蒙医心身互动疗法的叙事特征

医学领域叙事的主要构成要素包括叙事主体、叙事能力、叙事疗效等,但鲜有研究深入探讨医学叙事构成要素的特点及其作用。蒙医心身互动疗法经过20多年的探索与发展,在叙事构成要素方面具有独特的创新性：叙事主体为主持医生和受益学员;主要叙事受益者为庞大的听众团体;稳定、高效、可重复使用的叙事框架加强了不同案例之间的可对比性;丰富多样的聆听形式以及“心身兼治、多病同治”的治疗特点突破了现有医学叙事研究中治疗病种的局限性。

     

叙事疗法的生命伦理学关怀

简要回顾了叙事疗法的诞生和在中国的传播过程,探讨了叙事疗法在三个方面的生命伦理学关怀:以生命权力的平等为前提、以人文生态的和谐为途径、以生命意义的丰富为旨归.最后探讨分析了叙事疗法的发展潜力,并指出叙事疗法所蕴含的生命伦理学关怀是一个重要的推动因素.     

叙事心理疗法对高校心理咨询专业化发展的启示

高校心理咨询工作在维护大学生心理健康方面发挥了重要的作用,也存在来访率低和咨询效果差两个突出的问题。这与整个社会对心理问题和心理咨询存在认识偏见有关,与咨询师咨询观念陈旧、专业伦理欠缺和混乱有关。后现代叙事心理疗法在心理问题、心理问题与人的关系、心理咨询任务、心理咨询效果的巩固、咨访伦理关系等方面,提出了新的理念。叙事心理疗法对当前高校心理咨询的专业化发展具有积极的启示。     

一例内观疗法结合叙事疗法提升双相情感障碍患者幸福感的个案报告

为探讨内观疗法结合叙事疗法对双相情感障碍患者人际关系问题的疗效,以1例双相情感障碍I型患者为对象,进行为期三周的干预,共计11次内观疗法和7次叙事疗法。采用90项症状自评量表（Symptom Check List 90,SCL-90）、总体幸福感量表（General Well-Being Schedule,GWB）、宗氏抑郁自评量表（Zung Self-Rang Depression Scale,SDS）、宗氏焦虑自评量表（Zung Self-Rang Anxiety Scale,SAS）对患者治疗前、治疗后以及出院后3个月的状态进行测评。11次内观疗法和7次叙事疗法干预后,患者GWB总评分从73分升至115分,SDS标准分从38分降至31分,SAS标准分持平为38分,SCL-90评分从103分降至91分;三个月后随访GWB、SCL-90、SDS、SAS评分分别为：112分、91分、41分、25分,测评分值与治疗后差别较小。内观结合叙事疗法让患者意识到过去生活中的问题所在,有助于改善患者人际关系、稳定情绪并提升幸福感。     

叙事疗法取向心理咨询个案一例

本案例是一例典型的由于失恋而导致低自我认同的个案,由于来访者性格和成长因素,与其建立自我统一性的过程比较漫长,采用叙事疗法能够有效避免来访者对问题的恐惧,提高来访者战胜问题的信心。     

抑郁症的心理治疗及认知疗法在抑郁症治疗中的应用

简述抑郁症的心理治疗的不同学派的观点，心理治疗把个人关系失常当作抑郁的成因，强调感情联系在心理治疗中的重要作用；治疗师应从6个方面支持及辅导患者；具体阐述了认知疗法这一心理疗法中较新的方法用于抑郁症治疗的理论基础、目的以及实际治疗中要注意的三个方面。     

疾病叙事阅读：医学叙事能力培养

在叙事医学和医学人文的情感转向这两大理念基础上,提出将医学叙事文本按照创作方式分为虚构疾病叙事和非虚构疾病叙事两大类型,按照作者身份分为文学疾病叙事、自我病情书写和医生病理书写（平行病历故事）等,并提出将元病历叙事作为医学院校叙事医学能力培养的重要阅读材料,在此基础上,增加阅读与某种具体疾病相关的叙事作品,如神经叙事,癌症叙事等。同时探讨如何将叙事学基本知识融入疾病叙事阅读中,切实引导医学生提高医学叙事能力,达到医患视域融合和医患沟通效果最佳化。     

论道德叙事

哲学的叙事就是有关生命和生活的道德叙事,道德叙事的主体通过生命体验和生活经历中的事件叙述,呈现或揭示隐藏在这些体验、经历、事件或行为背后的道德思想和价值观念,以创造出生命或生活的意义。生命的存在形式和生活运行轨迹表明道德叙事的主体是一个在时间流逝中呈现的历史主体;有意义的人生和道德生活表明道德叙事是基于一个统一主题对人性目的的理解。"道德主体""历时性""人性目的论""主题统一性"和"可理解性"构成了道德叙事的基本要素。这些基本要素通过"道德训诫"把"未受教化而偶然所是的人"转化为"实现其目的而可能所是的人",这是人类深层次的道德叙事。     

论建筑的伦理叙事

营造具有伦理性叙事的建筑空间,是从古至今建筑艺术体现其精神功能的重要手段.文章主要以有代表性并具有明显伦理意蕴的叙事性建筑,即纪念建筑、宗教建筑和政治建筑为例,探讨了建筑的叙事现象,阐述了建筑的伦理叙事主题及其基本策略.     

中国叙事医学实践的反思

首先,以叙事学、人类学、叙事医学三个学科领域的界定与分析来厘清叙事概念。其次,在此基础上指出叙事医学发展进程中存在的问题,包括医学教育与临床实践适应性不同、平行病历工具的运用不宜脱离临床情境、对反思性写作进行反思、对叙事走进医学的质疑与反思等。最后,提出中国叙事医学高质量发展的可能路径：叙事病历研究构成临床实践落地的重要起点、构建中国主体的叙事医学教育框架、跨学科多向度的综合实践意义重大等。

     

Enhancing Narrative Couple Therapy Process with an Enactment Scaffolding

Despite the growing popularity of narrative approaches to couple and family therapy and the demonstrated effectiveness of enactments—a clinical process typically articulated and utilized in more modern or positivistic approaches to therapy—there is very little, if any, literature exploring how enactments may fit within a narrative therapeutic framework. In this paper we suggest: That narrative therapy theoretical assumptions, principles, and therapeutic processes may coexist within an enactment framework articulated by Butler and Gardner; that such assumptions and processes may be enhanced when clinicians use an enactment scaffolding throughout the therapeutic process; and that this enactment framework empirically informs the narrative therapy process and strengthens the stance of narrative therapy under the scrutiny of those claiming a need for an evidence basis in psychotherapy.     

抑郁症认知治疗理论及实践进展

认知治疗分化为认知行为与认知分析治疗两个流派。抑郁的贝克认知模型、归因模型、自我价值关联模型以及抑郁的注意过程等认知理论为认知治疗奠定了基础。认知行为治疗、认知行为分析系统心理治疗以及基于冥想的认知治疗等已经在实践中被较有力的临床证据检验。认知治疗在抑郁症的治疗中已显示出广泛的应用前景。     

后现代叙事心理治疗探幽

近15年来国际心理治疗界出现一种由科学隐喻向叙事隐喻转变的潮流。它突出了心理问题的多维性和生活方式的多样性,强调整体联系的视角,与中国文化中的“大人”思想相契合。对叙事心理治疗做探讨,分为三个部分:什么是叙事心理治疗,介绍对叙事心理治疗的整体理解;叙事心理治疗的哲学渊源,介绍叙事心理治疗的理论基础;伦理问题,探讨叙事心理治疗在组织实施过程中权力关系与责任分布。     

Mechanisms of Change in Brief Couple Therapy for Depression

The goal of the present study was to investigate potential mechanisms of previously documented treatment effects for a brief, 5-session, problem-focused couple therapy for depression in a sample of 35 depressed women and their nondepressed husbands. The primary treatment effects were reducing women’s depressive symptoms and their husbands’ psychological distress and depression-specific burden. Secondarily, treatment resulted in increased relationship satisfaction for both partners. Given these significant treatment changes observed in 5 sessions, we sought to examine the mechanisms of change by testing the following three factors as potential mediators: (a) negative behaviors and attitudes toward depression, (b) support provision, and (c) empathic communication towards the depressed female partners. Women’s depression and husbands’ depression-specific burden were alleviated by positive changes in their illness-related attitudes and behaviors. Improvements in women’s marital satisfaction were also mediated by positive change in their illness-related attitudes and behaviors, along with perceptions of increased positivity and support from their husbands. Findings highlight the importance of targeting specific treatment agents in a brief couple therapy for depression such as psychoeducation about depression and support-building to increase partners’ understanding and acceptance of the illness, and teaching communication skills to reduce negative behaviors and criticism that are replaced by more empathic communication towards the depressed individual.     

Using Contextual Therapy to Treat Depression with Couples

Abstract

Though depression is one of the most common presenting problems treated by systemic therapists, there have been relatively few attempts to describe how specific systemic therapy models can be applied to treat couples dealing with depression. In this paper, we discuss how contextual therapy can be used to treat depression in couples therapy. We identify multidirected partiality as an intervention and as a characteristic. We introduce letter writing and internalized other interviewing as contextual interventions that help to facilitate partiality and understanding between clients. A clinical vignette illustrates our discussed concepts.     

叙事治疗在老年双心病患者中的实践

为研究叙事疗法作用,选取江苏省人民医院老年心血管科40名心血管疾病合并情绪障碍住院患者为研究对象,分为试验组和对照组。对照组20人给予常规治疗和常规人文关怀,试验组20人在常规服务的基础上增加多学科协作模式的叙事治疗个案服务,干预前后采用医院焦虑抑郁量表测量作为评估工具,旨在探索医务社工参与的“双心”医学多学科协作模式。结果显示,对照组与试验组分值均有下降,试验组患者的焦虑分值和抑郁分值下降幅度更大(P < 0.05),叙事疗法对双心病患者的干预效果显著。多学科协作模式下的叙事疗法可有效缓解双心病患者的心理障碍、提高科室满意度、提升医疗团队专业能力、创新学科建设与人文服务,具有可推广性。

     

Therapist Role in Narrative Group Psychotherapy

With its assumptions about the interpersonal origins of individual learning, narrative theory suggests certain leadership functions for group therapists: providing a perspective on how multiple meanings may be constructed about experience; leading the process of deconstructing individual narratives through careful questioning to distinguish persons from problems; enlisting participants in active awareness and engagement with group dynamics and group process; and enabling the co-creation of a group narrative through the development of a new community of conversations.     

Using Narrative Therapy in the Treatment of Adult Survivors of Childhood Sexual Abuse in the Context of Couple Therapy

Abstract

Childhood Sexual Abuse (CSA) is a prevalent social issue. Many theoretical approaches have been applied to the treatment of CSA, these approaches predominately focus on the treatment of children and adolescents, failing to address adulthood and couples’ relations. This limited focus fails to address long-lasting relational implications CSA survivors face. This paper proposes the application of a systemic therapeutic modality, Narrative therapy when treating adult survivors of CSA in couple therapy. The treatment of CSA in the context of couple therapy will be discussed. Clinical vignettes will be used. Implications for clinical practice and future research will be discussed.     

A Narrative Approach to Child and Family Therapy in Africa*

Professional family therapy in Africa is heavily influenced by theories and principles of Western family practice. Its practice structure and philosophies are however grounded on African family values and the principles and orientations of traditional African psychology. This paper presents a clinical report that illustrates adaptations we make to incorporate compatible aspects of narrative family practice in African and Western cultures. A summary of African family values and child psychology intended as a background perspective is provided. The paper is significant against the background of the current need for forging multiculturally relevant healing methods that fit well with the globalized nature of the contemporary world. Augustine Nwoye, PhD, is Associate Professor and Chairman, Department of Psychology, Kenyatta University, Nairobi, Kenya (amnwoye@avu.org). Professor. Nwoye has developed an African paradigm for mental health and, in particular, for family and couple therapy. He also has experience in dealing with stress and multiple losses, especially surrounding HIV/AIDS within an African context. *An earlier version of the paper was presented to the members of staff and students of the Faculty of Education, University of Cambridge, England, UK, and the initial version was presented to the members of the Family Therapy Program of the Faculty of Medicine of the University of Calgary, Calgary, Canada. I wish to thank Dr. Colleen McLaughlin (University of Cambridge) and Professor Karl Tomm (University of Calgary) for their invitation, assistance, time, attention, and suggestions.