心智化的方法與技術(shù)：第12講課件

AttachmentandMentalizinginSocialSystems:Family,Community,andCulture社會(huì)系統(tǒng)中的依戀和心智化：家庭，社區(qū)以及文化

SocialContextofMentalizingfortheTherapist治療師進(jìn)行心智化的社會(huì)背景Attachmentrelationshipsandsocialsupport依戀關(guān)系和社會(huì)支持Institutionalcontext機(jī)構(gòu)背景Individual(andteam)supervision個(gè)體（以及團(tuán)體）督導(dǎo)Informalconsultationwithcolleagues.

來自同行的非正式咨商Mentalization-BasedFamilyTherapy(MBFT)基于心智化的家庭治療（MBFT）“nocontextismorelikelytoinducealossofmentalizingthanfamilyinteractions”(Bateman&Fonagy,2016)“沒有什么互動(dòng)如同家庭互動(dòng)那樣更容易導(dǎo)致心智化的喪失”（貝特曼&福納吉，2016）Improvingcommunicationisabroadgoaloffamilytherapies;attentiontomentalizingisafocusedwayofachievingthisgoal.改善溝通是家庭治療的一個(gè)主要目標(biāo)；關(guān)注心智化是實(shí)現(xiàn)這一目標(biāo)的重點(diǎn)。ObjectivesofMBFT基于心智化的家庭治療的目標(biāo)1）Mentalizingstance:curiosity,reflectiveness,perspective-taking心智化的立場：好奇心，反思性，觀點(diǎn)采擷2）Understandeachmember’scontributiontoproblembehavior了解每個(gè)成員對(duì)問題行為的貢獻(xiàn)

Mentalization-BasedFamilyTherapy(MBFT)基于心智化的家庭治療（MBFT）3）Tousementalizingtounderstandandregulateemotions使用心智化來理解和調(diào)節(jié)情緒4）Toshiftfromnonmentalizing(controlling)tomentalizinginteractions從非心智化（控制）轉(zhuǎn)向心智化互動(dòng)5）Topromoteparents’competenceinhelpingchildrentomentalize促進(jìn)父母幫助孩子心智化的能力6)Topracticementalizingregardingfamilyproblemareas在存在問題的家庭領(lǐng)域?qū)嵺`心智化FamilyPsychoeducationforBPD邊緣人格障礙的家庭心理教育FamiliesandCarersTrainingandSupportProgram(FACTS)家庭及養(yǎng)育者培訓(xùn)和支持項(xiàng)目（FACTS）Programdesignedtobedeliveredbyfamiliestofamilies項(xiàng)目的目標(biāo)是通過家屬傳遞給家屬Leadersarefamilymemberswhoaretrainedbyprofessionals領(lǐng)導(dǎo)者是經(jīng)過專業(yè)人員培訓(xùn)的家庭成員Familiesshareexperiencesbutthegroupistask-oriented,notasupportgroup家庭分享經(jīng)驗(yàn)，但該團(tuán)體是任務(wù)導(dǎo)向的，而不是支持性團(tuán)體Fivemodules,eachina90-minuteeveningsession五個(gè)模塊，每個(gè)模塊安排在90分鐘的晚間會(huì)談中1）UnderstandingBPD(withsensitivitytoparents’feelingblamed&guilty)了解邊緣人格障礙（并且對(duì)父母的被責(zé)備感和內(nèi)疚感保持敏感性）FamilyPsychoeducationforBPD邊緣人格障礙的家庭心理教育FamiliesandCarersTrainingandSupportProgram(FACTS)家庭及養(yǎng)育者培訓(xùn)和支持項(xiàng)目（FACTS）

2）Understandingmentalizing理解心智化3）Mindfulnessandemotionmanagement正念和情緒管理4）Validationskills(empathizingwithoutaffirmingdestructivebehavior)

確認(rèn)技巧（在不認(rèn)可破壞性行為的情況下表達(dá)共情）5）Problemsolving問題解決AsinMBFT,exercisesareincludedtopracticementalizing與基于心智化的家庭治療（MBFT）一樣，練習(xí)會(huì)包含在心智化的鍛煉中PeacefulSchoolsIntervention和睦校園干預(yù)Ananti-bullyingandviolence-preventioninterventioninitiatedinapublicschoolforearlyelementary-schoolchildren(ages5-10)在公立學(xué)校為低年級(jí)小學(xué)生（5-10歲）開展的反欺凌和暴力的預(yù)防干預(yù)Interventionisdesignedtopromoteamentalizingclimateintheschoolasawhole干預(yù)旨在促進(jìn)整個(gè)學(xué)校的心智化氛圍Everyindividual,teachersandstudents,isinvolvedinbullyinginone(ormore)ofthreeroles,eachofwhichistobementalized(1)bully,(2)victim,(3)bystander.每個(gè)人，教師和學(xué)生，都以三種角色中的一種（或多種）參與到欺凌中，每種角色都要被心智化（1）

欺凌者，（2）受害者，（3）旁觀者。Counselor-leddiscussionsexplaintherolesandencourageperspective-taking(e.g.,bystanders’awarenessofthevictim’sfeelingsratherthancheeringonthebully)咨詢師主導(dǎo)的討論解釋不同角色，并鼓勵(lì)觀點(diǎn)采擷（例如，旁觀者覺察到受害者的感受，而不是為欺凌者叫好）PeacefulSchoolsIntervention和睦校園干預(yù)Classroommanagementincludes“pushingthepausebutton”whendisruptivebehavioroccurs,interruptingtheclasstodiscusstheproblem,avoidingpunishmentasmuchaspossible.課堂管理包括當(dāng)發(fā)生破壞性行為時(shí)“按下暫停按鈕”，中斷課程以討論問題，盡可能避免懲罰。Adultmentors(e.g.,ontheplayground)interveneinepisodesofbullyingandviolencetohelpwithconflictmanagement成年輔導(dǎo)員（例如在操場上）干預(yù)欺凌和暴力事件，以幫助進(jìn)行沖突管理。Physicaleducationprovided(defensivemartialarts)tolearnnon-aggressivestrategiesforself-protection(e.g.,whenpushed,shoved,grabbed).提供體育課程（防御性武術(shù)）以學(xué)習(xí)非侵犯性的自我保護(hù)策略（例如，當(dāng)被人推、搡、抓時(shí)）。Outcomes:Decreasedvictimization&disruptiveclassroombehavior;increasedempathyforvictimsofviolence,improvedacademicperformance,gainsmaintainedfor1year結(jié)果：減少受害和破壞性的課堂行為；增加對(duì)暴力受害者的同情心，提高學(xué)業(yè)成績，效果可維持1年

的時(shí)間CulturalVariationinAttachment依戀的文化差異Mainstreamattachmenttheory(asIhavepresentedit)hasbeenvigorouslychallengedbycross-culturalresearch.主流依戀理論（正如我之前介紹的）受到了跨文化研究的強(qiáng)烈挑戰(zhàn)。Mainstreamresearchisaccurateasfarasitgoesbutmisleadingifconstruedascharacteristicofallculturesaroundtheworld.主流研究的結(jié)果基本上是準(zhǔn)確的，但如果被看作是世界上所有文化的特點(diǎn)，則會(huì)帶來誤導(dǎo)。96%ofattachmentresearchhasfocusedon12%oftheworldpopulation.96％的依戀研究集中于世界人口的12％。Universal(cross-cultural)featuresofattachment:依戀的通用（跨文化）特征：ensuressafeengagementwiththeenvironmentwhilesupportingpsychobiologicalregulation確保與環(huán)境的安全接觸，同時(shí)支持心理、生理的調(diào)節(jié)providesanentrypointforsociallearning提供社會(huì)學(xué)習(xí)的切入點(diǎn)CulturalVariationinAttachment依戀的文化差異Culturaldifferencesareassociatedwithvastlydifferentpatternsofcaregiving,attachment,andsocializationgoals.文化差異與極其不同的養(yǎng)育模式、依戀和社會(huì)化目標(biāo)有關(guān)。Twobroad(butoverlapping)culturalcontexts:兩種廣泛（但有重疊）的文化背景：dyadic(maternal)attachments二元（母性）依戀socialnetworks社會(huì)網(wǎng)絡(luò)—Otto&Keller(2014).Differentfacesofattachment—Otto&Keller(2014)，依戀的不同面—Keller&Bard(2017).Theculturalnatureofattachment—Keller&Bard(2017)，依戀的文化性質(zhì)MajorContrast主要對(duì)比Dyadic(maternal)Attachments二元（母性）的依戀Ainsworth:sensitiveresponsiveness;Fonagy:mentalizingthechild安斯沃斯：敏感的響應(yīng)性；福納吉：心智化孩子Sensitizeschildrentoexperiencethemselvesasseparateanddistinct,withneedsanddesiresoftheirown;toactbasedonwhattheythinkandbelieve;andtochangetheirenvironmentaccordingly.

使孩子敏感地體驗(yàn)到他們自己是獨(dú)立和獨(dú)特的，可以擁有屬于他們自己的需求和欲望；可以根據(jù)他們自己的想法和信念采取行動(dòng)；并可以相應(yīng)地改變他們的環(huán)境。Promotestrustinmotherandotherindividuals(dyadictrust)促進(jìn)對(duì)母親和其他個(gè)體的信任（二元信任）MajorContrast主要對(duì)比SocialNetworks社會(huì)網(wǎng)絡(luò)controlchild’sactions,anticipatechild’sneeds控制孩子的行為，預(yù)測孩子的需求dampenchild’semotionalexpressiveness抑制孩子的情緒表達(dá)性teachchildrentoseethemselvesasothersseethem教導(dǎo)孩子如何從他人的視角看自己intensifysocialconnections,strengthenactionsthatmaintainthem加強(qiáng)社會(huì)聯(lián)結(jié)，強(qiáng)化維持聯(lián)結(jié)的行動(dòng)promotesocialtrust(trustincommunity)促進(jìn)社會(huì)信任（對(duì)社群的信任）Dyadic(Maternal)Attachments二元（母性）的依戀CulturalContext文化背景WEIRD(Western,Educated,Industrialized,Rich,Democratic)WEIRD（西方的W、受過教育的E、工業(yè)化的I、富裕的R、民主的D）parenthoodatolderage,fewerbirths

成為父母時(shí)年齡較大，生育數(shù)較少smallnuclearfamily小型核心家庭5%ofworldpopulation世界人口的5%Caregiving養(yǎng)育1）motherasprimarycaregiver;dyadicattachment;strangeranxiety母親作為主要養(yǎng)育者；二元依戀；陌生人焦慮Dyadic(Maternal)Attachments二元（母性）的依戀2）child-centered(childiscenterofattention;face-to-faceinteraction)以兒童為中心（兒童是關(guān)注的焦點(diǎn)；面對(duì)面的互動(dòng)）3）mind-minded(mentalizing)focusoninnerworld,verbaldialogue對(duì)心靈的思考（心智化）專注于內(nèi)在世界，口頭對(duì)話4）sensitivelyresponsivetoinfants’expressionofemotionaldistress敏感地響應(yīng)嬰兒表達(dá)出的情緒困擾5）securityinemotionalcomforting情緒安撫的安全感6)appropriatelyassessedinlaboratory(StrangeSituation)適宜在實(shí)驗(yàn)室中進(jìn)行評(píng)估（陌生情境）SocializationGoal:Independence社會(huì)化目標(biāo)：獨(dú)立psychologicalautonomy,selforientation心理自治，自我引導(dǎo)SocialNetworks社會(huì)網(wǎng)絡(luò)CulturalContext文化背景1)farming,pastoral,foraging,hunter-gatherer,subsistence,indigenous農(nóng)業(yè)、田園、覓食、狩獵采集、生計(jì)、土著2)parenthoodatyoungerage,manybirths;higherinfantmortality成為父母時(shí)年齡較小，分娩多；嬰兒死亡率較高3)largeextendedkinnetwork+non-relatedcaregivers大型擴(kuò)展親屬網(wǎng)絡(luò)+非相關(guān)養(yǎng)育者Caregiving養(yǎng)育1)multiplecaregivers(“Ittakesavillagetoraiseachild”—Africanproverb)多個(gè)養(yǎng)育者（“撫養(yǎng)孩子需要一個(gè)村莊”–非洲諺語）SocialNetworks社會(huì)網(wǎng)絡(luò)2)continuousphysicalavailabilityandbodycontact持續(xù)的身體可獲得性和身體接觸3)neveralonebutneverthecenterofattention;minimalstrangeranxiety永遠(yuǎn)不會(huì)孤單，但從不是關(guān)注的焦點(diǎn)；最少的陌生人焦慮4)comparativelylittleface-to-facecontactorverbalinteraction相對(duì)較少的面對(duì)面接觸或口頭互動(dòng)5)securityincontinuousavailabilityofcommunalprotectionandcare公共保護(hù)和照料的持續(xù)可獲得性6)inappropriatelyassessedinlaboratory(StrangeSituation)不適宜在實(shí)驗(yàn)室中進(jìn)行評(píng)估（陌生情境）SocializationGoal:Interdependence社會(huì)化目標(biāo)：相互依存obedience,conformity,properdemeanor,respectforauthority服從、順從、正當(dāng)行事、尊重權(quán)威Cross-CulturalResearch(Mesman,2016)跨文化研究（Mesman，2016）AttachmentinChina中國的依戀1)AllstudiesinChinaconfirmuniversalityofattachmentclassifications所有在中國的研究都證實(shí)了依戀分類的普遍性2)Majorityofchildrensecurelyattached大多數(shù)兒童是安全依戀3)Relativelylowprevalenceofavoidantattachment回避型依戀相對(duì)較少Supportforcross-culturalvalidityofattachmenttheory支持依戀理論的跨文化有效性1)Attachmentbehaviorisuniversalasareclassifications依戀行為與分類一樣具有普遍性2)Inalmostallcultures,majorityofinfantsclassifiedsecure在幾乎所有文化中，大多數(shù)嬰兒都是安全的Cross-CulturalResearch(Mesman,2016)跨文化研究（Mesman，2016）3)Sensitivecareisassociatedwithsecureattachment敏感的養(yǎng)育與安全依戀相關(guān)4)Securityrelatestopositivedevelopmentaloutcomes(wherestudied)安全性與積極的發(fā)展成果有關(guān)（有研究支持）Qualifications限定條件1)“currentcross-culturaldatabaseisalmostabsurdlysmall”“目前的跨文化數(shù)據(jù)庫幾乎都是出奇地小”2)Extremelylimitedresearchonattachmenttonon-maternalcaregivers關(guān)于非母親養(yǎng)育者依戀的研究極其有限3)Limitedresearchondevelopmentaloutcomes,whichareculture-specific對(duì)發(fā)展結(jié)果的研究有限，發(fā)展結(jié)果是有文化特異性的4)Attachmentbehaviorandmaternalsensitivitytakedifferentforms依戀行為和母親的敏感性有著不同的（表現(xiàn)）形式AsenE&FonagyP(2012).Mentalization-BasedFamilyTherapy.InAWBatemanandPFonagy(Eds.),Handbookofmentalizinginmentalhealthpractice.Washington,DC:AmericanPsychiatricPublishing.BatemanAW&FonagyP(2016).Mentalization-BasedTreatmentforpersonalitydisorders.NewYork:OxfordUniversityPress.FonagyP,Luy