ST自学笔记5 - 20200418 ST4BPD 全书结构（治疗策略）
本部分所有笔记见 图式治疗（ST）自学笔记汇总
翻译的荣耀归给 DeepL （https://www.deepl.com）~ 照例，英文原文附在最后。
（括号中的不是引用，而是我的解释和议论）
（
今天说下 Chap 3 Treatment
这章相当于是一个全书结构章节。因为第一章是BPD介绍，第二章是ST介绍（昨天已经整理了 ST自学笔记4 - 20200417 ST4BPD 治疗理论 ）。第三章，把ST治疗BPD的整个框架介绍了一下，也就是，把后面章节的内容简单说明。
）
Structure of Treatment 治疗的结构
在治疗BPD时，改变的过程是沿着三个不同的路径进行的：感觉、思考和行动。这些路径对应于模式中存在的三个层次的知识表征：显性知识（思维）、隐性知识（包括情感表征或感觉）和操作性表征（做）。
除了这三个路径之外，我们还可以区分出三个不同的话题，这些话题可以通过这些路径来解决。这些主题是治疗之外的生活、治疗中的经验和过去的经验。在表3.1中，我们将这些途径和主题以矩阵的形式列出，以便在任何一种情况下都能清楚地知道哪些相关的治疗技术可以最好地应用。
(表3.1 里就是整个治疗会用到的技术了。前文已经解释过了横坐标和纵坐标的三类分别是怎样来的。)
无论患者关注的主题是什么，尝试的途径是什么，只有当患者对治疗师形成一定程度的信任和依恋时，这些技术才会成功（见表3.1中的 "治疗内"）。 由于患者和治疗师之间的关系非常重要，所以我们将在本章讨论治疗之后的第四章中立即讨论这种关系。只有当这种关系被完全解决后，我们才会转到技术上。首先，我们将在第五章讨论隐性知识的变化（体验式技术），然后是 第六章（认知技术）中的思维或显性知识，最后是第七章（行为技术）中的 "做 "或改变操作表象。在矩阵中找到的所有主题（表3.1）可以在下面的章节中找到。然而，首先我们将研究在治疗BPD与ST的过程中所涉及的阶段。
（注意，这里五六七章内容，对应这改变的三种途径，也就是感觉、思考和行动。第八章 “Specific Methods and Techniques” 并没有在这里提到，读者可以理解位就是除一些特殊疗法工具。）
治疗首先要对患者所经历的问题进行全面的盘点。这是在彻底解释模式模式模式的基础上进行的。在这些开始的治疗过程中，还包括对实际问题的讨论，如治疗的频率（每周一次或两次）和预期的治疗时间（一年半到四年或更长时间（如有必要）。
治疗过程中的录音并不罕见。ST的独特之处在于，在下一次治疗前，患者会得到这段录音，并被要求在下一次治疗前听一听。听录音可以加强治疗的效果。没有人能够将所有的信息都纳入到一个疗程中。因此，听录音课程对病人来说是一个非常有益的工具。通常情况下，只有在听了录音后，病人才会真正听到并理解治疗过程中所说的内容。在实际的治疗过程中 患者可能处于一种不利于倾听或处理信息的模式。模式可以扭曲语气和语言的感知方式，从而强烈影响信息加工。正因为如此，聆听或重新聆听录音会话，不仅可以重申会话本身，还可以证明会话中实际说了什么，做了什么。
（我很震惊其实！ST建议咨询师把整个过程录音并且发给来访？？但想想也有好处，这样容易去追踪治疗中问题出现在哪里，尤其BPD如此缺乏界限感，治疗师理应在录音监督下明确自己的工作职责和界限。同时，复习是个好方式，我做了400多次咨询了，仍然常常无法整理好我在咨询过程中处理过的问题。）
最后，重要的是要就治疗师的可用性达成协议。病人需要有明确的指引，说明她何时可以（和不能）在治疗之外与治疗师联系。她需要知道当危机来临时应该采取什么行动，当治疗师不在的时候，她可以向谁求助（见第4章，"有限的亲子关系"）。 通常情况下，同伴监督小组的另一位成员会在一旁参与治疗。他可以在需要的时候临时代替治疗师，例如，在假期或生病的时候。
Phases in Treatment 治疗的阶段
BPD患者的模式疗法（ST）并没有固定的方案，每个疗程都会描述哪些问题需要解决。毕竟，这是一个涵盖两到三年的治疗方法。然而，在治疗中，有一些可区分的阶段，这将在后面描述。对于ST的治疗方案来说，治疗师要知道如何最好地 在这一点上，我们选择了在描述了不同的治疗技术（第5-8章）之后，用一章来介绍治疗师如何在不同的治疗阶段对不同的治疗模式做出反应。由于这一点的重要性，我们在描述了不同的治疗技术（第5-8章）之后，我们选择用一章来介绍治疗师在治疗的不同阶段如何处理每一种模式（第9章）。在第十章中，我们将单独关注治疗的最后阶段 。
虽然这些阶段没有固定的顺序，但有7个明显的、可区分的治疗阶段。有些阶段可能会被省略，而另一些阶段可能会在治疗的后期复发。这些阶段是：
1.开始阶段和个案概念化。 2.治疗轴-I症状。 3.危机管理。 4.治疗干预与模式化模式的治疗干预。 5.治疗儿童时期的创伤。 6.改变行为模式。 7.结束治疗。
（注意一下，这里的治疗阶段和《图式治疗》里的不完全一样噢）
（本章的后面部分就是按照这个治疗阶段，从1讲到7.我偷懒不翻译了。第九和第十章还会说到的）
（“开始阶段和个案概念化 ”这里有个图，和上一章里讲到的模型对应的哈）
Structure of Treatment
The process of change is approached along three distinct pathways when treating BPD: feeling, thinking and doing. These pathways correspond to the three levels of knowledge representation that are present in the schemas: explicit knowledge (thinking), implicit ‘ felt ’ knowledge (including emotional representations or feeling) and operational representations (doing). In addition to these three pathways, we can also distinguish three different topics, which can be addressed by these pathways. These topics are life outside of therapy, experiences in therapy and past experiences. The pathways and topics are presented in a matrix in Table 3.1 so that it is clear which relevant therapeutic techniques can be best applied during any of the given situations.
Whatever topic the patient focuses on and whatever pathway is tried, these techniques can only be successful once a certain level of trust and attachment to the therapist is formed (see ‘ within therapy ’ in Table 3.1 ). Because of the importance of the relationship between patient and therapist, we will address this relationship in Chapter 4 immediately after discussing treatment in this chapter. Only once this relationship is fully addressed will we move on to the techniques. First we will discuss the change of implicit knowledge in Chapter 5 (experiential techniques), then thinking or explicit knowledge in Chapter 6 (cognitive techniques) and finally ‘ doing ’ or changing operational representation in Chapter 7 (behavioural techniques). All of the subjects found in the matrix (Table 3.1 ) can be found in the following chapters. However, first we will examine the phases involved in the course of treating BPD with ST.
Treatment begins with a comprehensive inventory of the problems as the patient experiences them. This is done in connection with a thorough explanation of the schema mode model. Also included in these beginning sessions is a discussion of practical matters such as the frequency of sessions (once or twice a week) and the expected duration of the therapy (one - and - a - half to four years or longer if necessary).
The recording of therapeutic sessions is not unusual. What is unique to ST is that the patient is given this recording and asked to listen to it before the next session takes place. Listening to the recorded sessions strengthens the effect of the therapy. No one is capable of incorporating all the information involved in a single session. Therefore, it is a very beneficial tool for the patient to listen to the recorded session. Often it is only upon listening to the recording that a patient actually hears and comprehends what was said during the session. During the actual session the patient could be in a mode that is not conducive to listening or processing information. Modes can distort how tone and language are perceived and therefore strongly influence information processing. Because of this, listening or re - listening, to recorded sessions not only reiterates the session itself, it also serves as proof of what was actually said and done during the session. Finally it is important that agreements are made regarding the therapist ’ s availability. The patient needs clear guidelines as to when she can (and cannot) contact the therapist outside of sessions. She needs to know what courses of action to take when a crisis is approaching and to whom she can turn when the therapist is unavailable (see Chapter 4 , ‘ Limited Reparenting ’ ). Normally there is another member of the peer supervision group who is involved in the therapy from the sidelines. He can temporarily replace the therapist if needed, for example, in case of holidays or illness.
Phases in Treatment Schema therapy (ST) for BPD patients does not have a fixed protocol that describes per session which issues need to be addressed. After all, this is a therapy that covers two to three years. There are, however, a number of distinguishable phases in the therapy, which will be described later. It is important to the protocol of ST that the therapist is aware of how best to react towards the different modes. Because of the importance of this we have chosen, after describing the separate therapeutic techniques (Chapters 5 – 8 ), to devote a chapter on how the therapist can deal with each mode during different phases of the therapy (Chapter 9 ). In Chapter 10 we will give separate attention to the final phase of the therapy.
While there is no set order to these phases, there are seven distinctive and distinguishable periods of therapy. Some phases may be omitted while others may recur at a later stage of therapy. These phases are: 1. starting phase and case conceptualization; 2. treating axis - I symptoms; 3. crisis management; 4. therapeutic interventions with schema modes; 5. treating childhood traumas; 6. changing behavioural patterns; 7. ending therapy.
