profesiuli Carevis sanqcias iZleva. erTxel daasvamen ra daRs, am adamianebs maTi gansxvavebulobis~ problemis gamo an rbilad da Tbilad eqcevian, an uxeSad da sastikad, arsebuli status-qvos~ darRvevis safrTxis gareSe. klinicistTa mcire jgufi Tu midis ase Sors, ZiriTadad, imitom, rom kvlevaTa da mkurnalobaTa didi nawili pirovnuli distresis gagebasa da Semsubuqebaze fokusirdeba. winamdebare TavSi aRweril aSlilobaTa umetesobis SemTxvevaSi

Tavi 15 / fsiqologiuri aSlilobebi

locvaSi rwmena fsiqologiur aSlilobebSi demonuri Zalebis rolis Sesaxeb. o, saSov, saSov, saSov, cilindrulo saSov, wiTelo saSov, TeTro saSov, msuqano saSov, sisxlmdeno saSov, farTo saSov, gaberilo saSov, o, demonuro... mogiwodeb Sen, o, saSov, wminda samebis saxeliT dabrunde im adgilze, saidanac arc unda daiZra da arc waxvide... da dabrunde risxvis gareSe im adgilze, sadac Tavdapirvelad dagafuZna maRalma RmerTma (Zilboorg and Henry, 1941, citirebulia Nietzel et al.-Si, 1991, gv.19). 1692 wels salemis kolonia masaCusetSi mraval axalgazrda qals aReniSneboda konvulsiebi, pirRebineba da sisuste. isini aRwerdnen SeboWilobis, Cxvletisa da dakbenilobis SegrZnebebs. mravali maTgani droebiT dabrmavda an dayruvda; zogierTebi haerSi frenis xilvebsa da SegrZnebebs aRwerdnen. aseTma ucnaurma simptomebma axsnis farTomasStabian Ziebas STaberes suli. mravali adamiani Tvlida, rom simptomebi eSmakis moqmedebis Sedegs warmoadgenda, rasac is miwieri grZneulebis ZalisxmeviT axalgazrda qalebis gonebasa da sxeulze zemoqmedebiT aRwevda. am Teoriebs jadoqrobis panika da grZneulebad wodebuli 20-ze meti qalis egzekucia mohyva. XVIII saukunemde dasavlur sazogadoebebSi fsiqikurad daavadebul adamianebs ugono qmnilebebad miiCnevdnen, romelTa gakontroleba mxolod jaWvebiTa da fizikuri discipliniT iyo SesaZlebeli. saavadmyofoebSi zrunvis nacvlad maT damnaSaveebTan erTad amyofebdnen sapyrobi-

leebSi. axla vnaxoT, rogor daiwyo am mdgomareobis Secvla.

samedicino modelis warmoqmna


XVIII saukunis meore naxevarSi paTologiuri qcevis mimarT axali damokidebuleba gaCnda _ adamianebma fsiqologiuri problemebis mqone individTa avadmyofebad, daavadebiT datanjulebad ufro daiwyes aRqma, vidre Sepyrobilebad an uzneoebad . amis Sedegad TandaTanobiT SeuracxadebisTvis keTilganwyobili pirobebis Sesaqmnelad mTeli rigi reformebi ganxorcielda. filip pineli (Philippe Pinel, 1745-1826) erTerTi pirveli klinicisti iyo, romelmac am ideebis gamoyenebiT fsiqologiuri sirTuleebis klasifikaciis sistemis ganviTarebis mcdeloba ganaxorciela da sayrdenad aiRo mosazreba imis Sesaxeb, rom azrovnebis, guneba-ganwyobilebisa da qcevis aSlilobebi bevrad hgavs fizikur, organul daavadebebs. aseTi sistemis mixedviT, TiToeul daavadebas gaaCnia damaxasiaTebel simptomTa erToblioba, romelic ganasxvavebs mas sxva aSlilobisgan da janmrTeli funqcionirebisgan. aSlilobebi klasificirebulia dakvirvebadi simptomebis paternebis, darRvevis dasawyisisTvis arsebuli pirobebis, aSlilobis bunebrivi mimdinareobisa da mkurnalobisadmi daqvemdebarebulobis mixedviT. aseTma saklasifikacio sistemebma, bunebismetyvelTa mier gamoyenebuli biologiuri saklasifikacio sistemebis Seqmnis Semdeg, modelireba ganicada da mowodebuli iyo klinicistebisTvis gavrcelebuli aSlilobebis gacilebiT iolad amocnobaSi daxmarebis gasawevad.

fsiqologiuri aSlilobebis buneba

609

1896 wels germanelma fsiqiatrma emil krepelinma (Emil Kraepelin, 1855-1926) Seqmna fsiqologiuri aSlilobebis pirveli realurad amomwuravi klasifikacia. vinaidan swamda, rom fsiqologiur problemebs fizikuri safuZveli hqonda, man samedicino diagnozis suliskveTebiT aRwera fsiqologiuri diagnostirebisa da klasifikaciis procesi; im suliskveTebiT, romelic dResdReobiTac arsebobs ( Rosenhan & Seligman, 1989). misi Sexedulebebi yvelaze iolad da swrafad damkvidrda fsiqiatrebis terminologiaSi _ saubaria fsiqikur daavadebaze da fsiqikurad daavadebuli pacientebis mkurnalobaze maTi daavadebuli tvinebis gankurnebis imediT.
Tavi 15 / fsiqologiuri aSlilobebi

fsiqologiuri modelebis warmoqmna


samedicino midgomis alternatiuli mimdinareoba paTologiuri qcevis fsiqologiur mizezebsa da mkurnalobaze fokusirdeba. es mosazreba kargad gamoikveTa XVIII saukunis dasasrulisaTvis, rasac xeli Seuwyo franc mesmeris (Franz Mesmer, 1734-1815) STambeWdavma Sromebma. mesmers miaCnda, rom mraval aSlilobas, maT Soris isteriasac, mis mier cxovelur magnetizmad wodebuli idumalebiT moculi Zalis nakadSi gaCenili darRvevebi iwvevda. man aRmoaCina cxoveluri magnetizmis Seswavlis ramdenime axali teqnika, maT Soris erT-erTi TandaTanobiT cnobili gaxda, rogorc hipnotizmi, rac, Tavdapirvelad, mesmerizmad moixsenie-

610

boda misi aRmomCenis sapativcemulod (Darnton, 1968; Pattie, 1994). miuxedavad imisa, rom mesmeris zogadi Teoria cxoveluri magnetizmis Sesaxeb diskreditirebul iqna, hipnozis miseuli teqnika mravalma mkvlevarma gadaiRo da aiTvisa. maT Soris iyo cnobili frangi nevrologi Jan Sarko (Jean Charcot, 1825-1893). Sarkom aRmoaCina, rom isteriis zogierTi simptomis likvidireba, rogoricaa, magaliTad, kidurebis paralizeba, SesaZlebelia, rodesac pacienti hipnoturi zemoqmedebis qveS imyofeba. hipnozs janmrTel individebSi isteriis simptomebis gamowvevac ki SeuZlia, riTac kargad aCvenebs fsiqologiuri faqtorebis rols im problemebis warmoqmnaSi, romelTac mxolod fizikuri safuZvlis mqoned miiCnevdnen. Sarkos erT-erTma studentma, zigmund froidma ganagrZo hipnoziT eqsperimentireba. igi am eqsperimentebs pirovnebisa da paTologiis Sesaxeb Tavisi fsiqodinamikuri Teoriis SemuSavebisTvis iyenebda, romelic, aseve, axdens zegavlenas fsiqopaTologiis bunebisa da mizezebis Sesaxeb Tanamedrove Teoriebze (man Semdgom Sewyvita praqtikaSi hipnoTerapiis gamoyeneba da xeli mihyo fsiqoanalizs, rogorc fsiqologiuri aSlilobebis mkurnalobis meTods). paTologiuris Sesaxeb Tanamedrove mosazrebebi, umravles SemTxvevaSi, fsiqikuri daavadebebis samedicino da fsiqologiuri modelebis aspeqtTa kombinirebul variants warmoadgens. qvemoT swored paTologiuris mizezebis axsnis am ZiriTad saxeebze visaubrebT.

fsiqologiuri midgomebi

fsiqopaTologiis etiologia
etiologia exeba fsiqologiuri da samedicino problemebis ganviTarebis mizezebsa da xelSemwyob faqtorebs. Tu viciT, ratom Cndeba aSliloba, saidan momdinareobs is da ra zegavlenas axdens azrovnebaze, emociebsa da qceviT procesebze, SesaZlebeli xdeba mkurnalobis da, saukeTeso SemTxvevaSi, misi prevenciis axali gzebis povna. TiToeuli aSlilobis ganxilvisas mniSvnelovani sakiTxi iqneba mizezebis analizi. qvemoT mizezobrivi faqtorebis or did kategoriaze _ biologiursa da fsiqologiurze _ visaubrebT. fsiqologiuri midgomebi fsiqopaTologiis ganviTarebaSi fsiqologiuri da socialuri faqtorebis rolze fokusirdeba. am midgomebSi fsiqologiuri aSlilobebis safuZvlad pirovnul gamocdilebas, travmebs, konfliqtebsa da garemos faqtorebs miiCneven. Cven ganvixilavT paTologiis sam ZiriTad fsiqologiur models: fsiqodinamikurs, bihevioralursa da kogniturs. fsiqodinamikuri modeli. biologiuri midgomis msgavsad, fsiqodinamikuri modelis mixedviT, fsiqopaTologiis mizezebi pirovnebis SigniTaa lokalizebuli, Tumca, zigmund froidis (am modelis avtoris) mixedviT, Sinagani faqtorebi fsiqologiuri ufroa, vidre biologiuri. rogorc wina TavebSi aRvniSneT, froids miaCnda, rom mravali fsiqologiuri aSliloba yvela adamianisaTvis damaxasiaTebeli fsiqikuri konfliqtebisa da egos dacviTi reaqciebis normaluri~ procesebis gamZafrebis Sedegia. fsiqodinamikuri modelis mixedviT, adreuli bavSvobis gamocdileba orives ayalibebs _ normalur da paTologiur qcevasac. fsiqodinamikuri modelis Tanaxmad, qceva xSir SemTxvevebSi gaucnobierebeli ltolvebiTa da survilebiTaa motivirebuli. fsiqopaTologiis simptomebi gaucnobierebeli konfliqtebidan da azrebidan iRebs saTaves. Tu aracnobieri konfliqtur mdgomareobaSi imyofeba da savsea daZabulobiT, pirovnebas SfoTva da sxva aSlilobebi Seawuxebs. am fsiqikur konfliqtTa umravlesoba idis araracionaluri, siamovnebis maZiebeli impulsebisa da superegodan momdinare internalizebuli socialuri iZulebebis urTierTdapirispirebis Sedegad warmoiqmneba. Cveulebisamebr, am dapirispirebaSi momrigeblis rols ego asrulebs, Tumca, bavSvobaSi paTologiis ganviTarebam SeiZleba Seasustos mis mier am funqciis Sesrulebis SesaZlebloba. erTmaneTTan konfliqtSi myofi motivebisTvis da SfoTvisTvis Tavis aridebas individebi dacvis iseTi meqanizmebis SemuSavebiT cdiloben, rogoricaa, magaliTad, gandevna, an uaryofa. dacvis meqanizmebis moWarbebulad gamoyenebas Tan sdevs realobis damaxinjeba, an TviTdamanetiologia (Etiology) _ aSlilobis ganviTarebis mizezebi, an masTan dakavSirebuli faqtorebi.

biologiuri midgomebi
samedicino modelis tradiciebze Camoyalibebuli Tanamedrove biologiuri midgomis daSvebis Tanaxmad, fsiqologiuri darRvevebi gamowveulia bazisuri biologiuri faqtorebiT. biologi mkvlevrebi da klinicistebi xSirad ikvleven Tavis tvinis struqturul anomaliebs, biologiur procesebsa da genetikur zegavlenebs. Tavis tvini rTuli organoa, romlis urTierTdakavSirebuli elementebi myife balansSi imyofebian erTmaneTTan. mis qimiur gadamtanebSi _ neirogadamtanebSi, an mis qsovilSi momxdar mcireoden cvlilebasac ki SeiZleba mniSvnelovani Sedegi mohyves. am cvlilebebis mizezi mravali ram SeiZleba iyos, maT Soris genetikuri faqtorebi, Tavis tvinis dazianeba da infeqcia. wina TavebSi vnaxeT, rom Tanamedrove teqnologia fsiqikuri janmrTelobis profesionalebs, qirurgiuli Carevis gareSe, cocxali individebis Tavis tvinis struqturisa da specifikuri bioqimiuri procesebis dakvirvebis saSualebas aZlevs. am teqnikis gamoyenebiT biologiurad orientirebuli mkvlevrebi axal kavSirebs ikvleven fsiqologiur aSlilobebsa da Tavis tvinis specifikur anomaliebs Soris. amasTanave, qceviTi genetikis sferoSi mimdinare miRwevebma gaaumjobesa specifikur genebsa da fsiqologiur aSlilobebs Soris kavSirebis dadgenis SesaZlebloba. SevecdebiT ra paTologiuris sxvadasxva formebis bunebis Secnobas, winamdebare TavSi biologiuri axsnis sxvadasxva tips mimovixilavT.

611

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612

greveli qcevebi. individma SeiZleba imdenad didi raodenobis fsiqikuri energia daxarjos SfoTvisa da konfliqtisgan Tavis dasacavad, rom mcireodeni energiaRa darCes nayofieri da komfortuli cxovrebisTvis. bihevioraluri modeli. xazs usvamen ra dakvirvebad reaqciebs, bihevioristebi naklebad saubroben hipoTetur fsiqodinamikur procesebze. maT miaCniaT, rom paTologiuri qcevis SeZena janmrTeli qcevis msgavsad _ daswavlisa da ganmtkicebis meSveobiT _ xdeba. isini yuradRebis miRma toveben Sinagan fsiqologiur fenomenebsa da adreuli bavSvobis gamocdilebas, Tumca, xazs usvamen mimdinare qcevasa da mimdinare mdgomareobebs da im ganmamtkiceblebs, romlebic inarCuneben qcevas. fsiqologiuri aSlilobebis simptomebi individebis mier TviTdamangreveli an araefeqturi qcevebis daswavlis Sedegad warmoiqmneba. nebismieri arasasurveli, paTologiuri qcevis garemoSi arsebuli SemTxveviTi ganmamtkiceblebis moZiebiT mkvlevrebs, an klinicistebs SeuZliaT maT Secvlaze mimarTuli mkurnalobis gzebis dasaxva da arasasurveli qcevis Caqroba. araadapturi qceviT gamowveuli procesebis kvlevisas bihevioristebi klasikuri da operantuli ganpirobebis modelebs eyrdnobian (ix. Tavi 7). kognituri modeli. fsiqopaTologiisadmi kognitur midgomas xSirad bihevioralur TvalsazrisTan erTad iyeneben. kognituri midgomis mixedviT, fsiqologiuri aSlilobebis saTaveebs yovelTvis ver aRmovaCenT obieqturad arsebuli garemos stimulebSi, ganmamtkiceblebsa da TvalsaCino reaqciebSi. mniSvneloba aqvs imas, Tu rogor aRiqvamen adamianebi sakuTar Tavsa da garemos da ras fiqroben maT Sesaxeb. kognitur cvladebs Soris, romelTac SeiZleba sworad an arasworad warmarTon adapturi qceva, aris pirovnebis mier mniSvnelovani ganmamtkiceblebis gakontrolebis xarisxis subieqturi aRqma, safrTxis momtan movlenebTan gamklavebis SesaZleblobis pirovnuli rwmena da movlenebis interpretacia situaciuri Tu pirovnuli faqtorebis terminebiT. kognituri midgomis mixedviT, fsiqologiuri problemebi realuri situaciis aRqmis damaxinjebis, mcdari msjelobebis, an problemis gadawyvetis uSedego mcdelobebis Sedegia. sociokulturuli midgoma. fsiqopaTologiis Sesaxeb sociokulturuli mosazreba xazs usvams

Tavi 15 / fsiqologiuri aSlilobebi

kulturis rols paTologiuri qcevis gansazRvrasa da etiologiaSi. Cven ukve SevexeT diagnostirebaze kulturis zegavlenas, rodesac obieqturobis problemaze vsaubrobdiT. Cven vTqviT, rom sxvadasxva kulturaSi erTsa da imave qcevas sxvadasxva interpretacia SeiZleba hqondes: zRurbli, romelzec garkveuli qcevis tipi individisTvis adaptaciaSi problemebis Semqmneli gaxdeba, nawilobriv, mis kulturul konteqstzea damokidebuli. rac Seexeba etiologias, gansakuTrebuli kulturuli garemo pirobebi, sadac cxovroben adamianebi, SeiZleba gansazRvravdes im pirobebs, romlebic xels uwyoben fsiqopaTologiis calkeuli tipebis an qvetipebis gamoyofas. Cven mogvianebiT, klasifikaciis Sesaxeb qveTavSi, visaubrebT aseT, kulturasTan SeWidul sindromebze. axla ukve SegiqmeniT zogadi warmodgena im ZiriTad midgomebze, romlebsac mkvlevrebi fsiqikuri daavadebis warmoqmnis Sesaxeb gvTavazoben. unda aRiniSnos, rom, miaCniaT ra fsiqopaTologia mTeli rigi biologiuri da fsiqologiuri faqtorebis rTuli urTierTqmedebis Sedegad, Tanamedrove mkvlevrebi ufro da ufro metad ikaveben interaqcionistul pozicias. ase magaliTad, genetikurma predispoziciam neirogadamtanebis, an hormonebis doneze zemoqmedebiT SeiZleba mowyvladi gaxados pirovneba fsiqologiuri aSlilobisadmi, magram aSlilobis srulad ganviTarebisTvis fsiqologiuri an socialuri stresi, an daswavlili qceva iyos saWiro. Semdeg nawilSi im mcdelobebze gveqneba saubari, romelic ganxorcielda aSlilobebis sxvadasxva kategoriebis klasificirebisa da aRwerisaTvis.

Sejameba
paTologia ganisazRvreba mTeli rigi kriteriumebis gaTvaliswinebiT: distresi, an uunaroba, araadapturoba, araracionaluroba, araprognozirebadoba, araSablonuroba da statistikuri iSviaToba, damkvirveblis doskomforti da zneobrivi da idealuri standartebis rRveva. arc erTi am kriteriumTagani ar aris aucilebeli da sakmarisi piroba fsiqikuri daavadebis gansazRvrisaTvis. mkvlevrebis upirvelesi mizania fsiqologiuri aSlilobebisadmi obieqturi mosazrebebis Camoyalibeba; es mizani

rTulia, radganac paTologiuris Sesaxeb daskvnebi xSirad aris damokidebuli konteqstze. kacobriobis TiTqmis mTeli istoriis manZilze fsiqikurad daavadebul adamianebs arasworad epyrobodnen, anda sapyrobileebSi amwyvdevdnen. mas Semdeg ganviTarda maTdami midgomis SedarebiT adamianuri meTodebi, rac iseTma adamianebma, rogorebic iyvnen pineli, mesmeri da krepelini, am aSlilobebis daavadebebad ganxilva daiwyes. es daavadebebi kategorizaciasa da mkurnalobas eqvemdebarebodnen. fsiqikuri daavadebis etiologiis asaxsnelad Tanamedrove mkvlevrebi, Cveulebisamebr, biologiuri da fsiqologiuri faqtorebis interaqciul models mimarTaven xolme.

zedmiwevniT aRweras imdenad, ramdenadac sxva kriteriumebi exmareba praqtikosebs imis gadawyvetaSi, aris Tu ara pirovnebis qceva garkveuli aSlilobis maniSnebeli.

klasifikaciis miznebi
imisaTvis, rom maqsimalurad sasargeblo iyos, diagnostikuri sistema Semdeg sam sargebels unda iZleodes: saerTo stenografiuli ena. klinikosTa da fsiqopaTologiis sferoSi momuSave mkvlevarTa Soris swrafi da gasagebi urTierTobisTvis praqtikosebi sayovelTaod SeTanxmebuli mniSvnelobebis mqone terminebs eZeben. diagnostikuri kategoria, rogoricaa depresia, didi raodenobis kompleqsur informacias aerTianebs, romelSic Sedis damaxasiaTebeli simptomebi da aSlilobis tipuri mimdinareoba. klinikur garemoSi, rogoricaa, klinikebi da saavadmyofoebi, diagnostikuri sistema fsiqikuri janmrTelobis profesionalebs ufro efeqturi komunikaciis saSualebas aZlevs im adamianebis Sesaxeb, visac exmarebian. fsiqopaTologiis sxvadasxva aspeqtebis kvlevisas an mkurnalobis programebis Sefasebisas mkvlevrebi unda SeTanxmdnen dasakvirvebeli aSlilobis Taobaze. etiologiis gageba. idealur SemTxvevaSi, konkretuli aSlilobis diagnozma naTeli unda mohfinos simptomebis gamomwvev mizezebs. samwuxarod, mravali fsiqologiuri aSlilobis etiologiis Sesaxeb arsebiTi uTanxmoebis an sakmarisi informaciis uqonlobis gamo Znelia am miznis miRweva. mkurnalobis dagegmva. diagnozma, aseve, unda gvikarnaxos, Tu mkurnalobis ra tipebi unda gamoviyenoT konkretuli aSlilobisaTvis. mkvlevrebma da klinikosebma aRmoaCines, rom garkveuli mkurnaloba an Terapia ufro efeqturad moqmedebs garkveuli tipis fsiqologiur aSlilobebze. magaliTad, Sizofreniis dros sakmaod efeqturi medikamentebi sruliad usargebloa da zogjer ufro amZimebs kidec mdgomareobas depresiis SemTxvevaSi. mkurnalobebis efeqturobisa da specifikurobis Sesaxeb codnis Semdgomi gaRrmaveba daaCqarebs da ufro sandos gaxdis diagnostirebis process, rac metad mniSvnelovania.

fsiqologiuri aSlilobebis klasifikacia


ratom aris sasargeblo fsiqologiuri aSlilobebis klasifikaciis sistemis arseboba? ra upiratesobebs iZleva paTologiuris amomwuravi Sefasebis gziT misi sxvadasxva tipebis erTmaneTisgan gamijvna? fsiqologiuri diagnozi aris paTologiurisTvis dakvirvebadi qcevis paternis klasificirebisa da kategorizaciis Sedegad micemuli iarliyi garkveuli diagnostikuri sistemis farglebSi. aseTi diagnozis miReba gacilebiT ufro rTulia, vidre samedicino diagnozis. samedicino konteqstSi diagnostirebisas eqims iseT fizikur monacemebze SeuZlia dayrdnoba, rogoricaa, magaliTad, rentgenis suraTi, sisxlis analizi da biofsia. fsiqologiuri aSlilobebis SemTxvevaSi diagnozisTvis saWiro monacemebs individis moqmedebis interpretaciidan viRebT. klinikosTa maqsimaluri SeTanxmebulobisa (konsistenturobis) da maT diagnostikur Sefasebebs Soris Tanmimdevrulobis misaRwevad, fsiqologebma diagnostirebisa da klasifikaciis sistema ganaviTares, romelic uzrunvelyofs simptomebis detalur,
fsiqologiuri diagnozi (Psychological diagnosis) _ fsiqologiuri paTologiisTvis dakvirvebuli qcevis paternis klasificirebisa da kategorizaciis Sedegad micemuli iarliyi garkveuli diagnostikuri sistemis farglebSi.

fsiqologiuri aSlilobebis klasifikacia

613

DSM-IV-TR
amerikis SeerTebul StatebSi yvelaze farTod miRebuli saklasifikacio sqema amerikis fsiqiatriul asociacias ekuTvnis. mas fsiqikuri aSlilobebis diagnostikuri da statistikuri saxelmZRvanelo ewodeba. meoTxe gamocemis (DSMIV, 1994) teqsturi gadasinjva~ 2000 wels gamoqveynda da mas klinikosebi da mkvlevrebi DSMIV-TR-is saxeliT icnoben. masSi klasificirebulia, gansazRvrulia da aRwerilia 200-ze meti fsiqikuri aSliloba. fsiqologiuri aSlilobebisadmi midgomebis mravalferovnebiT gamowveuli diagnostikuri sirTuleebis Sesamcireblad DSM-IV-TR-Si yuradReba simptomTa paternebis aRwerasa da aSlilobebis mimdinareobebze ufro metad aris gamaxvilebuli, vidre etiologiur Teoriebsa da mkurnalobis strategiebze. wmindad aRweriTi xasiaTis terminebi klinikosebsa da mkvlevrebs problemebis aRsawerad sayovelTao, saerTo enis gamoyenebis saSualebas aZlevs nacvlad imisa, rom SeTanxmebis miuRwevlad datovon Sexvedrebi da ikvlion, Tu romeli Teoriuli modeli ukeT xsnis arsebul problemebs.
DSM-IV-TR _ amerikis fsiqiatriuli asociaciis amJamad momqmedi diagnostikuri da statistikuri saxelmZRvanelo, romelSic klasificirebulia, ganmartebulia da aRwerilia fsiqikuri aSlilobebi.

DSM-is pirveli versia, romelic 1952 wels gamoCnda (DSM-I), ramdenime aTeul fsiqikur daavadebas moicavda. 1968 wels gamosuli, gadasinjuli DSM-II ufro metad Seesatyviseboda meore popularul sistemas _ msoflio janmrTelobis organizaciis daavadebaTa internacionalur klasifikacias (ICD _ International Classification of Diseases). DSM-is meoTxe gamocema (DSM-IV, 1994) komitetebisa da mecnierebis ramdenimewliani intensiuri muSaobis Semdeg gamovida. cvlilebebis gansaxorcieleblad (1987 wels gamosul DSM-III-R-Si) am komitetebma dawvrilebiT ganixiles fsiqopaTologiaSi dagrovili gamokvlevebis uzarmazari raodenoba da, aseve, Seamowmes, Tu ramdenad muSaobda SemoTavazebuli cvlilebebi realur klinikur pirobebSi. DSMIV, aseve, srulad Seesabameba ACD-is meaTe gamocemas. DSM-IV-TR-Si (2000), DSM-IV-is teqstur gadasinjvaSi, axali kvlevebis Sedegebic aris mocemuli, Tumca, saerTod ar aris Secvlili DSM-IV-is klasifikaciis struqtura. fsiqologiur aSlilobasTan SesaZlo kavSirSi myofi fsiqologiuri, socialuri da fizikuri faqtorebis ganxilvisas klinikosebis dasaxmareblad DSM-IV-TR ganzomilebebs, anu RerZebs iyenebs, romlebzec mocemulia informacia yvela am faqtoris Sesaxeb (ix. cxrili 15.1). ZiriTad klinikur aSlilobaTa umravlesoba I RerZzea moTavsebuli. aq Sedis yvela aSliloba, gonebrivi CamorCenilobis garda, romelic

cxrili
Tavi 15 / fsiqologiuri aSlilobebi

15.1
DSM-IV-TR-is xuTi RerZi
informaciis klasi klinikuri aSlilobebi aRwera es fsiqikuri aSlilobebi warmoadgens qceviTi an fsiqologiuri problemebis simptomebs, an paternebs, romelic, rogorc wesi, mtkivneulia da auaresebs funqcionirebas romelime sferoSi. aq Setanilia aSlilobebi, romlebic Tavs iCens Cvilobis, bavSvobis an Wabukobis periodSi. samyaros aRqmisa da masze reagirebis disfunqcionaluri paternebi. am RerZze warmodgenilia fizikuri problemebi, romelic ukavSirdeba I da II RerZebze aRwerili fsiqologiuri aSlilobebis gagebas, an mkurnalobas. am RerZze warmodgenilia is fsiqosocialuri da garemos stresorebi, romelmac SeiZleba zegavlena moaxdinos aSlilobis diagnostirebasa da mkurnalobaze da gamojanmrTelebis albaTobaze. am RerZze warmodgenilia fsiqologiur, socialur da profesionalur sferoebSi individis mimdinare funqcionirebis erTiani done.

RerZebi RerZi I

RerZi II RerZi III

(a) pirovnuli aSlilobebi (b) gonebrivi CamorCeniloba zogadi samedicino mdgomareobebi fsiqosocialuri da garemos problemebi

RerZi IV

RerZi V

funqcionirebis mTlianobiTi Sefaseba

614

bavSvobaSi iCens Tavs. II RerZze mocemulia rogorc gonebrivi CamorCeniloba, aseve, pirovnuli aSlilobebi. es problemebi SeiZleba Tan sdevdes I RerZis aSlilobebs. III RerZi moicavs informacias zogadi samedicino mdgomareobis Sesaxeb, rogoricaa, magaliTad, diabeti, rac SeiZleba relevanturi iyos I an II RerZze ganTavsebuli aSlilobis gagebisas, an mkurnalobisas. IV da V RerZebi uzrunvelyofs damatebiT informacias, romelic SeiZleba sasargeblo iyos konkretuli individisTvis mkurnalobis kursis dagegmvisas, an prognozis Sefasebisas (momavali cvlilebebis winaswar ganWvretisas). IV RerZi afasebs fsiqosocialur da garemodan momdinare problemebs, romlebmac SeiZleba axsnas pacientis stresuli reaqciebi, an stresTan misi gamklavebis resursebi. V RerZze klinikosebi afaseben individis funqcionirebis saerTo, zogad dones. DSM-IV-TR-is sistemis sruli diagnozi TiToeuli RerZis ganxilvas unda moicavdes.

diagnostikuri kategoriebis ganviTareba


diagnostikuri kategoriebi da maTi organizebisa da warmodgenisTvis gamoyenebuli meTodebi DSM-is yovel gadanisjvaSi icvleboda. es cvlilebebi fsiqikuri janmrTelobis eqspertebis umravlesobis mosazrebaTa cvlilebebs asaxavs imis Taobaze, Tu konkretulad risgan Sedgeba fsiqologiuri aSliloba da sad unda gaiaros zRvarma aSlilobaTa sxvadasxva tipebs Soris. aseve, maTSi asaxulia sazogadoebaSi paTologiuris Sesaxeb arsebuli mosazrebebis cvlilebebi. TiToeuli DSM-is gadasinjvis procesSi gamoiricxa zogierTi diagnostikuri kategoria, zogierTi ki, piriqiT, daemata kidec. magaliTad, DSM-III-is (1980w.) SesavalSi amoRebulia nevrotul da fsiqotur aSlilobebs Soris gansxvavebis tradiciuli ganmarteba. nevrotuli aSlilobebi, anu nevrozebi Tavdapirvelad gaigeboda, rogorc SedarebiT zogadi fsiqologiuri problemebi, romlis drosac pirovnebas ar aReniSneboda tvinis paTologiis niSnebi, Warbad araracionaluri azrovneba da ar arRvevda ZiriTad normebs, Tumca, ganicdida subieqtur distress, an xasiaTdeboda TviTdamangreveli

nevrotuli aSliloba (Neurotic disorder) _ fsiqikuri aSliloba, romlis drosac pirovnebas ar aReniSneba Tavis tvinis paTologiebi da ar avlens moWarbebul, mkveTrad gamoxatul iracionalur azrovnebas, an ar arRvevs qcevis ZiriTad normebs, Tumca, ganicdis subieqtur distress. es kategoria gadmotanilia DSM-IIIdan. fsiqoturi aSliloba (Psychotic disorder) _ mwvave fsiqikuri aSliloba, rodesac uaresdeba individis mier realobis aRqma, rac vlindeba azrovnebis, emociebisa da aRqmis sferoSi warmoqmnil sirTuleebSi; aRar gamoiyeneba, rogorc diagnostikuri kategoria DSM-III-is Semdeg.

615

fsiqologiuri aSlilobebis klasifikacia

an daZlevis araadekvaturi strategiebiT. fsiqoturi aSlilobebi, anu fsiqozebi nevrotuli problemebisgan gansxvavebulad moiazreboda rogorc xarisxis, ise _ simwvavis mixedviT. miaCndaT, rom fsiqoturi qceva mniSvnelovanwilad gadis socialuri normebis farglebidan da mas Tan axlavs racionaluri azrovnebisa da zogadad emociur da azrovnebis procesebSi arsebiTi, Rrma darRvevebi. DSM-III-is sakonsultacio komitetebi xvdebodnen, rom terminebi nevrotuli aSlilobebi da fsiqoturi aSlilobebi Zalze ganzogadda Sinaarsis TvalsazrisiT da usargeblo gaxda, rogorc diagnostikuri kategoria (Tumca, am terminebs mravali fsiqiatri da fsiqologi isev iyenebs pirovnebis darRvevebis zogadi donis aRsawerad). DSM-is gamocemebis manZilze calkeuli diagnozebic erTveboda da akldeboda CamonaTvals. amis erT-erTi saukeTeso magaliTia homoseqsualoba. SegiZliaT gaixsenoT XII Tavidan, rom 1973 wels amerikis fsiqiatriulma asociaciam xma misca fsiqologiuri aSlilobebis nusxidan homoseqsualurobis amoRebas. im dromde homoseqsualoba DSM-Si Setanili iyo, rogorc fsiqikuri daavadeba. fsiqiatri eqspertebis mosazrebebis Secvla kvlevebis Sedegebma gamoiwvia, romelmac aCvena homoseqsuali mamakacebisa da lesboseli qalebis, zogadad, fsiqikuri janmrTeloba. dResdReobiT homoseqsualobas ubralod seqsualuri TviTgamoxatvis erT-erT variantad miiCneven. is mxolod maSin Tanxvdeba DSM-IVTR-is diagnozs, rodesac individs aReniSneba mdgradi da SesamCnevi distresi seqsualur orientaciasTan dakavSirebiT~ (DSM-IV-TR, 2000,

fsiqologia Cvens cxovrebaSi

marTla gvicavs Tu ara Seuracxadoba


naTeni (Daniel M`Naghten) mkvlelobaSi udanaSaulod cnes Seuracxadobis mizeziT. misi savaraudo msxverpli britaneTis premier ministri iyo. maknaTens swamda, rom mas RmerTma Caagona mkvleloba (man SemTxveviT premier ministris nacvlad misi mdivani mokla). bodvebis gamo igi cixis nacvlad fsiqiatriul saavadmyofoSi moaTavses. am verdiqtis Tanmdevma risxvam biZgi misca lordTa palatas, rom gamoekveTa mimarTuleba, e.w. maknaTenis wesi, romelic gansazRvravda Seuracxadobis farglebs. am wesis mixedviT, damnaSave ver unda xvdebodes mis mier ganxorcielebuli qmedebebis xasiaTsa da kategorias; anda Tu xvdeba, ar unda icodes, rom rasac akeTebs, ar aris swori.~

1981 wlis 30 marts msoflio SeZra aSS-is prezidentis _ ronald reiganis mkvlelobis TiTqmis warmatebulma mcdelobam, romelic jon hiklim ganaxorciela. 1982 wlis ivnisSi, Sokma yvela zRvars gadaaWarba, rodesac naficma msajulebma hinkli udanaSaulod cnes Seuracxadobis gamo~. ramdenad misaRebi iyo es? ras niSnavs, rom viRac Seuracxadia? Seuracxadoba ar aris ganmartebuli DSM-IV-TR-Si; ar arsebobs misi sayovelTao klinikuri gansazRvreba. metic, Seuracxadoba popularuli kulturisa da samarTlebrivi sistemis cnebaa. samarTalSi Seuracxadobis gaTvaliswinebis praqtika 1843 wlidan iRebs saTaves, rodesac inglisSi deniel mak-

aris ki maknaTenis wesi damnaSaveobis an udanaSaulobis samarTliani sazomi? fsiqikuri daavadebebis gagebaSi winsvlasTan erTad, mkvlevrebma ufro meti ician im garemoebebis Sesaxeb, romelSic damnaSave SesaZloa ansxvavebdes swors mcdarisgan _ damnaSavem SesaZloa icodes, rom mis mier ganxorcielebuli qmedeba arasamarTlebrivi an arazneobrivi iyo, magram mainc ver SeZlos moqmedebis daTrgunva da misgan Tavis Sekaveba (disociaciis am tipis Sesaxeb SfoTviTi aSlilobebis ganxilvisas visaubrebT). xSirad, magaliTad, fobiebis mqone adamianebma ician, rom oboba maT arafers dauSavebs, magram ar xelewifebaT misi danaxvisas panikuri qcevisagan Tavis Sekaveba.

Tavi 15 / fsiqologiuri aSlilobebi

gv.582). diagnostikuri kriteriumi, cxadia, gamoiyeneba im homoseqsualebis mimarT, visac awuxebs es problema. dabolos, DSM-is adreuli gamocemebis kritikosebs afiqrebdaT is faqti, rom fsiqologiuri aSlilobebis SemTxvevebSi yuradRebis miRma rCeboda kulturuli variaciebi. DSM-IVTR-Si aSlilobaTa umravlesobis aRwera moicavs informacias specifikuri kulturuli maxasiaTeblebis~ Sesaxeb. metic, danarTSi aRwerilia daaxloebiT 25-mde kulturasTan SeWiduli sindromi: ganmeorebiTi, normidan gadaxrili qcevis adgilobrivad specifikuri paternebi da Semawuxebeli gamocdileba, romelic SeiZleba ukavSirdebodes, an ar ukavSirdebodes DSM-IVSeuracxadoba (Insanity) _ samarTlebrivi (ara klinikuri) aRniSvna im mdgomareobisa, romlis drosac individi ganixileba, rogorc iuridiulad Seuracxadi, an araqmediTi, arakompetenturi.

is garkveul diagnostikur kategorias~ (DSMIV-TR, 2000, gv.898). qvemoT moyvanilia ramdenime magaliTi: Boufee delirante. aJitirebuli da agresiuli qcevis moulodneli amofrqveva, SesamCnevi dabneuloba da fsiqologiuri agzneba~ (gv.899); aRniSnulia dasavleT afrikaSi, taitze; Koro. moulodneli da intensiuri SfoTva imis Taobaze, rom penisi (an, qalebis SemTxvevaSi, sasqeso bageebi da sarZeve jirkvlebi) mowydeba sxeuls, ramac SesaZloa sikvdili gamoiwvios~ (gv. 900); aRniSnulia samxreT da aRmosavleT aziaSi; Taijin Kyofusho. individis intensiuri SiSi imis Taobaze, rom individis sxeuli, sxeulis nawilebi an funqciebi arasasiamovno, samarcxvino, an Seuracxmyofelia sxva adamianebisaTvis Tavisi garegnobiT, suniT, saxis gamo-

616

fsiqikuri daavadebis Sesaxeb aseTi mosazreba samarTlebriv standartebSic iqna CarTuli, ramac imoqmeda hinklis SemTxvevaSi. mis nafic msajulebs miaCndaT, rom hinkli ar akontrolebda Tavis qcevas, romelic msaxiob judi fosteris akviatebidan momdinareobda. gaanTavisufles Tu ara hinkli? _ araviTar SemTxvevaSi. igi vaSingtonis olqis wm. elizabetis fsiqiatriul klinikaSi moaTavses da 2001 wlamde iq imyofeboda. faqtobrivad, Seuracxadobis, rogorc dacvis, sazogadoebaSi arsebuli erT-erTi ZiriTadi araswori gageba m k v l e l e b s Ta v i s u f l a d darCenis saSualebas aZlevs (Caplan, 1992; Silver et al., 1994). Seuracxadobis sarCeliT udanaSaulod miCneul individTa daaxloebiT 90% fsiqiatriul klinikebSi xvdeba. hinklis SemTxvevis msgavs SemTxvevebSi individebs sazogadoebaSi mxo-

lod mas Semdeg uSveben, rac eqspertebi daadgenen, rom isini aRar arian saSiSni. dapatimrebisgan gansxvavebiT, xSirad winaswar ar aris gansazRvruli, Tu ra vadiT aTavseben individs fsiqiatriul dawesebulebaSi. rogor fiqrobT, hinklis SemTxvevaSi ramdenad darwmunebulni unda yofiliyvnen fsiqiatrebi da fsiqologebi, rom hinklis gamoSvebaze Tanxmoba ganecxadebinaT? hinklis SemTxvevis Sedegad mravalma sasamarTlom Secvala Seuracxadobis dacvis arsebuli standartebi: ZiriTadi mimarTuleba Seuracxadobis gamo udanaSaulod cnobis~ verdiqtis miRebis garTuleba iyo ( Appelbaum, 1994). iyo Tu ara es cvlilebebi aucilebeli? praqtikuli motivebidan gamomdinare, pasuxi TiTqmis ueWvelad aris ara~. miuxedavad im didi yuradRebisa, romelsac sainformacio saSualebebSi uTmoben Seuracxadobis mo-

Txovnebs da, Sesabamisad, sazogadoebis kargad informirebulobisa mis Sesaxeb, aseTi sarCelebi sakmaod iSviaTia (Blau et al., 1993; Lymburner & Roesch, 1999). magaliTad, erT-erTi kvlevis Sedegad aRmoCnda, rom baltimorSi, merilendSi 60 432 sabraldebo aqtidan mxolod 190-ma damcvelma (0.31%) Seitana Seuracxadobis sarCeli da mxolod 8 maTgani (4.2%) iqna dakmayofilebuli (Janofski et al., 1996). amgvarad, mcirea albaToba imisa, rom Tqven odesme mogmarTaven TxovniT, rom dajdeT nafic msajulTa skamze da gansajoT, meore adamiani Seuracxadia Tu ara, magram warmoidgineT, rom es moxda. vTqvaT, Tqven jefri dameris saqmis ganxilvisas iyaviT msajuli, romelic kanibaluri ritualebiT iyo dakavebuli da romelic Seracxadad cnes (msajulebma uaryves Seuracxadobis dacva). rogor imoqmeda am TavSi miRebulma informaciam Tqvens mosazrebebze?

Sejameba
fsiqologiuri aSlilobebis klasificirebis mizania rogorc sxvadasxva aSlilobebis aRwerisa da ganxilvis sayovelTaod miRebuli stenografiuli enis uzrunvelyofa, ise _ etiologiisa da mkurnalobis gegmis dadgena. DSMIV-TR warmoadgens yvelaze farTod gamoyenebad saklasifikacio sistemas; mTeli informacia xuT RerZzea mocemuli. diagnostikuri kategoriebi droTa ganmavlobaSi ganviTarda, raTa sistema ufro Tanmimdevruli da gamosadegi gamxdariyo.

mas Semdeg, rac aRvwereT paTologiuris Sesaxeb msjelobis ZiriTadi farglebi, mivadeqiT ZiriTad informacias _ iseTi ZiriTadi fsiqologiuri aSlilobebis mizezebsa da Sedegebs, rogoricaa SfoTva, depresia da Sizofrenia. TiToeuli kategoriis SemTxvevaSi jer aRvwerT, ras ganicdian Tavad daavadebuli individebi da rogor aRiqvamen maT damkvirveblebi. Semdeg ganvixilavT, Tu rogor xsnian etiologiisadmi biologiuri da fsiqologiuri midgomebi am aSlilobebis ganviTarebas. arsebobs fsiqopaTologiis mTeli rigi sxva kategoriebi, romelTa ganxilvasac ver davuTmobT dros, Tumca, qvemoT mocemulia maT Soris

fsiqologiuri aSlilobebis ZiriTadi tipebi

metyvelebiT an moZraobiT~ (gv. 903); aRniSnulia iaponiaSi. aRvwerT ra fsiqologiuri aSlilobis TiToeul ZiriTad formas, mniSvnelovania gvaxsovdes, rom erTsa da imave qcevas yvela kultura ar miiCnevs erTnairad normalurad an paTologiurad.

fsiqologiuri aSlilobebis ZiriTadi tipebi

617

yvelaze mniSvnelovanTa Sesaxeb mokle, Semajamebeli informacia. nivTierebebis gamoyenebis aSlilobebi moicavs alkoholsa da qimiur nivTierebebze damokidebulebasa da maT borotad gamoyenebas. nivTierebebis borotad gamoyenebis Sesaxeb mravali sakiTxi cnobierebis mdgomareobebis uaxloes konteqstSi ganvixileT (ix. Tavi 6). somatoformul aSlilobebSi Sedis fizikuri (somaturi) simptomebi, rogoricaa: kidurebis paralizeba, an tkivilebi, fizikuri mizezis gareSe. es kategoria moicavs isteriad wodebul simptomebs. seqsualuri aSlilobebi seqsualuri Sekavebisa da disfunqciis problemebsa da deviantur seqsualur praqtikas moiazrebs. aSlilobebi, romlis diagnostireba, Cveulebisamebr, CvilobaSi, bavSvobaSi, an WabukobaSi xdeba, moicavs gonebriv CamorCenilobas, komunikaciur aSlilobebs, rogoricaa: enabluoba da autizmi. kvebis aSlilobebi, rogoricaa: anoreqsia da bulimia, me-12 TavSia ganxiluli. winamdebare TavSi SevafasebT im sixSires, ra sixSiriTac aReniSnebaT individebs calkeuli fsiqologiuri aSlilobebi. monacemebi miRebulia kvlevebidan, romelSic 20 000-ze meti adamiani monawileobda da, Sesabamisad, fsiqikuri janmrTelobis Sesaxeb istoriebi populaciis didi SerCevebidan aris miRebuli. diagramebSi asaxulia sxvadasxva aSlilobebis gavrceleba erTi Tvis, erTi wlis da mTeli cxovrebis periodSi (Kessler et al., 1994; Regier et al., 1993a, 1993b). citirebuli diagramebi da cxrilebi aRebulia National Comorbidity Study-dan (NCS), romelSic 15dan 54 wlamde 8 098 amerikeli monawileobda (Kessler et al., 1994). miuxedavad imisa, rom am SerCevas mozrdilebad~ movixseniebT, unda aRvniSnoT, rom masSi monawileobdnen mozardebi da ar monawileobdnen ufrosi asakis mozrdilebi. aseve, aRsaniSnavia, rom xSir SemTxvevaSi erTsa da imave individebs cxovrebis garkveul etapze erTdroulad erTze meti aSliloba aReniSnebodaT. es fenomeni komorbidulobis saxeliT
komorbidi (Comorbidity) _ erTdroulad erTze meti aSliloba.

aris cnobili (morbidulobas daavadebis arsebobas uwodeben, komorbidulobas ki _ daavadebaTa Tanaarsebobas). NCS-Si dadginda, rom individTa 56%-s, romelic Tvlida, rom aqvT erTi aSliloba, realurad erTdroeulad ori an meti aSliloba aReniSneboda. mkvlevrebma sxvadasxva fsiqologiuri aSlilobebis komorbidulobis paternebis intensiuri Seswavla daiwyes. gaecnobiT ra sxvadasxva fsiqologiuri darRvevebisaTvis tipur simptomebsa da gamocdilebebs, gagiCndebaT grZnoba, rom zogierTi maxasiaTebeli Tqvenc, yovel SemTxvevaSi xandaxan mainc, an Tqvens irgvliv arsebul romelime Tqvens nacnobsac axasiaTebs. Cven mier aRwerili zogierTi aSliloba arc ise iSviaTad gvxvdeba, amitom gasakviri iqneba, Tu isini sruliad ucxod mogeCvenebaT. bevrs axasiaTebs adamianuri sisusteebi, romelTac konkretuli fsiqologiuri aSlilobis kriteriumTa nusxaSi SexvdebiT. am msgavsebebis gacnobiereba xels Seuwyobs paTofsiqologiis gagebas, magram unda gaxsovdeT, nebismieri aSlilobis diagnozi mTel rig kriteriumebzea damokidebuli da fsiqikuri janmrTelobis gamocdil profesionalebs saWiroebs. gTxovT, winaaRmdegoba gauwioT cdunebas da ar gamoiyenoT axlad SeZenili codna megobrebisTvis da ojaxis wevrebisTvis paTologiuris diagnozis dasasmelad. Cven dawvrilebiT ganvixilavT SfoTvasa da depresias da SedarebiT mokled visaubrebT pirovnul aSlilobebsa da disociaciur aSlilobebze.

Tavi 15 / fsiqologiuri aSlilobebi

SfoTviTi aSlilobebi
garkveul cxovrebiseul situaciebSi TiToeul Cvengans ganucdia SfoTva an SiSi. Tumca, zogierTi adamianisTvis SfoTva imdenad problemuri xdeba, rom efeqturad funqcionirebasa da yoveldRiuri cxovrebiT tkbobaSi uSlis xels. dadgenilia, rom mozrdili mosaxleobis TiTqmis 25%-s drodadro aReniSneba sxvadasxva SfoTviTi aSlilobebisTvis damaxasiaTebeli simptomebi ( Kessler et al., 1994). TiToeul am aSlilobaSi SfoTva gadamwyvet rols asrulebs, Tumca, isini erTmaneTisgan gansxvavdebian SfoTvis gancdis xarisxiT, SfoTvis simwvaviT/

618

panikuri aSliloba
generalizebuli SfoTviTi aSlilobisTvis damaxasiaTebeli SfoTvis qronikulad arsebobisgan gansxvavebiT, panikuri aSlilobis mqone adamianebi ganicdian moulodneli, mwvave panikis Setevebs, romelic mxolod ramdenime wuTi SeiZleba grZeldebodes. es Setevebi intensiuri daZabulobis, SiSis, an saSinelebis grZnobebiT iwyeba. am grZnobebs Tan axlavs SfoTvis fizikuri simptomebi, maT Soris TviTregulirebadi hiperaqtiuroba (rogoricaa aCqarebuli guliscema), Tavbrusxveva, gonebis dakargva da xuTvis, an daxrCobis SegrZnebebi. Setevebi moulodnelia im TvalsazrisiT, rom maT ar iwvevs raime konkretuli situacia. qvemoT mocemuli panikis Setevis dros gakeTebuli komentari dagexmarebaT imis SefasebaSi, Tu ra sixSiriT ganicdis am aSlilobis mqone es pirovneba panikis Setevebs: o, me ver gavakeTeb amas. veravin damexmareba, veravin SeZlebs am grZnobis gagebas. es hgavs grZnobas, romelic Txemidan fexis TiTebamde gagirbens sxeulSi da me mZuls es grZnoba. Zalze SeSinebuli var... TiTqos vkvdebi, an raRac msgavsi (Muskin & Fyer, 1981, gv.81). panikuri aSlilobis diagnostireba maSin xdeba, rodesac individs aReniSneba panikis ganmeorebiTi moulodneli Setevebi da, amasTanave, intensiurad nerviulobs Semdgomi Setevebis ganviTarebis SesaZleblobaze.
SfoTviTi aSlilobebi (Anxiety disorder) _ fsiqikuri aSlilobebi, romelic xasiaTdeba fsiqologiuri agznebiT, daZabulobis grZnobiT da TvalsaCino mizezis gareSe warmoqmnili intensiuri daZabulobiT. generalizebuli SfoTviTi aSliloba (Generalized anxiety disorder) _ SfoTviTi aSliloba, rodesac individi ganicdis SfoTvas an nerviulobs specifikuri safrTxis an safrTxis momatni obieqtis ar- arsebobis pirobebSi, sul mcire, eqvsi Tvis manZilze. panikuri aSliloba (Panic disorder) _ SfoTviTi aSliloba, rodesac individi ganicdis moulodnel mwvave panikur Setevebs, rac intensiuri daZabulobis, SiSisa, an saSinelebis grZnobiT iwyeba.

siRrmiTa da misi gamomwvevi situaciebiT. Cven mimovixilavT ZiriTad kategoriebs, esenia: generalizebuli SfoTviTi aSliloba, panikuri aSliloba, fobiuri aSliloba, obsesiur-kompulsuri aSliloba da posttravmatuli stresis aSliloba.

generalizebuli SfoTviTi aSliloba


rodesac pirovneba drois umetes nawils, sul mcire, eqvsi Tvis manZilze, SfoTvaSi, an nerviulobaSi atarebs, klinikosebi mas generalizebuli SfoTviTi aSlilobis diagnozs usvamen. xSirad SfoTva specifikur cxovrebiseul situaciazea fokusirebuli, rogoricaa: ararealuri SfoTva finansebis, an sayvareli adamianis kargad yofnis Taobaze. SfoTvis gamoxatvis gzebi _ specifikuri simptomebi _ varirebs pirovnebidan pirovnebamde, magram generalizebuli SfoTvis diagnozis dasmisaTvis pacients, sul mcire, sami sxva simptomic unda aReniSnebodes, rogoricaa: kunTebis daZabuloba, gadaRliloba, mousvenroba, susti koncentracia, gaRizianebadoba, an Zilis problemebi. generalizebuli SfoTviTi aSliloba funqcionirebis gauaresebas iwvevs, radganac SeuZlebelia pirovnebis nerviulobis gakontroleba, an gverdze gadadeba. SfoTvis wyaroebze koncentrirebis gamo individi veRar uTmobs sakmaris yuradRebas socialur Tu samsaxureobriv valdebulebebs. am sirTuleebs aSlilobasTan dakavSirebuli fizikuri simptomebic erTvis Tan.

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fsiqologiuri aSlilobebis ZiriTadi tipebi

DSM-IV-TR-is mixedviT, panikuri aSlilobis diagnostireba unda moxdes agorafobiis Tanmxlebi arsebobis, an ararsebobis SemTxvevaSi. agorafobia iseT xalxmraval adgilebSi, an Ria sivrceSi yofnis ukiduresi SiSia, saidanac gaqceva rTuli, an samarcxvino SeiZleba iyos. agorafobiis mqone individebs, rogorc wesi, aSinebT iseTi adgilebi, rogoricaa: _ xalxmravali oTaxebi, saseirno adgilebi, avtobusebi da avtomagistralebi. maT xSirad eSiniaT, rom, Tu saxlis gareT SeeqmnebaT garkveuli sirTuleebi, rogoricaa Sardis Seukavebloba Sardis buStze kontrolis dakargvis gamo, an panikis Setevis simptomebi, SeuZlebeli iqneba daxmarebis miReba samarcxvino situaciaSi aRmoCndebian. es SiSebi zRudavs maT Tavisuflebas, ukidures SemTxvevebSi ki sakuTari saxlebis patimrebad gadaiqcevian xolme. SeniSneT, Tu ratom aris dakavSirebuli agorafobia panikur aSlilobasTan? panikis Setevebis mqone zogierTi (magram ara yvela) adamianisTvis momavali Setevis saSiSroeba _ umweobis grZnoba misi dawyebisas _ SeiZleba sakmarisi gaxdes CaketilobisTvis. agorafobiis mqone pirovnebam SeiZleba datovos saxlis usafrTxo garemo, magram TiTqmis yovelTvis ukiduresi SfoTvis TanxlebiT.

fobiebi
SiSi aris racionaluri reaqcia obieqturad identificirebul garegan safrTxeze (rogoricaa xanZari, an yaCaRoba quCaSi), ramac SeiZleba aiZulos adamiani, rom gaiqces, an gadavides

Setevaze Tavdacvis mizniT. amis sapirispirod, fobiis mqone adamians aReniSneba specifikuri obieqtis, moqmedebis, an situaciis mdgradi da araracionaluri SiSi, romelic moWarbebulobiTa da umizezobiT xasiaTdeba da realobas safrTxis momtanad aRaqmevinebs adamians. mraval adamians aSfoTebs obobebi, an gvelebi (an mravalarCevniani testebic ki). es msubuqi SiSebi ar aferxebs individTa yoveldRiur saqmianobas. Tumca, fobiebi zegavlenas axdens adaptaciaze, mniSvnelovan distress iwvevs da miznebis miRwevisaTvis aucilebel moqmedebebs aferxebs. Zalze speficikurma, aSkarad SezRudulma fobiamac ki SeiZleba udidesi gavlena moaxdinos konkretuli individis cxovrebaze. DSM-IV-TR-Si fobiebis ori kategoriaa aRwerili: socialuri fobiebi da specifikuri fobiebi (ix. cxrili 15.2). socialuri fobia aris mdgradi da iracionaluri SiSi, romelic warmoiqmneba iseTi sazogadoebrivi situaciis winaswar warmodgenisas, romelSic individi SeiZleba sxvaTa dakvirvebis obieqti gaxdes. socialuri fobiis mqone adamians samarcxvino qcevis ganxorcielebis eSinia. pirovneba acnobierebs, rom SiSi moWarbebuli da safuZvels moklebulia, magram SiSi mainc aiZulebs mas, rom Tavi aaridos iseT situaciebs, sadac arsebobs sxvaTa dakvirvebis obieqtad gaxdomis SesaZlebloba. socialuri fobia xSirad TviT-damakmayofilebel winaswar ganWvretas gulisxmobs. inagorafobia ( Agoraphobia) _ iseT xalxmraval adgilebSi, an Ria sivrceSi yofnis ukiduresi SiSi, saidanac gaqceva SeiZleba rTuli, an samarcxvino iyos. SiSi (Fear) _ racionaluri reaqcia obieqturad identificirebul garegan safrTxeze, ramac SeiZleba aiZulos adamiani, rom gaiqces, an gadavides Setevaze Tavdacvis mizniT. fobia (Phobia) _ specifikuri obieqtis, aqtivobis, an situaciis mdgradi da iracionaluri SiSi, romelic moWarbebulobiTa da umizezobiT xasiaTdeba; romelic realobas safrTxis momtanad aRaqmevinebs adamians. socialuri fobia (Social phobia) _ mdgradi da iracionaluri SiSi, romelic warmoiqmneba iseTi sazogadoebrivi situaciis winaswar warmodgenisas, romelSic individi sxvaTa dakvirvebis obieqti SeiZleba gaxdes.

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Tavi 15 / fsiqologiuri aSlilobebi

cxrili

15.2
gavrcelebuli fobiebi
sqesobrivi gansxvaveba umravlesoba qalia gamovlenis tipuri asaki mozardobis periodi

ZiriTadi tipebi socialuri fobiebi (raime damamcireblis keTebis dros dakvirvebis obieqtad yofnis SiSi) specifikuri fobiebi cxovelebis tipi katebi (ailurofobia) ZaRlebi (kinofobia) mwerebi (inseqtofobia) obobebi (araknofobia) gvelebi (ofidiofobia) mRrRnelebi (rodentofobia) bunebrivi garemos tipi Stormebi (brontofobia) simaRleebi (akrofobia) sisxlis-infeqciis-dazianebis tipi sisxli (hematofobia) nemsebi (belonofobia) situaciuri tipidaxuruli sivrceebi (klaustrofobia) rkinigza (saidrodromofobia)

TiTqmis yvela qalia

bavSvoba

umravlesoba an TiTqmis yvela qalia

bavSvoba

umravlesoba qalia

nebismieri asaki

TiTqmis yvela qalia

bavSvoba an 20-iani wlebis Sua periodi

SfoTviTi aSlilobebis mqone zogierTi adamiani iketeba azrebisa da qcevebis specifikur paternebSi. mxolod raRac erTi wlis win 17 wlis jimi mravalmxrivi niWiT dajildoebuli da farTo interesebis mqone normaluri Wabuki iyo. Semdeg, TiTqmis erTbaSad, fsiqologiuri uunarobis gamo, martosul gariyulad, socialuri cxovrebidan gamoTiSulad iqca. kerZod, mas banaobis akviateba (obsesia) ganuviTarda. aikviata ra azri, rom WuWyiani iyo, ganurCevlad imisa, Tu ras SeigrZnobda, man drois udidesi nawilis gatareba warmosaxviTi WuWyis CamobanaSi daiwyo. Tavdapirvelad dabanvis rituali mxolod dasvenebis dReebsa da saRamoebs ikavebda, magram male am

specifikuri fobiebi (Specific phobias) _ fobiebi, romlebic Tavs iCenen specifikuri tipis obieqtebze, an situaciebze reaqciis saxiT.

fsiqologiuri aSlilobebis ZiriTadi tipebi

divids SeiZleba imdenad eSinodes sxvaTa dakvirvebis obieqtad yofnisa da uaryofis, rom warmoqmnili SfoTva sakmarisi iyos aqtivobis realurad gasauareseblad. maSinac ki, rodesac socialuri fobiis mqone adamianebi warmatebulni arian socialur garemoSi, isini ar uSveben, rom warmateba dadebiTad aisaxos maTze (Wallace & Alden, 1997). amerikel mozrdilTa 13.3%-s aReniSneba socialuri fobia (Magee et al., 1996). specifikuri fobiebi Tavs iCenen zogierT sxvadasxva tipis obieqtebze, an situaciebze reaqciis saxiT. rogorc naCvenebia 15.2 cxrilSi, specifikuri fobiebi dayofilia ramdenime qvetipad. magaliTad, cxoveluri tipis specifikuri fobiis mqone individs SeiZleba obobebze hqondes fobiuri reaqciebi. TiToeul SemTxvevaSi fobiuri reaqcia SemaSinebeli obieqtis realurad arsebobisas, an warmodgenisas warmoiqmneba. kvlevis mixedviT, amerikel mozrdil-

Ta 11.3%-s aReniSneba specifikuri fobia (Magee et al., 1996).

obsesiur-kompulsuri aSlilobebi

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qcevam imdenad daikava mTeli misi dro, rom skolis mitovebasac ki aiZulebda. jimi itanjeboda mdgomareobisgan, romelic obsesiur-kompulsuri aSlilobis saxeliT aris cnobili (obsessive-compulsive disorder _ OCD), romelic, monacemebis mixedviT, amerikel mozrdilTa 2.5%-s aReniSneba cxovrebis romelime etapze (DSM-IV-TR). obsesiebi (akviatebebi) aris azrebi, xatebi an impulsebi (rogoric iyo jimis rwmena imis Sesaxeb, rom WuWyiani iyo), romelic maTi gandevnis mcdelobisda miuxedavad, mainc meordeba an narCundeba. obsesiebi ganicdeba, rogorc arasasurveli SeWra cnobierebaSi; isini suleluri, an autanelia da miuRebelia im pirovnebisTvis, vinc ganicdis maT. Tqven SeiZleba gqondeT garkveuli tipis msubuqi obsesiebis gamocdileba, rogoricaa wvrilmani safiqralebis akviatebebi, vTqvaT, namdvilad Cavkete kari?~ an gamovrTe Tu ara gazqura?~ obsesiur-kompulsuri aSlilobis mqone adamianTa obsesiuri azrebi gacilebiT metad iZulebiTia, met distress iwvevs da SeiZleba imoqmedos socialur da profesiul saqmianobaze. kompulsiebi (iZulebebi) ganmeorebiTi, mizanmimarTuli moqmedebebia (rogoric iyo jimis banaoba), romelic obsesiebze sapasuxod xorcieldeba garkveuli wesebis mixedviT, an ritualebis saxiT. kompulsuri qceva SiSis momgvrel raime situaciasTan dakavSirebuli diskomfortis Sesamcireblad, an aRsakveTad xorcieldeba, magram is an mizanSeuwonelia, an _ aSkarad moWarbebuli. tipuri kompulsiebi
obsesiur-kompulsuri aSliloba (Obsessive-compulsive disorder OCD) _ fsiqikuri aSliloba, romelic xasiaTdeba obsesiebiT, anu akviatebuli, ganmeorebadi azrebiT, warmodgenebiT an impulsebiT, romelic meordeba da ewinaaRmdegeba gandevnis mcdelobebs da kompulsiebiT, anu ganmeorebadi, mizanmimarTuli moqmedebebiT, romelic garkveuli wesebis mixedviT, an ritualebis saxiT xorcieldeba. posttravmatuli stresis aSliloba (Posttraumatic stress disorder PTSD) SfoTviTi aSliloba, romelic xasiaTdeba travmatuli movlenis ganmeorebadi mdgradi gancdebiT, Tanmxlebi distresis gamomwvevi mogonebebiT, sizmrebiT, halucinaciebiTa da disociaciuri xatebiT/ fleSbeqebiT (flashbacks).

moicavs dabanvis dauZlevel swrafvas, sinaTlis, an sxva xelsawyoebis gamorTulobis gadamowmebas da sagnebisa da sakuTrebis gadaTvlas. obsesiur-kompulsuri aSlilobis mqone individebi, sawyis periodSi mainc, ewinaaRmdegebian kompulsiebs. simSvidis mdgomareobaSi ar vlindeba kompulsiebis arseboba, Tumca, SfoTvis gaCenisTanave, dauZleveli xdeba daZabulobis Semcirebaze mimarTuli ritualuri kompulsuri qcevis Zala. tkivilis nawili, romelsac am fsiqikuri problemis mqone adamianebi ganicdian, obsesiebis iracionalurobis, an moWarbebulobis da maTi Semcirebis unaris arqonis gacnobierebiT gamowveuli frustraciidan momdinareobs.

posttravmatuli stresis aSliloba


XIII TavSi warmogidgineT diskusia or qalbatons Soris, romlebic jer kidev ebrZodnen gaupatiurebis Sedegebs. saubari asaxavda ori qalbatonis mimdinare SfoTvas. erTi ambobda, rom SiSisa da risxvis xangrZlivi periodi~ gaiara da esizmreboda, Tu rogor esxmodnen Tavs saerTo saZineblis win, megobrebi ki idgnen, uyurebdnen da ar fiqrobdnen dasaxmareblad misvlas. meores, romelic sirbilis (varjiSis) dros gaaupatiures, isev eSinoda sirbilis ganaxlebis: yovelTvis, roca sarbenad mivdivar, mudmivad meSinia. majiscema miormagdeba. cxadia, marto aRar davdivar sarbenad, magram SiSi jer isev rCeba~. am qalbatonebs posttravmatuli stresis aSliloba (posttraumatic stress disorder _ PTSD) aqvT. es aris SfoTviTi aSliloba, romelic xasiaTdeba travmatuli movlenis ganmeorebadi mdgradi gancdebiT, Tanmxlebi distresis gamomwvevi mogonebebiT, sizmrebiT, halucinaciebiTa da disociaciuri xatebiT, anu e.w. fleSbeqebiT (flashbacks). individebs PTSD SeiZleba ganuviTardeT gaupatiurebaze, sicocxlisaTvis safrTxis momtan cxovrebiseul movlenebze, an Zlier dazianebaze, travmaze, anda stiqiur ubedurebaze reaqciis saxiT (Davidson et al., 1991; Kairbank et al., 1993; Foa & Riggs, 1995; Green, 1994). adamianebs PTSD SeiZleba ganuviTardeT, rodesac Tavad arian travmis msxverplni, an rodesac xdebian msxverplis mowmeni. arsebobs albaToba imisa, rom PTSD-is mqone adamianebs amavdroulad sxva fsiqopaTologiebic aReniSnebodeT, rogo-

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Tavi 15 / fsiqologiuri aSlilobebi

ricaa klinikuri depresia, nivTierebebis borotad gamoyenebis problemebi da seqsualuri disfunqciebi. kvleva aCvenebs, rom amerikel mozrdilTa daaxloebiT 8% cxovrebis manZilze erTxel mainc avaddeba PTSD-iT (DSM-IV-TR, 2000). mTlianobaSi mTeli mosaxleobis daaxloebiT sami meoTxedi ganicdis movlenas, romelic SeiZleba travmatulad miviCnioT, rogoricaa: seriozuli ubeduri SemTxveva, stiqiuri ubedureba an fizikuri Zaladoba (Green, 1994). kolejis studentTa SerCevis 84%-ma aRniSna, rom gamocdilebaSi hqondaT, sul mcire, erTi travmatuli movlena; daaxloebiT erTma mesamedma ki _ oTxi da meti aseTi calkeuli movlena daasaxela (Vrana & Lauterbach, 1994). miuxedavad imisa, rom mamakacebi da qalebi Tanabari sixSiriT ganicdian travmatul movlenebs, qalebSi orjer metia PTSD-is ganviTarebis albaToba, vidre mamakacebSi (Breslau et al., 1997). mamakacebisgan gansxvavebiT, qalebTan gansakuTrebiT didia albaToba imisa, rom bavSvobaSi miRebuli travmis Sedegad ganviTardes PTSD. mkvlevrebi jer kidev cdiloben am sqesobrivi gansxvavebis gagebas. posttravmatuli stresis aSliloba Zalian arRvevs individis cxovrebas. rogor umklavdebian mkvlevrebi PTSD-isa da sxva SfoTviTi aSlilobebis wyaroebis aRmoCenis rTul amocanas? wyaroebis, mizezebis gagena fsiqologiuri distresis Semsubuqebis imeds iZleva.

SfoTviTi aSlilobebi: mizezebi


rogor xsnian fsiqologebi SfoTviTi aSlilobebis ganviTarebas? qvemoT ganxilul TiToeul etiologiur midgomaSi (biologiuri, fsiqodinamikuri, bihevioraluri da kognituri) erTmaneTisgan gansxvavebul faqtorebze keTdeba aqcenti. vnaxoT, Tu rogor Seaqvs TiToeul maTgans Tavisi ganumeorebeli wvlili SfoTviTi aSlilobebis bunebis garkvevaSi.

biologiuri
sxvadasxva mkvlevrebs miaCniaT, rom SfoTvas biologiuri safuZvlebi aqvs. erT-erTi Teoria cdilobs axsnas, Tu ratom aris garkveuli fobiebi, vTqvaT, obobebis an simaRleebis SiSi,

ufro metad gavrcelebuli, vidre sxva safrTxeebis, magaliTad, eleqtroobis, SiSebi. vinaidan mravali SiSi saerToa sxvadasxva kulturisTvis, SemoTavazebul iqna mosazreba, rom evoluciuri warsulis garkveul etapze garkveuli SiSebi zrdida Cveni winaprebis gadarCenis Sansebs. SesaZloa, evoluciur warsulSi adamianebs Tandayolili hqondaT seriozuli safrTxis gamomwvevi nebismieri ramis SiSi. am mzaobis hipoTezis Tanaxmad, CvenSi mocemulia erTxel SemaSineblad aRqmul stimulze swrafad da daufiqreblad~ reagirebis evoluciuri tendencia (Ohman, 1986; Seligman, 1971); Tumca, es hipoTeza ar xsnis im obieqtebze, an situaciebze reaqciis saxiT ganviTarebul fobiebs, romelTac evoluciuri istoriis manZilze ar hqoniaT gadarCenisTvis mniSvneloba, rogoricaa, magaliTad, nemsebis, manqanis tarebis an liftebis SiSi. SfoTvis simptomebis garkveuli medikamentebiT aRkveTis an, piriqiT, gamowvevis SesaZlebloba SfoTviT aSlilobebSi biologiuri faqtoris rolis damadasturebel monacemebs iZleva (Holland et al., 1999; Klerman et al., 1994). magaliTad, gavixsenoT me-3 Tavidan, rom Tavis tvinSi GABA neirogadamtanis Semcvelobis Semcirebisas adamianebi xSirad ganicdian SfoTvas. rogorc me-16 TavSi vnaxavT, GABA-is Semcvelobaze moqmedi nivTierebebi warmatebiT gamoiyeneba SfoTviTi aSlilobebis mkurnalobisas. mkvlevrebi isev agrZeleben am aSlilobebis Tavis tvinSi arsebuli safuZvlebis sakvlevi teqnikebis Seqmnas (Malizia, 1999). magaliTad, PET- skanirebam gamoavlina gansxvaveba panikuri aSlilobis mqone da sakontrolo jgufis individTa GABA receptorebis funqcionirebas Soris (Malizia et al., 1998). es gansxvavebebi SeiZleba panikuri aSlilobis warmoqmnis axsnaSi dagvexmaros. MRI teqnikis saSualebiT OCD-s mqone pacientTa Tavis tvinSi gamovlenil iqna Zalze farTod gavrcelebuli paTologiebi, kerZod, mielinizirebuli nervuli boWkoebis gacilebiT naklebi raodenoba, vidre normalur Tavis tvinSi (Jenike et al., 1996). mkvlevrebi dResdReobiTac cdiloben OCD-s simptomebsa da Tavis tvinis paTologiebs Soris damokidebulebis gagebas. dabolos, identuri da araidenturi tyupebis Seswavla SfoTviTi aSlilobis xuTi kategoriidan oTxisadmi midrekilebis genetikur safuZvels iZleva (Skre et al., 1993). magaliTad, identuri

fsiqologiuri aSlilobebis ZiriTadi tipebi

623

tyupebis wyvilSi panikuri aSlilobis ganviTarebis albaToba orjer metia, igive aSlilobis araidentur tyupebTan ganviTarebis albaTobasTan SedarebiT. SfoTviTi aSlilobebis erTaderT tips, romelsac ar gaaCnia genetikuri faqtoris wvlilis damadasturebeli monacemebi, fobiebi warmoadgens, sadac garemos faqtorebi ufro metad aris CarTuli.

momdinare, sawyisi TemisTvis Tavis aridebis saSualebas warmoadgens.

bihevioraluri
SfoTvis bihevioraluri axsnebi fokusirdeba imaze, Tu rogor xdeba SfoTviTi aSlilobebis simptomebis gamomuSaveba da ganmtkiceba. mkvlevrebi ar eZeben safuZvelSi myof aracnobier konfliqtebs, an adreuli bavSvobis gamocdilebebs, radganac SeuZlebelia am fenomenebis pirdapir dakvirveba. rogorc me-7 TavSi vnaxeT, bihevioristuli Teoriebi xSirad xsnian fobiebis ganviTarebas, romelTac klasikurad ganpirobebul SiSebad miiCneven. gavixsenoT patara alberti, romelsac jon vatsonma da rozali reinerma TeTri virTxis SiSi ganuviTares. bihevioraluri axsnis Tanaxmad, manamde neitraluri obieqti, an situacia SemaSinebel gamocdilebasTan Sewyvilebis saSualebiT fobiis stimulad gadaiqceva. magaliTad, Tu deda bavSvis gvelTan miaxloebisas yviris gafrTxilebis niSnad, bavSvs SeiZleba gvelebis fobia Camouyalibdes. am gamocdilebis Semdeg gvelebze fiqrmac ki SeiZleba gamoiwvios SiSis talRa. fobias inarCunebs SfoTvis Semcireba/reduqcia, rasac adgili aqvs SemaSinebeli situaciisTvis Tavis aridebis SemTxvevaSi. obsesiur-kompulsuri aSlilobis bihevioraluri analizi aCvenebs, rom kompulsur qcevas SeuZlia akviatebul (obsesiur) azrebTan dakavSirebuli SfoTvis Semcireba, riTic xdeba kompulsuri qcevis ganmtkiceba. magaliTad, Tu qals nagavze xelis mokidebiT mowamvlis (kontaminaciis) eSinia, xelebis dabana Seamcirebs SfoTvas, rac, Sesabamisad, ganmamtkicebelic iqneba. fobiebis msgavsad, obsesiurkompulsuri aSlilobebis SenarCuneba SfoTvis Semcirebis, anu reduqciis saSualebiT xdeba, rac Tan sdevs kompulsur qcevebs.

fsiqodinamikuri
fsiqodinamikuri modeli amodis daSvebidan, rom SfoTviTi aSlilobebis simptomebi warsulis fsiqikuri konfliqtebidan, an SiSebidan momdinareobs. simptomebi fsiqologiuri tkivilisgan individis dacvis mcdelobebs warmoadgens. amgvarad, panikuri Setevebi aracnobieri konfliqtebis cnobierSi SeWris Sedegia. magaliTad, davuSvaT, bavSvi cnobieridan gandevnis saxlis rTuli garemodan gaqcevis survils. Semdgom cxovrebaSi obieqtma, an situaciam, romelic simbolizebuli saxiT gamoxatavs konfliqts, SeiZleba fobiis gaaqtiureba moaxdinos. xidi, magaliTad, SeiZleba im gzis simbolizacia iyos, romelic man unda gaiaros saxlis samyarodan gare samyaroSi gasasvlelad. amitom xidis danaxvam aracnobieri konfliqti SeiZleba cnobierSi amoitanos, rasac fobiebisTvis damaxasiaTebeli SiSi da SfoTva mohyveba Tan. xidebisTvis Tavis arideba iqneba bavSvobaSi saxlSi miRebul gamocdilebasTan dakavSirebuli SfoTvisgan Tavisuflad darCenis simboluri mcdeloba. obsesiur-kompulsuri aSlilobebis SemTxvevaSi, obsesiuri qceva ganixileba, rogorc masTan dakavSirebuli, SemaSinebeli survilebis, an konfliqtebis mier warmoqmnili SfoTvis gadanacvlebis mcdeloba. obsesiis, romelic simbolurad akrZalul impulss gamoxatavs, CanacvlebiT pirovneba garkveul Semsubuqebas aRwevs. magaliTad, zemoT aRwerili jimis mier gancdili WuWyis akviatebuli (obsesiuri) SiSi SeiZleba seqsualurad aqtiurad yofnis survilsa da sakuTari reputaciis gaWuWyianebis~ SiSs Soris warmoqmnili konfliqtidan momdinareobdes. kompulsuri saqmianoba, romelic mcire ritualuri moqmedebebis Sesrulebas gulisxmobs, individisTvis, aseve, aracnobieri konfliqtidan

Tavi 15 / fsiqologiuri aSlilobebi

kognituri
SfoTvis Taobaze kognituri mosazrebebi yuradRebas amaxvilebs im perceptul procesebsa da ganwyobebze, romelmac SeiZleba daamaxinjos pirovnebis winaSe arsebuli safrTxis miseuli Sefaseba. man SeiZleba an gadaafasos safrTxis xasiaTi an realuroba, an saTanadod ver

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Seafasos safrTxisadmi efeqturad gamklavebis sakuTari SesaZleblobebi. magaliTad, socialuri fobiis mqone adamianma farTo auditoriis winaSe sityviT gamosvlis win SeiZleba xeli Seuwyos SfoTvas: ra moxdeba, Tu damaviwydeba, ra unda vTqva? sulelad gamovCndebi mTeli am xalxis winaSe. Semdeg ufro metad avnerviuldebi da gaoflianebas daviwyeb, xma amikankaldeba da kidev ufro sulelurad gamovCndebi. roca ar unda mnaxon am adamianebma am wuTidan, maT vemaxsovrebi, rogorc suleli adamiani, romelic sityviT gamosvlas cdilobda. SfoTviTi aSlilobebis mqone adamianebs TavianTi distresi xSirad gardauvali ubedurebis maniSneblad miaCniaT. maTma reaqciam SeiZleba Caketili wre Sekras: pirovnebas eSinia ubedurebis, romelic SfoTvis momatebas iwvevs; es ki, Tavis mxriv, amZafrebs SfoTvis SegrZnebas da ganamtkicebs pirovnebis SiSebs (Beck & Emery, 1985). es kognituri axsna fsiqologebma SfoTvisadmi mgrZnobelobis gazomviT Seamowmes: individebs sjeraT, rom iseT sxeulebriv simptomebs, rogoricaa zedapiruli da xSiri sunTqva, an gaxSirebuli guliscema, SeiZleba damRupveli Sedegebi mohyves. SfoTvisadmi maRali mgrZnobelobis mqone adamianebs axasiaTebT daTanxmebis tendencia iseT debulebebze, rogoricaa _ rodesac vamCnev, rom guliscema mixSirdeba, vnerviulob, rom SeiZleba gulis Seteva damemarTos.~ erT-erT kvlevaSi mkvlevrebi afasebdnen im studentTa jgufis mgrZnobelobas SfoTvisadmi, romelic aSS-is sahaero akademiis kadetTa ZiriTadi wvrTnis stresul kurss gadioda. am studentTa daaxloebiT 20%-s, romelsac SfoTvisadmi mgrZnobelobis 90 procentilze maRali maCvenebeli daudginda, xuTkviriani kursis ganmavlobaSi aReniSneboda panikis Seteva, mTliani jgufis darCenili nawilis 6%-isgan gansxvavebiT (Schmidt et al., 1997). es monacemebi gvafiqrebinebs, rom zogierT individs imis gamo SeiZleba daemarTos panikis Seteva, rom igi sakuTar sxeulebriv agznebas SiSis mniSvnelobis mqoned miiCnevs.

saidan viciT
SfoTvasTan dakavSirebuli sityvebis gadamuSaveba da panikuri aSliloba kognituri Teoriebis mixedviT, SfoTviTi aSlilobebis mqone adamianebi momatebul mgrZnobelobas unda avlendnen safrTxesTan dakavSirebul cnebebze. panikuri aSlilobis mqone individebisTvis am cnebebSi panikis Setevis fiziologiuri, sxeulTan dakavSirebuli simptomebi Sedis, magaliTad, Tavbrusxveva, gonebis dakargva da Sekavebuli sunTqva. panikuri aSlilobis mqone individebs mkvlevarTa jgufi warudgenda sityvebis rogorc am kategorias, ise _ sakontrolo CamonaTvals (magaliTad, delikaturi, neli da megobruli) Zalze xanmokle drois, daaxloebiT wamis 1/100-is ganmavlobaSi. cdis pirebs evalebodaT TiToeul cdaSi wardgenili sityvebis aRdgena. panikuri aSlilobis mqone cdis pirTa Sedegebi dardeboda sakontrolo jgufSi miRebul Sedegebs. kognituri Teoriis hipoTezis mixedviT, mxolod panikuri aSlilobis mqone cdis pirebi SeZlebdnen sxeulTan dakavSirebuli sityvebis CamonaTvalidan ufro metis cnobas, vidre sakontrolo jgufSi. es hipoTeza dadasturda: panikuri aSlilobis mqone pacientebma sxeulTan dakavSirebuli kategoriidan 2.6-ze meti sityva icnes maSin, roca janmrTelma sakontrolo jgufma _ mxolod 0.7 sityva (Pauli et al., 1997). kvlevis Sedegad, aseve, dadginda, rom SfoTvis mqone pacientebi xels uwyoben SfoTvis SenarCunebas kognituri tendenciurobiT, rac wina planze swevs da metad gamokveTils xdis SemaSinebel stimuls. es Sedegebi gvafiqrebinebs, rom SfoTvis mqone pacientebs, SesaZloa, yuradRebisa da informaciis gaSifvris tendencia axasiaTebT, rac gansakuTrebiT zrdis SemaSinebeli stimulis SemCnevis albaTobas maSinac ki, rodesac es stimuli mxolod wamis 1/100-s grZeldeba.

fsiqologiuri aSlilobebis ZiriTadi tipebi

625

TiToeuli ZiriTadi midgoma SfoTviTi aSlilobebisadmi etiologiuri mozaikis mxolod nawils xsnis. TiToeuli mimarTulebiT mimdinare gamokvlevebi naTels gaxdis mizezebs da, Sesabamisad, mkurnalobisken mimaval gzas. axla, rodesac ukve gvaqvs bazisuri codna SfoTviTi aSlilobebis Sesaxeb, gadavideT paTologiuris sami didi kategoriidan Semdegis ganxilvaze, romelsac, aseve, detalurad ganvixilavT. es aris guneba-ganwyobilebis aSlilobebi.

cxrili

15.3

klinikuri depresiuli aSlilobis maxasiaTeblebi


maxasiaTebeli disforiuli ganwyobileba magaliTi sevda, daTrgunuloba, uimedoba; TiTqmis yvela Cveuli saqmianobisadmi interesis an maTgan siamovnebis miRebis unaris dakargva. umadoba; mniSvnelovani kleba wonaSi. insomnia an hipersomnia (uZiloba an moWarbebuli Zilianoba) SesamCnevi Senelebuloba (motoruli CamorCena) an agznebuloba. usargeblobis gancda; TviT-gankicxva/ TviTgvema

mada Zili

guneba-ganwyobilebis aSlilobebi
aucileblad geqnebodaT cxovrebaSi periodebi, rodesac Tavs saSinlad daTrgunulad, an warmoudgenlad bednierad grZnobdiT. Tumca, zogierTi adamianis SemTxvevaSi ganwyobilebis ukiduresi gamovlinebebi arRvevs maTi cxovrebis normalur ritms. guneba-ganwyobilebis aSliloba warmoadgens emociur darRvevas, rogoricaa Rrma depresia an depresia, romelic maniasTan monacvleobiT iCens Tavs. mkvlevrebma daadgines, rom mozrdilTa daaxloebiT 19%-s aReniSneba guneba-ganwyobilebis aSlilobebi (Kessler et al., 1994). Cven aRvwerT or ZiriTad kategorias: klinikur depresiul aSlilobasa da bipolarul aSlilobas.

motoruli aqtivoba danaSaulis gancda

koncentracia azrovnebisa da koncentrirebis Semcirebuli unari; gulmaviwyoba. suicidi akviatebuli fiqri sikvdilis Sesaxeb; suiciduri ideebi an mcdelobebi.

klinikuri depresiuli aSliloba


depresias fsiqopaTologiaSi surdos analogad miiCneven, radganac Zalze xSirad emarTebaT adamianebs da cxovrebis garkveul periodSi TiTqmis yvela Cvengans ganucdia sruli aSlilobisTvis damaxasiaTebeli niSnebi. ama Tu im periodSi nebismier Cvengans udardia da uglovia sayvareli adamianis dakargva, an sevdiani da ganawyenebuli yofila sasurveli miznis miRguneba-ganwyobilebis aSliloba (Mood disorder) _ guneba-ganwyobilebis darRveva, rogoricaa Rrma depresia, an maniasTan adgilmonacvle depresia. klinikuri depresiuli aSliloba (Major depressive disorder) _ guneba-ganwyobilebis aSliloba, romelic xasiaTdeba droSi ganfenili daTrgunulobis intensiuri grZnobiT bipolaruli depresiis maniakaluri fazis gareSe.

626

wevaSi warumateblobis gamo. es sevdiani grZnobebi mxolod erTi simptomia im simptomTa Soris, romelsac ganicdian klinikuri depresiuli aSlilobis mqone individebi (ix. cxrili 15.3). depresiis diagnozis mqone individebi erTmaneTisgan arsebuli simptomebis siRrmiTa da xangrZlivobiT gansxvavdebian. Tu mravali maTgani cxovrebis garkveuli etapis mxolod ramdenime kviris manZilze ebrZvis klinikur depresias, arseboben iseTebic, visTvisac es epizodur, an qronikul xasiaTs atarebs wlebis ganmavlobaSi. guneba-ganwyobilebis aSlilobebis gavrcelebis statistikis mixedviT, qalTa 21%sa da mamakacTa 13%-s cxovrebis ganmavlobaSi erTxel mainc aReniSneba klinikuri depresia (Kessler et al., 1994). depresia uzarmazar fasad ujdeba Tavad daavadebuls, mis ojaxsa da sazogadoebas. evropaSi Catarebul erT-erT gamokvlevaSi gamovlinda, rom rekurentuli depresiis mqone adamianebi mTeli TavianTi mozrdili cxovrebis mexuTeds klinikebSi atareben, xolo maTi 20% simptomebis gamo sruliad araqmediTunariania da veRar axerxebs samuSaoze dabrunebas (Holden, 1986). aSSis fsiqiatriul klinikebSi yvela diagnostirebul daavadebaTa umravlesobas depresia warmoadgens, magram jer isev miaCniaT, rom es ar aris diagnostirebisa da mkurnalobis sruli

Tavi 15 / fsiqologiuri aSlilobebi

iZleva nebismier dapirebas da SeuZlia yvelafris darigeba-gaCuqeba. semi kolejis 20 wlis studentia, romelsac maniakaluri epizodis simptomebi aReniSneba: bolo periodSi semi Tavs fantastiurad grZnobda. mas imdeni energia hqonda, rom TiTqmis arasodes sWirdeboda Zili da igi sruliad darwmunebuli iyo, rom skolaSi saukeTeso moswavlea. mas anerviulebda, rodesac vinme Zalze nela iqceoda; maT ar SeeZloT misi monologebis brwyinvalebis gageba da aravis xelewifeboda misi tempiT cxovreba. sems hqonda finansebTan dakavSirebuli aRmafrTovanebeli ideebi da ver xvdeboda, ratom ar cdilobdnen misi megobrebi mis gegmebSi CarTvas. rodesac mania Semcirebas iwyebs, semis msgavsi adamianebi maT mier dauokeblobis periodSi Seqmnili usiamovnebebisa da zianis gamosworebas cdiloben. amgvarad, maniakaluri epizodi TiTqmis yovelTvis Rrma depresiuli periodiT icvleba. bipolaruli aSlilobebisas guneba-ganwyobilebis darRvevebis xangrZlivoba da sixSire pirovnebidan pirovnebamde varirebs. zogierT maTgans normaluri funqcionirebis xangrZlivi periodebi aqvT, romelTac drodadro xanmokle maniakaluri, an depresiuli epizodebi wyvets, Tumca arsebobs adamianTa mcire raodenoba, romelTac gansakuTrebiT ar gaumarTlaT da romelTa cxovrebaSi maniakalur epizodebs pirdapir klinikuri depresia cvlis, Semdeg isev maniakaluri faza brundeba da ase uwyvetad viTardeba dausrulebeli cikli, romelic angrevs da anadgurebs Tavad am aSlilobis mqone adamianebs, maT ojaxebs, megobrebsa da TanamSromlebs. maniakalur periodSi maT SeiZleba
bipolaruli aSliloba (Bipolar disorder) _ gunebaganwyobilebis aSliloba, romelic xasiaTdeba depresiisa da maniis periodebis monacvleobiT. maniakaluri epizodi ( Manic episode) _ bipolaruli aSlilobis komponenti, romelic xasiaTdeba ukiduresi aRfrTovanebisa da usazRvro eiforiis periodebiT, grandiozulobis grZnobebiTa da azrebiT, sakmarisi mizezis da realuri pirovnuli SesaZleblobebis ararsebobis pirobebSi

suraTi. klinikuri depresiuli aSlilobis mqone individTa naxevarze naklebi Tu iRebs raime saxis profesiul daxmarebas (Regier et al., 1993b).

bipolaruli aSliloba
bipolaruli aSliloba xasiaTdeba Rrma depresiuli periodebis maniakalur epizodebTan monacvleobiT. maniakalur epizodSi pirovneba, rogorc wesi, uCveulod mxned da eqspansiurad iqceva da aseve grZnobs Tavs, Tumca, xandaxan individis wamyvani ganwyobileba gaRizianebadoba ufroa, vidre aweuli guneba-ganwyobileba da enTuziazmi, gansakuTrebiT ki maSin, roca igi ramenairad winaaRmdegobas grZnobs. maniakalur periodSi individi xSirad ganicdis moWarbebul TviTpativiscemas, an ararealur rwmenas imisa, rom igi gansakuTrebul SesaZleblobebsa da Zalas flobs. individs SeiZleba aReniSnebodes Zilis moTxovnilebis mkveTri Semcireba da SeiZleba Warbad iyos dakavebuli samsaxureobrivi Tu sxva socialuri, an siamovnebis momtani saqmianobiT. Sepyrobilia ra maniakaluri ganwyobilebiT, individi avlens usafuZvlo optimizms, midis usargeblo riskze,

627

fsiqologiuri aSlilobebis ZiriTadi tipebi

waagon mTeli danazogi, an ucnobebs guluxvi saCuqrebi daurigon, rac gaamZafrebs danaSaulis grZnobas Semdgom depresiul fazaze. bipolaruli aSliloba gacilebiT iSviaTia, vidre klinikuri depresiuli aSliloba. is mozrdilTa 1.6%-Tan aRiniSneba da Tanabrad nawildeba mamakacebsa da qalebs Soris (Kessler et al., 1994).

guneba-ganwyobilebis aSlilobebi: mizezebi


ra faqtorebi moqmedebs guneba-ganwyobilebis aSlilobis ganviTarebaze? am kiTxvas biologiuri, fsiqodinamikuri, bihevioraluri da kognituri midgomebis poziciebidan davsvamT. unda aRiniSnos, rom klinikuri depresiuli aSliloba, misi gavrcelebulobis gamo, bipolarul aSlilobaze metad aris Seswavlili da es garemoeba Cvens mimoxilvaSi aisaxeba.

suraTi

15.3

bipolaruli depresiis PET skanireba


PET skanireba maniakaluri frazis dros, depresiulobasTan SedarebiT, cerebraluri glukozis metabolozmis ufro maRal dones aCvenebs. zeda da qveda rigze depresiul fazaSi myofi pacientis monacemebia, Sua rigze ki _ maniakalur fazaSi myofis.

biologiuri
garkveuli tipis kvlevebis Sedegebi gunebaganwyobilebis aSlilobebSi biologiur faqtorze migvaniSnebs. magaliTad, is faqti, rom sxvadasxva nivTierebebiT SesaZlebelia maniakaluri da depresiuli simptomebis Semsubuqeba, imaze miuTiTebs, rom bipolaruli aSlilobis or ukidures gamovlinebas Tavis tvinis gansxvavebuli mdgomareoba udevs safuZvlad. ori qimiuri agentis, serotoninisa da norepinefrinis, Semcvelobis Semcireba depresias ukavSirdeba, momateba ki _ manias, Tumca, jerjerobiT ar aris aRmoCenili guneba-ganwyobilebis aSlilobebis zusti bioqimiuri meqanizmi (Duman et al., 1997). mkvlevrebi PET skanirebas iyeneben maniakalur da depresiul fazebze Tavis tvinSi cerebraluri glukozis (saqaridis saxeoba, romelic energiis gamosanTavisufleblad gamoiyeneba) metabolizmSi sxvaobis dasadgenad (ix. sur. 15.3), magram aseTi gansxvavebebi ganwyobilebis ori mdgomareobis Sedegi ufro SeiZleba iyos, vidre mizezi. matulobs monacemebi imis Sesaxeb, rom guneba-ganwyobilebis aSlilobaze genetikuri faqtorebi axdens gavlenas (McGue & Christensen, 1997). tyupebis Seswavlam aCvena, rom, Tu identuri tyupebidan erT-erTi guneba-ganwyobilebis

628

aSlilobiT avaddeba, arsebobs 67%-iani Sansi, rom meore tyupiscalsac aRmoaCndes igive aSliloba. es monacemi mxolod 20%-s udris araidentur tyupebSi, romelTac ar aqvT identuri genetikuri masala (Ciaranello & Ciaranello, 1991; Gershon et al., 1987). iReben ra mosazrebas guneba-ganwyobilebis aSlilobebis Tandayolilobis Sesaxeb, mkvlevrebi Taobidan Taobamde am daavadebis gadacemaze pasuxismgebeli genetikuri masalis konkretuli lokalizaciis adgilis dadgenas cdiloben. kvlevaTa erT-erT seria pensilvaniaSi emiSebis Temis warmomadgenelTa bipolaruli aSlilobis paternze iyo mimarTuli (Egeland et al., 1987). emiSebi aseTi kvlevebisTvis idealuri monawileebi arian maTi didi ojaxebis, detaluri genealogiuri Canawerebis warmoebis, genetikurad izolirebulobisa da maT Soris iseTi qceviTi faqtorebis iSviaTobis gamo, rogoricaa, alkoholizmi da Zaladoba, (romelic zegavlenas moaxdenda monacemebze). am religiuri seqtis yvela 15 000 wevri XVIII saukunis dasawyisSi evropidan migrirebuli 30 wyvilis STamomavalia. aris tendencia, rom bipolaruli depresia

Tavi 15 / fsiqologiuri aSlilobebi

fsiqologiuri aSlilobis erT-erTi tipis gagebisadmi biologiuri midgomis TvalSisacemi magaliTi depresiis uCveulo formis kvlevidan modis. zogierT adamians regularulad eufleba depresia zamTris TveebSi, gansakuTrebiT grZeli skandinaviuri zamTris dros, rodesac dRe xanmoklea (ix. sur. 15.4). guneba-ganwyobilebis am darRvevas samarTlianad uwodes sezonuri afeqturi aSliloba _ saa (anu SAD _ seasonal affective disorder). mkvlevrebma Seqmnes Terapiuli teqnika, romelic sruliad efeqturad amsubuqebs SAD-s _ pacientebs sistematurad waredginebodaT mkveTri TeTri manaTobeli sinaTle (Blehar & Rosental, 1989). mkvlevrebi amtkiceben, rom sinaTliT Terapias SeuZlia zegavlena moaxdinos neirogadamtan serotoninze, romelic, rogorc zemoT aRiniSna, depresiis gamomwvev faqtorad aris miCneuli.

saidan
Taobebis manZilze gamovlindes zogierT, magram ara yvela ojaxSi. es kanonzomiereba mkvlevrebs aSlilobis mqone da misgan Tavisufali individebis genetikuri masalis uSualod Sedarebis saSualebas aZlevs. miuxedavad imisa, rom naadrevi aRmoCnda bipolaruli genis~ identificirebaSi warmatebis Sesaxeb pirveli moxsenebebi (Kelsoe et al., 1989), mkvlevrebi ar kargaven optimizms da Tvlian, rom es Sedarebebi moitans im codnas, romelsac eZieben (Berrettini et al., 1997; Ginns et al., 1992; Kelsoe et al., 1993).

viciT
serotonini da sezonuri afeqturi aSliloba (saa) saa-is mqone pacientebi yovel saRamos, sakuTar saxlSi sinaTlis Terapiis _ mkveTri manaTobeli sinaTlis orsaaTian kurss gadiodnen. mxolod is pacientebi (14-dan 12 pacienti) monawileobdnen kvlefsiqologiuri aSlilobebis ZiriTadi tipebi

suraTi

15.4

sezonuri afeqturi aSliloba


sezonuri afeqturi aSlilobis mqone individebs depresiis simptomebi xanmokledRian sezonebze aReniSnebaT. diagramaze mocemulia maRali ukuproporciuli mimarTeba depresiis SemTxvevebsa (nawili A) da dRis sinaTlis xangrZlivobias (nawili B) Soris

629

vis meore etapSi, romelTac sinaTlis Terapiam SedarebiT Seumsubuqa mdgomareoba. am etapze mowmdeboda hipoTeza imis Sesaxeb, rom sinaTlis Terapia zegavlenas axdens Tavis tvinSi serotoninis Semcvelobaze. eqsperimentuli jgufis pacientebi Tavis tvinSi serotoninis Semcvelobis Semcirebaze mimarTul dietaze dasves; sakontrolo jgufis pacientebs ki serotoninis Semcvelobis SesanarCunebeli dieta daeniSnaT. eqsperimentuli jgufis pacientebs saa-is simptomebis recidivi aReniSnaT, sakontrolo jgufis pacientebs ki _ ara. es faqti gvafiqrebinebs, rom sinaTlis Terapia Tavdapirvelad pasuxismgebeli iyo serotoninis Semcvelobis aRdgenaze, ramac pacientebs aradepresiuli afeqtis gancdis saSualeba misca, anu Tavidan aacila depresiuli simptomatika (Neumesiter et. al., 1997).

gankicxvis wyaros. es risxva bavSvobis gansakuTrebulad Zlier da damokidebul urTierTobas ukavSirdeba, rogoricaa, magaliTad, mSoblisa da Svilis urTierToba, sadac ar xdeba pirovnebis moTxovnilebebisa da molodinebis dakmayofileba. mozrdilobaSi gancdili danakargi, realuri iqneba es Tu simboluri, aaqtiurebs mtrul grZnobebs, romelic axla ukve pirovnebis egoze miemarTeba da Sedegad depresiisTvis damaxasiaTebel TviTgankicxvas iwvevs.

bihevioraluri
depresiis fesvebis aracnobierSi Ziebis nacvlad, bihevioraluri midgoma pirovnebis mier miRebuli dadebiTi da uaryofiTi ganmtkicebis raodenobis efeqtze amaxvilebs yuradRebas (Lewinsohn, 1975; Lewinsohn et al., 1985). am Tvalsazrisis mixedviT, depresiuli grZnobebi maSin viTardeba, rodesac individi garemodan arasakmaris dadebiT ganmtkicebasa da bevr sasjels iRebs danakargis, an raime sxva mniSvnelovani cxovrebiseuli cvlilebebis Semdeg. sakmarisi dadebiTi ganmtkicebis gareSe pirovneba sevdiani da gulCaTxrobili xdeba. sevdianobis mdgomareobas dasawyisSi sxvaTa mxridan momatebuli yuradReba da TanagrZnoba ganamtkicebs (Biglan, 1991), Tumca, Cveulebisamebr, Tavidan TanagrZnobiT ganmsWvalul megobrebs Rlis depresiuli pirovnebis uaryofiTi guneba-ganwyobileba da damokidebulebebi da mas Tavs arideben. es reaqcia spobs dadebiTi ganmtkicebis erT-erT wyaros da pirovneba ufro metad iZireba depresiaSi. kvleva, aseve, aCvenebs, rom depresiul adamianebs dadebiTi ukukavSiris verSefasebisa da uaryofiTi ukukavSiris gadafasebis tendencia axasiaTebT ( Kennedy & Craighead, 1988; Nelson & Craighead, 1977).

Tavi 15 / fsiqologiuri aSlilobebi

Tqven, SesaZloa, moeliT, rom adamianebma wamlebi unda miiRon Tavis tvinSi neirogadamtanebis moqmedebaze gavlenis mosaxdenad (zogierT maTganze me-16 TavSi visaubrebT), Tumca, es kvleva aCvenebs, rom sinaTlis Terapias iseTive efeqti SeiZleba hqondes, rogorc zogierT fsiqoaqtiur wamals. mkurnalobis orive saxeoba _ medikamenturi, an sinaTlis Terapia _ ganamtkicebs mosazrebas aSlilobis etiologiaSi biologiuri wonasworobis darRvevis rolis Sesaxeb. amave dros, Tu SAD-is aRwerilobaSi sakuTar Tavs icnobT, gaerkvieT sakuTar Tavsa da am problemaSi. axla vnaxoT, damatebiT ras gacnobebT gunebaganwyobilebis aSlilobebis warmoSobis Sesaxeb sami ZiriTadi fsiqologiuri midgoma.

fsiqodinamikuri
fsiqodinamikuri midgomis mixedviT, depresiis ganviTarebaSi gadamwyvet rols aracnobieri konfliqtebi da bavSvobidan momdinare mtruli grZnobebi asrulebs. froids depresiul adamianebTan TviTkritikasa da danaSaulis grZnobasTan uxdeboda Sejaxeba. mas miaCnda, rom Tavdapirvelad sxvaze, Semdeg ki sakuTar Tavze mimarTuli risxva warmoadgenda am TviT-

kognituri
kognituri midgomis farglebSi depresiis Sesaxeb ori Teoria arsebobs. erTi Teoriis mixedviT, aRqmis sqemebis Camoyalibebas uaryofiTi (negatiuri) kognituri sqema (ix. Tavi 5) ganapirobebs _ adamianebs uaryofiTi mosazrebebi SeeqmnaT maT cxovrebaSi mimdinare im movlenebze, romelzec pasuxismgeblobas grZnoben. meore, axsnis stilis Teoria miiCnevs, rom

630

depresias iwvevs individis rwmena imisa, rom igi sakmaod, an saerTod ver akontrolebs sakuTari cxovrebis mniSvnelovan movlenebs. TiToeuli am modelTagani xsnis depresiuli gamocdilebis zogierT aspeqts. ganvixiloT TiToeuli maTgani. aaron bekma (Aaron Beck, 1983, 1985, 1988), depresiis wamyvanma mkvlevarma, ganaviTara kognituri sqemebis Teoria. bekis mixedviT, depresiuli adamianebi sami tipis uaryofiTi kogniciiT gamoirCevian, rasac igi depresiul kognitur triadas uwodebs. esaa uaryofiTi Sexeduleba sakuTar Tavze, mimdinare movlenebsa da momavalze. depresiul adamianebs axasiaTebT tendencia imisa, rom sakuTari Tavi garkveuli TvalsazrisiT araadekvaturad, an naklovanad aRiqvan, mimdinare movlenebs mouZebnon uaryofiTi axsna da sjerodeT mtanjveli da sirTuleebiT aRsavse momavlis. uaryofiTi azrovnebis paterni Crdilavs yvela gancdas da depresiis kidev erT maxasiaTebels qmnis. individi, romelic yovelTvis uaryofiT Sedegs moelis, ver iqneba motivirebuli raime miznis miRwevaze, rasac Tan sdevs depresiis gamokveTili maxasiaTebeli _ nebisyofis paralizeba. axsnis stilis Teoriis mixedviT, romelic martin seligmens (Martin Seligman) (ix. Tavi 12) ekuTvnis, individebs sjeraT, sworad an mcdarad, rom ar SeuZliaT maTTvis mniSvnelovani momavlis gakontroleba. seligmenis Teoria

daswavlili umweoba ( Learned helplessness) _ zianis momtani stimulis arsebobis pirobebSi reaqciis ar, qonis zogadi paterni, romelic xSirad Tan erTvis mdgomareobas, rodesac individi ganicdis araSemTxveviTi, gardauvali uaryofiTi stimulis zemoqmedebas.

fsiqologiuri aSlilobebis ZiriTadi tipebi

ganviTarda kvlevidan, romelSic naCvenebi iyo depresiismagvari simptomebi ZaRlebSi (mogvianebiT ki, sxva saxeobebSic). seligmeni da maieri (1967) ZaRlebze mtkivneuli da gardauvali eleqtroSokiT zemoqmedebdnen: rac ar unda eqnaT ZaRlebs, Sokisgan gaqcevis gza ar arsebobda. ZaRlebs ganuviTardaT, rogorc seligmenma da maierma uwodes, daswavlili umweoba. daswavlili umweoba sami tipis deficitiT xasiaTdeba: motivaciuri deficitiT _ ZaRlebi ar Cqarobdnen cnobili moqmedebebis dawyebas; emociuri deficitiT _ isini rigidulni, gulgrilni, SeSinebulni da ubedurni Candnen; kognituri deficitiT _ isini cudad iTvisebdnen axal situaciebs. iseT situaciaSic ki, sadac eZleodaT SokisTvis Tavis aridebis SesaZlebloba, isini ar daiswavlidnen aseT qcevas (Maier & Seligman, 1976). seligmens miaCnda, rom depresiuli adamianebic daswavlili umweobis mdgomareobaSi imyofebian: isini elian, rom, rac ar unda gaakeTon, yvelaferi uSedego iqneba (Abramson et al., 1978; Peterson & Seligman, 1984, Seligman, 1975); Tumca, am mdgomareobis warmoqmna didad aris damokidebuli imaze, Tu rogor xsnis individi mis cxovrebaSi mimdinare movlenebs. rogorc me-12 TavSi iTqva, arsebobs axsnis stilis sami ganzomileba: Sinagani-garegani (internalurieqsternaluri), zogadi-konkretuli (globaluri-specifikuri) da ucvleli-cvalebadi (stabiluri-arastabiluri). vTqvaT, fsiqologiis gamocdaze dabali Sefaseba miiReT. Tqven gamocdis uaryofiT Sedegs Sinagan faqtors miawerT (me suleli var~), rac ufro dagasevdianebT, vidre garegani faqtori (gamocda namdvilad Zneli iyo~), ramac SeiZleba gangarisxoT. Sedegis asaxsnelad Tqven SegeZloT inteleqtze metad cvalebadi Sinagani mdgomareoba agerCiaT. nacvlad imisa, rom is Sinagani, ucvleli faqtorisTvis (sisulele) migeweraT, romelic zogad, anu Sors mimaval gavlenas axdens, Tqven SemoifargleT fsiqologiis gamocdasTan an kursTan dakavSirebuli axsniT

631

(me ar vvargivar fsiqologiis kursisaTvis~). axsnis stilis Teoriis Tanaxmad, individebi, romlebic warumateblobas Sinagan, ucvlel da zogad mizezebs miaweren, mowyvladni arian depresiisadmi. es prognozi mravalgzis dadasturda (Peterson & Seligman, 1984; Seligman, 1991). depresiis orive kognituri TeoriisTvis misaRebia mosazreba imis Sesaxeb, rom is stili, romliTac depresiuli adamianebi ganixilaven sakuTar Tavsa da maT cxovrebaSi mimdinare movlenebs, maT depresiul mdgomareobaSi amyofebs. magaliTad, adamianebs, zogadad, axasiaTebT TviTdadasturebis, anu maTi mekoncefciis Sesatyvisi informaciis moZiebis tendencia (Swann, 1990, 1997). am tendencias uaryofiTi Sedegebi moaqvs depresiuli adamianebisaTvis.

Sefasebis wakiTxviT; dabali TviTpativiscemis mqone individebTanac gamovlinda uryofiTi ukukavSiris miRebisken midrekileba maSin, roca maRali TviTSefasebis mqone individebi aSkarad dadebiT ukukavSirs aniWebdnen upiratesobas. cxrili 15.4 imasac aCvenebs, Tu ramdenad zustad miaCndaT TiToeul jgufs daxasiaTebebis dadebiToba da uaryofiToba. miaqcieT yuradReba, rom mxolod depresiul cdis pirebs sjerodaT, rom uaryofiTi daxasiaTeba ufro zusti iyo (Giesler et al., 1996).

saidan viciT
TviTdadastureba da depresia mkvlevrebma erTmaneTisgan ganarCies individTa sami jgufi: erTi jgufi depresiuli iyo, meore jgufi _ aradepresiuli, magram xasiaTdeboda dabali TviTpativiscemiT da mesame jgufi, romelic, aseve, aradepresiuli iyo da xasiaTdeboda maRali TviTpativiscemiT. TiToeuli jgufis cdis pirebma interviusTvis mosamzadebel etapze mTel rig kiTxvarebze gasces pasuxi. interviuze cdis pirebs uTxres, rom am kiTxvarebs orma studentma gasca pasuxi da TiToeulze daiwera pirovnebis daxasiaTeba~, rasac win uZRvoda sruli pirovnuli Sefaseba. realurad, cdis pirebs miawodes erTi da igive daxasiaTeba _ erTi dadebiTi (es pirovneba kargad damkvidrebuli, TviTdarwmunebuli da bednieria~ da a.S.) da erTi uaryofiTi (es pirovneba ubeduria, daurwmunebelia, arakomfortulad grZnobs Tavs sxvebTan~ da a.S.). cdis pirebs moeTxovebodaT, amoerCiaT, Tu romel srul Sefasebas waikiTxavdnen. Sedegebi 15.4 cxrilSia mocemuli. rogorc xedavT, depresiuli cdis pirebi araTanabrad iyvnen dainteresebulni uaryofiTi

Tqven SeiZleba moelodiT, rom depresiuli adamianebi sakuTari Tavis amowevas~ Seecdebodnen dadebiTi ukukavSiris moZiebiT. es eqsperimenti aCvenebs, rom, piriqiT, isini TavianTi depresiis Sesabamis informacias eZeben, romelic TiTqmis ueWvelad xels uwyobs depresiis SenarCunebas. me-16 TavSi vnaxavT, rom depresiis kognituri Teoriebidan miRebulma codnam biZgi misca Terapiis warmatebuli formebis Seqmnas. amJamad depresiis Seswavlis ori sxva mniSvnelovani aspeqti arsebobs: didi gansxvaveba mamakacebsa da qalebSi depresiis gavrcelebaSi da kavSiri depresiasa da suicids (TviTmkvlelobas) Soris.

cxrili

15.4

TviTangariSi da depresia
depresiuli negatiuri Sefasebis amorCevis procenti arCeuli daxasiaTebis sizuste * dadebiTi daxasiaTeba uaryofiTi daxasiaTeba Sereuli dabali TviT- dabali TviTpativiscema pativiscema

Tavi 15 / fsiqologiuri aSlilobebi

82

64

25

5.67

6.60

9.70

7.89 -2.22

6.48 0.12

2.45 7.25

632

*sizustis reitingi 11-qulian skalaze gakeTda misi saerTod ararsebobidan (1) maqsimalur (11) sizustemde.

depresia: sqesTa Soris gansxvavebani


depresiis kvlevis erT-erTi centraluri sakiTxia is, Tu ratom emarTebaT qalebs depresia mamakacebze orjer xSirad. suzan nolenhoeqsemas (Susan Nolen-Hoeksema, 1990; Nolen-Hoeksema et al., 1999) gonebamaxviluri SemoTavazeba Seexeba reaqciis stils, romliTac mamakacebi da qalebi uaryofiT guneba-ganwyobilebaze dgebian. am mosazrebis mixedviT, rodesac qalebi ganicdian sevdas, maT TavianTi grZnobebis SesaZlo mizezebze fiqrisken midrekileba axasiaTebT; mamakacebi ki, piriqiT, aqtiurad cdiloben depresiuli grZnobebis Tavidan moSorebas sxva rameze yuradRebis gadataniT, an fizikuri saqmianobebis wamowyebiT, romlis drosac aRar fiqroben mimdinare emociur mdgomareobaze. am modelis Tanaxmad, qalebisTvis damaxasiaTebeli metad Cafiqrebuli, gansjiTi (ruminative) reaqciis stili, TavianT problemebze akviatebulad fiqris tendencia zrdis maT mowyvladobas depresiisadmi (Butler & Nolen-Hoeksema, 1994). kognituri midgomis Tanaxmad, uaryofiT ganwyobilebaze yuradRebis gamaxvileba aZlierebs fiqrs uaryofiTi movlenebis Sesaxeb, rac, Tavis mxriv, zrdis uaryofiTi grZnobebis raodenobasa da/an intensiurobas. kvleviT dasturdeba, rom individebSi, romlebic zogadad msjeloben, fiqroben depresiaze, ufro mosalodnelia mwvave depresiuli epizodebis ganviTareba (Just & Alloy, 1997; Nolen-Hoeksema et al., 1993). qalTa da mamakacTa Soris reaqciis stilis mixedviT arsebuli gansxvaveba qalebs bavSvobaSi depresiis ganviTarebis didi risks uqmnis (NolenHoeksema & Girgus, 1994). amerikis fsiqologTa asociaciis iniciativiT depresiisas sqesobrivi gansxvavebebis kvlevis gadasinjvam aCvena, rom depresiis maRali riski qalebSi SeiZleba gagebul iqnes mxolod, rogorc mTeli rigi fsiqologiuri, socialuri, ekonomikuri da biologiuri faqtorebis urTierTqmedebis Sedegi (McGrath et al., 1990). mraval kulturaSi zogierTi am faqtorTagani qalad yofnis gamocdilebas ukavSirdeba, raSic moiazreba qalebze fizikuri da seqsualuri Zaladobis, an siRaribeSi cxovrebisa da bavSvebisa da asakovani mSoblebis momvlelis funqciebis Semsruleblis ufro meti albaToba. aseTi

gamokvlevebi miuTiTebs, rom depresiis mizezi SeiZleba faqtorTa rTuli kombinacia iyos da rom normaluri~ qcevidan depresiisken mravali gza midis.

suicidi
gadarCenisa da warmatebis miRwevis survili damsxvreuli da ganadgurebulia... dgeba dro, rodesac yvelaferi kargavs brwyinvalebas, rodesac ikargeba imedis sxivi~ (Shneidman, 1987, gv.57). suicidaluri axalgazrda mamakacis am sevdian gamonaTqvamSi nebismieri fsiqologiuri aSlilobis ukiduresi Sedegi _ suicidia (TviTmkvleloba) asaxuli. miuxedavad imisa, rom depresiul adamianTa umravlesoba ar iklavs Tavs, analizi aCvenebs, rom mTlianad ganxorcielebul TviTmkvlelobaTa 50-80% depresiul adamianTa mier ganxorcielebul mcdelobebze modis (Shneidman, 1985). mTlianad aSS-is mosaxleobaSi oficialurad TviTmkvlelobad miCneul sikvdilTa raodenoba daaxloebiT 30 000-s Seadgens. miaweren ra mraval TviTmkvlelobas ubedur SemTxvevebs, an sxva mizezebs, realuri raodenoba, albaT, ufro metia. miuxedavad imisa, rom TviTmkvleloba aSS-is yvela asakis mosaxleobaSi sikvdilianobis merve wamyvani mizezia, SemTxvevaTa mesamedi 15-dan 24 wlis asakamde adamianebze modis (Murphy, 2000). TiToeul ganxorcielebul TviTmkvlelobaze 8-20 suicidaluri

633

fsiqologiuri aSlilobebis ZiriTadi tipebi

634

mcdeloba modis. kolejis 594 pirvelkurselTa gamokvlevam aCvena, rom 26%-s nafiqri hqonda TviTmkvlelobaze ukanaskneli 12 Tvis manZilze, 2%-ma realurad scada Tavis mokvla amave periodSi, 10%-s ki cxovrebis garkveul periodSi ganxorcielebuli hqonda Tavis mokvlis mcdeloba (Meehan et al., 1992). vinaidan depresias qalebSi ufro xSirad vxvdebiT, ar aris gasakviri, rom qalebi Tavis mokvlas samjer ufro xSirad cdiloben, vidre mamakacebi; Tumca, mamakacebis mier ganxorcielebuli mcdeloba ufro xSirad aris warmatebuli. am gansxvavebas iwvevs is faqti, rom mamakacebi ufro xSirad iyeneben cecxlsasrol iaraRs, qalebi ki mimarTaven naklebad mtkivneul saSualebebs, rogoricaa, magaliTad, saZile abebi (Berman & Jobes, 1991). bolo aTwleulebis erT-erT sagangaSo socialur problemas mozardTa suicidi warmoadgens. yovel cxra wuTSi erTi mozardi cdilobs Tavis mokvlas da yovel 90 wuTSi mcdeloba warmatebulia. yovel kviraSi 1 000 mozardis mier Tavis mokvlis mcdelobidan 125 aRwevs mizans. 1960 wlidan amerikel mozardebSi TviTmkvlelobis sixSire 200-dan 300%-mde gaizarda (Garland & Zigler, 1993). Tavgamodebuli mcdelobebisda miuxedavad, mozard vaJebSi oTxjer metia warmatebuli suicidis SemTxvevebi, vidre mozard gogonebSi (Bingham et al., 1994). sainteresoa, rom afrikuli warmoSobis amerikelebis orive sqesis mozardebSi gacilebiT naklebia TviTmkvlelobis sixSire, TeTrkanianebTan SedarebiT, miuxedavad imisa, rom ar arsebobs am monacemebis zusti axsna (Bingham et al., 1994; Murphy, 2000). es rasobrivi gansxvaveba mTeli cxovrebis manZilze grZeldeba. monacemebis rasobrivma, sqesisa da asakis niSnis mixedviT Sedarebam aCvena, rom TviTmkvlelobis yvelaze maRali riskis winaSe TeTrkaniani mowifuli mamakacebi dganan, yvelaze mcire riskis winaSe ki _ afrikuli warmoSobis amerikeli qalebi. cxovrebis rogori stili ubiZgebs mozardebs TviTmkvlelobis mcdelobisken? orive sqesisTvis winmswreb travmatul movlenas axlo urTierTobis rRveva warmoadgens (Gould et al., 1996). sxva mniSvnelovanma movlenebma, romelic sircxvilisa da danaSaulis grZnobas iwvevs, SeiZleba daTrgunos moumwifebeli ego da mozardma TviTmkvlelobis mcdeloba ganaxorcielos. aseT movlenaTa ricxvSi Sedis,

upirveles yovlisa, Tavdasxma, cema, gaupatiureba an dapatimreba. metic, homoseqsuali da lesboseli mozardebi ufro meti riskis winaSe dganan, vidre danarCenebi (Radkowsky & Siegel, 1997; Remafedi, 1999). suicidis aseTi maRali sixSire ueWvelad asaxavs homoseqsualuri orientaciisadmi SedarebiT nakleb socialur mxardaWeras. TviTmkvleloba ukiduresi reaqciaa, romelsac gansakuTrebiT maSin aqvs adgili, rodesac mozards ar SeuZlia sxvebisaTvis daxmarebis Txovna. mozardTa suicidi aris ara imwuTieri zegavlenis Sedegad, impulsurad ganxorcielebuli aqti, aramed, Cveulebisamebr, Sinagani areulobisa da garegani usiamovnebebis periodis finaluri stadia. suicidis axalgazrda msxverplTa umravlesoba acnobebs sxvebs, an wers Tavisi ganzraxvis Sesaxeb. amrigad, TviTmkvlelobis Sesaxeb saubari yovelTvis seriozulad unda iqnes miRebuli ( Marttunen et al., 1998). suiciduri azrovnebisa da gancdebis amocnoba, ramac SeiZleba warmoqmnas, an gaaZlieros aseTi destruqciuli azrebi, pirveli nabijia prevenciis mimarTulebiT. fsiqologi edvin Sneidmeni (Edwin Shneidmen, 1999), romelmac 40 weliwadi miuZRvna suiciduri tendenciebis mqone adamianebis Seswavlasa da mkurnalobas, askvnis, rom suicidi aRelvebuli da Seviwroebuli gonebis mier autaneli da dausrulebeli tkivilis pirobebSi ganxorcielebuli Tavganwirvis aqtia... faqtia, rom Cven SegviZlia tkivilis daameba, uaryofili moTxovnilebebis dakmayofileba da suicidur azrovnebamde Seviwroebulobis Semcireba~ ( 1987, gv .58). suiciduri ganzraxvebis niSnebisadmi mgrZnobiaroba da sakmarisi Carevis uzrunvelyofa arsebiTia rogorc mozardi, ise mowifuli adamianebis sicocxlis gadasarCenad, romelTac sruli TviTganadgurebis garda ver ipoves sirTuleebisgan Tavis daRwevis sxva saSualeba. miuxedavad imisa, rom, rogorc zemoT aRvniSneT, TviTmkvlelobis sixSire, zogadad, araTeTrkanianebSi ufro dabalia TeTrkanianebTan SedarebiT, arsebobs erTi gansacvifrebeli gamonaklisi: adgilobriv amerikel mozardebSi TviTmkvlelobis sixSire xuTjer aRemateba mTeli mosaxleobis mozardebis Sesabamis maCvenebels. suicidi TviTganadgurebaze mimarTuli qcevis erT-erTi formaa da aSS-is adgilobriv amerikul TemebSi miRebuli

Tavi 15 / fsiqologiuri aSlilobebi

destruqciuli qcevis nawils warmoadgens (Strickland, 1997). adgilobrivi amerikeli fsiqologi tereza lafroboizi (Teresa LaFromboise), romelic am problemas ikvlevda da profilaqtikisa da mkurnalobis strategiebi ganaviTara, Tavis tomSi mozardTa suicidis socialur mizezebze saubrobs. farTod gavrcelebul siRatakesa da umuSevrobasTan erTad, suicidis sixSires ganapirobebs ojaxebis ngreva, sayovelTao gaWirveba, didi raodenobis danakargebi (es SeiZleba iyos sikvdili, ojaxidan wasvla an ganqorwineba), nivTierebebis borotad gamoyeneba, ojaxebis momatebuli aramdgradoba da mniSvnelovani mzrunvelis dapatimreba~ (LaFromboise, 1988, gv.9). garda amisa, adgilobriv amerikelebs sjeraT, rom sulier samyaroSi myof TavianT winaprebTan uwyveti kavSiriT cxovreba gulisxmobs, rom sikvdili arc ise saSiSia. Cven ukve mimovixileT fsiqopaTologiis ori ZiriTadi klasi: SfoTviTi aSlilobebi da guneba-ganwyobilebis aSlilobebi. sanam Sizofreniaze visaubrebdeT, mokled ganvixiloT pirovnuli aSlilobebi da disociaciuri aSlilobebi.

pirovnuli aSlilobebi
pirovnuli aSliloba warmoadgens aRqmis, azrovnebisa da qcevis xangrZliv (qronikul), xist, araadaptur paterns, romelic seriozulad auaresebs individis funqcionirebis SesaZleblobas socialur da sxva garemoSi da SeuZlia mniSvnelovani distresis gamowveva. misi amocnoba, Cveulebriv, siWabukis an adreuli mowifulobis asakSi xdeba SesaZlebeli. pirovnuli aSlilobis mravali saxeoba arsebobs (DSM-IVTR-Si mocemulia 10 sxvadasxva tipis pirovnuli aSliloba). Cven ganvixilavT oTx maTgans: paranoidul, Teatralur, narcisul da antisocialur pirovnul aSlilobas. paranoiduli pirovnuli aSlilobis mqone adamianebs maTTan kontaqtSi myofi pirovnebebis motivebisadmi undoblobis da eWvianobis mdgradi paterni axasiaTebT. isini eWvoben, rom sxva adamianebi maTTvis zianis miyenebasa da motyuebas cdiloben. maT SeuZliaT sruliad uwyinar situaciebs faruli usiamovno mniSvneloba mouZebnon; moelian, rom maTi megobrebi, meuRle an mSoblebi uRalateben maT.

pirovnuli aSliloba (Personality disorder) _ aRqmis, azrovnebisa da qcevis qronikuli, xisti, araadapturi paterni, romelic seriozulad auaresebs individis funqcionirebis SesaZleblobas socialur da sxva garemoSi.

fsiqologiuri aSlilobebis ZiriTadi tipebi

Teatraluri pirovnuli aSliloba moWarbebuli emociurobiTa da yuradRebis ZiebiT xasiaTdeba. am aSlilobis mqone adamianebs yovelTvis yuradRebis centrSi surT yofna da Tu ver aRweven amas, yuradRebis misapyrobad raime araadekvaturis gakeTeba SeuZliaT. isini didi TeatralurobiT ayeneben TavianT moTxovnebs, Tumca, naklebad interesdebian ukukavSiriT; amasTanave, umniSvnelo movlenebzec moWarbebuli emociurobiT reagireben. narcisuli pirovnuli aSlilobis mqone adamianebi sakuTari mniSvnelobis moWarbebuli grZnobiT, warmatebisa da Zalis fantaziebis siWarbiTa da mudmivi aRtacebis obieqtad yofnis moTxovnilebiT gamoirCevian. am adamianebs xSirad eqmnebaT problemebi pirovnebaTSoris urTierTobebSi; maT aqvT tendencia, rom sxvebTan ormxrivi pasuxismgeblobis gareSe gansakuTrebuli keTilganwyobis, uflebebis mqoned igrZnon Tavi da sxva adamianebi sakuTari miznebisaTvis gamoiyenon. garda amisa, uWirT sxvaTa grZnobebis SemCneva da Tanagancda. antisocialuri pirovnuli aSliloba gamoirCeva upasuxismgeblo, an ukanono qcevebis xangrZlivi paterniT, romelic arRvevs socialur normebs. Cveul qcevaTa rigSi Sedis sicrue, qurdoba da Cxubi. antisocialuri pirovnuli aSlilobis mqone adamianebs xSirad ar scxveniaT da ar awuxebT sindisis qenjna maT mier Cadenili zianismomtani qcevebis gamo. socialuri normebis darRveva cxovrebis adreuli periodidan iwyeba, es SeiZleba iyos klasSi areulobebis gamowveva, CxubebSi CarTva da saxlidan gaqceva. es moqmedebebi sxvaTa uflebebisadmi gulgrilobiT gamoirCeva. antisocialur pirovnul aSlilobas xSirad sxva paTologiebic axlavs Tan. magaliTad, erT-erT kvlevaSi individTa daaxloebiT 25%-s, romelic akmayofilebda opiumis borotad gamoyenebis kriteriums, antisocialuri pirovnuli aSlilobac daudginda (Brooner et al., 1997). miuxedavad imisa, rom pirovnuli aSlilobebi ufro naklebad aris Seswavlili, vidre sxva

635

mel cdis pirTa mSoblebs aReniSnebodaT antisocialuri pirovnuli aSliloba. es monacemebi aSlilobaSi genetikuri faqtoris wvlilis Sefasebis saSualebas iZleoda. mkvlevrebma mimRebi ojaxebis cxovrebis pirobebis, garemoebebis Sesaxebac moipoves informacia: interviuirebis saSualebiT sazRvravdnen, Tu romeli cdis pirebi gaizardnen mimReb mSoblebTan araxelsayrel garemoSi; magaliTad, vis hqonda qorwinebis, iuridiuli, nivTierebebze, an alkoholze damokidebulebis problemebi. es monacemebi antisocialur pirovnul aSlilobaSi garemos wvlilis Sefasebis SesaZleblobas iZleoda. Sedegebma aCvena, rom mniSvnelovani iyo orive tipis zegavlena: aSlilobis mqone biologiuri mSoblebis SvilebTan, an araxelsayrel garemoSi gazrdil cdispirebTan, saSualod, ufro meti iyo antisocialuri pirovnuli aSlilobis albaToba (Cadoret et al., 1995). tipis aSlilobebi, aris monacemebi, romelic am aSlilobebSi genetikuri komponentis arsebobaze miuTiTebs (Livesley et al., 1993; Nigg & Goldsmith, 1994). Tu pirovnuli maxasiaTeblebis Tandayolilobis Sesaxeb msjelobas gavixsenebT me-14 Tavidan, ar unda gagvikvirdes, rom am maxasiaTeblebis mqone aSlilobebic Tandayolilia. arsebobs pirovnuli aSlilobebis gamomwvev garemo pirobebze mimarTuli kvlevebic (Norden et al., 1995; Paris, 1997). ganvixiloT genetikisa da garemos urTierTqmedebebi, romlebic antisocialur pirovnul aSlilobas iwveven.

Tavi 15 / fsiqologiuri aSlilobebi

am Sedegebidan vxedavT, rom antisocialuri pirovnuli aSlilobis ganviTarebis riskis winaSe pirovneba SeiZleba bunebam an aRzrdam, genetikurma an garemos faqtorebma daayenos. amave dros, es aSliloba ar uviTardeboda im adamians, romlis mSoblebsac aReniSnebodaT pirovnuli aSlilobebi, an romelic rTul garemo pirobebSi izrdeboda. mkvlevrebs kvlav surT imis garkveva, Tu ra ganapirobebs zogierTi adamianis mowyvladobasa da zogierTis moqnilobas.

saidan viciT
genetika, garemo da antisocialuri pirovnuli aSliloba mkvlevarTa jgufma Seadgina SerCeva, sadac Sedioda 95 mamakaci da 102 qali, romlebic Svilad aiyvanes dabadebidan ramdenime dReSi. Sesabamis uwyebebSi daculi monacemebi sakmaris informacias iZleoda maTi biologiuri mSoblebis Sesaxeb, amitom mkvlevrebs SeeZloT daedginaT, ro-

disociaciuri aSlilobebi
disociaciuri aSliloba aris identurobis, mexsierebisa da cnobierebis integraciis darRveva. adamianebisTvis mniSvnelovania, rom akontrolebdnen TavianT qcevas, anu emociebs, azrebsa da moqmedebebs. TviTkontrolis aRqmisTvis arsebiTia individualurobis SegrZneba _ me-s (self) sxvadasxva aspeqtebis SeTanxmebuloba (konsistenturoba) da identurobis uwyvetoba drosa da sivrceSi. fsiqologebs miaCniaT, rom disociaciur mdgomareobaSi individebi gaurbian sakuTar konfliqtebs SeTanxmebulobisa da

636

lilobaa, rodesac erT individSi arsebobs ori an meti calkeuli pirovneba. yovel mocemul momentSi erT-erTi maTgani dominanturia da individis qcevas warmarTavs. disociaciuri identobis aSliloba popularul enaze gaxleCili pirovnebis saxeliT aris cnobili da xandaxan mas SecdomiT Sizofreniasac (aSliloba, romelsac Semdeg nawilSi ganvixilavT da vnaxavT, rom am dros pirovneba xSirad uaresdeba, magram ar ixliCeba orad) uwodeben xolme. dia-is SemTxvevaSi TiToeuli warmoqmnili pirovneba raime mniSvnelovani niSniT originaluri me-s (self) sapirispiroa _ maT Soris gansvlas eqneba adgili, Tu sawyisi pirovneba sustia da seqsualurad mimzidveli, maSin erTi pirovneba morcxvi, SeboWili iqneba, meore ki _ mfrTxali da seqsualurad gulubryvilo. TiToeul pirovnebas Taviseburad ganumeorebeli identoba, saxeli da qceviTi repertuari aqvs. zogierT SemTxvevaSi yalibdeba mTeli rigi sxvadasxva maxasiaTeblebisa, romelic pirovnebas rTul cxovrebiseul situaciasTan gamklavebaSi exmareba. qvemoT mocemulia nawyveti dia-is mqone qalis wamyvani~ pirovnebis angariSidan (Mason, 1997, gv.44): rogorc talRebi atrialebs okeanes Signidan gareT da gadaalagebs wyals, sxvadasxva CvenTagani trialebs wreze, modis da midis miqcevasaviT da miedineba zogjer mSvidad, zogjer _ mSfoTvared. bavSvi aferadebs flomasterebiT. igi gverdze iweva da adgils administrators uTmobs, romelic bankis angariSs aTandisociaciuri aSliloba (Dissociative disorder) _ pirovnuli aSliloba, romelsac axasiaTebs identurobis, mexsierebisa da cnobierebis integraciis darRveva. disociaciuri amnezia ( Dissociative amnesia ) _ mniSvnelovani pirovnuli gamocdilebis gaxsenebis unaris arqona, romlis mizezia fsiqologiuri faqtorebi, yovelgvari organuli disfunqciis arsebobis gareSe. disociaciuri identobis aSliloba (dia) (Dissociative identity disorder DID) _ disociaciuri fsiqikuri aSliloba, rodesac erT individSi arsebobs ori an meti calkeuli pirovneba; warsulSi cnobili iyo, rogorc Sedgenili (multiple) pirovnuli aSliloba.

uwyvetobis daTmobis gziT da uaryofen sakuTari Tavis nawilebs. yovelgvari organuli disfunqciis ararsebobis pirobebSi fsiqologiuri faqtorebiT gamowveul process, romelic mniSvnelovani pirovnuli gamocdilebis daviwyebaSi mdgomareobs, disociaciur amnezias uwodeben da is disociaciis erT-erTi magaliTia. fsiqologebma daiwyes monacemebis Segroveba imis Sesaxeb, Tu ra xarisxiT SeiZleba axldes Tan mexsierebis aseTi danawevreba (disociacia) bavSvobaSi seqsualuri da fizikuri Zaladobis SemTxvevebs (Spiegel & Cardena, 1991). mwvave/Rrma travmis sxva tipebi, rogoricaa 1991 wels oklendsa da berkliSi (kaliforniis Stati) momxdari xanZari, romelmac 25 sicocxle Seiwira da milion dolarze meti zarali moitana, aseve iwvevs disociaciis simptomebs (Koopmen et al., 1996). disociaciuri identobis aSliloba (dia) (Dissociative Identity Disorder _ DID), warsulSi cnobili Sedgenili pirovnuli aSliloba (multiple personality disorder), disociaciuri fsiqikuri aS-

fsiqologiuri aSlilobebis ZiriTadi tipebi

637

xmebs. mcire xnis Semdeg mkvdari Cvili iwevs win da umoZraod wevs iatakze. igi droebiT ase rCeba, magram aravis swydeba guli _ es misi droa. cocxali Cvili xoxavs da Cerdeba mtverSi amogangluli. mzareuli sami dRis saWmels amzadebs da TiToeuls calke paketSi alagebs _ Cven yvelas sxvadasxva midrekilebebi, miswrafebebi da antipaTiebi gvaqvs. SeSinebuli me~ xmamaRla yviris, daWrili _ kvnesis, mgloviare _ moTqvams. SegiZliaT Tqveni Tavi daayanoT am qalis adgilze da warmoidginoT, rogori iqneba amdeni pirovnebebis~ _ bavSvis, mkvdari Cvilis, cocxali Cvilis, mzareulisa da a.S. _ erT TavSi moTavseba? zogierT fsiqologs miaCnia, rom disociaciuri aSlilobis mqone pirovnebis Semadgenili pirovnebebis ganviTareba gadarCenis arsebiT funqcias emsaxureba. dia-is msxverpli SeiZleba ecemaT, daemwyvdiaT, an mietovebinaT im adamianebs, visac, savaraudod, uyvarda igi; maT, viszec imdenad iyvnen damokidebulni, rom ar SeeZloT maTTan SebrZoleba, maTgan wasvla da maTi SeZulebac ki. fsiqodinamikuri Tvalsazrisis mixedviT, es msxverplebi danawevrebis (disociaciis) saSualebiT simbolurad gaeqcnen gadatanil saSinelebas. ufro Zlieri Sinagani xasiaTebis SeqmniT maT daicves TavianTi ego arsebuli travmatuli situaciisagan. rogorc wesi, dia-is msxverpls warmoadgenen qalebi, romlebic bavSvobaSi, xangrZlivi periodis ganmavlobaSi fizikurad, an seqsualurad iqnen Zalze Seuracxyofilni mSoblebis, naTesavebis, an axlo megobrebis mier. erT kvlevaSi kiTxvaris saSualebiT mopovebul iqna 448 klinikosis monacemi, romelTac gamocdilebaSi hqondaT disociaciuri identobis aSlilobisa da klinikuri depresiis (gamoiyeneboda Sesadareblad) SemTxvevebze muSaoba. rogorc 15.5 cxrilSia naCvenebi, dia-is 355 SemTxvevaSi wamyvani maxasiaTebelia Seuracxyofa, romelic TiTqmis yvelasaTvis saerToa da romelsac adgili aqvs 3 wlis asakidan da aT welze metxans grZeldeba. miuxedavad imisa, rom 235 depresiul pacientTanac aRiniSneboda Seuracxyofis xSiri SemTxvevebi, es maCvenebeli mniSvnelovnad mcire

cxrili

15.5

Seuracxyofis Sesaxeb gamokiTxvis Sedegebi: disociaciuri identobis aSlilobisa ( DID) da depresiis Sedareba
kiTxvaris debuleba Seuracxyofis SemTxveva tipebi fizikuri seqsualuri fsiqologiuri uaryofa yvela zemoT CamoTvlili erTad fizikuri da seqsualuri 82 86 86 54 47 74 (N=355) 24 25 42 21 6 14 (N=235) DID (%) depresia (%)

98

54

Tavi 15 / fsiqologiuri aSlilobebi

iyo dia-is mqone individTa gamocdilebasTan SedarebiT (Schultz et al., 1989). miuxedavad imisa, rom es monacemebi da zemoT moyvanili pirovnuli angariSebi eWvgareSea, mravali fsiqologi mainc skeptikurad uyurebs dia-is diagnozs (Lilienfeld et al., 1999; Spanos, 1994). ar arsebobs sando monacemebi am aSlilobis gavrcelebis Sesaxeb (DSM-IV-TR, 2000). skeptikosebi xSirad gamoTqvamen masazrebas, rom Terapevtebs, visac swamT~ diais arsebobis, SeuZliaT misi Seqmna _ es Terapevtebi TavianT pacientebTan, xSirad hipnoturi zemoqmedebisas, saTanado kiTxvebis dasmiT biZgs aZleven Semadgenili pirovnebebis warmoqmnas~. sxva fsiqologebs miaCniaT, rom sakmarisi monacemebi arsebobs dia-is diagnozis sasargeblod, romelic aCvenebs, rom is ar aris mxolod gulmodgine Terapevtebis mier Seqmnili produqti (Gleaves, 1996). yvelaze uwyinari daskvna Semdegi SeiZleba iyos: dia-is diagnozis mqone adamianTa jgufSi zogi SemTxveva namdvilia, WerSmaritia maSin, rodesac zogierTi SemTxveva Terapevtisgan aris gaCenili.

Sejameba
SfoTviTi aSlilobebi xuT kategoriad iyofa: generalizebuli SfoTviTi aSliloba, panikuri aSliloba, fobiebi, obsesiur-kompulsuri aSli-

638

fsiqologia XXI saukuneSi

marTla arsebobs Tu ara `internetomania~?

fsiqologiuri aSlilobebis ZiriTadi tipebi

SegimCneviaT, rom imaze met dros atarebT internetSi, vidre unda~ atarebdeT? megobrebTan internetis saSualebiT saubari girCevniaT maTTan piradad urTierTobas? internetze xarjavT dros, romelsac sxva mniSvnelovan saqmianobas unda uTmobdeT, rogoricaa gamocdebisTvis mzadeba an Zili? SeiZleba vTqvaT, rom Tqven damokidebuli (addicted) xarT internetze? ukanaskneli ramdenime wlis manZilze internetomaniis~ sakiTxs didi adgili eTmoba popularul presaSi: es axali istoriebi qmnian (xSir SemTxvevebSi) mozardi vaJis xats, romelic realuri samyaros adamianebTan kontaqtze uars ambobs da chat-oTaxebisa da MUD-is kiber-samyaroSi uCinardeba. zogierT mkvlevars aRmoCenili aqvs realuri SemTxvevebi, romelic Tanxvdeba sainformacio saSualebebSi Seqmnil aseT xats. maT internetomaniis~ diagnozi miusadages (magaliTad, Young, 1998). sxva mkvlevrebi ufro skeptikurni rCebian am diagnozis, rogorc fsiqopaTologiis calkeuli tipis, mimarT. vnaxoT, ratom. rogorc aRvwereT, fsiqopaTologiis TiToeuli tipisaTvis aucilebelia, rom individi aSkarad specifikuri tipis araadaptur qcevebs

axorcielebdes, rogorc aRniSnulia DSM-IV-TR-Si. Tumca, internetze damokidebulobis, internetomaniis~, SemoTavazebuli diagnozis SemTxvevaSi gaugebaria, Tu konkretulad romeli qcevaa araadapturi im qcevaTa Soris, romelsac individi qselSi yofnis dros axorcielebs. erT-erTi mkvlevris sityvebiT: Tu zogierTi adamiani mijaWvulia internetze, mainc razea igi mijaWvuli?~ (Griffiths, 1998, gv.72). gadavxedoT im miznebs, romelsac emsaxureba individebis mier internetis gamoyeneba da mTeli rigi aqtivobebisa, romliTac isini dakavebulni arian xazze yofnisas. magaliTad, adamianebi qselSi Sedian informaciis mosaZieblad, saTamaSod da romantikuli an seqsualuri partniorebis sapovnelad. SeuZliaT ki adamianebs, damokidebulni gaxdnen miznebisa da aqtivobebis erTobliobaze, romelTac interntomaniis~ diagnozs usadageben? Tu arsebobs internetis gamoyenebis ufro specifikuri aspeqtebi, romelic fsiqologiuri Seguebis problemebs iwvevs? Tu es ukanaskneli mosazreba sworia, maSin arsebobs albaToba imisa, rom mocemul individs aRmoaCndeba f s i q i k u r i j a n m r Te l o b i s profesionalebis mier ukve dadgenili ufro specifikuri

diagnozi. magaliTad, rogorc vnaxeT, DSM-IV-TR-Si gansazRvrulia socialuri fobiis kategoria. ufro miwanSewonili iqneboda, rom individisTvis, romelic zRudavs sxva adamianebTan urTierTobas internet-urTierTobis sasargeblod, socialuri fobiis diagnozi dagvesva da ara _ internetomaniis~. adamianebis mier internetis moWarbebulad gamoyenebis gzebi SeiZleba warmoadgendes cnobili aSlilobebis simptomebs, Tumca, TavisTavad internetis Warbad moxmareba ver kvalificirdeba, rogorc aSliloba. unda aRiniSnos, rom Cven ar uarvyofT im faqtis arsebobas, rom adamianTa mcire procenti internets pirovnuli, socialuri da profesiuli cxovrebisTvis saziano gzebiT iyenebs. magaliTad, kvlevebi aCvenebs, rom adamianebi, romlebic intensiurad iyeneben internets, izolirebulad da martosulad grZnoben Tavs (Kraut et al., 1998; Nie & Erbring, 2000). Tumca, risi frTxilad SemoTavazeba da gaazrebac gvsurs, aris mosazreba imis Sesaxeb, rom arsebobs internetis zogadi maxasiaTeblebi, romelic fsiqopaTologiis specifikur formas iwvevs da am fsiqopaTologias samarTlianad uwodeben internetze damokidebulebas _ internetomanias~.

639

640

loba da posttravmatuli stresis aSliloba. generalizebuli SfoTviTi aSliloba qronikuli SfoTviT xasiaTdeba maSin, roca panikuri aSliloba mwvave SfoTvas ukavSirdeba. fobiebs axasiaTebs imdenad Zlieri iracionaluri SiSi, rom isini gansjis unarze zemoqmedeben. obsesiebi arakontrolirebadi, damangreveli azrebia, kompulsiebi ki, aseve, arakontrolirebadi qcevebi. travmatulma movlenebma, rogoricaa gaupatiureba, an Rrma dazianeba, SeiZleba posttravmatuli stresis aSlilobis ganviTareba gamoiwvios. mkvlevrebma aCvenes SfoTvis aSlilobebs, genetikur faqtorebsa da Tavis tvinis paTologiebs Soris kavSiris arseboba. am aSlilobaTa fsiqologiur axsnebSi klasikuri ganpirobebuloba da kognituri tendenciuroba moiazreba. guneba-ganwyobilebis aSlilobebSi Sedis klinikuri depresiuli aSliloba _ fsiqopaTologiis yvelaze gavrcelebuli forma da bipolaruli aSliloba. depresia iwvevs gunebaganwyobilebis, Semecnebisa da motivaciis cvlilebebs. bipolaruli depresiis mqone adamianebi ganicdian depresiisa da maniis periodebis monacvleobas. mkvlevrebma aCvenes, rom gunebaganwyobilebis aSlilobis genetikuri komponenti iseve ukavSirdeba depresiasa da manias, rogorc cvlilebebi Tavis tvinis funqcionirebaSi. depresiis Teoriebi xSirad amaxvileben yuradRebas kognitur interpretaciaze, romelsac adamianebi aZleven TavianT cxovrebiseul gamocdilebas. seriozuli depresiis maRali sixSire qalebSi, SesaZloa, dakavSirebuli iyos qalebisa da mamakacebis mier depresiaze reagirebis gansxvavebul gzebTan. depresiuli individebi sakmaod xSirad fiqroben TviTmkvlelobaze. pirovnuli aSlilobebi azrovnebisa da qcevis araadapturi formebia; isini SeiZleba imdenad Rrma iyos, rom ziani miayenos normalur funqcionirebas socialur da profesiul garemoSi. disociaciuri aSlilobebi identobis mTlianobis darRvevebia. miuxedavad imisa, rom mkvlevrebi disociaciuri identobis aSlilobis mizezad bavSvobaSi gadatanil seqsualur Seuracxyofas miiCneven, aSlilobis gavrcelebuloba sakamaTo rCeba.

Sizofreniuli aSlilobebi
TiToeulma Cvenganma icis, rogoria depresiuloba an SfoTvis gancda maSinac ki, rodesac umravlesobas ar gangvicdia es grZnobebi aSlilobisTvis damaxasiaTebeli simwvaviT. Sizofrenia ki aris aSliloba, romelic normaluri funqcionirebisgan Tvisobrivad gansxvavebul mdgomareobas gulisxmobs. Sizofreniuli aSliloba fsiqopaTologiis mwvave formaa, romlis drosac dezintegrirebulia pirovneba, darRveulia azrovneba da aRqma, gasadavebulia emociebi. Sizofreniuli aSlilobis mqone pirovnebebi swored iseTebi arian, rogorsac yvelaze xSirad warmovidgenT xolme sigiJisa da Seuracxadobis Sesaxeb fiqris dros. SizofreniiT daavadebuli mravali adamianisTvis avadmyofoba cxovrebiseuli ganaCenia ganTavisuflebis SesaZleblobis gareSe, romelsac isini ganmartoebulni da izolirebulni zidaven da iZulebulni arian yvelasgan moSorebiT icxovron. miuxedavad imisa, rom Sizofrenia SedarebiT iSviaTia _ aSS-is mozrdili mosaxleobis daaxloebiT 0.7%-s aReniSneba cxovrebis romelime etapze (Kessler et al., 1994) _ es monacemi gulisxmobs, rom daaxloebiT ori milioni adamiani itanjeba am yvelaze saidumloebiT moculi da tragikuli fsiqikuri aSlilobiT. fsiqiatriuli klinikebis adgilTa naxevari Sizofreniis mqone pacientebs ukaviaT, radganac mravali maTgani Tavisi cxovrebis umetes nawils saavadmyofoSi atarebs, normalur~ cxovrebaSi odesme dabrunebis mcire imediT. mark voneguti (Mark Vonnegut), mweral kurt vonegutis vaJiSvili, 25 wlisac ar iyo, rodesac Sizofreniis simptomebma iCina Tavi. samoTxis eqspresSi~ ( Eden Express, 1975) igi sakuTari gamocdilebidan mogviTxrobs realobidan gasvlisa da saboloo gamojanmrTelebis Sesaxeb. erTxel, xexilis gasxvlisas misma realobam damaxinjeba daiwyo: damainteresa, tkivils xom ar vayenebdi xeebs da mobodiSeba daviwye. TiToeulma maTganma pirovnebis saxe miiRo. damainteresa, romelimes movwondi Tu ara. mTlianad mSTanTqa TiToeuli xis Tvali-

Tavi 15 / fsiqologiuri aSlilobebi

erebam da daviwye SemCneva, rom isini yovelTvis imdenad msubuqad anaTebdnen, rom rbili, Signidan momdinare sinaTlis naTeba totebis irgvliv ifrqveoda; da saidanRac warmoudgenlad danaoWebuli, gardamavalferebiani saxe movida. Tavidan mxolod ganusazRvrel manZilze myof patara wertilad moCanda, igi win moiwevda da bolos uzarmazari gaxda. mis garda veRarafers vxedavdi. guli gamiCerda. dro usasrulod gaiWima. saxis Tavidan moSoreba vcade, magram man damcina... misTvis TvalebSi Sexedva vcade da gavacnobiere, rom fexqveS miwa gamomecala (1975, gv. 96). vonegutis aRwera garkveul warmodgenas SegiqmniT Sizofreniis simptomebze. Sizofreniis samyaroSi azrovneba aralogikuri xdeba; ideaTa Soris asociaciebi Soreuli da yovelgvar sqemas moklebulia. xSirad aRiniSneba halucinaciebi, romelic warmosaxviT sensorul aRqmebs _ xatebs, sunebs an, yvelze xSirad, bgerebs (Cveulebriv, xmebs) moicavs da romelTac pacientebi realurad miiCneven. pirovnebas SeiZleba esmodes xma, romelic uwyvet komentars ukeTebs mis qcevas, an ramdenime xmis saubari; damaxasiaTebelia bodvebic _ cru, an iracionaluri rwmena, romelsac adgili aqvs sawinaaRmdegos naTlad arsebobis pirobebSi. metyveleba SeiZleba araTanmimdevruli gaxdes _ erTmaneTTan daukavSirebeli, an gamogonili sityvebis sityvier salaTas~ daemsgavsos, an individi sulac damunjdes. emociebs gasadaveba axasiaTebs, qreba maTi garegani gamoxatuleba, an SeiZleba situaciis Seusabamo iyos. fsiqomotoruli qceva SeiZleba dezorganizebuli (grimasebi, ucnauri manerebi), poza ki _ rigiduli gaxdes. mxolod zogierTi simptomis arsebobis SemTxvevaSic ki mosalodnelia profesiuli funqcionirebisa da pirovnebaTSorisi urTierTobebis gauareseba, radganac pacienti socialurad gariyuli, an emociurad gulgrili xdeba. fsiqologebi simptomebs dadebiT da uaryofiT kategoriebSi aTavseben. Sizofreniis mwvave anu aqtiuri fazis dros gamokveTilia dadebiTi simptomebi _ halucinaciebi, bodvebi, araTanmimdevruloba da dezorganizebuli qceva, sxva dros ki uaryofiTi simptomebi _ socialuri gariyuloba da gasadavebuli emociebi. zogierT

cxrili

15.6

Sizofreniuli aSlilobis ti pebi


Sizofreniis tipebi dezorganizebuli ZiriTadi simptomebi araadekvaturi/araSesatyvisi qceva da emociebi; araTanmimdevruli metyveleba. gayinuli, rigiduli an iolad agznebadi qceva. grandiozulobis an devnis mania. simptomebTa Sereuli nakrebi azrovnebis aSlilobebiTa da sxva tipis maxasiaTeblebiT. ar aris warmodgenili ZiriTadi simptomebi, Tumca, aRiniSneba aSlilobis ganaxlebis Tanmxlebi, meorexarisxovani simptomebi.

katatoniuri paranoiduli aradiferencirebuli

rezidualuri

individs, rogoricaa, magaliTad, mark voneguti, Sizofreniis mxolod erTi, an ori mwvave faza aReniSneba da Semdeg normalur, Cveul cxovrebas ubrundeba. sxvebs, romelTac xSirad qronikul avadmyofebad miiCneven, axasiaTebT ganmeorebadi mwvave fazebi uaryofiTi simptomebis xanmokle periodebiT an calkeuli mwvave fazebi uaryofiTi simptomebis xangrZlivi periodebiT. yvelaze metad `darRveuli~ individebic ki ar imyofebian mudmivad mwvave bodviT mdgomareobaSi.
fsiqologiuri aSlilobebis ZiriTadi tipebi

Sizofreniis ZiriTadi tipebi


SizofreniisTvis damaxasiaTebeli simptomebis mravalferovnebis gamo, mkvlevrebi mas calkeuli tipebis erTobliobad miiCneven da ara _ erTeul aSlilobad. 15.6 cxrilSi mocemulia Sizofreniis xuTi yvelaze gavrcelebuli qvetipi.
Sizofreniuli aSliloba (Schizophrenic disorder) _ fsiqopaTologiis mwvave forma, romelic xasiaTdeba integrirebuli pirovnuli funqcionirebis rRveviT, realobidan gasvliT, emociuri gaukuRmarTebebiTa da azrovnebis darRveviT. halucinacia (Hallucinations) _ cru, aRqma, romelsac adgili aqvs obieqturi gamRizianeblis ararsebobis pirobebSi. bodva (Delusions) _ cru an iracionaluri rwmena, romelsac adgili aqvs sawinaaRmdegos naTlad arsebobis pirobebSi.

641

dezorganizebuli tipi
Sizofreniis am qvetipis SemTxvevaSi individs araTanmimdevruli azrovneba da moWarbebulad ucnauri da dezorganizebuli qceva axasiaTebs. emociebi gasadavebuli, an situaciis Seusabamoa. xSirad pirovneba sulelurad an bavSvurad iqceva, magaliTad, xiTxiTebs yovelvgari TvalsaCino mizezis gareSe. metyveleba SeiZleba imdenad araTanmimdevruli da uCveulo sityvebiTa da daumTavrebeli winadadebebiT aRsavse gaxdes, rom dairRves sxva adamianebTan komunikacia. Tu adgili aqvs bodvebs an halucinaciebs, isini ar Seexeba gasageb Temas. mister f.b. 30 wels mitanebuli hospitalizebuli fsiqikuri pacienti iyo. rodesac mas saxeli hkiTxes, man upasuxa, rom cdilobda mis daviwyebas, radganac yovelTvis atirebda Tavisi saxelis gagoneba. Semdeg igi ramdenime wuTis ganmavlobaSi gulamoskvniT tiroda. rodesac raime seriozulisa da sevdianis Sesaxeb hkiTxes, mister f.b.-ma xiTxiTi da sicili daiwyo. rodesac hkiTxes mniSvneloba andazisa When the cats away, the mice will play~2, man upasuxa: nakleb adgils ikavebs. katam ar icis, ras akeTebs Tagvi da Tagvma ar icis, ras akeTebs kata. kata ufro saeWvo mxares warmoadgens, vidre Tagvi. dumbo kargi biWi iyo. man dainaxa, rac katam gaakeTa, Tavisi Tavi katasTan daayena, amrigad, xalxi aRar Sexedavda maT, rogorc komediantebs~ (Zimbardo, Personal Communication, 1957). mister f.b-is maneruloba, depersonalizebuli, araTanmimdevruli metyveleba da bodvebi am tipis Sizofreniis ZiriTadi niSnebia.

periodis manZilze da ar/an sustad reagireben garemoSi mimdinare movlenebze. sxva dros es pacientebi moWarbebuli motoruli aqtivobiT xasiaTdebian, romelic aSkarad umiznod da garegani gamRizianeblebis zemoqmedebis gareSe xorcieldeba. katatoniur tips ukiduresi negativizmic axasiaTebs, romelic aSkarad aramotivirebulad ewinaaRmdegeba yvela instruqcias.

paranoiduli tipi
Sizofreniis am tipis mqone adamianebs rTuli da sistematuri bodvebi axasiaTebT, romlebic garkveul Temebzea mimarTuli: devnis bodva. individebi grZnoben, rom maT mudmivad uTvalTvaleben, SeTqmulebas uwyoben da rom maT sicocxles safrTxe emuqreba. grandiozulobis bodva. individebs sjeraT, rom isini mniSvnelovani da amaRlebuli arsebani arian _ milionerebi, didi gamomgoneblebi an religiuri figurebi, rogoricaa, magaliTad, ieso qriste. devnis bodvas SeiZleba grandiozulobis bodva axldes Tan _ individi didi pirovnebaa, magram mas mudmivad ewinaaRmdegebian eSmakeuli Zalebi. eWvianobis bodva. individi yovelgvari mizezis gareSe darwmunebulia, rom megobrebi Ralatoben mas. isini igoneben TavianTi Teoriis Sesatyvis monacemebs da adastureben~ bodvis simarTles. paranoiduli Sizofreniis mqone individebTan simptomebis gamovlena, Sizofreniuli aSlilobis sxva tipebis simptomebTan SedarebiT, cxovrebis ufro gviandel periodSi iwyeba. paranoiduli Sizofreniis mqone individebi iSviaTad axorcieleben aSkarad dezorganizebul qcevas, Tumca, maTi qceva daZabuli da sruliad formaluria.

Tavi 15 / fsiqologiuri aSlilobebi

katatoniuri tipi
Sizofreniis katatoniuri tipis wamyvani maxasiaTebelia motoruli aqtivobis darRveva. xandaxan am aSlilobis mqone adamianebi stuporSi arian gayinulni. individebi umoZraod, xSirad ucnaur pozebSi, rCebian xangrZlivi
2 sityva-sityviTi qarTuli Targmani ase JRers: rodesac kata midis, Tagvebi TamaSoben~; Sinaarsobrivad _ uZaRlo qveyanaSi katebs ayefeben.~ (mTargmnelis SeniSvna)

aradiferencirebuli tipi
Sizofreniis es krebiTi kategoria aRwers pirovnebas, romelsac aReniSneba gamokveTili bodvebi, halucinaciebi, araTanmimdevruli metyveleba, an Zalze dezorganizebuli qceva, rac erTze meti tipis kriteriumebs, an gaurkvevel, bundovan tips Seesabameba. individis mier gancdil simptomTa am nazavSi ar xdeba

642

sxvadasxva Sizofreniuli reaqciebis erTmaneTisgan gamodiferencireba.

gzebis SecnobaSi sxvadasxva midgomebis mier Setanil wvlils.

rezidualuri tipi
rezidualuri tipis diagnozis mqone individebs, Cveulebisamebr, Sizofreniis ZiriTadi ganvlili epizodi awuxebT, Tumca, amasTanave, Tavisufalni arian iseTi ZiriTadi simptomebisgan, rogoricaa halucinaciebi an bodvebi. aSlilobis arseboba Tanmxlebi, meorexarisxovani, dadebiTi an gasadavebuli afeqtis msgavsi uaryofiTi simptomebiT vlindeba. rezidualuri tipis diagnozi SeiZleba miuTiTebdes imaze, rom pirovnebis avadmyofoba remisiis fazaSi Sedis, anu faruli xdeba.

genetikuri midgomebi
didi xania cnobilia, rom Sifozrenias ojaxebSi gavrcelebis tendencia axasiaTebs (Bleuler, 1978; Kallmann, 1946). kvlevis sami damoukidebeli mimarTuleba _ ojaxebis kvleva, tyupebis kvleva da gaSvilebis SemTxvevebis Seswavla _ erTsa da imave daskvnamde midis: Sizofreniis gamovlenis albaToba im individebTan ufro metia, visac genetikuri kavSiri aqvs am aSlilobis mqone adamianTan, vidre maTTan, visac ar aqvs aseTi naTesauri kavSiri (Kendler & Diehl, 1993; Tsuang, 2000). 15.5 suraTze mocemulia sxvadasxva tipis naTesavebisgan Sizofreniis miRebis riskis xarisxis maCveneblebi. es monacemebi Sizofreniis mkvlevarma irving gotesmanma (Irving Gottesman, 1991) dasavleT evropaSi 1920-1987 wlebSi Caratebuli TiTqmis 40 sando kvlevis Sedegebis gaerTianebiT miiRo da maqsimalurad viwro kategoriebSi moaTavsa. rogorc xedavT, monacemebi genetikuri naTesaobis xarisxis mixedviT aris dalagebuli, rac maRal korelaciaSi imyofeba riskis xaris-

Sizofreniis mizezebi
sxvadasxva etiologiuri midgoma Sizofreniis Zalze gansxvavebul sawyis mizezebze, misi ganviTarebis sxvadasxva gzebsa da mkurnalobis sxvadasxva mimarTulebebze miuTiTebs. gadavxedoT Sizofreniuli aSlilobis ganviTarebis

suraTi

15.5
fsiqologiuri aSlilobebis ZiriTadi tipebi

Sizofreniis ganviTarebis genetikuri riski


grafikze naCvenebia Sizofreniis ganviTarebis riskis saSualo maCveneblebi. monacemebi mogrovda ojaxebisa da tyupebis kvlevebiT, romelic evropis mosaxleobaSi ganxorcielda 1920-1987 wlebSi; gamovlinda maRali korelacia riskis xarisxsa da genetikuri naTesaobis xarisxs Soris.

643

xTan. magaliTad, rodesac orive mSobeli daavadebulia SizofreniiT, maT SvilebSi am aSlilobis gamovlenis riski 46%-s udris, mTeli populaciis 1%-Tan SedarebiT. rodesac mxolod erTi mSobelia avad, Svilebis daavadebis riski mkveTrad mcirdeba 13%-mde. aRsaniSnavia, rom albaToba imisa, rom identur tyupebs orives aRmoaCndeba Sizofrenia, daaxloebiT samjer aRemateba araidentur tyupebSi am aSlilobis gamovlenis albaTobas. mkvlevrebi gaSvilebis SemTxvevebis Seswavlasac mimarTaven imis saCveneblad, rom genetikuri faqtorebi mniSvnelovan zegavlenas axdens Sizofreniis etiologiaze (Kety et al., 1994). ganvixiloT kvleva, romelSic fasdeboda Sizofreniis mqone pacientTa biologiur da mimReb naTesavebSi azrovnebis aSlilobebis SemTxvevebis sixSire.

reniuli aSlilobis mqone naSvilebi cdis pirebis biologiurma naTesavebma azrovnebis aSlilobis ufro maRali maCvenebeli miiRes, vidre sakontrolo SerCevis naSvilebi cdis pirebis biologiurma naTesavebma. Tumca, orive SerCevis naSvilebTa naTesavebi ar gansxavdebodnen erTmaneTisgan azrovnebis aSlilobis mixedviT. monacemebi gvafiqrebinebs, rom genetikuri faqtori garemos faqtorze metad miuTiTebs imaze, Tu vis aRmoaCndeba azrovnebis aSlilobebi (Kinney et al., 1997).

saidan viciT
azrovnebis aSlilobebi Sizofreniis mqone pacientTa biologiur da mimReb naTesavebSi am kvlevaSi Sizofreniis mqone iseTi pacientebi aarCies, romelTac aSliloba gaSvilebis Semdeg ganuviTardaT. sakontrolo SerCeva Sizofreniis mqoneTa SerCevas Seesabameboda sqesisa da asakis mixedviT; sakontrolo SerCevaSi Semaval cdis pirebs ar hqondaT fsiqiatriul klinikaSi yofnis gamocdileba. Caweres eqsperimentuli da sakontrolo SerCevebis cdis pirTa da maTi biologiuri naTesavebis metyveleba, genetikis mniSvnelovnebis Sesafaseblad da maTi mimRebi naTesavebis metyveleba, garemos mniSvnelovnobis Sesafaseblad. am verbalur masalaze dayrdnobiT, TiToeul individs (aseve, mSoblebsa da naTesavebs) mieniWa azrovnebis aSlilobis maCvenebeli, risTvisac gamoyenebul iqna azrovnebis aSlilobis indeqsi (Thought Dosirder Index _ TDI). Sedegebi mocemulia 15.7 cxrilSi _ TDI-is yvelaze maRali maCvenebeli metad darRveul azrovnebaze miuTiTebs. Sedegebi aCvenebs, rom Sizof-

TiTqmis yvela naSvilebi individi dabadebidan mcire xnis Semdeg daaSores TavianT biologiur ojaxs. Sesabamisad, rasac ar unda gamoewvia Sizofreniis mqone gaSvilebul individebSi azrovnebis aSlilobis Zalian maRali xarisxi da SedarebiT maRali maCvenebeli maT biologiur naTesavebSi, ver mivakuTvnebT mas garemos faqtorTa rigs. sxvadasxva tipis monacemebi erTiandeba da yalibdeba Semdegi daskvnis saxiT: zogierTi individi Tandayolili, memkvidreobiT miRebuli genetikuri masalis matarebelia, romelic mas Sizofreniis riskis winaSe ayenebs. mkvlevrebi, romelTac surT am paTologiuri genetikuri
cxrili

15.7

Tavi 15 / fsiqologiuri aSlilobebi

azrovnebis darRvevis maCveneblebi Sizofreniis mqone naSvileb individebSi, sakontrolo SerCevis naSvileb individebsa da maT naTesavebSi
azrovnebis darRvevis indeqsi
Sizofreniis mqone naSvilebi individebi sakontrolo SerCevis naSvilebi individebi

gansxvaveba

Tavad naSvilebi individebi maTi biologiuri naTesavebi maTi biologiuri dedmamiSvilebi da naxevrad dedmamiSvilebi maTi mimRebi naTesavebi

4.82 1.37

1.15 0.99

3.67 0.38

1.44 1.11

0.82 1.31

0.62 -0.20

644

sawyisi etapi

SizofrenikTa
Svilebi

N=100

riski

maRali riski N=10-50

aranairi riski N=90-50

fsiqikuri janmrTeloba 30 wlis asakSi

Sizofreniki

N=5

araSizofreniki N=5-45

araSizofreniki N=90-50

fsiqikuri janmrTeloba riskis periodis bolos

Sizofreniki, adreuli dasawyisi N=5

Sizofreniki, gviani dasawyisi N=5

ara Sizofreniki, N=0-40

ara Sizofreniki, N=90-50

suraTi

15.6

Sizofreniuli aSlilobis genetikuri riski


Sizofreniis mqone mSobelTa 100 bavSvisgan Semdgar SerCevaSi 50-dan 10%-s aqvs Sizofreniis ganmapirobebeli genetikuri struqtura. amasTan, daaxloebiT 5%-s cxovrebis sawyis etapze, 5%-s ki Semdgom cxovrebaSi ganuviTarda aSliloba. aRsaniSnavia, rom maRali riskis mqone cdis pirTa 40% ar daavadda SizofreniiT.

masalis gamocalkeveba, emiSebis populaciaSi bipolaruli daavadebis genetikuri wyaroebis kvlevis ganxilvisas aRwerili midgomis msgavs pozicias ikaveben. kvlevis mizania genebis im wilis dadgena, romelic aSlilobis mqone individebs misgan Tavisufali individebisgan ganasxvavebs. mkvlevrebi progress aRweven genTa im kombinaciebis aRmoCenaSi, romelic adamianebs Sizofreniis riskis winaSe ayenebs (Brzustowicz et al., 2000). miuxedavad imisa, rom genetikur msgavsebasa da Sizofreniis risks Soris ueWvelad maRali korelaciaa, yvelaze didi genetikuri msgavsebis jgufebSic ki, risk-faqtori 50%-ze naklebia (ix. sur. 15.6). es imaze metyvelebs, rom genebis rolis garda, garemos pirobebic aucilebelia aSlilobis ganviTarebisaTvis. Sizofreniis mizezis Sesaxeb farTod gavrcelebuli hipoTeza midrekileba-stresis hipoTezis (diathesis-stress

Tavs tvinis funqcionireba da biologiuri maniSneblebi


arsebobs Sizofreniisadmi meore biologiuri midgoma, romelic am aSlilobis mqone individTa Tavis tvinSi arsebuli darRvevebis ZiebiT aris dakavebuli. am mimarTulebiT warmoebul kvlevaTa umravlesoba Tavis tvinis gamosaxvis teqnikebs eyrdnoba (ix. Tavi 3), romelic Sizof-

fsiqologiuri aSlilobebis ZiriTadi tipebi

hypothesis) saxeliT aris cnobili. am hipoTezis Tanaxmad, genetikuri faqtorebi riskis winaSe ayenebs individs, magram maT garemos stresis faqtorebic unda daerTos, raTa potenciurma riskma gamovlenili (manifestirebuli) Sizofreniuli aSlilobis saxe miiRos. ganvixileT ra Sizofreniis biologiuri aspeqtebi, axla am aSlilobis warmoqmnis damaCqarebeli garemos stresorebis tipebze visaubrebT.

645

Tavi 15 / fsiqologiuri aSlilobebi

reniis mqone da sakontrolo SerCevis normaluri individebis Tavis tvinis struqturisa da funqcionirebis uSulod Sedarebis saSualebas iZleva (Gur & Pearlson, 1993; Marsh et al., 1997; Vita et al., 2000). magaliTad, magnituri rezonansis procedura imis saCveneblad gamoiyeneba, rom Sizofreniis mqone individTa 50%-ze mets gadidebuli aqvs parkuWebi _ Tavis tvinis struqturebi, romelSic miedineba cerebrospinaluri siTxe (Degreef et al., 1992). bavSvobaSi gamovlenili Sizofreniis mqone individebTan mozardobis periodSi aRiniSneba parkuWebis zomis progresuli zrda (Rapoport et al., 1997). garda amisa, gamosaxvis teqnikebiT dadgenilia, rom Sizofreniis mqone individebs sakontrolo jgufisgan gansxvavebuli Tavis tvinis aqtivobis paternebi SeiZleba axasiaTebdeT. magaliTad, erT-erT kvlevaSi Seswavlil iqna identuri tyupebis SemTxvevebi, rodesac erT-erTi an orive tyupiscali SizofreniiT iyo daavadebuli (Berman et al., 1992). mxolod im individebs aReniSnebodaT Tavis tvinis Sublis wilebis dabali aqtivoba normasTan SedarebiT, romelTac realurad hqondaT Sizofrenia. kvlevis aseTi sqemiT genetika~ konstantad iqceva, rac am aSlilobis kidev erTi biologiuri aspeqtis gamovlenis saSualebas iZleva. mkvlevrebi agrZeleben Sizofreniis biologiuri maniSneblebis CamonaTvalis Sevsebas.
midrekileba-stresis hipoTeza ( Diathesis-stress hypothesis) _ hipoTeza zogierTi aSlilobis mizezis Sesaxeb, rogoricaa Sizofrenia, romlis mixedviTac, individSi genetikuri faqtorebi qmnian garkveuli aSlilobisadmi midrekilebas, magram garemo pirobebidan momdinare stresulma faqtorebma biZgi unda misces am potencias, raTa gamovlindes.

biologiuri maniSnebeli daavadebis gazomvadi indikatoria, romelic SeiZleba iyos, an arc iyos, mizezobrivi~ (Szymaski et al., gv. 99). sxva sityvebiT rom vTqvaT, biologiuri maniSnebeli SeiZleba korelirebdes daavadebasTan, Tumca, ar iwvevdes mis ganviTarebas. dResdReobiT ar aris cnobili arc erTi maniSnebeli, romelic zustad iwinaswarmetyvelebda Sizofrenias, magram maniSneblebs didi potenciuri Rirebuleba aqvT diagnostirebisa da kvlevisaTvis. magaliTad, Sizofreniis mqone pirovnebebTan ufro metad mosalodnelia vizualuri velis Tvalierebisas Tvalebis moZraobis disfunqciis gamovlena, vidre Cveulebriv adamianebTan. SesaZlebelia am biologiuri maniSneblis raodenobrivi Sefaseba da es Sefaseba ojaxebSi Sizofreniis arsebobas ukavSirdeba (Clementz & Sweeney, 1990; Lencer et al., 2000). mkvlevrebi agrZeleben kvlevas Tvalebis moZraobis im specifikuri elementebis aRmoCenis mimarTulebiT, romelic maqsimalurad zustad ganasxvavebs Sizofreniis mqone individebs sxva fsiqikuri aSlilobebis mqone individebisgan (Katsanis et al., 1997; Sweeney et al., 1994). biologiuri maniSneblebis zusti codna mkvlevrebs am aSlilobis ganviTarebis risk-jgufebis gamovlenaSi daexmareba. Sizofreniis simptomTa farTo speqtrTan gacnobis Semdeg, albaT, aRar gikvirT biologiuri darRvevebis Sesabamisi diapazonis arseboba, romelic SeiZleba Sizofreniis mizezs an Sedegs warmoadgendes. rogor uwyobs xels garemos maxasiaTeblebi risk-jgufSi Semaval adamianebs daavadebis ganviTarebaSi?

646

ojaxuri urTierToba, rogorc stresori


rogorc Znelia imis mtkiceba, rom Zalze specifikuri biologiuri faqtori Sizofreniis sakmarisi mizezia, aseve, ver vityviT gadaWriT, rom fsiqologiuri faqtori aucilebeli pirobaa amisaTvis. sociologebi, ojaxis Terapevtebi da fsiqologebi ikvleven ojaxSi roluri urTierTobebisa da komunikaciis stilis gavlenas Sizofreniis ganviTarebaze. gamokvlevis mizania garemos im pirobebis dadgena, romelic zrdis Sizofreniis albaTobas da risk-jgufSi Semavali individebis dacva am pirobebisgan. mkvlevrebs gaaCniaT im TeoriaTa empiriuli dasabuTeba, romlebic xazs usvams mSoblebis urTierTobaSi gadaxrebis (deviaciebis) zegavlenas Sizofreniis ganviTarebaze (Milkowitz, 1994; Wearden et al., 2000). am gadaxrebSi Sedis ojaxSi saerTo yuradRebis ganawilebis SeuZlebloba; mSoblebis mier ojaxis danarCeni wevrebis mosazrebebis gaTvaliswinebis an gasagebi da zusti komunikaciis sirTuleebi. kvlevebi aCvenebs, rom, im ojaxis metyvelebis paternebi, sadac Sizofreniis mqone wevri cxovrobs, naklebi gulisxmierebiTa da naklebi interpersonaluri mgrZnobelobiT xasiaTdeba, vidre Cveulebrivi ojaxebis. gadauWreli rCeba sakiTxi: devianturi ojaxis struqtura Sizofreniis mizezia, Sizofreniis simptomebis mqone individze reaqciaa, Tu erTic aris da meorec (Rosenfarb et al., 1995)? am kiTxvaze pasuxis gasacemad mkvlevrebi prospeqtul (momavalze orientirebul) kvlevebs axorcieleben:

isini zomaven ojaxis funqcionirebas, raTa naxon, Tu romeli paterni uZRvis win Sizofreniis ganviTarebas, an mis ganmeorebas momavalSi. magaliTad, erT-erTi kvleva Seexeboda pacientTa naTesavebis empaTiis unars, rac maT mier pacientebis guneba-ganwyobilebis mdgomareobis wvdomisa da gagebis SesaZleblobaSi gamoixateboda (Giron & Gomez-Beneyto, 1998). ori wlis Semdeg im pacientebTan ufro meti iyo Sizofreniis simptomTa gameorebis albaToba, romelTa naTesavebsac empaTiis dabali done aReniSnebodaT. am kvlevis Sedegebi Tanxvdeba sxva kvlevebiT miRebul monacemebs, romlis Tanaxmadac, ojaxis faqtori mniSvnelovan rols asrulebs individis funqcionirebaSi simptomebis pirvelad gamoCenis Semdeg.

saidan viciT
emociis gamoxatva da simptomis gameoreba Sizofreniis dros ojaxuri komunikaciis rolis Sesaswavlad, mkvlevrebma gansazRvres cneba emociis gamoxatva. emociis gamoxatvis maRali xarisxis mqoned miiCnevdnen ojaxebs, Tu pacientis mimarT mravlad gamoiTqmeboda kritikuli komentarebi, Tu ojaxis wevrebi Warbad iyvnen CarTulni pacientis cxovrebaSi (vTqvaT, iyvnen zedmetad mzrunvelni da momabezrebelni) da Tu maT zogadad arakeTilganwyobili damokidebuleba hqondaT pacientisadmi. erT kvlevaSi Segrovda monacemebi Sizofreniis mqone 65 pacientis ojaxis Sesaxeb, romlebic SedarebiT stabilur periodebSi saxlSi cxovrobdnen. TiToeuli ojaxi fasdeboda emociis gamoxatvis moculobis mixedviT: rodesac cxra Tvis Semdeg Seafases pacientTa mdgomareoba, emociis gamoxatvis maRali xarisxis mqone ojaxebSi mcxovreb pacientTa 50%-s aReniSneboda ganmeorebiTi simptomatika maSin, roca analogiuri mdgomareoba emociis gamoxatvis dabali xarisxis mqone ojaxebSi mcxovreb pacientTa mxolod 17%Tan dafiqsirda. Tumca, emociis gamoxatvis

647

fsiqologiuri aSlilobebis ZiriTadi tipebi

zogierTi aspeqti sasargeblo aRmoCnda pacientebisaTvis. is pacientebi, romelTa ojaxebic metad iyvnen CarTulni mis cxovrebaSi, cxra Tvis Semdeg socialurad ukeT Seguebulni aRmoCndnen. albaT, rigiduli ojaxuri garemo arTulebs saavadmyofodan gare samyaroSi gasvlas (King & Dixon, 1996).

Tavi 15 / fsiqologiuri aSlilobebi

es kvleva imeorebs zogad models: Svilebis mimarT mSoblebis kritikis, mtruli damokidebulebisa da momabezreblobis SemcirebasTan erTad, Sesabamisad, mcirdeba mwvave Sizofreniuli simptomebis gameorebis sixSire da ganmeorebiTi hospitalizaciis saWiroeba (Wearden et al., 2000). qveteqsti isaa, rom mkurnaloba mimarTul unda iqnes mTel ojaxze, rogorc sistemaze, raTa Seicvalos daavadebuli Svilisadmi damokidebulebis stili. Sizofreniis Cven mier ganxiluli mTeli rigi interpretaciebis da mniSvnelovani kvlevebis miuxedavad Riad darCenili kiTxvebi gviCvenebs, Tu ramdenad bevria kidev Sesaswavli am mZlavri fsiqologiuri aSlilobis Sesaxeb. garTulebul gagebas iwvevs is faqti, rom Sizofreniad wodebuli fenomeni, albaT, ukeTesia ganvixiloT, rogorc aSlilobaTa jgufi, TiToeuli SesaZlo calkeuli mizezebiT. genetikuri midrekileba, Tavis tvinSi mimdinare problemebi da ojaxuri urTierTobebi _ TiToeuli maTgani ganisazRreba, rogorc monawile, sul mcire, zogierT SemTxvevaSi. mkvlevrebs jer kidev gansasazRvri aqvT im elementTa kombinirebis konkretuli gzebi, romelTac Sifozreniis ganviTarebamde mivyavarT.

katatoniuri, paranoiduli, aradiferencirebuli da rezidualuri. arsebobs Sizofreniis genetikurad gadacemis utyuari dasabuTeba. garda amisa, mkvlevrebma am aSlilobasTan SeWiduli Tavis tvinis anomaliebi da sxva biologiuri maniSneblebic aRmoaCines. ojaxuri urTierTobebis garkveulma paternebma, maT Soris emociis gamoxatvam, SeiZleba xeli Seuwyos Sizofreniuli aSlilobis warmoqmnas, mimdinareobas an gameorebas.

fsiqikuri daavadebis daRi (stigma)


winamdebare Tavis erT-erT umniSvnelovanes amocanas fsiqikuri daavadebis, rogorc gasaidumloebulisa da mistikuris, Sesaxeb warmodgenis gabaTileba warmoadgenda. es dagexmarebaT, gaigoT, rom paTologiuri qceva sinamdvileSi sruliad Cveulebrivi da gavrcelebuli movlenaa. fsiqologiuri aSlilobebis mqone adamianebs xSirad devianturis (normidan gadaxrilis) iarliys awebeben; sazogadoeba Zvir sazRaurs moiTxovs maTgan, vinc scildeba misi normis farglebs. Tumca, devianturis iarliyi ar Seesatyviseba arsebul realobas: rodesac aSS-is axalgazrda da Sua asakis mozrdilebis 50%-s cxovrebis manZilze erTxel mainc aReniSneba romelime fsiqiatriuli aSliloba (Kessler et al., 1994). fsiqopaTologia, statistikurad mainc, SedarebiT normis farglebSi Tavsdeba. normalur cxovrebaSi~ fsiqopaTologiis SeWris sixSiris dadgenisda miuxedavad, fsiqologiuri aSlilobebis mqone adamianebs xSirad iseT daRs asvamen, romelsac ar vxvdebiT fizikurad daavadebulTa SemTxvevaSi. daRi (stigma) samarcxvino niSania; fsiqologiur konteqstSi es aris pirovnebisadmi uaryofiTi damokidebulebebis erToblioba, romelic mijnavs mas, rogorc miuRebels (clausen, 1981). gavixsenoT Tavis dasawyisSi citirebuli sityvebi: pacientsa da sazogadoebas ganaTleba sWirdebaT fsiqikuri daavadebis Sesaxeb, radganac adamianebi dagvcinian da arasworad gveqcevian, zogjer arasworadac esmiT Cveni gadamwyvet momentebSi~. sxva gamojanmrTelebuli pacienti wers: _ CemTvis

Sejameba
Sizofreniis simptomebSi Sedis aralogikuri azrovneba, halucinaciebi, bodvebi, araTanmimdevruli metyveleba, gasadavebuli emociebi da dezorganizebuli fsiqomotoruli qceva. arsebobs Sizofreniis xuTi tipi: dezorganizebuli,
daRi (Stigma) _ individze, an jgufze adamianebis uaryofiTi reaqcia garkveuli savaraudo arasrulfasovnebis, an gansxvavebulobis gamo, rac damamcireblad moqmedebs maTze.

648

fsiqikuri daavadebis daRi iseTive damangreveli iyo, rogorc Tavad saavadmyofoSi yofna~. igi cxadad aRwers Tavis pirad gamocdilebas: fsiqikuri daavadebis mizeziT saavadmyofoSi moxvedramde SesaSuri cxovrebiT vcxovrobdi. Cemi albomi savse iyo jildoebiT, premiebiTa da mosawvevebiT... fsiqikuri daavadebis krizisi birTvul afeTqebasaviT iyo Cems cxovrebaSi. yvelaferi, rac manamde vicodi da siamovnebas maniWebda, moulodnelad Seicvala, ucnauri bunebrivi ukuprocesis msgavsad _ mSvenieri peplidan Wuprisken. es iyo nawilobriv arCeulis, nawilobriv _ Tavsmoxveuli Cemi cxovrebis xarisxis Sekaveba, SezRudva, Caketva. mravaljeradma uaryofam, Cems irgvliv arsebuli sxvebis mouqnelobam da Cemma sakuTarma diskomfortma da TviTcnobierebam ganmartoebuli Caketilobisken mibiZga. fsiqikuri daavadebisgan gamojanmrTeleba da misi Sedegebi brZolas moicavda _ brZolas winaaRmdeg Cemi sakuTari sxeulisa, romelic energiisgan daclilad da amtanobas moklebulad gamoiyureboda, da sazogadoebisa, romelic uxalisod miRebda (Houghtin 1980, gv. 7-8). fsiqologiuri darRvevebis mqone adamianebisadmi uaryofiT damokidebulebas mravali wyaro aqvs: masobrivi informaciis saSualebebi fsiqiatriul pacientebs Zaladobis Semcveli danaSaulisken midrekilebas miaweren; miRebulia xumroba fsiqikurad daavadebul adamianebze; ojaxebi uaryofen erT-erTi wevris fsiqikur sirTuleebs; samarTlebrivi terminologia xazs usvams fsiqikur uunarobas. garda amisa, adamianebi Tavad asvamen sakuTar Tavs daRs imiT, rom malaven arsebul fsiqologiur sirTuleebs, an fsiqiatriul klinikaSi yofnis gamocdilebas. mkvlevrebma daadgines mTeli rigi gzebisa, romliTac fsiqikuri daavadebis daRi uaryofiTad zemoqmedebs adamianTa cxovrebaze (Farina et al., 1996; Wright et al., 2000). fsiqikuri daavadebis mizeziT klinikaSi moxvedrili 84 mamakacisgan Semdgar SerCevaSi 6%-ma aRniSna, rom saavadmyofoSi moxvedris gamo dakarga samuSao; 10%-s uari uTxres binis an oTaxis daqiravebaze; 37%-s sxvebi Tavs aridebdnen; 45% aRniSnavda, rom

fsiqikuri daavadebis gamocdilebas sxvebi maTTvis tkivilis misayeneblad iyenebdnen. mxolod 6%-s ar hqonia uaryofis SemTxvevebi (Link et al., 1997). mamakacTa am jgufma mkurnalobis erTwliani kursi gaiara, rasac maTi fsiqikuri janmrTelobis mniSvnelovani gaumjobeseba mohyva, Tumca, wlis bolos ar aRiniSneboda cvlilebebi maT mier daRis aRqmaSi: miuxedavad maTi funqcionirebis gaumjobesebisa, pacientebs ukve aRar hqondaT garemosgan keTilad mopyrobis molodini. am tipis kvlevam aCvena, rom mraval adamians ambivalenturi, gaorebuli damokidebuleba aqvs fsiqikuri aSlilobebisadmi: daxmarebisken swrafva da aSlilobis mqone adamianTa problemebisTvis iarliyis miwebebis daSveba. aseT damokidebulebas Semsubuqebac moaqvs da daRic; mkurnaloba aumjobesebs cxovrebis xarisxs, daRi ki, amave dros, auaresebs mas (Rosenfield, 1997). damatebiT sirTules qmnis is faqti, rom fsiqikuri daavadebis mqone adamianebi xSirad axdenen uaryofis molodinebis internalizacias (gaSinagnebas),3 ramac, Tavis mxriv, SeiZleba uaryofiTi urTierTqmedeba gamoiwvios (Link et al., 1997). ganvixiloT qvemoT aRwerili klasikuri eqsperimenti.

saidan viciT
uaryofis molodini 29 mamakacma, romlebic manamde fsiqikuri daavadebis mizeziT iyvnen klinikaSi moTavsebulni, sakuTari surviliT miiRes monawileoba winamdebare kvlevaSi. maT icodnen, rom kvleva yofil fsiqiatriul pacientebTan samuSaos povnasTan dakavSirebul sirTuleebs exeboda. cdis pirebs acnobes, rom maT saqmiani dawesebulebidan mowveul kadrebis momzadebis specialistTan, trenerTan mouwevdaT urTierToba. cdis pirTa erT naxevars uTxres,
internalizacia _ gaSinagneba da ara _ gaTaviseba, radgan gaTaviseba niSnavs cnobierebis komponentis arsebobas _ adamiani cnobierad iTavisebs informacias, xolo gaSinagneba gulisxmobs iracionaluri komponentis arsebobas, romelic cnobierebis miRma, avtomaturad Semodis.
3

fsiqikuri daavadebis damRa (stigma)

649

rom trenerma icoda maTi statusis (yofili fsiqiatriuli pacientebi) Sesaxeb; meore naxevars ki uTxres, rom treners isini saavadmyofoSi myof samedicino, an qirurgiul pacientebad miaCnda. realurad, treneri~ eqsperimentatoris mokavSire iyo, romelmac araferi icoda imaze, Tu ra icodnen cdis pirebma misi codnis Sesaxeb. amgvarad, man ar icoda, Tu romeli cdis piri fiqrobda, rom mas hqonda informacia maTi eqspacientobis Sesaxeb. Sesabamisad, nebismieri gansxvaveba urTierTobaSi im drois ganmavlobaSi, romelic erTad unda gaetarebinaT cdis pirebsa da eqsperimentatoris asistents, SeiZleboda cdis pirTa molodinebisTvis migvewera. aRmoCnda, rom pacientebi, romelTac sjerodaT, rom eqsfsiqiatriuli pacientebis iarliys atarebdnen, naklebs laparakobdnen sesiis ganmavlobaSi da efeqturad warmoadgines Tavi erToblivi amocanis Sesrulebisas. metic, am jgufis cdis pirebs asistentma ufro daZabuli da mSfoTvare~ uwoda imis codnis gareSe, Tu romel jgufs miekuTvnebodnen isini (Farina et al., 1971).

waikiTxes Sizofreniisgan gankurnebuli jimis Sesaxeb, ufro optimisturad uyurebdnen mis momavals im SemTxvevaSi, rodesac maT ukve hqondaT fsiqikuri aSlilobis mqone individTan urTierTobis gamocdileba (Penn et al., 1999). aseve, studentebis mier Sizofreniis mqone pacientebisgan momdinare safrTxis Sefaseba SedarebiT naklebi iyo, Tu maT gamocdilebaSi hqondaT maTTan urTierToba (Penn et al., 1999). vimedovnebT, rom winamdebare da Semdeg TavTan gacnoba dagexmarebaT Tqveni mosazrebebis (Tu ras niSnavs, iyo fsiqikurad avad da ras niSnavs iyo gankurnebuli~) modifikaciasa da fsiqikurad daavadebuli individebis mimarT tolerantulobisa da TanagrZnobis momatebaSi. fsiqopaTologiasTan gacnobisas Tqven SegeZloT SegeTvisebinaT normis, realobisa da socialuri Rirebulebebis cnebebi. fsiqologiuri aSlilobebis Secnobis, mkurnalobisa da, saukeTeso SemTxvevaSi, profilaqtikis gzebis Ziebisas mkvlevrebi ara marto exmarebian maT, vinc itanjeba am aSlilobebisgan da cxovrebiseuli sixarulis miRma rCeba, aramed afarToeben adamianis bunebis fundamentur gagebas. rogor axdenen fsiqologebi da fsiqiatrebi araswori fsiqikuri procesebis sworad warmarTvas da usargeblo qcevebis Secvlas? amas Terapevtebisadmi miZRvnil Semdeg TavSi vnaxavT.

650

Tavi 15 / fsiqologiuri aSlilobebi

aq mniSvnelovania daskvna, rom adamianebma, romelTac sjeraT, rom sxvebma maT fsiqikuri daavadebis~ iarliyi miawebes, SeiZleba imgvarad Secvalon urTierTqmedeba, rom WeSmariti diskomforti SeeqmnaT _ uaryofis molodinma SeiZleba warmoSvas uaryofa; fsiqikuri daavadeba kidev erT samwuxaro TviTqmnad winaswarmatyvelebad SeiZleba iqces. bolo SeniSnva daRis Sesaxeb: kvlevam aCvena, rom im adamianTa damokidebulebebi, visac warsulSi kontaqti hqonia fsiqikuri daavadebis mqone adamianTan, naklebad ganicdis daRis moqmedebas. magaliTad, studentebi, romlebmac

Sejameba
fsiqikurad daavadebulad wodebuli mravali adamiani itanjeba stigmisgan. stigmam pirovnebaTSorisi da sazogadoebrivi gaucxoebis sxvadasxva forma SeiZleba warmoqmnas. pacientebi mkurnalobis Sedegad fsiqikuri daavadebis Semsubuqebis SemTxvevaSic ki ganicdian stigmis zemoqmedebas. metic, Tavad pacientebis molodinebma maTze sxvebis SesaZlo reaqciebis Taobaze, SeiZleba gamoiwvios is uaryofiTi reaqciebi, risic ase eSiniaT maT.

sakvanZo sakiTxebi
fsiqologiuri aSlilobebis buneba
paTologiebis Sesaxeb daskvna keTdeba im xarisxis mixedviT, ra xarisxiTac pirovnebis moqmedeba Tanxvdeba indikatorTa erTo b l i o b a s , r o m e l S i c Sedis distresi, araadekveturoba, araracionaluroba, araprognozirebadoba, araSablonuroba, damkvirveblis diskomforti da socialuri normebis standartebis darRveva. adreul periodSi fsiqikurad daavadebul adamianebs xSirad epyrobodnen, rogorc demonebiT Sepyrobilebs, an arasrulfasovan, adamianze dabla mdgom arsebebs. fsiqikuri daavadebisadmi Tanamedrove midgomebis warmoqmna daiwyo imis gacnobierebiT, rom fsiqikuri aSlilobebi avadmyofobaa, romelic mkurnalobas saWiroebs. arsebobs mTeli rigi midgomebisa, romelic fsiqopaTologiis etiologias ikvlevs. biologiuri midgoma Tavis tvinis paTologiebze, bioqimiur procesebsa da genetikur zegavlenaze fokusirdeba. fsiqologiur midgomebSi moiazreba fsiqodinamikuri, bihevioraluri, kognituri da sociokulturuli modelebi. sistema fsiqopaTologiisa da specifikuri SemTxvevebis zogadi tipebis Sesaxeb komunikaciis saerTo, sayovelTaod miRebul parametrebs ( common shorthand) unda uzrunvelyofdes. yvelaze farTod miRebul sadiagnostiko da saklasifikacio sistemas DSM-IV-TR warmoadgens. DSM-IV-TR xuTRerZian mravalganzomilebian sistemas iyenebs, rac exmareba fsiqikuri janmrTelobis profesionalebs im fsiqologiuri, fizikuri da socialuri faqtorebis ganxilvisas, romelic SesaZloa romelime konkretul aSlilobas Seesabamebodes. da qcevis xangrZliv da xist paternebs, romelic auaresebs individis funqcionirebas. disociaciuri aSlilobebi gulisxmobs pirovnuli identobis, mexsierebisa da cnobierebis integralurad funqcionirebis darRvevas.

Sizofreniuli aSlilobebi
Sizofrenia fsiqopaTologiis mwvave formaa, romelic xasiaTdeba aRqmis, emociebis, qcevisa da metyvelebis ukiduresi darRveviT. arsebobs Sizofreniis xuTi qvetipi, esenia: dezorganizebuli, katatoniuri, paranoiduli, aradife ren cirebuli da rezidualuri. Sizofreniis savaraudo mizezebi, damamtkicebeli sabuTebi aRmoCenilia sxvadasxva faqtorebSi, maT Soris aris genetikuri, Tavis tvinis paTologiebi da ojaxuri procesebi.

fsiqologiuri aSlilobebis ZiriTadi tipebi


SfoTviTi aSlilobebis xuTi ZiriTadi tipi arsebobs, esenia: generalizebuli, panikuri, fobiuri, obsesiur-kompulsuri da posttravmaturi stresis aSliloba. guneba-ganwyobilebis aS lilobebSi moiazreba emociis darRvevebi. yvelaze gavrcelebul afeqtur aSlilobas klinikuri depresiuli aSliloba warmoadgens maSin, roca bipolaruli aSliloba gacilebiT iSviaTia. s u ici di y v elaz e xSir ia depresiis mqone adamianebSi. biologiuri da fsiqologiuri axsna SfoTviTi da gunebaganwyobilebis aSlilobebis etiologiis sxvadasxva aspeqts ganixilavs. pirovnuli aSlilobebi warmoadgens aRqmis, azrovnebisa

fsiqikuri daavadebis daRi


fsiqologiuri aSlilobis mqone adamianebs xSirad iseT iarliyebs awebeben, ro melsac ar vxvdebiT fizikurad daavadebuli adamianebis SemTxvevaSi. miuxedavad imisa, rom fsiqologiuri aSlilobebis mkurnalobas dadebiT cvlilebebamde mivyavarT, fsiqikur daavadebasTan dakavSirebuli daRi cxovrebis xarisxze uaryofiT gavlenas axdens.

fsiqologiuri aSlilobebis klasifikacia


fsiqologiuri aSlilobebis saklasifikacio

sakvanZo sakiTxebi

651

ZiriTadi cnebebi
agorafobia bipolaruli aSliloba bodva generalizebuli SfoTviTi aSliloba guneba-ganwyobilebis aSliloba daswavlili umweoba disociaciuri amnezia disociaciuri aSliloba disociaciuri identobis aSliloba

DSM-IV-TR etiologia klinikuri depresiuli aSliloba komorbidi maniakaluri epizodi midrekileba-stresis hipoTeza nevrotuli aSliloba obsesiur-kompulsuri aSliloba paTofsiqologia panikuri aSliloba pirovnuli aSliloba

posttravmatuli stresis aSliloba stigma (daRi) fsiqoturi aSliloba fsiqologiuri diagnozi fsiqopaTologiuri funqcionireba fobia Seuracxadoba Sizofreniuli aSliloba SiSi SfoTviTi aSliloba socialuri fobia specifikuri fobiebi halucinaciebi

652 652

Tavi 15 / fsiqologiuri aSlilobebi

pirovnebis cvlilebebis Terapiebi

16
Terapiuli konteqsti

miznebi da ZiriTadi Terapiebi Terapevtebi da Terapiuli garemo istoriuli da kulturuli konteqsti


fsiqodinamikuri Terapiebi

froidis fsiqoanalizi neofroidianuli Terapiebi


fsiqologia Cvens cxovrebaSi: sdevs Tu ara gandevnili mogonebebi adamians mTeli cxovrebis manZilze bihevioraluri Terapia

kontrganpirobeba pirobiTi ganmamtkiceblebis marTva socialuri daswavlis Terapia generalizaciis teqnikebi


kognituri Terapiebi

kognitur-bihevioraluri modifikacia mcdari warmodgenebis Secvla


fsiqologia XXI saukuneSi: Terapia kompiuteris saukuneSi egzistencialur-humanisturi Terapiebi

klientze centrirebuli Terapia geStalt-Terapia


jgufuri Terapiebi

ojaxuri wyvilebisa da ojaxis Terapia sazogadoebrivi mxardaWeris jgufebi


biosamedicino Terapiebi

fsiqoqirurgia da eleqtrokonvulsiuri Terapia farmakoTerapia


ramdenad muSaobs Terapia

Terapiis Sedegianobis Sefaseba mkurnalobis Sefaseba prevenciis strategiebi


sakvanZo sakiTxebi

ZiriTadi cnebebi

653

vtobiografiaSi mxeci~ treisi tomsoni (1995) aRwers 25 wlian brZolas depresiasTan. am nawyvetSi tomsoni aRwers Tavis adreul urTierTobas qalTan, romelsac sxvisi rCeviT mimarTa daxmarebisTvis. is fsiqoTerapevti iyo. me mas amanda meihiud movixsenieb. Cven erTad unda gagvetarebina Semdgomi aTi weliwadis umetesi nawili. amanda iyo saSualo asakis, masiuri, gemovnebiT Cacmuli, gawonasworebuli qali. misi kilo, romelic Cems gamocdil smenas ar gamoparvia, maRal sazogadoebaSi aRzrdaze an, sul cota, samxreTul daxvewilobaze mianiSnebda. misi ofisi atlantis feSenebelur nawilSi, baqhedSi mdebareobda. pirvel Sexvedraze SevTanxmdiT, rom Semxvdeboda kviraSi erTxel, oTxSabaTobiT, saaTSi ormocdaTxuTmeti dolaris safasurad. amanda Wkviani da kompetenturi qali Canda, romelsac SeeZlo CemTvis daxmarebis gaweva. magram, rogorc Tavad miTxra, Terapia ar iqneboda advili da oridan xuT wlamde

Tavi 16 / pirovnebis cvlilebebis Terapiebi

intensiuri muSaoba dagvWirdeboda. orixuTi weli CemTvis patimrobis tolfasi iyo. dasawyisSi, 1977 wlis zamTarSi, masTan yovelkvireuli seansebi Cemi stabilurobis saSualeba iyo, radgan vicodi, rom Cems qaotur azrebs mousmendnen da seriozulad aRiqvamdnen. gasul gazafxuls dawyebulma depresiam nel-nela iklo. gazafxulisTvis Tavs vgrZnobdi ukeTesad ara bednierad, magram TviTmkvlelobasTan dakavSirebuli fiqrebi aRar mawuxebda. axla vfiqrob, rom Terapia realurad amuSavda. Tumca, rodesac Zlierma krizisma gadaiara, seansebi deda-Svilis xangrZliv brZolas daemsgavsa. amandasTan SemeZlo xmis amaRleba, rasac ver vaxerxebdi dedasTan. saxlSi arasodes vyofilvar Cem nebaze; dedaCems imdenad esaWiroeboda simSvide da usafrTxoeba, rom mozardisTvis Cveuli gasarTobebi _ lawiraki biWebi, Cum-Cumad kanafis moweva, uxeSi, uxamsi musika _ anadgurebda mas, dedaCemi amandam Caanacvla... amandas imisTvis uxdida dedaCemi fuls, rom CemTvis gaeZlo. es Taviseburad SesaniSnavi sistema iyo _ erTgvari pasiuragresiuli janyi (gv. 62-65).

654

am nawyvetSi mocemulia pirovnuli cvlilebebis Terapiis mravali TvalsaCino maxasiaTebeli. umniSvnelovanesia, rom, tomsonis TqmiT, man fsiqoTerapiuli kursis Sedegad Tavi ukeT igrZno, Tumca, es ar iyo myisieri Sedegi. tomsonis depresia imdenad damangreveli iyo, rom mas uwyveti mkurnaloba esaWiroeboda. aseve, monaTxrobidan Cans, rom Terapiuli urTier-

Tobebi pirovnuli urTierTobebia. amandas, fsiqoTerapevts, hqonda garkveuli Tvisebebi, romlebic dasawyisSi dadebiTad moqmedebda tomsonis fsiqikur janmrTelobaze, magram Terapiis msvlelobisas, amave Tvisebebma igi tomsonis dedis `Semcvlelad~ aqcia. winamdebare TavSi SevexebiT TiToeul dasaxelebul Temas. ganvixilavT Terapiis tipebs, rom-

lebic pirovnuli kontrolis aRdgenaSi exmareba mTeli rigi aSlilobebis mqone adamianebs. davsvamT mravlismomcvel kiTxvebs: ra gavlenas axdens istoriuli, kulturuli da socialuri Zalebi fsiqologiuri aSlilobebis mkurnalobaze? rogor urTierTmoqmedebs erTmaneTTan Teoria, kvleva da praqtika, rodesac mkvlevrebi qmnian da amowmeben mkurnalobis meTodebs? rogor vimoqmedoT racionalurobas moklebul gonebaze, rogor SevcvaloT arakontrolirebadi qceva da emociebi, rogor gamovasworoT tvinis anomaliebi? winamdebare TavSi ganxilulia Terapiis ZiriTadi tipebi, romelsac iyeneben janmrTelobis dacvis sferoSi dakavebuli Tanamedrove profesionalebi. esenia fsiqoanalizi, qcevis modifikacia, kognituri cvlilebebi, humanisturi Terapia da farmakoTerapia. Cven ganvixilavT am meTodebis moqmedebis principebs. garda amisa, SevafasebT, Tu ramdenad sandoa TiToeuli saxis Terapiis warmatebulobis Sesaxeb mtkicebulebebi.

3. problemis Semdgomi ganviTarebis prognozireba, anu Sefaseba mkurnalobis SemTxvevaSi da mkurnalobis gareSe. 4. mkurnalobis garkveuli formebis SerCeva da ganxorcieleba, romliTac SesaZlebeli gaxdeba Semawuxebeli simptomebis Semcireba an gaqroba da, Tu moxerxda, maTi mizezebis mospobac. Tu tvins kompiuters SevadarebT, SeiZleba iTqvas, rom fsiqikuri problemebi Tavs iCens an hardware-Si, an _ software-Si, romelic aprogramebs mis funqcionirebas. fsiqikuri aSlilobebis mkurnalobis ori ZiriTadi tipi mimarTulia an erTze, an _ meoreze. biosamedicino Terapiebi fokusirdeba hardware-is, anu im meqanizmebis Secvlaze, romelic safuZvlad udevs centraluri nervuli sistemis moqmedebas. mas farTod iyeneben fsiqiatrebi da eqimebi, rodesac tvinis funqcionirebis Secvlas cdiloben qimiuri an fizikuri intervenciebiT; aq Sedis qirurgia, eleqtroSoki da medikamentebi, romlebic uSualod zemoqmedebs tvini-sxeulis kavSirze. fsiqologiuri Terapiebi, romelTac erTad fsiqoTerapias uwodeben, software-is Secvlazea orientirebuli; misi samiznea adamianebis mier mcdarad daswavlili sityvebi, azrebi, interpretaciebi da ukukavSiri, romelic ganapirobebs yoveldRiuri cxovrebis strategiebs. am Terapiebs axorcieleben rogorc klinikuri fsiqologebi, ise _ fsiqiatrebi. arsebobs fsiqoTerapiis oTxi ZiriTadi saxe: fsiqodinamikuri, bihevioraluri, kognituri da egzistencialurhumanisturi. fsiqodinamikuri midgoma nevrotul tanjvas Sinagani, dauZleveli travmis an konfliqtis
biosamedicino Terapiebi (Biomedical therapies) _ fsiqologiuri aSlilobebis mkurnaloba, romelic cvlis tvinis funqcionirebas qimiuri, an fizikuri Carevis gziT, rogoricaa medikamentebiT mkurnaloba, qirurgia, an eleqtrokonvulsiuri Terapia. fsiqoTerapia (Psychotherapy) _ TerapiaTa jgufidan nebismieri, romelic gamoiyeneba fsiqologiuri aSlilobebis samkurnalod da fokusirebulia konkretul aSlilobasTan dakavSirebuli araswori qcevis, azrebis, aRqmebisa da emociebis Secvlaze.

Terapiuli konteqsti
fsiqikuri aSlilobebis samkurnalod mravalgvari Terapia arsebobs. mravali mizezis gamo iTxovs zogierTi adamiani (da zogic, saWiroebis miuxedavad, ar iTxovs) daxmarebas. aseve, sxvadasxvagvaria Terapiis miznebi, is garemo, sadac Terapia xorcieldeba da Tavad Terapevtebic, Tumca, pirovnebis cxovrebaSi nebismieri aseTi Careva mowodebulia misi funqcionirebis garkveuli mimarTulebiT Sesacvlelad.

Terapiuli procesi SeiZleba moicavdes oTx ZiriTad Temas an mizans: 1. problemuri momentebis diagnostireba, arsebuli problemisTvis, savaraudod, saTanado fsiqiatriuli (DSM-IV-TR) kategoriis gansazRvra da aSlilobis klasificireba. 2. savaraudo etiologiis dasaxeleba aSlilobis SesaZlo mizezebis da simptomTa funqciebis identificireba.

Terapiuli konteqsti

miznebi da ZiriTadi Terapiebi

655

Tavi 16 / pirovnebis cvlilebebis Terapiebi

garegan simptomad miiCnevs. fsiqodinamikosi Terapevtebi fsiqikur aSlilobebs ganmakurnebeli saubriT~ mkurnaloben, romlis drosac Terapevti exmareba pirovnebas, rom man dainaxos kavSiri TvalsaCino simptomebsa da maT SesaZlo gamomwvev gadauWrel dafarul konfliqtebs Soris. bihevioraluri Terapia Tavad qcevas mkurnalobs, rogorc darRvevas, romelic unda Seicvalos. aSlilobebi ganixileba, rogorc daswavlili qceviTi paternebi da ara, rogorc fsiqikuri daavadebis simptomebi. qceva SeiZleba Seicvalos sxvadasxva gziT, maT Soris, sasurveli da arasasurveli reaqciebis ganmamtkiceblebis SecvliT, gamomuSavebuli reaqciebis CaqrobiT da problemis efeqturad gadaWris modelebis uzrunvelyofiT. kognituri Terapia cdilobs adamianis azrovnebis nakadis restruqturizacias, rasac problemis mizezis Sesaxeb pirovnebis mier Seqmnili, xSirad damangreveli TviTdamarwmunebeli debulebebis SecvliT aRwevs. restruqturirebuli kogniciebi, Tavis mxriv, cvlis pirovnebis midgomas siZneleebis gansazRvrisa da axsnisadmi, rac xSirad problemebis daZlevis SesaZleblobas iZleva. egzistencialur-humanistur tradiciebze aRmocenebuli Terapiebi pacientis faseulobebze koncentrirdebian da mimarTulni arian TviTaqtualizaciisaken, fsiqologiuri zrdisaken, ufro Sinaarsiani pirovnebaTSorisi urTierTobebis ganviTarebisaken. isini arsebiTad janmrTeli adamianebis funqcionirebis gaumjobesebaze ufro fokusirdebian, vidre seriozuli darRvevebis mqone individTa simptomebis koregirebaze.

Terapevtebi da Terapiuli garemo


rodesac fsiqologiuri problemebi Cndeba, adamianTa umetesoba nacnob wreebSi eZebs araformalur konsultantebs. es SeiZleba iyos ojaxis wevri, uaxloesi megobari, piradi eqimi, advokati, sayvareli maswavlebeli, xelmZRvaneloba an sabWo. religiuri orientaciis adamianisTvis es SeiZleba iyos sasuliero piri. sxvebi rCevisTvis mimarTaven da esaubrebian

barmenebs, gamyidvelebs, taqsis mZRolebsa da nebismiers, vinc mousmens maT. sazogadoebaSi arsebuli araformaluri Terapevtebis mxrebze mravali frustracia da konfliqti gadadis. rodesac problemaTa diapazoni SemosazRvrulia, araprofesionalTa daxmareba sakmaod didia. miuxedavad imisa, rom dResdReobiT adamianebi ufro xSirad mimarTaven Terapias, vidre adre, isini, Cveulebriv, mxolod maSin akiTxaven fsiqikuri janmrTelobis specialistebs, rodesac fsiqologiuri problemebi mwvavdeba, an droSi xangrZlivdeba. am dros maT sxvadasxva saxis TerapevtTan SeuZliaT misvla. fsiqolog-konsultants, Cveulebriv, iseT sferoebSi uwevs adamianebis megzuroba, rogoricaa profesiis arCeva, skolis problemebi, narkotikebix moxmareba da ojaxuri konfliqti. xSirad es konsultantebi konkretul problemebTan dakavSirebul garemoSi _ biznesis sferoSi, skolebSi, cixeebSi, samxedroTa momsaxurebis centrebSi, an raionul klinikebSi muSaoben. isini iyeneben intervius, testebs da iZlevian rCevebs, raTa daexmaron adamianebs konkretuli problemebis gadaWrasa da arsebuli sirTuleebis daZlevaSi. klinikuri socialuri muSaki fsiqikuri janmrTelobis specialistia, romelsac socialuri muSaobis skola amzadebs da mowodebulia fsiqiatrebTan da klinikur fsiqologebTan TanamSromlobisTvis. mravali fsiqiatrisa da fsiqologisgan gansxvavebiT, am konsultantebs naswavli aqvT adamianTa problemebis socialuri konteqstis gaTvaliswineba da amitom SeuZliaT Terapiis procesSi ojaxis wevrebis CarTva an, sul mcire, klientis ojaxur Tu samuSao garemosTan gacnoba. RvTismsaxuri-konsultanti religiuri jgufis wevria, romelic fsiqologiuri aSlilobebis mkurnalobaSi specializirdeba. xSirad
fsiqolog-konsultanti (Counseling psychologist) _ fsiqologi, romelic specializirdeba iseT sferoebSi, rogoricaa profesiis arCeva, saskolo problemebi, narkotikebis moxmareba da ojaxuri konfliqti. klinikuri socialuri muSaki (Clinical social worker) specialuri programiT momzadebuli fsiqikuri janmrTelobis profesionali, romelic adamianTa problemebs socialur konteqstSi ganixilavs.

656

arsebobs doqtoris ori saxis xarisxi: (1) Ph.D _ filosofiur mecnierebaTa doqtori; eniWeba nebismieri profesiis adamians, romelic akmayofilebs saTanado kriteriumebs; (2) magaliTad, M.D. _ xarisxi, romelic eniWeba romelime konkretuli specialobis mqone adamians, romelic aris Tavisi saqmis profesionali da akmayofilebs saTanado kriteriumebs; am SemTxvevaSi medicinis mecnierebaTa doqtori (mTargmnelis SeniSvna).

klienti (Client) termini gamoiyeneba im pirovnebis aRsaniSnad, romlis mimarTac xorcieldeba Terapiuli RonisZiebebi. mas iyeneben specialistebi, romlebic fsiqologiur aSlilobebs `cxovrebiseul problemebad~ miiCneven da ara fsiqikur daavadebad.

Terapiuli konteqsti

es konsultantebi sulierebaze zrunvas problemaTa praqtikul gadawyvetasTan aerTianeben. klinikuri fsiqologi aris specialisti, romelic universitetSi specializirdeba fsiqologiuri problemebis Sefasebasa da mkurnalobaSi; klinikis pirobebSi, superviziis CaTvliT, gavlili unda hqondes internatura da unda hqondes filosofiur an fsiqologiur mecnierebaTa doqtoris1 akademiuri xarisxi. am fsiqologebs gacilebiT farTo codna aqvT fsiqologiaSi, testirebasa da kvlevaSi, vidre fsiqiatrebs. fsiqiatri aris specialisti, romelsac miRebuli unda hqondes medicinis doqtoris akademiuri xarisxisTvis saWiro sruli samedicino ganaTleba da, aseve, doqtoranturis dasrulebis Semdeg gavlili unda hqondes specializacia fsiqikur da emociur aSlilobebSi. fsiqoanalitikosi aris medicinis an filosofiur mecnierebaTa doqtoris akademiuri xarisxis mqone Terapevti, romelic doqtoranturaSi fsiqikuri aSlilobebis gagebisa da mkurnalobisadmi froidiseul midgomaSi specializirdeboda. CamoTvlili specialistebi sxvadasxva garemoSi muSaoben. es SeiZleba iyos saavadmyofoebi, klinikebi, skolebi da kerZo ofisebi. humanisturi orientaciis zogierTi Terapevti, ufro bunebriv garemoSi muSaobis mizniT, sakuTar saxlSi amjobinebs jgufuri seansebis Catarebas. TerapiebisTvis, romelic klientis garemocvis CarTvasac gulisxmobs mkurnalobis procesSi, SeiZleba gamoiyos iseTi adgilebi, rogoricaa calke Sesasvlelis mqone oTaxebi, an samlocvelo saxlebi. dabolos, Terapevtebi, romlebic klientebTan in vivo TerapiiT muSaoben, arsebul problemebTan asocirebul garemoSi amjobineben muSaobas. magaliTad, klientebTan, romelTac frenis eSiniaT, TviTmfrinavSi muSaoben, sociofobiis mqone klientebTan ki _ xalxmraval savaWro centrebSi.

Terapiaze mosul adamians, rogorc wesi, klients, an pacients uwodeben. termins pacienti is specialistebi iyeneben, romlebic fsiqologiuri problemebis mkuralobas biosamedicino kuTxiT udgebian, termins klienti ki _ isini, vinc fsiqologiur aSlilobebs cxovrebiseul problemebad~ miiCneven da ara fsiqikur daavadebad. Cven TiToeuli midgomis ganxilvisas misTvis damaxasiaTebel termins gamoviyenebT: pacients biosamedicino da fsiqoanalituri TerapiebisTvis da klients _ sxva danarCenisTvis. vidre Tanamedrove Terapiebsa da Terapevtebze ufro dawvrilebiT SevCerdebodeT, jer ganvixiloT fsiqikurad daavadebulTa mkurnalobis
RvTismsaxuri-konsultanti (Pastoral counselor) religiuri fenis warmomadgeneli, romelic specializirdeba fsiqologiuri aSlilobebis mkurnalobaSi da xSirad sulierebaze zrunvas problemaTa praqtikul gadawyvetasTan aerTianebs. klinikuri fsiqologi (Clinical psychologist) pirovneba, romelsac miRebuli aqvs doqtoris xarisxi fsiqologiaSi da specializirdeba fsiqologiuri problemebis Sefasebasa da mkurnalobaSi. fsiqiatri (Psychiatrist) pirovneba, romelsac aqvs medicinis doqtoris xarisxi da doqtoranturis dasrulebis Semdeg gavlili aqvs specializacia fsiqikur da emociur aSlilobebSi. fsiqologiuri aSlilobebis samkurnalod fsiqiatrs SeuZlia medikamentebis daniSvna. fsiqoanalitikosi (Psychoanalyst) _ pirovneba, romelsac aqvs medicinis an filosofiur mecnierebaTa doqtoris xarisxi da romelic doqtoranturaSi specializirdeboda fsiqikuri aSlilobebis gagebisa da mkurnalobisadmi froidiseul midgomaSi. pacienti (Patient) termini gamoiyeneba im pirovnebis aRsaniSnad, romlis mimarTac xorcieldeba Terapiuli RonisZiebebi. mas iyeneben specialistebi, romlebic fsiqologiuri problemebis mkuralobas biosamedicino kuTxiT udgebian.

657

ganviTarebis istoriuli pirobebi, Semdeg gavafarTovoT dasavluri kulturisTvis damaxasiaTebeli xedvis kuTxe da sxva kulturebSi miRebul mkurnalobis praqtikasac gavecnoT.

istoriuli da kulturuli konteqsti


rogor gimkurnalebdnen gasul saukuneebSi, Tu fsiqologiuri problemebi SegeqmnebodaT? Tu evropasa, an aSS-Si icxovrebdiT, metad mosalodneli iqneboda, rom mkurnaloba uSedego yofiliyo, Tumca, arc gavnebdaT rames. sxva kulturebSi fsiqologiuri aSlilobebis mkurnaloba, Cveulebisamebr, religiur da socialur faseulobaTa ufro farTo konteqstSi ganixileboda da ufro adamianur mopyrobasac imsaxurebda.

dasavluri mkurnalobis istoria


XIV saukunis dasavleT evropaSi mosaxleobis zrdam da migraciam umuSevroba da socialuri gaucxoeba gamoiwvia, rasac, Tavis mxriv, siRaribe, danaSauli da fsiqologiuri problemebi mohyva. maleve gaixsna specialuri dawesebulebebi, sadac sazogadoebis sami axali usargeblo~ kategoriis _ RaribTa, damnaSaveTa da fsiqikurad daavadebulTa _ warmomadgenlebs aTavsebdnen. 1403 wels londonis beTlemis wminda mariamis hospitalma fsiqologiuri problemebis mqone pirveli pacienti miiRo. momdevno 300 wlis manZilze sulierad daavadebul pacientebs jaWvebiT abamdnen, awamebdnen da garkveuli sazRauris fasad xalxs gasarTobadac uCvenebdnen. droTa ganmavlobaSi beTlemis transformirebuli dasaxeleba bedlemi~2 qaosis sinonimad iqca, hospitalSi gamefebuli saSineli uwesrigobisa da pacientebisadmi araadamianuri mopyrobis gamo (Foucault, 1975). fsiqologiuri problemebisadmi, rogorc fsiqikuri daavadebebisadmi, damokidebuleba evropaSi mxolod XVIII saukunis bolosTvis gaCnda. 1801 wels frangi eqimi filip pineli (Philippe Pinel) werda: fsiqikurad daavadebuli adamianebi, romlebic ar arian damnaSaveni da
2

658

badlam inglisurad ,,bad~ _ `cudi~.

ar imsaxureben sasjels, avadmyofebi arian, romelTa samwuxaro mdgomareoba yvelanair zrunvasa da yuradRebas imsaxurebs, romelic nebismier tanjul adamianur arsebas ekuTvnis. unda vecadoT, rom maT umartivesi saSualebebiT davubrunoT saRi goneba~ (Zilboorg & Henry, 1941, gv. 233-324). amerikis SeerTebul StatebSi fsiqologiuri darRvevebis mqone adamianebs, maTive da sazogadoebis usafrTxoebis mizniT, izolaciaSi amyofebdnen, Tumca, ar mkurnalobdnen. XIX saukunis Sua wlebSi, rodesac fsiqologiam, rogorc mecnierebis dargma, garkveuli ndoba da pativiscema moipova, qveyanaSi mkurnalobis kulti~ gaCnda. im periodSi Seuracxadobas garemodan momdinare stresis Sedegad miiCnevdnen, rasac axlad ganviTarebadi qalaqebis aurzaursa da areulobas ukavSirebdnen. Sesabamisad, sigiJes socialur problemad aRiqvamdnen, romelsac iseve esaWiroeboda fsiqikuri higieniT~ (Mental Hygiene) mkurnaloba, rogorc gadamdeb fizikur daavadebas _ fizikuri higieniT.

Tavi 16 / pirovnebis cvlilebebis Terapiebi

1900-ian wlebSi kliford birsma (Clifford Beers) dasabami misca fsiqikuri higienis moZraobas. droTa ganmavlobaSi fsiqikurad daavadebul pacientTa SezRudvas axali sareabilitacio mizani gamouCnda. suliT avadmyofTa TavSesafrebi am socialur-politikuri moZraobis ZiriTad elementad iqca. maT aTavsebdnen soflad, qalaquri cxovrebis stresisgan moSorebiT mowyobil aseT TavSesafrebSi ara marto dacvis, aramed mkurnalobis mizniTac (Rothman, 1971). samwuxarod, mravali aseTi TavSesafari maleve gadaiWeda. reabilitaciis humanuri mizani ucnauri adamianebis daSorebul adgilebSi moTavsebiT Seicvala. es uzarmazari fsiqiatriuli dawesebulebebi, arasakmarisi odenobis momsaxure personaliT, mcirediT Tu gansxvavdeboda darRvevebis mqone individebisTvis gankuTvnili konteinerisgan (Scull, 1993). 1960-iani wlebidan reformatorebma aseTi TavSesafrebis winaaRmdeg daiwyes gamosvla, sul mcire, im fsiqiatriuli pacientebis deinstitucionalizaciis sasargeblod, visac ambulatoriuli mkurnalobisa da saTanado sazogadoebrivi mxardaWeris pirobebSi normalurad SeeZloT funqcionireba. samwuxarod, mravali deinstitucionalizebuli anu fsiqiatriuli klinikidan gawerili pacienti ver iRebs saTanado daxmarebas Tavis sacxovrebel adgilze. magaliTad, gamokvlevebma aCvena, rom seriozuli fsiqikuri daavadebis mqone 438 individidan 24% usaxlkaro iyo (Kuno et al., 2000).

kulturuli simboloebi da gankurnebis rituali


fsiqologiuri aSlilobebis mkurnalobis istoriuli tendenciebis mimoxilva dasavluri mosazrebebiTa da praqtikebiT Semoifargleboda, romelic xazs usvams individis unikalurobas, damoukideblobas da warmatebasa Tu warumateblobaze pirovnul pasuxismgeblobas. demonologia da daavadebis modeli igive aqcents akeTebs da fsiqikur aSlilobas ganixilavs, rogorc pirovnebis SigniT mimdinare process da individis marcxs. mravali sxva kultura ar iziarebs am mosazrebas (Triandis, 1995). anTropologebma gaaanalizes fsiqologiuri aSlilobebis axsnebi da mkurnalobisadmi midgomebi sxvadasxva kulturaSi (Bourguignon, 1979; Evans-Pritchard, 1937;

Samanizmi (Shamanizm) spiritualuri tradicia, romelic moiazrebs mkurnalobas da sulier samyarosTan kontaqts.

Terapiuli konteqsti

Kluckhohn, 1944; Marsella, 1979). magaliTad, afrikul msoflmxedvelobaSi aqcenti keTdeba TanamSromlobaze, urTierTdamokidebulebaze, tomis gadarCenaze, bunebasTan erTianobasa da jgufur pasuxismgeblobaze (Nobles, 1976). fsiqikurad daavadebuli adamianebis sazogadoebidan CamoSorebiT mkurnaloba ewinaaRmdegeba mravali araevropuli kulturis azrovnebas. mraval afrikul kulturaSi gankurneba socialur konteqstSi xorcieldeba; procesSi CarTulia daavadebulis rwmena, ojaxi, samuSao da Cveuli garemo. Terapiis procesSi jgufuri mxardaWeris gamoyenebis afrikuli praqtika daixvewa da qselur Terapiad~ wodebul procedurad Camoyalibda, sadac mkurnalobaSi CarTulia pacientis mTliani garemocva _ naTesavebis, TanamSromlebisa da megobrebis CaTvliT (Lambo, 1978). bevr kulturaSi fsiqikuri da fizikuri daavadebebis mkurnaloba religiasa da jadoqrobas ukavSirdeba. gansakuTrebuli adamianebi, romelTac Samanebs uwodeben, gansakuTrebul mistikur Zalas floben TavianTi daavadebuli TanamoZmeebisTvis daxmarebis gasawevad. Samanizmi uZvelesi da mZlavri spiritualuri tradiciaa, romelic TiTqmis 30 aTasi wlis manZilze gamoiyeneba. Samanistur tradiciaSi tanjvasa da avadmyofobas uZlurebis Sedegad miiCneven. kulturuli rwmenis es sistema bedisweris, an iRblis im uxilavi Zalebis personalizacias axdens, romelic zemoqmedebs individis cxovrebaze da problemebs uqmnis mas. aseTi personalizacia borot Zalebze uSualo zemoqmedebis da savaraudo saswaulmoqmedi mkurnalis mxridan daxmarebis saSualebas iZleva (Middleton, 1967). xSirad paTologiuri mdgomareoba, romelsac daavadebuli adamianis Sepyrobilobis Sedegad miiCneven, mkurnali Samanis Terapiuli CareviT icvleba. Zrwolvis gamosawvevad da cnobierebis mdgomareobis Sesacvlelad dolebze dakvra, Selocvebi da sxva ritualebi gamoiyeneba, rac axali codnisa da Zalis Ziebisken mimarTavs individs (Wash, 1990). xalxuri gankurnebis ceremoniebSi mniSvnelovani funqcia ekisreba simboloebs, miTebsa

659

Tavi 16 / pirovnebis cvlilebebis Terapiebi

da ritualebs (Levi-Strauss, 1963). ritualuri gankurnebis ceremonia gankurnebis process gansakuTrebul emociur intensiobasa da mniSvnelobas sZens. is aZlierebs pacientis STagonebadobas da mniSvnelovnebis gancdas, SeSlilobis dasamarcxeblad zebunebriv ZalebTan akavSirebs daavadebul adamians, Samansa da Tems (Devereux, 1961). erT-erT Terapiul teqnikas, romelsac gankurnebis mraval ceremoniaSi iyeneben, cnobierebis disociacia ewodeba. am dros daavadebuli adamiani, an morwmune mkurnali cnobierebis Secvlil mdgomareobaSi gadadis. dasavluri TvalsazrisiT, disociacia TavisTavad aris fsiqikuri aSlilobis simptomi, romelic prevencias, an gamosworebas saWiroebs. sxva kulturebSi ki cnobierebis Secvlil mdgomareobaSi keTili sulebi esaubreba adamians da boroti ganidevneba. cnobierebis ritualuri Secvla niu iorkis puertorikeli espiritistas~ (Espiritistas) kultis RvTismsaxurebisas gamoiyeneba. maT gankurnebis ceremoniaSi Sedis adamianis miRma arsebul keTil sulebTan urTierToba (Garrison, 1977). miuxedavad imisa, rom Samanebi da sxva mkurnalebi gansakuTrebul rols asruleben gankurnebis ritualebSi, makurnebeli Zala xSirad scildeba erT konkretul mkurnals da gacilebiT did spiritualur Zalebs uerTdeba (Katz, 1982, 1993). fijize gavrcelebuli gankurnebis meTodebis aRwerisas fsiqologi riCard kaci (Richard Katz) wers: sulebTan kavSiri im Zalebisadmi damyolobas moiTxovs, romelic scildeba erT konkretul mkurnals da gankurnebaSi mkurnalis wvlilis Tavmdablur Sefasebas moiazrebs. fijeli mkurnali ar amtkicebs, rom Tavad flobs manas (Temis winaprebisgan miRebul sulier Zalas) da mis makurnebel moqmedebas ar aRiqvams sakuTar damsaxurebad~ (gv. 327-328). kaci naTlad gvaCvenebs TvalsaCino sxvaobas aRwerilsa da dasavlur praqtikas Soris: dasavlel eqims ki, piriqiT, pretenzia aqvs mkurnalobisa da gankurnebis kontrolze. komritualuri mkurnaloba (Ritual healing) ceremonia, romelic mkurnalobis process gansakuTrebul emociurobasa da mniSvnelobas sZens.

petenturobas, anu imis codnas, Tu ra aris gasakeTebeli, an, ukidures SemTxvevaSi, sakuTari ucodinarobis ardanaxvas, ufro meti mniSvneloba eniWeba, vidre adamianis bunebriv mowyvladobas daavadebisadmi~ (gv. 28). zogierTi es aradasavluri midgoma gzas ikvlevs dasavluri mkurnalobis praqtikaSi (Katz, 1982, 1983). amis naTeli magaliTebia im uaxles Terapiul midgomebSi socialur garemosTan urTierTqmedebis koncefciis gavlena da ojaxur garemosa da mxardamWer garemocvaze mimarTuloba, romlebic xazs usvamen sazogadoebrivi mxardaWeris sistemisa da ojaxuri Terapiis mniSvnelovnebas. sxva dasavleli praqtikosebi SamanebTan erTad muSaoben, raTa SesaZlebeli gaxdes dasavluri fsiqoTerapiisa (romelSic TviTanalizi moiazreba) da koleqtivisturi sazogadoebebis Terapiebis (romelic individs arsebul sazogadoebriv konteqstSi moazrebs) integrireba. es mcdeloba Terapias, kulturuli TvalsazrisiT, klientTa ufro farTo speqtrisTvis xdis misaRebs (Kraut, 1990). istoriuli tendenciebisa da zogierTi kulturuli variaciis mokle mimoxilvis Semdeg, ufro dawvrilebiT ganvixiloT Tanamedrove praqtikaSi gamoyebuli Terapiebi.

Sejameba
Terapiuli garemos mTavari mizania fsiqikuri daavadebis mizezebis gansazRvra da mkurnalobis dagegmva. arsebobs biologiuri da fsiqologiuri mimarTulebis Terapiebi. Terapevtebi bevrgan muSaoben da sxvadasxva saxis Terapiul meTodebs iyeneben. dasavlur kulturaSi fsiqikurad daavadebul adamianebs, Tavdapirvelad, sazogadoebisgan izolirebulad amyofebdnen. fsiqikuri daavadebis, rogorc gankurnebadi avadmyofobis, modelis ganviTarebas ufro adamianuri mkurnalobis meTodebis Seqmna mohyva. mravali aradasavluri kultura xazs usvams farTo sazogadoebriv da spiritualur konteqsts, sadac viTardeba da ikurneba fsiqikuri daavadeba. dasavleli praqtikosebi am sxva kulturebidan TandaTanobiT iTviseben sazogadoebrivi mkurnalobis zogierT models.

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fsiqodinamikuri Terapiebi
fsiqodinamikuri Terapiebis SemTxvevaSi uSveben, rom pacientis problemebs aracnobier impulsebsa da cxovrebiseuli situaciebidan momdinare SezRudvebs Soris warmoqmnili daZabuloba warmoSobs, aSlilobis birTvsa da saTaveebs ki Tavad daavadebul pirovnebaSi eZieben.

froidis fsiqoanalizi
fsiqoanalizi im saxiT, rogoric Seqmna zigmund froidma ( Sigmund Freud ), warmoadgens intensiur da droSi gaxangrZlivebul Terapiul teqnikas, romelic ikvlevs nevrotuli da mSfoTvare pirovnebis aracnobier motivebsa da konfliqtebs. rogorc wina TavebSi vnaxeT, froidis Teoriis mixedviT, SfoTviTi aSlilobebi im Sinagani konfliqtebis adekvaturad mogvarebis unaris arqonas warmoadgens, romelic warmoiqmneba idis aracnobier, iracionalur impulsebsa da superegos internalizirebul (anu gaSinagnebul) socialur moTxovnebs Soris. fsiqoanalizis mizania intrafsiqikuri harmoniis damyareba, rac idis Zalebis metad gacnobierebas, superegos moTxovnebisadmi zedmetad damyolobis Semcirebasa da egos rolis gaZlierebas gulisxmobs. TerapevtisTvis umniSvnelovanesia, gaarkvios, rogor iyenebs pacienti represiis, anu gandevnis process konfliqtebTan gamklavebisas. simptomi ganixileba, rogorc aracnobieridan wamosuli Setyobineba imis Sesaxeb, rom raRac ar aris wesrigSi. fsiqoanalitikosis amocanaa, daexmaros pacients gandevnili azrebis cnobierebaSi amotanaSi da aRmoaCeninos3 arsebul simptomebsa da gandevnil konfliqtebs Soris arsebuli kavSiri. fsiqodinamikuri TvalsazrisiT, Terapia warmatebulia, pacienti ki _ gamojanmTelebuli mxolod maSin, rodesac igi adreul bavSvobaSi
3 aq originalur teqstSi gamoyenebulia sityva insight, romelic wvdomas~ da intuicias~ niSnavs. es termini Targmanis gareSec xSirad gamoiyeneba amave konteqstSi (magaliTad, emociuri insaiti~ an inteleqtualuri insaiti~) Tumca, am konkretul SemTxvevaSi umjobesad CaiTvala misi Targmna (mTargmnelis SeniSvna).

ganxorcielebuli gandevnisgan gaTavisufldeba~. vinaidan Terapevtis ZiriTadi mizani pacientisTvis im kavSiris danaxvisken, anu insaitisken wayvanaa, romelic awmyoSi arsebul simptomebsa da warsul gamocdilebas Soris arsebobs, fsiqodinamikur Terapias xSirad insaitur Terapiasac uwodeben. tradiciuli fsiqoanalizi didi xnis win gandevnili (anu daviwyebuli) mogonebebis aRdgenisa da mtkivneuli grZnobebis gavliT efeqtur gadawyvetamde misvlis mcdelobaa. Sesabamisad, es aris droSi gaxangrZlivebuli, anu grZelvadiani Terapia (romelic SeiZleba, sul mcire, ramdenime weliwadi _ kviraSi xuT seansamde _ grZeldebodes). garda amisa, is saWiroebs kargi metyvelebis mqone introspeqciul pacientebs, romlebic sakmarisad Zlierad arian motivirebulni TerapiisTvis da SeuZliaT soliduri Tanxis gadaxda (fsiqodinamikuri Terapiis SedarebiT gviandel formebSi gacilebiT Semoklebulia Terapiuli procesis xangrZlivoba.) gandevnili konfliqtebis gacnobierebasa da maT mogvarebaSi pacientisTvis daxmarebis gasawevad fsiqodinamikuri tradiciebiT momuSave Terapevtebi sxvadasxva teqnikebs iyeneben; esenia: Tavisufali asociaciebi, winaaRmdegobis analizi, sizmrebis analizi, gadatanisa da kontrgadatanis analizi.

Tavisufali asociaciebis meTodi da kaTarzisi


ZiriTad meTods, romelic fsiqoanalizSi gamoiyeneba aracnobieris gamokvlevisa da gandevnili masalis gamonTavisuflebisTvis, Tavisufali asociaciebis meTodi ewodeba. pacienti, romelic moxerxebulad zis skamze, an
fsiqodinamikuri Terapiebi

fsiqoanalizi (Psychoanalysis) fsiqodinamikuri Terapia, romelic Seqmna froidma; es aris intesiuri da droSi gaxangrZlivebuli teqnika, romelic mowodebulia nevrotuli da mSfoTvare individebis aracnobieri motivebisa da konfliqtebis gamosakvlevad. insaituri Terapia (Insight Therapy) teqnika, romliTac Terapevts pacienti mihyavs im kavSiris danaxvisken, aRmoCenisken anu insaitisken, romelic awmyoSi arsebul simptomebsa da warsul gamocdilebas Soris arsebobs.

661

debulebas ukavSirdeba. saboloo jamSi, rodesac gandevnili masala zedapirze amodis, pacienti, rogorc wesi, amtkicebs, rom is umniSvnelo, absurduli, araSesatyvisi, an Zalze arasasiamovnoa imisaTvis, rom ilaparakos masze. Terapevti ki sruliad sapirispiros fiqrobs. fsiqoanalizis mizania, daZlios winaaRmdegoba da pacients misces SesaZlebloba, Tvali gausworos am mtkivneul azrebs, survilebsa Tu gamocdilebas.

sizmris analizi
fsiqoanalitikosebs miaCniaT, rom sizmari pacientis aracnobieri motivebis Sesaxeb informaciis mniSvnelovan wyaros warmoadgens. rodesac adamians sZinavs, superego SedarebiT naklebad akontrolebs ididan momdinare miuRebel impulsebs, amitom motivebi, romelTa gamoxatvac ver xerxdeba cxadSi, SeiZleba sizmris saxiT gamovlindes. fsiqoanalizis mixedviT, sizmars ori saxis Sinaarsi aqvs: manifesturi, anu xiluli Sinaarsi, romelic gaRviZebis Semdeg axsovs adamians da latenturi, anu faruli Sinaarsi _ realuri motivebi, romlebic gamovlenas cdiloben, Tumca, imdenad mtkivneuli da miuRebelia, rom damaxinjebulad, simboloebis saxiT gamoixateba. Terapevti am dafaruli motivebis gamovlenas sizmris analiziT cdilobs; es aris Terapiuli meTodi, romelic gulisxmobs pirovnebis sizmris Sinaarsis garCevas da miznad isaxavs safuZvlad mdebare an damaxinjebuli motivebis, mniSvnelovani cxovrebiseuli gamocdilebisa da survilebis simboluri mniSvnelobebis gamovlenas.
Tavisufali asociacia (Free association) Terapiuli meTodi, rodesac pacienti uwyvetad, gaazrebis gareSe saubrobs sakuTar azrebze, survilebze, fizikur SegrZnebebsa da warmodgenebze. kaTarzisi (Catharsis) Zlieri, magram, rogorc wesi, gandevnili emociebis gamoxatvis procesi. winaaRmdegoba (Resistance) fsiqoanalizis msvlelobisas pacients ar surs, an ar SeuZlia garkveul mosazrebebze, survilebsa Tu gamocdilebaze saubari. sizmrebis analizi (Dream analysis) sizmrebis fsiqoanalituri interpretacia, riTac xdeba pacientis aracnobieri motivebisa da konfliqtebis wvdoma.

Tavi 16 / pirovnebis cvlilebebis Terapiebi

wevs taxtze, SeZlebisdagvarad aTavisuflebs gonebas da uwyvetad aRwers sakuTar azrebs, survilebs, fizikur SegrZnebebsa da warmodgenebs. pacients sTxoven, rom aRweros TavSi mosuli nebismieri azri Tu grZnoba, ganurCevlad imisa, Tu ramdenad mniSvnelovnad eCveneba is mas. froids miaCnda, rom asociaciebi ganpirobebulia da ar aris SemTxveviTi. analitikosis amocanaa, Tvali gaadevnos maT da ubralo sityvebis miRma nagulisxmevi realuri mniSvnelobebi dainaxos. pacients Zlieri grZnobebis gamoxatvis saSualeba eZleva, romelic, rogorc wesi, avtoritetul figurebzea mimarTuli da romelic gandevnil iqna dasjis, an samagieros mizRvis SiSiT. nebismier emociur ganmuxtvas, romelic xdeba Terapiul garemoSi aman sxva procesis Sedegad, kaTarzisi ewodeba.

winaaRmdegoba
fsiqoanalitikosi gansakuTrebul mniSvnelobas aniWebs sakiTxebs, romelTa ganxilvac ar surs pacients. Tavisufali asociaciebis dros garkveul momentSi pacienti avlens winaaRmdegobas, anu mas ar surs, an ar SeuZlia garkveul mosazrebebze, survilebsa Tu gamocdilebaze saubari. aseT winaaRmdegobas aracnobiersa da cnobiers Soris barierad miiCneven. es masala (anu masala, romelsac barieri akavebs da ar amodis Tavisuflad asociacirebis dros) xSirad individis seqsualur cxovrebas (aq Sedis yvelaferi, rac mas siamovnebas aniWebs) an mSoblebisadmi mtrul, ganawyenebul damoki-

662

gadatana da kontrgadatana
fsiqoanalituri Terapiis intensiuri kursis dros pacients, rogorc wesi, Terapevtis mimarT emociuri reaqcia uyalibdeba. xSirad xdeba Terapevtis identificireba warsulSi gadatanili emociuri konfliqtis centralur figurasTan _ umeteswilad, mSobelTan, an seqsualur partniorTan. am emociur reaqcias gadatana, anu transferi ewodeba. gavixsenoT nawyveti treisi tomsonisa da misi Terapevtis, amandas urTierTobis Sesaxeb _ is naTlad axdenda mis identificirebas dedasTan (dedaCemi amandam Caanacvla...~). gadatanas ewodeba dadebiTi, rodesac Terapevti siyvarulis, an aRtacebis obieqti xdeba; gadatana aris uaryofiTi, rodesac igi mtruli damokidebulebis, an Suris obieqtad iqceva. xSirad xdeba, rom pacientis damokidebuleba ambivalenturia da dadebiTi da uaryofiTi emociebis nazavs warmoadgens. gadatanasTan gamklaveba rTuli amocanaa analitikosisTvis, Tundac, pacientis emociuri mowyvladobis gamo. miuxedavad amisa, es aris mkurnalobis arsebiTi da mniSvnelovani nawili. warsulis gamocdilebasa da damokidebulebebSi realuri wyaros moZiebiTa da gacnobierebiT, Terapevti pacients masze gadatanili grZnobebis interpretirebaSi exmareba (Henry et al., 1994). pacientze Terapevtis reaqciaSic CarTulia piradi grZnobebi. kontrgadatana, anu kontrtransferi Seexeba imas, Tu ra xdeba, rodesac Terapevts moswons, an ar moswons pacienti, radgan pacienti mis cxovrebaSi mniSvnelovani figuris msgavsad aRiqmeba. kontrgadatanis damuSavebisas Terapevti SeiZleba sakuTari aracnobieri mamoZravebeli Zalebis gacnobierebamde mivides. igi pacientis cocxal sarked~ iqceva, pacienti ki, Tavis mxriv, misTvis iZens amave funqcias. Tu Terapevti ver axerxebs kontrgadatanis efeqtis gacnobierebas, Terapia SeiZleba warumatebeli gamodges (Winarick, 1997). am saxis Terapiuli urTierTobis emociurad datvirTulobisa da pacientis mowyvladobis gamo, Terapevtma mkacrad unda daicvas zRvari, romelic pacientze profesiul zrunvasa da mis problemebSi pirad CarTulobas Soris gadis. cxadia, rom Terapiulma situaciam iolad SeiZleba daarRvios balansi, rac unda gaacnobieros da gaiTvaliswinos Terapevtma.

neofroidianuli Terapiebi
froidis mimdevrebma SeinarCunes misi mravali ZiriTadi idea, Tumca, zogierTma principma da praqtikulma meTodma modificieba ganicada. zogadad, neofroidistebi, froidTan SedarebiT, ufro met aqcents akeTeben: (1) pacientis awmyo socialur garemoze (da naklebad fokusirdebian warsulze); (2) cxovrebiseuli gamocdilebis mimdinare gavlenaze (da ara mxolod bavSvobis konfliqtebze); (3) socialuri motivaciis rolsa da pirovnebaTSoris sasiyvarulo urTierTobebze (da naklebad fokusirdebian biologiur instinqtebsa da egoistur moTxovnilebebze ); (4) egos funqcionirebis mniSvnelovnebaze da me-koncefciis ganviTarebaze (da nakleb yuradRebas aqceven idsa da superegos Soris konfliqts). me-14 TavSi vaxseneT ori cnobili neofroidisti _ karl gustav iungi da alfred adleri. SedarebiT Tanamedrove fsiqodinamikur neofroidianul mosazrebebzec rom Segveqmnas warmodgena, gavecnoT hari stek salivanis, melani kleinisa da hainc kohutis Sromebs (froidis wris sxva wevrebis Sesaxeb ix. Ruitenbeek, 1973). hari stek salivans (Harry Stack Sullivan, 1953) miaCnia, rom froidis Teoriasa da TerapiaSi ar aris gaTvaliswinebuli socialuri urTierTobebis roli da miRebis, pativiscemisa da siyvarulis moTxovnilebebi. misi azriT, fsiqikuri aSlilobebi moicavs ara marto travmatul intrafsiqikur procesebs, aramed _ problemur interpersonalur urTierTobebsa da Zlier socialur zewolasac ki. patara bavSvs usafrTxoebis grZnoba da sxvebis mxridan zrunva da siTbo esaWiroeba. SfoTva da sxva fsiqikuri daavadebebi mSoblebTan da mniSvnelovan sxvebTan urTierTobebSi usafrTxoebis ararsebobidan momdinareobs. salivanis azriT, sakuTar
gadatana (Transference) procesi, rodesac fsiqoanalizis msvlelobisas pacienti Terapevtze mimarTavs im grZnobebs, romelic Tavdapirvelad warsuli emociuri konfliqtis centralur, mniSvnelovan figuraze miemarTeboda. kontrgadatana (Countertransference) situacia, rodesac fsiqoanalitikoss pirovnuli grZnobebi uCndeba pacientis mimarT, radgan pacients sakuTar cxovrebaSi arsebuli mniSvnelovani adamianis msgavsad aRiqvams.

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fsiqodinamikuri Terapiebi

fsiqologia Cvens saukuneSi

sdevs Tu ara gandevnili mogonebebi adamians mTeli cxovrebis manZilze


1969 wlis 22 seqtembers, CrdiloeT kaliforniaSi, rva wlis suzan neisoni gauCinarda. amave wlis dekemberSi ipoves misi gvami. oci wlis manZilze aravin icoda, vin mokla igi. 1989 wels mxaris gamomZieblebs suzanis megobari eilin franklin-lipskeri daukavSirda. eilinma uTxra maT, rom fsiqoTerapiis daxmarebiT, man aRidgina didi xnis win gandevnili, daviwyebuli saSineli mogonebebi imis Sesaxeb, Tu ra SeemTxva suzans. 1990 wlis Semodgomaze eilinma daadastura, rom oci wlis win man sakuTari TvaliT naxa, rogor gaaupatiura suzani misma mamam, jorj franklinma da Semdeg sikvdilamde rogor urtya qvis keti (Marcus, 1980, Workman, 1990). eilinma isic Tqva, rom mama mokvliT daemuqra, Tu vinmes uambobda nanaxis Sesaxeb. es Cveneba sakmarisi aRmoCnda imisaTvis, rom jorj franklini damnaSaved ecnoT damamZimebel viTarebaSi Cadenil mkvlelobaSi. Teoriulad Tu vimsjelebT, rogor daifara mogonebebi 20 wlis manZilze? am kiTxvaze pasuxi gandevnili mogonebebis froidiseul koncefciaSi iRebs saTaves. rogorc aRvniSneT, froidi (1923) fiqrobda, rom adamianis cxovrebiseuli gamocdilebis zogierTi mogoneba sakmaris safrTxes uqmnis mis keTildReobas, amitom es mogonebebi ganidevneba cnobierebidan. klinikur fsiqologebs xSirad SeuZliaT, rom daexmaron klients sakuTari cxovrebis gakontrolebaSi. amisaTvis cxovrebis damangreveli paternebi interpretirdeba, rogorc gandevnili mogonebebis Sedegi. Terapiis mniSvnelovan mizans am gandevnil mogonebebiTan mimarTebaSi kaTarzisis miRweva warmoadgens. magram gandevnili mogonebebi yovelTvis ar rCeba Terapevtis kabinetSi. ukanaskneli wlebis manZilze masmediaSi intensiurad saubroben gandevnili mogonebebis STambeWdavi gacnobierebis SemTxvevebze. drois xangrZlivi periodis gasvlis Semdeg individebi moulodnelad detalurad ixseneben SemaZrwunebel movlenebs, rogoricaa mkvlelobebi, an bavSobaSi gadatanili seqsualuri Zaladoba. SesaZlebelia, rom es yvelaferi marTali iyos? me-8 TavSi ganxiluli mowmeTa mexsierebis kvleva skepticizmis safuZvels iZleva (Loftus, 1993; Loftus & Ketcham, 1994, Lynn & Payne, 1997). xsenebuli kvlevidan SegviZlia gavixsenoT, rom adamianebi WeSmarit mogonebebad miiCnevdnen xelovnuri wyarodan miRebul informacias. es maSinac xdeboda, rodesac maT, rogorc mowmeebs, afrTxilebdnen, rom isini SecdomaSi Seiyvanes. Sesabamisad, mogonebis arseboba TavisTavad ar iZleva misi wyaros ueWveli sandoobis mtkicebis safuZvels. faqtobrivad, ukanasknel wlebSi, popularul mediaSi gandevnili mogonebebis Sesaxeb xSiri saubari SeiZleba Tavad iqces xelovnul wyarod~. televiziiT nanaxi individis pirovnul mogonebad SeiZleba iqces, Tu mas aRar axsovs, rom es televizorSi naxa. amrigad, gandevnili mogonebis mediaSi mosmenilma daxasiaTebam zogierTi individi igive mogonebebis gaxsenebamde~ SeiZleba miiyvanos. individma, praqtikulad, dakarga mogonebis wyaro, magram SeinarCuna Sinaarsi (Johnson et al., 1993). fsiqoTerapevtebma, romelTac sjeraT gandevnili mogonebebis, fsiqoTerapiis meqanizmebis saSualebiT, SeiZleba isini Caunergon kidec pacients ( de Rivera, 2000; Sarbin, 1997 ) . magaliTad, mkvlevrebma Seiswavles qalebi, romlebmac, saboloo jamSi, uari Tqves sakuTar braldebebze da aRiares, rom aravis gauupatiurebia bavSvobaSi. es qalebi mixvdnen, rom maTi mogonebebi~ gaupatiurebis Sesaxeb ararealuri iyo. es gamokvlevebi adasturebs, rom Terapevtebi xSirad ubiZgeben pacientebs aseTi mogonebebis aRmoCenisken da sityvier waxalisebas ar iSureben, rodesac mogoneba~ gamomzeurdeba (de Rivera, 1997). aseTi SemTxvevebi afiqrebinebs klinicistebs, rom Seswavlil unda iqnes Terapiis procesSi CarTuli socialuri Zalebi, raTa gaarkvion, Tu rogor xorcieldeba Terapevtis Teoria pacientis realobaSi (Lynn et al., 1997). gandevnili mogonebebis aRdgenis rwmenam SeiZleba mniSvnelovnad Seamsubuqos fsiqoanalitikosTa pacientebis mdgomareoba. faqtobrivad, aRdgenili mogonebebis garkveuli nawili adreuli travmatuli gamocdilebis sando asaxvas warmoadgens (Schooler & Eich, 2000; Williams, 1995). miuxedavad amisa, Tu davinteresdebiT, SeuZlia Tu ara warsulis gandevnil mogonebebs awmyo diskomfortis axsna, darwmunebulni unda viyoT, rom pasiurad ar viRebT Cveni cxovrebis viRaciseul versias. jorj franklinis sabednierod, eWvi Seitanes misi qaliSvilis gandevnil mogonebebSi, rac sakmarisi gaxda verdiqtis uarsayofad.

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Tavi 16 / pirovnebis cvlilebebis Terapiebi

me-ze warmodgenaTa sistema mowodebulia SfoTvis optimaluri donis SesanarCuneblad. es sistema bavSvis pirovnebaTSorisi urTierTobebis gamocdilebidan momdinareobs da organizebulia me-s cnebis irgvliv; masSi Sedis: kargi-me (asocirebulia dedis siTbosTan), cudime (asocirebulia dedis daZabulobidan, romelsac is bavSvTan urTierTobisas avlena), ara-me (disociaciuri me, romelic miuRebelia danarCeni me-sTvis). aseT interpersonalur Tvalsazrisze dafuZnebuli Terapia moicavs Terapevtis ganwyobebisadmi pacientis grZnobebze dakvirvebas. Terapiuli interviu ganixileba, rogorc socialuri garemo, sadac orive mxaris grZnobebi da ganwyobebi zemoqmedebs erTmaneTze. pacienti frTxilad mihyavT iqamde, rom gamoTqvas sakuTari varaudebi Terapevtis ganwyobebis Sesaxeb. garda amisa, salivanisTvis Terapiuli situacia, upirvelesad, iseTi situaciaa, sadac Terapevti siyvaruliT swavlobs da aswavlis (Wallach & Wallach, 1983). melani kleini (1975) gaemijna froidis mosazrebas oidiposis konfliqtis fsiqopaTologiis ZiriTad wyarod aRiarebis Sesaxeb. vinaidan froidi oidipuri periodidan (4-5 wlis asaki) momdinare nevrotul simptomebze fokusirdeboda, Terapiuli Carevis amocana am aracnobieri seqsualuri konfliqtebis interpretireba da saaSkaraoze gamotana iyo. Tumca, zogierTi Terapevti

obieqti-urTierTobis Teoria (Object relation theory) fsiqoanalitikuri Teoria, romelic momdinareobs melani kleinis mosazrebidan imis Sesaxeb, rom samyaros Cveneuli gancdis samSeneblo agurebs~ siyvarulisa da siZulvilis obieqtebTan _ Cveni cxovrebis mniSvnelovan adamianebTan _ urTierToba qmnis.

fsiqodinamikuri Terapiebi

sirTuleebs awydeboda im pacientebTan muSaobisas, romelTa konfliqtebi verbaluri mexsierebis ganviTarebamde gacilebiT adreuli periodidan iRebda saTaves, rac xSirad, Tavis mxriv, gacilebiT mkveTrad gamoxatuli paTologiis mizezi xdeboda. es pacientebi xSirad itanjebodnen ararealurobis, sicarielis da cxovrebis sazrisis dakargvis grZnobebiT. kleins miaCnda, rom superegos primitiuli formebi cxovrebis pirvelive TveebSi Cndeba. igi amtkicebda, rom oidiposis seqsualuri konfliqtis, rogorc fsiqikis umniSvnelovanesi maorganizebeli faqtoris, nacvlad sqesobrivi mikuTvnebulobis gacnobierebas win uswrebs sikvdilis instinqti, rac Sinagani agresiuli impulsis gaCenas iwvevs da romelic, aseve, mniSvnelovania fsiqikis organizebisTvis. kleini, aseve, amtkicebda, rom fsiqikis ori fundamenturi maorganizebeli Zalaa agresia da siyvaruli, agresia anawevrebs da siyvaruli aerTianebs fsiqikas. samyaros agresiuli danawevrebisas xdeba arasasurvelis uaryofa da sasurvelis SenarCuneba; siyvaruli badebs erTianobasa da mTlianobas. kleinisTvis siyvaruli mxolod erotikuli ltolvebis ganxorcieleba ki ar iyo, aramed _ WeSmariti sikeTe da namvdili zrunva sxvebze. Tumca, es cnobieri siyvaruli dakavSirebulia sinanulTan sayvarel adamianebze mimarTuli savaraudo destruqciuli siZulvilisa da potenciuri Zaladobis gamo. amrigad, kleinma axsna erT-erTi udidesi saidumlo, romelsac awydeba yvela adamiani _ siyvaruli da siZulvili _ Cveni pirovnuli samoTxe da jojoxeTi _ ganuyofelia erTmaneTisgan~ (Frager & Fadiman, 1998, gv. 135). kleinis mosazreba imis Sesaxeb, rom samyaros Cveneuli gancdis samSeneblo agurebs~ siyvarulisa da siZulvilis obieqtebTan _ Cveni cxovrebis mniSvnelovan adamianebTan _ urTierToba qmnis _ fsiqoanalituri Teoriisa da praqtikis centralur mosazrebad iqca da obieqtiurTierTobis Teoria (Object relation theory) ewoda. kleinma, aseve, pirvelma gamoiyena agresiuli

665

Tavi 16 / pirovnebis cvlilebebis Terapiebi

da seqsualuri ltolvebis damarwmunebeli interpretacia fsiqoanalizis pacientebTan. fsiqodinamikuri Terapiebi, aniWeben ra sxvadasxva xarisxis mniSvnelobas froidis koncefciebs, isev viTardeba. erT-erTi umniSvnelovanesi axali mimarTulebaa me-s (self) mimarT Tanamedrove interesi; kerZod, interesis sagans Seadgens is, Tu rogor xdeba individis me-koncefciis, anu sakuTar Tavze warmodgenis Camoyalibeba, rogor aRiqvams, rogor ganicdis mas mocemuli pirovneba da rogor xdeba, rom xandaxan is sxvaTa mxridan Tavdasxmis obieqtad iqceva, romelsac dacva sWirdeba. am mimarTulebis wamyvani damcveli da fsiqoanalizSi obieqti-urTierTobis skolis damaarsebelia hainc kohuti (1977; Siegel, 1996). misi saavtoro Terapia fokusirdeba imis garkvevaze, Tu rogor saWiroebs me-s sxvadasxva aspeqtebi me-obieqtebs _ gulisxmier adamianebs da mniSvnelovan sagnebs, rac nebismier adamians sWirdeba optimaluri pirovnuli funqcionirebis SesanarCuneblad. me-fsiqologiis am formisTvis mniSvnelovania me-s gamocdileba da, gansakuTrebiT, is gamocdileba, romelic me-s fragmentacias iwvevs. Sesabamisad, Terapevtis amocanaa, SeZlebisdagvarad Rrmad Cawvdes sxvadasxva fsiqologiur mdgomareobas, romelsac ganicdis klienti da, amasTan, gaiTvaliswinos klientis gancdebis miseuli (klientiseuli) xedva (Chicago Institute for Psychoanalysis, 1992). Cven ukve aRvniSneT, rom fsiqoanalitur Terapias miznis misaRwevad xSirad drois xangrZlivi periodi sWirdeba. Tumca, xSirad adamianebi iseTi aSlilobebiT itanjebian, romelic gacilebiT swraf gankurnebas saWiroebs. bihevioraluri Terapia, romelsac axla ganvixilavT, simptomebisgan swafad gaTavisuflebis SesaZleblobas iZleva.

neofroidianeli Terapevtebi SedarebiT met mniSnelobas aniWeben pacientis awmyo socialur garemos, cxovrebiseuli movlenebis mimdinare gavlenas, socialuri motivaciis rols, pirovnebaTSoris urTierTobebs da me-koncefciis ganviTarebas.

bihevioraluri Terapia
Tu fsiqodinamikuri Terapiebi hipoTetur Sinagan mizezebze fokusirdebian, bihevioralur TerapiaTa yuradRebis sagans dakvirvebadi garegani qceva warmoadgens. bihevioraluri orientaciis Terapevtebi amtkiceben, rom paTologiuri qcevebis SeZena iseve xdeba, rogorc normaluris _ daswavlis procesiT, romelic ganpirobebulobisa da daswavlis ZiriTadi kanonebis mixedviT xorcieldeba. bihevioraluri Terapevtebi iyeneben ganpirobebisa da ganmtkicebis principebs, fsiqikur aSlilobebTan asocirebuli arasasruveli qcevis paternebis modificirebis mizniT. terminebi bihevioraluri (qceviTi) Terapia da qcevis modifikacia xSirad sinonimebad gamoiyeneba. oriveSi moiazreba daswavlis principebis meToduri gamoyeneba sasurveli qcevis sixSiris gazrdis, an arasasurveli qcevis sixSiris Semcirebis mizniT. bihevioraluri Terapia muSaobs devianturi qcevebisa da pirovnuli problemebis farTo speqtrze, sadac Sedis fobiebi, kompulsiebi (akviatebebi), depresia, damRupveli miswrafebebi (magaliTad, alkoholizmi, an narkotikebi), agresia da delikventuri qcevebi. zogadad, bihevioraluri Terapia specifikur problemebTan ukeT muSaobs, vidre zogadi xasiaTis pirovnul problemebTan: fobiis SemTxvevaSi is gacilebiT efeqturi iqneba, vidre _ zogadi, usagno SfoTvisas. Terapiebi warmoiqmna ganpirobebulobisa da daswavlis Teoriidan, romelic pragmatuli,
qceviTi Terapia (Behavior therapy) ixileT qcevis modifikacia. qcevis modifikacia (Behavior modification) daswavlis principebis meToduri gamoyeneba sasurveli qcevis sixSiris gazrdis an arasasruveli qcevis sixSiris Semcirebis mizniT.

Sejameba
fsiqodinamikuri Terapiebi zigmund froidis aracnobieri konfliqtisa da gandevnis Teoriidan iReben saTaves. Terapevtebi pacientTan kaTarzisis misaRwevad da fsiqikuri energiis gamosaTavisufleblad sxvadasxva teqnikebs iyeneben, maT Soris Tavisufal asociaciebs, sizmrebis analizs da gadatanis interpretacias.

666

empiriuli kvlevis tradiciebzea dafuZnebuli. yvela cocxali organizmis umTavresi amocanaa, daiswavlos aqtualur socialur da fizikur garemos moTxovnebTan adaptaciis xerxebi. Tu organizmma ver daiswavla problemebis efeqturad daZleva, misi araadapturi reaqciebis koregireba SesaZlebelia daswavlis (an xelaxali daswavlis) principebze dafuZnebuli TerapiiT. samizne qceva ar ganixileba raime safuZvlad mdebare procesis simptomad. simptomi Tavad aris problema. fsiqodinamikosi Terapevtebis prognozis mixedviT, mxolod garegani qcevis koregirebiT, realuri Sinagani problemis gamovlenis gareSe, mxolod simptomis Canacvlebamde mivalT, anu Tavs iCens axali fizikuri Tu fsiqologiuri problema. Tumca, gamokvlevebi aCvenebs, rom bihevioraluri TerapiiT paTologiuri qcevis aRkveTis Semdeg aRar xdeba axali simptomebiT misi Canacvleba (Kazdin, 1982; Wolpe, 1986). piriqiT, samizne simptomebis gaqrobis Semdeg pacientebi xSirad aRniSnavdnen, rom sxva, naklebad mniSvnelovani simptomebic gaqra~ (Sloane et al., 1975, gv. 219). axla ganvixiloT bihevioraluri Terapiis sxvadasxva formebi, romelTac Sveba moaqvT daavadebuli adamianebisTvis.

Cover Jones, 1924) aCvena, rom pirobiTi refleqsis gamomuSavebiT, anu ganpirobebiT SesaZlebelia SiSis gadaCveva4 (qvemoT mocemuli magaliTi SevadaroT patara albertis magaliTs me-7 Tavidan). misi pacienti 3 wlis biWuna iyo, saxelad piteri, romelsac gaurkveveli mizeziT eSinoda kurdRlebis. Terapia moicavda oTaxis erT mxares piteris gamokvebas, meore mxares ki kurdReli iyo moTavsebuli. mTeli rigi seansebis ganmavlobaSi kurdRels TandaTanobiT uaxlovebdnen mas. sabolood, SiSi gaqra da piteri Tavisuflad TamaSobda kurdRelTan. qover jonsis Semdeg bihevioristi Terapevtebi kontrganpirobebis sxvadasxva teqnikebs _ sistematur desensitizacias, imploziur5 Terapias, situaciaSi daZirvas6 da aversiul7 Terapias _ iyeneben.

sistematuri desensitizacia da sxva eqspoziciuri Terapiebi


nervuli sistema erTdroulad ver iqneba modunebulic (anu relaqsirebuli) da agznebulic, radgan SeuZlebelia urTierTsapirispiro procesebis erTdroulad aqtivireba. es martivi debuleba centraluria reciprokuli (urTierT) Sekavebis TeoriisTvis, romelic samxreT afrikelma fsiqiatrma jozef volpem SemogvTavaza (Joseph Wolpe, 1958, 1973). avtori mas SiSebisa da fobiebis samkurnalod iyenebda. volpe Tavis pacientebs kunTebis modunebas da Semdeg maTTvis SiSis momgvreli situaciis warmosaxvas aswavlida. isini amas TandaTanobiT, anu gradualurad akeTebdnen _ Soreuli asociaciebidan SemaSinebeli obieqtebis uSualo xatebamde. relaqsirebul mdgomareobaSi SemaSinebel stimulTan gradualuri fsiqologiuri
4 unlearned sityvasityviT SeiZleba iTargmnos, rogorc gamoswavla~ ( ). vinaidan aseTi sityva literaturul qarTulSi ar arsebobs, amitom iTargmna, rogorc gadaCveva~ (mTargmnelis SeniSvna). 5 implosion inglisuridan, SigniT mimarTuli afeTqeba~, implozia. 6 flooding _ inglisuridan, CaZirva~, daZirva~, siWarbe~. 7 aversion _ inglisuridan, zizRi~, zizRis obieqti~.

kontrganpirobeba
ratom SfoTavs zogierTi adamiani iseT uwyinar gamRizianebelTan (anu stimulTan) Sexvedrisas, rogoricaa oboba, araSxamiani gveli, an socialuri kontaqti? bihevioraluri axsna aseTia: SfoTva warmoiqmneba ganpirobebis martivi principebis mixedviT, romelic me-7 da me15 TavSi ganvixileT. Zlieri emociuri reaqciebi, romelic yovelgvari mizezis gareSe~ angrevs pirovnebis cxovrebas, xSirad ganpirobebulia pirovnebis mier warsulSi SeumCnevlad daswavlili reaqciebiT. kontrganpirobebisas Zveli, araadapturi reaqciis Canacvlebis mizniT, xdeba axali reaqciis gamomuSaveba. bihevioraluri Terapiis Sesaxeb pirvel CanawerebSi swored aseT logikas vxvdebiT. meri qover jonsma (Mary
kontrganpirobeba (Counterconditioning) Terapiuli teqnika, romliTac xdeba gamomuSavebuli axali reaqciiT araadapturi reaqciis Canacvleba.

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bihevioraluri Terapia

cxrili

16.1

testirebaze SfoTvis mqone studentis mier Sedgenili SfoTvis gamomwvevi stimulebis ierarqia (SfoTvis mzardi TanmimdevrobiT)
1. erTi Tve gamocdamde; 2. ori kvira gamocdamde; 3. erTi kvira gamocdamde; 4. xuTi dRe gamocdamde; 5. oTxi dRe gamocdamde; 6. sami dRe gamocdamde; 7. ori dRe gamocdamde; 8. erTi dRe gamocdamde; 9. gamocdis wina Rame; 10. gadmobrunebulad awyvia sagamocdo testis furclebi; 11. sagamocdo testebis darigebis molodini; 12. sagamocdo oTaxis daxurul karTan dgoma; 13. uSualod testirebis procesi - xvebze pasuxebis gacema; 14. gamocdis dRes universitetSi misvlis procesi.

klienti cxadad warmoidgens SfoTvis gamomwvevi stimulebis nusxidan yvelaze sust stimuls. Tu mas amis gakeTeba diskomfortis gareSe SeuZlia, gadadis Semdeg, SedarebiT Zlier stimulze. garkveuli raodenobis seansebis Semdeg SesaZlebeli xdeba stimulTa CamonaTvalSi pirvel adgilze myofi (anu yvelaze metad damTrgunavi) situaciis SfoTvis gareSe warmodgena. desensitizaciis warmatebiT gamoyeneba SesaZlebelia mTeli rigi problemebisas, romelic SeiZleba adamians Seeqmnas, maT Soris iseTi generalizebuli SiSebis dros, rogoricaa scenis SiSi da impotencia (Emmelkamp, 1990; Spiegler & Guevremont, 1998). mravali SefasebiTi kvleva aCvenebs, rom am tipis bihevioraluri Terapia gansakuTrebiT kargad muSaobs fobiebis mqone pacientebTan.

saidan viciT
daZirvis Terapia sahaero buStebis fobiis dros bils, kolejis 21 wlis students, sahaero buStis gaskdomis xmis eSinoda. amitom is Tavs aridebda iseT situaciebs, sadac SeiZleboda gaegona buStis gaskdomis xma _ cekvis saRamoebs, wveulebebs da sportul RonisZiebebs. bilma Tanxmoba ganacxada fobiis dasaZlevad daZirvis Terapiis gavlaze. Terapia Sedgeboda sami Tanmimdevruli seansisgan _ bili Terapevts xvdeboda yovel dRe, sami dRis ganmavlobaSi. am periodSi aTasobiT buSti gaskda. pirveli seansis dasawyisSi bilma subieqturi diskomfortis maRali done aCvena _ 100 qula (100-qulian skalaze, sadac 0 aRniSnavda srul simSvides, 100 _ ukiduresad SeSinebuls). roca pirvelad man subieqturi diskomforti mxolod 5 quliT gamoxata (imave 100-qulian skalaze), ukanaskneli 115 buSti man Tavisi xeliT gaxeTqa. daZirvis Terapiis Sedegad bili aRar aridebda Tavs mxiarul, buStebiT savse situaciebs (Houlihan et al., 1993).

Tavi 16 / pirovnebis cvlilebebis Terapiebi

Sexvedra Terapiuli teqnikaa, romelic sistematuri desensitizaciis saxeliT aris cnobili. desensitizaciuri Terapia sami ZiriTadi etapisgan Sedgeba: (1) klienti axdens SfoTvis gamomwvevi stimulebis identificirebas da ierarqiulad alagebs maT _ yvelaze sustidan yvelaze Zlieramde. magaliTad, cxrilSi 16.1 mocemuli ierarqia ekuTvnis students, romelSic testireba Zlier SfoTvas iwvevs. yuradReba miaqcieT, rom gamocdis uSualo molodini (debuleba 14) man ufro stresulad miiCnia, vidre Tavad gamocdaze gasvla (debuleba 13). (2) klients aswavlian kunTebis TandaTanobiT Rrmad modunebas. modunebis swavlebas, anu relaqsaciis trenings ramdenime seansi sWirdeba, romlis drosac klienti swavlobs daZabulobisa da modunebulobis SegrZnebebis erTmaneTisgan garCevas da SfoTvis moxsnas fizikuri da fsiqikuri modunebis misaRwevad. (3) bolos iwyeba Tavad desensitizaciis procesi: relaqsirebuli
sistematuri desensitizacia (Systematic desensitization) bihevioraluri Terapiuli teqnika, rodesac relaqsirebul mdgomareobaSi SemaSinebel stimulTan SexvedriT klients aswavlian SfoTvis ganviTarebis Sewyvetas.

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imploziuri Terapia sistematuri desensitizaciisgan diametralurad gansxvavebuli midgomaa. nabij-nabij, gradualuri winsvlis nacvlad, usafrTxo garemoSi klients dasawyisSive waredgineba yvelaze SemaSinebeli stimuli (SfoTvis gamomwvevi stimulTa ierarqiuli CamonaTvalidan). Terapiuli situacia isea mowyobili, rom is ver gaeqceva SemaSinebel stimuls. Terapevti aRwers klientis SiSTan dakavSirebul ukiduresad SemaSinebel situacias, rogoricaa, magaliTad, mTel sxeulze Semoxveuli gvelebi da aiZulebs klients, rom man srulad warmoidginos, SeZlebisdagvarad Zlierad ganicados es situacia. iTvleba, rom aseTma warmosaxvam panikis afeTqeba unda gamoiwvios. vinaidan es afeTqeba Sinagania (individis SigniT xdeba), process implozias, anu SigniT mimarTul afeTqebas uwodeben; aqedan momdinareobs saxelwodebac imploziuri Terapia . rodesac situacia mravaljer meordeba, stimuli kargavs Zalas da veRar axerxebs SfoTvis gamowvevas. rodesac SfoTva aRar warmoiqmneba, qreba is araadapturi qcevac, romelic misTvis Tavis asarideblad gamoiyeneboda. am proceduris ZiriTadi idea isaa, rom klients ar eZleva SfoTvis gamomwvevi situaciis uaryofis, misTvis Tavis aridebis Tu misgan ramenairad Tavis daRwevis saSualeba. igi aRmoaCens, rom stimulTan kontaqti sulac ar iwvevs im uaryofiT Sedegs, rasac moeloda (Stampfl & Levis, 1967). situaciaSi daZirva implozias hgavs, im gansxvavebiT, rom am dros klients, misi TanxmobiT, realurad aTavseben SiSis momgvrel situaciaSi. magaliTad, klaustrofobiis mqone pirovnebas bnel sxvenze aTavseben, bavSvs, romelsac wylis eSinia _ auzSi. daZirvis Terapiis kidev erTi forma warmosaxviT iwyeba. am SemTxvevaSi klients SeuZlia mousminos Canawers, romelSic erTi an ori saaTis ganmavlobaSi Zalze dawvrilebiT yvebian fobiis Sesatyvisi ukiduresad SemaSinebeli situaciis Sesaxeb. mas Semdeg, rac SeZrwuneba da SiSi Cacxreba, klients aTavseben SiSis momgvrel situaciaSi, romelic, cxadia, aRar aris imdenad SemaZrwunebeli, ramdenadac Tavad mis mier warmosaxuli situacia. daZirva gacilebiT efeqturia, vidre sistematuri desenzitizacia, rodesac saqme exeba zogierT iseT qceviT problemas, rogoricaa agorafobia.

imploziuri Terapia (Implosion therapy) bihevioraluri Terapiuli teqnika, romelic miznad isaxavs stimulTan asocirebuli SfoTvis Semcirebas, rac klientisTvis warmosaxviTi SemaSinebeli stimulis wardgeniT xorcieldeba. situaciaSi daZirva (Flooding) fobiebisTvis gankuTvnili Terapia, rodesac klients, misi TanxmobiT, waredgineba misTvis maqsimalurad SemaSinebeli stimuli.

bihevioraluri Terapia

amasTan, praqtikuli gamocdilebis mixedviT, klientTa umravlesobasTan miRebuli Sedegi mdgradia (Emmelkamp & Kuipers, 1979). sistematuri desensitizaciis, imploziuri Terapiisa da daZirvis TerapiisTvis _ yvelasTvis damaxasiaTebelia saerTo komponenti _ eqspozicia, anu stimulis wardgena. warmosaxviT iqneba, realuri kontaqtiT Tu uaxlesi meTodiT _ virtualurad (Rothbaum et al., 1995), klients waredgineba is obieqti, an situacia, romelic mas SiSs gvris. eqspoziciuri Terapia obsesiurkompulsuri aSlilobebis SemTxvevaSic gamoiyeneba. magaliTad, qalbatoni, romelsac akviatebuli hqonda azri WuWyis Sesaxeb (anu xasiaTdeboda WuWyis obsesiiT), iZulebiT (anu kompulsurad) ibanda xelebs daskdomamde da dasisxlianebamde. igi zogjer Tavis mokvlazec ki fiqrobda, imdenad gausaZlisi iyo aSliloba, romelmac sruliad mowyvita normaluri cxovrebis ritms. bihevioristi Terapevtis meTvalyurebis qveS es qalbatoni pirispir Seejaxa im obieqtebs, romelic yvelaze metad aSinebda _ WuWysa da nagavs da TandaTanobiT xeliTac ki Seexo. man isic ki moaxerxa, rom xuTi dRis

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manZilze ar daibana xelebi da saxe. yuradReba miaqcieT, rom am SemTxvevaSi bihevioralur Terapias damatebiTi komponenti aqvs _ reaqciis prevencia. klients ara marto warudgines SiSis gamomwvevi stimuli (WuWyi da nagavi), aramed man aRkveTa kidec kompulsuri qceva (xelebis dabana), romelic, Cveulebisamebr, amcirebda SfoTvas. am TerapiiT qalbatonma iswavla SfoTvis Semcireba kompulsuri qcevis ganxorcielebis gareSe.

aversiuli Terapia
zemoT aRwerili eqspoziciuri Terapiis formebi klients uSualod realurad uwyinar stimulTan gamklavebaSi exmareba. magram ra unda movimoqmedoT maT dasaxmareblad, visac saziano stimulebi izidavs ? narkotikebze damokidebuleba, seqsualuri perversiebi da umarTavi Zaladoba is problemebia, romelTa SemTxvevaSic devianturi qcevis aRmZvrelad mimzidveli stimuli gvevlineba. aversiuli Terapiisas iyeneben kontrganpirobebis procedurebs, raTa moxdes mocemuli stimulis Sewyvileba mZlavr damazianebel stimulTan, rogoricaa, magaliTad, eleqtruli Soki an safaRaraTo abebi. amavdroulad, igive uaryofiT reaqciebs iwvevs mimzidveli stimuli. Sedegad pirovnebas uyalibdeba aversiuli reaqcia am mimzidveli stimulis mimarT _ ezizReba is da am zizRiT Caanacvlebs stimulis adrindel sasurvelobas. magaliTad, aversiuli Terapia gamoiyeneba iseT individebTan, romlebic TviTdamazianebel qcevebs axorcieleben, rogoricaa Tavis mravaljeradi dartyma an mirtyma sxva sagnebze. aseTi qcevis ganxorcielebis dros individs msubuq eleqtrul dartymas ayeneben. es mkurnaloba efeqturad amcirebs TviTdamazianebel qcevas zogierTi, magram ara yvela, pacientis SemTxvevaSi (Duker & Seys, 1996).
aversiuli Terapia (Aversion therapy) qceviTi Terapiis tipi, romelic gamoiyeneba saziano stimulebisaken midrekilebis mqone adamianebis samkurnalod. pirobiTi ganmamtkiceblebis marTva (Contingency menegement) zogadi mkurnalobis strategia, romelic gulisxmobs qcevis Secvlas Tanmimdevruli cvlilebis saSualebiT.

ukiduresi formis aversiuli Terapia wamebas gavs. sainteresoa, ratom eqvemdebarebian adamianebi sakuTari nebiT am proceduras? Cveulebriv, isini amas mxolod imitom akeTeben, rom realurad xedaven _ aseTi qcevis paternis droSi gaxangrZlivebuli Sedegebi daangrevs maT janmrTelobas, karieras, an ojaxur cxovrebas. garda amisa, aseTi Terapiis gavlis mizezi instituciuri zewolac SeiZleba gaxdes, rogorc xdeba, magaliTad, patimrebisTvis gankuTvnil mkurnalobis zogierT programaSi. mravali kritikosis azriT, aversiul TerapiaSi gamoyenebuli mtkivneuli procedurebi: (1) zedmet Zalauflebas aZlevs Terapevts; (2) damsjeli RonisZiebebi ufroa, vidre _ Terapiuli; (3) ufro xSirad gamoiyeneba iseT dawesebulebebSi, sadac adamianebs TiTqmis ar aqvT arCevanis ufleba da maTgan aravin iRebs proceduris Catarebis nebarTvas. ukanasknel wlebSi, instituciur sareabilitacio programaSi CarTuli aversiuli Terapiis gamoyeneba eTikuri kodeqsiTa da Statis8 kanoniT regulirdeba. imedia, aseTi SezRudvebis pirobebSi aversiuli Terapia Terapiuli ufro iqneba, vidre _ iZulebiTi da Zaladobrivi.

pirobiTi ganmamtkiceblebis marTva


kontrganpirobeba gamosadegia, rodesac SesaZlebelia erTi reaqciis Canacvleba meore reaqciiT. qcevis modifikaciis sxva meTodebi operantuli ganpirobebis principebs efuZneba, romelic b. f. skineris (B. F. Skinner) mier dawyebuli kvlevebis tradiciebze Camoyalibda. pirobiTi ganmamtkiceblebis marTva gulisxmobs mkurnalobis zogad strategias, romelic mimarTulia qcevis Secvlaze misi Sedegebis modificirebis gziT. bihevioralur TerapiaSi pirobiTi ganmamtkiceblebis marTvis ori ZiriTadi teqnika arsebobs: dadebiTi ganmtkicebis strategia da Caqrobis strategia.

Tavi 16 / pirovnebis cvlilebebis Terapiebi

dadebiTi ganmtkicebis strategia


rodesac reaqcias dauyovnebliv, uSualod mohyveba waxaliseba, mosalodnelia, rom es reaqcia ganmeordes da droTa ganmavlobaSi gax8

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saubaria aSS-is Statebze (mTargmnelis SeniSvna).

Sirdes. operantuli daswavlis es ZiriTadi principi Terapiul strategiad iqca, rodesac sasurveli qcevis sixSiris Sesacvlelad gamoiyenes mas Semdeg, rac am qcevam arasasurveli qceva Caanacvla. qcevis problemebze muSaobisas STambeWdavi Sedegi miiRes, rodesac dadebiTi ganmtkicebis procedura gamoiyenes. SegiZliaT gaixsenoT me-7 TavSi ganxiluli ori magaliTi. Cven aRvwereT, rogor gamoiyenes qcevis formireba autisti bavSvis cxovrebis gasaumjobeseblad. pacienti sami wlis biWuna iyo, romelsac saTvale unda etarebina. Terapevtma pirobiT ganmamtkiceblad xmauriani saTamaSo gamoiyena, raTa is nel-nela, TandaTanobiT mieaxlovebina saTvalemde. Cven, aseve, visaubreT Jetonebis ekonomikaze, rodesac winaswar aris gansazRvruli (magaliTad, sakuTari Tavis movla da medikamentebis miReba) sasurveli qceva da momsaxure personali samizne qcevis yoveli ganxorcielebisas individs Jetons aZlevs. es Jetonebi mogvianebiT SeiZleba mTel rig waxalisebebsa da privilegiebze gaicvalos (Kazdin, 1994; Martin & Pear, 1999). waxalisebis aseTi sistemebi gansakuTrebiT efeqturia pacientis iseTi qcevebis Sesacvlelad, rogoricaa sakuTari Tavis movla, wesrigisa da sisufTavis dacva saarsebo garemoSi da xSiri dadebiTi socialuri urTierTqmedebebi. sxva midgomaSi Terapevti gamorCeulad ganamtkicebs arasasurveli qcevis sapirispiro qcevas. am teqnikas warmatebiT iyeneben narkotikebze damokidebuli adamianebis mkurnalobisas.

analizi aCvenebda, rom maTi Sardi ar Seicavda narkotikul nivTierebas. TiToeuli baraTis Rirebuleba 25 cents Seadgenda da mis sanacvlod sabiTumo saqonlis SeZena SeiZleboda. dasawyisSi Sardis yoveli uaryofiTi analizis SemTxvevaSi monawileebs 10 baraTs aZlevdnen. mas Semdeg, rac maTi Sardis analizi isev da isev uaryofiTi iyo, yovel Semdeg jerze baraTebis raodenoba izrdeboda. monawileTaTvis baraTebi pirobiT ganmamtkiceblad iqca, romelic narkotikis gareSe yofnasTan Seawyviles. danarCen 34 monawilesac aZlevdnen baraTebs, Tumca, maTi ganmamtkicebeli ar iyo Sewyvilebuli narkotikis gareSe yofnasTan: SeuwyvilebelTa~ jgufis TiToeuli wevri mimagrebuli iyo SewyvilebulTa~ jgufis romelime wevrze da orive erTnairi odenobiTa da erTdroulad iRebda ganmtkicebas (baraTebs). kvlevis aseTi sqemidan gamomdinare, SegviZlia darwmunebulni viyoT, rom baraTebis nebismieri efeqti Sewyvilebis Sedegi iyo da ara mxolod ganmtkicebis. faqtobrivad, pirobiTi ganmamtkiceblisa (baraTebis) da sasurveli qcevis (narkotikis gareSe yofna) Sewyvileba mdgradi aRmoCnda: kvlevis dasasrulisTvis da kvlevidan erTi wlis Semdegac SewyvilebulTa~ jgufis wevrebi, SeuwyvilebelTa~ jgufis wevrebisgan gansxvavebiT, uwyveti warmatebiT axerxebdnen narkotikisgan Tavis Sesavebas (Higgins et al., 2000).

saidan viciT
bihevioraluri mkurnaloba narkotikebze damokidebulebisas mkvlevrebma moZebnes 70 mamakaci da qali, romelsac kokainze damokidebulebisgan gankurneba surda. TiToeulma monawilem sakonsultacio seansebi gaiara, raTa am damokidebulebis gadalaxvis strategiebsa da unar-Cvevebs gacnobodnen. garda amisa, 36 monawiles aZlevdnen specialur baraTebs yovel jerze, rodesac SeiZleba, SeamCnieT, rom aq igive principi moqmedebs, rac arasasurveli reaqciis sasurveliT Canacvlebisas (razec zemoT visaubreT): adapturi qcevis albaTobis gasazrdelad daswavlis ZiriTadi principebi gamoiyeneba.

Caqrobis strategia
ratom agrZeleben adamianebi imis keTebas, rasac tkivili da tanjva moaqvs maSin, roca sxvagvarad moqcevis SesaZlebloba gaaCniaT? pasuxi aseTia: qcevis mraval formas mravalricxovani da sxvadasxvagvari Sedegi aqvs, zogierTi

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bihevioraluri Terapia

Tavi 16 / pirovnebis cvlilebebis Terapiebi

maTgani dadebiTia da zogic _ uaryofiTi. xSirad SeumCneveli dadebiTi ganmamtkicebeli axerxebs qcevis SenarCunebas, misi aSkarad uaryofiTi Sedegebis miuxedavad. magaliTad, bavSvma, romelsac sjian cudi saqcielisTvis, SeiZleba ganagrZos cudad moqceva, Tu dasja misTvis yuradRebis miqcevis erTaderTi formaa. Caqrobis strategia TerapiaSi gamosadegia maSin, rodesac disfunqciuri qcevebis SenarCuneba gaurkveveli ganmamtkicebeli garemoebebiT xdeba. am ganmamtkiceblebis gamovlena situaciis zedmiwevniTi analiziT SeiZleba. Semdeg ise xdeba programis Sedgena, rom arasasurveli qcevis ganxorcielebisas SeuZlebeli gaxdes maTi gamoCena. Tu SesaZlebelia am midgomis gamoyeneba da Tu klientis garemocvaSi myofi adamianebi, romlebic uneburad ganamtkiceben qcevas, TanamSromloben TerapevtTan, Caqrobis procedura amcirebs qcevis sixSires da droTa ganmavlobaSi, TandaTanobiT sruliad gaaqrobs mas. ganvixiloT klasis magaliTi. mkvlevrebma gaarkvies, rom dawyebiTi skolis oTxi moswavlis araadaptur qcevaze ganmamtkiceblad moqmedebda TanaklaselTa yuradReba. mkvlevrebma miaRwies, rom bavSvebi yuradRebas iCendnen am oTxi moswavlis misaRebi qcevebisadmi da uyuradRebod tovebdnen arasasurvel qcevebs. amiT maT SeZles moswavleTa araadapturi qcevis paternebis Caqroba (Broussard & Northup, 1997). aramizanmimarTuli ganmtkicebiT Sizofreniuli qcevis SenarCuneba da waxalisebac ki SeiZleba. ganvixiloT aseTi situacia: mraval fsiqiatriul klinikaSi dadgenili wesia, rom momsaxure personali xSirad ekiTxeba pacientebs: rogor grZnobT Tavs?~ rac socialuri komunikaciis erTgvari formaa. pacientebs xSirad arasworad esmiT es SekiTxva da hgoniaT, rom amiT momsaxure personals diagnozisTvis saWiro informaciis miReba surs. amitom sakuTar azrebze, grZnobebze, ucnaur simptomebsa da halucinaciebze iwyeben laparaks. aseT pasuxebs sawinaaRmdego Sedegi moaqvs; momsaxure personali mihyavs daskvnamde, rom pacientebi sakuTar
socialuri daswavlis Terapia (Social-learning therapy) mkurnalobis forma, rodesac klienti uyurebs, Tu rogor iRebs modeli waxalisebas sasurveli qcevis ganxorcielebisaTvis.

TavSi arian Caflulni da aranormalurad iqcevian. faqtobrivad, gamodis, rom, rac ufro ucnaur simptomebs da sityvier masalas miawvdian pacientebi, miT met yuradRebas miiReben momsaxure personalisgan, rac, Tavis mxriv, ganamtkicebs ucnauri simptomebis ganmeorebiT gamoxatvas. klasikur gamokvlevaSi naCvenebi iqna Sizofreniuli qcevis STambeWdavi Semcireba, rodesac momsaxure personals mieca martivi instruqcia _ moexdinaT qcevis ignorireba da mxolod normalurad moqcevis SemTxvevaSi mieqciaT pacientebisTvis yuradReba (Ayllon & Michael, 1959).

socialuri daswavlis Terapia


bihevioraluri Terapiebis diapazoni socialuri daswavlis Teoretikosebma gaafarToves, romlebic miuTiTebdnen, rom adamianebi sxva adamianebis qcevaze dakvirvebiT swavloben. axal situaciebSi qcevis wesebs xSirad iseTi simboluri saSualebebiT vswavlobT da viyenebT, rogoricaa realur cxovrebaSi, filmebsa Tu televiziiT sxva adamianebis gamocdilebaze dakvirveba. socialuri daswavlis Terapia mowodebulia problemur qcevaTa paternebis modificirebisTvis iseTi pirobebis SeqmniT, sadac klienti xedavs, Tu rogor waxalisdeba modeli ganxorcielebuli sasurveli qcevisTvis. daswavlis aseTi gaSualebuli procesi gansakuTrebiT Rirebulia fobiebis daZlevisa da socialuri Cvevebis Camoyalibebisas. wina TavebSi aRvniSneT, rom socialuri daswavlis es Teoria, ZiriTadad, albert banduras (Albert Bandura) naSromebSi damuSavda (1977, 1986). aq misi midgomis mxolod or aspeqtze SevCerdebiT: modelis mibaZvasa da socialuri unar-Cvevebis SemuSavebaze.

modelis mibaZva
socialuri daswavlis Teoriis mtkicebiT, individebi reaqciebs dakvirvebis meSveobiT daiswavlian. aqedan gamomdinareobs, rom fobiebis mqone adamianebs unda SeeZloT, rom modelis qcevis mibaZviT gadaeCvion SiSis

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suraTi

16.1

monawilis modelirebis Terapia


fotoze gamosaxuli cdis piri jer models uyurebda, romelic TandaTanobiT uaxlovdeboda gvels. Semdeg Tavad gaimeora igive qceva. saboloo jamSi, mas SeeZlo gvelis xlSi aReba da sakuTar sxeulze misTvis moZraobis saSualebis micema. grafikze asaxulia cdis piris mier ganxorcielebuli miaxlovebis qcevaTa raodenoba monawileobis meSveobiT Terapiamde (rac yvelaze efeqturi aRmoCnda) da Semdeg; es qceva waredgina danarCeni ori Terapiuli teqnikis da sakontrolo jgufsac.

socialuri unar-Cvevebis SemuSaveba


reaqcias. magaliTad, gvelebis SiSis mkurnalobisas Terapevti jer aCvenebs klients, rom SedarebiT usafrTxo garemoSi SesaZlebelia gvelTan uSiSrad miaxloeba; es SeiZleba iyos galiasTan axlos misvla, an misTvis xelis Sexeba. amis Semdeg klients CvenebiTa da waxalisebiT exmarebian, rom gaimeoros igive qceva. TandaTanobiT formirdeba miaxloebis qceva. sabolood, klients SeuZlia, rom gveli xelSi aiyvanos da mas sxeulze Tavisuflad moZraobis saSualeba misces. klients aranairi qcevis ganxorcielebas ar aiZuleben. nebismier momentSi warmoqmnili winaaRmdegobis daZleva miaxloebis qcevis wina, warmatebul, naklebad SemaSinebel safexurze dabrunebiT xdeba. ramdenad Zlierad moqmedebs monawileobis meSveobiT modelireba, kargad Cans kvlevaSi, romelSic es teqnika simbolur modelirebas, desensitizaciasa da sakontrolo jgufis mdgomareobas Seadares. simboluri modelirebiT Terapiisas pacientebi, romelTac naswavli hqondaT relaqsacia, uyurebdnen films, sadac ramdenime modeli uSiSrad epyroboda gvelebs. Tu ekranze nanaxi maTSi SfoTvas iwvevda, SeeZloT, nebismier dros gaeCerebinaT filmi da modunebuliyvnen. sakontrolo jgufSi ar yofila Terapiuli Careva. rogorc 16.1 suraTidan Cans, monawileobis meSveobiT modelireba aSkarad yvelaze warmatebuli iyo am teqnikebs Soris. monawileobis meSveobiT modelirebis jgufis 12-dan 11 monawile ganikurna gvelebis SiSisgan (Bandura, 1970). socialuri daswavlis TerapevtTa mier Semotanil umTavres siaxles warmoadgens araadekvaturi socialuri Cvevebis mqone adamianebisTvis ufro efeqturad funqcionirebis swavleba. fsiqikuri aSlilobis mqone adamianebi mraval sirTules awydebian; Cveulebriv, janmrTel adamianebsac xSirad eqmnebaT problemebi yoveldRiur cxovrebaSi, Tu isini uxerxulad grZnoben Tavs sxvebTan urTierTobisas, mouxerxeblebi arian, an ar SeuZliaT sakuTari poziciebis dacva. socialuri unar-Cvevebi, anu urTierTobis unar-Cvevebi reaqciaTa erTobliobaa, romelic adamianebs socialuri miznebis efeqturad miRwevis SesaZleblobas aZlevs, rodesac isini mimarTaven sxvebs, an urTierTqmedeben sxvebTan. am unar-CvevebSi Sedis imis codna, Tu (1) ra (Sinaarsi) vTqvaT da movimoqmedoT mocemul situaciaSi, raTa gamoviwvioT sasurveli reaqcia (Sedegi); (2) rogor (stili) vTqvaT da moviqceT; (3) rodis (dro) vTqvaT da vimoqmedoT. urTierTobis unar-Cvevebis TvalsazrisiT, erTerTi yvelaze gavrcelebuli problemaa sakuTar TavSi daurwmunebloba _ sakuTari mosazrebebisa Tu survilebis gamoxatva da dacva pirdapir, gasagebad da agresiis gareSe (Alberti &Emmons, 1990; Bower & Bower, 1991). am problemis daZlevaSi
modelireba monawileobis meSveobiT (Participant modeling) Terapiuli teqnika, rodesac Terapevti uCvenebs sasurvel qcevas da klients mxardamWeri waxalisebiT exmareba modelis mier ganxorcielebuli qcevis gameorebaSi.

socialuri daswavlis Terapia

673

dasaxmareblad socialuri daswavlis mravali Terapevti gvirCevs qcevis repeticias _ imis TvalsaCinod warmoadgenas, Tu rogor unda moviqceT mocemul situaciaSi da ra sasurveli dadebiTi Sedegebi mohyveba Cven mier ganxorcielebul qcevas (Yates, 1985). mozrdilTa paTologiur qcevas xSirad win uswrebs socialuri unar-Cvevebis nakleboba bavSvobaSi (Oden & Asher, 1977). amitom mkvlevarTa da TerapevtTa mniSvnelovani Zalisxmeva mimarTulia Caketil da fsiqikuri problemebis mqone bavSvebSi sakuTar TavSi darwmunebulobis ganviTarebaze (Fantuzzo et al., 1996; Pfiffer & McBurnett, 1997). erT-erTma gamokvlevam aCvena, rom drois xanmokle periodSi SesaZlebeli iyo urTierTobis Cvevebis swavleba winasaskolo asakis bavSvebisTvis, romelTac socialurad izolirebulad Tvlidnen.

TanatolTan TamaSis gamocdilebamac gazarda bavSvebis sociabiluroba, magram Zalze mcired. mkvlevrebma daaskvnes, rom erTi-erTze, wyvilSi TamaSis situacia morcxv bavSvebs SesaZleblobas aZlevs, rom socialurad usafrTxod igrZnon Tavi da sakuTar TavSi darwmunebulebi iyvnen sxvasTan urTierTobisas. maT SeeZloT xelmZRvanelis rolSic gamoecadaT Tavi mewyvilis umcrosi asakidan gamomdinare, usafrTxo situaciaSi TamaSisas (Furman et al., 1979).

saidan viciT
sxvasTan urTierTobisas sakuTar TavSi darwmunebulobis daswavla skolis 24 moswavle SemTxveviTad moxvda sam sxvadasxva situaciaSi: maT unda eTamaSaT Tavisive asakis mewyvilesTan, 11,5 wliT umcros mewyvilesTan da marto, mewyviles gareSe (sakontrolo). erTi Tvis manZilze wyvilebi saTamaSod aTjer Sekribes da TiToeuli Sexvedra mxolog 20 wuTi grZeldeboda. iwereboda maTi qceva saklaso oTaxSi eqsperimentamde da Semdeg. aRmoCnda, rom zemoT aRwerilma Carevam Zlieri gavlena moaxdina. umcros mewyvilesTan TamaSis SesaZleblobam gaaormaga da sxva bavSvebis saSualo maCvenebels miuaxlova TanaklaselebTan urTierTobis sixSire im bavSvebTan, romlebic Caketilebad da arakontaqturebad iTvlebodnen.
qceviTi repeticia (Behaviotal rehearsal) procedura, romelic mowodebulia ZiriTadi unarCvevebis gamomuSavebisTvis da ganmtkicebisTvis; rodesac CarTulia socialuri unar-Cvevebis gavarjiSebis programaSi, igulisxmeba, rom klienti gonebaSi imeorebs sasurveli qcevis Tanmimdevrobas.

Tavi 16 / pirovnebis cvlilebebis Terapiebi

sxva gamokvlevaSi emociuri problemebis mqone hospitalizirebul bavSvebs, socialuri unar-Cvevebis gavarjiSebis Sedegad, gauumjobesdaT socialur situaciebSi qcevis verbaluri da araverbaluri komponenti (Matson et al., 1980). bavSvebs sxvadasxvagvar socialur situaciebSi saTanado sityvieri pasuxebis gacema (daxmarebis gaweva, an komplimentis Tqma, TxovniT mimarTva) aswavles. maT, aseve, aswavles saTanado emociebis demonstrireba (magaliTad, gaRimeba Seqebisas), saubrisas sworad moqceva (mosaubrisken saxiT mibruneba) da Tvalebis kontaqtis damyareba (mosaubrisTvis TvalebSi yureba). es gaumjobesebuli socialuri unarCvevebi gavrcelda (anu generalizirda) im situaciebzec, romelic ar Sedioda saswavlo programaSi: bavSvebi gamomuSavebul unar-Cvevebs palatebSic iyenebdnen. es dadebiTi Sedegi Tveebis manZilze SenarCunda.

generalizaciis teqnikebi
biheviorist Terapevtebs yovelTvis ainteresebT Semdegi sakiTxi: ramdenad ganaxorcieleben maTi klientebi Terapiul garemoSi daswavlil qcevebs yoveldRiur cxovrebaSi (Kazdin, 1994). es sakiTxi yvela TerapevtisTvis mniSvnelovania, radgan mkurnalobis efeqturobis nebismieri sazomi grZelvadian cvlilebebs unda moicavdes, romelic mas Semdegac SenarCundeba, rac klienti datovebs Terapevtis taxts, klinikasa Tu laboratorias. rodesac Terapiul programaSi ar aris gaTvaliswinebuli klientis realuri cxovrebis mniSvnelovani mxareebi, Terapiis procesSi

674

cxrili

16.2
fsiqoanalizi
biologiuri instinqtebi, pirvel rigSi, seqsualuri da agresiuli, romelTac dauyovneblivi gamonTavisufleba esaWiroebaT da aiZuleben adamians, rom daupirispirdes socialur realobas. ganviTareba xdeba Tanmimdevrul stadiebze konfliqtebis gadawyvetis Sedegad. identifikaciisa da internalizaciis gziT yalibdeba egos mxridan zrdasrulisTvis damaxasiaTebeli marTvis meqnizmebi da xasiaTis struqturebi. paTologiaSi aisaxeba konfliqtis araadekvaturi gadawyveta da ganviTarebis adreul stadiebze fiqsacia, amis Sedegia Zalian Zlieri impulsebi da/an maTi Sesustebuli kontroli. fsiqoseqsualuri mowifulobis miRweva, egos funqciebis gaZliereba da aracnobieri da gandevnili impulsebis mxridan kontrolis Sesusteba. gamocdilebaSi arsebuli motivebi, grZnobebi, fantaziebi da kogniciebi. wasrulis konfliqtebisa da gandevnili grZnobebis cnobierebaSi amotanaze, garCevasa da gaazrebaze orientacia. es aris fsiqoanalizis centraluri sakiTxi, romelsac neofroidianebeli SedarebiT nakleb mniSvnelobas aniWeben. insaits centraluri adgili ukavia; Cndeba makoregirebel emociur gamocdilebaSi. Terapevti moqmedebs, rogorc gamomZiebeli : eZebs pirvelad, sawyisi konfliqtebisa da winaaRmdegobis warmoqmnis mizezebs; gamijnuli da neitraluri, xels uwyobs gadatanis reaqciis ganviTarebas.

fsiqoTerapiisadmi fsiqoanalitikuri da bihevoraluri midgomebis Sedareba


sagani
adamianis sawyisi buneba

bihevioraluri Terapia
sxva cxovelebis msgavsad, adamianebi mxolod swavlis SesaZleblobiT ibadebian; daswavlis procesi igive principebs emorCileba adamianTan, romelsac yvela sxva saxeobis SemTxvevaSi. adapturi qcevebi daiswavleba ganmtkicebiTa da mibaZviT.

normaluri adamianuri ganviTareba

fsiqopaTologiis buneba

problemuri qceva momdinareobs araadapturi qcevebis arasworad daswavlidan. simptomi aris problema da ar arsebobs aranairi safuZvlad mdebare daavadeba. aRikveTeba simptomaturi qceva da Canacvldeba adapturi qcevebiT.

Terapiis mizani

gamokveTili fsiqologiuri sfero drois aspeqti

Terapia mimarTulia qcevaze da dakvirvebad grZnobebsa da moqmedebebze. ainteresebT mxolod klientis qcevis ganmtkicebis istoria. ikvleven da mkurnaloben awmyoSi realurad arsebul qcevas. ar ainteresebT aracnobieri procesebi da cnobieri subieqturi gamocdileba. insaiti zedmetia da/an ar aris saWiro. Terapevti moqmedebs, rogorc treneri : exmareba klients Zveli qcevisgan gadaCvevasa da/an axali qcevis daswavlaSi. mniSvnelovania ganmamtkiceblebis marTva; naklebi mniSvneloba eniWeba pirovnebaTSoris urTierTobas.

aracnobieri masalis roli insaitis roli Terapevtis roli

qcevaSi miRweuli cvlilebebi droTa ganmavlobaSi, Terapiis dasrulebis Semdeg SeiZleba daikargos. am TandaTanobiTi danakargis Tavidan asacileblad miRebuli praqtikaa generalizaciis teqnikebis SemuSaveba da maTi Terapiul procedurebSi CarTva. es teqnikebi mowodebulia, raTa maqsimalurad miuaxlovon erTmaneTs Terapiuli garemosa da realuri cxovrebis samizne qceva, ganmamtkiceblebi, modelebi da stimulis moTxovnebi. magaliTad, klientebs aswavlian qcevebs, romelic mis Cveul garemoSic ganmtkicdeba, iqneba es Tavazianobis gamoCena Tu windaxeduleba. waxaliseba eZlevaT parcialuri (nawilobrivi) ganmtkicebis ganrigiT, raTa miRebuli Sedegi realur situaciebSic SenarCundes, sadac ganmtkiceba yovelTvis ar mosdevs qcevas. TandaTanobiT amcireben sagrZnobi garegani gamtkicebis molodins da, amasTan, aCveven socialur miRebasa da SedarebiT bunebriv Sedegebs,

maT Soris sakuTari Tavisadmi wamaxalisebel gamonaTqvamebs. magaliTad, bihevioristma Terapevtebma TandaTanobiTi Semcirebis meTodi 7 wlis biWunasTan muSaobisas gamoiyenebs, romelic xSirad paravda nivTebs Tanaklaselebs (Rosen & Rosen, 1983). biWs sjidnen, Tu Semowmebis Sedegad masTan sxva bavSvebis nivTebs poulobdnen, an qulebiT~ ajildovebdnen (romelTa gadacvlac SesaZlebeli iyo iseT sasiamovno ganmamtkiceblebze, rogoricaa damatebiTi dasveneba), Tu mas aseTi nivTebi ar hqonda. dasawyisSi 15 wuTSi erTxel amowmebdnen. droTa ganmavlobaSi SemowmebaTa ricxvi TandaTanobiT Seamcires da biWis Semowmebebs Soris intervali 2 saaTamde gazardes, sabolood ki, sruliad Sewyvites. mas Semdegac ki, rac sruliad Sewyvites ganmamtkiceblebiT uSualo manipulacia, biWs aRaraferi mouparavs. kognituri Terapiebis ganxilvamde, erTi wuTiT SexedeT cxrils 16.2, dafiqrdiT da

675

socialuri daswavlis Terapia

gaiazreT, ra arsebiTi gansxvavebaa Cven mier ganxilul or fsiqoTerapiul mimdinareobas _ fsiqoanalitursa da bihevioralurs _ Soris.

Sejameba
adapturi qcevis sixSiris gasazrdelad da araadapturi qcevis sixSiris Sesamcireblad bihevioraluri Terapia daswavlis principebs iyenebs. kontrganpirobebis meTodebSi Sedis sistematuri desensitizacia, implozia da daZirva. TiToeuli Terapiuli meTodis arsebiTi nawilia eqspozicia, anu stimulis wardgena. aversiuli Terapiisas xdeba aversiuli stimulisa da arasasurveli qcevis Sewyvileba. pirobiTi ganmamtkiceblebis marTvisas, samizne qcevis gasaZliereblad, an Sesasusteblad, dadebiTi ganmtkiceba da Caqrobis strategia gamoiyeneba. socialuri daswavlis Terapiis gamoyenebis erT-erTi mimarTulebaa fobiebis moxsna; individebs SiSis daZleva modelis mibaZviT SeuZliaT. Terapevtebi socialuri daswavlis teqnikebs socialuri unar-Cvevebis SemuSavebis mizniTac iyeneben.

fiqroben da rogor (kognituri procesi) fiqroben adamianebi. kognituri Terapia sxvadasxvagvari SemecnebiTi procesebis cvlilebebsa da kognituri gadastruqturebis sxvadasxva meTodebis swavlebaze fokusirdeba. am midgomis zogierTi nairsaxeoba me-13 TavSi ganvixileT, rogorc stresTan gamklavebisa da janmrTelobis gaumjobesebis saSualebebi. am qveTavSi aRvwerT kognituri Terapiis or ZiriTad formas: kognitur bihevioralur modifikacias (sakuTari Tavis rwmenis, anu TviTefeqturobis gamomuSavebis CaTvliT) da mcdari warmodgenebis sistemebis Secvlas (depresiis kognituri Terapiisa da racionalur-emociuri Terapiis CaTvliT). Y

kognitur-bihevioraluri modifikacia
Cven is varT, rasac STavagonebT sakuTar Tavs, rom unda viyoT da vakeTebT imas, rac gvgonia, rom unda vakeToT. es aris kongiturbihevioraluri midifikaciis sawyisi piroba. am Terapiul midgomaSi gaerTianebulia, erTi mxriv, motivaciasa da qcevaze azrebisa da ganwyobebis gavlenis kognituri aqcenti da, meore mxriv, qcevis modifikaciisas pirobiTi ganmtkicebis bihevioraluri aqcenti. arasasurveli, miuRebeli qcevis paternebi modificirdeba kognituri gadastruqturebis gziT _ sakuTar Tavze uaryofiTi gamonaTqvamebis SecvliT konstruqciuli, qmediTi gamonaTqvamebiT. mocemuli Terapiuli midgomis kritikuli nawilia fsiqoTerapevtisa da klientis mier imis garkveva, Tu ras fiqrobs klienti da rogor gamoxatavs problemas, romelic unda mogvardes Terapiis procesSi. mas Semdeg, rac Terapevti da klienti gaarkveven, Tu ra saxis azrebi ubiZgeben klients araproduqtuli, an disfunqciuri qcevisken, isini axali, konstruqciuli debulebebis SemuSavebas da TviTpativiscemis Semamcirebeli, an SfoTvis gamomwvevi TviTganmkicxavi debulebebis Semcirebas iwyeben (Meichenbaum, 1977, 1985, 1993). magaliTad, negatiuri debuleba saSinlad mosawyeni viyavi wveulebaze, aRarasodes dampatiJeben~, Canacvldeba konstruqciuli kritikiT: Tu minda, rom sainteresod gamoviyurebode, momavalSi raime damaintrigebeli frazebi unda movifiqro saubris dasawyebad, gaviwafo kargi anekdotis moyolaSi

kognituri Terapiebi
kognituri TerapiiT cdiloben problemuri grZnobebisa da qcevebis Secvlas, mniSvnelovani cxovrebiseuli movlenebisadmi klientis damokidebulebis SecvliT. es Terapia efuZneba Semdeg daSvebas: paTologiuri qcevis paternebi da emociuri distresi momdinareobs problemebidan, romelic exeba imas, Tu ras (kognituri Sinaarsi)
kognituri Terapia (Cognitive therapy) fsiqoTerapiuli mkurnalobis forma, romliTac cdiloben problemuri grZnobebisa da qcevebis Secvlas, mniSvnelovani cxovrebiseuli movlenebisadmi klientis damokidebulebis SecvliT. kognitur-bihevioraluri modifikacia (Cognitive behavior modification) _ Terapiuli midgoma, romelic aerTianebs motivaciasa da qcevaze azrebisa da ganwyobebis gavlenis kognitur aqcents da, meore mxriv, qcevis modifikaciisas pirobiTi ganmtkicebis bihevioralur aqcents.

676

Tavi 16 / pirovnebis cvlilebebis Terapiebi

warmoaCines sakuTari Tavi, vidre maT, visac miaCnda, rom es amocana mxolod ukve arsebuli SesaZleblobebis Sefasebis saSualeba iyo (Wood & Bandura, 1989). am kvlevaSi iseTi azrebi, rogoricaa me SemiZlia viswavlo amis ukeTesad gakeTeba~, realurad exmareboda studentebs amocanis ukeT SesrulebaSi.

mcdari warmodgenebis Secvla


zogierTi kognitur, bihevioraluri Terapevti, pirvel rigSi, rwmenebis, ganwyobebisa da azrTa Cveuli paternebis Secvlazea mimarTuli. isini amtkiceben, rom mravali fsiqologiuri problema sxva adamianebTan da movlenebTan mimarTebaSi sakuTari Tavisadmi araadekvaturi damokidebulebidan momdinareobs. mcdar azrTa nakadi SeiZleba efuZnebodes; (1) usafuZvlo, arakeTilgonier ganwyobebs (idealurad swavla studentis umniSvnelovani Tvisebaa~); (2) mcdar winapirobebs (Tu yvelafers gavakeTeb, rasac momTxoven, popularuli gavxdebi~) da (3) xist wesebs, romelTac qceva avtomatur reJimSi gadahyavT ise, rom qcevis ukve arsebuli paternebi maSinac ki meordeba, roca realurad ukve usargebloa (unda davemorCilo xelmZRvanelobas~). emociur distress, anu sulier tanjvas araswori warmodgenebi da arsebuli realobisa da sakuTari warmosaxvebis (an molodinebis) erTmaneTisgan gamijvnis unaris arqona badebs.

da cocxlad gamovexmauro maspinZlis monaTxrobs~. ganvlili situaciebis uaryofiTi momentebis Zebnis nacvlad, romelTac veRar Secvlis, klients momavali movlenebis dadebiT aspeqtebze fokusirebas aswavlian. kognitur-bihevioraluri modifikacia klients qcevis warmatebulobaze ganawyobs. Terapevtebma ician, rom am molodinebis Seqmna zrdis adamianebis mxridan efeqturad moqcevis albaTobas. miRwevadi miznebis dasaxvis, maT misaRwevad realisturi strategiebis SemuSavebis da Sedegebis realisturad Sefasebis gziT viTardeba gawafulobis SegrZneba da sakuTari Tavis rwmena, anu TviTefeqturoba (Bandura, 1992, 1997). rogorc me-14 TavSi vnaxeT, TviTefeqturoba mravalmxriv moqmedebs aRqmaze, motivaciasa da qcevaze. sakuTari Tavis rwmenis Sefaseba gavlenas axdens imaze, Tu ra Zalisxmevas gaiRebT da ramdenad didxans SeewinaaRmdegebiT warmoqmnil cxovrebiseul siZneleebs (Schwarzer, 1992). qcevis modelirebis zemoT aRwerili procedura individebs saSualebas aZlevs, rom gaiZlieron sakuTar qcevaSi darwmunebulobis gancda, anu bihevioraluri TviTefeqturoba: isini daiswavlian, rom xelewifebaT garkveuli saxis qcevebis ganxorcieleba. amis sapirispirod, sakuTar azrebsa da warmodgenebSi darwmunebulobis, anu kognituri TviTefeqturobis gamuSavebaze mimarTuli Terapia cvlis klientis mosazrebebs sakuTari SesaZleblobebis Sesaxeb. magaliTad, erT gamokvlevaSi im studentebma, romelTac sjerodaT, rom amocana, romelic maTgan gadawyvetilebis miRebas iTxovda, gaaumjobesebda maT SesaZleblobebs, gacilebiT ukeT

depresiis kognituri Terapia


kognitivisti fsiqoTerapevti pacients exmareba, rom azrovnebis damaxinjebuli, araswori paternebi problemebis gadawyvetis ufro efeqturi meTodebiT Caanacvlos. aaron bekma (Aaron Beck, 1976) warmatebiT gamoscada da moargo kognituri Terapia depresiis mkurnalobas. mkurnalobis formula man martivad Camoayaliba: Terapevti exmareba pacients damaxinjebuli, mcdari azrebis gamovlenasa da miRebuli gamocdilebis formulirebis ufro realisturi gzebis aTvisebaSi~ (gv. 20). magaliTad, depresiul individebs SeiZleba sTxovon, rom daweron is uaryofiTi azrebi, romlebic sakuTari Tavis mimarT uCndebaT; gaarkvion da gaiazron, ratom aris es TviTkritikuli gamonaTqvamebi usafuZvlo da SeimuSavon SedarebiT realisturi (da naklebad damangreveli) warmodgenebi sakuTar Tavze.

677

kognituri Terapiebi

bekis azriT, depresia imitom xangrZlivdeba droSi, rom adamianebma araferi ician im uaryofiTi avtomaturi azrebis Sesaxeb, romlebic, Cveulebriv, maTgan damoukideblad warmoiqneba; avtomaturi azrebis magaliTebia: verasodes viqnebi iseTive kargi, rogoric Cemi Zmaa~, rom gaigon simandvileSi rogori var, aravis veyvarebi~, arc ise Wkviani var, rom rames mivaRwio skolaSi, sadac aseTi gacxarebuli brZolaa pirvelobisTvis~. Terapevti oTx taqtikur svlas axorcielebs, romelic mowodebulia depresiis kognituri safuZvlis Sesacvlelad (Beck & Rush, 1989; Beck et al., 1979): eWvqveS ayenebs klientis sayrden daSvebebs sakuTari moqmedebebis Sesaxeb; afasebs klientis xelT arsebul mtkicebulebebs, romlebic adastureben, an uaryofen avtomaturi azrebis sizustes; gadaaqvs braleuloba situaciur faqtorebze da ar miawers mas klientis mouxerxeblobas an arakompetenturobas; ganixilavs im rTuli amocanebis gadawyvetis alternatiul gzebs, romelTa uSedegod gadawyveta SeiZleboda uaryofiT gamocdilebad qceuliyo klientisTvis. bihevioraluri Terapiebis msgavsad, am TerapiaSic centraluri adgili ukavia klientis mimdinare mdgomareobas. depresiul mdgomareobaSi yofnis erT-erTi uaresi Tanmxlebi movlenaa misTvis damaxasiaTebeli uaryofiTi grZnobebiT cxovrebis aucilebloba da apaTiuroba. sakuTari uaryofiTi guneba-ganwyobilebis Sesaxeb akviatebuli azrebi mexsierebaSi acocxlebs yvelafers, rac ki odesme cudi momxdara cxovrebaSi, rac, Tavis mxriv, kidev ufro amwvavebs daTrgunulobis gancdas. depresiuli adamianebi samyaros depresiis Savi saTvaliT uyureben _ kritikas xedaven iq, sadac ar aris; Seqebas sarkazmad aRiqvamen, rac kidev erTi mizezia~ imisTvis, rom
racionalur-emociuri Terapia (reT) (Rationalemotive therapy RET) pirovnebis Secvlis yovlismomcveli sistema, romelic im iracionaluri azrebis transformacias efuZneba, romelic iwvevs arasasurvel, Zlieri emociuri muxtis mqone iseT reaqciebs, rogoricaa Zlieri SfoTva.

depresiulebi iyvnen. kognituri Terapiebi aCereben depresiis am daRmaval spirals imiT, rom exmarebian klients, ufro metad ar CaiZiros depresiaSi Tavad depresiis gamo (Teasdale, 1985). kognituri Terapiebis daxvewis mizniT, mkvlevrebi agrZeleben depresiis gancdaSi siRrmiseuli azrobrivi wvdomis (insaitis) gamoyenebas (Jacobson et al., 1996; Teasdale et al., 1995). magaliTad, erT-erTi gamokvleviT dasabuTda, rom Terapia yvelaze efeqturia maSin, rodesac misi maxasiaTeblebi miesadageba klientis mosazrebebs sakuTari depresiulobis mizezebis Sesaxeb (Addis & Jacobson, 1996). am codnis gaTvaliswinebiT, klinicistebs yoveli individualuri klientisTvis saTanado mkurnalobis misadageba SeuZliaT.

racionalur-emociuri Terapia
kognituri Terapiis erT-erTi adreuli formaa racionalur-emociuri Terapia (reT), romelic albert eliss (Albert Ellis, 1962, 1995; Windy & Ellis, 1997) ekuTvnis. racionalur-emociuri Terapia pirovnebis Secvlis yovlismomcveli sistemaa, romelic im iracionaluri azrebis transformacias efuZneba, romelic arasasurvel, Zlieri emociuri muxtis mqone iseT reaqciebs iwvevs, rogoricaa Zlieri SfoTva. klientebs SeiZleba hqondeT gamyarebuli ZiriTadi faseulobebi, romlebic moiTxoven, rom iyvnen warmatebulni da aRiarebulni; amtkiceben, rom maT samarTlianad unda moeqcnen da karnaxoben maT, rom irgvliv yvelaferi ufro sasiamovno unda iyos. racionalur-emociuri TerapiiT momuSave praqtikosi aswavlis klients, Tu rogor unda gadaastruqturos yvela saWiroa~, valdebuli xar~ da ase unda iyos~, romelic mis qcevas akontrolebs da ar aZlevs sakuTari survilisamebr cxovrebis saSualebas. Terapevtis amocanaa, daanaxos klients, rom emociuri reaqcia, romelic Tan sdevs nebismier movlenas, sinamdvileSi am movlenis Sesaxeb klientisTvis ucnobi warmodgenebis arsebobis Sedegia. amiT Terapevti klientis Caketil cnobierebaSi SeWras cdilobs. magaliTad, sqesobrivi aqtis dros orgazmis ararseboba (movlena) iwvevs daTrgunulobisa da TviTgakicxvis emociur reaqcias. emociuri reaqciis gamomwvevi warmodgenebi daaxloebiT aseTia: ar vvargivar seqsualuri cxovrebisTvis, albaT, impotenti var,

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Tavi 16 / pirovnebis cvlilebebis Terapiebi

radgan ise ver moviqeci, rogorc unda movqceuliyavi~. Terapiis dros es (da sxva) warmodgenebi Riad ganixileba racionaluri konfrontaciiTa da momxdari movlenis iseTi sxva mizezebis garCeviT, rogoricaa: gadaRla, alkoholis zemoqmedeba, mcdari warmodgenebi sqesobrivi aqtis msvlelobaze, anda mocemul dros, an am konkretul partniorTan urTierTobis damyarebis survilis arqona. konfrontaciis teqnikas Terapiuli zemoqmedebis sxva formebi mohyveba, romliTac xdeba dogmaturi, iracionaluri azrovnebis Canacvleba racionaluri, situaciurad ganpirobebuli ideebiT. racionalur-emociuri Terapia mimarTulia individisTvis sakuTari Rirebulebisa da potencialis SegrZnebis gaZlierebaze, romlis realizeba mas Semdeg gaxdeba SesaZlebeli, rac igi Tavs daaRwevs pirovnuli zrdis damabrkolebel mcdar warmodgenaTa sistemas. am TvalsazrisiT, mas bevri aqvs saerTo humanistur TerapiebTan, romelTac axla ganvixilavT.

Sejameba
kognituri Terapiebis msvlelobisas adamianebis tanjvisgan gaTavisuflebas imis SecvliT cdiloben, Tu ras da rogor fiqroben isini cxovrebiseul movlenebze. kognitur- bihevioraluri modifikaciisas icvleba arasasurveli qcevis paternebi; amisaTvis sakuTari Tavis Sesaxeb uaryofiT gamonaTqvamebs cvlian konstruqciuli, qmediTi gamonaTqvamebiT. depresiis kognituri Terapiisas aRkveTen avtomatur azrebs, cvlian klientis azrebis Cveul nakads da mimdinare movlenebis mizezebis axsnis Cveul paternebs. racionalur-emociuri Terapia xels uwyobs klients cnobierebaSi barierebis daZlevasa da sakuTari survilebiT cxovrebis dawyebaSi.

egzistencialurhumanisturi Terapiebi
yoveldRiuri cxovrebis problemebi, Sinaarsiani adamianuri urTierTobebis arqona da iseTi mniSvnelovani miznebis ararseboba, romelTaTvisac Rirs brZola _ tipuria egzistencia-

luri krizisebisTvis _ ase fiqroben adamianis bunebisadmi humanisturi da egzistencialuri midgomis momxreebi. es mosazrebebi gaerTianda Terapiis ganzogadebul saxeobaSi, romelic mimarTulia yvela adamianisTvis saerTo, yofierebis ZiriTad problemebze. rogorc me-14 TavSi vnaxeT, humanisturi Teoriebis birTvs mTliani pirovnebis cneba warmoadgens, romelic mudmivi cvlilebisa da Camoyalibebis procesSi imyofeba. miuxedavad imisa, rom garemo da memkvidreobiToba garkveul SezRudvebs awesebs, adamianebi Tavad irCeven, rani iyvnen; amisaTvis qmnian faseulobaTa sistemebs da sakuTar gadawyvetilebebSi axorcieleben maT. Tumca, arCevanis Tavisuflebas pasuxismgeblobac axlavs Tan. vinaidan adamianebi bolomde mainc ver acnobiereben TavianTi qcevis yvela SesaZlo Sedegs, SfoTva da sasowarkveTa euflebaT. maT danaSaulis gancdac stanjavT, sakuTari potencialis srulad realizebis SesaZleblobebis xelidan gaSvebis gamo. egzistencialuri fsiqologiis klinikisTvis gankuTvnili axali versia, romelic aerTianebs mis mravalferovan Temebsa da midgomebs, efuZneba mosazrebas, rom Tanamedrove cxovrebis damabneveli realoba adamianisTvis damaxasiaTebel ori ZiriTadi saxis daavadebas aZlevs dasabams. depresiuli da obsesiuri sindromebi realobidan wasvlas asaxavs, sociopaTuri da narcisistuli sindromebi ki _ am realobis eqspluatacias (Schneider & May, 1995). fsiqoTerapevtebi, romlebic praqtikaSi iyeneben adamianis bunebis zogadi Teoriis principebs, exmarebian klientebs, gansazRvron sakuTari Tavisufleba, ganicadon da daafason yvela maTi arsebuli, moqmedi me da mimdinare momentis, imwuTieri gaelvebis simdidre da mravalferovneba; SeZlon sakuTari individualurobis damkvidreba da gamonaxon sakuTari potencialis srulad realizebis (TviTaqtualizaciis) gzebi. egzistencialur midgomaSi mniSvnelovania mimdinare cxovrebiseuli situacia, romelic pirovnebas gamocdilebaSi eZleva. egzistencialur-humanisturma filosofiam, aseve, dasabami misca moZraobas adamianis potencialis ganviTarebisTvis, romelic amerikis SeerTebul StatebSi Camoyalibda XX saukunis 60-iani wlebis bolos. am moZraobaSi saSualo adamianis potencialis ganviTarebis meTodebi

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egsistencialur-humanisturi Terapiebi

fsiqologia XXI saukuneSi

Terapia kompiuteris saukuneSi


fsiqoTerapiisadmi miZRvnili Tavis erT-erTi mniSvnelovani mizania, daganaxoT misi qmediTunarianoba da efeqturoba. gamokvlevebisa da praqtikuli SemTxvevebis aRweriT SegviZlia dagarwmunoT, rom realurad SesaZlebelia fsiqologiuri tanjvis Semsubuqeba. XXI saukunis dasawyisisTvis kompiuteruli teqnologiebis ganviTarebam da kompiuterebis iolad xelmisawvdomobam SesaZlebeli gaxada fsiqologTa da fsiqikuri janmrTelobis sferoSi dakavebul praqtikosTa xelT arsebuli im saSualebebis diapazonis gafarToveba, romlebic Terapiuli cvlilebebis misaRwevad gamoiyeneba. magaliTad, dResdReobiT mraval adamians aqvs SesaZlebloba saubriT gankurnebis~ _ iseTi interaqtiuri Terapiis, romelic
froidma da misma mimdevrebma ganaviTares Terapevtisa da pacientis pirispir urTierTobis pirobebSi _ gamocdileba eleqtronuli fostiT, an internetiT miiRos (Fink, 1999; King & Moreggi, 1998). kompiuteris gamoyenebiT ganxorcielebuli Terapiisas Terapevti da klienti eleqtronuli fostiT ukavSirdebian erTmaneTs. mkvlevrebma Tavidanve miuTiTes internetiT Terapiis potenciur naklovanebebsa da sargebelze. maTi azriT, aseTi Terapiis nakli isaa, rom SezRuduli da damaxinjebuli informaciis miwodebis SemTxvevaSi Terapevtma SeiZleba araswori diagnozi dasvas, gadamowmebis saSualeba ki mas ar eqneba, rogorc es pirispir situaciaSia SesaZlebeli (King & Moreggi, 1998). garda amisa, momxmareblebs iSviaTad SeuZliaT internet-fsiqologTa kompetenturobis gadamowmeba; kibersivrceSi eqspertoba nebismierma SeiZleba daibralos. miuxedavad am naklovanebebisa, eleqtronuli fostiT ganxorcielebuli Terapia unikalur SesaZleblobebs aZlevs Terapevtebsa da maT klientebs. magaliTad, bevr Terapevts miaCnia, rom am formis Terapiis fardobiTi anonimuroba klientebs yvelaze Semawuxebeli problemebis gacilebiT swrafad da sircxvilis gareSe gamovlenis SesaZleblobas aZlevs; isini SeiZleba gacilebiT gulwrfelni iyvnen, roca ar uwevT sakuTar monaTxrobze Terapevtis dakvirvebadi reaqciebis gamo nerviuloba (Grohol, 1998). kibersivrceSi Terapiis yvela uaryofiTi da dadebiTi mxaris gaTvaliswinebiT, mkvlevrebma

Tavi 16 / pirovnebis cvlilebebis Terapiebi

gaerTianda, romelic miznad isaxavda mis ufro srulad gamoyenebasa da pirovnuli gamocdilebis mniSvnelovnad gamdidrebasa da gamravalferovnebas. am moZraobis wyalobiT, Terapia, romelic Tavdapirvelad mowodebuli iyo fsiqologiuri aSlilobebis mqone adamianebisTvis, gafarTovda da gamoyenebadi gaxda fsiqikurad janmrTeli adamianebisTvisac, romelTac surdaT, rom yofiliyvnen metad efeqturebi, metad produqtulebi da gacilebiT ufro bednieri adamianebi.
moZraoba adamianis potencialis ganviTarebisTvis (Human-potential movement) _ Terapiuli moZraoba, romelic moicavs yvela im meTods da praqtikul saqmianobas, rac xels uwyobs saSualo adamianis potencialis gamovlenas, misi ufro srulad gamoyenebisa da pirovnuli gamocdilebis mniSvnelovnad gamdidrebisa da gamravalferovnebis mizniT.

Cven ganvixilavT humanistur-egzistencialur tradiciebze ganviTarebul sam Terapiul midgomas: klientze centrirebul Terapias, jgufur Terapiasa da ojaxuri wyvilebisa da ojaxis Terapias.

klientze centrirebuli Terapia


klientze centrirebulma Terapiam, romelic karl rojersma (Carl Rogers, 1951, 1977) SemogvTavaza, mniSvnelovani gavlena moaxdina imaze, Tu rogor xedaven sxvadasxva mimarTulebis Terapevtebi klient-Terapevtis urTierTobas. klientze centrirebuli Terapiis upirvelesi mizania pirovnebis jansaRi fsiqologiuri zrdis waxaliseba da xelSewyoba. es midgoma efuZneba daSvebas, rom yvela adamiani xasiaTdeba TviTaqtualizaciis _ sa-

680

fsiqikuri janmrTelobis saerTaSoriso internet-sazogadoeba Camoayalibes, romelic mowodebulia internet-Terapiis praqtikuli da eTikuri SezRudvebis Sesaswavlad. garda amisa, Terapevtebi igoneben internetisa da kompiuterebis gamoyenebis axal saSualebebs, romliTac SesaZlebeli iqneba ufro viwro profilis Terapiuli daxmarebis gaweva (Newman et al., 1999; Strm et al., 2000). magaliTad, mkvlevarTa erTma jgufma Seqmna kompiuteruli programa, romelic mowodebuli iyo panikuri aSlilobis kognitur bihevioraluri mkurnalobisTvis ( Newman et al., 1997). eqsperimentSi Sedarda cdis pirTa ori jgufis mkurnalobis monacemebi: erT jgufs, nawilobriv, kompiuteris daxmarebiT umkurnales, meorem ki _ tradiciuli Terapiis sruli kursi gaiara. orive SemTxvevaSi mkurnaloba bihevioralur komponents _

SemaSinebeli situaciebis wardgenas da relaqsacias da kognitur komponents _ kognitur gadastruqturebas moicavda. Terapiuli programa CatvirTuli iyo jibis portatul kompiuterebSi. amitom klientebs, msubuqi wonis gamo, yvelgan SeeZloT maTi tareba. kompiuteruli programa sxvadasxva saxis mxardaWeras uzrunvelyofda; maT Soris iyo moduli, romelsac ekranze gamohqonda gamonaTqvamebi sakuTari Tavis Sesaxeb da SeTavazebebi azrovnebis mimarTulebis Secvlis Taobaze. aseve, iyo moduli, romelic axleburad sunTqvis Cvevas karnaxobda klients. orive Terapia warmatebuli aRmoCnda: mkurnalobidan eqvsi Tvis Semdeg orive jgufs SenarCunebuli hqonda TerapiiT miRweuli Sedegebi. magaliTad, orive tipis mkurnalobis Semdeg monawileTa 67%-s aRar aReniSneboda panikuri Setevebi. aseTi gamokvlevebi imeds gvaZlevs,

rom Terapevtis Semcvleli kompiuteruli programebiT mkurnalobis kursis gavla klientebs nebismier dros SeeZlebaT. rogorc winamdebare TavSi vnaxeT, arsebul fsiqoTerapiaTa umravlesobis ganviTarebis aucilebel pirobas Terapevtisa da pacientis Tu klientis pirispir urTierToba Seadgenda. XXI saukunis dasawyisSi mkvlevrebi cdiloben, daadginon, Tu ra situaciebSia SesaZlebeli, rom kompiuterebi da interneti am pirispir urTierTobis sasargeblo damxmare gaxdes. veb-gverdebi: www.ismho.org - fsiqikuri janmrTelobis saerTaSoriso internet-sazogadoebis veb-gverdi. www.metanoia.org/imhs/ - wamyvani veb gverdi, sadac mocemulia dadasturebuli saTanado kvalifikaciis mqone TerapevtTa CamonaTvali.

kuTari SesaZleblobebis realizaciis _ umTavresi tendenciiT. rojersi darwmunebuli iyo, rom organizmi bunebrivad iswrafvis yvela sakuTari SesaZleblobis realizaciisken, raTa gaZlierdes da gaumjobesdes~ (1959, gv. 196). jansaR ganviTarebas araswori daswavlis paternebi abrkolebs; amasTan, pirovneba eTanxmeba sxvebis mier mis mimarT gamoTqmul Sefasebebs nacvlad imisa, rom mousminos da miendos sakuTar gonebasa da sxeuls. konfliqti, bunebrivad dadebiT me-s xatsa da Tavsmoxveul uaryofiT kritikas Soris, SfoTvasa da ubedurebis gancdas badebs. es konfliqti, anu Seusabamoba SeiZleba cnobierebis farglebs miRma mimdinareobdes, amitom adamiani Tavs ubedurad da gaufasurebulad grZnobs, Tumca, ar icis, ratom. rojersianuli Terapiis amocanaa iseTi Terapiuli garemos Seqmna, romelic klients saSualebas aZlevs, naxos, Tu rogor unda moiqces

klientze centrirebuli Terapia (Client centered therapy) mkurnalobisadmi humanisturi midgoma, romelic xazs usvams pirovnebis jansaR fsiqologiur zrdas; efuZneba mosazrebas, rom yvela adamiani xasiaTdeba TviTaqtualizaciis umTavresi tendenciiT.

egsistencialur-humanisturi Terapiebi

sakuTari Tavis gasaumjobeseblad da TviTaqtualizaciisTvis. vinaidan iTvleba, rom adamiani bunebiT keTili da kargi arsebaa, Terapevtis amocana ZiriTadad isaa, rom klients daxmareba gauwios im dabrkolebebis gadalaxvaSi, romelic zRudavs bunebrivad dadebiTi midrekilebebis gamovlenas. ZiriTadi Terapiuli strategiaa klientis grZnobebis danaxva, miReba da gageba, rac upirobo keTilganwyobis _ gankiTxvis gareSe miRebisa da pativiscemis _ atmosferoSi xdeba. Terapevtic Tavisuflad gamoxatavs klientTan sakuTar azrebsa da grZnobebs. aseTi gulwrfelad gaxnili situa-

681

Tavi 16 / pirovnebis cvlilebebis Terapiebi

ciis gansamtkiceblad Terapevti cdilobs, rom Tavadac ganimsWvalos klientis grZnobebiT. aseTi empaTiisTvis saWiroa, rom Terapevti klients epyrobodes, rogorc pativsacem, qmediTunarian pirovnebas, romelic ki ar unda ganikiTxos an Seafasos, aramed romelsac unda daexmaros sakuTari individualobis aRmoCenaSi (Meador & Rogers, 1979). Terapevtis damokidebuleba da emociuri stili klientis waxalisebis saSualebaa, raTa man kidev erTxel gadaxedos pirovnuli konfliqtis WeSmarit wyaroebs da gaTavisufldes gavlenisgan, romelic TviTaqtualizacias abrkolebs. Tu Terapevtebi, romlebic sxva TerapiebiT muSaoben, mosmenilis interpretacias axdenen, pasuxebs, an miTiTebebs iZlevian, Terapevti, romelic klientze centrirebuli TerapiiT muSaobs, mxardamWeri da monawile msmenelia, romelic msjelobs da xandaxan formas ucvlis klientis SefasebiT gamonaTqvamebsa da gamoxatul grZnobebs. klientze centrirebuli Terapia cdilobs, rom aradireqtiuli iyos _ is mxolod exmareba klients sakuTar TavSi garkvevasa da sakuTari me-s miRebaSi. rojerss miaCnda, rom, Tu adamianebs sxvebTan Tavisuflad urTierTobisa da sakuTari Tavis miRebis SesaZleblobas mivcemT, maT Tavad SeeZlebaT sakuTari fsiqologiuri sijansaRis aRdgena. am optimisturma mosazrebam da Terapevtis, rogorc mzrunveli eqspertis, da klientis, rogorc pirovnebis, humanurma urTierTobam mraval praqtikos-Terapevtze moaxdina gavlena.

geStalt-Terapia
geStalt-Terapia, pirovnebis mTlianobis aRdgenis mizniT, gonebisa da sxeulis gaerTianebazea mimarTuli (gavixsenoT, aRqmisadmi geStalt-fsiqologiuri midgoma, romelzec me5 TavSi gvqonda saubari). misi mizania sakuTari Tavis Secnoba, anu TviTSemecneba, rac Semdegnairad miiRweva: klients exmarebian, rom gamoxatos Sekavebuli grZnobebi da aRiaros warsulis konfliqtebis Semdeg darCenili
geStalt-Terapia (Gestalt therapy) Terapia, romelic mimarTulia pirovnebis gamTlianebis mizniT gonebisa da sxeulis gaerTianebaze.

daumTavrebeli saqmeebis arseboba, romlebic mas axal urTierTobebSi gadaaqvs da romelTa damTavreba aucilebelia pirovnuli zrdis gasagrZeleblad. geStalt-Terapiis fuZemdebeli _ fric perlzi (Fritz Perlz, 1969) Tavis klientebs konfliqtebTan dakavSirebuli fantaziebisa da Zlieri grZnobebis gaTamaSebas sTxovda. isini aseve, aRadgendnen sakuTar sizmrebs, romelTac perlzi maTi pirovnebis aracnobierSi gandevnil nawilad miiCnevda. perlzi ambobda: Cven xelaxla unda vaRiaroT da Cvenad miviRoT sakuTari pirovnebis es proecirebuli, danawevrebuli nawilebi da Cvenad unda miviRoT is dafaruli potenciali, romelic sizmarSi iCens Tavs~ (1969, gv. 67). geStalt-Terapiuli Sexvedrebis dros xdeba monawileTa waxaliseba, rom aRadginon kontaqti TavianT WeSmarit Sinagan xmebTan~ (Hatcher & Himelstein, 1996). geStalt-Terapiis erT-erT yvelaze cnobil meTods carieli skamis teqnika ewodeba: Terapevti klientTan axlos dgams cariel skams. klientma unda warmoidginos, rom skamze moTavsebulia romelime grZnoba, pirovneba, obieqti an situacia. igi esaubreba~ skamze mjdoms~. magaliTad, klientma SeiZleba warmoidginos, rom skamze misi deda, an mama zis; is maT mimarT gamoxatavs grZnobebs, romelTac sxvagvarad ar gamoxatavda. Semdeg klientma SeiZleba warmoidginos, rom axla es grZnobebi sxedan~ skamze da maT gaesaubros~ imis Sesaxeb, Tu ra gavlena aqvT maT klientis cxovrebaze. es teqnika saSualebas aZlevs klients, daupirispirdes da gamoikvlios gamoxatvis gareSe darCenili Zlieri grZnobebi, romlebic, SesaZloa, gavlenas axdendnen mis fsiqologiur keTildReobaze.

Sejameba
egzistencialur-humanistur TerapiebSi xazgasmulia mTliani pirovnebis cneba, romelic mudmivi cvlilebisa da Camoyalibebis procesSi imyofeba. karl rojersma Seqmna klientze centrirebuli Terapia, romelic miznad isaxavs aradireqtiuli garemos Seqmnas, sadac klienti SeZlebs arasworad naswavli paternebis daZlevas da sakuTari Tavis gaumjobesebisa da TviTrealizaciis miRwevas. geStalt-Terapia

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xels uwyobs jgufis monawileebs gonebisa da sulis gamTlianebaSi, rasac grZnobebis gamoxatviTa da konfliqtebis gacnobierebiT aRwevs. mravali adamiani sargeblobs TviTdaxmarebis jgufebis fsiqologiuri mxardaWeriT.

jgufuri Terapiebi
mkurnalobisadmi yvela aqamde ganxiluli midgoma, pirvel rigSi, Terapevti-pacientis, an Terapevti-klientis pirispir, erTi-erTze urTierTobas iTvaliswinebda. miuxedavad amisa, dResdReobiT mravali adamiani iRebs Terapiul daxmarebas, rogorc jgufis wevri. jgufuri Terapiis ganviTarebis ramdenime mizezi arsebobs. aqve unda iTqvas, rom jgufuri Terapia zogjer SeiZleba ufro efeqturi iyos, vidre individualuri Terapia (Fuhriman & Burlingame, 1994). jgufuri Terapiis zogierTi upiratesoba praqtikuli xasiaTisaa: is ufro iafia da mcire raodenobis fsiqoTerapevtebs meti klientisTvis SeuZliaT daxmarebis gaweva. danarCeni upiratesobebi jgufuri garemos Zalas, anu jgufis efeqts ukavSirdeba: jgufi (1) SedarebiT usafrTxo garemos qmnis im adamianebisTvis, vinc iolad eqceva sxvaTa gavlenis qveS da Tavad ver axerxeben maTgan Tavis daRwevas; (2) iZleva

saSualebas, rom jgufSi mimdinare procesebma gavlena moaxdinos calkeuli monawileebis araadaptur qcevaze; (3) SesaZleblobas aZlevs adamianebs, rom Terapiuli seansebis msvlelobisas daakvirdnen sxvebs da pirovnebaTSorisi urTierTobis unar-Cvevebi gaivarjiSon; (4) uzrunvelyofs pirveladi ojaxuri jgufis analogias, rac emociuri gamocdilebis koregirebis saSualebas iZleva. jgufuri Terapiis zogierTi wanamZRvari gansxvavdeba individualuri Terapiis wanamZRvrebisgan. jgufuri Terapiis socialuri garemo SesaZleblobas gvaZlevs viswavloT sakuTari mosazrebebis gamoxatva iseTi formebiT, rom isini sxvebisTvisac gasagebi gaxdes; vnaxoT, ramdenad gansxvavdeba Cven mier sxvebze moxdenili STabeWdileba imisgan, rogori STabeWdilebis moxdenasac vcdilobdiT, an imisgan, rogoric warmogvidgenia sakuTari Tavi. garda amisa, jgufi TvalsaCinod gvaCvenebs da gvarwmunebs, rom Cveni simptomebi, problemebi da devianturi~ qcevebi ar aris erTaderTi da ganumeorebeli _ isini sakmaod xSiria da adamianTa did raodenobas axasiaTebs. vinaidan adamianebs ar uyvarT sxvebTan TavianT uaryofiT mxareebze saubari da sakuTar Tavze uaryofiTi informaciis gacema, mosalodnelia, rom erTi da igive problemis mqone mraval adamians egonos, rom is aris erTaderTi, visac es problema aqvs~. jgufur situaciaSi gamocdilebis gaziareba exmareba adamianebs, gaaqarwylon es pluralisturi umecreba _ mravali maTganisTvis saerTo mcdari warmodgena unikalur, ganumeorebel marcxze. garda amisa, jgufuri Terapiis procesSi dawyebuli urTierToba da urTierTdaxmareba SeiZleba mkurnalobis dasrulebis Semdegac gagrZeldes.

jgufebis umravlesoba Sedgeba erTmaneTisTvis ucxo adamianebisgan, romlebic jgufSi droebiTi urTierTobebis dasamyareblad modian, ramac SeiZleba garkveuli sargebeli misces maT. ojaxuri wyvilebisa da ojaxis Terapiis SemTxvevaSi Terapiul garemoSi Semodian mravalmxrivi kavSirebiT gamyarebuli, ukve arsebuli erTeulebi.

683

jgufuri Terapiebi

ojaxuri wyvilebisa da ojaxis Terapia

saidan viciT
ojaxis Terapia da mozardebis mier narkotikebis moxmareba mozardebis mier narkotikebis moxmarebis Sesamcireblad mkvlevarTa jgufma gadawyvita jgufuri Terapiis gamoyeneba. maTi ZiriTadi hipoTeza iyo: kvlevaSi monawile mozardebi maSin ufro Seamcirebdnen narkotikebis moxmarebas, Tu mTlianad Seicvleboda maTi ojaxuri garemo. amitom ojaxis Terapiis samizne iyo rogorc mozardTa moqmedebebis gamosworeba, ise _ mSoblebis mier gamoyenebuli aRzrdis meTodebis gaumjobeseba. eqvsTviani mkurnalobis kursis dasawyisisTvis ojaxebze dakvirvebam gamoavlina, rom mSoblebisTvis Cveuli uaryofiTi qcevebi SvilebTan urTierTobisas (magaliTad, uaryofiTi emociebis gamoxatva, sityvieri agresia) _ 72%, sWarbobda dadebiT qmedebebs (magaliTad, optimizmisa da siyvarulis gamoxatvas) _ 53%; Terapiis dasasrulisTvis ki, dadebiTma urTierTobis Cvevebma _ 77%, gadaaWarba uaryofiTs _ 47%. garda amisa, im mSoblebis Svilebma, romlebmac aRzrdis stilis zogadi gaumjobeseba aCvenebs, mniSvnelovnad Seamcires narkotikebis moxmareba (Schmidt et al., 1996).
Tavi 16 / pirovnebis cvlilebebis Terapiebi

684

qorwinebaSi warmoqmnili problemebis Taobaze ojaxuri wyvilebis konsultacia partniorTa Soris informaciis gacvlis Cveuli paternebis gamovlenas da Semdeg maTi urTierTqmedebis xarisxis gaumjobesebas gulisxmobs (Napier, 2000). wyvilTan erToblivi SexvedrebiT, xSir SemTxvevebSi, maTi urTierTqmedebis videofirze CaweriTa da Semdeg Canaweris garCeviT, Terapevts SeuZlia daexmaros maT urTierTobis im verbaluri da araverbaluri stilebis danaxvasa da garCevaSi, romelsac isini erTmaneTze upiratesobis mopovebis, an marTvis, anda erTmaneTis dabnevis da SecdomaSi Seyvanis mizniT iyeneben. TiToeul mxares aswavlian, Tu rogor unda ganamtkicos meoresTan sasurveli reaqciebi da yuradRebis gareSe datovos arasasurveli reaqciebi. garda amisa, isini iTviseben aradireq-

tiuli mosmenis unar-Cvevebs, raTa partniors grZnobebisa da azrebis naTlad gamoxatvaSi daexmaron. qorwinebis problemebis mogvarebisTvis wyvilebis Terapia gacilebiT efeqturia, vidre individualuri Terapia mxolod erTi partniorisTvis. amasTan, Sedegebi aCvenebs, rom mcirdeba ojaxuri krizisebis raodenoba, wyvili ki inarCunebs qorwinebas (Shadisn et al., 1993, 1995). ojaxuri Terapiis klienti mTliani ojaxia, romelsac aqvs Tavisi birTvi, xolo ojaxis TiToeuli wevri ganixileba, rogorc urTierTqmedebaTa sistemis wevri (Schwebel & Fine, 1994). ojaxis fsiqoTerapevti ojaxis Sewuxebul, aforiaqebul wevrebTan muSaobs da maT imis garkvevaSi exmareba, Tu ra uqmnis erT, an ramdenime maTgans problemebs. Terapiis mizania adamianebs Soris fsiqologiuri manZilebis da erTi mTlianis saxiT moqmedi adamianebis pirovnebaTSorisi dinamikis Secvla, rac gansxvavdeba calkeuli araadapturi individebis qcevis Secvlisgan. ganvixiloT ojaxis Terapiis magaliTi, romelic mozardebis mier narkotikebis moxmarebis mizeziT ganxorcielda. es gamokvleva ojaxis Terapiis mniSvnelovnebis TvalsaCino magaliTia. vinaidan mTel ojaxTan muSaobdnen, Terapiulma Carevam Secvala garemos is faqtorebi, romelmac, SesaZloa, miiyvanes kidec mozardi narkotikebis gasinjvamde da moxmarebamde. ojaxis Terapias SeuZlia ojaxSi arsebuli daZabulobis Semcireba da calkeuli wevrebis funqcionirebis gaumjobeseba imiT, rom daexmaros klientebs da daanaxos maTi urTierTobis rogorc dadebiTi, ise _ uaryofiTi aspeqtebi. virjinia satiri (Virginia Satir, 1967), ojaxis Terapiis meTodebis avtori, aRniSnavda, rom ojaxis TerapiiT dakavebuli fsiqoTerapevti mraval rols asrulebs: is aris Terapiul seansebze ganxorcielebuli urTierTqmedebebis interpretatori da amxsneli; is aris gavlenis wyaro, Suamavali da arbitri. ojaxis TerapiiT dakavebul praqtikosTa umravlesobas miaCnia, rom Terapiis procesSi ganxiluli da mogvarebuli problemebi situaciuri xasiaTisaa da adamianebs Soris warmoqmnil siZneleebs, an socialuri urTierTqmedebis problemebs warmoadgens, da ara _ pirovnebebis dispoziciur aspeqtebs. es siZneleebi droTa ganmavlobaSi SeiZleba warmoiqmnas, rodesac ojaxis wevrebi iZulebul-

ni xdebian Seasrulon, an Tavis Tavze aiRon arasasiamovno rolebi. ojaxis bunebrivi ganviTarebis procesSi _ iqneba es samuSaos dakargva, bavSvis skolaSi miyvana, qorwineba Tu bavSvis dabadeba _ sruliad SesaZlebelia urTierTqmedebis araefeqturi formebis Camoyalibeba. ojaxis Terapevtis amocanaa ojaxis struqturis garkveva da masze moqmedi Zalebis (da es Zalebi SeiZleba uamravi iyos) gamovlena. is muSaobs ojaxis wevrebTan da am muSaobis mizania disfunqciuri~ struqturuli elementebis gaqroba da axali, ufro efeqturi struqturebis SemuSaveba da ganmtkiceba (Fishman, 1993).

sazogadoebrivi mxardaWeris jgufebi


fsiqoTerapiis ganviTarebaSi amaRelvebeli periodi iyo TviTdaxmarebis jgufebisadmi interesis gaZliereba. yovelwliurad amerikis daaxloebiT 10 milioni mozrdili moqalaqe dadis aseTi jfugebis Sexvedrebze (Kessler et al., 1997). mxardamWeri jgufebis Sexvedrebi, rogorc wesi, ufasoa, gansakuTrebiT im SemTxvevaSi, Tu jgufis wamyvanebi ar arian janmrTelobis dacvis sferoSi momsaxure profesionalebi. aseTi jgufebi adamianebs saSualebas aZlevs, Sexvdnen msgavsi problemebis mqone sxva adamianebs, romlebic agrZeleben cxovrebas da xandaxan wamratebebsac aRweven. specialur jgufebSi TviTdaxmarebis idea pirvelad gamoiyena organizaciam anonimuri alkoholikebi~ (AA), Tumca, alkoholizmis farglebidan gaitana da ganavrco XX saukunis 60-ian wlebSi dawyebulma qalTa moZraobam, romelic mowodebuli iyo sazogadoebrivi cnobierebis gaZlierebisTvis. dResdReobiT mxardaWeris jgufebi oTxi ZiriTadi kategoriis problemebze muSaoben: damokidebulebis sxvadasxva formebi, fizikuri daavadebebi da fsiqikuri aSlilobebi, cxovrebiseuli cvlilebebi da sxva krizisebi, seriozuli problemebis mqone megobrebis an naTesavebis gamo miRebuli travmebi. ukanasknel wlebSi adamianebma daiwyes internetis, rogorc TviTdaxmarebis jgufebis kidev erTi formis, gamoyeneba. zogadad, TviTdaxmarebis internetjgufebi imave sakiTxebiT arian dakavebulni, romliTac maTi fizikuri oreulebi (Davison et al., 2000). Tumca, interneti gansakuTrebiT mniSvne-

lovan Sexvedris adgils warmoadgens iseT mdgomareobaSi myofi adamianebisTvis, romelTac avadmyofobis _ magaliTad, qronikuli gadaRlis sindromis, an gafantuli sklerozis _ gamo SezRuduli aqvT gadaadgilebis SesaZlebloba. jgufis Sexvedrebze fizikurad misvlis SeuZlebloba aRar arTmevs adamianebs TviTdaxmarebis jgufebis muSaobidan sargeblis miRebis saSualebas. mkvlevrebi did yuradRebas uTmoben imis garkvevas, Tu ra Taviseburebebi unda hqondes TviTdaxmarebis jgufs, rom maqsimaurad efeqturi iyos. rogorc maTi moRvaweobidan Cans, aseTi jgufebi mTel rig funqciebs asruleben TavianTi wevrebisTvis; magaliTad, adamianebs unergaven imeds da rwmenas, rom SeuZliaT sakuTari problemebis gakontroleba; uzrunvelyofen socialur mxardaWeras cxovrebiseuli sirTuleebiT gatanjuli adamianebisTvis; uzrunvelyofen aSlilobebisa da mkurnalobebis Sesaxeb informaciis gacvlas (Riessman, 1997; Schiff & Bargal, 2000). Tu aseT jgufSi monawileobas gadawyvetT, gaiTvaliswineT, rom es jgufebi gansakuTrebiT kargad moqmedebs adamianebis mier sakuTari keTildReobis gancdaze, rodesac isini kmayofilni arian SexvedrebiT (Schiff & Bargal, 2000). magaliTad, erTi gamokvlevis Sedegad cnobili gaxda, rom is adamianebi, romelnic gansakuTrebiT miejaWvnen anonimur alkoholikTa sazogadoebas mas Semdeg, rac alkoholizmis mkurnalobis kursi gaiares, alkoholisken miswrafebis ganaxlebis gansakuTrebiT naklebi midrekilebiT xasiaTdebodnen. naTelia, rom am sazogadoebasTan mWidro urTierToba individebs, alkoholizmis kontrolis TvalsazrisiT, sakuTari qcevis sisworeSi darwmunebulobis ganmtkicebis SesaZleblobas aZlevs (Morgenstern et al., 1997). TviTdaxmarebis ganviTarebaSi mniSvnelovani wvlili Seitana jgufuri Terapiebis gamoyenebam ukurnebeli daavadebebis mqone adamianebTan. aseTi Terapiis mizania, daexmaros pacientebsa da maT ojaxebs, rom avadmyofobis periodSi SeZlebisdagvarad savse cxovrebiT icxovron, realurad Sexedon gardauval sikvdils da Seeguon ukurnebel sens (Fobair, 1997; LrGrand, 1991). ganukurnebel pacientebTan aseTi mxardamWeri jgufebis muSaobis zogadi mimarTulebaa _ aswavlon maT, Tu rogor icxovron savse cxov-

685

jgufuri Terapiebi

rebiT im momentamde, rodesac isini ityvian mSvidobiT~ (Nungesser, 1990). jgufuri Terapiebi bolo magaliTia Cven mier ganxiluli Terapiebisa, romlebic mxolod fsiqologiur mkurnalobazea dafuZnebuli _ mkurnalobaze, romelic zemoqmedebs tvinis software-ze. axla SevudgebiT imis garkvevas, Tu rogor muSaoben biosamedicino Terapiebi, gonebaze zemoqmedebis mizniT, sxeulisa da tvinis hardware-is Secvlaze,

narkotikebi da Zaladoba, aseve, SeuZlia tvinis qimiis da moqmedebis Secvla. biosamedicino Terapiebi, umeteswilad, fsiqikur aSlilobebs tvinis hardware-is problemebad miiCneven. fsiqologiuri aSlilobebis simptomebis Semsubuqebis sami saxis biosamedicino midgomas aRvwerT: _ fsiqoqirurgias, eleqtrokonvulsiur Soks da farmakoTerapias.

fsiqoqirurgia da eleqtrokonvulsiuri Terapia


Sejameba
jgufuri Terapiebi ufro xelmisawvdoms xdis fsiqikur janmrTelobaze zrunvas; amasTan, socialuri qcevebis dakvirvebisa da aTvisebis SesaZleblobas iZleva. ojaxuri wyvilebisa da ojaxis Terapia individis iseT problemebze muSaobs, romlebic Seguebas ukavSirdeba da urTierTobebis sistemebSi wrmoqmnili siZneleebis Sedegebs warmoadgens. Terapiis mizania wyvilebsa da ojaxebSi urTierTobebis sistemebis Secvla. mravali adamiani TviTdaxmarebis jgufebSi iRebs fsiqologiur mxardaWeras. es jgufebi individebs aZleven imeds, socialur mxardaWeras da informacias rogorc fizikur, ise _ kibersivrceSi. los anjeles Taims~-is saTauri iuwyeboda: tvinSi moxvedrili tyvia adamians fsiqikuri daavadebisgan kurnavs~ (2/23/188). statia 19 wlis axalgazrda mamakacis Sesaxeb mogviTxrobda, romelic obsesiur-kompulsuri aSlilobiT itanjeboda. TviTmkvlelobis mcdelobisas man pirdapir SublSi isrola 22 kalibriani tyvia. saintereso iyo, rom is gadarCa, ganikurna paTologiuri simptomatikisgan da uvneblad SeunarCunda gonebrivi SesaZleblobebi, Tumca, problemis zogierTi mizezi jer kidev arsebobda. es SemTxveva biosamedicino Terapiis erTerTi yvelaze pirdapiri gamoyenebis SesaZleblobas _ tvinSi qirurgiul Carevas _ gviCvenebs. aseTi Careva tvinis nawilebs Soris kavSirebis CaWras an mcire nawilis amokveTas gulisxmobs. xSirad es ukanaskneli gzaa iseTi fsiqopaTologiebis mkurnalobisas, romelTa daZleva ver moxerxda sxva, ara aseTi ukiduresi Terapiuli zemoqmedebiT. fsiqoqirurgia zogadi terminia, romelic aerTianebs tvinis qsovilze ganxorcielebul qirurgiul procedurebs, fsiqologiuri aSlilobebis Semsubuqebis, an aRkveTis mizniT. Sua saukuneebSi fsiqoqirurgia SeSlilTa tvinebidan sisulelis marcvlis amokveTas~ niSnavda, rac xatovnad aris asaxuli maSindel graviurebsa da ferwerul tiloebze. Tanamedrove fsiqoqirurgiul procedurebSi Sedis korZiani sxeulis boWkoebis amokveTa mwvave epilefsiuri gulyrebis Sesamsubuqeblad, razec me-3 TavSi vsaubrobdiT _ limburi sistemis funqcionirebis ganmapirobebeli gzebis CaWra (amigdalotomia) da prefrontaluri lobotomia. fsiqoqirurgiis yvelaze cnobili formaa prefrontaluri lobotomia _ operacia, romlis drosac iWreba Tavis tvinis Sublis

biosamedicino Terapiebi
Tavi 16 / pirovnebis cvlilebebis Terapiebi

tvinis ekologia myife balansiT xasiaTdeba. rodesac tvinSi rame arasworad xdeba, Cven qcevis paTologiuri paternebs, an ucnaur kognitur da emociur reaqciebs vxedavT. garemos, socialur Tu qceviT darRvevebs, rogoricaa
fsiqoqirurgia (Psychosurgery) _ fsiqologiuri aSlilobis Semsubuqebis an aRkveTis mizniT tvinis qsovilze ganxorcielebuli qirurgiuli procedurebi. prefrontaluri lobotomia (Prefrontal lobotomy) _ operacia, romlis drosac iWreba Tavis tvinis Sublis wilebisa da diencefalonis SemaerTebeli nervuli boWkoebi, gansakuTrebiT, TalamusTan da hipoTalamusTan ganlagebuli boWkoebi; fsiqoqirurgiis yvelaze cnobili forma.

686

wilebisa da diencefalonis SemaerTebeli nervuli boWkoebi, gansakuTrebiT, TalamusTan da hipoTalamusTan ganlagebuli boWkoebi. procedura SeimuSava egaS moniSma (Egas Moniz). man 1949 wels nobelis premia miiRo mkurnalobis sakuTar meTodSi, romelic, rogorc Canda, cvlida fsiqikurad daavadebul adamianTa finqcionirebas. Tavdapirvelad lobotomiis kandidatebi agznebadi Sizofreniuli pacientebi da kompulsiuri da SfoTviTi aSlilobebis mqone pacientebi iyvnen. fsiqoqirurgiis efeqti STambeWdavi iyo: proceduris Semdeg saxeze iyo axali pirovneba, romelic ar xasiaTdeboda Zlieri emociuri agznebiT da, Sesabamisad, arc yovlismomcveli SfoTviT, danaSaulis gancdiTa da risxviT itanjeboda. Tumca, operacia samudamod anadgurebda adamianis bunebis arsebiT maxasiaTeblebs: pacientebi, romelTac lobotomiis procedura hqondaT gavlili, kargavdnen sakuTar unikalur pirovnul maxasiaTeblebs. lobotomiis Semdeg maT aRar SeeZloT momavlis dagegmva, axasiaTebdaT gulgriloba garSemomyofTa mosazrebebisadmi, infantilizmi, inteleqtualuri da emociuri gasadaveba; eseni iyvnen adamianebi sakuTari me-s mTlianobis gancdis gareSe (moniSis erT-erTi pacienti imdenad gaognebuli da ganawyenebuli iyo aseTi moulodneli SedegebiT, rom esrola kidec eqims, ris Semdegac is nawilobriv paralizebuli darCa.) vinaidan fsiqoqirurgiis moqmedeba Seuqcevadia da vinaidan kargad aris cnobili misi mZime uaryofiTi

eleqtrokonvulsiuri Terapia (ekT) (Electroconvulsive therapy ECT) _ eleqtrokonvulsiuli Sokis gamoyeneba Rrma depresiis warmatebulad samkurnalod.

687

biosamedicino Terapiebi

Sedegebi, dadebiTi ki _ naklebad TvalsaCinoa, misi gamoyeneba Zalian SezRudulia. eleqtrokonvulsiuri Terapia (ekT) aris Tavis tvinze eleqtruli Sokis gamoyeneba iseTi fsiqiatriuli aSlilobebis mkurnalobis mizniT, rogoricaa Sizofrenia, mania da, yvelaze xSirad, depresia. meTodika aseTia: pacientis safeTqlebze moqmedeben susti eleqtruli nakadiT (75-dan 100 voltamde) 1/10 wamidan erT wamamde manam sanam ar moxdeba konvulsia. konvulsia, Cveulebriv, 45-dan 60 wamamde grZeldeba. pacients winaswar amzadeben aseTi mtkivneuli mkurnalobisTvis _ amSvideben xanmokle moqmedebis barbituratebiT da kunTebis mosadunebeli preparatebiT, rasac pacienti ugono mdgomareobaSi gadahyavs da rac minimumamde amcirebs Zlier umarTav fizikur reaqciebs (Abrams, 1992). eleqtrokonvulsiuri Terapia Zalze warmatebuli aRmoCnda Rrma depresiis simptomebis SemsubuqebisTvis (Sackheim et al., 2000). misi Rirseba, nawilobriv, isaa, rom Zalze swrafad moqmedebs. rogorc wesi, sam-oTxdRiani mkurnalobis kursis Semdeg depresiis simptomebi Sesustebas iwyebs farmakoTerapiisgan gansxvavebiT, romelic erTi an ori kviris Semdeg iwyebs moqmedebas. miuxedavad amisa, TerapevtTa umetesoba ekT-s mkurnalobis ukidures formad miiCnevs. is xSirad

Tavi 16 / pirovnebis cvlilebebis Terapiebi

gamoiyeneba, rogorc saswrafo gadaudebeli mkurnaloba suicidur, an cudad nakveb depresiul pacientebTan da maTTan, vinc ar reagirebs antidepresantebze, an ver itans maT gverdiT movelenebs. Tu ekT ase kargad moqmedebs, ratom aris ase xSirad demonizirebuli? magaliTad, 1982 wels berklis (kaliforniis Stati) mcxovreblebma xma misces fsiqikuri aSlilobebis samkurnalo yvela saxelmwifo dawesebulebaSi eleqtrokonvulsiuri Sokis gamoyenebis akrZalvas (Semdgom es gadawyvetileba gabaTilda iuridiul safuZvelze). ekT-is mimarT samecniero wreebis uaryofiTi damokidebulebis ZiriTadi mizezi isaa, rom ucnobia misi moqmedebis meqanizmebi. es Terapia pacientze dakvirvebisas gaCnda, romelsac erTdroulad Sizofrenia da epilefsia hqonda. epilefsiuri gulyrebis Semdeg mas Sizofreniis simptomebi umsubuqdeboda. klinicistebma ivaraudes, rom igive efeqtis miRweva xelovnurad gamowveuli gulyrebiTac iqneboda SesaZlebeli. miuxedavad imisa, rom maTi daSveba nawilobriv gamarTlda _ ekT gacilebiT ukeTesad amsubuqebs depresias, vidre Sizofranias _ mkvlevrebs jer kidev win aqvT am SemTxveviTi dakvirvebis mecnieruli dasabuTeba. garda amisa, kritikosebs ekT-is SesaZlo gverdiTi movlenebic aRelvebT (Breggin, 1979, 1991). eleqtrokonvulsiuri Terapia droebiT dezorientaciasa da mexsierebis mTel rig darRvevebs iwvevs. pacientebi xSirad itanjebian amneziiT _ aRar axsovT movlenebi, romlebic win uswrebda mkurnalobas; rac ufro xangrZlivia mkurnaloba, miT mZimea amneziac. Tumca, gamokvlevam aCvena, rom, pacientebi, rogorc wesi, aRidgenen mexsierebis Sinaarsebs mkurnalobis dasrulebidan ramdenime Tvis manZilze (Cohen et al., 2000). metic, pacientebs, romelTac mTeli cxovrebis manZilze eleqtrokonvulsiuri Terapiis 100-ze meti procedura hqondaT gavlili, ar aReniSnebodaT cvlilebebi funqcionirebaSi im pacientebTan SedarebiT, romelTac arasodes gauvliaT aseTi procedura (Devanand et a., 1991). dResdReobiT, tvinis muSaobis xanmokle Seferxebebis minimizaciisTvisac ki, xSirad
f s i q o f a r m a k o l o g i a (Psychopharmacology) fsiqologiis dargi, romelic swavlobs qcevaze medikamentebis moqmedebas.

eleqtrokonvulsiuri SokiT tvinis mxolod erTi mxaris stimulacias axdenen da isic _ mxolod metyvelebis gauaresebis albaTobis Sesamcireblad. aseTi calmxrivi ekT efeqturi antidepresantia. axla vnaxoT, ratom gaxda farmakoTerapia fsiqopaTologiaSi biosamedicino Carevis yvelaze polularuli forma.

farmakoTerapia
fsiqikuri aSlilobebis mkurnalobis istoriaSi uprecendento gadatrialeba iyo medikamentebis aRmoCena, romelTac SeeZloT mSfoTvare pacientebis damSvideba, autisti pacientebis realobasTan kontaqtis aRdgena da fsiqoturi pacientebis halucinaciebis daTrgunva. es axali Terapiuli epoqa 1953 wels, klinikebis Terapiul programebSi trankvilizatorebis, gansakuTrebiT, qlorpromazinis, SetaniT daiwyo. medikamentebiT mkurnalobam TiTqmis dauyovnebliv moipova aRiareba da pacientis qcevis efeqturi Semcvlelis statusi. fsiqofarmakologia fsiqologiis dargia, romelic qcevaze medikamentebis moqmedebas Seiswavlis. fsiqofarmakologiis sferoSi momuSave mkvlevrebi swavloben, Tu rogor moqmedeben medikamentebi zogierT biologiur sistemaze da rogor icvleba reaqcia am zemoqmedebis Sedegad. medikamentebiT mkurnalobis meTodebis aRmoCenam udidesi gavlena moaxdina mZime aSlilobebis mqone pacientebis mkurnalobaze. fsiqiatriuli klinikebis momsaxure personals aRar sWirdeboda mcvelebis rolSi yofna, pacientebis izolatorebSi moTavseba an maTTvis damamSvidebeli perangis Cacma. personalis moraluri saxe gaumjobesda mas Semdeg, rac fsiqiatriul dawesebulebebSi fsiqikurad daavadebulTa ubralo patimroba reabilitaciiT Seicvala ( Swazey, 1974). metic, revoluciam, romelic medikamentebiT mkurnalobis danergvas mohyva, didi gavlena iqonia aSS-is fsiqiatriuli klinikebis kontingentze. 1955 wlisTvis naxevar milionze meti adamiani (romelic, saSualod, iq ramdenime weliwads atarebda) cxovrobda fsiqiatriul dawesebulebebSi. mkurnalobaSi qlorpromazinisa da sxva medikamentebis gamoyenebam SeaCera da sapirispiro mimar-

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Tuleba misca pacientTa raodenobis zrdas. 1970-iani wlebis dasawyisisTvis qveyanaSi arsebul fsiqiatriul pacientTa naxevarze naklebi imyofeboda realurad fsiqiatriul klinikebSi da isic, saSualod, mxolod ramdenime Tvis manZilze. dReisaTvis Terapiul programebSi sami ZiriTadi kategoriis medikamentebi gamoiyeneba: antifsiqoturi, antidepresantuli da anqsiolizuri naerTebi. rogorc dasaxelebebidan Cans, es medikamentebi qimiuri gziT cvlian tvinis specifikur funqciebs, romlebic fsiqotur simptomebze, depresiasa da ukidures SfoTvazea pasuxismgebeli.

antifsiqoturi preparatebi
antifsiqoturi preparatebi cvlis bodviTi mdgomareobebis, halucinaciebis, socialuri gariyulobis (Caketilobis) da perioduli agznebadobis (aJitaciis) Sizofreniul simptomebs (Dawkins et al., 1999). antifsiqoturi preparatebis moqmedeba zRudavs neirogadamtan dofaminis aqtivobas tvinSi. iseTi preparatebi, rogoricaa qlorpromazini (aSS-Si savaWro dasaxeleba _ Torazini) da haloperidoli (cnobilia, rogorc haldoli), dofanimuri receptorebis mgrZnobelobas amcirebs an Trgunavs. klozapini (cnobilia, rogorc klizarili), uaxlesi wamyvani antifsiqoturi preparatia, romelic uSualod amcirebs dofaminis aqtivobas da zrdis serotoninis aqtivobis dones, romelic akavebs dofaminur sistemas. miuxedavad imisa, rom es preparatebi amcireben, tvinis aqtivobis zogad dones, isini ar arian mxolod trankvilizatorebi.

antidepresantebi
antidepresantebi aZliereben neirogadamtanebis _ norepinefrinisa da serotoninis _ aqtivobas (Holmes, 1994). tricikluri antidepresantebi, rogoricaa tofranili da elavili, amcireben sinafsuri napralidan neirogadamtanebis ganmeorebiT STanTqmas. bicikluri antidepresanti prozaki amcirebs serotoninis ganmeorebiT STanTqmas. monoaminoqsidazas (mao)

biosamedicino Terapiebi

mravali pacientisTvis yvela es preparati gacilebiT metia, vidre ubralod agznebis Semasustebeli da damamSvidebeli. isini aqroben, an amcireben Sizofreniis dadebiT simptomebs, bodvebisa da halucinaciebis CaTvliT. samwuxarod, antifsiqotur preparatebs uaryofiTi gverdiTi moqmedeba axasiaTebs. vinaidan dofamins Tavisi roli aqvs motorul kontrolSi, medikamenturi mkurnalobis kurss xSirad axlavs kunTebis muSaobis darRvevebi. motoruli kontrolis _ gansakuTrebiT saxis kunTebis muSaobis _ gamorCeuli darRvevaa gviani diskinezia, romelic antifsiqoturi preparatebis zemoqmedebis Sedegad viTardeba. aseTi gverdiTi movlenis mqone pacientebs aReniSnebaT ybis, tuCebisa da enis uneblie moZraobebi. preparati klozapini ufro SerCeviTad akavebs dofaminur receptorebs, rac motoruli darRvevebis ganviTarebis albaTobas amcirebs. samwuxarod, im pacientTa 1-2%-Si, romelic klozapiniT mkurnalobda, viTardeba iSviaTi daavadeba agranuklocitozi, rodesac Zvlis tvini aRar gamoimuSavebs sisxlis TeTr ujredebs. mkvlevrebi agrZeleben preparatebis xangrZlivi gamoyenebis Sedegebis Seswavlas; aseve, swavloben pacientis mier preparatis miRebis Sewyvetis Sedegebs. preparatis miRebis Sewyvetis Semdeg recidivebis sixSiris maCvenebeli sakmaod maRalia _ pacientTa or mesameds 18 Tvis ganmavlobaSi axali simptomebi uviTardeba; Tumca, im pacientTa daaxloebiT erT mesamedTanac mosalodnelia recidivebi, romlebic regularulad iReben medikamentebs (Gitlin, 1990). amrigad, antifsiqoturi preparatebi ar kurnavs Sizofrenias _ isini ar aqroben safuZvlad mdebare fsiqopaTologias. sabednierod, isini sakmaod kargad axerxeben daavadebis yvelaze damangreveli simptomebis kontrols.

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inhibitorebi zRudaven ferment monoaminoqsidazas aqtivobas, romelic pasuxismgebelia norepinefrinis daSlaze (metabolizmze). rodesac mao Sekavebulia, neirogadamtanTa meti raodenoba xdeba Tavisuflad xelmisawvdomi. antidepresantebi, Cveulebriv, warmatebiT xsnian depresiis simptomebs, Tumca, gaumjobeseba ar aReniSneba pacientTa 30-40%-s (es pacientebi SeiZleba eleqtrokonvulsiuri Terapiis kandidatebi gaxdnen) (Hirschfeld, 1999). prozaks intensiurad aqebdnen, rogorc saswaulmomqmed wamals, romelsac sxva danarCen wamlebze gacilebiT mZlavri Terapiuli efeqti aqvs. zogierT fsiqiatrs usityvod sjera prozakis efeqturobis. Tavis Zalian popularul wignSi prozakis mosmena~ (Kramer, Listening to Prozac, 1993) fsiqiatri piter krameri aRwers mTel rig SemTxvevebs, rodesac pacientebma, romelTac prozaki hqondaT daniSnuli, gasaocari pirovnuli cvlilebebi ganicades. magaliTisTvis ganvixiloT qalbatonis SemTxveva, romelsac krameri tezs uwodebs. tezi Tavad gaecno kramers da aRuwera sakuTari mZime cxovrebiseuli pirobebi da depresiis istoria. prozakiT orkviriani mkurnalobis Semdeg tezi ukve sxva adamianad iqca: Cem win iyo pacienti, romlis qcevis Cveuli stili STambeWdavad Secvliliyo. is msubuqad saubrobda, aRar iyo daTrgunuli da kedelze akruli; piriqiT, pepelasaviT dafarfatebda adamianebs Soris. iq, sadac sxvebis gulis mogebaze da keTilganwyobis mopovebaze mimarTuli qceva iyo, axla sicocxlis siyvaruli da mxiaruleba sufevda (Kramer, 1993, gv. 11). tezis mdgomareobis gaumjobeseba Zalze STambeWdavi iyo, Tumca, prozakisa da sxva fsiqoaqtiuri medikamentebis kritikosebi Relaven imis gamo, rom prozaki ara marto depresias xsnis, aramed pacientebs sakuTari individualurobisa da SemoqmedebiTi sawyisisganac aTavisuflebs~ (Breggin & Breggin, 1994). liTiumis marilebi efeqturi aRmoCnda bipolaruli aSlilobebis mkurnalobaSi (Schou, 1997). adamianebi, romlebic umarTavi moWarbebuli agznebis periodebs ganicdian, rodesac maTi energia, erTi SexedviT, amouwuravia, qceva ki _ ucnauri da TvalSisacemi, maniakaluri siWarbis

mdgomareobidan liTiumis dozebiT gamoyavT. pacientTa 60-80%-s, romlebic liTiumiT mkurnalobdnen, gamojanmrTelebis kargi Sansi aqvT (Walden et al., 1998). Tumca, bipolaruli aSlilobis mqone im adamianebisTvis, romelTa mdgomareoba xSirad irxeva maniakalur da depresiul periodebs Soris, liTiumi naklebad efeqturia, vidre mkurnaloba sxva preparatebiT, rogoricaa, magaliTad, valproati _ preparati, romelic Tavdapirvelad gulyrebis Sesakaveblad Seiqmna.

anqsiolizuri saSualebebi
antifsiqoturi da antidepresiuli preparatebis msgavsad, anqsiolizuri, anu damamSvidebeli saSualebebi, Cveulebriv, tvinSi neirogadamtanebis aqtivobis doneebis regulacias axdens. sxvadasxva saxis SfoTviTi aSlilobis dros sxvadasxva saxis preparatia yvelaze efeqturi (Spiegel et al., 2000). generalizebuli SfoTviTi aSliloba saukeTesod ikurneba benzodiazepinebiT, maT Soris valiumiT, an qsanaqsiT, romelic neirogadamtan gaem-is9 aqtiurobas zrdis. vinaidan gaem Semakavebel neironebs aregulirebs, misi aqtiurobis zrdiT mcirdeba tvinis aqtiuroba im ubnebSi, romelic generalizebul SfoTviT reaqciebs Seesabameba. panikuri aSlilobebi _ agorafobia da sxva fobiebi _ SeiZleba ganikurnos antidepresantebiT, miuxedavad imisa, rom mkvlevrebma jer ar ician, Tu ra biologiuri meqanizmi udevs amas safuZvlad. obsesiur-kompulsuri aSliloba, romelic serotoninis ukmarisobam SeiZleba gamoiwvios, gansakuTrebiT kargad reagirebs iseT preparatebze, rogoricaa prozaki, radgan is konkretulad serotoninis moqmedebaze axdens gavlenas.

Tavi 16 / pirovnebis cvlilebebis Terapiebi

daniSnuleba fsiqoaqtiuri preparatebisTvis


Cven mier aRweril medikamentebs, romlebic mowodebulia sxvadasxvagvari fsiqikuri aSlilobebis simptomebis Sesamsubuqeblad, xSirad aZleven adamianebs daniSnulebis saxiT. vinaidan fsiqikuri janmrTelobis dacva TandaTanobiT sazogadoebrivi jandacvis organizaciebis kompetenciis sferoSi gadadis da vinaidan miRebuli
9

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gamaaminoerbo mJava _ GABA-GammaAminoBatterAcid

praqtikaa am sferoze xarjebis ekonomia, mcirdeba pacientTa raodenoba, romlebic fsiqoTerapiuli daxmarebisTvis Terapevtebs akiTxaven; isini fsiqoTerapias SedarebiT iafi saSualebiT _ medikamenturi mkurnalobiT anacvleben. axlaxan Catarebulma gamokvlevam, romelic fsiqoaqtiuri medikamentebis pacientebisTvis gamoweris tendencias Seexeboda, aCvena, rom aSS-Si 1985 wlidan 1994 wlamde periodSi 20%-iT moimata fsiqiatrebisTvis, pirveladi samedicino daxmarebis eqimebisTvis da sxva specialobis medikosebisTvis mimarTvebis ricxvma _ 32.7 milionidan 45.6 milion mimarTvamde (Pincus et al., 1998). amasTan, adamianTa zogierTi jgufi ufro metad iRebs medikamentebs, vidre _ sxvebi. erT-erT gamokvlevaSi, romelic xuTi weliwadi grZeldeboda, mkvlevrebi akvirdebodnen, Tu rogor niSnavdnen medikamentebs kaliforniis zogadi profilis oTxi saavadmyofos pirveladi gadaudebeli daxmarebis samsaxuris (umeteswilad TeTrkaniani) eqimebi. isini afroamerikelebs ufro meti raodenobis antifsiqotur medikamentebs da ufro didi dozebiT uniSnavdnen, vidre sxva pacientebs. Tumca, afroamerikeli pacientebi sulac ar iyvnen ufro saSiSni, an ufro metad daavadebulni, vidre danarCenebi (segal et al., 1996). aseTi aRmoCenebi gviCvenebs, Tu ratom miaCniaT farmakoTerapiis kritikosebs, rom medikamentebi yovelTvis ar gamoiyeneba mxolod samedicino miznebisTvis.

am kiTxvebs kidev ufro aqtualurs da sainteresos xdis gamokvlevebi, romlebic aCveneben, rom Terapiis zogierTi forma iseve moqmedebs tvinze, rogorc medikamenturi mkurnalobis kursi.

saidan viciT
bihevioraluri Terapiis Sedegad tvinSi momxdari cvlilebebi obsesiur-kompulsuri aSlilobis mqone monawileebs unda aerCiaT da gaevloT medikamenturi Terapia (fluoqsetin hidroqloridiT), an bihevioraluri Terapia (stimulis wardgena da reaqciis aRkveTa). emisiur-pozitronuli tomografiiT gadaiRes pacientebis tvini mkurnalobamde da mkurnalobis Semdeg, ramac orive saxis Terapiis Semdeg tvinis funqcionirebaSi erTnairi cvlilebebi aCvena (Baxter et al., 1992; Schwartz et al., 1996). am tipis kvlevebi SesaniSnav SesaZleblobebze migviTiTebs: aramedikamentur Terapiebs SeiZleba iseTive ganmkurnebeli efeqti hqondes tvinze, rogorc medikamentebiT mkurnalobas, Tumca, medikamentebiT mkurnalobisTvis damaxasiaTebeli SesaZlo uaryofiTi Sedegebis gareSe. erTi TerapiisTvis upiratesobis miniWeba meoresTan SedarebiT xSirad daavadebis simwvaveze da sxvadasxva saxis Terapiebis damtkicebul efeqturobazea damokidebuli. magaliTad, ganurCevlad riskisa, Sizofreniis mkurnaloba ubralod aucilebelia medikamentebiT, raTa pacientebs normalurad cxovrebis mcireodeni SesaZlebloba mainc hqondeT. axla ganvixiloT meTodebi, romlebsac mkvlevrebi Terapiis sxvadasxva formebis efeqturobis Sesafaseblad iyeneben.

rodis aris aucilebeli medikamentebiT mkurnaloba


Cven mokled mimovixileT fsiqologiuri aSlilobebis medikamenturi mkurnalobis zogierTi SesaZlebloba. bevri garemoebaa, rodesac medikamenturi mkurnalobis kursma SeiZleba mniSvnelovnad gaaumjobesos daavadebuli adamianis cxovreba. Tumca, farmakoTerapiis nebismieri kursi ar gamoricxavs fizikuri, an fsiqologiuri miCvevis SesaZleblobas da SesaZlo seriozul gverdiT movlenebs. rogor afaseben adamianebi am faqtorebs Semsubuqebis albaTobasTan mimarTebaSi? Cven, aseve, aRvniSneT, rom medikamentma SeiZleba Seamsubuqos simptomi, magram ver gankurnos misi ganmapirobebeli paTologia. ramdenad arian adamianebi mzad, rom mTeli cxovrebis manZilze miiRon medikamentebi?

Sejameba
Tanamedrove praqtikaSi iSviaTad gamoiyeneba qirurgiuli procedurebi tvinze fsiqologiuri aSlilobebis Sesamsubuqeblad. eleqtrokonvulsiuri Terapia sakmaod efeqturia Rrma depresiis Sesamsubuqeblad. Tumca, vinaidan misdami damoki-

biosamedicino Terapiebi

691

debuleba isev sakamaToa, adamianebi eridebian am saxis mkurnalobas. antifsiqoturi, antidepresiuli da anqsiolizuri preparatebi, rogorc wesi, Semamsubuqeblad moqmedeben; isini tvinSi neirogadamtanebis aqtiurobaze axdenen gavlenas. medikamenturi mkurnalobis, gansakuTrebiT, antidepresantebis, daniSvnebis ricxvma mkveTrad moimata bolo aTwleulis manZilze.

ramdenad muSaobs Terapia


davuSvaT, Tqvens cxovrebaSi dainaxeT problema da migaCniaT, rom misi daZleva mxolod profesional klinicistTan urTierTqmedebiT aris SesaZlebeli. Cven mravali saxis Terapiaze visaubreT. rogor unda gavarkvioT, romeli maTgani imoqmedebs saukeTesod da SegimsubuqebT problemas? rogor davrwmundeT, rom romelime maTgani saerTod imoqmedebs? am qveTavSi ganvixilavT gamokvlevebs, romlebic miznad isaxavs calkeuli Terapiebis Sedegianobis Semowmebas da sxvadasxva Terapiebis urTierTSedarebas. am kvlevebis zogadi mizania adamianebisTvis daxmarebis gawevis yvelaze efeqturi saSualebis gamovlena. Cven, aseve, mokled mimovixilavT prevenciis sakiTxs: ra da rogor unda gaakeTon fsiqologebma winaswar, rom Tavidan iqnes acilebuli fsiqikuri daavadeba?
Tavi 16 / pirovnebis cvlilebebis Terapiebi

Terapiis Sedegianobis Sefaseba


britanelma fsiqologma hans aizenkma (Hans Eysenck, 1952) furori moaxdina: man ganacxada, rom fsiqoTerapia saerTod ar moqmedebs! man xelT arsebuli yvela publikacia mimoixila, sadac saubari iyo sxvadasxva saxis Terapiebis Sedegianobaze da aRmoaCina, rom im pacientebis mdgomareoba, romlebic aranair Terapias ar iRebdnen, iseTive sixSiriT umjobesdeboda, rogorc im pacientebisa, romlebic fsiqoanalitur an sxva saxis insaituri Terapiis kurss gadiodnen. man ganacxada, rom nevrotuli problemebis mqone adamianTa daaxloebiT ori mesamedi TavisTavad gamojanmrTeldeboda problemis gaCenidan ori wlis ganmavlobaSi.

aizenkis gamowvevis sapasuxod mkvlevrebma Terapiis Sedegianobis Sefasebis ufro zusti meTodologiebi SeimuSaves. aizenkis kritikulma gamonaTqvamebma naTeli gaxada, rom mkvlevrebs saTanado sakontrolo jgufebi sWirdebaT. mTeli rigi mizezebis gamo, individTa garkveuli procentis mdgomareoba, romelsac fsiqoTerapia esaWiroeba, marTlac umjobesdeba yovelgvari profesiuli Carevis gareSe. spontanuri remisiis efeqti is bazisuri kriteriumia, romliTac unda Sefasdes Terapiebis Sedegianoba. martivad rom vTqvaT, unda Candes, rom raRacis keTeba gamojanmrTelebis SemTxvevaTa met procents iZleva, vidre _ arafris keTeba. aseve, mkvlevrebi cdiloben, dagvanaxon, rom maT mier gamoyenebuli mkurnaloba ufro mets akeTebs, vidre klientis sakuTari gankurnebis molodinis gamoyenebaa. SegiZliaT gaixsenoT Cven mier adre ganxiluli placebo efeqtebi: bevr SemTxvevaSi adamianebis fsiqikuri Tu fizikuri janmrTeloba mxolod imitom umjobesdeba, rom isini moelian gaumjobesebas. Terapiuli situacia xels uwyobs am rwmenis ganmtkicebas imiT, rom Terapevts mkurnalis specifikur socialur rolSi ayenebs (Frank & Frank,
spontanuri remisiis efeqti (Spontaneous-remission effect) _ fsiqikuri problemebis mqone zogierT pacientTa da klientTa, romelsac esaWiroeba fsiqoTerapia, mdgomareobis gaumjobeseba yovelgvari profesiuli Carevis gareSe; bazisuri kriteriumi, romliTac unda Sefasdes Terapiebis Sedegianoba.

692

1991). miuxedavad imisa, rom Terapiis placebo efeqti Terapiuli Carevis mniSvnelovani nawilia, mkvlevrebs, Cveulebriv, surT imis Cveneba, rom maT mier gamoyenebuli Terapiis specifikuri forma ufro Sedegiania, vidre placebo Terapia (neitraluri Terapia, romelic mxolod gankurnebis molodins qmnis) (Enserink, 1999). ukanasknel wlebSi mkvlevrebi Terapiul Sedegianobas statistikuri meTodis _ meta-analizis _ gamoyenebiT afaseben. meta-analizi mkvlevrebs formaluri meqanizmiT uzrunvelyofs, romelic mowodebulia mravali sxvadasxvagvari eqsperimentis monacemebSi zogadi daskvnebis gamosavlenad. bevr fsiqologiur eqsperimentSi mkvlevari svams kiTxvas: gamovlinda Tu ara eqsperimentis monawileTa umravlesobaSi Cem mier nawinaswarmetyveli movlena?~ meta-analizis cdis pirebs eqsperimentebi warmoadgenen. Terapiis SedegianobasTan mimarTebaSi mkvlevari svams kiTxvas: gamoavlina Tu ara Sedegebis gamokvlevaTa umravlesobam dadebiTi cvlilebebi?~ am kiTxvaze pasuxia Zalze damajerebeli diax~ (Lipsey & Wilson, 1993; Shadish et al., 1997). rogorc Cans, Terapiuli kursebis umravlesobas sul mciredi dadebiTi efeqti mainc aqvs, romelic SesaZlo mkurnalobis gareSe~ an placebo~ efeqtebis farglebs scildeba. aseTi Sedegebis gamo, Tanamedrove mkvlevrebs naklebad afiqrebT, moqmedebs Tu ara fsiqoTerapia; isini ufro metad arian dakavebulni iseTi sakiTxebiT, rogoricaa: ratom moqmedebs fsiqoTerapia da aris Tu ara romelime konkretuli mkurnaloba yvelaze efeqturi konkretuli problemisTvis da garkveuli tipis pacientebisTvis (Drozd & Goldfried, 1996, Goldfried et al., 1990). unda aRiniSnos, rom yovelTvis ar aris ioli im kvlevebis urTierTSedareba, romlebic sxvadasxva Terapiebis Sesaxeb iZlevian monacemebs. Zneli gasaTvaliswinebelia TerapevtTa gamocdilebebs Soris gansxavavebebi, Terapiis xangrZlioba, pirveladi diagnozis sizuste, aSlilobis tipi, pacientis sirTuleebis simwvavesa da tipebs Soris gansxvavebebi, Sedegebis gazomvis meTodebi, pacientis molodinebisa da SeTavazebuli Terapiis urTierTTanxvedra da mkurnalobis dasrulebis Semdeg pacientze dakvirvebis xangrZlioba _ da es mxolod mcire nawilia parametrTa im grZeli CamonaTvalisa, romelic gaiTvaliswinebul unda iqnes. rogorc qvemoT vnaxavT,

mkvlevrebi jer kidev cdiloben am problemebis daZlevas da depresiis mkurnalobis sxvadasxva tipebis pirdapir Sedarebaze fokusirdebian.

mkurnalobis Sefaseba
depresiis farTo gavrcelebidan gamomdinare (ix. Tavi 15), mravali gamokvleva, romelSic sxvadasxva tipis Terapiebis urTierTSedarebas axdenen, depresiuli adamianebis jgufebze tardeba. erTi gansakuTrebiT gabeduli proeqti daafinansa da koordinireba gauwia fsiqikuri janmrTelobis nacionalurma institutma (aSS, National Institute os Mental Health NIMH). am kvlevis ZiriTadi maxasiaTeblebi iyo: (1) xanmokle fsiqoTerapiis ori gansxvavebuli formis _ tricikluri medikamenturi mkurnalobis da placebo kontrolis _ Sedegianobis Sedareba; (2) 28 profesionali Terapevtis mier Catarebuli mkurnalobis zusti gansazRvra da standartizacia; amasTan, TiToeuli Terapevti Terapiis oTxi tipidan erT-erTSi specializirdeboda da TiToeuli tipis mkurnaloba sxvadasxva qalaqis sam sxvadasxva dawesebulebaSi tardeboda; (3) SemTxveviT SeirCa 240 ambulatoriuli pacienti, romelic klinikuri depresiuli aSlilobis standartul kriteriumebs akmayofilebda; (4) dadginda Sefasebis standartizirebuli procedurebi Terapiis procesisa (magaliTad, Terapiuli seansebis videoCanawerebis) da saboloo Sedegebis gasazomad gankuTvnili meTodikebis monitoringisTvis mkurnalobis dasawyisSi, 16kviriani Terapiuli procesis ganmavlobaSi, mkurnalobis dasasrulisTvis da dasrulebidan 18 Tvis Semdeg; (5) Sedegebis damoukidebeli Sefaseba romelime dawesebulebaSi, romelic ar monawileobda kvlevis arc erT fazaSi (Elkin et al., 1989). afasebdnen ori saxis fsiqoTerapias, romelic specialurad Seiqmna, an modificirda arasaavadplacebo Terapia (Placebo therapy) _ nebismieri specifikuri klinikuri procedurisgan damoukidebeli Terapia, romelic iwvevs klienti mdgomareobis gaumjobesebas. meta-analizi (Meta-analysis) _ hipoTezebis Semowmebeli statiskituri meTodi, romelic iZleva formalur meqanizms mravali sxvadasxvagvari eqsperimentis monacemebSi zogadi daskvnebis gamosavlenad.

693

ramdenad muSaobs Terapia

suraTi

16.2

depresiis Terapiebi
depresiis simptomebi yvelaze metad medikamenturi mkurnalobis Sedegad Semcirda, Tumca, simptomebi, aseve, mniSvnelovnad Semcirda fsiqodinamikuri da kognituri Terapiebis Sedegadac.

694

myofos pirobebSi depresiis samkurnalod. es ori xanmokle Terapia iyo kognitur-bihevioraluri Terapia da interpersonaluri fsiqoTerapia _ fsiqodinamikuri orientaciis Terapia, romelic pacientebis mimdinare cxovrebasa da pirovnebaTSoris urTierTobebze fokusirdeboda. ormag brma proceduraSi, (anu eqsperimentatorebma ar icodnen, romeli pacienti romel preparats iRebda) tricikluri antidepresanti imipramini da placebo kontrolis preparati gamoiyenes. rogorc medikamentebis, ise placebos SemTxvevaSi TiToeul pacients kviraSi erTxel naxulobda fsiqiatri, romelic minimalur mxardamWer Terapias axorcieldebda. Terapiis Sedegebis am samagaliTo kvlevis monacemebis erTi nawili mocemulia suraTze 16.2. grafiki aCvenebs, rom Rrmad depresiuli pacientebis mkurnalobis TiToeuli forma ufro Sedegiani iyo, vidre placebo; amasTan, antidepresiuli medikamenti yvelaze Sedegiani aRmoCnda, fsiqodinamikurma da kongiturbihevioralurma Terapiebma, Sedegianobis mixedviT, Sualeduri mdgomareoba daikaves (Klein & Ross, 1993). Semdgom proeqtebSi mkvlevrebi afa-

sebdnen da erTmaneTs adarebdnen mxolod fsiqoTerapiis Sedegianobasa da kombinirebul fsiqoTerapiul da medikamentur mkurnalobas. erTerT gamokvlevaSi kombinirebuli Terapia yvelaze warmatebuli aRmoCnda (Keller et al., 2000). 519 monawilidan, romelmac mkurnalobis kursi gaiara, simptomebis Semsubuqebis kvlevaSi dadgenil kriteriumebs im monawileTa 55%-is mdgomareoba akmayofilebda, vin mxolod medikamenturi mkurnaloba miiRo da im monawileTa 52%-is mdgomareoba, vinc mxolod fsiqoTerapiiT mkurnalobda, xolo im pacientebidan, vinc iRebda kombinirebul _ fsiqoTerapiul da medikamentur mkurnalobas _ 85%-s mdgomareobis gaumjobesebis igive maCvenebeli hqonda. depresiis mkurnalobis Sesafaseblad Catarebuli kvlevebi aCvenebs, rom orive _ biologiur da fsiqologiur _ mkurnalobas mniSvnelovani wvilili Seaqvs fsiqikuri janmrTelobis gaumjobesebaSi. garda amisa, es kvlevebi naTel warmodgenas gviqmnis im meTodebze, romelTa gamoyenebiTac SeiZleba ganisazRvros, Tu romeli Terapia iqneba saukeTeso TiToeuli tipis aSlilobisTvis. suraTze 16.3 mocemulia ganzogadebuli ierarqiuli sqema imisa, Tu ra rols asrulebs Teoria, klinikaSi warmoebuli dakvirveba da mecnieruli kvleva mkurnalobis (rogorc fsiqikuri, ise _ fizikuri daavadebebis) nebismieri formis ganviTarebasa da SefasebaSi. is gviCvenebs, Tu ra saxis sistematuri kvlevaa saWiro, rom klinicistebma ufro iolad gasazRvron, Teoriis winaswarmetyvelebis Sesabamisad, marTlac cvlis rames Tu ara maT mier gamoyenebuli Terapia. sqemis erT mxares xedavT klinikaSi warmoebuli dakvirvebis Sedegebs _ klinicistis sakuTar gamocdilebas axali procedurebis gamoyenebisas. Cveulebisamebr, mkurnalobis axali meTodebi dasawyisisTvis praqtikaSi mkacri eqsperimentuli kontrolis gareSe gamoicdeba. sqemis meore mxares Teoriis ganviTarebas xedavT. Teoria winaswarmetyvelebs im meTodebis Sesaxeb, romelmac unda gaamarTlos da imuSaos praqtikaSi, rac SeiZleba dadasturdes laboratoriuli gamokvlevebiT. es ori saxis insaiti _ klinikuri da eqsperimentuli _ erTiandeba da axal Terapias iZleva (Goldfried & Wolfe, 1996; Seligman, 1996). winamdebare Tavis daskvniT qveTavSi cxovrebis mniSvnelovan princips SevexebiT: rogori

Tavi 16 / pirovnebis cvlilebebis Terapiebi

mkurnalobis mimdinare statusi

prevenciis strategiebi
ori megobari mdinaris piras seirnobda. uecrad, mdinarem gatacebuli bavSvi Camoatara. erT-erTi maTgani Caxta mdinareSi da bavSvi gadaarCina. amis Semdeg megobrebma ganagrZes seirnoba. moulodnelad, kidev erTi bavSvi Camohyva dinebas. pirveli bavSvis gadamrCeni isev gadaeSva mdinareSi da isev gamoiyvana samSvidobos mdinaris msxverpli. male mesame wyalwaRebulic gamoCnda. jer isev mSrali megobari swrafad gauyva mdinaris napirs dinebis sapirispirod. maSvelma megobarma gasZaxa: ei, sad midixar?~ mSralma megomarma upasuxa: vcdilob, im naZiralas mivagno, vinc am bavSvebs wyalSi yris~ (Wolman, 1975, gv. 3). am moTxrobis morali naTelia: problemis prevencia, anu Tavidan acileba saukeTeso gadawyvetaa. Cven mier ganxiluli yvela tradiciuli Terapia iseTi adamianis Secvlazea mimarTuli, romelsac ukve aqvs problema, an romelic araqmediTunariania. isini mas Semdeg iwyeben muSaobas, rac Tavs iCens problemuri qceva da es gausaZlisi xdeba adamianisTvis. im droisaTvis, rodesac adamiani mkurnalobas gadawyvets, an iZulebuli gaxdeba, rom imkurnalos, fsiqikuri aSliloba ukve kargad aris mokalaTebuli~ da damangrevlad moqmedebs mis yoveldRiur funqcionirebaze, sazogadoebriv saqmianobaze, samsaxursa Tu profesiul zrdaze.

klinikuri dakvirveba

pirveladi kvleva _ Teoriuli modeli

gamocda kontrolis gareSe klinikur populaciaSi

sawyisi gamokvlevebi laboratoria Si

axali Terapia

moklevadiani klinikuri kvlevebi kontroliT

grZelvadiani klinikuri kvlevebi kontroliT

praqtikaSi efeqturobis Sefaseba


ramdenad muSaobs Terapia

suraTi

16.3

ufro Sedegiani Terapiis Seqmna


fsqiqikuri/fizikuri daavadebebis mkurnalobis ganvioTarebis afexurebi

Sedegianic ar unda iyos mkurnaloba, xSirad ukeTesia daavadebis prevencia, vidre misi mkurnaloba.

695

Tavi 16 / pirovnebis cvlilebebis Terapiebi

fsiqologiuri problemebis prevencia ramdenime doneze SeiZleba ganxorcieldes (Rabins, 1992, Reiss & Price, 1996). pirveladi prevencia mimarTulia daavadebis ganviTarebamde mdgomareobis Tavidan acilebaze. am mizniT, magaliTad, SeiZleba gadaidgas nabijebi imisaTvis, rom individebs gamklavebis unar-Cvevebi davaswavloT, romliTac isini garemos uaryofiTi aspeqtebisadmi, romelmac SeiZleba SfoTva, an depresia gamoiwvion, metad adaptirebadni gaxdebian, an romelTa saSualebiTac SeeZlebaT maTi Secvla (Durlak & Wells, 1997; Kaplan, 2000). meoradi prevencia cdilobs ukve ganviTarebuli aSlilobis simwvavis, an xangrZlivobis Semcirebas. es keTdeba programebiT, romelic aSlilobis dasawyisSive gamovlenisa da mkurnalobis dawyebis SesaZleblobas iZleva. mesameuli prevencia cdilobs, ar dauSvas recidivebi da amiT zRudavs fsiqologiuri aSlilobis xangrZliv zemoqmedebas. mesameuli prevenciuli zomebisTvis saWiroa, rom ukve cnobili da SeZlebisdagvarad aRmofxvrili iyos aSlilobis mizezebi. dasaxelebuli tipebis prevenciis ganxorcieleba im msxvilmasStabian cvlilebebze mianiSnebda, romelic fsiqikuri janmrTelobis dacvis zogadma mimarTulebam da ZiriTadma paradigmebma ganicada. umniSvnelovanesi sistemuri cvlilebebia: (1) mkurnalobisTvis prevenciis damateba; (2) daavadebebis mkurnalobis viwro samedicino modelidan sazogadoebrivi janmrTelobis ufro farTo modelze gadasvla; (3) im situaciebsa da garemo pirobebze yuradRebis gamaxvileba, romelic adamianebs riskis winaSe ayenebs da maT risk-jgufSi myofi adamianebisgan~ mijnavs; (4) meti interesi Cveuli cxovrebiseuli garemos situaciebisadmi, romelic xels uwyobs daavadebis ganviTarebas da naklebi _ predispoziciuri maxasiaTeblebis Ziebisadmi Tavad adamianebSi (Ammerman & Hersen, 1997; Kendrick et al., 1996). samedicino modeli mowodebulia daavadebuli adamianebis mkurnalobisTvis; sazogadoebrivi jandacvis modeli daavadebebisa da avadmyofobis garemoSi arsebuli mizezebis gamovlenasa da aRkveTas gulisxmobs. am midgomiT, daavadebuli
klinikuri ekologia (Clinical ecology) fsiqologiis dargi, romelic iseT aSlilobebs, rogoricaa SfoTviTi aSliloba da depresia, garemoSi arsebul gamRizianeblebs ukavSirebs.

individi ganixileba, rogorc maspinZeli, an matarebeli _ mimdinare daavadebis saboloo Sedegi. rodesac SesaZlebeli gaxdeba im garemo pirobebis Secvla, romelic daavadebis ganviTarebas ganapirobebs, mogvianebiT aRar gaxdeba saWiro adamianebis Secvla Zvirad Rirebuli, eqstensiuri mkurnalobiT. iseTi infeqciuri daavadebebis mkveTri Semcireba, rogoricaa tuberkulozi, yvavili da malaria, am midgomis wyalobiT gaxda SesaZlebeli. rac Seexeba fsiqopaTologias, am SemTxvevaSic SesaZlebelia stresis mizezebis gamovlena garemosa Tu aqtivobis organizaciaSi. SeiZleba maT Sesustebaze mimarTuli programis Seqmna da amiT im adamianTa ricxvis Semcireba, vinc maTi moqmedebis samizne gaxdeba. klinikuri ekologiis sfero afarTovebs biosamedicino Terapiebis sazRvrebs imiT, rom iseT aSlilobebs, rogoricaa SfoTviTi aSliloba da depresia, garemoSi arsebul gamRizianeblebs ukavSirebs _ es SeiZleba iyos: qimiuri gamxsnelebi, xmauri, sezonuri cvlilebebi da radiacia (Bell, 1982). vinaidan wvlili Seaqvs fsiqopaTologiaSi, zogierTma Terapevtma gaafarTova garemos cneba da masSi garegani garemos10 yvela is maxasiaTebeli CarTo, romelic normalur adaptaciaze zemoqmedebs yoveldRiur cxovrebaSi (Ghadirian & Lehmann, 1993). aq Sedis, kvebis zemoqmedeba, fsiqoaqtiuri nivTierebebi, terorizmi, bunebrivi ubedurebebi da socialuri mxardaWeris sistemebis ararseboba. fsiqikuri aSlilobebis prevencia mravalmxrivi da rTuli amocanaa. masSi ara marto relevanturi mizezobrivi faqtorebis gageba moiazreba, aramed individualur, dawesebulebebis da samTavrobo doneebze warmoqmnili winaaRmdegobis daZleva cvlilebebisken mimaval gzaze. aucilebelia seriozuli samecniero kvleviTi Zalisxmeva prevenciuli RonisZiebebis xangrZlivi sargeblis demonstrirebisTvis da fsiqopaTologiisadmi sazogadoebrivi jandacvis modelis gamoyeneba, raTa gamarTleba moeZebnos amisaTvis gaRebul xarjebs sxva problemebis winaSe, romelic, aseve, dauyovnebel gadawyvetas saWiroebs. prevenciuli programebis saboloo
10 External environment igulisxmeba yvelaferi is, rac arsebobs adamianis gareT. amis sapirispiroa Sinagani garemo, anu is, rac adamianis SigniTaa (mTargmnelis SeniSvna).

696

mizani sazogadoebis yvela wevrisTvis fsiqikuri janmrTelobis SenarCunebis uzrunvelyofaa.

Sejameba
fsiqoTerapiiT dakavebuli mkvlevrebi cdiloben, gansazRvron, Terapiuli Carevis romeli formebi uzrunvelyofen saukeTeso Sedegs. didi raodenobis gamokvlevebis analizi aCvenebs, rom mTlianobaSi fsiqoTerapia Sedegiania. farTomasStabiani kvlevebi, rogoricaa depresiis mkurnalobis kvleva (romelic aSS fsiqikuri

janmrTelobis dacvis nacionaluri institutis, koordinaciiT ganxorcielda), miznad isaxavs calkeuli aSlilobebisTvis maqsimalurad Sedegiani konkretuli tipis mkurnalobis gamovlenas. ukeTesi Terapiuli meTodis Seqmnis procesi laboratoriuli kvlevebis aRmoCenebsa da klinikuri gamocdilebis Sedegebs aerTianebs. prevenciuli mimarTuleba ubiZgebs klinicistebs, rom Seecadon individebisTvis unarCvevebis gamomuSavebas da maTi garemos Secvlas ise, rom SesaZlebeli gaxdes aSlilobis ganviTareba da misi Sedegebis minimizacia.

sakvanZo sakiTxebi
Terapiuli konteqsti
Terapia diagnozis dasmas da mkurnalobis kursis daniSvnas moiTxovs. Terapia SeiZleba iyos samedicino, an fsiqologiuri. arsebobs fsiqoTerapiis o T x i Z i r i Ta d i t i p i : fsiqodinamikuri, bihevioraluri, kognituri da egzistencialur-humanisturi. mravali sxvadasxva profesionali dakavebulia fsiqoTerapiiT. warsulSi fsiqikuri aSlilobebis mkurnaloba uxeSi da araadamianuri iyo. fsiqikuri aSlilobis daavadebad miCnevas pacientTa ufro humanuri meTodebiT mkurnaloba mohyva. kulturuli anTropologia gviCvenebs, rom mraval kulturaSi arsebobs fsiqikuri aS lilobebis gagebisa da nalobis meTodebi, rac vnelovani gakveTili leba iyos dasavluri piuli praqtikisTvis. mkurmniSSeiZTera-

bihevioraluri Terapiebi
bihevioraluri Terapia daswavlis da ganmtkicebis principebs iyenebs problemuri qcevis modificirebisas, an aRkveTisas. kontrganpirobebis meTodebiT xdeba uaryofiTi qcevebis, rogoricaa, fobiuri reaqciebi, Canacvleba ufro adapturi qcevebiT. fobiebis modifikaciis yvela teqnikisTvis damaxasiaTebeli elementia stimulis wardgena. pirobiTi ganmamtkiceblebis marTva; pirobiTi ganpirobebuloba qcevis modificirebis mizniT gamoiyeneba; upiratesad iyeneben dadebiT ganmtkicebasa da reaqciis Caqrobas. socialuri daswavlis TerapiaSi qcevis modelireba da socialuri unarCvevebis gavarjiSeba gamoiyeneba, raTa individebs sakuTari SesaZleblobebis darwmunebaSi daexmaron.

fsiqodinamikuri Terapiebi
fsiqodinamikuri Terapiebi zigmund froidis fsiqoanalitikuri Teoriis safuZvelze Seiqmna. froidi xazs usvamda aracnobieri konfqliqtebis rols fsiqopaTologiis etiologiaSi. fsiqodinamikuri Terapiis mizani am konfliqtebis gadaWraa. am Terapiis mniSvnelovani mdgenelebia: Tavisufali asociaciebi, winaaRmdegobisadmi yuradReba, sizmrebis analizi, gadatana da kontrgadatana. neofroidianelebi met aqcents akeTeben pacientis awmyo, mimdinare socialur situaciaze, pirovnebaTSoris urTierTobebze da me-koncefciaze.

697

sakvanZo sakiTxebi

kognituri Terapiebi
kognituri Terapia mimarTulia uaryofiTi, an iracionaluri azrebis paternebis Secvlaze, romelic individs sakuTari Tavisa da socialuri urTierTobebis Sesaxeb gaaCnia. kognitur-bihevioraluri modifikacia klientisgan moiTxovs problemis Sesaxeb mosazrebaTa ufro metad konstruqciuli paternebis daswavlas da axali teqnikebis sxva, Terapiulisgan gansxvavebul situaciebSi gamoyenebas. kognituri Terapia warmatebiT gamoiyeneba depresiis mkurnalobisTvis. racionalur-emocionaluri Terapia exmareba klientebs gaacnobieron sakuTari iracionaluri mosazrebebi sakuTari Tavis Sesaxeb, romlebic xels uSliT maT warmatebul cxovrebas.

ojaxis da ojaxuri wyvilebis Terapia wyvilis, an ojaxis situaciur siZneleebsa da pirovnebaTSoris dinamikaze muSaobs; aq wyvili, an ojaxi ganixileba, rogorc sistema, romelic gaumjobesebas saWiroebs. sazogadoebrivi da internetis TviTdaxmarebis jgufebi SesaZleblobas aZlevs individebs, miiRon informacia da socialuri mxardaWeris pirobebSi sakuTar TavSi darwmunebuloba igrZnos.

aSlilobebis ganviTarebis SesaCereblad da ukve warmoqmnili aSlilobebis Sedegebis minimizaciisTvis.

ZiriTadi cnebebi
aversiuli Terapia qcevis repeticia qcevis modifikacia bihevioraluri Terapia biosamedicino Terapia kaTarzisi klienti klientze centrirebuli Terapia klinikuri ekologia klinikuri fsiqologi klinikuri socialuri muSaki kognitur-bihevioraluri modifikacia kognituri Terapia pirobiTi ganmamtkiceblebis marTva fsiqolog-konsultanti kontrganpirobeba kontrgadatana sizmris analizi eleqtrokonvulsiuri Terapia (ECR) daZirva Tavisuafali asociacia geStalt-Terapia moZraoba adamianis potencialis ganviTarebisTvis imploziuri Terapia insaituri Terapia meta-analizi obieqti-urTierTobis Terapia monawileobis meSveobiT modelireba RvTismsaxuri-konsultanti pacienti placebo Terapia prefrontaluri lobotomia fsiqiatri fsiqoanalitikosi fsiqofarmakologia fsiqoqirurgia fsiqoTerapia racionalur-emociuri Terapia (per) winaaRmdegoba ritualuri mkurnaloba Samanizmi socialuri daswavlis Terapia spontanuri remisiis efeqti sistemuri desensitizacia gadatana

biosamedicino Terapiebi
biosamedicino Terapiebi fsiqikuri daavadebis fiziologiuri aspeqtebis cvlilebaze orientirdebian. radikaluri da Seuqcevadi moqmedebis gamo fsiqoqirurgia iSviaTad gamoiyeneba. eleqtrokonvulsiuri Terapia Zalze efeqturia depresiul pacientebTan, magram is mainc sakamaTo sakiTxad rCeba. farmakoTerapiaSi Sedis antifsiqoturi medikamentebi SizofreniisTvis, antidepresantebi da anqsiolizuri saSualebebi. tradiciulma fsiqoTerapiebma da medikamenturma mkurnalobam SeiZleba tvinSi zogierTi erTnairi cvlileba gamoiwvios.

egzistencialur-humanisturi Terapia
egzistencialur-humanisturi Terapiebi individebs TviTaqtualizaciaSi exmareba. Terapevtebi cdiloben aradireqtiulni iyvnen, rodesac klients exmarebian sakuTar Tavze dadebiTi warmodgenis SeqmnaSi, romelsac SeuZlia garemodan momdinare kritikasTan gamklaveba. geStalt-Terapia mimarTulia erTian pirovnebaze _ sxeulze, fsiqikasa da sacxovrebel garemoze.

Tavi 16 / pirovnebis cvlilebebis Terapiebi

ramdenad muSaobs Terapia


kvleva aCvenebs, rom mravali Terapia ukeTes Sedegs iZleva, vidre drois tyuilad xarjva, an placebo Terapia. Sefasebis proeqtebi, rogoricaa depresiis Terapiebis NIMH-is mier warmoebuli kvleva, gvexmareba, rom vupasuxoT kiTxvas: ra qmnis Terapiis efeqturobas? prevenciis strategiebi aucilebelia fsiqologiuri

jgufuri Terapiebi
jgufuri Terapia saSualebas aZlevs adamianebs, daakvirdnen da CaerTon socialur urTierTobebSi, rac Seamcirebs maT fsiqologiur problemebs.

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socialuri procesebi da urTierTobebi

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situaciis Zala

rolebi da wesebi socialuri normebi konformuloba situaciis Zala: mxilebani faruli kameriT
fsiqologia Cvens cxovrebaSi: rogor zemoqmedeben jgufebi gadawyvetilebis miRebaze socialuri realobis konstruireba

atribuciis Teoriis warmoSoba atribuciis fundamenturi Secdoma sakuTari Tavisadmi mikerZoeba molodinebi da TviTqmnadi winaswarmetyveleba qcevebi, romlebic amarTleben molodinebs
damokidebulebebi, maTi Secvla da qceva

damokidebulebebi da qcevebi darwmunebis procesi sakuTari qmedebiT darwmuneba daTanxmeba


socialuri urTierTobebi

mowoneba Seyvareba
fsiqologia XXI saukuneSi: urTierTobebi da interneti sakvanZo sakiTxebi

ZiriTadi cnebebi

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Tavi 17 / socialuri procesebi da urTierTobebi

ems siciliel papa salvatores Zalian uyvarda opera, magram metismetad Raribi iyo imisaTvis, rom odesme Tavis axal samSobloSi amerikis SeerTebul StatebSi operis TeatrSi wasuliyo. amis nacvlad, is yovel SabaTs usmenda patara radioTi saopero gadacemebs metropoliten operidan, romelic Tavis fexsacmlebis SesakeTebel saxelosnoSi, bronqsSi hqonda. is mTel xmaze rTavda radios, xolo, Tu opera italiuri iyo, tenoris partiebis umetesobas SemsrulebelTan erTad TviTonac asrulebda. Tanac papa grZnobda imis aucileblobas, rom gaenaTlebina amerikelebi~ da isini saopero xelovnebis saswaulisTvis eziarebina, amitom Tavisi saxelosnos karsac aRebda, raTa radios xma quCebs grialiT mosdeboda. erT SabaT dRes, papaCemis netareba Tavxedi biWebis jgufma daarRvia, romlebic mas sawyeni epiTetebiT amkobdnen: turtliano, saidanac mosulxar, iq waeTrie~ da uaressac eubnebodnen. isini ise xmamaRla Rrialebdnen, rom papam veRar SeZlo Tavisi sayvareli operis _ traviatas~ mosmena. is TviTonac lanZRavda maT, magram pasuxad ufro daundobel dacinvasa da abuCad agdebas iRebda. garkveuli drois Semdeg biWebi wavidnen, magram papas operis dasasrulis mosmeniT aRaranairi siamovneba miuRia. Semdeg SabaTs, saaTis sizustiT, biWebi isev movidnen yviriliTa da lanZRviT. amjerad papa salvatore gareT gamovida da biWebs uTxra: me

saTanadod ver Sevafase, Tu ra kargi xmebi gqoniaT, modiT gaagrZeleT yvirili, rac SegiZliaT xmamaRla da me TiToeul Tqvengans warmodgenisaTvis 25 cents gadagixdiT~. biWebmac yvirili daiwyes da sirenebiviT naxevar saaTs mainc gahyvirodnen gauCereblad. papa salvatorem maT safasuri gadauxada da isinic gancvifrebulebi da bednierebi gaiqcnen koka-kolisa da kinosTvis naSovni fuliT. momdevno SabaTs, rodesac isini kvlav gamocxaddnen, papa salvatore gareT gamovida da auwya biWebs, Tu rogor moswonda maTi Rriali, Tanac ufro xmamaRali, vidre operisa Tu mezoblad momuSave sanagve manqanebis xmaa, magram, amasTan, isic uTxra, rom erTi sawyali mewaRe iyo da imis saSualeba ar hqonda, rom maTTvis ise gadaexada, rogorc imsaxurebdnen da rom dRevandeli SousTvis mxolod 10 centis gaRebas SeZlebda. Sen Cven patara bavSvebi xom ar ggonivarT, bebruxanav? sulac ar vapirebT, Sous iafad mowyobas, Seitene Seni fuli! _ am sityvebiT isini iqaurobas moSordnen da, Tumca, isev ilanZRebodnen, magram ufro dabal xmaze. momdevno da yvela sxva SabaTs biWebma uari Tqves beberi italieli mewaRis lanZRvaze, romelsac Ciradac ar agdebdnen da romelsac axla arxeinad SeeZlo, yovel SabaTs Tavisi operebisaTvis esmina, ise xmamaRla CaerTo, rogorc moisurvebda da Tavi ar Seewuxebina imaze fiqriT, rom mas myudroebas daurRvevda an Seawuxebda uxeSi, crurwmenebiT savse jeelebis banda.

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Tu Tqven aRtacebaSi mogiyvanaT papa salvatores qcevam, hkiTxeT Tqvens Tavs, ratom iyo is ase efeqturi? ratom iyo, rom misma sawyisma safasurma 25 centma ase Secvala situacia? ratom moxda, rom sawyisi safasuris 10 centamde

dayvanam iZulebulni gaxada Tavxedebi, aRar gahkarebodnen papa salvatores da mis operebs. rogorc ki am kiTxvebze pasuxis gacemas SeecdebiT, socialuri fsiqologiis fsiqologiis im dargis samyaroSi moeqceviT, romelic swav-

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