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一例失恋受挫的心理治疗案例分析-给力心理
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一例失恋受挫的心理治疗案例分析

一例失恋受挫的心理治疗案例分析
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发表时间:2015-02-06 16:48:29 392 0 0

一、一般资料
小宇,男,24岁,某大学研究生二年级学生,独生子女,满族,爱新觉罗氏。出身高干家庭,父亲严格,母亲早逝,后娶了一位年纪很小的妻子。自小跟爷爷奶奶过,与奶奶的感情至深,而与父亲关系疏远,父子关系紧张。该求助者性格开朗,为人热情,但性格执拗,在很多事情上喜欢一意孤行。奶奶溺爱他,在家里自己说了算,在学校里,颇受老师、同学的喜欢,学生会主席。成长经历一帆风顺,未遭遇大的挫折。

 

二、来访者主诉

两个月前,我的情绪就一直很消沉,用现在时兴的话来说就是“颓废”吧。任何事情都激不起我的兴趣,连我最爱的篮球也不行。我觉得生活中再也没有让我开心的事儿,上课和做实验都进不了状态,还有一个月就要开题,可我现在根本无法专心学习。每天到了图书馆,不是磨磨蹭蹭地虚度时间,就是趴在桌上睡觉打发时间,而且经常在午夜躲在被窝儿里哭、回忆往事。在虚度时间后,我又会好自责,焦虑得不得了,可还是改变不了这种一直低能的状态,在学习的时候经常走神。实在没辙了,我就想到来心理咨询中心求助。

 

三、咨询师观察:

该求助者身材高大,五官端正,打扮清爽,但精神面貌极差,目光暗淡,面无表情,浑身无力。落座后,头低垂胸前,双手紧合,双肩下垂,毫无生气。

 

四、心理评估与诊断:

1、按照病与非病的原则: 

该求助者主客观统一,认知、情感、意志统一,身心协调一致,人格稳定,所以排除精神病症状。

2、按照许又新神经症三标准: 

因为该求助者病程特别短,评1分;精神痛苦程度看起来虽重,但持续时间较短,借助外界帮助可以摆脱,评2分;社会功能虽有所受损,但社会交往能力没有受太大影响,所以,社会功能受损方面最多给2分,总分5分,排除神经症。

3、通过咨询师观察,作出如下诊断

(1)情绪低落。小宇情绪低落无法振作起来,觉得整个世界都是灰暗的,他的生活也失去了原有的快乐。

(2)学习效率不高。小宇上课和做实验时都会出现强迫性分心的现象。据他本人讲,他很想好好学习,但就是一到上课时间,就无法集中注意力。上图书馆时,也会看着书本发呆,自己也不知道都想些什么,就是无法专心学习。

(3)性格变得内向封闭。自从学习低能低效后,小宇就变得异常封闭,不愿与外界接触,不但不愿意参加班上的任何活动,就连寝室同学的小聚会也躲得远远的。

(4)自我评价过低。小宇不但性格发生了变化,而且自信心也受到严重打击,变得很自卑,觉得别人都比他强,看不到自己的任何优点。

(5)对于现状很焦虑。小宇本身自省能力很强,能够经常反省自己的表现,当小宇觉察出自己目前面临的情况时,感到很焦虑,但无法改变现状。

 

五、心理咨询目标制定:

根据评估,同本人协商并经其同意,确定如下咨询目标:

①咨询师和求助者建立起良好咨询关系;

②让求助者对爱情有正确认识;

③解决自我评价过低,找回自信;

④解决注意力不集中,学习效率低下的问题;

⑤完善个性,增强其适应性,加强其调控情绪,适应社会能力。

 

六、咨询方案的制定:

咨询所用原理:贝克、雷米认知疗法

1、贝克理论

贝克认为如果个体不能正确使用共同感受这一工具来处理日常生活中的问题,或是对自己自动化思维中某些错误观念不能加以内省,或是过分按规则行事,都会造成认知歪曲,产生不良的情绪和不适应的行为问题。贝克坚信有情绪困难的人倾向于犯一种特有的“逻辑错误”,即将客观现实向自我贬低的方向歪曲。同时他认为心理问题是缘于一般过程的,如错误思维,在思维不足或错误思维的基础上进行的不正确的推理以及不能区分现实和想象。

贝克另外一个观点是:改变功能失调的情绪和行为的最直接方式就是修改不正确的及功能失调的思维。而认知咨询师就是要让求助通过评价过程来确认这些歪曲的和功能失调的认知。在咨访双方共同努力下,求助者学会把他们的想法和现实中发生的事区分开来,让他们了解到认知对他们的情感和行为的影响,甚至对环境事件的影响。咨询师还教给求助者识别、观察和监督自己的想法与假设,尤其是那些负性的自动想法。

 在现实治疗过程中,贝克还特别重视求助者的潜能。他强调咨询师应注意引导求助者去充分调动和发挥自身内部潜在能力,对自己认知过程进行反省,发现自己的问题并主动加以改变。

2、雷米理论

雷米和贝克理论基本前提都是一致。即都认为导致不适应行为和情绪的根本原因是错误的认知过程和观念。而雷米理论主要强调这些错误观念的存在状态,即这些观念是什么样的顺序和方式表现出来并发生作用的。因而,雷米提出“中心—边缘”模型,即错误理念有主要观念和次要观念。只有解决了那些表层的或边缘的错误观念,才能逐步揭示出那些处于中心位置的基本错误观念。那么治疗目的是要揭示并改变那些中心的、深层的错误观念;而治疗的手段则应从边缘、表层的错误观念入手,逐步靠近中心,挖掘深层并最终予以纠正。

3、依据以上原理,其疗法基本过程如下:

1)建立咨询关系

 良好的咨询关系对任何种类的心理治疗都非常重要,它是治疗得以持续下去的基础,而在此咨询师既是诊断者又是教育者。

2)确定咨询目标

因为错误的认知和观念是导致情绪和行为问题的根源。因此我咨询的根本目标就是要发现和纠正错误观念及其赖以形成的认知过程,使之改变到正确的认知方向上来。

3)确定问题:提问和自我审查

提问,就是咨询师提出某些特定问题,把求助者的注意力导向与他情绪和行为密切相关的方面。而自我审查,就是鼓励求助者说出他对自己的看法,并对自己的这些看法进行细致的体验和反省。

4)检验表层错误:建议、演示和模仿

所谓表层错误观念或边缘性错误观念,就是指求助者对自己的不适应行为的一种直接的、具体的解释。建议求助者进行某一活动,让求助者检验自己原来解释是否正确。而演示则是让求助者演示某个“角色”,通过观察体验“角色”使他能够更为客观地看待自己问题。模仿则是要求助者去模仿某个特定示范者行为,让求助者直接去体验与之相联系的情绪产生过程。

5)纠正核心“错误”:语义分析技术

语义分析针对求助者错误的自我概念,具体方法有突变祛除、重新归因、认知重建等。

6)进一步改变认知:行为改变技术

该理论认为,认知过程决定着行为的产生,而同时行为的改变也可以引起认知的改变。

7)巩固新概念,认知复习

认知复习是以布置家庭作业或让求助者阅读有关认知疗法,材料的方式给求助者提出某些相应的任务,它实际上是前面几个咨询过程在实际生活情景中的进一步延伸。

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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
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