心理疗法在针灸治疗中的应用

随着疾病谱和死亡谱的改变,生物医学模式逐渐地不能满足医学发展的需要,取而代之的是生物心理社会医学模式。现代医学模式全方位探求影响人类健康与疾病的因果关系,认为生物学、心理学及社会学因素是人类致病共同的重要因素。针灸是中国传统医学同时也是西方辅助与替代医学的重要内容。针灸医护人员应大力宣传针灸知识,应用生物心理社会医学模式去对待每一位患者。本文试述心理疗法如支持性心理治疗、认知行为疗法、放松疗法在针灸临床的应用,展现针灸心身同治的诊疗特点。     

Counselling and psychotherapy,complementary and alternative medicine and the future of healthcare

The counselling and psychotherapy profession is undergoing considerable change as a result of government intervention in the form of regulation, funding and efficacy research. In this paper we argue that these changes, even though they challenge some of the basic ways of thinking which have come to underpin the profession since its inception, also offer an opportunity to stimulate debate and thought in regard to how the profession might contribute to the development of healthcare systems in the future. We argue that this could be enhanced if therapists can learn from the experience of practitioners in the field of complementary and alternative medicine (CAM), which has been experiencing similar changes in recent years. Indeed, both fields of clinical activity adopt many similar underlying clinical principles and, according to Samuels (2001), have similar political outlooks. With reference to anthroposophic psychotherapy which, as well as being a form of psychotherapy, is also part of a ‘whole systems’ approach to CAM, we will examine those characteristics of psychotherapy and CAM that can inform the thinking of healthcare systems as a whole.     

The emerging therapeutic landscape of psychotherapy in the twenty-first century and the contribution of anthroposophic psychotherapy

In recent years the counselling and psychotherapy profession has experienced significant changes. On the one hand there has been the advent of managed care and evidence based practice which in the UK takes the form of the Improved Access to Psychological Therapy scheme. On the other hand there has, during the same period since the 1980s, been a rich and varied process of innovation in the profession. This has included the so-called relational inter subjective turn in the United States. Second, an increased sensitivity to the interface between therapy and social and political phenomena. Third, the revolution in neuroscientific thinking. Finally, the development of therapy as an interdisciplinary intervention in complementary and alternative medicine teams as in the case of the spiritually-orientated anthroposophic psychotherapy in Europe. In this article I will argue that these innovatory developments, which I refer to as the ‘new integration’, are much needed in order to counterbalance the increasing dominance of managed care and evidence based practice.     

Der biopsychosoziale Krankheitsbegriff in der Praxis

Many of the recent approaches in diagnostics and therapy, e. g. the behavioral medicine, consider themselves as “holistic” or “multidimensional”. By closer consideration, however, it turns out, that while more or less referring back to the system-theoretically founded “bio-psycho-social model” (Engel, Weiner et al.) its implications are not taken seriously in practice. Presenting a concrete work project (“simultaneous diagnostics”) we will show, how to implement this (theoretically potent) bio-psycho-social conception of disease in clinical practice. It can be clearly seen, that it cannot replace the conventional reductional approach of medicine which focusses on the examination of single processes and structures under simplified conditions. On the contrary, such reductionism remains indispensable, because to be able to grasp any higher (more complex) structure one has to know its elements. Comprehensive explanation of phenomena, however, is not possible in a reductionist way. Therefore, the bio-psycho-social disease model in its operationalization is not a new way of medicine, rather an expanded approach to diagnostical and therapeutic issues.     

A Social Constructionist Model of Therapeutic Factors

Evidentiary support for the efficacy of therapeutic models has been a contentious issue since the professionalization of psychology. Despite advances in evidence-based practices in psychology and common factors research, discontent still exists among postmodern psychotherapists in that evidence is mainly defined in modernist/positivistic terms, thereby excluding therapeutic models based on alternative nonpositivistic epistemologies. I proposes a model, which is based on social constructionist theories, for investigating the therapeutic efficacy of various approaches. This article evaluates and differentiates between two models for viewing the efficacy of psychotherapy, namely outcome versus process efficacy. A social constructionist model of therapeutic factors is proposed as a means to incorporate therapeutic factors into psychotherapy processes that are consistent with a social constructionist theory of change. Three main therapeutic elements, which are identified as central to an effective psychotherapy process, are outlined in the model. The proposed model may be useful as a guide to efficacious psychotherapy and as a means for investigating the efficacy of social constructionist therapies.     

Microphenomena research,intersubjectivity and client as self-healer

This article describes an approach to counselling and psychotherapy which complements dominant discourse approaches to clinical evaluation based on New Public Management systems which underpin the Improved Access to Psychological Therapies scheme within the field of therapy. It is based on an approach to research and practice development which I will call practitioner microphenomena research. In order to demonstrate the method, I will examine an extract from a single case study of a client with major depressive disorder from the point of view of intersubjective theory and a little-known approach to therapy called anthroposophic psychotherapy based on the work of Rudolf Steiner. I will show how the two clinical methods are well suited to examining the microphenomena of practice and can be integrated into a coherent whole. A central feature of the account will be the anthroposophical view about the central importance of our individuality or ‘I’ which has similarities with the Jungian self but is still distinct from it.     

人类基因组计划与医学模式

人类基因组计划将为医学科学的发展提供广泛的可能性,并结生物医学带来革命性的变化,但是人类的社会性,疾病产生的非生物因素以及社会及伦理的限制都决定了任何生物医学上的成就,包括人类基因组计划都不能改变生物社会心理医学模式的深刻内涵。     

骨髓造血干细胞移植治疗自身免疫性疾病的进展

本土化研究是当前世界人文社会科学发展的必然趋势,也是中国传统心理治疗思想发展的唯一出路。近百年来,随着西学热潮的兴起和现代西方心理治疗方法的涌入,我国心理学工作者和中医学工作者为了保护传统文化中的心理治疗思想,对其开展了广泛的研究,经历了萌芽阶段、曲折发展阶段、活跃阶段和繁荣阶段等四个时期。随着研究队伍的融合,未来的研究将不断凸显其自身特色,自身体系,并逐渐走向临床应用。     

流行病学病因推断的辩证思维

随着疾病谱和死亡谱的改变,生物医学模式逐渐地不能满足医学发展的需要,取而代之的是生物-心理-社会医学模式.生物医学模式向生物-心理-社会医学模式的转变,是医学思维方式从单纯的还原论走向整体综合辩证思维的必然结果.因此,疾病病因的内涵及病因推断方法也相应地发生变化.     

Wie können Langzeittherapien mit kürzeren Behandlungen verglichen werden?

Long-term psychotherapy is not recommended in the current guidelines, which are based on the criteria of evidence-based medicine, as there is a lack of confirmation for long-term psychotherapy by efficacy studies. Using the example of psychoanalytic long-term psychotherapy this article describes six dilemmas which impede the realization of efficacy studies for long-term psychotherapy. Finally, basic elements of a study design are proposed, which are considered as being adequate to compare (psychoanalytic) long-term psychotherapy with shorter treatment forms in terms of outcome and cost-effectiveness. The anxiety and personality disorders (APD) study is briefly described as an example of a study realizing the proposed design.     

Contextualizing psychotherapy as a healing practice: Culture,history, and methods

The histories of modern medicine and psychotherapy are examined to situate psychotherapy in the array of healing practices. Although modern medicine relies on specificity as its central organizing concept, psychotherapy has consistently produced results that are not consistent with a medical model. Moreover, the development of research methodologies used to validate treatments, although useful in the medical context, ignores the experience of the patients as well as the provider of services. It is demonstrated that psychotherapy is a culturally imbedded healing practice and shares similarities with healing practices other than modern medicine. Psychotherapy shares one important feature with modern medicine, however: empirical support for efficacy. Various theories of placebo effects are examined to propose explanations for the effects of psychotherapy. Finally, issues and paradoxes are presented for future consideration.     

A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: Preliminary report

Utilizing audio-recorded psychoanalytic interviews of both patients and their analysts, group discussions of these interviews, and the application of questionnaires commonly used in psychotherapy research, the authors investigate the potential use of the Leuzinger-Bohleber methodology as an objective evaluative instrument to assess the quality of psychoanalytic treatment. Preliminary study results were obtained through interviews conducted with seven analysts and their respective patients, three of whom were treated with psychoanalysis (three or more sessions per week, for a duration of no less than one year) and four with psychotherapy (one or two sessions per week, for a duration of no less than one year). Patients were found to be eager to participate, and no adverse experiences were reported by analysts, patients or the research team. In addition to the interviews, further data were obtained through review of mailed-in questionnaires completed by 21 patients. The authors present both preliminary observations regarding the methodology as a whole, as well as the detailed results of one specifi c case subject treated with psychotherapy. Review of study fi ndings supports the utilization of this methodology as an evaluative instrument which may ultimately advance current knowledge of the process and outcome of psychoanalytic treatment.     

当前临床决策的问题及对策

随着传统生物医学模式向生物-心理-社会医学模式的转变,临床决策也应由目前以经验医学为主导的经验决策向以循证医学为基础的科学决策转变。     

A Model for the Role of Defined Spirituality in South African Specialist Psychiatric Practice and Training

The current bio-psycho-social approach in South African psychiatry refers to Engel’s extended model of health care. It forms the basis of the existing collaboration between medicine, nursing, psychology, occupational therapy and social work. Psychiatry also has to bridge the multi-cultural, multi-religious and spiritual diverse reality of everyday practice. It has become important to establish how, within accepted boundaries, spirituality should be incorporated into the model for practice. Referring to methods described for nursing theory development, a defined core concept was used to construct a model. It may contribute to the discourse on spirituality in local psychiatry, health and mental health.     

Persuasion criteria in research and practice: Gathering more meaningful psychotherapy data

Psychotherapy research should ultimately benefit the psychotherapy client. Unfortunately, traditional psychotherapy research continues to have little influence on practicing clinicians and, therefore, does not benefit psychotherapy clients. As behavior analysts begin to show interest in this area of research, they may be in a position to improve its quality. We argue that traditional psychotherapy researchers have become prematurely wedded to a methodology that does not address the concerns of clinical audiences. Furthermore, we make a case for defining and evaluating psychotherapy data in terms of its capacity to influence both researchers and clinicians. We also suggest several alternative methods for gathering psychotherapy data based on the case formulation approach. We argue that this approach may be one of the most promising methods for gathering useful psychotherapy data.     

Welche Rolle spielt die Diagnostik in der systemischen Psychotherapie?

Diagnostic procedures in systemic psychotherapy are bound to raise questions: These procedures are indebted to a medical model which is pathology- and deficit-oriented and which requires that diagnosis precedes therapy. Yet diagnostic procedures in systemic psychotherapy are mainly geared to assessing the psychic and social domains rather than the domain of medicine proper. The article takes up some of the issues and problems deriving from this state of affairs.     

The effect of therapist interventions on the therapeutic alliance with borderline patients

The authors draw attention to the problems of establishing and maintaining a therapeutic alliance in the psychotherapy of the borderline patient. They elaborate an extensive methodology designed to study the manner in which shifts in collaboration occur in response to therapist interventions. This report demonstrates how one particular borderline patient increased his ability to collaborate with the therapist in response to a transference focus in the psychotherapy. Methodological problems are noted as are directions for future research. Only a series of patients studied with this or with similar methodology will allow for a sophisticated and empirical rationale for choosing a particular form of psychotherapy for a particular kind of borderline patient.     

Plädoyer für eine Direktausbildung zum Psychotherapeuten

The undisputed necessity of a reform of the Psychotherapist Act could open up the chance to reconsider the training of psychological psychotherapists and to completely renew the structure from the ground up. This article proposes that psychotherapy training should be designed based on the profession itself. Starting from the question of what a good psychotherapist needs to have learnt, a study curriculum is drafted which is structured towards this professional target from the very beginning. This direct training imparts psychotherapeutic competence based on a broad psychological, medical and social scientific education, encourages targeted social competences and enables clinical experience in advance. The training terminates after six years with a state examination and qualification for the profession of psychotherapist. Subsequently, qualified psychotherapists undertake a four-year in-house advanced professional education to an adult or pediatric and adolescent psychotherapist. After completing half of the study period, i.e. after three years, students decide on one of the scientifically recognized courses and subsequently the study course is partly procedure-related and mostly interprocedural. The study incorporates a practical year which accompanies the last four semesters as a half day practical training. Universities which want to offer this study course must be qualified to award doctorates and have a psychotherapy research walk-in clinic. They must also cooperate with recognized training partners who participate in the course of the study and professionally structure the four-year in-house advanced professional education.     

心理咨询的LIWC语言特征对咨询效果的预测

语言是心理咨询的重要内容。语言探索和词频统计（Language Inquiry and Word Count, LIWC）被广泛用于分析语言使用的心理意义。本研究收集了28名当事人共144次有效咨询录音及每次会谈后当事人的症状自评结果。将录音转录成文本后,抽取当事人的LIWC语言特征,进行主成分降维,结果获得8个因子,解释了总体方差的75.11%。一般线性回归中,躯体感受、功能词、情绪、认知和口语赘词对当事人的症状水平具有显著的预测作用,进一步多层线性模型中,躯体感受和情绪用词显著预测咨询效果。LIWC文本特征能够呈现与当事人症状相关的信息,为未来计算机自动化监控咨询过程和结果提供了新视角。     

Studying psychotherapy change in narrative terms: The innovative moments method

This paper aims to describe the Innovative Moments (IM) Coding System (IMCS), an idiographic and transtheoretical methodology that allows the identification of IMs—markers of changes in the client's initial maladaptive framework of meaning—throughout psychotherapy. The present study introduces the theoretical background underlying this methodology, along with the main empirical findings resulting from former studies that have applied this tool to clinical data. The IMCS application is also detailed: the coding phases, the training steps and inter‐rater agreement measures. In order to illustrate the application of IM coding, a case study is presented. Although a partial coding was used, the results are in line with previous research. Discussion is centred on the usefulness of the IMCS for the advance of process research in psychotherapy, and the potential use of this methodology in group format.