1、結(jié)構(gòu)式家庭治療- 技術(shù)篇,陽(yáng)光家庭俱樂部 馮旭東 2008-6,2020/8/30,2,1、基本概念篇 2、治療架構(gòu)篇 3、技術(shù)篇,The therapistjob is to help the family change, not to keep them comfortable.,2020/8/30,3,技術(shù)是從怎么產(chǎn)生的? 技術(shù)最初都是在治療中自發(fā)產(chǎn)生的.,2020/8/30,4,進(jìn)入和順應(yīng) 活現(xiàn) 聚焦 強(qiáng)化和重復(fù) 明晰界限,制造界限 去平衡 互補(bǔ)性,現(xiàn)實(shí)-認(rèn)知的建構(gòu) 自相矛盾 循環(huán)提問 差異性提問 隱喻 拋棄提問,第五章 治療技術(shù)(Family Therapy Techniques),

2、2020/8/30,5,(1) 進(jìn)入和順應(yīng) (joining and accommodating),受傷的人在治療之前需要安全感。 和個(gè)體治療不一樣，家庭由其他非癥狀的人組成。他們準(zhǔn)備好了為自己辯護(hù)和戰(zhàn)斗。只有被家庭容納，治療師的干預(yù)才會(huì)成功。 Joining: confirms people, emphasize their strength , and thus becomes a significant source of self-esteem to them.,2020/8/30,6,(2) 活現(xiàn)（Reframe - Enactment）,抓住和選擇一個(gè)具體的事件進(jìn)行活現(xiàn)，成員的描述

3、一定沒有現(xiàn)場(chǎng)演示準(zhǔn)確。 Family stop the dancing when they come to the session and try to describe, comment and explain to the therapist how the music and the dance are at home. When the therapist asks the family questions, the family members can control what they are presenting. Enactment is the technique by wh

4、ich the therapist asks the family to dance in his presence. Therapist gather information that the family members do not consider relevant, and even more difficult, how to gather information that family members do not have available.,2020/8/30,7,Enactment steps and example,1.observe spontaneous trans

5、actions and decide which dysfunction areas to highlight.(觀察家庭自發(fā)行為,決定那些方面需要聚焦) the mother defines herself as understaning and helpless, the father defines himself as effective and authoritative, and they both define the daughter as uncontrollable. With this information, the therapist is ready to impl

6、ement the enactment of a transaction around control, The therapist guides his interventions here by a diagnostic assumption: when a preschool child cannot be controlled in effect, he is taller than one of his parents, he is sitting on the other parents shoulders.,2020/8/30,8,Enactment steps and exam

7、ple,2.Elicting transaction-therapist organize scenarios in which the family members dance their dysfunctional dance in his presence(通過問問題,建議,設(shè)法讓成員活現(xiàn)出來) 3.therapist suggests alternative ways of transaction.(讓家庭互有更多選擇) Help the mother to experience herself as competent in the presence of her husband a

8、nd without the husband taking over or becoming authoritarian. If the mother is effective, the daughters label of impossible will disappear.,2020/8/30,9,Patti (4 years old girl) Story Therapist remains peripheral so that interactions between the family members occur, soon the problem appears, the the

9、rapist frame certain evens enacted in the session, by blocking the fathers entrance, he makes the “usual end point” impossible, forcing the mother and child to go beyond their accustomed patterns to the point where the mother actually asserts control.,2020/8/30,10,另一種聲音,作為觀察者的咨詢師會(huì)不會(huì)已經(jīng)影響了家庭的活現(xiàn)?,2020/

10、8/30,11,(3) 聚焦 (Reframe Focus ),In observing a family, the clinician is flooded with data.the therapist will arrange the facts she perceives in a way that both relates them to each other and has therapeutic relevance. First, therapist select a focus and, second, she develop a theme for work. She scr

11、eens out the many areas which, though interesting, do not contribute to her therapeutic goal at the moment. She selects elements of this familys transactions, and organizes the material in such a way that it fits her therapeutic strategy. Therapist concentrates on a small segment of family experienc

12、e. And because family interactions tend to be isomorphic, exploring this small segment in depth will yield useful information on the rules that govern behavior in many other area as well.,2020/8/30,12,注意點(diǎn),為了治療的目標(biāo)，可以阻止和打斷成員們暫時(shí)無關(guān)的話題,并不被其他有趣的領(lǐng)域吸引而失去進(jìn)展的方向。對(duì)于沒有經(jīng)驗(yàn)的咨詢師來說，這是治療是否成功的關(guān)鍵。 共情并不意味著被當(dāng)事人帶著說到哪里，我們就共

13、到哪里。 If you cant focus, maybe you are in a collusion of avoidance.,2020/8/30,13,另一種聲音,Be aware of “tunnel vision”,therapist is ignoring information and family say “youre relating to your theories , not us.”(“你就知道你的理論,從來不管我們”),2020/8/30,14,(4)強(qiáng)化和重復(fù) (Reframe Intensity ),The therapist must make the fam

14、ily hear and his message go above the family threshold of deafness. Family members may listen to the therapists message, but they may not assimilate it into their cognitive schema. Therapist are frequently satisfied that a message has been received just because it has been sent. But a therapeutic me

15、ssage must be recognized by family members , meaning that it needs to be received in such way that it encourages them to experience things in new ways.,2020/8/30,15,(1) Repetition of the message (重復(fù)信息) e.g 75 times: say “Why didnt you move out?” (2) Repetition of the message in isomorphic transactio

16、ns.(反復(fù)指出類似的互動(dòng)模式) (3) Changing the time (prolong time) in which people are involved in a transaction.(增加互動(dòng)在時(shí)間和空間的強(qiáng)度,跨越以往模式的底線) “we have reached a dangerous thresh hold, beware, slow up or stop”. This signaling is so automatic that family members respond without being aware that. Encourage the family

17、members to continue transacting after rules of the system have indicate a red light. Their move from the habitual into the unfamiliar opens up the possibility of their exploring alternative modes of transaction.,2020/8/30,16,(4) Changing the distance between people involved in a transaction. (5) Res

18、isting the pull of a family transactional pattern. e.g Wife (she speak to him alone at the beginning of next session) : Frank doesnt understand me. every time I mention my concerns about my mother, he get mad. Therapist: this is between you and Frank. he needs to be here to respond. (堅(jiān)持讓夫妻之間來處理),202

19、0/8/30,17,(5)明晰界限,制造界限(Restructuring Boundaries),Boundary making are designed to change the participation of members of different holons. (關(guān)系界限對(duì)防止投射認(rèn)同的循環(huán)有幫助) 2 ways: 1. make psychological distance between family member (心理空間) 2. make duration of interaction within a significant holon.(心理時(shí)間),2020/8/3

20、0,18,1. Make psychological distance between family member（3 case） Case 1: separate the over-involved mother-child dyad, increase the fathers participation in parental subsystem. E,g Solution: Tell parents : “If you can not handle a young kid, maybe you are pulling in different directions.” “That Im

21、backing Patti up against you.” “She doesnt listen to you because she looks at you more of a playmate than as her mother.”,2020/8/30,19,Case 2: Observing(把過分參與者拉出來站在觀察者位置) grandparent join with grandchildren against their parents. Solution: Therapist tell grandparent : since he has the wisdom of age,

22、the therapist is interested in hearing his observations after he has carefully listened without interfering, to the discussion between parents and children.,Case 3: Spatial Use concrete spatial maneuvers to change the proximity between family member.(觀察家庭的座位空間位置),2020/8/30,20,2. make duration of int

23、eraction within a significant holon. Extending or lengthen a process, which is one way of increasing its intensity, may also be utilized to demarcate subsystem or to separate them. Case : over-involved mother-son dyad with a peripheral husband. - Solution : ask father to help boys homework or teach

24、boy play soccer. - “Since your wife has been working so hard with boy, it is important that she should take a week rest, and since your son will grow to be a man, you should discipline or teach ,or play with him.” - 讓父子兩人出去旅游一周。,2020/8/30,21,(6)去平衡(Restructuring - Unbalancing ),Change the hierarchic

25、al relationship of the members in a subsystem - 在子系統(tǒng)中,打破原來的平衡.(舉例:強(qiáng)調(diào)父親其實(shí)是會(huì)很好的照顧孩子) - 改變子系統(tǒng)內(nèi)部成員的關(guān)系，通過去平衡制造了壓力，夫妻突破了原來的差異. 比較: - Unbalancing : change hierarchical relationship of the members of a subsystem. - Boundary making : change family subsystem membership,or distance between subsystem.,2020/8/30

26、,22,(6)去平衡(Restructuring - Unbalancing ),3 ways ： Affiliate with family members (支持一方) This technique is used mostly to support a peripheral family member or one in a down postion. Feeling the therapists affiliation, that person begins to challenge his prescribed position in the system Ignore family

27、 members (忽略一方) The therapist ignore switchboard by increasing his dyadic contact with the other member and blocking the intrusion of the switchboard. Enter into a coalition with some family members against them. (參加一方),2020/8/30,23,(7)互補(bǔ)性(Restructuring - Complementarily ),從家庭治療的角度來看,一個(gè)人的語(yǔ)言、行為和情緒是和家

28、庭中另一個(gè)或幾個(gè)人的語(yǔ)言、行為或情緒密切相關(guān)的。如果網(wǎng)絡(luò)中的某個(gè)人發(fā)生了變化,關(guān)系網(wǎng)絡(luò)就變了,另外的人自然也就會(huì)因此受到影響而發(fā)生變化。 如果丈夫可以多做點(diǎn)家務(wù),妻子自然就可以少做點(diǎn)。,2020/8/30,24,丈夫抱怨妻子過于嘮叨;其次也應(yīng)該認(rèn)識(shí)到妻子的嘮叨和丈夫的抱怨是相互影響的。一個(gè)人被認(rèn)為嘮叨,可能是覺得長(zhǎng)久以來都沒有被傾聽或者被忽略所導(dǎo)致。被忽略或者不被傾聽使其變得憤怒,覺得失去支持,因而會(huì)變得更加嘮叨。治療師可以通過指出他們行為的互補(bǔ)性,例如,“你越嘮叨,他越忽略你。你越忽略她,她越嘮叨”,尋求家庭成員作出改變。 抱怨女兒優(yōu)柔寡斷的母親也許常常給女兒太多的忠告和幫助.,2020/8

29、/30,25,適度的互補(bǔ)能夠幫助夫妻分工合作,但僵化的互補(bǔ)則扼殺了彼此的潛能,難以成長(zhǎng).例如 - 一位妙齡女郎和一為位高權(quán)重的年長(zhǎng)男人組成的家庭 - 妻子為了孩子們負(fù)起全部責(zé)任,而丈夫則將所有精力投入到事業(yè)中. 極化的夫妻關(guān)切能維持一段時(shí)間,但任何一方發(fā)生改變的時(shí)候,另一方會(huì)加一抵制: - 你變了,你以前是多么溫柔,多么順從 - 當(dāng)母親需要更多幫助,一是她丈夫從事業(yè)中抽出時(shí)間會(huì)很難,二是母親會(huì)難以接受對(duì)方在處理孩子問題有不同觀點(diǎn).,2020/8/30,26,Minuchin: The therapist must challenge the family members accustomed

30、epistemology in three respects. (1) Challenge the problem,the familys certainty that he is one identified patient (2) Challenge linear notion that one family member is controlling the system, rather than each member serving as a context of others Say to adolescent: you are acting like like a four-ye

31、ar-old Say to mother: how do you manage to keep him that young? Say to wife: you seems to control all the decisions in this family. Say to husband: how did you engineering all of that work for her? (3) Challenge the familys punctuation of events , introducting an expanded time frame which teaches fa

32、mily members to see their behavior as part of a larger whole.,2020/8/30,27,(8)認(rèn)知建構(gòu) (Reality cognitive constructions ),The family has constructed its present reality by organizing facts in a way that maintains its institutional arrangements. There are alternative ways of seeing, but the family has ch

33、osen a certain preferred explanatory schema.(it may also induct therapist into supporting the family reality) The goal is the conversion of the family to a different worldview- one that does not need the symptom-and to a more flexible, pluralistic view of reality-one that allows for diversity within

34、 a more complex symbolic universe.,2020/8/30,28,三個(gè)技術(shù)： 借用公認(rèn)的社會(huì)文化 利用家庭現(xiàn)存的認(rèn)識(shí)推出有利于治療的結(jié)論 運(yùn)用和介紹專業(yè)經(jīng)驗(yàn),2020/8/30,29,(9)自相矛盾 (Reality - Paradoxes ),When the cycle that produced the symptom is consciously enacted, it loses its power to produce a symptom. If the symptom is eliminated, that part of the system wi

35、ll be left unregulated. Family present therapist with a contradictory request: asking that the symptom be changed without changing their system. The issue is no longer how to eliminate the symptom but what happen if it is eliminated. We reserve paradoxical interventions for those covert, long-standi

36、ng, repetitious patterns of interaction that do not respond to direct interventions such as logical explanations or rational suggestions.,2020/8/30,30,注意: 懇切的姿態(tài)而不是諷刺和幽默 要求患者故意保持或“加重”癥狀行為。 孩子應(yīng)該保持抑郁，因?yàn)檫@樣他才能得到母親的關(guān)注，母親就不會(huì)執(zhí)著于從父親那里得到愛和關(guān)懷。因?yàn)楦赣H依然在情緒上與自己的母親糾纏。 鼓勵(lì)兒子保持破壞性的行為，否則死氣沉沉的家庭恐怕維持不了多久，直到父母可以找到一種有效的方式為止

37、。,案例1-丈夫事業(yè)失敗的家庭 案例2-母女吵架 案例3-厭食癥案例,2020/8/30,31,丈夫事業(yè)失敗的家庭 The therapist tells the mother it is important for her to continue to express her disappointment in Billy, because otherwise she might begin to express her dissatisfaction with her husband. This would be risky , as her husband might become depressed, and since Billy is younger and more resilient than her husband, he can take it better. 母女吵架 Thats the only time father becomes involved in family and if they stopped, father become disappear. its important for you to fight with your mother until she can find another way to keep father at