心智化的方法与技术：第2讲课件

MentalizingandMindfulness:

BridgingtheGapBetweenPsychodynamicandCognitive-BehavioralApproaches

心智化与正念：

心理动力和认知行为取向之间的桥梁

JonG.Allen,Ph.D.ConceptsofMindfulnessandMentalizingOverlap正念与心智化概念的重叠Mindfulnessand“Third-WaveCBT”OverlapwithMentalizing正念和“认知行为治疗第三浪潮”与心智化有重叠MentalizingbridgespsychodynamicapproachesandCBT*心智化将心理动力取向与CBT桥接到一起Clinicalexample:Mentalizingsuicidalstates临床示例：对自杀状态加以心智化*focusingonsocialcognition(interpersonalrelationships),thementalizingapproachcouldbeconsidered“social-cognitivetherapy”(SCT)*聚焦于社会认知（人际间关系），心智化取向可以被理解为“社会-认知疗法”（SCT）Introduction:KeyPoints介绍：关键点Definition:“theawarenessthatemergesthroughpayingattentiononpurpose,inthepresentmoment,andnonjudgmentallytotheunfoldingofexperiencemomentbymoment”(Kabat-Zinn,2003)定义：“通过有目的地将注意力放在在当下，非批判性地让体验随着时间逐渐展开，而浮现出的觉察”（卡巴金，2003）ExtremelypopularintheU.S.,generalpublicandpsychotherapistsInU.S.psychotherapy,secularorientationtomindfulnesspracticeHighlyeffectiveforstressreduction(e.g.,MBSR,Kabat-Zinn)在美国，受到大众和心理治疗师的欢迎美国的心理治疗行业，有将正念练习世俗化的倾向对缓解压力非常有效（例如，基于正念的压力缓解训练，卡巴金）decreasedanxietyanddepression,improvedattention,improvedemotionregulation,decreasedstressreactivity,improvedwellbeing,increasedpositiveemotion,improvedphysicalhealthandpainmanagement减少焦虑和抑郁、改善注意力、增进情绪调节力、减少应激反应、促进健康、增加积极情绪、增进身体健康和疼痛管理能力Employedintreatmentofawiderangeofpsychiatricdisorders用于治疗各种精神疾病anxiety,depression,borderlinepersonalitydisorder,substanceabuse,eatingdisorders,psychoticsymptoms焦虑、抑郁、边缘人格障碍、物质滥用、进食障碍、精神病症状Mindfulness正念MindfulAttentiveness:

Afoundationforeffectivementalizing

正念注意力：

有效心智化的基础makinginferencesaboutmentalstates对心理状态做出推论reflectingonthemeaningofmentalstates反思心理状态的意义constructingbiographicalandautobiographicalnarrative构建传记与自传叙事Mentalizing心智化ethical:nonjudgmental;acceptance,compassion,curiosity伦理标准：非批判性的；接纳的；同情的；好奇的awarenessofmentalstatesasrepresentational表征性地觉察心理状态Overlap重叠bareattention,present-centered全然专注，以当下为中心attentivenesstomentalstatesinselfandothers注意自我和他人的心理状态Mindfulness正念Firstwave:behaviortherapy(e.g.,exposureforanxiety)Secondwave:cognitivetherapy(e.g.,cognitivedistortions)Thirdwave:mindfulnessandacceptanceapproaches;notchangingthecontentofthoughtsbutratherthewayyourelatetofeelingsandthoughts(likethe“mentalizingstance”)第一波：行为治疗（例如，焦虑的暴露法）第二波：认知治疗（例如，认知扭曲）第三波：正念和接纳取向；不改变思考的内容，而是改变你与情绪和思考的关系（比如“心智化的立场”）AcceptanceandCommitmentTherapyusesacceptanceandmindfulnessprocesses,andcommitmentandbehaviorchangeprocessestoproducegreaterpsychologicalflexibility(Hayes2004)接纳承诺疗法使用接纳和正念过程、承诺和行为改变过程，来创造更大的心理灵活性（海斯，2004）Twoformsofavoidance:situationalandexperientialExperientialacceptance(mindfulness)promotesflexibility,includingcommitmenttovaluedaction(whileacceptingdistressingfeelings)回避的两种形式：情境性和经验性回避对经验的接纳（正念）促进灵活性，包括符合价值方向的行动的承诺（同时接受令人痛苦的感受）Third-WaveCognitive-BehavioralTherapy认知行为治疗的第三浪潮TheMentalizingStance:

mentalizing

mindfully

心智化立场：

带着思考的心智化Psychologicalaspects心理学方面inquisitive,curious,playful,open-minded探究、好奇、好玩、开放心态“notknowing”(clevernessisaunhelpful)“不知道”（聪明是没有帮助的）notcreatingthecapacitybutratherpromotingattentivenesstotheactivityofmentalizing并不在于创造“能力”，而是在于促进对心智化活动的“专注”Ethicalaspects(asinparenting,forexample)伦理标准方面（如同在养育中所体现的）goodwillandcompassion善意和同情acceptanceandforgiveness接纳和宽恕respectforautonomy尊重自主性love爱意EthicalDimensionofMentalizing:MotivationforMentalizing心智化的伦理标准维度：心智化的动机PROTECT 保护COMFORT 安抚UNDERSTAND 理解Cooperate 合作Help 帮助Teach 教授Learn 学习Explore 探索Judge(e.g.,responsibility)评价（例如，责任）Avoiddanger 避免危险Compete 竞争Deceive 欺骗Detectdeception 侦测欺骗Exploit 剥削Seduce 引诱Control 控制Dominate 主导Defeat 击败CollaborativeAssessmentandManagementofSuicide(DavidJobes)自杀的合作评估与管理（大卫·Jobes）Mary,apastoralcounselorinher40s:玛丽，一位40余岁的教牧辅导师：emotionallyneglectedbymother,rejectedandcriticizedbyfather在情感上被母亲忽视，遭到父亲的拒绝和批评sexuallyabusedbyapriestinlatechildhood在童年后期被一名牧师性侵犯marriedwiththreechildren,feltunabletolove婚后育有三个孩子，感到无法去爱depressionworsenedaftermovingawayfromfriends离开朋友后，抑郁恶化priortosuicideattempttoldherdepressionwas“treatmentresistant”在自杀尝试之前，告诉她抑郁症是“治疗阻抗”believedthatherfamilywouldbebetteroffwithouther相信如果没有她，她的家人会更好BridgingPsychodynamicTherapyandCBT:StructuredMentalizingofSuicidalStates桥接精神动力治疗和CBT：自杀状态的结构化心智化方法SuicideStatusForm(worstpoint,current,weeklyupdates)自杀状态表（最差点时、当下的，每周更新）Ratementalstatefromlowtohigh(1-5)andgivereasons从低到高（1-5）给心理状态打分，并给出原因Psychologicalpain,5,feelingfrightenedanddisconnected心理痛苦，5分，感到恐惧、失去连接Stress,4,argumentswithchildrenandhusband压力，4份，与孩子和丈夫争吵Agitation,5,feelingtrapped,likea“cagedanimal”激惹，5分，感到被困住了，像一只“困兽”Hopelessness,5,nothingwillchange,nothingtolookforwardto无望感，5分，没有事情能改变，没有事情可期待Self-hate,4,I’vemadeamessofeverything,completefailure自我憎恨，4分，我把所有的事情都搞砸了，彻底的失败Overallriskofsuicide,4自杀的总体风险，4分Ratewishtoliveandwishtodie,lowtohigh(1-8)给活下去的愿望和死亡的愿望打分，从低到高（·-8）Wishtolive,1活下去的愿望，1分Wishtodie,7死亡的愿望，7分CollaborativeAssessment&ManagementofSuicideDavidJobes自杀的合作评估与管理大卫·JobesReasonsforLiving活下去的理由Don’twanttohurtmyfamily不想伤害我的家庭Imightgetbetter我可能可以变好ReasonsforDying死亡的理由I’maburden我是个负担I’llnevergetbetter我不会变好了Fearoffailure害怕失败Endthepain结束痛苦SuicideStatusForm,continued自杀状态表，续LessacutelydistressedafterhospitalizedbutstillsuicidalAftergradualimprovement,moreacutelydistressedwhenhergrouptherapymemberspressuredhertodivorceRecognizedroleofearlytraumaindistancefromhusbandandmadeacommitmenttoworkonhermarriageinfamilytherapy;husbandwaspositivelyinvolved;recognizedasa“long-term”projectandthatsheneednotcommitsuicideifmarriagebrokeupIdentifiedperfectionismaskeyproblemrelatedtoself-hateSoughtpastoralcounselingtoworkonalienationfromthechurchTherapyincludedawrittenformulation,revisedtowardtheendTreatedongoingsuicidalthoughtswithmindfulacceptanceByendoftreatment,wishtolive7,wishtodie1(reversed)住院后不那么剧烈，但仍有自杀倾向经过一段时间的逐步改善，在她的团体治疗成员压迫她离婚时，再次变得更加剧烈认识到早期创伤在疏远丈夫的方面的作用，并承诺接受家庭治疗，做婚姻工作；丈夫积极参与；认识到这是“长程”的工作，而且即使婚姻破裂，她也不需要自杀认出完美主义是与自我憎恨相关的关键问题寻求教牧辅导以解决与教会异化的问题治疗包括书面的案例建构，在结束时再做修订带着思考的接纳态度，处理持续的自杀念头治疗结束时，活下去的愿望7分，死亡的愿望1分（逆转了）CourseofTreatment治疗过程References

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