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“啐人”强迫症的治疗案例-给力心理
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“啐人”强迫症的治疗案例

“啐人”强迫症的治疗案例
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发表时间:2015-02-06 15:53:31 389 0 0

1、求助者资料

  刘斌, 男, 19 岁, 大一学生

  2、主诉内容

  求助者说: 我很苦闷, 我是某高校动力系一年级学生。入学初, 我发现自己看到不顺眼的同学就想“啐”,不久, 我见人就想“啐”。我明知“啐”人是不礼貌的行为, 会引起误解, 造成人际关系紧张, 但我控制不住自己, 见人就不由自主地想“啐”, 这种冲动十分强烈, 不“啐”就浑身不舒服, 这使我苦恼不堪, 以致不得不整天躲在宿舍里, 连课也害怕上。现在我害怕去教室, 我几乎每天都逃课睡觉, 这严重影响了我的学习和生活, 非常焦虑。

  3 背景资料

  一年前, 刘斌因高考落榜插班到另一所中学高三班, 坐在他后面的男生颇爱玩恶作剧, 经常在他背上贴胶带、涂墨水, 刘斌与那位男生经常闹矛盾。高考前夕,那位男生叫来一帮人在下晚自习的时候将刘斌打倒在地, 并且每人向他“啐”了一口。从那以后, 刘斌满脑子都是那晚的情景, 他在日记里发誓: 一定要复仇。

  4、心理测验

  5、 诊断

  刘斌主观上能感觉到有一种不能克制, 不可抵抗的意向(“啐”) 存在, 而且也意识到这种意向(“啐”) 是不合情理的, 没必要的, 但不能控制自己, 这在心理学上被称为强迫症。因为, 自我强迫和自我反强迫同时存在, 使他极度焦虑、恐惧, 因此, 这是一种典型的冲突性心理疾病。可能求助者对笔者上面所分析的感到不可信, 但可以明确告诉求助者的是: 求助者的各种症状确实是一种典型的冲突性心理疾病。求助者见人就想“啐”, 那么应该如何改变求助者的现状呢?

  6、咨询和治疗方案

  第一步:

  通过启发式谈话, 引导刘斌发现自己思维上的不合逻辑的因素。

  咨询师:“刘斌, 每个人无故被当众欺侮后, 心里总是特别难受, 我能理解你当时的心情, 一个人的心灵受伤远比身体受伤更为严重。特别是像你这样自尊心很强的男孩,你当时一定想找个地缝钻进去, 永不出来。是吗?”为拉近与患者的心理距离, 与患者进行共情是必要的。

  求助者:“那样的奇耻大辱我受不了, 现在大家都知道我是个懦夫, 我要报仇, 要让他们知道我不是懦夫。”在患者自我暴露的基础上, 分析其深层的认知结构, 不难看出,他对被人打这件事的负性影响评价过高。

  咨询师:“可是你现在换了环境, 没有人知道你的过去。”

  求助者:“这所学校有我的老乡, 我原来班上的同学肯定告诉了他们, 他们肯定把这件事告诉了我现在的同学, 所以大家都知道。”患者在认知过程中犯了逻辑错误, 因此导致了他不合情理的情绪和行为。

  咨询师:“刘斌, 当你看到别人无故被欺, 你会站到哪一方, 支持谁?

  求助者:“应该是有理的一方。”

  咨询师:“一般说来, 人都是有正义感的, 肯定会站到有理的一方。据我所知, 你当初是无故被欺负的, 你想想你的同学会支持谁?

  求助者:“现在想来应该是我。”

  咨询师:“这就对了, 既然大家支持你, 有人还会嘲笑你吗?能不能告诉我, 你从高中到现在看到过多少次打架, 每次被打的人穿什么衣服, 长得怎样, 叫什么名字?

  求助者:“记不太清了。”

  咨询师:“是啊, 发生在我们周围的事情太多了, 我们要记的东西很多, 我们的记忆力是有限的, 对于那些与我们毫不相干的事情, 我们是不会去记的。像你一样, 别人也不会把你被打这件事放在心上, 因为这与他们也毫不相干。事实上, 你的同学也许早已忘记了这件事, 而你却坚信别人一直记得, 并且逢人就说, 还嘲笑你是个懦夫, 这就是你的病因所在。你过分夸大消极影响, 这是一种在认知过程中产生的错误观念, 这种错误的观念继而导致了你不适当的情绪和行为。”

  求助者:“陈老师, 听您这么讲, 我现在觉得这件事真的不值一提, 只是我想得过于严重而已。”

  经过分析, 求助者知道了他为什么会有目前的这些症状了, 它们的根源在于: 求助者不合情理的情绪和行为。

  第二步:

  用过度校正法来治疗强迫行为,当求助者明白病因后, 采用过度校正法, 对其进行治疗。所谓过度校正法, 是厌恶疗法中的一种, 其原理是“物极必反”, 由渴望“啐”到反复“啐”, 引起生理疲劳, 心理厌恶, 多次以后就会对“啐”产生恐惧反应, 利用这种恐惧反应, 使患者形成对这种不良行为的逃避或者避免。因此, 建议刘斌每次想“啐”的时候, 不要控制, 找一个合适的地方去“啐”, 直到疲劳为止。这样持续一段时间, 症状 会自然减少或消失。

  一个月以后, 刘斌的班主任带来了对笔者的感谢信, 并告诉知刘斌的病情有所好转,能坚持上课了。刘斌后来也找过笔者两次, 主要是闲聊, 我把第一次见面时, 他交给我的那一篇日记还给他, 并祝他以后心情愉快, 学有所成。

  7、预后和评价

  通过以上有效的办法和求助者的密切配合, 第五次咨询以后, 求助者“看到不顺眼的同学就想“啐”等症状已有明显改观。情绪方面: 焦虑、紧张等感觉减轻, 明白了作为大学生应把主要精力放在学习和生活上。已无不“啐”就浑身不舒服, 苦恼不堪, 整天躲在宿舍里,连课也害怕上等不合理信念了。跟踪观察结果: 随着时间的推移, 该生紧张、焦虑感已无。今年即将毕业。

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本文作者

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公益助人

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收费助人

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长程个案

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续单率

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