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心理治疗案例:社交恐怖症案例-给力心理
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心理治疗案例:社交恐怖症案例

心理治疗案例:社交恐怖症案例
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发表时间:2015-02-06 16:07:02 246 0 0

一、来访者一般资料
来访者情况:吴某,女,一十九岁,某大学一年级学生。既往健康状况与咨询史:该来访者既往身体健康,没有得过大病,也无明显躯体疾病,未进行过心理咨询。
二、主述和个人陈述
她认为自已是个怪人,有个害羞的怪毛病。两年多来,从不多与人讲话,与人讲话时不敢直视,眼睛躲闪,像做了亏心事。一说话脸就发烧,低头盯住脚尖。心怦怦跳,肌肉起鸡皮疙瘩,好像全身都在发抖。她不愿与班上同学接触,觉得别人讨厌自己,在别人眼中是个“怪人”。最怕接触男生,即使在寝室里,只要有男生出现,也会不知所措。对老师也害怕,上课时,只有老师背对学生板书时才不紧张。只要老师面对学生,就不敢朝黑板方向看。常常因为紧张对老师所讲的内容不知所云。更糟糕的是,现在在亲友、邻居面前说话也“不自然”了。由于这些毛病,极少去社交场所,很少与人接触。自己曾力图克服这个怪毛病,也看了不少心理学科普图书,按照社交技巧去指导自己;用理智说服自己,用意志控制自己,但作用就是不大。后来她哭诉说,这个怪毛病严重影响了她各方面的发展:学习成绩下降;交往失败,同学们说她清高。她急切地问:“老师,请她快点告诉我,我为什么会这样呢,我该怎样才能克服怪毛病呢?”
三、观察和他人反映
神色慌张而羞怯,动作僵硬,面谈中眼神不敢直视对方。
四、评估与诊断
对照scl-90国内常模(成人),可以显著地看出晓婷的人际敏感分明显偏高,焦虑分次之(因子分一般应低于2分,3分以上表明有相当严重的程度)。
分析她是一种常见的心理障碍--社交中的对人恐怖症。
五、咨询目标的制定
具体目标是指导来访者正确对待自己的问题,加深对自己心理问题来源的认识,降低人际敏感程度和焦虑强度;最终目标是指导来访者克服社交恐怖心理,获得正常健康的人际交往。
六、咨询方案的制定
(一)方法和原理
认知领悟疗法:是通过解释使求治者改变认识、得到领悟而使症状得以减轻或消失,从而达到治病目的的一种心理治疗方法。由中国大陆心理治疗专家钟友彬先生首创,是依据心理动力学疗法的原理与中国实情及人们的生活习惯相结合而设计的
第一阶段:建立有效的咨询关系,以患者为中心,以倾听,共情为主,积极关注。
首先,让她回顾一下所经历过的不愉快事件,分析一下自己性格形成的过程,以找出造成她现在这种情况的真正原因,在我的耐心开导下,吴某细细地回忆道:“我从小性格内向、胆小、孤僻。父母对我要求极严甚至苛求。父亲动起怒来特可怕。记得一次我的考试成绩不理想,父亲让我重做生题,我不乐意。父亲怒气冲天地将钢笔甩到我脸上,笔尖刺伤了我的脸,鲜血直流.至今想起那件事还很害伯。父母很正统、很古板,对我的禁忌很多,不准我和男孩子交往。父亲认为女孩子在外蹦蹦跳跳、打打闹闹是不正经的,还容易上坏人的当。所以除了学校和家,我很少在外玩耍,从不和男生交往.中学时,见到男女生之间的往来很反感。”说到不愉快的经历,吴某还讲道:‘初中时,一向成绩很好的我,一次提问没答好,老师当众批评我、挖苦我,我难过得直流眼泪。再就是大一时,同室一位同学来自农村,家境不好,我经常主动帮助她;资助她,可这样反而伤了她自尊似的。她不但不把我当朋友,反而时常挑剔我、指责我、刁难我,故意当我的面和其他同学亲亲热热,冷落我、孤立我。这使我委曲极了,难过极了。我恨自己,自责自己是不受欢迎的人。后来,我们发生了冲突。我讨厌她、恨她、和她不讲话。我也觉得她讨厌我。不知不觉地我就怕和人接触了,愈来愈害羞了。”
此阶段获得了吴某的充分信任,吴某把自己的成长经历经历和内心感觉和盘托出,使其内心中压抑等不良情绪得到发泄,使其内心平静下来,开始理性面对自己的问题。
第二阶段:认知领悟过程,每次探讨一个问题。
与吴某进行探讨其成长过程中发生的对其内向、孤僻、胆小的性格产生影响的因素。使其领悟到:
1、父母对她交往中的禁忌以及灌输的与男性交往的“羞耻感道德意识”,使她的性格中形成了较强羞耻,这对人际交往起着阻碍作用;
2、少儿时,她父亲发怒导致的恐惧反应和老师当众的批评、挖苦所产生的羞辱反应在她心灵深处留下了负性心理印痕。这种印痕会由于日后的负性生活事件而被激活,对心理障碍的产生和发展起作用;
3、在与同学相处中感到“好心未得好报”,反被误解,恶意相待,于是委屈、怨恨、愤激;又由于心理防御机制的作用,这些挫折反应在潜意识中被转换为对那位同学的压抑的敌意和回避反应导致她产生了泛化心理现象(即由对某一人的敌意、回避发展为对周围的人都产生了戒备心和回避反应);另一方面,自责、自怨加重了她性格中的羞耻心和胆怯。所以,人际矛盾这桩负性生活事件是导致她对人恐怖的直接的、现实的诱因。
4、正值青春期的她,一方面有着正常的与异性接触的愿望;另一方面她已经内化了的有关两性交往的“羞耻感道德意识”有意无意地使她批判自己的想法,抑制自己的欲望。因而,她常常处在一种是否与异性交往的心理冲突之中。而害伯、羞于见男生这种病态反而减轻了她的这种冲突。从心理学上讲,躯体的“症状”是内心冲突的“改头换面”。
5、当她出现对人恐怖反应后,便批评、督促自已该怎样怎样,控制自己不要怎样怎样,这就产生了一种暗示、强化“症状”的作用。再加之她愈感到“不自然”头脑中就愈多地出现“想象观念”。这进一步导致了她的自我感觉恶化。如此恶性循环,“症状”便日益严重了。她在这种想改变又未能改变,想摆脱又无力摆脱的困境中,早年的负性心理印痕被激活了,与现实问题交织在一起,产生了综合作用。这就是为什么除了回避同性,害怕男生外,还那么怕上课的老师的缘故。
在吴某对自己人际恐怖症状成因有了理性的认识之后,焦虑心情有所缓解。
第三阶段:运用系统脱敏疗法进行放松训练
由于个体在人际交往有心理恐惧感的同时还伴有强烈的焦虑、紧张和抑郁情绪,且和心理恐怖感产生交互作用,进一步加深患者的痛苦,所以在鼓励其带着症状自然生活的同时,辅以交互抑制松驰训练和躯体放松技术,利用这种方法诱导求治者缓慢地暴露出导致神经症焦虑的情境,并通过心理的放松状态来对抗这种焦虑情绪,。当在社交场合恐怖感觉出现时,意志上不是人为地与之它进行对抗,而是保持情绪自然,以一种新的刺激替代当前的思维活动。让吴某在一个假想的空间里,不断地模拟发生社交恐惧症的场景,不断练习重复发生症状的情节,我不断地鼓励吴某面对这种场面,让吴某从假想中适应这种产生焦虑紧张的环境。当出现恐怖感觉时,进行简单易行的自我放松训练。即让她在一套我的一些语言指令暗示下和轻松音乐伴随下,全身肌肉依次放松。
每天做二至三次想象——放松训练。即在想象中将最想见又最怕见的人(如某位男生),想回避又回避不了的人(如任课老师)突然呈现在自己面前,体察自己的情绪反应和心理反应,然后放松,使情绪和肌体产生由紧张到松驰的反应,最后产生意向上的适应并扩展到现实行为中。
经过几次放松训练法,情景想象的治疗,吴某已经降低了在人际接触过程的敏感心理和焦虑症状,可以实现正常的社交活动,具备了相应的自信和平静。
八、咨询效果评估

吴某自述对人际交往不再感觉焦虑,与男生的交往已能保持轻松自信的态度,不再消极回避。

心理咨询人员观察到吴某在咨询的后期收尾阶段,表情放松,见面、交谈、离开的几个过程中表现出正常的人际交往态度,态度平静、积极,情绪良好。

通过scl-90自评量表对吴某进行复查,人际敏感分数、焦虑分数已恢复到常模水平。考试大收集整理。

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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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咨询时
0 性价比

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