结构式家庭治疗PPT-技术篇.ppt

1、结构式家庭治疗- 技术篇,阳光家庭俱乐部 冯旭东 2008-6,2020/8/30,2,1、基本概念篇 2、治疗架构篇 3、技术篇,The therapistjob is to help the family change, not to keep them comfortable.,2020/8/30,3,技术是从怎么产生的? 技术最初都是在治疗中自发产生的.,2020/8/30,4,进入和顺应 活现 聚焦 强化和重复 明晰界限,制造界限 去平衡 互补性,现实-认知的建构 自相矛盾 循环提问 差异性提问 隐喻 抛弃提问,第五章 治疗技术(Family Therapy Techniques),

2、2020/8/30,5,(1) 进入和顺应 (joining and accommodating),受伤的人在治疗之前需要安全感。 和个体治疗不一样，家庭由其他非症状的人组成。他们准备好了为自己辩护和战斗。只有被家庭容纳，治疗师的干预才会成功。 Joining: confirms people, emphasize their strength , and thus becomes a significant source of self-esteem to them.,2020/8/30,6,(2) 活现（Reframe - Enactment）,抓住和选择一个具体的事件进行活现，成员的描述

3、一定没有现场演示准确。 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.(观察家庭自发行为,决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(通过问问题,建议,设法让成员活现出来) 3.therapist suggests alternative ways of transaction.(让家庭互有更多选择) 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,另一种声音,作为观察者的咨询师会不会已经影响了家庭的活现?,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,注意点,为了治疗的目标，可以阻止和打断成员们暂时无关的话题,并不被其他有趣的领域吸引而失去进展的方向。对于没有经验的咨询师来说，这是治疗是否成功的关键。 共情并不意味着被当事人带着说到哪里，我们就共

13、到哪里。 If you cant focus, maybe you are in a collusion of avoidance.,2020/8/30,13,另一种声音,Be aware of “tunnel vision”,therapist is ignoring information and family say “youre relating to your theories , not us.”(“你就知道你的理论,从来不管我们”),2020/8/30,14,(4)强化和重复 (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 (重复信息) e.g 75 times: say “Why didnt you move out?” (2) Repetition of the message in isomorphic transactio

16、ns.(反复指出类似的互动模式) (3) Changing the time (prolong time) in which people are involved in a transaction.(增加互动在时间和空间的强度,跨越以往模式的底线) “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. (坚持让夫妻之间来处理),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. (关系界限对防止投射认同的循环有帮助) 2 ways: 1. make psychological distance between family member (心理空间) 2. make duration of interaction within a significant holon.(心理时间),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(把过分参与者拉出来站在观察者位置) 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.(观察家庭的座位空间位置),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.” - 让父子两人出去旅游一周。,2020/8/30,21,(6)去平衡(Restructuring - Unbalancing ),Change the hierarchic

25、al relationship of the members in a subsystem - 在子系统中,打破原来的平衡.(举例:强调父亲其实是会很好的照顾孩子) - 改变子系统内部成员的关系，通过去平衡制造了压力，夫妻突破了原来的差异. 比较: - 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. (参加一方),2020/8/30,23,(7)互补性(Restructuring - Complementarily ),从家庭治疗的角度来看,一个人的语言、行为和情绪是和家

28、庭中另一个或几个人的语言、行为或情绪密切相关的。如果网络中的某个人发生了变化,关系网络就变了,另外的人自然也就会因此受到影响而发生变化。 如果丈夫可以多做点家务,妻子自然就可以少做点。,2020/8/30,24,丈夫抱怨妻子过于唠叨;其次也应该认识到妻子的唠叨和丈夫的抱怨是相互影响的。一个人被认为唠叨,可能是觉得长久以来都没有被倾听或者被忽略所导致。被忽略或者不被倾听使其变得愤怒,觉得失去支持,因而会变得更加唠叨。治疗师可以通过指出他们行为的互补性,例如,“你越唠叨,他越忽略你。你越忽略她,她越唠叨”,寻求家庭成员作出改变。 抱怨女儿优柔寡断的母亲也许常常给女儿太多的忠告和帮助.,2020/8

29、/30,25,适度的互补能够帮助夫妻分工合作,但僵化的互补则扼杀了彼此的潜能,难以成长.例如 - 一位妙龄女郎和一为位高权重的年长男人组成的家庭 - 妻子为了孩子们负起全部责任,而丈夫则将所有精力投入到事业中. 极化的夫妻关切能维持一段时间,但任何一方发生改变的时候,另一方会加一抵制: - 你变了,你以前是多么温柔,多么顺从 - 当母亲需要更多帮助,一是她丈夫从事业中抽出时间会很难,二是母亲会难以接受对方在处理孩子问题有不同观点.,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)认知建构 (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.,2020/8/30,28,三个技术： 借用公认的社会文化 利用家庭现存的认识推出有利于治疗的结论 运用和介绍专业经验,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: 恳切的姿态而不是讽刺和幽默 要求患者故意保持或“加重”症状行为。 孩子应该保持抑郁，因为这样他才能得到母亲的关注，母亲就不会执着于从父亲那里得到爱和关怀。因为父亲依然在情绪上与自己的母亲纠缠。 鼓励儿子保持破坏性的行为，否则死气沉沉的家庭恐怕维持不了多久，直到父母可以找到一种有效的方式为止

37、。,案例1-丈夫事业失败的家庭 案例2-母女吵架 案例3-厌食症案例,2020/8/30,31,丈夫事业失败的家庭 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