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心理治疗师该说和不该说的话:如何回答来访者的提问

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心理治疗的魔力在于人们可以自由地谈论任何事情。所以,来访者说出任何令治疗师吃惊的经历或者提出任何棘手的问题都不足为奇。这些问题触及的领域包括宗教、性、金钱以及治疗边界,等等。也许这些五花八门的提问的确让人为难或令人不适,但《心理治疗师该说和不该说的话:如何回答来访者的提问》将向你揭示,治疗师利用好这些敏感问题可以大大推动整个治疗过程,而不是瓦解治疗师与来访者的关系。作者将用一问一答的形式告诉治疗师,如何作答有助于营造鼓励个人自我发现与成长的治疗氛围。
Author Description

Linda N.Edelstein,博士,一位有着30年临床经验的心理治疗师与督导师,美国西北大学教授。

Charles A.Waehler,博士,美国艾科朗大学咨询心理学合作项目的副教授。在其学术生涯中,他主要从事个体青少年与成人的临床工作。他的研究领域包括咨询过程以及人格测评。
Catalogue

第一部分 在大背景下看来访者的提问
引言
来访者的问题为什么会引发恐惧?
不同的理论会带给我们怎样不同的建议?
记住,这与你本人无关
回答提问的指导方针
风格和语言的考虑
进一步的思考

第二部分 来访者的提问和回应——主题章节
引言
第一章 治疗前期
问题
回应
进一步的思考
第二章 经验
问题
回应
进一步的思考
第三章 治疗进程
问题
回应
进一步的思考
第四章 对改变的预期
问题
回应
进一步的思考
第五章 技术
问题
回应
进一步的思考
第六章 专业角色
问题
回应
进一步的思考
第七章 金钱
问题
回应
和治疗无关的金钱问题
回应
进一步的思考
第八章 保密性
问题
回应
进一步的思考
第九章 边界
问题
回应
边界失误
进一步的思考
第十章 私人问题
问题
……
总结
Book Abstract

那么这个问题就变得很不一样了,比如如果这个问题背后跟着的信息是,你的来访者是一个不高兴的丈夫,体验着婚姻的困难和因为作为“失败者而我的所有朋友都有着成功的婚姻”而感觉到深深的内疚,那么这和一个青少年来访者说到“我的父母的离婚毁了我的生活”,是完全不同的。这两位来访者都想要知道你和婚姻、分手有关的经验。一个泛泛的回答可能是:“是的,婚姻可以是很困难的,而且所有的分手都是悲伤的。”但是要回到他们独特的情境中,“你能跟我再说说你的情况吗”这样子,你支持了来访者的体验,没有提供过多细节进行表露,然后你把焦点放到了来访者身上。
在治疗室里,来访者不是唯一有动机的人。治疗师也会被驱动去进行表露,因为他们想要让来访者知道他们的理解是源自曾经经历过的、具有可比性的事件。有的时候,有着类似的经历可以为你的来访者提供一种被理解的感受,例如:“太好了,如果你也有配偶或孩子,可能你会理解那些我想要逃开并且在别的地方重新开始新的生活的那些时候。”另一方面,你的婚姻或者孩子可能会引发恐惧:“哦,你可能有着完美的婚姻和孩子,你永远不会理解我的糟糕的处境。”
稳固的联结不是通过和来访者有类似的或者相同的经历铸造出来的。联结是通过理解、共情和努力的工作来创造和加强的。要把这一点记在心里,当你的表露突出了你和来访者之间的差异时。你的回应是:“不,我还没有结婚。”或者“不,我没有孩子”。这些都可以让你产生不必要的恐惧,觉得在你和来访者中间有间隙。不要被这些差异占住你的心神。找到那些坦诚的以及能够传达理解的话。“尽管我没有结过婚,但是我了解关系,而且我从你那里知道……”或者“我没有养育过孩子,但是我可以理解你有的那种强有力的体验……”如果来访者因为你和她之间的差异而犹豫了,你可以对她的顾虑进行共情而且你可以潜在地提示这点:“我们之间有不同的经历的一个优势在于,我绝对不会把我处理情况的方式强加在你身上。”同时,如果来访者在寻找一个理由回避治疗,那么什么理由都可以成为理由。
……
Introduction

许多年以来,作为心理治疗师、老师和督导,我们常常就自己的工作互相交换意见。我们总是同意我们是多么享受和新的专业人士工作,以及享受参与到未来一代人的临床治疗工作当中。去年,我们讨论要写下对来访者提问的回答,以更好地武装治疗师,因为我们知道,在治疗过程中针对来访者的问题和回答是一个很少被写到的话题,尽管治疗师对此有很多担忧。当我们认真地着手写这本书的时候,我们意识到,与其说是武装治疗师,仿佛他们要上战场,还不如说是我们更想使治疗师以他们看待临床工作的其他协同合作的部分那样去观察问题并进行回应。
大多数关于心理治疗进程的书籍都会有几个段落专门用来描述来访者会问的问题以及这些问题可能有的重要含义。这些意见也提示我们应该在成长和治愈的进程中有效地使用来访者的问题。然而,我们很少能找到对这些问题的充分讨论。对回答的具体建议就更加罕见了。取而代之的是,我们可以看到和如何回应问题相关的严肃谈话被留给了督导,或者作为其他工作的副产品被扔进了某些课程之中。但是从我们自己的临床经验里,从教学工作和其他治疗师的商议中,我们知道来访者会问很多的问题,这些通常是非常好的问题。不幸的是,当这些发生时,治疗师可能感觉很慌乱,因为他们没有机会处理他们的担忧、信念和实务操作。
对于写作一本关于来访者的提问和治疗师的回应的书这样一个想法,我们和其他治疗师以及学生商议得越多,我们揭开的各种之前没有被说出来的感受也越强,大多数感受是不舒服的和恐惧的。像“我不想把我的来访者领上错误的道路”,“我不会知道答案的”,“我透露太多了”,“我会看起来很笨”,“我会感觉很笨”和“我会说错话”这样的担忧既来自新手治疗师,也来自那些经验丰富的治疗师。我们开始认为,被来访者询问问题像魔法一样召唤出了一些意象,就像可怕的三年级老师把你放在聚光灯下,或者那些窃笑的刻薄小孩,或者在晚饭时间提问测验的父母。问问题开始感觉像是审问,回应变成了一个有竞争性的赢或输的比赛。但是治疗不是一场考试;它甚至不是一个小测验,它是一段关系。不管怎样,你和你的来访者是被拴在一起的,所以如果你们中一个人失败了,那么你们就都失败了。
我们知道,作为心理健康服务的提供者,你在房间里和来访者待在一起时感到舒适和有能力的程度,和你治疗的有效性有关。如果你感到焦虑、分心或者需要不停地搜索要说些什么,那么这将会危及你关注来访者的能力。在这些让人迷茫的时候,你希望可以和你的督导或者同事有一个简短的意见交换。之后,在车里或者在洗澡的时候,你想到了一个完美的回应,而且希望自己要是早点想到就好了。我们想要写一本书,这本书能帮助心理健康专业人员在焦虑被触发的情境下仍然感到有信心。
这本书可以使刚开始学习的学生和更加有经验的治疗师去思考他们和来访者提问之间的互动。我们想要本书成为这样的一本书,即治疗师但愿自己在坐在来访者对面和被能力不足的感受压倒之前,就读过这本书。总有些时候,每个治疗师都会不愉快地想要知道,“为什么我的督导或者我的教授并没有让我对此做些准备呢?”我们希望以类似于完美的督导的方式去服务读者,这样的督导会帮助治疗师形成一些他们想要表达的话语。史密斯学院的MSW毕业生罗尼把这本书叫做“我背包里的督导”。

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