来源：《边缘型人格障碍的图式治疗》
作者：Arnoud Arntz and Hannie van Genderen
翻译：陈明
健康成人模式
或许应对BPD的“健康成人的模式”看起来有些奇怪，但是患者需要逐渐形成和最终维护的正是这种模式。由于缺少正常、健康的童年，以及在此期间不可控的事件，健康成人模式是很少深刻的呈现于治疗初始阶段。
患者健康发展亏欠的地方，比如与他人链接、自主性、自我表达、自我价值以及缺少处理现实边界的经验，需要治疗师充当“健康一面”的代表，尤其是在治疗的开始阶段。
然而，一开始是健康成人确保了患者在治疗中的寻求和维持。在之后的治疗阶段，这种模式帮助患者实现健康目标。
这些治疗性的目标，比如与他人的关系，寻找教育或工作机会，以及患者乐享其中并能够完成的其他类似的活动，对于治疗过程的成功完成是有必要的。在这种模式下，患者不但敢于展示自己的感情，而且也展示她对这些表达的控制能力，对于BPD患者来说是一个必要去完成的技能。
如前所述，在治疗开始阶段，是治疗师充当了所谓的健康一面的代表。在治疗后期，健康成人模式演变方式是：她可以从治疗师哪儿接管这个角色，同时治疗以健康、适当的方式结束。
健康成人的治疗方式
治疗关系
治疗关系缓慢而稳步地从父母-儿童关系转变为两个成人之间的关系。患者变得越来越自主，并且能够在没有治疗师的帮助下找到她问题的解决方案。从治疗之初，治疗师寻求与健康成人接触，即便这些时刻是少之又少。特别是处理攻击性和冲动行为的时候，为了继续治疗，治疗师寻求直接与健康成人接触并试图结束这种行为。
与健康成人对话的例子
诺拉威胁要停止治疗，因为她的男朋友和她分手了，现在的生活已经没有意义了。
T：诺拉，我理解你现在处在一个非常困难的时期，但现在我想和你的健康成人的一面谈谈。我想说的是，你现在不应该停止治疗，因为到了最后，你还会有更多的问题。我理解你现在的无所可依的感受，当我们开始治疗时，你也有这种感觉，但是你坚持了。眼下的一切似乎惨淡无望，但你的健康成年人部分知道这些都将过去，而且我可以帮你。
在治疗期间期很容易观察到，她情感的表达没有受到任何威吓的时候，患者有能力表达她的感受并与他人分享。她与治疗师分享的故事，展现了她与他人的关系中处理情绪和情感的能力。她面对强烈情感的时候，她有能力探究出这是她的哪一种旧有的图式在工作。她可以提供不同的健康图式来抵消她自己的这些旧模式。
想法
健康成人有能力学习威胁性的负面情绪或冲动的行为的深层想法，并与之争辩。她可以琢磨自己和世界以微妙的方式成为一体，同时有能力在头脑里进行苏格拉底式的对话（见第6章），而不必在认知日记里全部写出来。
做
患者参与诸如怎样保持友谊和建立关系等不同种类的、适合正常成人生活方式的活动。
她工作、研究，或者是接受一些有意义的其他方法来填补她的日常生活。健康成人根据那些她过去希望保持接触的人和她选择不去联系的人来做出决定。
困难
在第一次治疗中的一半时间里，治疗师有时会觉得他正在与健康成人对话，而实际上他所面对的是保护者。尤其是在应对保护性父母的时候，会倾向于合理化和淡化处理，治疗师可让自己相信，他所面对的病理并不太严重。在此阶段，治疗师必须自问，这个健康的行为是否与治疗之初的病理学严重性相符。他必须至少检查病人的情绪，以便清晰于就此问题（参见之前关于处理保护者时的困难的讨论）
The healthy adult
It may seem odd to have a ‘ healthy adult ’ mode when dealing with BPD, but it is exactly this mode that the patient needs to cultivate and eventually maintain. Due to absence of a normal, healthy childhood, as well as uncontrollable events during this period, the healthy adult mode is seldom strongly present during the initial stages of the therapy.
The patient's deficit of healthy development in areas such as bonding with others, autonomy, self - expression, self - value and the lack of experience in dealing with realistic limitations, requires the therapist to serve as a representative of the ‘ healthy side ’ particularly in the beginning of the therapy.
However, it is the healthy adult who initially ensures that the patient seeks out and remains in therapy. At later stages of therapy this mode helps the patient to achieve healthy goals. These therapeutic goals such as relationships with others, looking for educational or work opportunities, and other such activities that the patient will enjoy and be capable of completing, are necessary for successful completion of the therapeutic process. While in this mode the patient not only dares to show her feelings, but also shows she is capable of controlling their expression, a necessary skill for the BPD patient to accomplish.
As previously stated, in the beginning of the therapy, it is the therapist who serves as a representative of the so - called healthy side. By the end of the therapy, the healthy adult is so evolved that she can take this role over from the therapist and the therapy can be concluded in a healthy, appropriate manner.
Treatment Methods for the Healthy Adult
Therapeutic relationship
The therapeutic relationship changes slowly but surely from that of a parent – child relationship to that of a relationship between two adults. The patient becomes more and more autonomous and is able to find solutions to her problems without the help of the therapist. From the very beginning of therapy the therapist searches for contact with the healthy adult, even if these moments are few and far between. In particular when dealing with aggressive and impulsive behaviour, the therapist seeks contact with the healthy adult directly and tries to end this behaviour in order to continue with therapy.
www.psychspace.com心理学空间网Example of talking with the healthy adult
Nora is threatening to stop therapy because her boyfriend broke up with her and now life has no meaning.
t : Nora, I understand that you're having a very difficult time right now but I want to talk to your healthy adult side. What I want to say is that you shouldn't stop therapy now because you will end up having more problems. I understand that right now you feel like it's going nowhere, but you also felt this way when we began therapy but you stuck it out. Right now everything may seem hopeless, but your healthy adult knows that this will pass and I can help you with it.
Feeling
The patient is capable of expressing and sharing her feelings with others. This is easily observed during therapy sessions as her feelings are expressed without any deterrents. The stories she shares with the therapist show her ability to deal with emotions and feelings in her relationships with others.When she is faced with strong emotions, she is capable of researching which one of her old schemas is at work.She can offer alternative healthy schemas to counter these old schemas on her own.
Thinking
The healthy adult is capable of studying the underlying thoughts of threatening negative feelings or impulsive behaviour and disputing them. She can think about herself and the world as a whole in a nuanced manner and is competent in having a Socratic dialogue (see Chapter 6 ) in her head without having to write everything down in a cognitive diary.
Doing
The patient participates in different sorts of activities appropriate to a normal adult lifestyle such as maintaining friendships and building a relationship.She either works or studies or has some other meaningful way to fill her days. The healthy adult makes the final decisions as to those individuals from her past she wishes to maintain contact with and those she chooses not to.
Obstacles
During the first half of the therapy the therapist may sometimes think he is talking to the healthy adult while in reality he is being faced by the protector. Especially when dealing with patients whose protector has a strong tendency to rationalize and trivialize, the therapist can be led to believe that the pathology he is dealing with is not too serious. In this phase the therapist has to ask himself whether this healthy behaviour is in accordance with the severity of the pathology at the start of therapy. He has to at least check the emotions of the patient to get more clarity on this issue (see earlier discussion on obstacles when dealing with the protector).
