心智化的方法與技術(shù)：第4講課件

AttachmentinAdulthood成人依戀JonG.Allen,Ph.D.Outline提綱Measurementofadultattachment成人依戀的測量Continuityanddiscontinuityfromchildhoodtoadulthood從童年到成年的連續(xù)性和不連續(xù)性Adulthoodpatternsofattachment成年人的依戀模式Attachmentinrelationshipwithself依戀與自體的關(guān)系Implicationsforpsychotherapy對心理治療的啟示Clinicalexample臨床實(shí)例

AdultAttachmentInterview(AAI)

成人依戀訪談Hour-longinterviewdesignedtobemoderatelystressful一小時(shí)的訪談，旨在施加適度的壓力fiveadjectivesforeachparent;concreteexamples用五個(gè)形容詞描述每一位家長；具體例子feelingsofcloseness親密的感覺howtheyrespondedwhenyouwerehurtorill當(dāng)你受傷或生病時(shí)，他們是如何回應(yīng)的separationexperiences分離的體驗(yàn)feelingrejectedorthreatened感到被拒絕或受到威脅lossesoverthelifetime一生中的喪失

Reflectiononexperiences(mentalizing)對體驗(yàn)的反思（心智化）howtherelationshipsaffectedyourpersonality這種關(guān)系如何影響你的人格reasonsparentsbehavedastheydid父母表現(xiàn)成那個(gè)樣子的原因changeinrelationshipsfromchildhoodtoadulthood從童年到成年的關(guān)系發(fā)生的變化relationshipswithchildren與子女的關(guān)系howrelationshipswithparentsaffectedrelationshipswithchildren與父母的關(guān)系如何影響與子女的關(guān)系notesimilaritytopsychotherapysessions注意與心理治療的會(huì)談相似Yieldsoneoverallattachmentclassification生成一個(gè)整體的依戀分類Self-ReportMeasures

自我報(bào)告法RelationshipQuestionnaire(Categorical)關(guān)系問卷（分類式）Briefdescriptionof3patterns:choosewhichbestfits3種模式的簡要說明：選擇最適合的模式Multi-Itemself-reportmeasures(Dimensional)多條目的自我報(bào)告法（維度式）Measureattachmentanxietyandavoidance(closeness-distance)測量依戀焦慮和回避（親近——距離）VariableTargets可變目標(biāo)Mostmeasuresfocusonasingletarget(e.g.,romanticrelationships)大多數(shù)測量方法都集中在單一目標(biāo)上（例如，親密關(guān)系）Somemeasuresincluderepeatedassessmentsfordifferenttargets(e.g.,mother,father,romanticpartner,therapist)一些測量方法包括對不同目標(biāo)的重復(fù)性評估（例如，母親、父親、親密伴侶、治療師）

ContinuityinAttachmentOvertheLifetime依戀在一生中的連續(xù)性Internalworkingmodelsarebuiltupfromcumulativehistoryofinteractionsthatenablepredictionoffuturefromthepast.內(nèi)部工作模型是根據(jù)累積的互動(dòng)歷史建立起來的，可以從過去預(yù)測未來。Longitudinalstudiesrelateinfantsecurity(StrangeSituation)toattachmentinearlyadulthood(AdultAttachmentInterview).縱向研究發(fā)現(xiàn)嬰兒的安全感（陌生情境）與成年早期的依戀（成人依戀訪談）相關(guān)。Continuityisgreaterforsecure/insecurethanspecificpatterns.連續(xù)性對安全/不安全的作用比特定模式更大。Infantsecurity(withparentalcare,peersupport)predictsqualityofromanticrelationships.嬰兒的安全感（父母照顧，同伴支持）預(yù)測出親密關(guān)系的質(zhì)量。LawfulDiscontinuityinAttachment依戀的不連續(xù)性的正當(dāng)之處Internalworkingmodelsareopentorevision.內(nèi)部工作模型可以修改Differentattachmentpatternsarepossiblewithdifferentcaregiversatthesametimeinlife(e.g.,ininfancy).在生活的同一時(shí)刻（例如，在嬰兒期），與不同的養(yǎng)育者可能有不同的依戀模式。Changeinattachmentpatternshasbeenobservedfrom12to18months.在12至18月齡之間可以觀察到依戀模式的變化。Manyfactorsareassociatedwithlawfuldiscontinuity:許多因素與不連續(xù)性的正當(dāng)之處有關(guān)：Changeincaregivingandfamilyfunctioning養(yǎng)育和家庭功能的變化Divorceanddeathofparents父母離婚和死亡Changeinsocialsupport社會(huì)支持的變化Stressfullifeevents,illness,andtrauma有壓力的生活事件，疾病和創(chuàng)傷Suchenvironmentalfactorsaccountfordiscontinuityoverthelifetime.這些環(huán)境因素導(dǎo)致了生命周期中的不連續(xù)性。Psychotherapyisassociatedwithpositivechangeinattachmentsecurity.心理治療與依戀安全的積極變化有關(guān)。AdultAnaloguestoChildAttachment童年依戀在成人身上的相似結(jié)果Romanticrelationshipsaretheclosestadultcounterpartstochildhoodattachmentpatterns親密關(guān)系是成人生活中最接近童年期依戀模式的對應(yīng)部分Psychotherapyevokesattachmentneedsandpatterns心理治療喚起了依戀需求和模式Secureattachmentisassociatedwithconfidenceandtrustinavailabilityandresponsiveness,coupledwithadispositiontoreachoutforsupportwhenneeded.Securityentailseffectivedependencyandacapacitytobridgethegapbetweenseparationandreunion(internalsecurity).安全依戀與對可獲得感和響應(yīng)性的信心和信任有關(guān)，并且在有需要時(shí)可以尋求支持。安全感需要有效的依賴以及彌合分離與團(tuán)聚之間的空缺的能力（內(nèi)部安全）。Ambivalentattachmentisassociatedwithstormyrelationships,clinging,feelingfrustratedanddeprived,andangryprotests(e.g.,borderlinepersonalitydisorder).Apositiveaspectofambivalenceiscontinuingengagementinrelationships.矛盾型依戀與暴風(fēng)驟雨般的關(guān)系、黏人、感到挫折和被剝奪感，以及憤怒的抗議有關(guān)（例如，邊緣人格障礙）。矛盾型的一個(gè)積極方面是繼續(xù)參與到關(guān)系中。Avoidantattachmentassociatedwithemotionaldistance—managingemotionaldistressbyoneself(e.g.,withtheaidofalcohol,drugs,nonsuicidalself-injury).回避型依戀與情感距離有關(guān)–自己處理自己的情感困擾（例如，借助酒精、藥物、非自殺性自傷）。TwoDevelopmentalLines

兩條發(fā)展路線Relatedness關(guān)聯(lián)性Typicaltraits:dependency,cooperation,collaboration,mutuality,reciprocity,altruism,empathy,affection,intimacy典型特征：依賴、合作、協(xié)作、相互性、互惠、利他、同理心、親情、親密Self-definition(autonomy)自我定義（自治）Typicaltraits:independence,self-reliance,agency,competition,achievement,dominance,power,separateness典型特征：獨(dú)立、自力更生、能動(dòng)性、競爭、成就、主導(dǎo)、權(quán)力、分離屬性—Blatt,SJ(2008)Polaritiesofexperience.-布拉特（2008）體驗(yàn)的極性DevelopmentalLinesandAttachment

發(fā)展線和依戀relatedness(effectivedependence)關(guān)聯(lián)性（有效的依賴）self-definition(autonomy)自我定義（自治）secureattachment安全型依戀BALANCE平衡excessivedependency過度依賴diminishedautonomy自治性降低Ambivalent矛盾型diminishedrelatedness關(guān)聯(lián)性降低excessiveautonomy過度自治Avoidant回避型AttachmentandPsychotherapy

依戀和心理治療Psychotherapystimulatesattachmentneedsandevokesattachmentstrategies.心理治療激發(fā)依戀需求并喚起依戀策略。Thedynamicnatureofattachmentstrategiesofferspromiseofchangethroughpsychotherapy.依戀策略具有動(dòng)力屬性，因此通過心理治療帶來改變是可能實(shí)現(xiàn)的。Securepatientshavestrongertherapeuticalliancesandbetteroutcomesthaninsecurepatients.與不安全依戀的病人相比，安全依戀的病人具有更強(qiáng)的治療聯(lián)盟和更好的結(jié)果。Avoidantpatientsarelessaffectedbypsychotherapy,lessself-disclosure.回避型病人受到心理治療的影響較小，自我暴露較少。Ambivalentpatientsfeelconnectedbuthaveamorestormycourseanddolesswelloverall.矛盾型病人感到有連接，但有更加暴風(fēng)驟雨的過程，總體上的進(jìn)展會(huì)不太好。Someevidenceindicatesthatadultpsychotherapyincreasesattachmentsecurity.一些證據(jù)表明，成人心理治療可提高依戀安全性。Therapistswhoaremoresecureandthosewhoaremoreexperiencedaremoreflexibleinrespondinginnon-complementarywaysoverthecourseoftherapy(increaseemotionwithavoidant,decreasewithambivalent).更為安全型的治療師以及更有經(jīng)驗(yàn)的治療師在治療過程中以非互補(bǔ)的方式更靈活地應(yīng)對（與回避型可增加情緒，與矛盾型可降低情緒）。—Slade(2016).Attachmentinpsychotherapy.斯萊德（2016）心理治療中的依戀ClinicalExample:AmbivalentAttachment臨床實(shí)例：矛盾型依戀Patientwasawomaninherthirtieswhowasdepressedandabusingalcoholafterrepeatedbreak-upsinromanticrelationships.病人是一位三十多歲的女性，她在多次親密關(guān)系分手后感到抑郁并且酗酒。sheknewshewas“stuckinarut”butshecouldnotunderstandwhatwasgoingwronginherrelationships.她知道自己“陷入了困境”，但她無法理解她的關(guān)系中出了什么問題。Shewasconfusedbythefactthatmeninevitablebrokeupwithherdespitethefactthatshewas“alwayssocaringandgood”tothem.Hercaringpatternwasevidentinthetherapyasshewassolicitousaboutthetherapist’semotionalwellbeing.盡管她對他們“總是非常關(guān)心和友善”，但他們?nèi)匀粫?huì)與她分手，這使她感到困惑。她的關(guān)心模式在治療中也很明顯，因?yàn)樗龍?zhí)著于治療師的情緒健康狀態(tài)。Thisconfusionprovidedafocusfortherapy,whichweexploredtogetherandIsummarizedinawrittenformulation.這種困惑提供了治療的焦點(diǎn)，我們一起探討，并在書面表述中進(jìn)行了總結(jié)。ClinicalExample:AmbivalentAttachment臨床實(shí)例：矛盾型依戀（續(xù)）Inthecourseofthetherapy,shebecameawareofherextremedependency.SheengagedinwhatBowlbycalled“compulsivecaregiving”inanefforttokeepmendependentonherandtopreventthemfromleaving.在治療過程中，她開始意識(shí)到自己的極度依賴。她使用了鮑爾比所謂的“強(qiáng)迫照顧”，試圖讓男人依賴她，以阻止他們離開。Shebecameawarethathercaregivingledtomenfeeling“smothered”byheranddistancingthemselvesfromher.她意識(shí)到她的照顧導(dǎo)致男人感到被她“窒息”，并與她保持距離。Furthermore,whenmendistancedthemselvesfromher,shefeltfrustratedanddeprived.Sheacknowledgedthatshebecame“passive-aggressive,”pouting,nasty,anddistancingherselfsexually.Herbehaviorwasaformofprotestingseparation.此外，當(dāng)男人遠(yuǎn)離她時(shí)，她感到抑郁和被剝奪。她承認(rèn)，她變得“被動(dòng)攻擊”，噘嘴、耍脾氣、并在性方面表現(xiàn)冷淡。她的行為是一種抗議分離的形式。Theprocessforchangeentailed(a)developingabroadernetworkofsocialsupportinrelationshipswithwomenthatwould(b)providesecurityanddecreaseheranxietyaboutabandonmentand(c)decreasetheclingingbycomfortingthatdrovemenaway.改變的過程包括（a）在與女性的關(guān)系中發(fā)展出更廣泛的社會(huì)支持網(wǎng)絡(luò)，這將（b）提供安全感并減少她對被拋棄的焦慮；（c）通過獲得安撫，從而減少會(huì)把男人趕跑的黏人行為。References參考文獻(xiàn)Allen,JG(2013).MentalizingintheDevelopmentandTreatmentofAttachmentTrauma.London:Karnac.Blatt,SJ(2008).Polaritiesofexperience:Relatednessandself-definitioninpersonality