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疑病症的心理治疗案例-给力心理
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疑病症的心理治疗案例

疑病症的心理治疗案例
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发表时间:2015-02-07 10:43:57 360 0 0

1、来询者基本情况

  方X,男,19岁,山东学生,个子高大,手大脚大,往那儿一站像座小山。上海某高职学校二年级学生。脸色苍白,显得乏力、憔悴。

  2、主诉

  “老师,我有病,可是又怎么也查不出来。”方X犯愁地打开了话匣子。方X家在山东农村,祖辈务农,只有一个叔叔拿工资。从小,宠爱他的叔叔就把他当做自己的儿子来关心照顾,因为,方家就他一个孙子。

  虽然高考不理想,方X只考上了高职,可在他家里人看来已经不错了,毕竟,以后可以彻底摆脱农村。但方X不这么想。“我其实有实力。将来路还长,社会对人的要求也更高,我读完高职后一定还得再提升。”他这时略微提高了点声音。为了打好基础,方X拼命地学着,他给自己定位是现在“班级第一”;日后“连续本科”。

 

  除了学业,方X还有其他目标。自打拿着木头手枪玩游戏起,他就老是当小司令;小学阶段,手臂上始终三道杠;中学里就更不用说,共青团、学生会,他都有不凡的表现。不知怎的,进了高职,方X竟没有被老师指定为干部。气恼之余,他憋着劲拼命表现,果然在后来的选举中如了愿。方X使出浑身解数——志愿者活动、理论学习、文艺表演、体育竞赛、宿舍评比、社会实践……如此长的“战线”他都想带领大家争第一,可是,这一切不会那么容易,他好累!

  就在他为自己心有余力不足的状况担忧不已的时候,一场高热将他击倒。虽然去医院做了多项检查,证实仅仅是上呼吸道感染,但抗不住连续几天的折腾。热度退去,他瘦了一圈,脸色有些苍白。为了少误课,仍有些虚弱的他夹着书本进了教室。可不知怎么,头有些晕,打不起精神来。“糟糕,这可怎么学习?已经拖了十天的功课,够急人了,要是再得点别的病,就更完了。”方X暗暗着急,越着急,头越晕;越头晕,越着急。最后,他趴在了桌子上。

  随后的几个月里,方X都是无精打采。每一个见到他的同学都关切地询问“为什么脸色那样苍白?”他肯定自己患了什么说不上来的病。于是,他开始频频跑医院。他在凡是可能相关的各科都做了检查,结果一切正常,可是他不相信。渐渐的,他觉得自己脑子被锈住了,眼珠转得不灵活了,上课精神集中不了,学习远远达不到应有的效率,更不用说履行自己承担的学生干部的职责了。

  3、分析与诊断

  社会个体在其社会化过程中,由于存在着“趋向更好”的心理动力,会与环境及自我经常发生冲突,这些冲突有可能引发各种心理问题,产生近常态甚至近病态的心理障碍。在青年心理咨询过程中,神经症并不鲜见。它们的基本特征是没有脑的器质性的病变为基础,也没有足以造成脑功能障碍的躯体疾病;当事人对自己的心理矛盾有察觉,只是无力自拔,从而精神痛苦不堪;由于对自己的病态有一定的自知,迫切希望摆脱痛苦,于是常常能够主动求医,寻求帮助;虽然因精神活动能力降低而使学习效率明显下降,但当事人的生活自理能力和社会适应力基本没有缺损;症状的表现并非偶然,而是持续或断续出现,至少缠绵数月,等等。方X的问题也基本归于此类。

  会谈中,方X明显表现出主观、任性、好强、过分自责以及求全、求完美等个性特征,而外部环境的文化变迁迅速、社会竞争激烈、人的选择性日益增强的情形又使他的精神及心理负荷更为加重,再叠加上对自我的过分高而缺乏弹性的目标,使得方X为了达成自己心目中的成功目标——学业中的第一名、社会工作中的第一名以及直接从高职专科升为高职本科,而长期处于高度紧张状态。缺乏必要的身心松弛,不能适当地进行自我调节,紧张、焦虑、压迫感又是如此之强烈,久而久之,他的大脑功能出现了潜在的失调。当发生偶然性的疾病时,方X变得过分的敏感、多虑。越是着急,焦虑、症状就越是明显;将注意力几乎全都放在了自己的“病症”上,使得他对自己的健康越来越没有信心;同学们关切的问候成了不良的暗示,进一步被他视作“自己的病任何一个明眼的人都能看出来”的“证据”,方X陷入了一个巨大的恶性循环圈之中而难以自拔。作为如此不断消极强化结果的疑病性神经症状的出现也就具有一定的必然性了。

  4、治疗与建议

  首先,建议方X去寻求他认同的权威的医学专家进行诊断。很快,一系列的必要的检查与化验明确排除了他大脑存在器质性病变的可能性。随后,帮助方X确立对疑病性神经症的正确认知。从病因、性质、机理及可能引起波动的各种因素和应对措施等方面,通过认知领悟帮助其走出认识误区,阻断以往的消极循环,树立治愈的信心,为科学的自我调治打下认识基础。接着,与方X一同探讨如何完善自己的个性,如何选择和设置适合于自己的独特的奋斗目标。由于问题的起因与他的不良人格因素和认知偏差导致的心理失调密切相关,因而,与其一同探讨完善个性的意义和需要加以关注的内容,帮助其认识自己独特的价值,发现真正的自我,学习进行选择,对自己做出成熟的、恰当的选择,显得非常重要。探讨中,方X整理了自己的价值观念,发现其实自己更加看重的是学业的成就和与别人相处时,受大家欢迎,这些在总体上表现为智能的和社会的需要。而过分刻板地追求各方面的“第一”,只会使自己在紧张、焦虑不安中不断产生“受挫”和“不愉快”的感受,进而使自己的心理冲突加剧,并在不合理认识的基础上让心理压力不断升级,最后在外界对自己的高要求和自己内在的高要求都毫无弹性而自身应对问题的能力却在下降的情形下,陷入难以自拔的困境。看清了自己个性上的不足,探索清楚了自己的价值观,把过高的自我期待降了下来,制定适合于自己的富有弹性的目标,选择自己所定义的独特的“成功方案”,在循序渐进中保持一种愉快、积极自信的状态,这样注意劳逸结合、协调生活节奏、避免大脑神经活动长时间处于紧张状态才成为可能,真正的成功才会由憧憬变为现实。

  此外,鼓励方X适当锻炼身体,积极调节身心,还教会他自我放松疗法,通过有意识的主观意念活动和自我心理锻炼,控制自己的人体机能活动,达到身心平衡和自我保健的目的。

  5、小结

  当事人特别关注自己的身体状况,对自己的健康水准过分低估,深信自己得了某种疾病,并为此忧虑不已,影响了正常的学习生活。尽管在求医过程中经过医生的多次检查得到否定的诊断,依然坚持自己的看法,焦虑、忧郁不堪。这是疑病性神经症的表现,已经超出了正常范围,当属近病态的心理障碍。

  虽然从青年学生整体而言,神经症只占很小的比例,但是它对青年的身心健康发展危害很大,严重的会使学生难以继续学业,从而丧失一次重要的人生发展机遇,甚至进一步损害格的健全,使之无法自立于社会。因此,它应该引起我们的重视。

  由于神经症的病因和发病机制比较复杂,涉及个体的人格缺陷、精神因素导致心理活动失调、儿童经历对现实产生的影响、生活中的挫折与不幸事件等,在咨询辅导治疗时,也同样应从完善个性、调整认知、学习建立健康的行为模式、积极的调节身心等方面着手,必要时还要辅以一定的药物治疗。

  同时,还应该特别注意学会鉴别神经症与精神病,是否有幻觉妄想,是否保持社会生活的适应能力,神经系统的紊乱是否暂时,当事人是否有自知,这些都需要加以注意,进行区别。

 

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本文作者

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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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