焦点解决疗法探索抗拒客户目标实现新路径

英文原文

Client Resistance in Therapy How to Help Difficult Clients Facing a client who is resistant or possibly hostile to the therapeutic process or therapist can be unsettling and challenge the treatment’s success. However, the therapist must be careful. Labeling behavior as resistant may result from a lack of knowledge or therapeutic skills, and an inadequate response to the situation can damage the client’s progress. Reframed, uncomfortable interactions can strengthen the therapeutic relationship and further treatment, and encourage client growth. This article explores resistance in therapy, the therapist’s potential to reduce its negative impact, and its use as part of the therapy process. While some clients may have unconscious resistance to therapy, others have “conscious, deliberate opposition to therapeutic initiatives that they fail to understand or accept.” Such resistance, or objection, to both the therapist and therapy is sometimes referred to as ‘realistic resistance’ and includes opposition to the therapist’s overall approach to therapy, specific in-session techniques, and some of the terms used by the therapist. Perhaps the biggest issue is not so much the client’s objections, but their potential invisibility. The client may claim and even appear to be on board with the therapy process and the therapist’s recommendations, yet keep their disagreement hidden. However, observant therapists are likely to spot covert acts of resistance when the client uses statements that distance the therapist, avoids particular topics, or physically withdraws from the conversation. Training and experience can help mental health professionals recognize the subtle acts of defiance, address them, and strengthen the collaboration with the client. Client resistance may take different forms, including arguing, interrupting, denying, and ignoring. Several theories attempt to explain resistance in psychotherapy, including the psychoanalytic model, behavioral models, and cognitive models. While resistance can interfere with collaboration and therapy, it should not cause it to stop. Such therapeutic ruptures can serve as vehicles that may be used to deepen the therapeutic bond and promote growth. They allow both client and therapist to practice interpersonal conflict resolution skills and promote growth that may not occur in their absence. There are several ways of fostering growth by encouraging the client’s agency, such as allowing the client to find and develop their skills and means to address problems, using open-ended questions to help the client explore their personal experience without influence, and letting the client sit and silently experience their emotions, even uncomfortable ones. Skilled counselors balance how they handle avoidant responses, remaining sensitive to the client’s needs and feelings while still tackling the reason for being in therapy. Several techniques and strategies can help therapists remain calm and manage the challenging therapeutic process, including calming yourself, expressing empathy, reframing resistance, cultivating patience, seeking support from peers, and considering terminating the relationship if necessary. According to the American Counseling Association, there are several exercises and approaches counselors can use to manage and reduce the negative impact of resistance, such as the reality approach and fostering a two-way street in therapy. Solution-focused therapy focuses on the discussion of solutions rather than problems and helps overcome resistance. Miracle questions invite the client to visualize how the future may look when the problem no longer exists and may be less daunting for the client than dwelling on existing issues. Invite the client to envision and describe how the future could be different once the problem has been resolved. The following therapy questions bring the exercise to life and are less confrontational, potentially avoiding the triggering of resistance mechanisms What do your senses pick up? What do you feel? What are you doing? With whom are you doing it? Where are you living? How much fun are you having? How much income are you earning? What difference are you making in the world each day? Recognizing resistance and taking the appropriate action in therapy may not always be straightforward. Practitioners must watch for subtle indications of avoidance or evidence that the therapeutic alliance is straining. The therapist can then gently raise concerns regarding either what is being avoided or the tensions that arise. They must bear in mind that, ultimately, resistance can provide helpful input to the therapeutic process, offering new insights and the opportunity for growth. It is important to remember that the therapeutic relationship is ultimately the priority. Observing and navigating resistance may require changing approaches and interventions. Indeed, when identified, it may be appropriate to let go of the planned agenda and focus on more pressing issues. The theories, examples, and techniques in this article should help you recognize that encountering resistance may be a significant breakthrough with a client, leading to a more robust client–therapist bond and valuable growth in the client.

中文翻译

治疗中的客户抗拒如何帮助困难客户 面对一个对治疗过程或治疗师表现出抗拒甚至敌意的客户，可能会令人不安并挑战治疗的成功。然而，治疗师必须小心谨慎。将行为标记为抗拒可能源于知识或治疗技能的缺乏，而对情况的不当反应可能会损害客户的进展。重新构建后，不舒服的互动可以加强治疗关系、推进治疗，并促进客户成长。 本文探讨了治疗中的抗拒、治疗师减少其负面影响的潜力，以及将其作为治疗过程一部分的运用。虽然一些客户可能对治疗有无意识的抗拒，但其他人则有“对不理解或不接受的治疗倡议有意识、故意的反对”。这种对治疗师和治疗的抗拒或反对有时被称为“现实性抗拒”，包括反对治疗师的总体治疗方法、具体的会话技巧以及治疗师使用的一些术语。 也许最大的问题不是客户的反对，而是其潜在的不可见性。客户可能声称甚至看起来支持治疗过程和治疗师的建议，但却隐藏他们的不同意见。然而，观察敏锐的治疗师可能会发现客户的隐蔽抗拒行为，例如使用疏远治疗师的陈述、避免特定话题或身体上退出对话。培训和经验可以帮助心理健康专业人士识别这些微妙的挑衅行为，解决它们，并加强与客户的合作。 客户抗拒可能采取不同的形式，包括争论、打断、否认和忽视。几种理论试图解释心理治疗中的抗拒，包括精神分析模型、行为模型和认知模型。虽然抗拒可能会干扰合作和治疗，但不应该导致治疗停止。这种治疗破裂可以作为加深治疗纽带和促进成长的工具。它们让客户和治疗师都能练习人际冲突解决技巧，并促进在它们缺席时可能不会发生的成长。 有几种方法可以通过鼓励客户的能动性来促进成长，例如允许客户找到和发展他们解决问题的技能和手段，使用开放式问题帮助客户在没有影响的情况下探索他们的个人经历，以及让客户坐下来默默地体验他们的情绪，即使是不舒服的情绪。熟练的咨询师平衡他们如何处理回避反应，在仍然处理治疗原因的同时保持对客户需求和感受的敏感。 几种技巧和策略可以帮助治疗师保持冷静并管理具有挑战性的治疗过程，包括让自己冷静、表达同理心、重新构建抗拒、培养耐心、寻求同伴支持，以及在必要时考虑终止关系。根据美国咨询协会的说法，咨询师可以使用几种练习和方法来管理和减少抗拒的负面影响，例如现实方法和在治疗中培养双向沟通。 焦点解决疗法侧重于讨论解决方案而非问题，并帮助克服抗拒。奇迹问题邀请客户想象当问题不再存在时未来可能是什么样子，这可能比纠结于现有问题对客户来说不那么令人生畏。邀请客户设想并描述问题解决后未来可能如何不同。以下治疗问题使练习生动起来，并且不那么对抗性，可能避免触发抗拒机制你的感官捕捉到了什么？你感觉如何？你在做什么？你和谁一起做？你住在哪里？你有多开心？你赚多少收入？你每天在世界上做出什么改变？ 识别抗拒并在治疗中采取适当行动可能并不总是直截了当的。从业者必须注意回避的微妙迹象或治疗联盟紧张的证据。然后，治疗师可以温和地提出关于被回避的内容或出现的紧张关系的担忧。他们必须记住，最终，抗拒可以为治疗过程提供有用的输入，提供新的见解和成长的机会。重要的是要记住，治疗关系最终是优先事项。观察和导航抗拒可能需要改变方法和干预措施。确实，当识别出抗拒时，可能适合放弃计划议程，专注于更紧迫的问题。本文中的理论、例子和技巧应该帮助你认识到，遇到抗拒可能是与客户的重要突破，导致更强大的客户-治疗师纽带和客户的有价值成长。

文章概要

本文围绕“治疗中的客户抗拒”这一主题，深入探讨了抗拒的表现形式、心理学理论解释以及应对策略。文章指出，客户抗拒可能表现为争论、打断、否认或忽视等行为，并可能源于无意识或有意识的反对。抗拒并非总是负面，它可以成为深化治疗关系、促进客户成长的契机。文章介绍了多种应对抗拒的技巧，如冷静应对、表达同理心、重新构建抗拒、培养耐心等，并特别强调了焦点解决疗法（SFBT）中“奇迹问题”等工具在帮助客户探索目标、克服抗拒方面的有效性。通过鼓励客户能动性、使用开放式问题和可视化未来，治疗师可以引导抗拒客户从问题焦点转向解决方案，从而促进积极改变和治疗成功。

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