依恋理论为基础的短期疗法

发布时间：2019-04-06 16:04:57 来源：翻译: 恳谈李

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www.nmgpsy.com内蒙古心理网　　几乎所有人在生活中的某个时期都会感受过焦虑或抑郁。这有许多原因: 压力；与亲爱的人的分离，或是失去生活中一些极重要的东西（比如失业）；孤独，与亲近的人际关系发生困难；对未来的忧虑等等。我们对困难的反应带我们回到孩童时期的痛苦或创伤：因为在孩提时代，我们就是这样软弱无力的，现在的这种情景仿佛让一切重演。有些人有种自小形成的忧虑的倾向，有些人的倾向是要求事物完美，另一些人则觉得生活是难以承受之重负。这些或多或少与童年经历有关。如果你有一个困难的童年时代，它有可能令你在后来应对成年时代生活显得有种脆弱，或遭遇许多麻烦。当然，这决不意味着你不能超越你童年时代的印痕。

　　半个世纪前，师，心理学家约翰•波尔比出理论来解释这些复杂的现象。这个理论后来被大量心理学家广泛研究并得以拓展。波尔比认识到，作为孩子，如果我们在需要时，可以有一些值得信赖和依靠的成人让我们依托，我们就会对自己感到安全，自在，从而自我感觉良好。这些依恋的对象，提供了一个象是安全基地的背景，在此背景下，我们自可充分放松，游戏和享受，无畏探索外在的世界。对幼儿而言，安全基础通常是母亲。随着我们长大，这范围扩展到父亲、祖父母、兄弟姐妹，然后是朋友，他们是我们的同伴，友朋，他们给我们提供了安全感。

　　虽然人人都在孩童时代得到某些保护——要是没有，我们根本无法活到成年——现实地说，我们的依恋对象并不是始终如一可靠安全的。关于这一点，我以为华文化中有关父母的神话应该打破，因为它并不是现实。我们的父母自己也是人，而不是神，有时他们也会忧郁，压抑，分心，生病，喝醉酒，或在我们需要得时候不在场。这些有时可以导致一种心理学上叫不安全依恋模式的现象。比如，在我们得到一些安全保障时，需要同时付出代价。若是我们害怕我们的依赖对象会不断批评我们，或打我们，我们就会下意识地与他们小心保持距离，也许还会把对他们怨恨的感觉秘密地藏匿起来，转而宣泄到其它人，比如兄弟姐妹或学校里的同伴身上。如果我们担心父母会忘记我们，我们会终日粘附在他们身上，因此牺牲了我们娱乐，交友，抗争，自立以及探索世界的能力。有时候一切事情都变得那么令人困扰，我们找不到任何可靠的感觉，于是我们会缩回到自己的幻想的世界里，与世隔绝；久而久之，在那幻想的迷宫里，我们迷了路。

　　“丧失”是一种人类普遍的经验。所丧失之物可以是我们亲爱的人，完整的家，工作以及相伴生的一种有价值之感。应对丧失的方式部分地取决于我们的依恋模式安全与否。具有不安全依恋的人们倾向于麻痹他们的感受，在这些灾难发生之前，他们可能就是那种被人们称为情感上比较冷漠的人；另一种不安全的人，会走向另一个极端，被痛苦与灾难所淹没，他们的情感好像洪水泛滥。

　　对丧失或丧失的威胁的反应方式之一是生气与抗议。同样，如果我们是不安全依恋的，我们也许不能表达适当的气愤，或在情境要求我们这样做时无法理直气壮表达我们的需求。我们要么在狂怒中爆炸，要么封锁我们的情绪，把生气转向我们自己，这就导致了抑郁症。

　　作为成年人，我们并非不再有对安全基础的需要了——我们仍然需要在困难时有人支持，救援，需要有人可以倾听我们。同时我们需要在自己身上找到安全基础 —— 也许是一些安慰人鼓舞人的思想，或一些宗教的或政治的信念，或只是一些让我们感到舒适的想象和活动（比如SPA、温暖的棉被、一本喜欢的书、一首乐曲、食物与饮料）。而且，我们还需要嗜好，兴趣，游戏，尤其是那些我们可以和其它人分享的快乐事务。

　　理论上，一切应该如此。而实际上，人际关系却并非总是那么有益。他人可以是让我们失望的，恶待我们的，忽略我们的，自私的；当我们需要的时候，他们不在那里，当我们不需要的时候，他们却在那。责备他人是容易的，而奇怪的是，我们似乎总是自身问题的始作俑者：我们似乎会无意识地依恋于那些吻合于我们依过往经验构造起来的关于世界的景象的人。我们关于世界的地图基于我们过去的航行。我们孩提时代的依恋人物要是不安全的，我们会在成年生活中寻找相似的类型。我们孩提时代受到排斥，我们就会在未来中也预期拒绝，因此要么回避亲密关系，要么把我们紧紧粘附于某些我们所喜爱的人，粘得这样紧最终把他们赶跑。仿佛，我们有着一系列的由外部经验与内在预期混合打造而成的按钮，他们随时将被触发，接下来演同样的戏。

　　最后，人们在这个方面差距甚大：一种谈论自己和自己的感受的能力。有人不惜代价保持沉默，有人则滔滔不绝不管别人是否在听。而研究表明，是否能反思我们自己的情境和表达我们自己——用话语、图画与音乐——可能决定了我们面对不幸时的不同结局：能者最终可以生机勃勃地再度崛起，不能者或勉强维持低质量生存，或被苦难压垮。关于这一点，我在做华人移民的心理咨询和社会福利工作中印象至深，同样面对复杂的移民及其他一些创伤，那些缺乏又没有发展这种能力者常常一环扣一环步步将自己陷入难以超拔的困境，并且他/她也许还意识不到其实他/她现在不佳的处境和他/她自己有关; 而那些本就有或后来通过心理咨询发展出这种能力者则步步回升。

　　这种能力在心理学上叫自传能力（autobiographical competence）或反思功能（reflexive function）。浸染于华文化的一些教条的朋友可能会误解或对心理学的这个发现表示怀疑。一种误解是将反思等同于传统意义上的道德自我批评，另一种误解是把它等同于“多思”：“啊，不要想太多啊，想太多会想出毛病来啊，要难得糊涂！”在此我必须再三强调：具备心理学上的反思功能的人自然会做道德上的反思，但是他们的思想肯定不会成为空泛僵硬的道德教条的呆板复制（而那恰恰是反思本身要破的）。至于我们常说的一个人多思钻了牛角尖其实包含了复杂的心理现象：或许人家正在思考的旅程中还未到达终点，是你自己不明白而已，你想通的理不见得就是别人应该达成的理；而钻牛角尖说明的是思维进了死胡同，心理学上讲的反思功能恰具一种灵活，宽广，生动，敏锐的思维特质，钻牛角尖说明你一个人再自言自语下去也弄不出什么名堂了，需要另一个人 – 比如心理咨询师和你一起想。

　　如果我们将生活中发生的恶性事件比喻成毒素或垃圾，那么这种反思功能就是毒素处理转换器，就是点石成金术。有人说，心理咨询师是垃圾箱，其实并非如此，但如果硬要用这个比喻，那么应这样修改一下：心理咨询师是点”垃圾”成金师。不过反思功能的种子是在你自己身上的，心理咨询师不过帮助你启动发展这一过程和能力而已。

　　那么建基于依恋理论上的这个法能帮助你达到哪些具体的目标呢？请看以下：

　　•　在亲近关系中不会害怕失去自我, 而是如鱼得水, 优游自如。
　　•　学会更容易地忍耐孤独。
　　•　在你需要的时侯，变得更有能力请求那些与你接近的人为你提供安全与保护。
　　•　在你需要的时侯，能够在你自己身上找到可以利用的内在力量。
　　•　学会请求你所想要的，拒绝你所不想要的。
　　•　能够让其它人了解你的感受，特别是那些困难的感受，一如生气与失望。
　　•　能够享受与可信赖的朋友或家人在一起的时光。
　　•　面对生活中的失落和失望，能自然无碍地感到适度的伤感。
　　•　更好地了解自身，尤其是自身的脆弱性。
　　•　当日常生活的浮沉激发这种脆弱性时，找到更有效的应对它们的方法。
　　•　理解你典型的“依恋类型”是怎样的：是回避型、矛盾型？还是无序型？
　　•　回顾你的过去谈论你的现在时，能够有一种成熟的理解和感受，公平对待你自己的成绩和挫折，不忽略他人对你的伤害和令你失望给你造成的影响，也要注意道你令他人失望以及给他人造成伤害的地方。
　　•　接受这个事实：你心中也有一个“孩子”部分，他/她需要安全与滋润，如果你给于它所需要的安全和滋润，他/她就能更好享受生活和成长。

附原文

　Handout for my clients Brief attachment-based psychotherapy (BABP)

Almost everyone feels anxious or depressed at some point in their lives. There are many reasons for this: stress, separation from or less of someone or something that is dear to us, loneliness, difficulties in our close relationships, worry about the future. The way we react to the difficulties may take us back to pain or trauma in childhood, which in itself can sometimes-but not always –predispose us to vulnerability in the later life.

When we are in difficulty we need support: we try to draw on our own inner strength, seek help from friends or family, or turn to professionals whose job is to help. BABP is a brief therapy based on the principles of . Attachment theory, which is based on some very simple and obvious ideas, was development half a century ago by the psychoanalyst John and has been extensively researched and extended since then. Bowlby realized that as children we feel safe and good about ourselves to the extent that we have trusted and reliable adults to whom we can turn at times of need. These attachment figures provide a secure base, which allows us to relax, have fun and feel able to explore the world. As babies the secure base is usually the mother, but as we grow the range extends to the father, grand-parents, brothers and sisters, and then to friends, who provide comradeship and companionship as well as security.

Although everyone has had some protection through their childhood - and would not have survived to adulthood without it - our attachment figures have not always been reliably secure. Sometimes our parents have themselves been depressed, distract, ill, intoxicated or unavailable. This can lead to insecure attachment. Here we can get some measure of security, but at a price. If we are fearful that our attachment figures will lash out at us in word or physically, we will warily keep our distance from them, and may also harbour secret feelings of resentment which we take out on others-brothers and sisters or companions at school. If we worry that our parents will forget us, we may cling to them, sacrificing our capacity to have fun, make friends, stand up for ourselves and explore the world. Sometimes everything becomes so confusing we just can’t find any reliable way to feel safe, and retreat into ourselves and a world of make-believe.

LOSS is another universal human experience. What is lost may be a loved pet, an intact family, the death of a close family member, a job and with it the sense of being worth something. How we cope with loss depends in part on how secure or insecure our attachment has been. People whose attachments were insecure tend either to switch off their feelings or, at the other extreme, to be overwhelmed with pain and misery.

One way in which we react to loss or to the threat of loss is with anger and protest. Again, if we have been insecurely attached we may be unable to express appropriate anger or to assert ourselves when the occasion demands it. Either we explore with rage or bottle up our emotions, turning anger in on ourselves, which sometimes ends up with feelings of depression.

As adults we don’t outgrow our need for a secure base- we still need someone to turn to, talk to, to be a source of succor at times of trouble. We also need to find a secure base within ourselves –a reassuring thought, religious or political beliefs, an image or an activity to comfort us when we feel bad (eg. Hot baths, warm duvets, a favorite book or piece of music, food or drink). And we need hobbies, interests, fun and pleasure too, especially if we can share them with others.

All of this is true in theory, but in practice relationships are often far from helpful. People let us down, abuse us, are neglectful and selfish, and are not there when we need them, or are there when we don’t. It is easy to blame others, but the curious thing is that we are in the part the authors of our own problems: we seem to be unconsciously attracted to people who fit in with our previous picture of the world. Our map of the world is based on previous navigation. If our attachment figures in the childhood have been insecure-making. We will seek out similar types in adult life. If we have been rejected in the past, we will expect rejection in the future and so either avoid close relationship or cling to our loved ones in a way that may eventually drive them away. It is as through we have a series of triggers or buttons built up from ‘outside’ experience and ‘inside’ expectation which are just waiting to be pressed.

Finally, we vary in the extend to which we are able and inclined to talk about ourselves and our feelings. Some avoided at all costs, other just can’t stop. Yet research shows that the ability to reflect on one’s situation and to express oneself - using words, picture or music – may make all the difference between survival and going under in the face of adversity. This is called autobiographical competence or reflexive function. In therapy, we hope to find a theme or guiding metaphor arising out of the clients life-story which brings together some of their difficulties in one image.

In this ten-session therapy, we will touch on all these aspects of psycho-logical functioning and in particular the six domains of:
·Secure base-within oneself and with others.
·Exploration-fun, pleasure and happiness.
·Loss- and how we have dealt with it.
·Assertiveness and appropriate anger-as opposed to rage or inhibition.
·Triggers and buttons- what trips us into states of depression or worry?
·Reflexive function –the ability to stand back from difficulties and think about them.

After one or two initial assessment sessions the client will come to a formulation with her therapist that will probably identify two or three of these domains which are particular relevant to her and her difficulties, and together they will begin to work on them. The overall aim of the therapy is (a) to start to understand how the overwhelming need for security and self-protection may at times be self-defeating, and expose the client to the very dangers which she is trying to avoid, and (b) to begin to strengthen her sense of secure attachment so that she will be better equipped in the future to cope with the problems with the problems with which everyday life present us.

　　Aims of BABP

BABP is an integrative therapy that draws on many psychotherapeutic traditions and techniques. The aims of BABP can be summarized as follows:

·To learn to feel more at ease in the situations of intimacy and closeness.
·To learn to tolerate being alone more easily.
·To be more able, when you need it, to call on the security and safety which
Those close to you can provide.
·To find inner strength which you can draw on when you need it.
·To learn to ask for what you want and to refuse what you do not want.
·To let other people know about your feelings, especially difficult once like anger and disappointment.
·To be able to enjoy yourself in the company of trusted friends or family.
·To be able to feel appropriately sad about the losses and disappointments of your life.
·For you to know yourself better, especially your vulnerabilities.
·To find alternative ways of copying when these vulnerabilities are triggered by the ups and downs of daily life.
·To have a sense of what is your typical ‘attachment style’ –avoidant, ambivalent or disorganized.
·To learn to talk about yourself and your life in a way that make sense, does justice to your achievement and setbacks, and takes account of the way in which you have been let down or harmed others.
·Coming to accept that there is a ‘baby’ part of yourself that need security and nurture if you are to have fun and to grow.www.nmgpsy.com内蒙古心理网