ACT治疗中的对话（1）

译/朱松

                                 (转自http://blog.sina.com.cn/m/zhusong)

阅读说明：

内容来源于《接受和承诺治疗：行为改变的经验方法》，这是一本心理治疗的专业书。ACT疗法是现在国际上很流行的一种疗法。现在我将其中的治疗对话摘出来，进行编译，以期能最快的接触到其精神。当然，这只是心急的吃法。后面还得慢慢的嚼。《ACT治疗中的对话》系列译文推荐心理治疗师阅读。

 

    下面是一个ACT治疗师在评估一个慢性忧虑者的改变日程（朱松：原文直译过来很难懂，大意就是评估来访者平日对自己问题采取的办法。）：

 

    Therapist: What else have you tried to do?
    治疗师(下简称“T”)：你还做过什么？

 

    Client: Well,sometimes I try to talk myself out of it. I say, "This is silly, you are making a mountain out of a molehill."
    来访者（下简称“C”）:嗯，有时我试图劝阻自己。我说：“太蠢了，你这是小题大做。”

 

    T：In other words, criticize and chastise yourself. And the purpose of this criticism...?
    也就是说，你责备和惩罚自己。你的目的是……？（朱松：ACT这点上比较快，比较简洁，直接总结，并提出下一个问题；不是继续针对“蠢”和“大题小作”让来访者谈更多。）

 

    C: To get me to stop it.
    让自己停下来。

 

    T: To get yourself to change-to stop worrying.
    让自己有所改变——停止担心。（朱松：这句实际上就是重复，虽然遣词不同，但是没有加入任何多的东西，是很准确的重复，但说法又不同，精彩。）

 

    C: Yeah... The things I worry about are silly. I mean some of the things that come into my mind are just nuts.
    是的……我的担心很愚蠢。我的意思是，我脑袋里冒出来的有些东西简直就是胡说八道。

 

    T: And the idea is that if you could get rid of those worries-those thoughts-then the anxiety would be less and you'd be able to face your daily situation better.
    你是说，如果你能去除那些担心——那些想法——那么焦虑就减少，你就能够更好的面对日常情况。

 

    C: Right, but it is pretty hard to convince myself to stop it, so sometimes it works but sometimes it doesn't.
    对，但是说服自己停下来相当困难，因此有时有用，有时没用。

 

    T: So if you could just convince yourself that you don't need to worry, then it would work and things would start moving ahead. OK. So far we've got criticism, chastising, and attempts to convince yourself to stop. What else have you tried?
    如果你能说服自己，你就无需担心了，那就有用了，事情就会向前发展。好。到目前为止，你受到了责备、惩罚，还试图说服自己停下来。你还做过什么？（朱松：简单几个回合，已经将来访者采取的办法评估清楚了，漂亮。）【94】

 

    C：So why am I coming in to see you? It sounds as if you are saying I will never be successful.
    听你这么说，我再也好不起来了。那我干嘛来看你？（朱松：在经过创造性无望阶段之后，来访者陷入了彻底的无望中。看上去风险是挺大的。）

    T: My purpose is not to help you win this struggle. That does not mean that you are hopeless or you can't be successful. In fact, my goal is to help you have your life work, and I 100% think I can help you do that if you are willing to face these monsters your have been running from.
    我的目标不是帮你赢得挣扎。但那并不意味你没有希望了，也不意味你好不起来了。事实上，我的目标在于帮你把生活运转起来。如果你愿意面对你一直在逃离的这些怪物，那我100％地相信能帮到你。（朱松：这个转折很好，能够有效的让来访者有豁然开朗的感觉。）

    C: If it is easy to have your life work, why haven't I done it?
    如果运转生活那么容易，为什么我做不到呢？（朱松：来访者为什么说“your” life？）

    T: I neve said it was easy. It is hard. Not hard effortful-it is hard tricky. This is a very tricky trap-one that catches us all. Look, it is absolutely clear to me that if you knew what to do, you would have done it. I don't believe for a minute that you are broken, weird, perverse, or self-destructive. You have done the absolute best you can. You have everything you need to move ahead from here to live a vital, committed, meaningful life. It is just that we have to start from here-here is where you are. So you look and you see whether your experience doesn't tell you that you are caught in a struggle you seemingly can't win. Are you willing to trust that experience, allow it to influence you, and then to move from here? That is what your life is asking of you right now.
    我从没说过容易。这很难。不是难在需要努力上——而是很难处理。（朱松：强调难度是必要的，这样可以调动来访者更好的在治疗中合作，付出努力。）这是个危险的陷阱——能逮住我们所有人。（朱松：的确是个危险的陷阱，治疗师在治疗中很容易和来访者一起陷入其中。）看，事情对我来说很清楚，如果你知道要做什么，早就做了。我根本不相信你有问题，不相信你是离奇的、反常的，不相信你在自我破坏。你已经做的绝对是最好的了。你拥有所需要的一切，这能让你离开这里，去过充满活力的、具有责任感的、有意义的生活。我们要做的正是从这里开始——从你这里开始。你看看，你会发现你的经验是否没有告诉你，你被似乎不可能赢得的挣扎给困住了。你愿意信任经验吗？让其影响你？然后离开这里？那是你的生活在邀请你。（朱松：这段话中有明显的人本的痕迹，这也是让来访者迅速有效的摆脱无望感的方法。其中提到的“经验”目前看来还是比较模糊的概念，不知道具体指的是什么。）【107】

ACT治疗中的对话（6）

译/朱松

 

下面的来访者诊断为惊恐障碍，治疗师试图阐明来访者的无效控制策略的本质：
T: What else did you observe?
你还注意到了什么？
C: Well, when I was about to go into the department meeting, I noticed I checked several times to see whether I still had my bottle of Valium in my purse. I kenw it was in there-I alsways carry it anyway-but I checked it maybe four times within 5 minutes right before the meeting.
嗯，当我打算进去会议室时，我发现自己检查了好几次钱包中是否有安定药瓶。我知道有——我总是带着它——但是在开会前的5分钟之内我大概检查了4次。
T: What do you think the checking was in the service of[1]?
你认为检查的作用是什么？
C: I guess reassuring myself that it was there.[2]
我想，如果在，我就放心了。
T: So that you could...
这样你就能……
C: Well, so that I could always quick sneak a pill if things got too bad. I have learned to open the bottle with one hand and sort of[3] tuck a pill in the knuckle joint. Like a magician does. Then I cough or something, and I get it in my mouth. It tastes pretty bad, but actually if I just let it dissolve it works faster anyway, so I don't need water or anything.
是的，这样，如果情况不对，我就能迅速偷吃一片。我已经学会用一只手打开瓶子，藏一片药在膝关节里。就像魔术师那样。然后咳嗽什么的，将药送进嘴里。味道很不好，但如果让其在嘴里溶解，实际上起效更快，所以我也不需要水什么的。
T: So one thing you observed is that before you go into the department meeting you make sure you have a way of dealing with your anxiety. And you check for the bottle to reassure yourself that you have that way out even if you can't just leave the room.
所以你注意到的一件事是，在进入会议室之前，你证实自己有处理焦虑的方法。你检查药瓶让自己安心，即使你不能离开房间，你也有办法处理。
C: Yeah.
是的。
T: And that is in the service of keeping the anxiety away.
作用是，远离焦虑。
C: For sure.
没错。
T: Can I say it this way?: Access to tranquilizers is probably one way you dig.[4]
我能这样说吗？：镇静剂的使用也许就是你寻找的方法。【119】

ACT治疗中的对话（7）

译/朱松

下面的对话演示了如何开始讨论个人经历的难控制性（uncontrollability of private experiences）问题（这段对话很多难翻的部分，翻译的感觉很糟糕，翻译的结果也很糟糕，建议大家直接看英文）：

T：OK. I think[1] I understand what you have been doing. Any others that you noticed[2].
好的。我想我理解你一直在做的事情。（以及）你提过的其它任何事情。
C: No. That is about it[3].
不。只是有关而已。
T: OK. Actually, there are probably a lot of others that will percolate up[4] as we proceed[5], but it is not important at this point that we know every one. We just need to get a sense of the range of things involved. What I want to do today is to try to get a clearer sense of this set of things-I want to have us get clearer about what digging even is anyway[6]. And I want to give it a name-not to figure it out intellectually, but just to have a way of talking about it in here.
好。事实上，在我们继续下去时，或许有很多其它事情将慢慢渗透；但这不重要，这点上，我们清楚每一个。我们只需对有关事情的范围有个认识就行了。今天我想做的是努力对这系列事情有个更清晰的认识——我想我们能清晰about what digging even is anyway。我想给它一个说法——不是从知性上解决，只是在这里有个谈论的方法。
C: You want us to have a name for the theme.[7]
你想我们给这个话题一个说法。
T: Right. I believe that most of what you have been doing is quite logical, sensible, and reasonable, at least according to your mind and my mind. The outcome isn't what you hoped it would be, but it seems to me that you've done pretty much the normal thing. You've really tried hard and fought the good fight. All these digging moves you just listed.[8] Aren't they the kinds of things people do?[9]
是的。我相信你一直在做的大多数事情是很有逻辑的、明智的、合理的，至少你我是这么认为的。结果并非如你所愿，但我觉得你已经做了很多符合常规的事情。你确实付出了努力，并且打了个漂亮仗。所有这些探索促使你listed。那不正是人们做的那类事情吗？
C: Maybe not normal people[10], but people like me sure do. It's like that support group I go to. It is almost laughable. Every single person in there has the same story. I mean you can tell even before they open their mouths what the story will be.[11]
也许不是心理健康的人，和我相似的人确实是那样做的。就像我参加的支持团体。那可以说是可笑的。那里的每个个体有着相同的经历。我认为甚至在他们开口之前，你就能知道故事是什么样的。
T: Exactly. Because we all show how the system works. Consider this as a possibility.[12] Everyone's story is similar (and similar to yours) because what you are doing is what we are all trained to do. It's just that it doesn't work here.[13] Human language has given us a tremendous advantage as a species because it allows us to break things down into parts, to formulate plans, to construct futures we have never experienced, and to plan action. And it works pretty well[14]. If we look just at the part of our existence that involves what goes on outside the skin, it works great.[15] Look at all the things the rest of creation is dealing with, and you'll see we do pretty well. Just look around this room. Almost everything we see in here wouldn't be here without human language and human rationality. The plastic chair. The lights. The heating duct[16]. Our clothes. That computer. And so on. So we are warm, it won't rain on us, we have light-in regard to the stuff nonhumans are struggling with, we pretty much have it made. You give a dog or a cat all this stuff-warmth, shelter, food, social simulation[17]-and it is about as happy as it knows to be. But without humans, dogs and cats are outside in the cold. So we've solved the problems nonverbal critters face.[18] We are also the only species that commits suicide, and we can be miserable when they would be happy. Really, really important things-important to us as a species competing with other like forms on this planet-have been done

 

下面的对话演示的是ACT治疗师如何弱化来访者对控制策略的信心：

T: If conscious, deliberate, purposeful control does not work very well, you have to wonder why we all use it so much. I can think of four primary reasons.[1] One we have already pointed to : It works very well in most aspects of your life. But there is more to it than that.[2] For one thing, try to recall how often you heard things as a young child like "Stop crying or I 'll give you something to cry about," or "Stop crying there is nothing scary in here. Stop it and go to sleep," or "Stop being such a baby about this. You're acting like a two-year old."[3]
如果说有意识、有准备、有目的的控制没什么用，你一定会想为什么我们还老用它。我想主要有四种理由。有一种我们已经提到过：在你生活的大多数方面，它的效果非常好。但是不仅与此（或：但并不都是这样）。首先，你尽量回忆一下，你小时候，有多少次听到这样的话：“不哭我就给你想要的东西，”或者“别哭了，这里又没有什么可怕的。别哭了，去睡觉，”或者“别跟这儿像个孩子似的。你的表现好像只有两岁。”
C: Some of those exact things were said to me. That one about "I'll give you something to cry about" was something my mom would do when she was mad. I'd be crying and she'd spank me if I didn't stop, but that made it even harder to stop.
这有些话我是听过的。那句“我就给你想要的东西”很像是妈妈生气时会说的。我哭的时候，如何不停下来，她就会打我，但那要不哭就更难了。
T: Right. What do you think was the message from all of that?
没错。你认为其中传达的信息是什么？
C: Shut up.
闭嘴。
T: Yeah, that you can and should be able to suppress undesirable emotions at will. Just do it and shut up.[4][5]
嗯，你能够，也应该能够止住随意的不良情绪。你只需要闭嘴就行。
C: I was never good at it, though.
可是，我从来没做到过。
T: Neither was I. Of course, what was actually happening was that Mom was saying, in effect,[6] "I don't like feeling what you feel so I don't have to feel what I feel."[7] If people can actually do that, you have to wonder why Mom just didn't do it in the first place[8] instead of asking a child to do what she couldn't do. It's like saying, "I can't just ge rid of mine, so you just get rid of yours so I can get rid of mine."
我也做不到。当然，事实上妈妈曾经说，“我不想感受你的感受，所以我没必要感受我的感受。”如果人们真的能做到，你一定会想为什么妈妈自己做不到，却要要求孩子去做她做不到的事情。这就好像在说：“我不能去掉我的，所以你要去掉你的，这样我才能去掉我的。”
C: The message was that I was supposed to cool it. It goes back as far as I can remember.
这里的信息是，我被要求放松下来。我的记忆回到很久以前。
T: So you were explicitly taught that you can and should control emotions, worry, and so on, just by deliberately controlling them. And this seems right, because you look at these giants called "grownups" and they don't cry like you do, they don'tworry like you do, they don't have fears like you do. To a child it looks as though they can usually control their emotions-except when they explode, and then that just makes it all the more important to control them if that is the alternative[9].
所以，你被明确的告知，你能够而且应该控制情绪、担忧等等，只需刻意的控制就行。这似乎是对的，因为你看到那些叫做“大人”的大人物，他们不像你这样哭，没有你这样的烦恼，没有你这样的害怕。在孩子的眼中，他们通常都能控制他们的情绪——除非当他们爆发时。那时，控制变得更加重要了，如果有可能的话。
C: It's different as an adult.
大人不是这样的。
T: Exactly. Now we know that adults can't do it either. Heck, half of the adults we looked up to were drinking Martinis every night, taking tranquilizers, avoiding situations like crazy, and whatever else they were doing to get through the day. But as a kid you didn't know that , so it appeared to you that this message-"Just conrol it"-was something they knew how to do. They weren't crying like you

 

下面的对话演示了心理回避(psychological avoidance)是如何在治疗中出现的,并举例说明从ACT的观点如何进行处理（这一段，读得我都快疯了，治疗师和来访者绕来绕去，而且是用英文在绕；权且放在这里，以后再回来重读；阅读者请绕过中文）：
C: It's hard to hang onto what we're doing here.
我弄不明白我们在干什么。
T: So, don't try to.
那就别弄了。
C: It's hard not to try to (chuckle and sigh).
不弄，也很难（咯咯的笑，然后叹了口气）。
T: So, notice that you have the thought that you want to try to.
好，注意，你的想法是，你想去弄。
C: OK.
是的。
T: And is it OK to think that you want to try to hang onto it? That you need to hang onto it?
想到你要弄明白，（你认为）这好吗？你需要弄明白？
C: I would like to say it's OK, but it's really not. I feel like I should hold onto it (sigh).
我想说好，但其实不好。我想我应该弄清楚（叹气）。
T: OK, but now let's just think about that. We've got this thing "I got to hang onto this." ...Is it OK to think, "I've got to hang onto this"?[1]
好的，现在我们来想想看。我们的想法是“我开始明白了。”……换成“我已经开始明白了”，这样想好吗？
C: Sure (sigh and chuckle)...No-I guess I'm afraid that I won't get it back if I can't hang onto something.
当然好（叹气，然后咯咯笑）……不——我想我是担心，如果我没弄明白点什么，我就不会好起来。
T: OK, so you have the thought that it[3] won't come back...Is it OK to have those words, "It won't come back?"
好，你的想法是，不会好起来……这样说可以吗：“不会好起来？”
C: If it didn't come back, that wouldn't be OK.
如果好不起来，就不好了。
T: But you didn't experience that it didn't come back, right?
但你并没有经历过好不起来，对吗？
C: Right, just the fear.
对，只是害怕。
T: The fear, right.
是害怕，很好。
C: Uh huh.
嗯哼。
T: And some words in your head called, "But it wouldn't be OK if it didn't come back"?
你的脑袋的声音说：“但是，如果好不起来，就不好了。”
C: Right.
是的。
T: Is it OK to experience the fact that you have the words called, "But it wouldn't be OK if it didn't come back"?[2]
如果你的经历真的像你想过的那样：“如果好不起来，就不好了”，这样好吗？
C: Sure, it's...it's OK to have that feeling.
当然，那种感觉挺，挺好的。
T: Great. Next thought.
好。下一个想法。
C: But what if it doesn't come back? (giggle) Same thing?
但是如果好不起来呢？（哈哈笑）还是老问题？
T: That's the next thought. What's here to accept is not what it says it is, but what you experience it to be. Now what did you actually experience?
不，那是个新想法。这里要谈的不是说了什么，而是你经历了什么。你到底经历了什么呢？
C: That fear that I'm getting confused and it might not ever come back. I might not ever understand.
害怕我会糊涂，那样事情可能就不会好起来。我不可能明白。
T: Is that OK?
这样好吗？
C: The fear is OK, um. So right, um, when I blank, when I blank out, I'm stuck behind the words... I couldn't have told you that . There weren't any thoughts there to describe.
害怕是好的，嗯。好，嗯，当我取消，当我取消，我受困于话语……我本应已告诉你的。没有什么想法来描述。
T: Isn't that the most amazing thing? That's true. The most amazing thing is that when you look at the world from words, you don't actually see the words.
那是最令人惊异的事情吗？没错。最惊人的事情是，当你用语言看世界的时候，你看不到语言。
C: Yeah, there weren't any. I was just confused...It's hard to do, um.
是，看不到。我只是不明白……很难做到，嗯。
T: Don't make an effort at trying to do this right. Just get present.
不要努力做这个。只需存在。
C: I get into a place, and my mind is just nothing, zero.
我进入一个地方，我的头脑什么都没有，空空的。
T: Go with that.
呆在那里。
C: And that anything we've been talking about here in the last hour is gone, it's not...
我们这个小时谈到的东西已经没有，没有……
T: Stay with that.
呆在那里。
C: I can't remember anything.
我什么都记不起来了。
T: OK. Good.
好，好的。
C: Yeah. The thought is that my mind is a blank and I can't remember.
是的。我的想法是，我的头脑空空的，什么都想不起来。
T: OK, "My mind is blank" um-Anything else your mind has to share?
好，“我的头脑空空的”嗯－还有什么可以分享的吗？
C: I'm confused.
我糊涂了。
T: Go with that, go right this moment with that confusion.
呆在那里，此刻，和糊涂呆在一起。
C: I need to keep my mind working.
我需要让我的意识工作。
T: OK. So you're having a thought that you have to keep your mind working... What are we trying to do here?
好。你有一个想法，你必须让你的意识工作……我们在这里做什么？
C: Just to look at my thoughts.
看我的想法。
T: Right, and all we are really trying to do is just be here with whichever ones come up without struggling with them. Whatever shows up. No particular thing has to show up. Notice how hard that was. Each one kept inviting you to struggle and run away.
对，我们要做的就是和出现的任何想法呆在一起，不做任何抗争。无论什么。没有特别的事情必须出来。注意那是多难。每个都不停的邀请你争斗和潜逃。
C: Right.
是的。
T: What are the numbers?
有多少个？
C: One, two, three.
一，二，三。【132】