ST自学笔记6 - 20200426 ST4BPD chap4 治疗关系
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。
继续本书第4章 (我作为一个BPD非常不认可，不喜欢的章节)，治疗关系。
前面的有限再养育和治疗师自我暴露部分，可以对照《图式治疗》第6章来看。后面的认知技术在第6章有详细阐述，行为技术是第7章内容。
因此本章非常之无聊。
（括号中的不是引用，而是我的解释和议论）
Chapter 4 治疗关系 The Therapeutic Relationship
要建立一个安全、信任的关系，需要治疗师付出大量的时间、精力和承诺，因为大多数BPD患者都有长期的被忽视、虐待和剥削的关系史。很遗憾的是，这些负面的经历中，有一些是与 治疗师或其他健康护理专业人员。因此，治疗师必须花费大量的时间和精力与病人建立安全、信任的治疗关系。此外，许多患者都曾经历过与治疗师的关系不好或过早结束。
治疗师要有很大的耐心，同时也要有良好的同伴监督小组的支持，这一点很重要。与其他形式的心理治疗相比，这种治疗对治疗师的时间和参与度都有很大的要求。一方面，治疗师必须在与病人共同参与的同时，保持自己的界限，并在此过程中保护病人的界限。因此，治疗师必须意识到自己的（功能失调的）模式，并且必须能够以健康的方式处理这些模式。在下面的段落中，我们将说明BPD患者和治疗师之间的治疗关系的重要因素。
1. 有限再养育（重塑？补偿？） Limited Reparenting
有限度的补偿可以被视为一种受限制的亲子关系的形式，在这种关系中，治疗师的举止构成了治疗过程的基础。 换句话说，治疗师进入这种关系，就好像他是病人的父母形象一样。请注意 "就像 "这句话。这种治疗的目的不是让治疗师成为父母，而是帮助患者塑造适当的父母行为和反应。治疗师在开始治疗的时候，要了解到他准备投入至少三年的时间（如果有必要的话，或更多的时间）与病人一起工作。有时，治疗师可能需要投入额外的时间来治疗病人，例如，当病人出现危机时。在治疗BPD患者时，我们建议治疗师保持与患者容易接触。Giesen-Bloo等人，2006年），在测试ST的试验中，治疗师们甚至提供了患者的电话号码，在危机或自杀企图的情况下，他们可以在办公时间以外的地方与患者联系。如果治疗师能够在危机时亲自接待病人，不仅有助于及时缓解危机，而且还能加强与治疗师的关系。在完成治疗后，Nora表示，仅仅是知道自己能够在发生危机时与治疗师联系，对她来说是非常重要的。这给了她一种被重视和关心的感觉。在她的三年治疗期间，Nora在非治疗时间之外给她的治疗师打了10次电话，其中8次是在第一年治疗期间。治疗师向病人提供一个电话号码，以便在发生危机或自杀未遂时使用，并不是为病人提供24小时的护理。治疗师是通过传呼机等方式提供自己的服务，比如说，病人可以在传呼机上留言说明情况的严重性。在这种方式下，治疗师一方面是暂时不方便（例如，在音乐会/剧院、睡觉或周末不在家），但是，信息系统可以让病人立即与治疗师联系。对于一些病人来说，只要听到答录机上治疗师的声音，就可以帮助他们度过眼前的危机。如果出现了需要立即关注的紧急危机，而治疗师又不在，病人可以按照第一次治疗时讨论的方案进行。这就需要她向其他人寻求帮助，例如她的主治医生或危机中心。
有限的亲子关系意味着治疗师要培养病人过去被忽视的部分。当病人无力解决某个问题时，他提供指导，并在必要时设定限制。治疗师将与她一起发展和提高她的能力，鼓励她发展自己的自主性和责任感。久而久之，患者会通过建立更健康的模式，将治疗师所扮演的角色内化，从而帮助她建立新的生活。下文将介绍有限再治疗中涉及的不同因素。
（说实在话，这部分是我认为ST不太好的地方。非常精分式的不好。（呃，也有比精分好一点的，就是坦率。)至少我接触过的大部分国内咨询师是无法胜任这种“有限度的再生父母”形象的，尤其是，特别喜欢做再生父母的那群精分动力。我不知道国外怎样，我对此非常非常非常怀疑。
在我与如此多流派风格不同受训背景的咨询师相处的过程里，我得到的结论是，我更愿意找一个教我在生活中如何建立更好的关系的咨询师。这样的效果比我移情给咨询师本人好太多。在我有限的几次移情经历来说，结果都挺灾难。我不认为仅仅是咨询师能力不足的原因，我筛过简历面试过的怎么也算华人圈里还不错的那批了吧。。。这是移情的锅，不用洗。
因此以下段落不翻译了。想看的翻出原著扔DeepL，不要抱怨我。）
1.1 Good care
1.2 Giving direction
1.3 Empathic confrontation
1.4 Role playing and role reversal
1.5 Setting limits
2. 治疗师的图式和自我暴露 Therapists’ Schemas and Self-Disclosure
（首先这部分和上一部分一样都是《图式治疗》里说过的内容，其次这部分很多内容是上一章做基础。所以不翻译了。
我不赞成以这样的预设去建立关系，虽然我赞成这样的关系模式需要被讨论。 ）
3.Cognitive Techniques and the Therapeutic Relationship
（这部分的认知技术和下一部分的行为技术都是很认知流派的了，这小节内容其实在第6章会详细讲，下一小节是第7章。）
如果在治疗关系中，患者显然对治疗师和治疗有某些不正常的认知（"他认为我是个爱发牢骚的人"）和治疗（"我早就该结束这种治疗了"），这些认知是反复出现的，那么在可能的情况下，应该用认知的方法来讨论（见第6章）。患者在治疗过程中或在治疗之外，通过挑战她的认知来解决这些问题。在治疗过程中，患者可以检查她对治疗师的想法是否正确。这就要求治疗师在回答问题时尽可能的透明，而不是只探讨病人为什么会对他有这些想法（见表4.3）。
（表略）
4.Behavioural Techniques and the Therapeutic Relationship
行为技术，如在治疗过程中强化预期的行为（特别是治疗--强化行为）以及在治疗过程外练习这些行为是ST的重要组成部分。
治疗师也可以鼓励病人在治疗过程中尝试某些行为实验。
在整个治疗过程中，治疗师的行为是病人的榜样，治疗师为病人树立健康行为的榜样。假设一切顺利，他是一个尊重、透明、诚实、有兴趣、不评判、值得信赖和平衡的行为榜样。目标是让病人接受和调整治疗师的不同行为，以发展成为一个健康的成年人。
5. Summary
建立安全的治疗关系是这种治疗的中心点。在运用经验、认知和行为技术的同时，治疗师继续采用所述的有限补偿方式。他将一次又一次地以一种友好而又明确而坚定的方式，用特定的技术来接近特定的问题，因为这也是对一个你想教的孩子最好的方式。他将平衡技术的变化，以便一方面不压倒病人，另一方面不下-刺激她。例如： 当利用想象力引发强烈的情绪时，在下一节课中多花一点时间讨论上一节课所发生的事情，在认知上给它一个位置，是明智的做法。`
在接下来的章节中，我们将讨论不同的技巧：第五章的体验式技巧，第六章的认知式技巧，第七章的行为式技巧，第八章的具体方法和技巧。接下来，我们将讨论如何将这些技术应用到不同的模式中（第九章）。
Creating a safe, trusting relationship will take a lot of time, energy and commitment from the therapist as most BPD patients have a long history of relationships in which neglect, abuse and exploitation took place. It is sad to say but some of these negative experiences are regrettably with therapists or other health care professionals. Because of this, therapists must spend a great deal of time and energy in creating a safe, trusting therapeutic relationship with their patients. In addition, many patients have experienced relationships with therapists that were bad or had come to a premature end. It is important for the therapist to have a great deal of patience as well as the support of a good peer supervision group. In comparison with other forms of psychotherapy, this treatment demands a great deal of both time and involvement. The therapist must, on the one hand, be unusually involved with his patient while at the same time maintaining the ability to set his own boundaries and in doing so protecting those of his patient. Therefore, the therapist has to be aware of his own (dysfunctional) schemas and must be able to deal with them in a healthy way. In the following paragraphs we illustrate important elements of the therapeutic relationship between the BPD patient and the therapist.
1. Limited Reparenting
Limited reparenting can be viewed as a form of constrained parenthood in which the therapist ’ s demeanour forms the basis for the therapeutic process.
In other words, the therapist goes into this relationship as if he were a parent figure for the patient. Please take note of the words ‘ as if ’ . It is not the intention of this therapy for the therapist to become the parent but rather help model appropriate parental behaviours and reactions. The therapist starts therapy with the understanding that he is prepared to invest at least three years (or more if necessary) in working with the patient. At times the therapist might have to invest extra time in the treatment of the patient, for example, when there is a crisis. When treating BPD patients we recommend that the therapist remains easily accessible to the patient. Therapists in the trial testing ST (Giesen - Bloo et al., 2006 ) went so far as to provide their patients with telephone numbers where they could be reached outside office hours in cases of crisis or suicide attempts. If the therapist is able to personally accommodate the patient during a crisis, not only will this help to eleviate the crisis in a timely fashion, but it will also strengthen the relationship with the therapist. Upon completion of her therapy, Nora stated that simply knowing she was able to contact her therapist in the event of a crisis was very important to her. It gave her the feeling that she was valued and cared about. During her three years of therapy, Nora called her therapist 10 times outside offi ce hours; 8 of these 10 times were during the first year. By providing a patient with a telephone number to use in the event of a crisis or suicide attempt, the therapist is not providing 24 - hour care for his patient. The therapist is making himself available by means of, for example, a pager on which the patient can leave a message describing the seriousness of her situation. In this manner the therapist is on the one hand temporarily unavailable (e.g. at a concert/theatre, sleeping or away for the weekend), but, the message system provides the patient with immediate access to her therapist. For some patients simply hearing the therapist ’ s voice on the answering machine offers enough reassurance to help them through whatever crisis is at hand. If there is an acute crisis requiring immediate attention and the therapist is not available, the patient can follow the protocol discussed during the first sessions. This will require her to turn to others for help such as her primary physician or a crisis centre.
Limited parenthood implies that the therapist fosters the neglected components of the patient ’ s past. He offers direction when the patient is incapable of addressing a problem and sets limits when necessary. The therapist will work with her in developing and improving her abilities and encouraging her to develop her autonomy and responsibility. In time, the patient will internalize the role the therapist plays by building healthier schemas, which will in turn help her to build a new life. The different elements that are involved in limited reparenting are described in the following paragraphs. 2. 治疗师的图式和自我暴露 Therapists’ Schemas and Self-Disclosure
3.Cognitive Techniques and the Therapeutic Relationship
If in a therapeutic relationship it becomes clear that the patient has certain dysfunctional cognitions regarding the therapist ( ‘ he thinks I ’ m a whiner ’ ) and the therapy ( ‘ I should have been fi nished with this therapy a long time ago ’ ) that are recurrent, one should discuss this using a cognitive approach when possible (see Chapter 6 ). The patient addresses these subjects by challenging her cognitions during the sessions or outside of the sessions. During the session the patient can check if her ideas about the therapist are correct. This requires the therapist to be as transparent as possible in his answers and not just explore why the patient has these thoughts about him (see Table 4.3 )
4.Behavioural Techniques and the Therapeutic Relationship
Behavioural techniques such as reinforcing desired behaviour (in particular therapy - enhancing behaviours) both within the therapy sessions as well as practising these behaviours outside of the sessions are an important part of ST .
The therapist can also encourage the patient to try out certain behavioural experiments on him during the session.
The behaviour of the therapist during the entire therapeutic process is that of a role model for the patient, with the therapist modelling healthy behaviour for the patient. Assuming all goes well, he is an example of respectful, transparent, honest, interested, non - judgemental, trustworthy and balanced behaviour. The goal is for the patient to take on and adjust the different aspects of the therapist ’ s behaviour in order to develop into a healthy adult. summary
Creating a safe therapeutic relationship is the central point of this therapy. While applying experiential, cognitive and behavioural techniques, the therapist continues to employ the described style of limited reparenting. Time and time again he will approach specific problems with a specific technique in a friendly but clear and determined manner, as this is also the best way to behave towards a child whom you want to teach something. He will balance the change of techniques so as not to overwhelm the patient on the one hand, and not under - stimulate her on the other. For example, when by using imagination strong emotions are triggered, it is sensible to take a little extra time during the next session to discuss what happened in the previous session and give it a place in a cognitive sense. ` In the following chapters we will discuss the different techniques: experiential techniques in Chapter 5 , cognitive techniques in Chapter 6 , behavioural techniques in Chapter 7 , and specific methods and techniques in Chapter 8 . This is followed by how one should apply these techniques to the different schema modes (Chapter 9 ).
-
（（（（（ 转发了这篇日记 2020-08-12 13:50:37
