心理治疗入门-整合性取向课件.ppt

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,心理治疗入门-整合性取向,Lecture 1,本课程概述,成功治疗的关键,心理治疗入门,本课程的任务,结构和目标,系统治疗选择(,Systematic Treatment Selection,STS),治疗原则,成功治疗的关键,成为有效心理治疗师的六个关键,:,Attitude(,态度),Knowledge(,知识),Tool(,工具),Technique(,技术),Time/Timing(,时机),Creative Imagination(,创造性的想象力),成功治疗的关键,Attitude(,态度),温和(,warm),乐观(,optimistic),感兴趣(,interested),接纳(,accepting),成功治疗的关键,Attitude(,态度),Knowledge(,知识),Tool(,工具),Technique(,技巧),Time/Timing(,时机),Creative Imagination(,创造性的想象力),成功治疗的关键,Knowledge(,知识),临床改变(,clinical change),原则（,principles),原则来自于临床经验与临床研究,成功治疗的关键,Attitude(,态度),Knowledge(,知识),Tool(,工具),Technique(,技巧),Time/Timing(,时机),Creative Imagination(,创造性的想象力）,成功治疗的关键,Technique(,技巧/技术),-是工具得以应用的一个媒介。,-强调成熟的，有实证研究支持的技术。,-工具与技巧是不可分割的。,成功治疗的关键,Attitude+Knowledge+Tool +Technique=,skill,成功治疗的关键,Attitude(,态度),Knowledge(,知识),Tool(,工具),Technique(,技巧),Time/Timing(,时机),Creative Imagination(,创造性的想象力）,成功治疗的关键,Time/Timing(,时机),-,跟治疗师的技能相关,-技能娴熟的治疗师懂得使用不同干预的时机,成功治疗的关键,Attitude(,态度),Knowledge(,知识),Tool(,工具),Technique(,技巧),Time/Timing(,时机),Creative Imagination(,创造性的想象力）,成功治疗的关键,Creative Imagination(,创造性的想象力）,Attitude,knowledge,skills and timing,通过创造性的相象力得以整合。,心理治疗作为一种艺术,几个术语,原则:是指一些一般的指南(,general guiding rules),策略:则用以区别如何特异性地应用这些原则(,strategies),技术(,technique):,则是指一些特定的(操作的)过程,本课程的目标,1.获得技能和知识，,“,量体裁衣,”,地为每一个病人进行干预-,在初次会谈后，做什么?,2.应用研究为基础的心理治疗的原则,如,何灵活有效地使用指导原则来进行心理治疗。,3.发展对心理治疗的理论和哲学,何种心理治疗取向最适合我?,本课程目标 1,1.获得技能和知识，,“,量体裁衣,”,地为每一个病人进行 干预-,在初次会谈后，做什么?,STS,系统治疗选择(,STS),STS:Systematic Treatment Selection,是测评的工具(,Measurement Device),也是治疗的模式(,Model of treatment),系统治疗选择（,STS）,测评的工具(,Measurement Device),探索四个层面的因素,系统治疗选择,Level#1,预,后指针（,Prognostic Indicators）,环境与情境（,Environment&Situation）,人格特征（,Personality Traits）,状态性因素（,States）,Level#2,提,供服务指针（,Contextual/Level of Service Indicators）,治疗模式和方式（,Format and Mode）,频率和疗程（,Frequency&Length）,地方,Level#3,关,系性指针（,Relationship Indicators）,与治疗师匹配,人口特征，风格（,Fit of Therapist-Demographics,Style）,期望与需求（,Expectations and Wants）,Level#4,治,疗指针,治疗效果（,Treatment Effects）,治疗匹配（,Treatment Fit）,Level#1.,预后指征,Level#2.,提供服务指征,Level#3.,关系指征,Level#4.,治疗指征,STS,Level#1,预后指征,Prognostic Indicators,STS-,临床评估表,STS-CRF,Clinician Rating Form,STS,Level#1,预后指征,病人人口学特征/文化,Patient demographics/culture,功能受损,Functional Impairment,主观痛苦,Subjective Distress,社会支持,Social Support,自信,Self-Esteem,内化性应对风格,Internalized Coping Style,外化性应对风格(,Externalized Coping Style),阻抗(,Resistance),慢性,病程(,Chronicity),问题的复杂性/合并情况,(,Problem Complexity/Co-morbidity),STS-,临床评估表,STS-CRF,STS-CRF,Clinician Rating Form,Level#2,提,供服务指征,Contextual/Level of Service Indicators,治疗模式和方式（,Format and Mode）,频率和疗程（,Frequency&Length）,地方(,Location),STS,Level#2,提供服务指征,心理社会模式,个人,配偶/伴侣,家庭,小组,心理药物模式,药物分类,Anxiolytic(,辅助药物),抗抑郁,抗分裂症状,抗躁狂,兴奋剂,药物用量,Level#2,提供服务指征,频率与疗程,治疗地方/设置,Level#3,关,系性指征,Relationship Indicators,STS,Level#3,关,系性指征,Therapist Selection,Demographic,Values/Beliefs,Style,Fit of Therapist Style and Expectations/Wants,Directive,Active,Focus in or out,Level#4,治,疗指征,Fit of Intensity and Impairment,Fit of Mode and Chronicity/Impairment,Fit of Complexity and Mode,Fit of Symptom vs Insight focus and Coping Style,Fit of Directiveness and Resistance,Fit of Expressive vs Supportive and Arousal/Distress,系统治疗选择,作为一种治疗模式,(,Model of Treatment),处方性心理治疗,Prescriptive Therapy,病人因素在,PT,计划中的考虑,治疗强度(长度/频度),症状/技能焦点,vs.,领悟焦点,治疗师的指导性(高/低),情感对峙,vs.,情感支持,本课程的目标,1.获得技能和知识，,“,量体裁衣,”,地为每一个病人进行干预-,在初次会谈后，做什么?,2.,应用研究为基础的心理治疗的原则,如,何灵活有效地使用指导原则来进行心理治疗。,3.发展对心理治疗的理论和哲学,何种心理治疗取向最适合我?,本课程的目标 2,2.,应用研究为基础的心理治疗的原则,如,何灵活有效地使用指导原则来进行心理治疗。,STS,治疗原则,STS,的 18 个原则,-10,个基本原则 (,Basic Principles),-8个最优化匹配原则(,Optimal Fit Principles),基本原则,Prognosis,1.The likelihood of improvement(prognosis)is a positive function of social support level and a negative function of functional impairment.,2.Prognosis is attenuated by patient complexity/chronicity,and by an absence of patient distress.Facilitating social support enhances the likelihood of good outcome among patients with complex/chronic problems.,基本原则,Level and Intensity of Care,3.Psychoactive medication exerts its best effects among those patients with high functional impairment and high complexity/chronicity.,Likelihood and magnitude of improvement are increased among patients with complex/chronic problems by the application of multi person therapy.,5.Benefits correspond to treatment intensity among functionally impaired patients.,基本原则,Clinical Principles of Risk Response,6.Risk is reduced by careful assessment of risk situations in the course of establishing a diagnosis and history.,7.Risk is reduced and patient compliance is increased when the treatment includes family intervention.,8.Risk and retention are optimized if the patient is realistically informed about the probable length and effectiveness of the treatment and has a clear understanding of the roles and activities that are expected of him or her during the course of the treatment.,9.Risk is reduced if the clinician routinely questions patients about suicidal feelings,intent,and plans.,10.Ethical and legal principles suggest that documentation and consultation are advisable.,最优化原则,Relationship Principles,1.Therapeutic change is greatest when the therapist is skillful and provides trust,acceptance,acknowledgment,collaboration,and respect for the patient within an environment that both supports risk and provides maximal safety.,2.Therapeutic change is most likely when the therapeutic procedures do not evoke patient resistance.,最优化原则,Principles of Exposure and Extinction,3.Therapeutic change is most likely when the patient is exposed to objects or targets of behavioral and emotional avoidance.,4.Therapeutic change is greatest when a patient is stimulated to emotional arousal in a safe environment until problematic responses diminish or extinguish.,最优化原则,Differential Treatment Principles,6.Therapeutic change is greatest when the relative balance of interventions either favors the use of skill building and symptom removal procedures among patients who externalize or favors the use of insight and relationship-focused procedures among patients who internalize.,7.Therapeutic change is greatest when the directiveness of the intervention is either inversely correspondent with the patient,s current level of resistance or authoritatively prescribes a continuation of the symptomatic behavior.,8.The likelihood of therapeutic change is greatest when the patient,s level of emotional stress is moderate,neither being excessively high nor excessively low.,本课程的目标 3,1.获得技能和知识，,“,量体裁衣,”,地为每一个病人进行干预-,在初次会谈后，做什么?,2.,应用研究为基础的心理治疗的原则,如,何灵活有效地使用指导原则来进行心理治疗。,3.发展对心理治疗的理论和哲学,何种心理治疗取向最适合我?,本课程的目标 3,3.发展对心理治疗的理论和哲学,何种心理治疗取向最适合我?,