Raffaele Popolo, Giancarlo Dimaggio, Angus MacBeth, Paolo Ottavi, Antonella Centonze
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引用次数: 0
Abstract
Individuals diagnosed with Complex PTSD (C-PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within-session, challenges with patient-therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom-focused work. We describe a case study involving a 38-year-old woman presenting with C-PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C-PTSD (with or without comorbidity).
被诊断为复杂性创伤后应激障碍(C-PTSD)的患者经历过反复且经常是长时间的创伤事件。从治疗的角度来看,这可能会导致治疗过程中的情绪调节困难、患者与治疗师之间的默契面临挑战,以及治疗互动过程中的情绪核心调节受损。因此,治疗联盟可能会频繁破裂,这反过来又给以症状为中心的工作带来了挑战。我们描述了一个案例研究,该案例涉及一名 38 岁的女性,她患有 C 型创伤后应激障碍、解离症、焦虑症以及边缘型和依赖型人格障碍。我们探讨了在治疗过程中,调适和情绪调节方面的困难如何主要归因于(i)关于自我和他人的适应不良观念;以及(ii)难以认识到自己和治疗师的心理状态。例如,患者认为治疗师是疏远的、挑剔的;她认为这是事实,而不是心理状态的反映。我们展示了治疗师如何解决这些困难,修复治疗联盟,从而恢复以症状为中心的工作。案例描述为我们提供了指导,帮助我们在治疗 C 型创伤后应激障碍(无论有无合并症)时,如何保持对治疗联盟和症状的双重关注。
期刊介绍:
Founded in 1945, the Journal of Clinical Psychology is a peer-reviewed forum devoted to research, assessment, and practice. Published eight times a year, the Journal includes research studies; articles on contemporary professional issues, single case research; brief reports (including dissertations in brief); notes from the field; and news and notes. In addition to papers on psychopathology, psychodiagnostics, and the psychotherapeutic process, the journal welcomes articles focusing on psychotherapy effectiveness research, psychological assessment and treatment matching, clinical outcomes, clinical health psychology, and behavioral medicine.