惩罚性父母的图式治疗
作者: Arnoud Arntz / 4919次阅读 时间: 2014年7月14日
来源: 陈明 译 标签: BPD 惩罚性父母 图式治疗
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惩罚性父母的图式治疗 

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来源:《边缘型人格障碍的图式治疗》 心理学空间){?"rnZ l5m

1qF&hZG~| k0作者:Arnoud Arntz and Hannie van Genderen 

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#gPM?B'~0ci%|0翻译:陈明 (初译稿)

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The punitive parent 惩罚性父母

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The mode of the punitive parent usually also gets a name. When it is very clear which parent represents the punitive parent for the patient this mode can be given a name such as ‘ your punitive mother [father] ’ . Sometimes the patient may be unwilling or unable to actually give a name to the punitive parent out of a sense of misplaced loyalty towards that parent. When this is the case, the patient can refer to her ‘ punishing side ’ or ‘ the punisher’ . The punitive parent is taunting in her manner and has a tone of disapproval and humiliation. She thinks that Nora is bad and deserves to be punished. The punitive parent states that Nora is showing off. When Nora fails, it is simply because she has not tried hard enough. Feelings are of little interest to the punitive parent and, according to this side, she uses them only to manipulate others. Should something go wrong, it is her own fault. In her mind, succeeding is dependent entirely upon her desire to succeed. If she really wants something, it will work out. If she fails or it does not work out, she obviously did not want it enough.心理学空间'l0MMA6?

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惩罚性父母模式一般也会有一个名字。父母非常清晰的呈现出惩罚性家长的时候,针对患者这一模式可以被命名为例如‘你的惩罚性母亲[父亲]’。有时候,患者出于对父母忠诚感的错放,可能不愿意或不能够真的去给惩罚性父母命名 。在这个案例中,患者可以用‘惩罚的一面’或‘惩罚者’来指代。惩罚性父母以她的态度,带着不满和羞辱的口吻奚落着。惩罚父母认为诺娜在卖弄,是坏的,应该受到惩罚。当诺拉失败,的确是因为她没有尽力而为 。情绪很少投注于惩罚性的父母,据此方式,她利用他们只是为了操纵他人。如果一些事情出了乱子,那就是她自己的错,在她的心中,成功是完全依赖于她的成功欲望。心理学空间X7R-Tr4Fb/Q W)?

d#]2ySo+M0P;pB*k0如果她真的想要什么,就会有结果。如果她失败或没有进展,显然她并不渴求。

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Sample dialogue with a patient in the punitive parent mode

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t : How are you doing? 

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/D;Q5M/U,Ad0p : (in an angry voice) Bad. 

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t : Why is that, did something bad happen? 心理学空间G&CzY-M%TUFN

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p : No, I did something stupid and now everything is ruined. 心理学空间g]n8A2q d.N

.S7]H&DiX;B D v0t : So things are not going well with you? 

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z[:m+s1Hx8p,y*p%rC,x0p : No, I ’ m hopeless and now I ’ m bothering you as well.

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与惩罚性的父母模式对话案例心理学空间;vlQ;Id(UK w#g9U(aC

H+c1o/rP)k(P0T:你好吗?

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P:(以愤怒的声音)不好。

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:fMV!_#S.T0T:为什么呢,发生了什么不好的事情呢?

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P:是的,我做了愚蠢的事,现在一切都毁了。

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nYv ZJt;@Og0T:所以事情进展不顺利呀?

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P:是啊,我很绝望,我觉得自己在打扰你。

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-q(v4ob G6{{x0When the punitive parent is present, Little Nora cowers away and is diffi cult to reach. While in this mode, the patient will punish herself by purposely denying herself enjoyable things or by ruining them. She will also punish herself by hurting herself or attempting to end her life. She provokes punishment everywhere, even from her therapist. She refuses to aid in her own recovery by spurning activities that would promote healthy improvement. This often results in a premature end to the therapy. When the patient is in this mode, the objective of the therapy involves extinguishing the unhealthy rules and behaviours and replacing them with more adequate rules and norms.

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当惩罚性父母存在时,小诺拉畏缩着,很难触及。处于这种模式时,患者会故意否认自己愉快的事情或破坏它们来惩罚自己。她也会通过伤害自己或企图结束自己的生命惩罚自己 。她到处挑衅,给别人吃苦头,甚至对她的治疗师也是如此。她拒绝帮助,唾弃能够促进健康改善的活动,以她的方式自行恢复。这经常导致治疗过早的结束 。当患者在此模式下,治疗的目标涉及不复存在的不健康的规则和行为,并被更多恰当的规则和规范所取代。

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Treatment Methods for the Punitive Parent惩罚性父母的治疗方法心理学空间R'w vf1ZzC0ukx

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Therapeutic relationship治疗关系

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The therapist protects the patient as much as possible from the punitive parent mode. This mode is very dangerous because the fact that the patient wants to punish herself can lead to destructive behaviour such as self - injury and suicide. During therapy the therapist tries to create as safe a situation as possible and makes sure that he is reachable in the event of a crisis (see Chapter 8, ‘ Crisis ’ and ‘ Suicide and Self- Injury’). Despite all of his efforts, the patient will at times interpret comments from the therapist as punitive. Most often the therapist is not aware of this; however, when the patient suddenly changes from one mode to another (to the punitive parent or protector), there is a large chance that the therapist said something ‘ wrong ’ .  He can ask the patient if this is the case and try to explain what he actually meant by his comments. It is possible, however, that the therapist did indeed react in a punishing way. This is most probably due to falling into the trap of acting out negative counter - transference and he must repair this situation. The therapist is the role model of a good parent (who also makes mistakes at times) and takes a completely opposite stance to that of the punitive parent.

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*W!paG}%H0治疗师尽其所能保护患者远离惩罚性父母模式。这种模式非常危险,因为患者想要惩罚自己,导致毁灭性的行为,例如自伤和自杀。治疗期间,治疗师试图去创造一个尽可能安全的环境,并确信,在危机事件中他很容易接近。(见第八章,危机和自杀与自伤) 。患者不在乎他的努力,时常将治疗师的诠释视为惩罚。大多数治疗师意识不到这一点,然而,当患者突然从一个模式切换为另一模式(惩罚性父母或保护者)时,很有可能是治疗师说的一些东西“错了”。他可以询问患者,如果是这样的话,并试图解释他谈话的真实的意思 。然而,这是可能的,治疗师的确没有以惩罚方式回应。最有可能的是,因为治疗师落入负性的反移情的行动化,他也就必须修复这一情景。治疗师是一个好父母(有时也会犯错)的角色模板,并采取了与惩罚父母完全相反的立场。

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? l!m|;jPUF^B$S)I0In imagery rescripting the therapist combats the punitive parent and teaches the patient to fight against this punishing mode. This can also be achieved using historical role play. The multiple - chair technique is an excellent method for dealing with the punitive parent (see Chapter 5 ). A hard confrontational manner is the best method for dealing with a punitive parent whose behaviour towards the patient is clearly cruel and derogatory. The therapist talks in a louder voice and interrupts the punitive parent should he refuse to listen. He uses a more formal type of language in dealing with the punitive parent by referring to him or her as Mr or Mrs X (name of parents). When the punitive parent is critical in a negative sense towards the patient, the accent of the disputation should lie in pointing out the parent ’ s own failings and rigidity. The critical parent appears reasonable and only stops when the parent ’ s own shortcomings are pointed out. One aspect he has definitely failed at is raising his daughter in a loving and accepting way. This is a particularly helpful method if this critical side is connected to one of the parents. The therapist, who should have enough information about this parent, gathered during intake interviews, can offer convincing examples.心理学空间b^3a,c[ iB

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在意象重构中,治疗师与惩罚性父母战斗,教导病人反抗这种惩罚性模式。这也可以用历史任务角色扮演来实现。多椅技术是应对惩罚性父母的优秀的技术。,硬性对抗的态度是处理针对惩罚性父母明显的残酷和贬低患者行为的最好方式 。治疗师大声的说话,打断惩罚性父母,并拒绝去听。他齿及(父母)为某先生或某女士,使用这种正式的语言来应对惩罚性父母。当惩罚性父母以消极的感受吹毛求疵的针对患者时,争议的重点应该放在指出家长自身的缺点和死板 。直到,父母自身的缺点被指出来,挑剔的父母显得合情合理时才停止。他明显失败的一个特性是,他正在以充爱和接纳的方式养育他的女儿。这是一种特别有用的方法,如果挑剔的一面是与父母的一方相联系的 。治疗师应该有足够的与父母有关的信息,在初始访谈中收集,可以提供有说服力的事例。

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Another possible variation on this theme is that of the guilt - inducing, complaining parent. This type of punitive parent insists that all attention be focused on him/her and holds Little Nora responsible for the parent ’ s unhappiness. Should Nora attempt to go her own way, she is punished and reproached. The patient herself finds her parent pitiful and feels responsible for the parent ’ s happiness, and therefore cannot directly disagree with the parent. In this case the therapist is not very strict with the punitive mode, but is more resolute in dealing with it. He tells the punitive mode that he must seek help for himself and must not rely on Little Nora to solve his problems.心理学空间1zJ2p7\5n"n&S+jT"tj

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在这个图式中的另一种可能的变形是内疚-诱导,抱怨的父母。这种惩罚性父母持续的将所有的注意力聚焦于他/她,并 通揽小诺拉对父母的不快。如果诺拉尝试走自己的路,她会被责备和惩罚 。患者自己发现她父母的可怜,感觉要对父母的幸福负责,因此不能直接反对父母。在这种情况下,治疗师并不严格要求这种惩罚模式,但在处理时更坚决。他告诉惩罚性模式,他必须自己寻求帮助,不能依靠小娜拉来解决他的问题。

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As with all experiential techniques, the therapist should not start an extended discussion with the punitive side , because doing so would only be an admission that the punitive side is partially correct. The punitive parent is not a person who is capable of thinking in a nuanced manner, but rather a mode that will attack even the slightest faults and mistakes. Thinking about things in a distinctive, refined manner is part of a healthy adult ’ s schema, not that of a punitive parent.

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Y)BBf9@;er V N@uB@0如同所有的经验技术,一开始治疗师不应该开始讨论的惩罚性一面的外延,因为这样做只会承认惩罚性一面是部分正确的。惩罚性父母不是一个能以细致入微的方式思考的人,而是一种攻击模式,哪怕是一丁点的故障和错误 。以独特的方式思考问题,举止文雅是健康成人的图式,而不是惩罚性父母的模式。心理学空间-T%XI"B%F

.W2[#gH7}0Thinking想法

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j`'J:}9o9rT,r4`0When the patient has negative thoughts about herself and realizes that this is due to the punitive mode, she can try to make a balanced judgement of herself using a cognitive diary with the help of her healthy adult side. The punitive parent will judge the patient in a very black - and - white manner. Thoughts like “ I am evil, dumb and ugly and everything is my fault ” are common. Techniques that can be used in this situation are multidimensional evaluation, the pie chart and the courthouse method (see Chapter 6 ). In addition the patient can ask other people who are close to her for help and advice by asking them for their point of view on, for example, a mistake that she has made.心理学空间&WH/V7n g O"d1`

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当病人对自己有消极的思想和认识,这是由于惩罚性的方式,她可以尽量在她的健康成人一面的帮助下使用认知日记来平衡对自己的判断。惩罚性父母会用非黑即白的极端方式评判患者 。像“我是邪恶的,愚蠢和丑陋的,一切都是我的错”的想法很普遍。在此情况下可以使用技术是多方面的评估,饼图和法院方式(见第六章)。此外,患者可以向亲密的人寻求帮助和建议,询问求他们对自己的看法,例如,她犯的一个错误。

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Keeping a positive logbook and historical testing are other methods that provide arguments opposing the punitive parent mode. Developing healthy adult norms and values is also a way to reduce the influence of the punitive parent as the patient is afraid that no norms and values will be left if she lets go of the excessively strict standards of her parents. The therapist should help her to develop more flexible and more reasonable norms without forcing his own ideas upon her. These new values and norms belong to the healthy adult.心理学空间 g2a)qD[%q$?m e

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提供论据,反对惩罚性父母模式的另一种方法是保持积极的工作日志和历史的检验。发展健康成人的标准和价值观也是一种方式,以减少对惩罚性父母的的影响,因为如果放开父母过分严格的标准,患者害怕没有规范和价值观,就会跟不上 。治疗师应该帮助她制定更灵活,更合理的规范,不要将自己的想法强加与她。这些新的价值观和规范都属于健康成人。

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The patient can do a number of things to rid herself of the punitive parent mode, for example:

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%vsc~RL:}&S4?0患者可以做很多事情,以去除惩罚性父母模式,例如:心理学空间b(s Z&^ [q

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• Listen to a recording during which the therapist sends the punitive parent away.心理学空间,mwB0{-YkA

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听治疗师赶走惩罚性父母时的录音。心理学空间!r @4{X0];tZd;t u(c6I

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• Read through flashcards with statements as to why the punitive parent is incorrect.心理学空间#])c rOEIH

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阅读闪卡,来陈述为什么惩罚性父母是错的。心理学空间,D%pv,f'Q)Es9oe)d"H

J.K0nLBp-N0• Visit friends and ask for support and affection.

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W:p6N)y*Ob0造访朋友并寻求支持和情意。心理学空间X2e `FI(b

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• Relax using meditative or relaxation exercises.心理学空间%hKy^9N7j7H%@5}

e&TA%NC9l6{9C0用冥想来放松或放松练习。心理学空间:Vxf(E X2BG.sMJ3?

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• Do things that the patient enjoys doing or is good at.

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做患者喜欢做或擅长的的事。心理学空间z/G2g2F)kd

W8YZ(b\ y2LY0• Learning to comfort herself, if necessary using a transitional object.

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A YC7jp I0• Have a schema dialogue at home between healthy and punishing modes.

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]z3Y8]#@0在家里,进行健康成人和惩罚模式的图式的对话。心理学空间x {r9Y q|/bH;^0C

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For further information about these forms of homework, please refer to Chapter 8, ‘ Homework ’ .

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q(uJ;us7RUos0有关这些形式的家庭作业的详细信息,请参阅第8章,“家庭作业”。心理学空间n/Lq6P~T(s%O2[5U

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AL!q#A?`0• The punitive parent can return after a session in which he was silenced and seek revenge. The therapist must not underestimate this. Different measures for dealing with this situation have been described earlier in this chapter under ‘ Treatment Methods for the Angry/Impulsive Child’ .

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o*]bzd0惩罚性父母会在一次被压制或打击报复的会谈后返回来。治疗师不应该低估这一点,处理这种情况的不同的措施,已在本章前面的“治疗方法的愤怒/冲动儿童”中讲述了。• The punishing side sometimes causes the patient not to do what is good or healthy for her, but rather to do the complete opposite. This comes from the thought that she does not deserve to be happy. It is also an unconscious attempt to provoke punishment from her therapist. This often leads to the patient not showing up for sessions. In this case the therapist must call the patient and convince her that he will not punish her, even though things have gone wrong. Further he must encourage her to attend the next session. If the patient is not available on the telephone, the therapist should send her a letter in which he expresses his concern for her well - being and invites her to the next session.心理学空间|S^i b^d

S5ry)N0g2dQ0惩罚性的一面有时会导致病人不去做对她健康或好的事情,而是做完全相反的事。这来自于那些她不应得到幸福的想法。这也是一种无意识的企图,以挑起她的治疗师的惩罚。经常导致患者不出席会谈 。在此情况下,治疗师必须打电话给患者,并说服她,即使事情已经错了,他也不会惩罚她。此外,他必须鼓励她参加下一节会谈。如果患者无法使用的电话,治疗师应该写一封信给她,来表达了他对她良好状态的关心并邀请她进行下一次会谈。

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~"XU%M0B w{p p0• The patient can also become protective of her parents ( “ they couldn ’ t help it; they had bad childhoods themselves ” ). The therapist explains that it is important to silence the punitive parent as this mode is damaging for the patient. He repeats that by rejecting the punitive parent, the patient is not rejecting the parent as he or she is now, but rather that part of the parent that was not good and was punishing during the patient ’ s youth. Actual understanding the parent or forgiveness only takes place once therapy has been completed and becomes the choice of the patient as a healthy adult. The patient must first learn to silence the punitive parent mode in her own head.心理学空间xO~*e qt@

1N3j,E+|;ki O#z+^p0患者也会变成她的保护的父母(他们不能帮助之;他们有他们自己悲惨的童年)。治疗师要去解释,对惩罚性父母沉默是重要的,因为这一模式对患者有害。他强调,患者没有拒绝父母,当他或她在场时,被拒绝的惩罚性父母是不好的父母,以及在患者年轻时被惩罚的父母 。实际上,理解或宽恕父母只发生一次治疗就已经完成了,并成为患者健康成人的选择。患者必须在自己的头脑里,首先学会对惩罚性父母模式保持沉默。心理学空间E)y1ne%j_:@ S0P

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