不同流派案例的治疗协作分析:基于治疗性最近发展区理论

Analysis of Therapeutic Collaboration in Cases of Different Approaches:Based on the Theory of Therapeutic Zone of Proximal Development

目的:基于治疗性最近发展区理论分析不同流派案例中治疗师和当事人的互动协作,比较不同流派心理治疗协作过程的差异。方法:使用治疗协作编码系统对4例心理治疗经典案例进行内容分析。结果:(1)在治疗师干预上,人本主义疗法案例中治疗师支持性干预显著高于理性情绪疗法和认知疗法案例,挑战性干预显著低于理性情绪疗法和认知疗法案例;(2)就当事人回应而言,认知疗法案例中的确认性回应显著低于其他两类案例,不确认性回应则更高;(3)在治疗性交流方面,人本主义疗法、理性情绪疗法和认知疗法案例在心理治疗最近发展区的“确认—可忍受冒险”和“不确认—不可忍受冒险”两个区段差异显著。结论:就治疗协作过程来看,人本主义疗法中治疗师更多采用支持性干预,理性情绪疗法和认知疗法案例更注重挑战性干预。认知疗法案例中治疗性交流更多超出当事人治疗性最近发展区,治疗师致力于及时推动问题声音的表达和对立声音之间的对话并提供更多解释和指导。

Objective:Based on the Therapeutic Zone of Proximal Development(TZPD),analyze the collaboration between therapists and clients in cases of different approaches,and explore the change process of clients.Methods:Using the content analysis and the therapeutic collaboration coding system to code and analyze the content of four classic psychotherapy cases of humanistic therapy,rational emotion therapy and cognitive therapy.Results:(a)There were significant differences in the therapist intervention in the cases of different approaches.(b)In terms of client response,the confirmatory response in the cognitive therapy case was significantly lower than the other two types of cases,and the non-confirmative response was even higher;(c)In terms of therapeutic communication,the cases of humanistic therapy,rational emotional therapy and cognitive therapy were significantly different in the“validation-tolerable risk”and“invalidation-intolerable risk”sectors of TZPD.Conclusion:From the therapeutic collaboration process of psychotherapy,therapists use supportive interventions more in humanistic therapy,while in rational emotional therapy and cognitive therapy therapists pay more attention to challenging interventions.In the case of cognitive therapy,therapeutic communication mostly falls above clients’TZPD.