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.     

心理隐喻的变迁与心理治疗模式的转换

心理治疗模式的转换始终伴随着心理隐喻的变迁,每一种心理治疗模式都蕴涵着一个独特的心理隐喻,支撑着研究领域的共同理解。揭示这些治疗模式内蕴的心理隐喻,梳理心理隐喻的变迁轨迹,有助于我们更好地理解心理治疗模式的转换规律,展望心理治疗的发展前景。     

心理隐喻的变迁与心理治疗模式的转换

心理治疗模式的转换始终伴随着心理隐喻的变迁,每一种心理治疗模式都蕴涵着一个独特的心理隐喻,支撑着研究领域的共同理解.揭示这些治疗模式内蕴的心理隐喻,梳理心理隐喻的变迁轨迹,有助于我们更好地理解心理治疗模式的转换规律,展望心理治疗的发展前景.     

心理治疗视域中自我认识的嬗变与启迪

自我认识是多学科、多领域探索的主题;认识自我是心理学的根本命题,也是心理治疗过程中的焦点所在。对包括精神分析疗法、认知行为疗法及以人为中心疗法的传统心理治疗、后现代叙事疗法及正念疗法的自我观进行梳理,揭示出心理治疗自我观从传统心理治疗流派的实体自我到后现代叙事疗法的关系自我,再到正念疗法无常无我的演变轨迹,发现东方佛教与西方心理学自我观走向融合的趋势,心理治疗各流派的理论和技术也日趋走向整合。     

叙事心理治疗的后现代视角

叙事心理治疗,作为一种本体存在一伦理实践的总体取向,隐含着某些基本的后现代主义视角,尤其是语言观的根本转变。现代主义的观点把语言看作是对现实的表征,而后现代主义关注语言的本体论地位,关注我们如何使用叙事和文本来建构和解构我们的生活世界,强调话语实践的自我反思性。该文探讨了后现代语境中心理治疗的几个关键问题,并讨论了叙事观在心理治疗的临床实践中的应用含义。     

心理治疗中隐喻的使用、疗效检验及作用机制

隐喻是用一种具体、熟悉的概念去表达和理解一种抽象、不熟悉的概念的语言形式和认知方式,因其在心理治疗中可以有效传递治疗信息而被治疗师们广泛使用。早期的隐喻理论阐述了隐喻具有高创造性和增强长时记忆的认知加工优势,虽然不同心理治疗流派在治疗过程中对使用来访者还是治疗师产生的隐喻各有侧重,但它们都认为隐喻可以通过高创造性的内容、形成更优的长时记忆以及带来高度的认知卷入来帮助咨访双方有效加工、传递和保存治疗信息。精神分析流派强调治疗性隐喻在无意识水平上的意义交换产生的顿悟过程,认知行为疗法既强调隐喻可以促进认知图式的重构,也强调其组块性和形象性产生的记忆功能,接纳与承诺疗法认为隐喻传递信息时具有非评判、非分析、直觉经验的方式有利于促进个体发生改变,后现代疗法中强调让来访者重新叙述自己的人生故事或者发展出一种形象性或象征性表达,让来访者产生更具有功能的观点和看法。因此治疗性隐喻具备了跨越不同心理治疗理论取向的广泛认同基础。在实证研究上,大多数研究聚焦于探索在某种治疗方法中加入隐喻是否会有更佳的治疗效果,其中使用CBT作为框架的研究最为集中,有些研究发现隐喻干预在缓解心理症状方面优于常规干预,也有研究发现隐喻干预和非隐喻干预都可以有效缓解被试的心理痛苦,因此虽然没有获得十分一致的结论,但这些研究总体上证明了在心理治疗中使用隐喻是有效的。随着研究的深入,对治疗性隐喻起效的心理神经机制进行探索的实证研究也有效观测到了隐喻理论中提出的认知加工优势,包括隐喻的高创造性可以诱发顿悟（并伴随杏仁核、海马、梭状回等特异性神经网络的显著激活）、带来更佳的治疗效果,隐喻内容更容易被记住、有助于治疗持续发挥作用,以及隐喻可以增加来访者的认知卷入程度进而带来更大程度的认知改变。综上,无论从理论构建还是实证证据上,治疗性隐喻都是一种具有独特认知加工优势的认知工具和治疗信息传递途径。未来研究可以从更加科学的设置对照组、增加隐喻特异性的效果衡量指标以及探索其他可能的心理机制三个方面来进一步观察在治疗性隐喻的独特优势。最后,对在心理治疗实践中更好的使用隐喻以及研发嵌入隐喻的低成本高效益的社会心理健康服务方案提供了建议。     

叙事医学——让医生走进患者的世界

叙事疗法是一种新兴的心理治疗方法,也是叙事医学在心理治疗方面的运用和体现。通过帮助患者重新叙事,让患者从个人经历中找到生命的意义和价值。本文从基本理论、主要方法、实施程序和临床应用几个方面对叙事治疗进行概述,并通过一个真实案例,展示了如何运用叙事医学让医生走进患者的世界。     

叙事心理治疗在失独者哀伤心理辅导中的应用

叙事心理治疗通过故事叙说、问题外化以及由薄到厚等方法重构积极的"替代性"故事取代"无效的"支配性故事。本文结合"失独者"哀伤心理辅导的实践,探寻叙事心理治疗在失独者哀伤心理辅导中的应用。     

味觉对判断与决策的影响及其机制

味觉作为人类生存必不可少的感觉之一, 早已超越“舌尖”的直接感受, 潜在地影响了个体对人际关系及伦理道德的知觉与判断, 改变着个体对冒险与消费等行为的决策。情绪中介假说、具身隐喻假说、进化假说以及社会建构假说从不同视角试图阐明味觉对判断与决策的影响机制。当前研究存在味觉感受存在个体差异、味觉测量难以保证效度、味觉实验缺乏统一研究范式等问题, 未来可继续进行味觉隐喻的验证并将其应用于感官营销、心理治疗等领域, 从生理、心理及社会等多个层面出发, 全方位探讨味觉对判断、决策的影响及其机制。     

论叙事医学的根基与价值

"叙事"本是语言范围内的一种现象。在这里,它是一种"隐喻",一种与理性科学相并列的认识世界的方式,一种哲学观的体现,现代性世界的诸多问题源自对它的疏离与遗忘。后现代哲学的"叙事转向"即对"叙事"的重新发现。叙事医学是在现代性反思的大背景下,医学所进行的自我修正与完善,阐述"叙事转向"的现实依据与理论资源为解读"叙事医学"做好铺垫。之后从叙事之于医学的源始性与优先性、生物医学对叙事的拒斥和遗忘、叙事医学的价值期望三个方面解读叙事回归医学的必然性与合理性。     

Using a Narrative Metaphor: Implications for Theory and Clinical Practice

The evolution of family therapy from a cybernetic metaphor to a narrative metaphor has led us to think differently about therapy, about clients, and about ourselves as therapists. In this article we pursue how this different way of thinking has informed a theoretical understanding of a narrative therapy approach and consequently has opened space for different ways of working clinically. We begin by tracing the evolution to narrative; we consider the implications of social constructionism and its political effects; and we complete the discussion by focusing on narrative theory. We then show how the clinical work follows logically and is coherent with the theoretical considerations. We describe, and illustrate with clinical examples, an innovative approach to working with couples and families with adolescents. In this work we pay attention to the larger cultural stories, including gender constructions, and to personal stories that persons have created to make meaning out of their experience as they interact with one another in a reciprocal meaning-making process. Interventions focus on externalizing the problem narrative that is influencing the client(s), mapping the effects of the problem pattern and/or the totalizing view persons might have of others, and creating space for client(s) to notice preferred actions and intentions. Finally, we close the loop by asking questions of ourselves and others about the effects of working from a narrative metaphor.     

“Not with me you don't”: A story of narrative practice and dissociative disorder

This paper discusses issues relating to therapeutic practice based upon the narrative metaphor. A case of someone suffering the effects of Dissociative Identity disorder is used to illustrate the difficulties that clients can experience with the “expert” knowledge conception of therapy. The value of the “respectful” and “non-expert” emphasis of Narrative Practice emerges even when the therapist believes that he or she lacks expertise in the client's apparent “condition.” Three themes emanating from the case form the basis for the discussion: the client's experience of being recruited into accepting the diagnostic label of Dissociative Identity Disorder; the effects of being forced to accept a contract to eliminate self-abusive behaviour; and the therapist's dealing with a gun in the therapy room.     

Storytelling agents: why narrative rather than mental time travel is fundamental

I propose that we can explain the contribution of mental time travel to agency through understanding it as a specific instance of our more general capacity for narrative understanding. Narrative understanding involves the experience of a pre-reflective and embodied sense of self, which co-emerges with our emotional involvement with a sequence of events (Velleman 2003). Narrative understanding of a sequence of events also requires a ‘recombinable system’, that is, the ability to combine parts to make myriad sequences. Mental time travel shares these two characteristics: it involves an embodied sense of self and the ability to create novel scenarios. What is unique about mental time travel is that it is a story explicitly about our selves, and it involves metarepresentation. Agency is enabled by narrative understanding when we are able to put our current situation into a larger narrative context, whereby some possible actions, but not others, make sense. However, new features of agency are enabled when we understand stories that are explicitly about our selves: we gain the ability to plan and act on plans.     

Narrative Therapy Using a Reflecting Team: An Ethnographic Study of Therapists' Experiences

Narrative therapy in the last 15 years has been utilized by many clinicians and yet there is a lack of research on therapists' experience of this approach. This ethnographic research explores the views and perceptions of eight narrative therapists who belonged to a narrative team in an outpatient clinic. These therapists were observed and interviewed. Five themes emerge from the data. The themes include a sense of success in reducing the clients' problems as well as some limitations of narrative therapy. Two recommendations for research and practice involve the use of narrative therapy without a team and the use of narrative therapy in addressing issues of family violence.     

Universal stories: How narratives satisfy core motives

Abstract

For millennia, narratives have been a primary mode of oral discourse. Narrative presentation of information has been shown to facilitate interpersonal and group communication. However, research indicates that narratives are more than merely an adaptive mode of communication. Narrative is a fundamental – and perhaps foundational – element of social and cultural life. The present article posits that the centrality of narrative in social life is due to narrative’s ability to help satisfy the five core social motives, as identified by Fiske belonging, understanding, control, self-enhancement, and trust. In so doing, this article reviews empirical and theoretical work examining basic narrative processes, autobiographical narratives, and entertainment narrative consumption to illustrate how narrative thought helps to satisfies core human motives and in turn, how the narrative construction process informs self and identity formation.     

Fitting a square peg in a square hole: Using metaphor in narrative therapy

This paper examines the assumptions of the narrative mode of therapy and the assumptions of therapeutic metaphors. The premise is that the use of metaphor fits the assumptions of narrative therapy and can enhance and expand narrative therapy. This paper examines the structure and types of metaphor, explores their fit within the narrative model, and gives three case examples which illustrate the use of metaphor in narrative therapy.Kevin Lyness, MS, is a doctoral candidate, MFT Program, 1269 Fowler House, Purdue University, West Lafayette, IN 47907-1268, and a doctoral candidate in the MFT Program, Purdue University. Volker Thomas, PhD, is assistant professor, Marriage and Family Therapy Program, 1269 Fowler House, Purdue University, West Lafayette, IN 47907-1269. Reprint requests should be sent to the first author.     

Towards a new philosophy of education: Extending the conversational metaphor for thinking

Recently, feminists like Jane Roland-Martin, Elizabeth Young-Bruehl, and others have advocated a conversational metaphor for thinking and rationality, and our image of the rational person. Elizabeth Young-Bruehl refers to thinking as a constant interconnecting of representations of experiences and an extension of how we hear ourselves and others. There are numerous disadvantages to thinking about thinking as a conversation.We think there are difficulties in accepting the current formulation of the conversational metaphor without question. First, there is danger that we will lose important dialectical connections like that between the self and society. Second, the conversational metaphor alone cannot fully express the way conversations are constructed. We will want to take up the notion of narrative as a metaphor for thinking advocated by Susan Bordo, Alasdair MacIntyre, Jerome Bruner, and others, including Mary Belenky and her colleagues.Eventually, we want to champion narrative and the dramatic narrative of culture as a metaphor for thinking that involves such expressions as sights, insights, silences, as well as sounds, moments of mood and poetic moments. The dramatic narrative provides the structural possibilities needed to criticize certain kinds of conversations, in order to talk about the relations of public and private, self and society and most importantly, about the drama of our lives within and without.The dramatic narrative for thinking helps dispel the dangerous dualisms of mind and body that not even conversation or narration alone can banish, and allows us to frame questions about education that do not require us to separate mind from body. The dramatic narrative metaphor for thinking lets us show who we are, act out what we think, and reconstruct rationality to reflect what many women, and some men, do.     

Visual Narrative Structure

Narratives are an integral part of human expression. In the graphic form, they range from cave paintings to Egyptian hieroglyphics, from the Bayeux Tapestry to modern day comic books ( Kunzle, 1973 ; McCloud, 1993 ). Yet not much research has addressed the structure and comprehension of narrative images, for example, how do people create meaning out of sequential images? This piece helps fill the gap by presenting a theory of Narrative Grammar. We describe the basic narrative categories and their relationship to a canonical narrative arc, followed by a discussion of complex structures that extend beyond the canonical schema. This demands that the canonical arc be reconsidered as a generative schema whereby any narrative category can be expanded into a node in a tree structure. Narrative “pacing” is interpreted as a reflection of various patterns of this embedding: conjunction, left‐branching trees, center‐embedded constituencies, and others. Following this, diagnostic methods are proposed for testing narrative categories and constituency. Finally, we outline the applicability of this theory beyond sequential images, such as to film and verbal discourse, and compare this theory with previous approaches to narrative and discourse.     

A Narrative Approach to Supporting Students Diagnosed With Learning Disabilities

Students diagnosed with learning disabilities experience many challenges that school counselors may address through narrative therapy. Narrative therapy is a postmodern, social constructionist approach based on the theoretical construct that individuals create their notions of truth and meaning of life through interpretive stories. This article identifies potential challenges students diagnosed with learning disabilities encounter, provides an orientation to narrative therapy, and offers a case example illustrating the application of narrative therapy with this client population.     

Narrative competence and constructive developmental theory: A proposal for rewriting theBildungsroman in the postmodern world

Some of the chief characteristics of the narrative psychology of Bruner, Polkinghorne, Sarbin, Freeman, Howard, and White and Epston are outlined with implications for therapy discussed. Narrative psychology is then related to some current models of adult development, including those of Kegan, Perry, Belenky, Labouvie-Vief, Levinson, Basseches, and Pascual-Leone. Types of narrative competence are discussed and an argument is made that developmental readiness for narrative must be considered if narrative approaches are going to be applied. Different types of narrative approaches are shown to be indicative of particular developmental stages. The social relativism of narrative psychology is addressed and it is argued that developmental models provide a scheme for assessing the maturity of alternative narrative constructions.