Chapter 30 Chapter 17 Psychotherapist-2

Nearly 2,000 years ago, the Stoic philosopher Epictetus wrote an aphorism that foreshadows the theory behind a major form of psychotherapy today: "Natural and man-made disasters don't come as a surprise; they only go wrong when you don't think about it." Some people may think that this statement is not very good, while others may think it is appropriate and just right.However, its correctness can be seen from the effect of "cognitive psychology".Albert Ellis, one of the founders of this therapy, summed up the basic principles of his therapy in a sentence that is almost a translation of Epictetus's words: "Your feelings are largely It’s about how you think, and if you can change your thoughts, you can change how you feel.”

Cognitive psychotherapy is often called "cognitive-behavioral therapy," because it includes elements of behavioral therapy.However, although the two forms overlap, their focus is different.Behavioral therapy often treats patients like sheep or pigs, whose behavior and responses can be shaped through desensitization and other forms of conditioning; cognitive therapy seeks to modify a patient's feelings and behavior by modifying the patient's conscious thoughts. Cognitive therapy for psychosis emerged early in the cognitive revolution in psychology.In the 1940s and 1950s, several psychologists theorized that faulty cognitive processes, rather than conflicts of consciousness, caused many mental illnesses.One of the therapists, Julian Rotter (whose work on internal and external control loci we have seen in earlier chapters) was both an academic researcher and a therapist who invented "social learning " method, which allows patients to rethink their incorrect expectations and values.

Albert Ellis, undoubtedly the most familiar cognitive therapist, said that he was "stimulated" by the writings of Rotter and others, and then began to practice and promote his own "rational-emotive approach." (RET), a form of cognitive therapy, in 1955, thus "the first major cognitive behavioral therapist" and "the father of RET and the grandfather of cognitive behavioral therapy." That's not a very humble statement, but Ellis is not a humble man.He once boasted that he was "one of the most outstanding alumni of 'Normal University'" and "one of the most famous clinical psychologists, and one of the most famous sexologists in the United States and the world".He also said recently, "My 'old age', the '80s, was the most focused period of my career and a time when rational-emotive methods and cognitive-behavioral therapy made steady progress." When I'm doing big moves, I'm not moving forward and I'm not at my most creative, (I) get fatiguing." He also admits that he's a workaholic - but a healthy one - and that A typical working day is 17 hours long, from 8:30 am to 1:15 am.Not surprisingly, he was thin and skinny; his long face was often dour, but could burst into a diabolical grin.Except for the lack of a winged black beard, he looked very much like the sullen and lonely devil of Faust.

Even if people don't like the hyperbole, Ellis' accomplishments and abilities are extraordinary because he didn't start off well.He said his father was a miser and an irresponsible person who did not give him any paternal love; and his mother also spent too much time playing bridge, mahjong, and other hobbies.Young Ellis grew up in the Bronx. He was hospitalized 8 times due to nephritis between the ages of 5 and 8, and he was unable to engage in strenuous exercise. People", and very shy, very introverted, afraid to speak in public.All of this, he says, has contributed to his being a "tenacious and determined problem solver":

I said to myself, if life is so full of brutality and strife, how am I going to live, not to mention being happy or not.It didn't take long for me to find the answer: Use your brains!So I figured out how to be the cutest kid of my dumb mother, how to get along with my siblings (despite) they fight all the time, how to have as much fun as possible while being very shy . As a teenager, Ellis aspired to be a writer, and he wrote a lot of unsuccessful manuscripts, but he was a realistic guy, and he went and got an accounting degree, and a business degree, so , despite the Great Depression, he found some pretty good jobs.In some of his unpublished manuscripts, there are large volumes of works on sexology, and friends often consult him about sex.He enjoyed advising them so much that he thought of becoming a clinical psychologist, and, while holding a job in a gift shop, he also took graduate classes at Columbia Normal University, earning his Ph.D. in 1947 , when he was 34 years old.

For any normal person, entering this field so late means that he can't do anything big.Not so with Ellis, however.He worked in a New Jersey mental hospital for several years, received four years of training in psychoanalysis, and began seeing patients himself from 1948.By 1952, he had gone to Manhattan to practice medicine on his own.He also began to write a large number of academic and popular books on sexology and related subjects. His radical views and tendency to use vulgar language have earned him a notorious reputation in the field of psychotherapy, and he himself seems to enjoy being so all his life. of a person.

Between 1953 and 1955 Ellis began a revolt against psychoanalysis.He felt that psychoanalysis was too slow, too passive (on the analyst's side) and out of character for him.As he explained to Claire Voga, the psychologist who wrote about him in Psychology Today a few years ago: The patient feels temporarily better because of talking and paying attention to him, but the sickness does not improve... I began to wonder why I had to passively wait for weeks or months until the client passed him or her. My initial request for explanation, saying that they are "ready" for my explanation.If the client is silent most of the time, why can't I help them with targeted questions or words?So I started to become an eclectic therapist who taught and persuaded, and who initiated and directed.

After a few years of experimenting with techniques to his own taste, he compiled a Rational-Emotional Therapy. In 1955, he began practicing the therapy and began writing about it.In an earlier paper, he said that the emotions associated with neuroses were essentially "the result of illogical, unrealistic, irrational, inflexible, and childlike thinking," and that therapy In the therapist "unmasking" the patient's illogical and self-deceiving thinking and showing him how to think "in a more logical and self-help way."The tone of the therapist's overall therapy—or at least Ellis's therapy—is indicated by a series of key words.The therapist should "point out the patient's irrational thoughts in general and in particular", "induce him to adopt more rational thoughts", and "constantly and repeatedly strike at his erroneous thoughts so that he can eliminate his fears".

It is not easy to convey the nature of RET therapy in writing, nor to see the situation in which Ellis uses this method.His evocative, challenging ways can only be imagined.The following example (slightly abbreviated) can capture his method and process.This was an early conversation with a 26-year-old artist who had a regular girlfriend and had regular sex with her but was terrified of being gay. Therapist: What was the main thing that got you into trouble? Client: I'm terrified of becoming gay, very terrified! Therapist: Because "if I become a gay—" then what? Client: I don't know.This worry is really bugging me.Doubt every day.I doubt everything.

Therapist: Yes.But let's go back to the front - please answer this question: "If I became gay, what would this do to me?" Client: (pause) I don't know. Therapist: No, you know!Now, I can give you this answer.But let's see if you can answer it yourself. Client: (Pause) To be less than human? Therapist: Yes.Obviously, you're saying, "I suck. But if I'm gay, then I'm gonna suck!  …Why are you shitting? Client: (paused) Therapist: No, why do you think you're going to suck?But what if you're the one percent who can't have sex with a woman, and the 99 sure can?Even so, why do you have to suck? (Ellis is rebutting here with the patient's self-reported figure - of course the number of homosexuals per 100 men would be higher than that. He has also said in another private occasion that he is not agreeing with the patient thinking that being gay is bad, but just showing him that thinking it's bad doesn't make him really a bad person.)

Client: (Silence for a while) Therapist: You haven't explained it to me yet!Why do you suck?Is there no value? Client: (Pause for a moment) Because I just suck. Therapist: What sucks? Client: I am not one of those 99 people. Therapist: "I don't belong so I should—" Client: I should belong. Therapist: Why?If you're really gay, you're gay.Now, if you're really gay, why are you non-gay?That doesn't sound right. Client: (Silence for a while) Therapist: See where your troubles are? Customer: Yes. Therapist: You're saying the normal line, "If I'm gay, it'd be better if I were uni," which translates to "Therefore, I should be (monosexual)." Don't you? Customer: That's right. Therapist: But does that make sense?It doesn't make sense! Here's another conversation with another client: Therapist: Same crap!Always the same crap!Now, please read this nonsense--don't say "Oh, how stupid I am! He hates me! I think I'm going to kill myself"--you'll be better soon. Client: Have you been eavesdropping? (laughing out loud) Therapist: Overhear what? Client: (Laughs) Some of the things that are going on in my head, like this, are exactly what I'm saying. Therapist: Of course!Also, it's my theory that people generally don't sulk if they don't say such stupid things to themselves... If I think you're the worst piece of shit I've ever seen, that's what I think.And that's what I do.But can I really turn you into a pile of shit when I think like this? Customer: No. Therapist: What could turn you into a pile of shit? Client: Consider yourself to be. Customer: That's right!You think you are.It's the only thing that can turn you into a pile of shit.Do you understand?You control your own mind.I control my thoughts - what I think about you.However, you don't have to be affected by this.You are always controlling what is in your own mind. Some of this can be overwhelming for clients, but, Ellis says, this face-to-face RET works much better than non-face-to-face RET.On the other hand, enthusiasm can be harmful, which is Ellis' point.Ellis had tried for ten months to be warmer to his patients while still in the psychoanalytic phase, but he found that it made the patients happy, they felt good, but it only made them sicker. Worse—creating a greater dependency and more need—was not as good as they started, so he gave up. Ellis codified his ideas into "The ABCs of RET Therapy."Phenomena that activate (A) in the patient's life are mixed with their beliefs about them (B), and primarily because of these beliefs, lead to subsequent consequences (C)—emotional and behavioral confusion.In recent years, he has detailed the multiple interactions and feedbacks between ABC.For example, something bad about C—the emotional response—feeds back into the belief system and reinforces B—the idea of ​​an experience, which in turn affects how the sensory system actually evaluates an experience (A). RET's goal is to bring about a "profound, fundamental, philosophical change in the client...to see, to surrender, to stop the need to refactor at its core because these necessities lie within the philosophic assumptions that they are not functioning properly." Lowest level".In summary: Rational thinking is the source of mental and emotional health. This may sound overly simplistic, but it turns out to be incredibly evocative.The development of this therapy was slow at the beginning, but, despite the opposition of dynamic psychotherapists, it was partly due to Ellis's own relentless propaganda, and partly because of various cognitions in general. Therapy continues to grow, also because the theory of RET is cited in various cognitive therapy and behavioral therapy textbooks, and it began to develop rapidly in the 1960s.Ellis' business became more and more busy, so he opened a Rational Emotional Therapy Institute in the 1960s and bought a house on East 65th Street in Manhattan to house the institute. From morning to night it is full of customers, students and employees. By the 1970s, RET institutes were being established in other cities and in Europe, although Ellis, his students, and his methods were often attacked in professional journals. In 1982, a survey of 800 clinical and counseling psychologists published in the American Psychologist, a journal of the American Psychiatric Association, showed that Ellis was considered the second most influential of psychotherapy gurus (the first being Carl Rogers, whom we'll get to shortly), references to 3 counseling journals show Ellis as the most-cited author of the 1980s. In 1985, the American Psychological Association awarded Ellis the "Outstanding Professional Contribution Award". Part of the award speech said: Dr Albert Ellis' theoretical contributions have had a profound impact on the professional practice of psychology.His theory of cognitive origins in psychopathology is at the forefront of clinical psychology theory and practice.Dr. Ellis' theories have greatly encouraged an active and instructive approach to psychological therapy, expressing a deep, humanitarian respect for the uniqueness of human beings. Just as Ellis published his first paper on RET, Alan Baker took his first steps along a similar path.He is a psychiatrist on the faculty of the Department of Psychiatry at the University of Pennsylvania.At the time, he was a brisk, middle-sized young man with thick straight hair and a broad smile, busy with psychoanalysis.In his own life, however, he had previously tried behavioral therapy and rational techniques on himself to overcome two serious fears.As a child, he underwent a series of operations, and since then he has fainted at the sight of blood.By the time he was a teenager, he decided to overcome this fear. “Part of why I studied medicine was to face my fears,” he said.In the first year of medical school, he forced himself to watch the operation from a distance, and in the second year he volunteered to be a surgical assistant.He forced himself to experience blood as a natural phenomenon, thereby repelling fear.Later, in life, he used the same method to overcome his fear of culverts. Before seeing culverts, he would unconsciously have shortness of breath and dizziness (he believed that his fear of culverts came from an asthma attack in childhood, Fearing that he would suffocate himself to death).He kept telling himself that the symptoms had started even before he entered the culvert, and that cured the problem.He proved to himself that these were unrealistic, so he gradually got rid of them rationally. Baker didn't believe in and use psychoanalysis to treat his patients until he was in his thirties.He was particularly interested in repression, which, according to psychodynamic theory—his own interpretation—is the result of the enmity that people have enclosed in themselves, interpreted as the "need to suffer."The repressed person satisfies his needs by provoking people to oppose or disagree with him. Distressed at the rejection of his theories by many psychiatrists and psychologists, he decided to gather evidence from his own clinical experience to support his theory.At first, the evidence seemed to support his theory, but after a while, he noticed some contradictions and anomalies.In particular, some of the repressed patients he studied seemed to be seeking acceptance and consent rather than deliberately being bored.Baker experienced a sense of lack of faith. "This stark discrepancy between experimental findings and clinical theory," he wrote in a retrospective, "has forced me to undergo a 'wrenching reevaluation.'"( Part of Baker's disappointment may have been due to his partial understanding of psychodynamic explanations for repression.Modern psychodynamic theory attributes repression to a broad combination of factors: disappointments from early years and missing weaknesses, Seeing myself as someone who is unloved and punished, has low self-confidence, etc.) In search of new faith, Baker returned to his research on the dreams of a repressed patient and found a new theory.In some of the patient's dreams there were always failures, inability to achieve certain goals, loss of valuables, or looking as if he were sick, defective, or ugly.Baker, who had previously interpreted these dreams as a wish to suffer, now had a new feeling: As I focused more on the patient's self-description and his experiences, I noticed that he was continually constructing a negative image of himself, seeing only the bad aspects of his life experiences.These frames - consistent with his dream image - seemed to be distortions of reality. Through a series of tests, Baker found that patients had "a generally negative view of themselves, of the outside world, and of the future, evident in widespread negative cognitive distortions." That being the case, he thought, it should be possible "to correct his distortions and to adjust his information processing of reality through the application of logic and the rules of evidence."Perhaps, through this therapy, not only this patient, but most patients can be cured.As Baker quotes the humanist psychologist Abraham Maslow: "A neurosis is not an emotional disease—it is a cognitive error." This concept is the basis of the cognitive therapy for repression that Beck developed, expressed in his professional papers written in 1963 and 1964 and in his book Repression: Clinical, Experimental, and Theoretical Explorations published in 1967. Thought.Later, through several years of weekly meetings and individual case discussions with colleagues in the Department of Psychiatry, he extended the use of cognitive therapy to other neurological conditions and, more recently, adapted it to address spousal relationships in the question. Baker's ideas were buried for many years, and he himself has always been something of a pariah in the industry.However, by the 1970s, when cognitive theory pervaded psychology, and to some extent psychiatry, his ideas were drawn into major theories of personality and behaviour.A growing number of clinicians began to rely on his theories to practice medicine, especially when dealing with depressed patients, and within a few years some of them modified or enriched Beck's theoretical formulas and compiled their own Version.Baker himself is not a good self-promoter, he is still not well-known among the public who knows some psychology, but in the psychology and psychiatry circles, he gradually gained wide recognition and was recognized as a cognitive therapy. the founder.In his version and those of others, cognitive therapy has become the most used therapy in America.About one-seventh of the psychiatrists were primarily cognitive-therapeutic in their practice, about one-third were cognitive-behavioral, and many others used cognitive-behavioral therapy some of the time. Cognitive therapy didn't pop out of Baker's brain all of a sudden, full-fledged.He himself said that part of this was due to the cognitive revolution going on in psychology, and also to the behaviorist movement, because behaviorism requires the patient to think about the mental steps to achieve change, so it is, in part, also Cognitive.Baker was unaware of Ellis' RET therapy when he first thought of cognitive therapy, but he did say that Ellis' work played a large role in the formation of cognitive-behavioral therapy. Although there were many similarities between Beck's approach and Ellis' system, Beck's style was more dignified and he provided a more detailed cognitive theory of neurotic illness.For example, when discussing repression, he identifies and labels three causes: - "Cognitive Triad": the depressor's distorted view of himself, the world, and the future ("I can't." "My life is disappointing..." "The future won't be much better."); - "silent assumptions": unspoken thoughts that negatively affect the person's emotional and cognitive responses ("If other people are angry, it's probably my fault." "If not every Everyone likes me, and I'm worthless."); - "Logical fallacies": overgeneralization (mistaking one example for all), selective attention (attention to some details and ignoring others), random inferences (drawing conclusions not supported by logic or available evidence), and other ailments . He also proposed other similar analyzes that could explain the cognitive distortions that give rise to a range of other neuroses and even mental illnesses. Beck's cognitive therapy involves much more than just pointing out a patient's cognitive distortions.An important step in making the patient aware of cognitive distortions is establishing a therapist-patient relationship.Baker places great value on giving his patients a sense of warmth, compassion, and sincerity.He employs many cognitive and behavioral therapy techniques, including role-playing, assertiveness training, and behavioral rehearsal.He also took advantage of "cognitive rehearsal."He would ask a depressed patient unable to perform even a familiar, outdated, long-learned task to visualize and discuss with him each step of the process.This removes the doubtful tendencies of the patient's mind and deflects his sense of inadequacy.Patients often report that they feel better after completing an imaginary task. Baker also assigns "homework."Patients observe their own thoughts and behaviors between sessions, work to change those thoughts and behaviors, and perform specific tasks.This not only overcomes the patient's inertia and lack of motivation, but also results in an actual sense of accomplishment which corrects the patient's incorrect belief that he can do nothing.To the same end, Baker often asks the patient to write a weekly report, recording his or her activities for the week and describing the degree of satisfaction each activity brings. The key work of the therapy, however, is to examine the patient's mind and correct his cognitive distortions during the office session.Baker's approach was very different from Ellis's."My family doesn't like me," one deeply repressed woman told Baker. "Nobody likes me. They think that's who I am." The little ones don't like doing things with her anymore.Here's how Baker leads her to examine the difference between reality and her thoughts: Patient: My son doesn't like going to the theater or going to the movies with me anymore. Therapist: How do you know he doesn't want to go with you? Patient: Teens actually don't like going with their parents. Therapist: Did you actually ask them to come with you? Patient: No.In fact, he asked me a few times if he wanted to take me... but I don't think he really wanted to. Therapist: How about trying to get him to answer your questions directly? Patient: I guess not bad. Therapist: The important thing is not whether he will follow you or not, but whether you are making the decision for him instead of letting him tell you directly. Patient: I think you're right, but he doesn't seem very considerate.For example, he never comes home on time for dinner. Therapist: Is it always like this? Patient: Well, once or twice... I guess it's not always late. Therapist: Is he coming home late for dinner because he's not very considerate? Patient: Seriously, he did say that he worked late those two days.Also, he is still very loving in other ways. The patient later discovered that her son was in fact willing to go to the movies with her. As this example shows, the key to Beck's style of cognitive therapy is his Socratic heuristic, which involves asking the patient to state something contrary to his assumptions or conclusions, thereby correcting these cognitive errors.The power of this technique can be seen more clearly in another of his reports.The following passage is from a therapeutic conversation he had with a 25-year-old woman who wanted to commit suicide because her husband had been unfaithful to her and therefore thought her life was "over": Therapist: Why do you want to end your life? Patient: Without Raymond, I'm worthless... I can't be happy without Raymond.However, I cannot save this marriage. Therapist: How has your marriage been? Patient: It sucks at the beginning.Raymond has always been unfaithful.For the past 5 years I have been seeing very little of him in person. Therapist: You said you couldn't be happy without Raymond.Did you ever feel happy when you were with Raymond? Patient: No, we fight all the time and I feel worse. Therapist: So why do you feel Raymond is indispensable to you? Patient: I guess it's because I'm worthless without Raymond. Therapist: Before you met Raymond, did you ever feel that you were "worthless"? Patient: No.I feel pretty good about myself. Therapist: If you felt good before you met Raymond, why do you need him to feel good now? Patient: (confused) Uh... Therapist: Has anyone ever been interested in you since you were married? Patient: Many people gave me winks, but I ignored them. Therapist: Besides Raymond, do you think anyone else is as good as him? Patient: I think there are many people who are better than Raymond, because Raymond doesn't love me. Therapist: Have you ever had a chance to get back together with him? Patient: No...he has another woman.He doesn't need me. Therapist: So what do you actually lose if you get divorced? Patient: I don't know (crying).I guess only completely disconnected. Therapist: Do you feel that the only way to get along with another man is to completely disconnect? Patient: I have loved other men before. After this consultation, the patient no longer felt compelled to die.She began to doubt her own idea that "I'm worthless unless someone loves me."After thinking about some of the issues Baker raised, she decided to officially divorce.In the end, she got divorced and started living a normal life. Although many therapists have tinkered with Beck's detailed protocol, cognitive therapy eventually became standardized.It typically requires 15-20 visits (Baker tends to call these visits "interviews").In each session, the therapist and patient review the patient's response to the previous session and its outcomes, plan the next session, agree on tasks and homework for the next session, and then apply logic, investigation, and reality testing to the A patient's feelings and thoughts about current events happening around him or her. By the 80s, cognitive psychotherapy had become part of the mainstream.Today, in addition to a third of all psychotherapists who are primarily cognitive-behavioral, another third is miscellaneous, most of whom use cognitive-behavioral therapy occasionally.This therapy has been widely understood as the mainstay of treatment for certain problems, especially in cases of depression and low self-confidence.Now the white-haired, mild-mannered Baker is still actively researching and practicing this kind of therapy at the University of Pennsylvania. He has become a veteran of the psychotherapy industry, and he is quite pleased with the development of the industry he created.He was also honored by the American Psychological Association, which awarded him the "Outstanding Science Award for Applied Psychology" in 1989, in which the words of the award read: Advances our understanding of psychotherapy and the application of psychotherapy.His pioneering work on the treatment of depression has profoundly changed the understanding of the disease.His seminal book, Depression: Causes and Treatment, is a widely cited and decisive text on the subject.His promotion of treatments for conditions as diverse as anxiety and phobias, personality disorders, and marital disharmony shows that his model is both integrative and eminently empirical. Arthur Janoff, a psychologist in California, began writing a book on primitive healing in 1970.Primitive therapy is his invention. He said a sentence in the book, and this sentence is also on the list in Kyogen: Primitive therapy aims to treat mental illness (psychophysical disease, to be precise).Plus, it can claim to be the only cure.The implication is that this renders all other psychological theories obsolete and invalid.It means that for the treatment of neuroses and psychoses there can only be one effective remedy. Janoff says he has discovered that all mental illness stems from masked "primordial pain" -- the pain a baby experiences when any of its needs aren't being met -- and that the key to successful therapy is It's about letting the patient release the locked-in hurt by feeling this primal feeling and screaming like an angry baby.Primitive shouting was an unassuming trendy therapy in the 70s, but the world hasn't given it the status Janoff said it was bound to earn, and it's now a rare practice that's just A small number of therapists still use it. In the larger sense, however, it is not an uncommon thing.It's just one of many approaches from the 1950s to the present day. People want to improve traditional psychoanalysis, come up with simpler and cheaper methods, or abandon it completely and use different methods to treat mental illness. . The three families of therapy we have examined—dynamic, behavioral, and cognitive—are by far the most dominant forms of these efforts, but there are still a host of others, nearly all of which are available. Its developers say it is more efficient, cheaper, faster and more scientific. Before 1950, there were only about a dozen psychotherapies, but by the early 1970s, Maurice Parloff, director of the Institute of Psychotherapy at the National Institute of Mental Health, counted 130, and by 1988, Pittsburgh Alan Katz of the University's Faculty of Medicine consulted primary sources and came up with a "pretty conservative estimate of about 230 different forms of psychosocial therapy". It may seem confusing, but therapies actually fall into relatively small categories: the three we've seen, and the others we only have to glance at. Humanistic Therapy: In the 1950s, humanist psychology was at the heart of the "human potential movement"—whose chief spokesman was Maslow—emerging as a "third force," or, on the one hand, On the other hand, the transformation of Freudian psychoanalysis is also a replacement for behaviorist psychology. Humanist is more of a title in a philosophical rather than a scientific sense. It opposes that people's character and behavior are completely attributed to their personal experiences, especially the psychoanalysis and preaching experienced in childhood, and also opposes behaviorism that describes human behavior as human behavior. Just a set of conditioned views on stimuli.Humanist psychology emphasizes the individual's right to choose how to act and to fulfill himself in his own way; it holds that behavior should be judged not by so-called objective, scientific standards, but by one's own frame of reference.如果一个人认为一种轻松的、非竞争性的生活是最理想的，则这就是他或她的有价值的生活，而不是一种性格缺陷的症状；宁愿单身而不婚娶也是这样的，性自由而不是只有一夫一妻制，其它与社会常理不一样的东西亦是如此。人文主义心理学因此具有很大的吸引力，特别是生活在个人主义和反叛的6O年代的年轻人。 从这种心理学中冒出了一大批疗法。尽管这些疗法各个不同，但都是基于这样一个立场的：即每个人都具有内在的资源，可以生长，可以自我疗救，治疗的目的不是要改变客户，而是为客户利用这些内在的资源而去除障碍，比如很差的自我形象或者感觉的否认。治疗师不是引导客户走向心理健康的科学理想，而是帮助他们向着自我成长。如今，有百分之六的临床心理学家和也许是同样比例的其它心理治疗师也认为他们主要是人文主义的。 以客户为中心的治疗法：这是人文主义疗法中最重要的一种，它是由卡尔·罗杰斯创造的。卡尔·罗杰斯在中西部农场出生和长大，起先是想当牧师的。他转向了心理学并接受了心理分析培训，可过了几年后认为心理分析法效率不太好，因而又转向了一个极为不同的、由他自己发明的治疗法。他是个乐天派，感觉到疗法应该集中在目前的问题上，而不是过去的成因上。他还认为，人们天生都是好的，一旦他们明白能够控制自己的命运这个道理后，大家都能处理好自己的问题，并且把这些想法转换进了一种疗法。根据这种疗法，治疗师只是回应或者反射客户所说的话——罗杰斯拒绝使用“病人”这个词。这应该能够传递一种对客户的尊敬感和对这个人处理他的心理情景以及把握自己的能力的“信任或者信仰”。这里有一个例子，是他与一位感到压抑的20岁的女子进行诊疗时的谈话（经删节）： 客户：有时候，沿着街往前走太费劲。真是件发疯的事。 治疗师：哪怕小事情——一些微不足道的事情，也会让人感到烦恼。 客户：呃，是啊。而且我还好像没办法处理这麻烦事。我意思是说，这事——每天都好像是这些周而复始的小事情。 治疗师：这样的话，哪怕人想办法去取得什么进展，（你发现）事情也并不会好到哪里去。 客户：我多少有点跟我自己过不去——一天到晚弄得自己很难受。 治疗师：这么一来，你就埋怨自己，也不太管自己是不是一天比一天差了。 客户：是啊。我甚至都懒得去费神干什么事了。我觉着自己就快什么也干不成了。 治疗师：你觉着还没开始，自己就觉得没什么劲头了。 这听上去有点像学舌疗法，可是，罗杰斯十分相信，通过他的方法，他可以营造一个“协助性的气氛，（客户）可以在这个氛围里探索她自己的感觉，这种方式是她所希望的，然后向她希望实现的目标靠近”。大部分动力学方向的治疗师都对罗杰斯的方法不以为然，可是，到50年代和60年代，以客户为中心的治疗法被广泛采纳，由被一些并没有接受过无意识过程，也没有以这种方法治疗过病人的一些心理学家和其它的心理治疗者们采用了。从此以后，其影响就退下去了。今天，有百分之六的临床心理学家和同样小百分比的其它心理治疗师们喜欢用这种疗法，不过，有时候，一些混合治疗者们也用这种方法。 格式塔疗法：这种疗法与罗杰斯的方法极不相同，尽管它们之间共有一些哲学上的人类健康和自我指导的看法。这种疗法是精神病学家弗雷德里克·佩尔斯（弗里茨）发明的。他管它叫做格式塔疗法，不过，如早先已经说过的一样，它与格式塔心理学没有任何瓜葛。佩尔斯的目的是要让病人意识到他们自己已经舍弃的一些感觉、欲望和冲动，可这些东西又是他们自己的一部分，并让病人认识到，他们认为那些是真正属于自己的东西实际上都是借来的，或者从别人那里接受来的。 佩尔斯实现这个目标的方法，是严格意义上的面对面，有时候还有非常生硬的，包括好多种“实验”、“游戏”和“小花招”，设计目的是挑起，刺激和逼迫病人承认他或她的真实感觉。在录制的诊疗片断里，佩尔斯有时候好像是虐待狂，可是，针对有些病人，他时常是非常有效的。格式塔心理疗法在60年代和70年代流行于人文主义者圈子内，今天，它在心理疗法中只处于一个次要的地位。 交往分析：交往分析流行于6O年代，也是惟一成了两本在全国畅销书榜上畅销一年多的书籍的主题的心理疗法（艾里克·伯尔尼的《人生游戏》和托马斯·A·哈里斯的《我好——你也没事》）。交往分析以动力学原理为基础，它主要关心人际行为，在“理性的”基础上处理神经症问题——但不是通过推理，不是RET和认知疗法里面的做法。它通过治疗师的解释发生作用，治疗师会解释三种自我状态中的哪一种应该对病人的某一特定行为负责。 这些自我状态或者自我，是病人在他或她的“交往”中发生的行为。在任何既定的交往——社会交往的基本单元——中，每个人都以儿童（即儿童自我，很大程度上是情绪化的，它始终存在于我们每个人的身上），父母（一套知觉对象和想法——“应该”和“不应该”——我们从儿童期开始对父母的感知的内化），或者成年人（认知的自我，成熟和理性的自我）的方式来对待别人。 尽管这三种自我状态都以无意识的感觉为基础，可是，在交往疗法中，治疗师是在有意识的层面上处理这些自我的，病人和他或者她正在处理的人正在成功交流或者卷入“交叉交往”中的一些方法被指出来。治疗师还指出来各种“游戏”——把真实交往意义隐藏起来的欺骗性的或者别有用心的交往——他们在以不合适的角色玩这个游戏。病人学会辨识他们在与别人（及与治疗师）交往时处在哪一个自我之中——还有与之交往的哪些别人正处在哪一种自我状态之中。在治疗师的指导下，他们学会利用自己的儿童自我进行玩乐，而利用其成人自我负责严肃的行为。 小组、配偶和家庭疗法：这些并不是严格意义上的治疗方法，而是一些“形式”；一种形式就是根据治疗的单元分类的治疗类型（单个的、配偶的、家庭的或者集体的。） 集体疗法：至少存在或者存在过100种这样的疗法。每年都有新花样出台，可许多都是昙花一现。 在6O年代和70年代，为了迎合时代精神和集体生活的理想，“邂逅集体”雨后春笋般冒了出来，而集体环境在人道主义圈子内被视为比一对一的方法更具疗效的办法。今天，大众的看法是，集体疗法之所以有用，主要是因为人际和社会的问题，尽管它也强调内部的问题；一个集体中的成员为彼此提供支持和同情以及一种反馈，告诉他每个人所表现出来的社会自我是如何被接受的，它的哪一个方面是受欢迎或者不受欢迎的。 集体活动从讨论彼此的问题和自我启示到角色扮演，从给一个难受的人或者有麻烦的成员以集体支持到集体讨罚一个其行为不能为大家所接受的成员不等。在大多数小组中，治疗师只指引方向，把彼此间的交往指导向一个程度，然后积极地干预事态，以防止小组以毁灭性的办法攻击一个成员。 小组的人数多少不一，但大多数治疗师认为8人为最理想之选择。他们通常每周会见一次，花费只有单个儿会面的几分之一，时间长度从8周到几年不等，这取决于他们的目标和治疗师的取向。小组治疗法以前是美国的一个专业，可现在已经在许多国家实行了，可是，这个国家比其他任何国家的治疗师还要多。美国小组疗法协会约有4000成员，这可能是不在协会里面，但仍然在至少部分时间里利用这种办法行医的医生的10倍之多。 配偶疗法：配偶疗法最早是作为婚姻咨询闻名的，可是，今天，它经常比往日的咨询走得更深，不仅向配偶，而且向快要结婚和同性恋伴侣们提供，所有这些人都多少有类似的一些关系问题。 治疗师在配偶中的作用有点像杂技中的吊绳：如果他或她被小组中的其他成员看见与其他的人一起滑动，这种疗法可能会立马中止。如果治疗师因此而寻找办法去避免有可能在任何客户中产生强烈感觉的交往，他必须当解释者，顾问者和教师，并强调，有麻烦的关系，而不是任何人，才是真正的客户。 治疗师会恳请人们讲出实情，然后做一些解释；教导人们运用交流技巧解决问题的办法；重演这对配偶听起来和看上去的交往（“你是否意识到，你坐得离我越来越远了？”）；他会把一些彼此尽量避免的敏感的话题挑起来，但可以在治疗师的办公室里安全地加以控制；然后分配家庭任务给这些人，让他们知道新的和更加令人满意的行为方式。配偶疗法通常是每星期进行一次，而大多数问题都可以在一年甚至更短的时间里得以解决。在某些情况下，一些配偶知道两个人或者其中的一个人真正希望的是这种关系的结束。在这种情况之下，治疗师有时候就能够帮助他们以合作的方式，而不是强行以争斗的方式分开，这样就可以把对双方和孩子的损害减少到最低限度，如果有什么损害的话。 家庭疗法：家庭疗法几乎是在50年代美国各地同时开展起来的，最为著名的是在帕罗阿尔托和纽约市。它的基本假定是，心理症状和各种困难皆来自家庭内部的关系处理不当，而不是个人内心的机制有毛病（尽管这些不能排除掉）。 尽管一个家庭可能会找出一个“有问题的”家庭成员来——一个替罪羊或者假设是有毛病的成员，全家人可以把家里全部的麻烦都堆积到他身上——但是，治疗师是把整个家庭当作病人来处理的，或者，说得更准确一些，有毛病的是家庭的相互来往。规定、角色、关系和组织。所有这些都组织了“家庭系统”；家庭疗法在很大程度上要利用系统理论，这是从生物学中采借来的。按照系统理论的说法，家庭成员之间也许干涉过多，也许交往不足；也许因为过严的家规而与外部影响切断了联系；也许反过来因为完全没有家族的概念而失去了家庭感等等。 治疗师用系统理论的方法来诊断家庭问题的方法有族系图（三代以上的家庭模式图）、确定家庭里面有哪些联盟和其它一些特别用于家庭治疗的方法。有好几个学派的家庭疗法，每种学派都发展出了它自己的介入办法。家庭疗法在最近几年有长足的发展，不仅在家庭里面私下里使用，而且还用在临床和社区精神卫生中心。 美国婚姻及家庭治疗协会有约10000成员，来自不同的学科，并符合这个协会的要求，即作为婚姻及家庭治疗师经过两年的指导研究生经验。还有好几千心理治疗师，他们经过或者没经过广泛的婚姻及家庭治疗培训，也称自己为婚姻及家庭治疗师——这个词的使用在许多州里并没有法律约束——这表明，他们治一般的单个病人，也治疗配偶和家庭的毛病。 五花八门：除上述以外，还可以选出好多种疗法来，至少在美国各大城市，特别是在加利福尼亚。有些疗法很奇怪，但是都建立在科学的心理学基础上，另外一些更奇怪，而且是以伪科学或者神秘观念为基础的。下列是一些随机抽取的例子： 原始疗法：如上面所述，它要求客户进行长时间的喊叫，以释放婴儿期的愤怒。要求客户在家里进行合适的练习。 森田疗法：一种日本疗法，以禅宗原理为基础。卧床4－7天，与外界隔绝，去除感官感受。此后，病人要接受他的感觉和症状，并积极地生活在现世，将思想从自己身上转移到周围的世界里去。 苦刑法：杰伊·哈利发明的一种疗法，让病人完成一项更难的任务，处于比目前更糟的环境，比如半夜起床，每夜都如此。通过这种方式进行练习。 矛盾指令：用来打破顽固的反抗行为，让病人坚持自己有问题的行为，其或加速错误行为。允许他做一些不允许的事情会缓和他的情绪，去掉里面的倒错因素，这常常会带来一项心理突破。 est法（艾哈德定期培训）：70年代很风行。在舞场呆两个周末（花费250美元）。除了正式的休息时间以外不准使用淋浴间的设施，参加者一整天要让主持人不停地辱骂（“你们全都是些没用的屁眼……你们他妈都算个什么东西？一堆废铁”）。如客户感到精疲力竭，大受羞辱，生活的秘密就显示出来了：你就是一堆废铁，一台机器，好不到哪儿去，就安于现状吧，知足长乐。 特别目的车间：持续半天或者一整天，有时候需要整个周末，只有出去进食、上厕所和睡觉的时间。听讲座，集体治疗，敏感度培训和其它一些活动，都可以用来解决来自参加者都有的一个问题的感觉和情绪症状：虐待儿童、乱伦、虐待配偶、怕暴露自己，还有其它许多问题。 其它：怎么给这些其它取名呢？好吧，让我们先不管这个其它叫什么名字，而只是简单地扫一眼吧：宇宙活力疗法（病人坐在一口特制的大箱子里，据说可以在里面收集一种有治病作用的、弥漫于全宇宙的能量）、舞蹈疗法、前生疗法、奇迹疗法、幻视疗法……可是，该打住了。我们已经超过了科学的界限，尽管许多人认为这些边缘活动是以心理学为基础的心理疗法。 现年七十多岁的H·J·艾森克在他最近的自传中很自豪地称自己为“有理有据的反叛者”。的确。有许多的理由。自从年轻时代从离开德国到英国后，他一直热情洋溢地投身于许多零七杂八的教育、政治和科学战斗中，这期间还对心理学的好些领域作出了坚实的贡献。长期以来，他一直是伦敦大学精神病学研究院的教授和研究员，在智力、测试和人格研究上著述颇丰，影响甚广。他和埃利斯一样（在严肃的层面上）在心理学领域里一直是个坚定不移、热情冲天的坏小子。 在他闹出来的一些乱子中，没有哪一次比1952年大肆攻击心理治疗史更沸沸扬扬的。艾森克一向对心理治疗抱轻蔑态度，因为他觉得它没有任何科学证据来支持。为了证明他的观点，他回顾了19例报告心理治疗结果的研究，并得出了令人震惊的结果。这些不同的研究宣称有“改善”的，少的只有百分之三十九，多的也只有百分之七十七，这样宽泛的一个范围，他说，很自然会引起人们的怀疑，说明一定有某些东西是有错误的。更糟的是，艾森克把这些发现加起来，然后加以计算，发现平均只有百分之六十六的病人有过一些改善——然后又引用了其它的一些研究报告，这些报告里谈到，在有监护照顾，但没有心理治疗的神经症病人当中，百分之六十六到七十二的人有所改善。他的结论是：没有证据证明心理治疗对其宣称的效果有作用。他的激进推论为：所有的心理治疗法培训都应该立即废止。 “天塌下来了，”他后来说，“我立即站到了弗洛伊德心理学、心理治疗学者和大部分临床心理学家及其弟子们的对立面。”不出所料，他树了新敌——包括英国和美国心理学界的一些头面人物——这些人撰文予以愤怒的反击。抛开愤怒不说，他们的反击也不无道理，并在英国和美国著名的心理学杂志上发表了许多反驳文章。他们最有见地的批评是，艾森克把不同疗法、不同病人的数据和不同病情改善的定义全都堆在一起了，另外，没有经过治疗的组别与经过治疗的组别根本就不能比较。尽管如此，他还提出了挑战；现在就靠那些信仰心理治疗的人来证明，心理治疗是一种有效的办法，而这方面却是他们从没有认真努力尝试过的。 从这以后，有关心理治疗效果的研究消息就源源不断地传了出来——事实上有数百篇研究报告出来——这些研究的科学质量、取样的规模和病情改善的标准以及是否有过对照组都有很大的差别。他们的发现因而是变化多样，众说纷纭。 可是，仔细的摘要，或者叫做“元分析”，即用科学质量给研究定级，调整方法上的差别，然后才统计结果，通过这种方法发现，证据的分量显然有利于心理疗法。1975年，由宾西法尼亚大学的莱斯特·鲁博斯基对近100种有控制的研究进行的一项极费力的元分析得出的结论是，大部分疗法都发现病人得益于心理疗法的人数占很高比率。而且，与艾森克的声明相反的是，有三分之二的研究表明，经过治疗的病人比没经过治疗的病人得到改善的情况多得多。（如果涉及到最低治疗的研究从鲁博斯基的研究中去掉的话，治疗相对于不治疗的优越性将更为明显。） 由国立精神卫生研究院在1978年进行的一项疗效综合研究也得出了类似结论：“经过心理治疗的病人在思想、情绪、性格和行为上，比没有经过治疗的对照抽样病人有极明显的改善。”这些发现在患有焦虑、恐惧和害怕等毛病的病人当中是最为显而易见的。 在由另一组心理学家研究组于1980年进行的更为复杂的一项元分析中，对475例研究进行了回顾和评估，利用到了更为广泛的疗效尺度将那些接受过心理治疗的病人与控制组中没有经过治疗的病人进行比较。其结论是毫不含糊的：治疗在大部分情况下都有益处，虽然不是在所有情况下。 心理治疗对所有年龄的人有可靠的益处，就像学校教育、各种药物肯定对其有益一样，或者像经营得出利润一样……接受治疗的人在治疗完毕后，一般比百分之八十没有接受过治疗的人情况要好些。可是，这并不意味着每个接受心理治疗的人病情都会有所改善。证据显示，有些人不会有改善，有一小部分人病情反而还会加重。 可是，这些元分析中有一个方面好像是令人大惑不解的：所有的治疗方法都好像只能对三分之二的病人有益。可是，如果每种疗法都对某些病因产生作用——如某种疗法所以为基石的理论所言——那么，怎么可能所有的办法都能产生很好的疗效呢？鲁博斯基的研究小组怀疑元分析结果，正如《艾丽丝奇境漫游记》中的渡渡鸟族一样，“大家都赢了，因此每个人都要发奖”，但他得出结论说，看上去的确是正确的。他们的解释是，在各种心理治疗法中，有一些共同的东西在里面，最值得注意的是治疗师和病人之间有益的关系。其它研究人员还指出了其它的一些共同因素，特别是能在一个受保护的环境里测出真实情况来的机会，还有通过治疗给病人带来的改善病情的希望，因而促发病人发生转机。 然而，最近几年，更为精细的分析已经开始提供越来越多的证据了，这些证据说明，某些治疗办法比其它一些治疗法对某些疾病有更好的疗效。我们已经听说过了这样一些特殊例子。其它的包括，行为和认知行为疗法对心悸和其它焦虑疾病的作用；认知疗法对社会恐惧的作用；集体疗法对性格毛病的疗效；认知－行为和人际疗法，或者任何一种与抗抑郁药物的合并使用对压抑的治疗作用。 尽管已经进行了好几百种疗效研究，但研究者们只是在最近才开始把疗效里面的因果关系分隔出来。而元分析中的总体数据并没有经过这种工作。一方面，它们在每份研究把不同治疗师获取的结果都平均起来。对照起来看，最近的研究却开始将所获取的结果与治疗师本人联系起来。鲁博斯基和他的治疗师同行利用三种不同的方法治疗药物依赖病人，得出的研究结果发现，疗法的选择比较治疗师本人的个人特点来说不太重要： 治疗师是一个重要的、独立的变化原因，他可以扩大或者缩小一种疗法的效果……有效心理疗法主要的促发因素是治疗师的性格，特别是因为他能够形成一种温暖和援助性的关系。 所以，毫不奇怪，早期的研究都支持渡渡鸟式的疗效观：它们把利用每种疗法的治疗师取得的疗效平均起来了。 大部分早期疗效研究的另一个缺点是，它们只看一种疗效最后或者中期的治疗效果。可是，一种新的研究实践已经开始更仔细地观察疗法中发生的事情了——观察有效的介入方式在特别的诊疗期内是如何以不同方式促进治疗过程的。 这些疗效研究的新形式，好像可以用比以前的疗效研究极为不同的具体方式显示出在心理治疗中产生疗效的东西和哪些病人起作用。可是，心理疗法的确能起作用这一点是不容置疑的。假设冯特可以得到这些数据的话，他的灵魂也许会一展愁容，勉强点头赞许。