心智化的方法與技術(shù)：第2講課件

MentalizingandMindfulness:

BridgingtheGapBetweenPsychodynamicandCognitive-BehavioralApproaches

心智化與正念：

心理動(dòng)力和認(rèn)知行為取向之間的橋梁

JonG.Allen,Ph.D.ConceptsofMindfulnessandMentalizingOverlap正念與心智化概念的重疊Mindfulnessand“Third-WaveCBT”O(jiān)verlapwithMentalizing正念和“認(rèn)知行為治療第三浪潮”與心智化有重疊MentalizingbridgespsychodynamicapproachesandCBT*心智化將心理動(dòng)力取向與CBT橋接到一起Clinicalexample:Mentalizingsuicidalstates臨床示例：對(duì)自殺狀態(tài)加以心智化*focusingonsocialcognition(interpersonalrelationships),thementalizingapproachcouldbeconsidered“social-cognitivetherapy”(SCT)*聚焦于社會(huì)認(rèn)知（人際間關(guān)系），心智化取向可以被理解為“社會(huì)-認(rèn)知療法”（SCT）Introduction:KeyPoints介紹：關(guān)鍵點(diǎn)Definition:“theawarenessthatemergesthroughpayingattentiononpurpose,inthepresentmoment,andnonjudgmentallytotheunfoldingofexperiencemomentbymoment”(Kabat-Zinn,2003)定義：“通過有目的地將注意力放在在當(dāng)下，非批判性地讓體驗(yàn)隨著時(shí)間逐漸展開，而浮現(xiàn)出的覺察”（卡巴金，2003）ExtremelypopularintheU.S.,generalpublicandpsychotherapistsInU.S.psychotherapy,secularorientationtomindfulnesspracticeHighlyeffectiveforstressreduction(e.g.,MBSR,Kabat-Zinn)在美國(guó)，受到大眾和心理治療師的歡迎美國(guó)的心理治療行業(yè)，有將正念練習(xí)世俗化的傾向?qū)徑鈮毫Ψ浅Ｓ行Вɡ纾谡畹膲毫徑庥?xùn)練，卡巴金）decreasedanxietyanddepression,improvedattention,improvedemotionregulation,decreasedstressreactivity,improvedwellbeing,increasedpositiveemotion,improvedphysicalhealthandpainmanagement減少焦慮和抑郁、改善注意力、增進(jìn)情緒調(diào)節(jié)力、減少應(yīng)激反應(yīng)、促進(jìn)健康、增加積極情緒、增進(jìn)身體健康和疼痛管理能力Employedintreatmentofawiderangeofpsychiatricdisorders用于治療各種精神疾病anxiety,depression,borderlinepersonalitydisorder,substanceabuse,eatingdisorders,psychoticsymptoms焦慮、抑郁、邊緣人格障礙、物質(zhì)濫用、進(jìn)食障礙、精神病癥狀Mindfulness正念MindfulAttentiveness:

Afoundationforeffectivementalizing

正念注意力：

有效心智化的基礎(chǔ)makinginferencesaboutmentalstates對(duì)心理狀態(tài)做出推論reflectingonthemeaningofmentalstates反思心理狀態(tài)的意義constructingbiographicalandautobiographicalnarrative構(gòu)建傳記與自傳敘事Mentalizing心智化ethical:nonjudgmental;acceptance,compassion,curiosity倫理標(biāo)準(zhǔn)：非批判性的；接納的；同情的；好奇的awarenessofmentalstatesasrepresentational表征性地覺察心理狀態(tài)Overlap重疊bareattention,present-centered全然專注，以當(dāng)下為中心attentivenesstomentalstatesinselfandothers注意自我和他人的心理狀態(tài)Mindfulness正念Firstwave:behaviortherapy(e.g.,exposureforanxiety)Secondwave:cognitivetherapy(e.g.,cognitivedistortions)Thirdwave:mindfulnessandacceptanceapproaches;notchangingthecontentofthoughtsbutratherthewayyourelatetofeelingsandthoughts(likethe“mentalizingstance”)第一波：行為治療（例如，焦慮的暴露法）第二波：認(rèn)知治療（例如，認(rèn)知扭曲）第三波：正念和接納取向；不改變思考的內(nèi)容，而是改變你與情緒和思考的關(guān)系（比如“心智化的立場(chǎng)”）AcceptanceandCommitmentTherapyusesacceptanceandmindfulnessprocesses,andcommitmentandbehaviorchangeprocessestoproducegreaterpsychologicalflexibility(Hayes2004)接納承諾療法使用接納和正念過程、承諾和行為改變過程，來創(chuàng)造更大的心理靈活性（海斯，2004）Twoformsofavoidance:situationalandexperientialExperientialacceptance(mindfulness)promotesflexibility,includingcommitmenttovaluedaction(whileacceptingdistressingfeelings)回避的兩種形式：情境性和經(jīng)驗(yàn)性回避對(duì)經(jīng)驗(yàn)的接納（正念）促進(jìn)靈活性，包括符合價(jià)值方向的行動(dòng)的承諾（同時(shí)接受令人痛苦的感受）Third-WaveCognitive-BehavioralTherapy認(rèn)知行為治療的第三浪潮TheMentalizingStance:

mentalizing

mindfully

心智化立場(chǎng)：

帶著思考的心智化Psychologicalaspects心理學(xué)方面inquisitive,curious,playful,open-minded探究、好奇、好玩、開放心態(tài)“notknowing”(clevernessisaunhelpful)“不知道”（聰明是沒有幫助的）notcreatingthecapacitybutratherpromotingattentivenesstotheactivityofmentalizing并不在于創(chuàng)造“能力”，而是在于促進(jìn)對(duì)心智化活動(dòng)的“專注”Ethicalaspects(asinparenting,forexample)倫理標(biāo)準(zhǔn)方面（如同在養(yǎng)育中所體現(xiàn)的）goodwillandcompassion善意和同情acceptanceandforgiveness接納和寬恕respectforautonomy尊重自主性love愛意EthicalDimensionofMentalizing:MotivationforMentalizing心智化的倫理標(biāo)準(zhǔn)維度：心智化的動(dòng)機(jī)PROTECT 保護(hù)COMFORT 安撫UNDERSTAND 理解Cooperate 合作Help 幫助Teach 教授Learn 學(xué)習(xí)Explore 探索Judge(e.g.,responsibility)評(píng)價(jià)（例如，責(zé)任）Avoiddanger 避免危險(xiǎn)Compete 競(jìng)爭(zhēng)Deceive 欺騙Detectdeception 偵測(cè)欺騙Exploit 剝削Seduce 引誘Control 控制Dominate 主導(dǎo)Defeat 擊敗CollaborativeAssessmentandManagementofSuicide(DavidJobes)自殺的合作評(píng)估與管理（大衛(wèi)·Jobes）Mary,apastoralcounselorinher40s:瑪麗，一位40余歲的教牧輔導(dǎo)師：emotionallyneglectedbymother,rejectedandcriticizedbyfather在情感上被母親忽視，遭到父親的拒絕和批評(píng)sexuallyabusedbyapriestinlatechildhood在童年后期被一名牧師性侵犯marriedwiththreechildren,feltunabletolove婚后育有三個(gè)孩子，感到無法去愛depressionworsenedaftermovingawayfromfriends離開朋友后，抑郁惡化priortosuicideattempttoldherdepressionwas“treatmentresistant”在自殺嘗試之前，告訴她抑郁癥是“治療阻抗”believedthatherfamilywouldbebetteroffwithouther相信如果沒有她，她的家人會(huì)更好BridgingPsychodynamicTherapyandCBT:StructuredMentalizingofSuicidalStates橋接精神動(dòng)力治療和CBT：自殺狀態(tài)的結(jié)構(gòu)化心智化方法SuicideStatusForm(worstpoint,current,weeklyupdates)自殺狀態(tài)表（最差點(diǎn)時(shí)、當(dāng)下的，每周更新）Ratementalstatefromlowtohigh(1-5)andgivereasons從低到高（1-5）給心理狀態(tài)打分，并給出原因Psychologicalpain,5,feelingfrightenedanddisconnected心理痛苦，5分，感到恐懼、失去連接Stress,4,argumentswithchildrenandhusband壓力，4份，與孩子和丈夫爭(zhēng)吵Agitation,5,feelingtrapped,likea“cagedanimal”激惹，5分，感到被困住了，像一只“困獸”Hopelessness,5,nothingwillchange,nothingtolookforwardto無望感，5分，沒有事情能改變，沒有事情可期待Self-hate,4,I’vemadeamessofeverything,completefailure自我憎恨，4分，我把所有的事情都搞砸了，徹底的失敗Overallriskofsuicide,4自殺的總體風(fēng)險(xiǎn)，4分Ratewishtoliveandwishtodie,lowtohigh(1-8)給活下去的愿望和死亡的愿望打分，從低到高（·-8）Wishtolive,1活下去的愿望，1分Wishtodie,7死亡的愿望，7分CollaborativeAssessment&ManagementofSuicideDavidJobes自殺的合作評(píng)估與管理大衛(wèi)·JobesReasonsforLiving活下去的理由Don’twanttohurtmyfamily不想傷害我的家庭Imightgetbetter我可能可以變好ReasonsforDying死亡的理由I’maburden我是個(gè)負(fù)擔(dān)I’llnevergetbetter我不會(huì)變好了Fearoffailure害怕失敗Endthepain結(jié)束痛苦SuicideStatusForm,continued自殺狀態(tài)表，續(xù)LessacutelydistressedafterhospitalizedbutstillsuicidalAftergradualimprovement,moreacutelydistressedwhenhergrouptherapymemberspressuredhertodivorceRecognizedroleofearlytraumaindistancefromhusbandandmadeacommitmenttoworkonhermarriageinfamilytherapy;husbandwaspositivelyinvolved;recognizedasa“l(fā)ong-term”projectandthatsheneednotcommitsuicideifmarriagebrokeupIdentifiedperfectionismaskeyproblemrelatedtoself-hateSoughtpastoralcounselingtoworkonalienationfromthechurchTherapyincludedawrittenformulation,revisedtowardtheendTreatedongoingsuicidalthoughtswithmindfulacceptanceByendoftreatment,wishtolive7,wishtodie1(reversed)住院后不那么劇烈，但仍有自殺傾向經(jīng)過一段時(shí)間的逐步改善，在她的團(tuán)體治療成員壓迫她離婚時(shí)，再次變得更加劇烈認(rèn)識(shí)到早期創(chuàng)傷在疏遠(yuǎn)丈夫的方面的作用，并承諾接受家庭治療，做婚姻工作；丈夫積極參與；認(rèn)識(shí)到這是“長(zhǎng)程”的工作，而且即使婚姻破裂，她也不需要自殺認(rèn)出完美主義是與自我憎恨相關(guān)的關(guān)鍵問題尋求教牧輔導(dǎo)以解決與教會(huì)異化的問題治療包括書面的案例建構(gòu)，在結(jié)束時(shí)再做修訂帶著思考的接納態(tài)度，處理持續(xù)的自殺念頭治療結(jié)束時(shí)，活下去的愿望7分，死亡的愿望1分（逆轉(zhuǎn)了）CourseofTreatment治療過程References

參考Allen,J.G.(2008).Mentalizingasaconceptualbridgefrompsychodynamictocognitive-behavioraltherapies.EuropeanPsycho