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强迫症患者治疗案例-给力心理
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强迫症患者治疗案例

强迫症患者治疗案例
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发表时间:2015-02-06 15:24:08 341 0 0

 一般资料:男性,17岁,高中学生。

  问题主诉:1年前自从其妹妹考入同他一个重点高中以来,日常生活几乎全部由其包揽,一日三餐亲自买给妹妹吃,无论妹妹是否愿意,必须当着其面吃下,即使已吃过也必须吃;弄得妹妹时常不高兴。来访者有时因学习紧张无暇顾及妹妹时,就异常不安和恐惧,唯恐有危险,必须打电话给她,千叮咛万嘱咐,致使入睡困难,次日早晨必去探望,才能放心。并称妹妹太小,身体不好,必需自己照顾才行,妹妹自上高中一年多以来,上街两三次,哪怕有同学相伴,他知后也不放心,说妹妹不懂事,不能体谅其苦心等。对自己所做的一切,自感非常疲倦,不愿这样做,甚至觉得没有必要,但又迫使自己不得不做,否则就焦虑不安,无法正常学习和生活。到后来发展到反复检查自己的作业,尤其考试题,不管是大考还是平常的测试考试,有时知道这样做不对,就是不能控制,为此非常痛苦。

  既往史和个人史:自幼性格内向,谨小慎微,做事认真。5岁时父亲外出打工,一年才回来一次,和父亲缺乏沟通,经常和母亲、妹妹一起生活,母亲经常唠叨,对他管理较严格。

  治疗目标:

  按照心理动力疗学的观点,神经症的基本问题是焦虑。所谓焦虑,是一种说不出原因的恐惧情绪状态,其焦虑来自不同意识层面的心理冲突,病人并不知道焦虑的真正原因,是因为引起焦虑的生活事件在过去甚至在幼年期,被潜抑到无意识中成为症结,其中与关键人物的分离引起的恐惧是原因之一,长大后遇到新的挫折,这些症结更成为神经症的根源。所以,本治疗的重点是引导病人追忆往事,或用一些心理测验做为辅助,帮助其认识其焦虑的早年根源,使无意识冲突进入意识,从而达到消除症状,缓解焦虑的目的。

  治疗过程:

  初诊:先与来访者建立良好的治疗关系,鼓励倾诉,积极表达,告诉患者这种病与过去创伤经历有关,找出症结,获得领悟,就可以消除症状。在来访者的回忆叙述时,不做道德评价,在充分轻松的气氛中探讨他的烦恼,并给予积极的关注、理解、肯定和共情,明确来访者属于强迫性神经症。这次会谈用了1个半小时,预约7天后复诊。

  再诊:诉说初诊听医生讲解后,心理压力减轻许多,心里踏实了,对治疗也有了信心。并回忆起初二时,曾与班里一女友感情甚好,其母怕影响学业,提出要么放弃学业与女友继续交往;要么与女友断交继续完成学业。为此,曾拒绝吃饭,但迫于压力放弃了与女友交往。升入高中后思念女友(考入中专),曾多次打电话均无法接通,后来想开了,决定不再想她,但心情烦躁并无明显减轻。

  三诊:一周后,述自上高中以来,经常不回家,在校思母心切,每接母亲来电就两眼模糊,心里不是滋味。不敢和母亲主动打电话,这样想的更很,常常夜间睡眠时独自流泪,睡眠不好,常梦见母亲病危,恶梦醒来时泪流满面。

  心理动力学分析:

  来访者对母亲强行使其与女友分离,心存怨恨;理智又告诉他母亲是出于对他的爱与责任。所以,对母亲的“怨恨”之感被潜抑到无意识中。升入高中后对生活不适应,高考的压力,学业困难带来的挫折,所有这些唤起无意识中所存在的对母亲的“恨”,于是梦中就出现了母亲病危;同时也产生了强烈的有罪感,于是接电话及梦醒流泪,更不敢主动打电话。来访者体验到的异常焦虑无以宣泄,就以置换机制迁怒于妹妹,以母亲强迫自己的方式,强迫妹妹做事,而这种强迫方式又为合乎情理的照顾妹妹所掩盖;为此其无法真正解脱焦虑,感到无力应对,疲惫不堪,“爱”“恨”交加,表现为强迫症状。不论是对妹妹的强迫行为,还是反复的检查作业,一方面是表达对母亲的不满和愤恨(原发性获益),一方面表达“我有病,不能像其他同学一样正常学习”,从而把学习成绩下降合理化,已取得老师、母亲的理解和同情(继发性获益)。

  四诊:二周后,来访者对医生的解释表示赞同,称自己私下也想了很多,“强迫症状几乎消失”,至此,来访者理解了早年的“怨恨”情结和现时症状的关系,获得了领悟,内心舒服了许多。

  七诊:在邻近高考的前三天,来访者又一次来咨询,倾诉了他的担心,担心高考中会重现强迫性检查,影响他的心理和考试成绩,给予了一般性的支持性心理治疗。

  医生进一步指导

  (1)爱有能力之分,母亲也会犯错,开导来访者谅解母亲。

  (2)妹妹已经有自理能力和她的生活方式,要尊重她的意愿,不重覆母亲的旧辙。

  (3)在对待女友的问题,采用暂时搁置的原则,等考上大学再做决定

  10天前随访,截止本稿发表至,来访者生活恢复正常,高考成绩不错,进入了一本线。

 

 

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本文作者

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0岁
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公益助人

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长程个案

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续单率

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