认知行为治疗、图式治疗和监督中权力的使用和滥用。

Neuro endocrinology letters Pub Date : 2025-04-28
Jan Prasko, Marija Abeltiņa, Jakub Vanek, Ilona Krone, Julius Burkauskas, Julija Gecaite-Stonciene, Alicja Juskiene, Frantisek Hodny, Milos Slepecky, Marta Zatkova, Marie Ociskova
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引用次数: 0

摘要

背景:权力动力学是心理治疗和监督关系的基础。在认知行为治疗(CBT)和图式治疗(ST)中,治疗师的权力管理可以帮助患者做出积极的改变。另一方面,滥用权力会损害患者的自主权,使治疗结果恶化。了解这些动态对于有效和合乎道德的实践至关重要。目的:本文旨在探讨权力和无力感如何在认知行为治疗(CBT)和图式治疗(ST)的实践中表现出来,分析它们对治疗和监督过程的影响,识别滥用权力的风险,并提出支持患者和被监管者自主的策略。方法:本文对权力在治疗和监督中的表现形式进行理论和实践分析,并以案例插图说明重要过程。讨论包括CBT和ST的比较,重点是他们各自的权力动力学方法。道德原则,监督实践,文化和制度的影响也进行了检查。结果:在治疗和监督中有效使用权力可以增加来访者和被监管者之间的信任、合作和自主性。在CBT治疗和监督中,治疗师和患者或主管和被监管者之间适当的权力分配促进了患者或被监管者的参与。然而,过度的指令性有时会威胁到双方的关系。在ST中,有限的修复是治疗和监督关系的主要载体,治疗和监督领导需要治疗师或主管提高敏感性,以避免强化适应不良模式。依赖于协作方法的监督方法比那些由等级权力结构主导的方法更能支持专业成长。结论:对权力动力学的反思在认知行为和图式治疗中对于维持伦理和有效的治疗和监督关系至关重要。有助于保持权力平衡的策略包括遵守道德原则、自我反省和定期监督。未来的研究应侧重于开发创新方法,以捕捉治疗和监督中的权力分配问题的解决方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The use and misuse of power in cognitive-behavioral therapy, schema therapy, and supervision.

Background: Power dynamics are fundamental to therapeutic and supervisory relationships in psychotherapy. In cognitive-behavioural therapy (CBT) and schema therapy (ST), the therapist's power management can help the patient make positive changes. On the other hand, the abuse of power can undermine the patient's autonomy and worsen therapeutic outcomes. Understanding these dynamics is essential for effective and ethical practice.

Objectives: This article aims to explore how power and powerlessness manifest themselves in the practice of cognitive behavioural therapy (CBT) and schema therapy (ST), analyse their impact on therapeutic and supervisory processes, identify the risk of abuse of power, and suggest strategies to support patient and supervisee autonomy.

Methods: The text provides a theoretical and practical analysis of the manifestations of power in therapy and supervision, illustrated with case vignettes to explain important processes. The discussion includes a comparison of CBT and ST, focusing on their respective approaches to power dynamics. Ethical principles, supervision practices, and cultural and institutional influences are also examined.

Results: Effective use of power in therapy and supervision increases trust, cooperation, and autonomy for both client and supervisee. In CBT therapy and supervision, collaboration with an appropriate power distribution between therapist and patient or supervisor and supervisee promotes patient or supervisee engagement. Still, excessive directiveness can sometimes threaten the relationship. In ST, where limited reparenting is the main vehicle for the therapeutic and supervisory relationship, therapeutic and supervisory leadership requires increased sensitivity by the therapist or supervisor to avoid reinforcing maladaptive modes. Supervisory approaches that rely on collaborative approaches are more supportive of professional growth than those dominated by hierarchical power structures.

Conclusions: Reflection on power dynamics is vital in cognitive-behavioural and schema therapy for maintaining ethical and effective therapeutic and supervisory relationships. Strategies that help maintain a balance of power include adherence to ethical principles, self-reflection, and regular supervision. Future research should focus on developing innovative methods to capture solutions to power distribution issues in therapy and supervision.

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