4.3 關於存在治療的筆記
作者: 张凯理 / 5418次阅读 时间: 2010年6月19日
标签: 存在主义 存在治疗 存在治療

真正重要的哲學問題是什麼 為什麼不退轉 為什麼不放棄 為什麼不自殺 為什麼要心存善念 人生倏忽即逝 這一切意義何在


I often think of my clinical work in terms of doing as much psychoanalysis as possible in a context where I do as much psychotherapy as necessary --- the latter being precisely what makes it possible to pursue the former.
(Fred Pine, Diversity and Direction in
Psychoanalytic Technique, 1998(2003), p3)

Fred Pine的話,我會做一個轉折,為存在治療註腳。

I often think of my clinical work in terms of doing as much existential therapy as possible in a context where I do as much dynamic psychotherapy as necessary --- the latter being precisely what makes it possible to pursue the former.

存在治療的作者,在國內除了Victor Frankl和Irvin Yalom之外,很少有人提及。但溯其發展之歷史,實與精神分析,並行於廿世紀。這是一個淵源自歐陸哲學,尤其是現象學、存在哲學、和詮釋學的治療傳統。對於心理治療的眾多學派而言,它是個小傳統,但它是最不受限於心理學或精神分析的思維,也是最親近人文學科的治療取向。它的精神在於現象學的方法(phenomenological method),詮釋學的經驗(hermeneutical experience),和存有的關懷(existential concern)。它的意義尤其是顯現於生命轉彎處、崩塌時、日復一日、無以為繼之際,一個人如何面對做一個人的腳跟下大事。

存在治療的歷史,可溯自早期的先行者Ludwig Binswanger,他首先從海德格的哲學,汲取靈感,開啟了 Daseinsanalyse。到世紀中葉,Medard Boss長年問學於海德格,結晶於Zollikon Seminars,繼續發展了Daseinsanalysis的傳統。其間,北美六零年代的第三心理學---人本心理學,Frankl 的Logotherapy,R.D. Laing的Anti-Psychiatry的激進思維與作為,到近二十年英國學派的總其成。當代英國學派之重要作者,包括Hans Cohn,Emmy van Deurzen,Ernesto Spinelli,Mick Cooper等人。

而且多年來,存在治療與精神分析對話的努力並未中斷。這個對話所涵之問題性 亦十分值得深思。



?    在生命轉彎處 崩塌時 日復一日 無以為繼之際 面對做一個人的腳跟下大事
?    存有的反抗 (Existential Revolt) (The Rebel, by Albert Camus, 1951)
?    存有的開啟或彰顯 (並非意含無盡的可能, 最明顯的例子是, 時空的限制, 死亡的必然, 任何系統都隱含遮蔽和阻隔的可能, 精神分析意欲面對的內在情結.)
?    存有的意義 (How to live a life that matters?)
(簡單講, 存在治療在講的是, 少了那一點人就不像人, 多了那一點人才比較像人, 的那一點東西.)

?    I often think of my clinical work in terms of doing as much psychoanalysis as possible in a context where I do as much psychotherapy as necessary --- the latter being precisely what makes it possible to pursue the former.
(Fred Pine, Diversity and Direction in
Psychoanalytic Technique, 2003, p. 3)

?    I often think of my clinical work in terms of doing as much existential therapy as possible in a context where I do as much dynamic psychotherapy as necessary --- the latter being precisely what makes it possible to pursue the former.

?    Phenomenological method
?    Hermeneutic experience
?    Existential concern

?    Existential therapy is best understood as a rich tapestry of intersecting therapeutic practices, all of which orientate themselves around a shared concern: human lived-existence.

?    Existential philosophers have depicted this existence in many different ways, but what is common to each of their deions is a radical challenge to many of our contemporary assumptions about what it means to be human. … together they create a radically new, and radically humanizing, image of what it means to exist. What better foundations, then, on which to construct the most human of professional practices: counseling and psychotherapy?

?    Some readers may have concluded that to be an existentialist one needs simply to accentuate in a rather brooding way the darker side of life and cosmologize his anguish. (Schrader, 1967) But existential philosophy is less a philosophy of doom and despair, and more a philosophy of balance. (Kohn, 1984)
?    直譯為 “EVERYDAY”, 字典上有數解: 每日的, 每日發作的 (比如 QUOTIDIAN FEVER 每日熱), 司空見慣的, 平凡的, 意思是說, 某君的再平常不過的某一天是怎麼過的, 這就是存在治療要問的事情. 這個問題JAMES JOYCE多年前顯然已經問過. (Ulysses, 1922).

Dublin, 16 June, 1906
?    The action of the novel, which takes place in a single day, 16 June 1906, sets the characters and incidents of the Odyssey of Homer in modern Dublin and represents Odysseus (Ulysses), Penelope and Telemachus in the characters of Leopold Bloom, his wife Molly Bloom and Stephen Dedalus.
Dublin, 16 June, 1906
?    … a day distinguished by its utter normality. Two characters, Stephen Dedalus and Leopold Bloom, go about their separate business, crossing paths with a gallery of indelible Dubliners. We watch them teach, eat, stroll the streets, argue, and (in Bloom's case) masturbate. And thanks to the book's stream-of-consciousness technique -- which suggests no mere stream but an impossibly deep, swift-running river -- we're privy to their thoughts, emotions, and memories. Almost every variety of human experience is crammed into the accordion folds of a single day … not just an experimental work but the very last word in realism.

?    The book is also an affectionately detailed study of the city, and Joyce claimed that if Dublin were to be destroyed in some catastrophe it could be rebuilt, brick by brick, using his work as a model … 18 chapters, each covering roughly one hour of the day, beginning around about 8 a.m. and ending sometime after 2 a.m. the following morning.
The Myth of Sisyphus (Camus, 1955)
?    Rising, streetcar, four hours in the office or the factory, meal, streetcar, four hours of work, meal, sleep, and Monday Tuesday Wednesday Thursday Friday and Saturday according to the same rhythm --- this path is easily followed most of the time. But one day the ‘why’ arises and everything begins in that weariness tinged with amazement.
Daseinsanalysis: Foundations for an Existential Therapy
?    Ludwig Binswanger (1881-1966) founded the Daseinsanalytic movement in the early 1930s … an approach he termed “Daseinsanalyse” or “phenomenological anthropology”.
?    Medard Boss (1903-1990), however, was to become the pivotal figure in the development of Daseinsanalysis.
Zollikon Seminars (1987, 2001)
?    (When Medard Boss was recruited to the Swiss Army mountain troop in WWII) For the first time in my life, I was occasionally gripped by boredom. In the midst of it, what we call ‘time’ became problematic for me. I began to think specifically about this ‘thing’. … By chance, I came across a newspaper item about Heidegger’s book Being and Time.
Zollikon Seminars
?    I plunged into it, but I discovered that I understood almost none of its content. The book opened up question after question which I had never encountered before in my entirely scientifically oriented education. For the most part, these questions were answered in reference to new questions. Disappointed, I laid the book aside only half-read, but strangely it gave me no rest.
Zollikon Seminars
?    Boss wrote to Heidegger finally in 1947 and asked for help in (reflective) thinking. Boss was very surprised when an answer arrived by return mail. In the ensuing years, there were 256 exchange of letters by Heidegger to Boss by the time of Heidegger’s death.
Zollikon Seminars
?    The series of seminars began on Sep 8, 1959, at “Burgholzli” at first. … from the second time the seminar was moved to my home in Zollikon. The seminars went on till 1970. From then on, I asked for his intellectual help only by mail or during my visit to his home in Freiburg.
Medard Boss, 1987
Heidegger reading Freud (1)
?    Even before our first encounter, I had heard of Heidegger’s abysmal aversion to all modern psychology. To me, too, he made no secret of his opposition to it. His repugnance mounted considerably after I had induced him with much guile and cunning to delve directly for the first time into Freud’s own writings.
Heidegger reading Freud (2)
?    During the perusal of the theoretical, ‘psychological’ works, Heidegger never ceased shaking his head. He simply did not want to have to accept that such a highly intelligent and gifted man as Freud could produce such artificial, inhuman, indeed absurd and purely fictitious construction about Homo sapiens. This reading made him literally feel ill.
(Medard Boss, 1988)
WHY? (1)
?    According to Heidegger, Freud was the epitome of a great contemporary scientific mind uncritically adopting and subsequently becoming entrapped by the tacit ontological commitments of his philosophical heritage.
WHY? (2)
?    “Psychoanalysis must accept the scientific Weltanschauung … the intellect and the mind are objects for scientific research in exactly the same way as non-human things. … Our best hope for the future is that intellect --- the scientific spirit, reason --- may in process of time establish a dictatorship in the mental life of man.”
(Freud, SE XXII, 171)
Zollikon Seminars
?    In this new and alternative view, human existence in its unique way, like everything else in our world, no longer appears as something present as an object within a pregiven world space. Rather human existence can be viewed as being, which cannot be objectified and which consists of an openness to the world and of the capacity to perceive what it encounters in that world. Through this openness, human existence itself, as well as any other given facts of our world, can come to their presence and unfolding.
Zollikon Seminars
?    The proper task of human Dasein is the event of letting-be what emerges into the openness of being. Human existence is necessary for this event, which constitutes its proper and most profound meaning. Thus, it also becomes clear that this meditative, alternative, and new way of thinking may also disclose meaning and purpose to the art of healing.

Zollikon Seminars
?    Heidegger would not have devoted as much time and energy to instructing medical doctors as he did in the Zollikon Seminars had he not thought his new and alternative thinking --- meditative thinking --- was of essential benefit to all medical therapies. From then on, they would understand themselves as individuals who are called upon to serve all beings including patients, who in their openness to the world encounter the therapist as a place for self-disclosure.
Medard Boss
Spring, 1990

Daseinsanalysis (1)
?    from psyche to being-in-the-world
?    from unconscious to closedness
?    from transference to real relationships
?    from causality to choice and freedom
?    Daseinsanalytic dream-work
?    from interpretation to deion

Daseinsanalysis (2)
?    Just as the psychologically healthy individual is a shepherd to the Beingness of the world, so the effective therapist is a shepherd to the Being of the client, which allows all of her world-disclosing possibilities to come to light.
Daseinsanalysis (3)
?    … the psychoanalysis it (Daseinsanalysis) criticizes is “only the most narrow, orthodox and stereotyped of psychoanalytic formulations which were more characteristic of psychoanalysis as it was practiced in the first half of 20th century.”
(Craig, 1993)
Daseinsanalysis (4)
?    Today it seems important for Daseinsanalysts to move away from reactive argumentation with psychoanalysis and, instead, move steadily toward proactive research of its own, drawing on the richness of their own investigative methods. (Craig, 1988, 229)
?    With the emergence of the “new school” of Daseinsanalysis, some of these developments are beginning to take place, and there is an increasing engagement with the works of more contemporary psychoanalysts, such as Winnicott, Fairbairn and Kohut. (Craig, 2001)
Daseinsanalysis (5)
?    The Daseinsanalytic Institute for Psychotherapy and Psychosomatic Medicine (Zurich, Switzerland, founded by Boss in 1971, present director Gion Condrau)

?    The Swiss Society for Daseinsanalysis (a second focal point for the Daseinsanalytic movement, less wedded to a strictly Heideggerian and Bossian viewpoint, Cf. Eric Craig, few of their writings have been translated into English)
Logotherapy: Healing Through Meaning
?    “He who has a why to live can bear with almost any how.”
?    the appealing technique
?    Socratic dialogue
?    paradoxical intention
?    dereflection
The American Existential-Humanistic Approach: Overcoming a Resistance to Life
?    Rollo May (1909-1994): “father of existential psychology in America”
?    Three of his protégés were to become the leading exponents of this approach.
James Bugental (1915- ) / Irvin Yalom (1931 - ) / Kirk Schneider (1956- )
?    Drive --- anxiety --- defense mechanisms
?    Reality of existence --- anxiety --- defense mechanisms

Ultimate concerns
?    death / freedom / isolation / meaninglessness (Yalom)

?    finiteness / potential to act / choice / embodiedness / awareness / separateness (Bugental)

R.D. Laing: Meeting Without Masks
?    Therapists developing Laing’s work have tended to fall into one of two relatively overlapping camps. First are those, like van Deurzen, who have developed the more existential aspects of his approach. Second are those who have attempted to articulate and develop the more psychoanalytic aspects, such as M. Guy Thompson, and members of the Philadelphia Association.
Ontological Insecurity
?    Fear of engulfment: fear that one’s autonomy will be devoured and subsumed by the will of others
?    Fear of implosion: a terror that one will be obliterated by the “real” world around
?    Fear of petrification and depersonalization: the dread of being turned into an inanimate object by the other
How Laing Worked (1)
?    A seven-year-old girl who was brought to him by her father because she had stopped talking. Without any plan, Laing sat down on the floor in front of her and touched the tips of her fingers with his … And for something like forty minutes or so, nothing (happened) except a gradually developing movement dance with the tips of her fingers … After about forty minutes, I opened my eyes and as I opened my eyes I found her eyes opening just at the same moment, without a word having been spoken. So we withdrew our fingers from each other, and went back to my chair. I said to her, bring your dad along now if that’s all right with you, and she nodded.

How Laing Worked (2)
?    According to Laing, when the father subsequently asked the young girl what had gone on between her and Laing, she had replied “It’s none of your business!” --- the first words she had spoken for approximately two months.
(Schneider, 2000)
The British School of Existential Analysis: the New Frontier (1)
Emmy van Deurzen: meeting the challenges of life (founded The Scoiety of Existential Analysis in 1988)
Four dimensions of existence:
?    Umwelt: the natural world with its physical, biological, dimension
?    Mitwelt: the everyday, public relations each of us has with others
?    Eigenwelt: the private and intimate relations each of us has with both ourselves and the significant others in our lives
?    Uberwelt: one’s connection to the abstract and absolute aspect of living

(Binswanger, 1968; van Deurzen, 1988)

?    Van Deurzen draws on a range of philosophical insights --- including those beyond the bounds of existentialism --- to help clients address the basic existential question: How can I live a better life?
Criteria for clients and therapists
?    Accepts --- or is open to --- the idea that their problem is with living, rather than a form of pathology.
?    Is not looking for immediate symptom relief, or expects the outcome of therapy to be a “smooth and perfect” life.
?    Has a critical mind and a desire to think, and is not looking for another’s opinion on what ails them.
?    Is ready to take stock of their lives --- to question themselves and be questioned.
?    Is someone who questions the status quo, rather than wanting to fit in and be “normal”.

Criteria for clients and therapists
?    Is mature and experienced, and has negotiated a number of life-difficulties themselves.
?    Is able to face their own dilemmas and challenges with dignity and courage.
?    Has been immersed in society from many different angles.
?    Is self-reflexive, questioning and curious.
Criteria for clients and therapists
?    Has a good knowledge of philosophy --- and existential philosophy in particular.
?    Has a broad, flexible stance, with no fixed ideology.
?    Has humility, and the wisdom to know that there are many things they do not know.
?    Is open to being transformed during the therapeutic encounter.
(Van Deurzen, 1995, 2002)

The British School of Existential Analysis: the New Frontier (2)
Ernesto Spinelli: embodying an
existential-phenomenological stance
?    The phenomenological method (Spinelli, 1989):
1. the rule of “epoche”
2. the rule of deion
3. the rule of horizontalization
(the equalization rule)

The British School of Existential Analysis: the New Frontier (3)
Hans Cohn (1916-2004 ): living within the givens
?    Cohn’s existential approach to therapy is based on a meticulous reading of Heidegger’s work, particularly the Being and Time and the Zollikon Seminars.
What happens when we read both psychoanalysis and philosophy? (1)
?    Any therapeutic approach that tries to take the writings of a philosopher as a guidebook for living will inevitably contain preive elements: squeezing and pushing the client’s experiences into a particular work.
What happens when we read both psychoanalysis and philosophy? (2)
?    The value of Heidegger’s writings lies not in their ability to guide the client, nor in the nuggets of wisdom that they contain and which can be mined for the therapeutic encounter, but in the therapist’s ability to directly engage with the texts --- learning to see the world in a new way. “In this way philosophical theory becomes something like an existential therapy training, with the aim of changing us into the sort of people who might be able to be philosophical or existential therapists.”
(Wolf, 2000)

What happens when we read both psychoanalysis and philosophy? The example of Lacan (1)
‘The unconscious is structured as a language’. … For Lacan, this notion of the unconscious belongs to the Romantic Lebensphilosphie (philosophy of life) and has nothing to do with Freud.
What happens when we read both psychoanalysis and philosophy? The example of Lacan (2)
?    The Freudian unconscious caused such a scandal not because of the claim that the rational self is subordinated to the much vaster domain of blind irrational instincts, but because it demonstrated how the unconscious itself obeys its own grammar and logic: the unconscious talks and thinks.
What happens when we read both psychoanalysis and philosophy? The example of Lacan (3)
?    Therein lies Lacan’s version of Freud’s motto ‘Wo es war, soll ich werden’ (Where it was, I am to become): not ‘the ego should conquer the id’, the site of the unconscious drives, but ‘I should dare to approach the site of my truth.’ What awaits me ‘there’ is not a deep Truth that I have to identify with, but an unbearable truth that I have to learn to live with.
What happens when we read both psychoanalysis and philosophy? The example of Lacan (4)
?    For Lacan, psychoanalysis at its most fundamental is not a theory of technique of treating psychic disturbances, but a theory and practice that confronts individuals with the most radical dimension of human existence. It does not show an individual the way to accommodate him- or herself to the demands of social reality; instead it explains how something like ‘reality’ constitutes itself in the first place.

(How to Read Lacan, by Slavoj Zizek, 2006, p. 3)
Conclusion: the Challenge of Change
?    Most importantly, however, what existential therapists may be able to contribute to the wider field of therapeutic practice is its critical and questioning edge: its willingness to challenge the assumptions and practices that many other therapists take for granted.
Conclusion: the Challenge of Change
?    Inside the body of existential philosophy, there are numerous concepts and ideas whose therapeutic potential has yet to be fully unpacked.
?    Van Deurzen states that one talking therapy that existential therapy will particularly need to “rub shoulders with” is that of philosophical counseling.
Conclusion: the Challenge of Change
?    Unlike van Deurzen, Cooper believes the postmodern challenge to existential therapy is primarily a positive one.
?    Just there is no one way of being an existential thinker, so there is no one way of being an existential therapist, and it is this very diversity and difference that is the life-blood of the field.

?    心理治療是奠基於一個人對另一個人的理解, 而這對人的現象與經驗的理解架構, 必然與人文學科和社會科學有關, 因為人文學科是我們構建人的存有的某種形上的可能性的基礎, 而社會科學則是理解人的生活世界的架構.
The Myth of Sisyphus
?    I leave Sisyphus at the foot of the mountain! One always finds one's burden again. But Sisyphus teaches the higher fidelity that negates the gods and raises rocks. He too concludes that all is well. This universe henceforth without a master seems to him neither sterile nor futile. Each atom of that stone, each mineral flake of that night filled mountain, in itself forms a world. The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.
---Albert Camus---




?    Art breaks open a clearing in whose openness everything is suddenly other than usual. (p. 403)
?    …give meaning to our lives, not by presenting objective truth but by offering what I would call a mythology created by artists ... artistic myths. (p. 379-380)
(Emotional Illness and Creativity: A Psychoanalytic and Phenomenologic Study, by Richard Chessick, 1999)www.psychspace.com心理学空间网
TAG: 存在主义 存在治疗 存在治療
«4.4 當治療室外就是廢墟 或拒馬 張凱理
4.2.4 晤談室裡的「現象-詮釋-存在」觀點»
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1981 陽明醫學院畢業
1983-1988 北榮精神科住院醫師
1989- 北榮精神科主治醫師
1991-1992 美國辛辛那堤大學精神科國際精神分析自體心理學研究中心研究員
2001-2003 台灣精神醫學會監事
2004-2010 台灣心理治療學會理事

    [catid] => 367
    [upid] => 336
    [name] => 張凱理
    [note] => 
1981 陽明醫學院畢業
1983-1988 北榮精神科住院醫師
1989- 北榮精神科主治醫師
1991-1992 美國辛辛那堤大學精神科國際精神分析自體心理學研究中心研究員
2001-2003 台灣精神醫學會監事
2004-2010 台灣心理治療學會理事

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