主题综合疗法辅导戒毒患者的个案报告

A case report on counseling drug abuser with thematic combined therapy

目的:中国戒毒心理辅导工作起步较晚,还未形成有效的方法体系,本个案采用主题综合疗法对戒毒人员进行心理辅导,旨在探索有效的戒毒心理辅导模式。方法:心理辅导于2004-11/12在广州三九脑科医院进行,戒毒患者,男,25岁,吸毒史8年,采用主题综合疗法。根据戒毒人员普遍存在的心理问题和患者所存在的特殊问题,围绕培养积极生活态度,促进自我发展;增强戒毒信心,防止复吸的总目标,确定咨访关系建立;发现自我,建立戒毒信心;家庭关系及人际关系辅导;约定辅导4个主题,采用了半结构式的综合策略,贯穿着人本主义理念,以行为矫正法为主,综合了精神分析,认知疗法的具体技术。共进行了12次辅导,每次约50min,每周3次,总时程1个月。在心理辅导前后对患者进行药物依赖程度量表,抑郁自评量表和焦虑自评量表的测试,比较前后得分情况。结果:整个辅导获得了一定的成效,与患者建立了良好的咨询关系,在金钱管理、拒绝毒友、家庭沟通、共同约定几个主题效果较显著。患者主观上对海洛因依赖程度减轻,客观上药物依赖程度量表得分较辅导前降低(18,24);抑郁自评量表和焦虑自评量表得分均降低(抑郁量表前测粗分为40,后测为34,焦虑量表前测粗分为42,后测为32)。结论:主题综合戒毒疗法对于培养戒毒患者的积极生活态度,增强戒毒信心有明显效果,认知行为矫正技术是针对戒毒心理辅导的有效疗法。

AIM： Psychological counseling for drug abuser is developed late and has not formed an effective counseling system in China. in this report, the thematic combined therapy was adopted to counsel the drug abusers, so as to explore an effective psychological counseling for drug abusers. METHODS： The counseling was performed in Guangdong 999 Brain Hospital from November to December 2004. The drug abuser, male, 25 years old with 8 years＇ drug-taking history was treated with thematic combined therapy. According to the psychological problems in common drug abusers and the special problems in this patient, the therapy was carried out with the general aim to cultivate active life attitude, improve self-development; strengthen the confidence in drug control, prevent retaking; and 4 subjects including establishing the relationship between counseling and visiting, recognizing oneself, establishing the confidence in drug withdrawal; family relationship and interpersonal relationship counseling; and appointment counseling. Meanwhile, semi-structure combined strategy was adopted with the belief of human-oriented and behavior modification combined with mental analysis and cognitive therapy. The counseling lasted for 1 month, 12 times, once for 50 minutes, 3 times every week. The patient was investigated with drug-dependent degree scale, self-rating depression scale and self-rating anxiety scale before and after psychological counseling to compare the scores. RESULTS： The counseling was effective, and during the treatment, we constructed a good counseling relationship with the patient; it was satisfactory in money management, drug friends refusing, family communication and common agreement. The subjective heroin dependent degree of the patient was lessened, and objectively, the scores of the drug-dependent degree scale were lower than that before counseling （18, 24）, so were the self-rating depression scale and self-rating anxiety scale （depression scale： before counseling 40, after 34; anxiety scale： before 42, after 32）. CONCLUSION： Thematic combined therapy is markedly effective in cultivating active life attitude and enhancing the confidence of the patient in drug control. Cognitive behavior modification is an effective therapy for psychological counseling in drug withdrawal.