Дипломная работа Павленко Дмитрия "Особенности психологической реабилитации инвалидов-колясочников".

        Характерной чертой современности являются такие общемировые процессы, как рост числа вооруженных конфликтов, ухудшение экологической обстановки, развитие высокотехнологичной медицины, благодаря которому удается сохранить жизнь в недавнем прошлом безнадежным больным... Эти, казалось бы, разноплановые процессы  имеют, тем не менее, некие общие последствия. Из года в год увеличивается число людей, имеющих те или иные ограничения физических возможностей. Физическая травма неизменно влечет за собой травматические изменения психики. Перенесенная человеком травма спо-собствует развитию у него определенных сим¬птомов, которые во многом определяют его поведение в социальной среде, затрудняют его адаптацию в обществе.    

       Врожденное (приобретенное) ограничение физических возможностей является одним из примеров острой травматической ситуации.  Найти выход из сложной ситуации, принять себя в новом качестве, адаптироваться к изменившимся условиям среды помогает реабилитация.
В настоящее время все большее число специалистов сходится во мнении, что реабилитация представляет собой комплексный процесс, в который каждая отрасль (медицина, психология, педагогика, социальная работа, спорт и т.д.) вносит свой значительный вклад.  Но только при объединении их усилий возможна максимальная успешность реабилитационного процесса. Основу реабилитационного процесса составляет сотрудничество реабилитолога и пациента, который сознательно прилагает усилия для поиска собственного пути к выздоровлению, выходу из психологического тупика.
       Психологическая реабилитация подразумевает в первую очередь восстановление утраченных или сниженных вследствие травм и (или) органических болезней психических функций и психических операций и  представляет собой систему мероприятий, направленных на восстановление, коррекцию или компенсацию нарушенных психических функций и состояний.
В преодолении последствий травматического воздействия  задействованы три важнейших фактора: когнитивный, эмоциональный, поведенческий.
       Соответственно,  выделяют следующие основные стратегии, используемые в процессе психологической реабилитации, для  преодоления стрессовой ситуации: когнитивную, эмоциональную, поведенческую.
       Существуют индивидуальные различия в том, какая из сфер психики окажется наиболее уязвимой при длительном высоком напряжении. Выбор мишени обусловливают с одной стороны ситуативные факторы, а с другой личностные особенности. [3]
Внимание при психокоррекционном воздействии должно быть направленно, прежде всего, на соответствующую сферу, но необходимые ресурсы могут быть найдены не только в ней; более того, основной вклад в преодоление может быть сделан при изменении активности в другой сфере. Поиск такой сферы, ее активация и составляет основную задачу психологической поддержки в преодолении жизненных трудностей.
       В результате пребы¬вания в экстремальной ситуации (к которой можно отнести  и болезнь, и физическую травму, приводящую к инвалидности)  у человека развивается особое состояние, получившее название посттравматическое стрессовое рас¬стройство. [4]
Инвалиды - колясочники представляют собой одну из  категорий инвалидов,  для которой характерны значительные ограничения физических возможностей. Люди утрачивают возможность передвигаться,  являющуюся необходимым условием для полной и активной жизни. Лишаясь возможности свободного передвижения,  человек автоматически получает ограничения собственной свободы и самостоятельности: выполнение многих привычных действий требует от него привлечения посторонней помощи, что ставит человека в зависимость от окружающих. Как следствие такого ограничения происходит ослабление (в ряде случаев -  полный разрыв) социальных связей,  изменение социального статуса, потеря привычного уклада жизни, изоляция ( в ряде случаев и самоизоляция) от общества.  Все эти составляющие приводят к травматизации психики.
Большинство инвалидов- колясочников находятся в травматическом или посттравматическом стрессовом состоянии, поскольку кроме личностных переживаний, связанных с самоопределением в новой для них жизненной ситуации, они, в большинстве случаев,  испытывают физические страдания.
       Предваряя свою работу с данной категорией, мы сделали предположение, что целенаправленное психологическое воздействие на людей, имеющих ограничения физических  возможностей в части способности к передвижению, снижает последствия травматического воздействия, облегчает процесс адаптации к изменившимся условиям среды.
Группа «инвалиды –колясочники» неоднородна по физическим и психологическим параметрам, тем не менее, можно выделить общую для всех черту, общую проблему. Мы  назвали ее «страх перед улицей», подразумевая под этим термином   то чувство уязвимости,  которое испытывают люди, передвигающиеся на коляске. 
        «Страх перед улицей» - условное обозначение группы страхов, тревог, комплексов, которое испытывают инвалиды - колясочники вне своего привычного замкнутого пространства и близкого круга общения. Понятие «страх перед улицей» включает в себя ряд страхов, среди которых: страх потери своей социальной идентичности, страх конфронтации с обществом (разделение на «я» и «они»), страх перед окружающей средой,  неадаптированной к их потребностям.
Анализ работы по разработке и внедрению в практику  программы психологической реабилитации инвалидов-колясочников показал, что в процессе психологической реабилитации инвалидов – колясочников  особое внимание необходимо уделять поискам путей преодоления страхов перед обществом и созданию мотивации на интеграцию человека в социум.
        Основные задачи,  которые необходимо решить в процессе  реабилитации инвалидов – колясочников, можно обозначить так:  повышение самооценки, выработка установки на успех, работа со страхами, снятие психологического напряжения, подбор  сфер и  направлений, в которых человек, имеющий ограничения физических возможностей, смог бы реализоваться максимально полно с учетом своего состояния.
        Общее количество участников программы реабилитации составило 12 человек,  из них 11 являются инвалидами-колясочниками,  один человек имеет заболевание, связанное с нарушением функционирования опорно-двигательной системы. Срок реализации программы составил три  месяца.
        Нами было выдвинуто предположение, что главным результатом реализации данной реабилитационной программы станет  улучшение психологического состояния и повышение уровня социальной адаптации участников программы, расширение их жизненного потенциала, формирование установок на достижение положительного результата.
       Для осуществления психологической коррекции были использованы методики повышения уверенности в себе, велась работа, направленная на преодоление страхов, осуществлялась аутогенная тренировка, применялись элементы арттерапии. Особое внимание было уделено работой с мотивационной сферой участников программы.
       По итогам реализации реабилитационной программы можно сделать вывод о ее эффективности. Об этом  свидетельствуют положительные результаты,  которые были получены в результате прохождения данной программы инвалидами – колясочниками. Испытуемые представили разные результаты, но общая динамика положительная. Практически у всех участников программы понизилась личностная и реактивная тревожность, наблюдалось уменьшение уровня напряженности, которая была характерна для них до реабилитации; появилась уверенность в себе и в собственных силах; повысилась самооценка.
       В целом гипотеза, выдвинутая в начале исследования, в процессе работы нашла свое подтверждение. Результатом целенаправленного психологического воздействия на людей, имеющих ограничения физических  возможностей в части способности к передвижению, стало снижение последствий травматического воздействия, проявившееся в улучшении психологического состояния, расширении их жизненного потенциала, формировании установок на достижение положительного результата в процессе преодоления трудной жизненной ситуации.
Наиболее важным и показательным результатом реабилитационной работы нам представляется формирование у участников установки на значимость личных усилий, собственной активности в преодолении различных жизненных трудностей и  достижении поставленных целей.
Безусловно, полученные положительные результаты требуют закрепления. Тем не менее,  наметившаяся положительная динамика дает основания рекомендовать продолжение реабилитационной работы. Однако для достижения максимально возможного положительного эффекта в реабилитационной работе необходимо уделять внимание формированию благоприятной социальной среды, менять  не только внутреннее психологическое состояние людей, имеющих ограничение физических возможностей, но и общественное мнение на уровне социальных установок.

Список литературы. 
1.    Василюк Ф.Е. Уровни построения переживания и методы психологической помощи // Вопросы психологии, 1988, N 5 -  27-37 с.
2.    Василюк Ф.Е. Психология переживания. М., 1984.- 200 с.
3.    Куликов Л.В.. Здоровье и субъективное благополучие личности//Психология здоровья /Ред. Г.С.Никифоров. СПб., Изд-во СПбГУ, 2000. (глава в коллективной монографии). - 405-442 с.
4.    Михайловский В.М. «Неспецифическая травматическая реакция», Москва, 1997 – 12 с.
5.    Малкина-Пых И. Психологическая помощь в кризисных ситуациях. М. Изд-во ЭКСМО  2010.- 928 с.
6.    Осухова Н. Г. Психологическая помощь в трудных и экстремальных ситуациях: Учебное пособие для студ. высш. учеб. заведений. 2-е изд., испр. М., 2007.- 288 с.
7.    Осипова А.А. Общая психокоррекция: Учебное пособие для студентов вузов. - М.: ТЦ «Сфера»», 2000. - 512 с.
8.    Психотерапия. / Под ред. Б.Д.Карвасарского. — СП6: Издательство «Питер», 2000. — 544 с.
9.    Селье Г. (Н. Selye), Стресс без дистресса.- Про¬гресс, Москва (1979) – 123 с.
10.     Селье Г. (Н. Selye), На уровне целого организма. -  Наука, Москва (1966).- 122 с.

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