当代心理咨询与心理治疗的特点与发展趋势

目前心理咨询与治疗发展迅猛,以认知一行为疗法为核心的理论整合是发展的总趋向;多元文化主义已成为影响心理学的第四势力;简短治疗因其省时省力、具有成本效益的优点在国外迅速崛起;同时随着危机发生率的增加,心理咨询与心理治疗在任务上加强了对心理危机干预、积极心理品质培养的重视;更加重视价值观和信仰在维护个体心理健康中的作用。文章主要阐述了这5个方面的形成原因与具体内容,旨在为我国的相关研究与实践提供参考。     

积极认知行为治疗的基本方法

积极认知行为治疗以调动患者的积极性和主动性为核心,在治疗师的积极引导下,指导患者自主完成思维记录和自我探索负性情绪对抗行为,并进行认知重建和行为矫正,以达到心理治疗的效果。积极认知行为治疗的操作程序包括四个阶段:首次会谈与诊断评估阶段、自我探索阶段、强化巩固阶段、效果评估和回归社会阶段。而自我探索阶段是整个治疗过程中的核心阶段,主要通过建立在患者问题概念化基础之上的"积极认知行为治疗记录"来分步完成。而六个核心治疗环节依次是:临床访谈、躯体和心理检查、对患者关于积极认知行为治疗表格记录和表中关系要素说明、对抗负性情绪行为模式的自我探索、非理性信念的批判及理性信念的建立、有效对抗负性情绪行为模式的确定和强化巩固。     

Is Managed Mental Health Treatment Psychotherapy?

The corporate takeover of mental health treatment has dramatically affected mental health treatment. Two essential constituents of psychotherapeutic process, the relationship between patient and therapist and the special communicative process associated with a talking treatment, have been significantly compromised. Therapists and patients are being forced to consider whether in the absence of confidentiality, self determination, and a secure treatment partnership managed mental health care can be called psychotherapy. Drawing on several detailed sessions from the managed treatment of a young woman, the writer concludes that the answer is no.     

On the Inside: A Narrative Review of Mental Health Inpatient Services

This paper describes and discusses the results of a narrativereview of inpatient mental health services in the UK. Four mainthemes emerge from the review: the growing pressure on inpatienthospital services; the negative experience of inpatient servicesreported by many service users; the problematic nature of hospitaldischarge; and possible alternatives to hospital admission.This review also suggests that a failure to recognize and acton what appears to be happening in hospitals could result ininpatient care once again being subject to the scrutiny andcriticism that cast a shadow over psychiatric services in the1960s and 1970s. To stop this happening, current governmentpolicy is right to focus attention back onto acute care throughnew guidance and by commissioning research. However, changesalso need to take place at a practice level so that front lineworkers are familiar with conditions in local acute servicesand can challenge unacceptable behaviour/services in supportof their service users. With current changes in the make-upof local mental health services and a greater emphasis on partnershipworking between health and social care, it may be that socialcare practitioners can do this not only from the outside, butincreasingly ‘on the inside’ (from within integratedhealth and social care organizations).     

折衷整合心理咨询理论与实践探索

国内外研究表明 ,折衷整合的心理疗法正呈现出强盛的发展势头 ,将成为未来心理咨询治疗的主流。异常心理问题主要表现在认知、情绪、行为三个方面。在遵循人性化、实用化、整体化原则的基础上 ,采取各种适宜的方法 ,围绕认知、情绪、行为进行咨询治疗 ,就会取得全面深入的效果     

Generative systemic-constructionist psychotherapy in the face of crisis in the context of armed violence in colombia: Case of MM,Montes de María – Department of Sucre

This article aims to show a process of systemic-constructionist and generative therapy in the face of crisis situations experienced by MM. MM is a woman victim–survivor from the region of Los Montes de María in Colombia, a territory hard hit by armed violence between 1990 and 2008. Methodologically, the fragments presented are those that are repeated in three sessions. Psychotherapeutic work is a combination of dialogical and interactive resources, opportunities, and capacities that combine three kinds of time in MM's daily life. These are: first, the past of the violence; second, the present comprised of the presence of memories of violence, social and family interactions, together with psychiatric diagnoses; and third, the sense of a future based on the hope of reducing their suffering and taking action against the violence. Analysis and interpretation are hermeneutical constructions carried out throughout the psychotherapeutic process and in the midst of generative dialogues. On the one hand, the scientific and everyday knowledge that helps to process and transform the crisis is recognised. On the other hand, it shows a form of knowledge that distances itself from the parameters of science and positivist approaches. In conclusion, this article is an opportunity to question traditional positions within the field of mental health in the light of moments constructed with MM in the framework of systemic-constructionist therapy, seen as a relational space where generative contexts are built.     

Early assessment of implementing evidence-based brief therapy interventions among secondary service psychiatric therapists

This implementation study was part of the Ostrobothnia Depression Study, in Finland, which covered implementation of motivational interviewing (MI) and behavioral activation (BA) within regional public psychiatric secondary care. It aimed to evaluate the mid-term progress of implementation and related factors. Altogether, 80 therapists had been educated through the implementation program by the point of the mid-term evaluation. Eligible information for evaluation was gathered using two questionnaires (q1, q2) with a one-year interval.A total of 45 of the 80 therapists completed q1, 30 completed q2, and 24 completed both questionnaires. Professional education was the only background factor associated with adopting the interventions (q1: p = 0.059, q2: p = 0.023), with higher education indicating greater activity. On the basis of trends such as changes in overall usefulness score from q1 to q2, the most involved therapists were slightly more likely to adopt MI/BA. Our experience so far suggests that encouraging staff to begin using new interventions during education is very important. The Consolidated Framework for Implementation Research was found to be a useful tool for constructing the evaluation.     

The duty to care and the need to split

This paper arises out of psychoanalytically oriented consultancy to teams of staff in the helping professions where there is a statutory 'duty to care'. It takes as its premise the seemingly paradoxical hypothesis that workers may need to split off part of their emotional experience in order to preserve their own mental health and provide reliable services to their clients. I argue that while a professional 'duty to care' requires us to be emotionally 'in touch', the demands of our clients together with the demands of the institutional response to the 'duty to care' cause us to split off parts of our awareness. I also argue that provided the splitting does not become extreme we are doing no more or less than the rest of society. In other words, there is a degree of 'normal splitting' which numbs our awareness of danger and destructiveness and seeks to protect us from too much anxiety and pain. Yet if professional workers are charged with the responsibility of assessing risk and acting accordingly for the protection of all concerned they need ways of being 'in touch' (re-integrating the splits) for some or enough of the time. Finally, I will describe ways of being 'in touch', illustrating the difficulty and the pain of re-integrating the splits and some of the insights that can arise out of this work with examples from my consultancy work.     

‘Queen of the world’: experiences of ‘at-risk’ young people participating in equine-assisted learning/therapy

There is a significant body of research into the benefits of animal-assisted therapy (AAT) but less into the fields known as equine-assisted learning and therapy (EAL/EAT) where horses are incorporated in therapeutic and learning interventions. This paper explores the experiences of seven ‘at-risk’ young people who participated in a therapeutic horsemanship (TH) programme. The study followed a practice-near approach seeking to capture the young people's experiences within a participative ethnography. Themes related to the risk and resilience literature such as self-confidence, self-esteem, self-efficacy and a sense of mastery, empathy and the opening of positive opportunities are explored in this paper.     

A CHILD PSYCHOTHERAPIST IN PRIMARY MENTAL HEALTH

This paper outlines the author's application of psychodynamic thinking and approaches to brief therapeutic work with children, adolescents and their families in community mental health settings. It is the author's belief that systemic and narrative therapy insights and techniques combine well with psychoanalysis in the assessment and treatment of many concerns felt and expressed by parents and young people. The therapist's tasks are to listen empathically to clients who are in distress and to explore the clients' beliefs about the origins of their problems, as well as their previously attempted solutions. In proceeding at the family's pace, opportunities arise for facilitating more effective ways of resolving conflict. Clients are often more free than they realise to change their interpretation of their experience, and this has important consequences for the maintenance and solution of problems. Brief therapy seeks to remind clients of their strengths and resources and to share ways to encourage clients to resume effective ways of learning about themselves.