Dynamic Deconstructive 心理治疗 Training: Part 2
II. 协会 Techniques
协会 techniques are the primary treatment methods of DDP. 它们包括帮助病人用语言描述和详细叙述人际交往或适应不良行为的顺序, identifying underlying emotions, and exploring emotional themes of creative activities, 比如艺术品, 诗歌, 或梦想. 冗长, 标签, 对情感体验的承认有助于降低与人际交往相关的觉醒水平，这对于发展主观的自我意识是必要的.
Patients are responsible for bringing in material for exploration. 一个有用且常见的焦点是最近与朋友、家人或同事之间的人际关系. 治疗师试图让病人保持在经验的层面上，而不是让病人泛泛地谈论, e.g. “He always takes me for granted,” or instead of having the patient try to make sense of their experiences, e.g. “She just wants to use me.为此目的, 治疗师询问具体的例子，并关注情绪反应(参见 协会 在第八章中， Specific Techniques 在 treatment manual for a more complete description of these techniques).
The following cases illustrate different aspects of 协会 techniques.
Case 1 : Developing a narrative of a recent interpersonal encounter
这个案例代表了对一个患有边缘性人格障碍和酗酒的年轻人使用联想技术. 以下小插图中采用的技术旨在帮助患者识别, 用言语表达, 并通过探索最近的人际交往来承认他们的情感经历. In this vignette, the therapist tries very hard to help the patient focus on his experiences, including the sequential connection between responses of self and of other, so as to form simple narratives. 此外，治疗师帮助病人用语言表达和承认潜在的情绪.
Case 1: Commentary
在小插曲中 that you just watched, the patient is discussing recent interpersonal encounters with his boss and with his mother. The vignette illustrates many different kinds of 协会 interventions, including the importance of getting down to specifics. 你可能已经注意到治疗师是如何反复尝试帮助病人详细说明事件的具体顺序的, rather than gloss over details. 例如, when the patient begins to focus on physical symptoms, the therapist brings the patient back again to the narrative.
协会的一些干预措施在这个小插曲中被采用，包括帮助病人把叙述放进一个他说, she-said sequence and clarifying the underlying emotions. 例如, when the therapist asks, “what did you say when he said, “Just give me a doctor’s note”, 治疗师试图帮助病人详细说明他和老板之间的反应顺序. When the therapist asks, “What was it like to say that to him,治疗师试图帮助病人识别和承认潜在的情绪.
This vignette also illustrates some other types of interventions. 例如, the therapist makes an empathic exclamation of “My goodness!” after the patient relates significant weight loss. An empathic, warm, and kind therapeutic stance is encouraged with DDP. 然而, the therapist also remains neutral, 在 sense of not taking sides when the patient is conflicted about something. 例如, the therapist makes an integrative comment by stating, “So you felt powerful on the one hand, but also worried a bit as well.” The therapist is pointing out the conflicting emotions of power versus worry, without implying that one feeling is more appropriate than the other in this situation.
Case 1 : Key Points
- The therapist should elicit details of specific interpersonal interactions, 尤其是互动的顺序和患者在互动过程中的潜在情绪
- The therapist’s stance should be warm and empathic, but also neutral, i.e. not taking sides 在 patient’s conflicts
Case 2 : Exploring an incident of cutting behavior
This case describes how cutting, or other maladaptive behaviors, might be explored. 在小插曲中, 治疗师将联想技术应用于行为，以形成叙述. 治疗师试图帮助患者确定割伤事件的人际和情感前因和后果，并加以识别, 用言语表达, and acknowledge the underlying emotions.
Case 2: Commentary
在小插曲中 you just watched, 治疗师试图通过询问情绪来帮助患者形成对其适应不良行为的叙述, 事件, 以及病人想要挠自己和想要喝一杯的想法. The patient displays enormous difficulty putting words to her emotional experience, and instead describes a kind of confusion and numbness.
这个小插曲是一个很好的例子，它是像工作的亚组病人提供明显不连贯的叙述. 这个亚组的患者可能需要广泛使用联想技术，有时需要更长的心理治疗疗程.
Case 2: Key Points
- The therapist should help patients to put maladaptive behaviors, such as cutting and drinking, into a narrative sequence
- Some patients convey disorganized and confusing narratives
Case 3 : Exploring a dream
This case is of a woman who has made considerable progress, but is now becoming ambivalent about continuing treatment and recovery. 这幅小插图说明了如何有效地探索病人带来的梦境. 在一般情况下, dream work involves narrative elaboration of the dream sequence, 询问病人对梦境中特别紧张的情况的情绪反应, and exploring possible meanings. 在DDP中有两种思考梦的方式，一种是它是一个移情梦，其中一个角色代表治疗师, or that all the characters 在 dream represent different aspects of the patient.
Case 3: Commentary
In the preceding vignette, the patient relates a dream about a helicopter ride. 这个梦的一个重要背景是，病人已经接受了很长时间的治疗，当她分享这个梦的时候，大致处于康复的第三和第四阶段. 第三和第四阶段的特点是对治疗和康复的矛盾心理，因为患者开始面对自我和他人局限性的艰难现实, 还有从孩子般的病态角色过渡到成年人的责任世界所固有的困难, 心痛, and disappointment.
In this vignette, the dream is fairly detailed, so the therapist does not need to spend a lot of time elaborating the narrative sequence, but instead focuses on the patient’s emotional responses. 例如, the therapist asks, “Are you scared a lot these days?” Towards the middle of the discussion, 治疗师还提供了一个进一步探索的框架，建议解释梦的一种方法是，梦中的所有不同角色代表了病人的不同方面. 这个框架允许患者更充分地接触到她对治疗和康复的矛盾心理, which is a central issue for this particular patient.
Case 3: Key Points
- Exploring a dream involves narrative elaboration of the dream sequence, 询问病人在梦中遇到特别紧张的情况时的情绪, and exploring possible meanings
- 治疗的第三和第四阶段的特点是对康复过程的矛盾心理，因为患者开始面对为自己的生活负责的艰难现实以及自我和他人的局限性
- 通过为不同的梦的解释方式提供一个框架，有时可以促进梦的探索
Case 4 : Patient describes developing a subjective sense of self
This vignette is a monologue of a young woman who is in Stage II of treatment. She is reflecting on her treatment and what she feels has been helpful to her.
Case 4: Commentary
This vignette was taken from a clip of a session about 3 months into treatment, when the patient was early in Stage II. Up to this point in treatment, the therapist had applied mainly 协会 techniques, helping the patient to put her experiences into narrative sequences and to identify, 用言语表达, and acknowledge her emotions.
我把这个小插图放在这里的原因是，它很好地说明了重要性和 改变生活 患者可以简单地有机会与移情治疗师用语言表达他们的情感体验. 注意，治疗师并没有试图通过暗示病人的感受是合适的还是不合适的来证实病人的感受, nor to make meaning of her experiences. The therapist had simply listened and asked questions.
As the patient so clearly states, 联合干预旨在帮助病人表达她的情感体验, have facilitated the development of a subjective sense of self. The patient now has a sense of existing or being and no longer feels invisible.
Case 4: Key Points
- 简单地为患者提供一个机会，用联想技术将他们充满情绪的经历用语言表达出来，就能导致主观自我意识的发展