邻家心理医生第一季

本期乐天心理成长沙龙中，咨询师和爱好者们围绕《扪心问诊》第一季第一集展开赏析。篇幅所限，我们将精彩内容截录如下，尤其是咨询师表现突出之处。点击获得全部内容及观影地址。

【引言】

这是个移情的个案，来访者Laura向咨询师Paul告白的大反转是这集的主线。Paul的处理既有大师级应对，也有张皇失措，跟着我们往下看。

【Laura兜圈子，试探Paul】



沈：这里咨询师的表现是比较中立的，大家可以看得到。大家可以想象一下，如果在咨询室，来访者问你“我悲伤的时候是不是很好看？”咨询师怎么说会比较好？

郑：这个问题是flirting吧？像问心上人没有收到回应。

沈：她预期的反应是咨询师会像那个男人一样说我悲伤的时候也不错，或者至少也挺好看的。

郑：再不济那个问题也集中在她身上，现在她瞬间泯然众人了。

沈：对。所以咨询师也要注意我们在咨询室里如果碰到来访者问这种问题千万不要简单地回答。因为这个她其实是有问题的。

郑：作为男性咨询师沈老师你会怎么回答？

沈：哦，我可能也会跟Paul一样，我会站在一个中立的角度。不能刻意去讨好来访者，但是也不能去回绝她，或者说指责她。

李：我觉得我的反应会给予一个模棱两可的答案。正常社交里人家这样问会起作用，就算不好看我也不会这么直接，我可能会说“其实我也不知道好看或是不好看”。我觉得在对话之间我的自然反应当时会反应出来。我觉得他这里还是蛮咨询师的回答。如果我在这个状态和她交流，我可能就模棱两可，既不是说好也不是说不好，就说“嗯”，这样点一下头，其实就很模棱两可，让她自己去理解这是好还是不好。

郑：我总觉得Paul在那时感到了什么，那些动作。

沈：其实这里是有伏笔的，来访者在乎咨询师对自己是什么看法。

【Paul点出时机问题】


沈：这里咨询师问到一个很关键的时机问题。为什么是现在？我觉得这个是这个咨询师做的最到位的一个点，就是把这一点指出来，为什么是现在？这个点非常关键。为什么不是半年前，一个月前，一个月后，而是现在？这个点问得很好。

郑：咨询师怎么会想到问这个点呢？我们现在马后炮知道他问了这个，如果你们作为咨询师在这个场景下也会选择问这个问题吗？你们也会关注时机吗？当她从卫生间回来之后。

沈：我不知道我当时可能会展开问些什么，但我就觉得咨询师这个点问得特别好。如果我可以问出他这个问题的话我会觉得他这个咨询抓住重点了。因为有时候来访者说了很多东西，咨询师就像要去捕捉关键点的一个角色，但你捕捉的不一定是和她的处境和问题很有关系的一个点。但咨询师现在这样问可以把一个重要的点引出来。

李：我记得问事件发生时间点在面询培训里也是作为模式一样的提供给我们。因为你刚刚开始做咨询不知道怎么问嘛，但是老师都会告诉你抓住这个点去问。问题呈现以后去问这个时间点，你为什么这个时候才来做咨询，是比较便于理清思路的一个方式。她前面不是说了很多嘛，如果你顺着她说的问题在男朋友之上，顺着这个下去会偏。有时候问题比较多的时候理不清，理不清就回到问题发生的这个时间点去帮自己重新把这个东西拉回来。尤其是已经描述了很多，大家都在兜了很大一个圈子，需要重新回到时间点，把主线拉回来，是这种感觉。

沈：对，经常你会发现访客没有这方面感觉，她就想到什么就说，但她其实会绕圈子，而且会偏离核心，这时候就需要咨询师一个拉回来的动作，把她拉回到一个需要讨论的话题。

李：很多时候我们和来访者聊了这么多以后你也跟她一起转了。像她这种断掉再回来你可能会回去强调你挖到的那些点，顺势挖掘下去。他没有，他是回到事件发生的时间重新拉了一个主题出来。

郑：你不会担心她的事实还没有完全讲完，还没有发散开发散够？

李：你看从它情景设计上就像一个断开，再重新开始的感觉。正好她前面离开了一下。

沈：接下来就是到她和Andrew的吵架，咨询师指出最初这事是你挑起的。她还是一开始习惯于让别人来承担责任。

李：我是觉得他后面这段对话很厉害，因为我来做的话我不会那么大胆，他已经把所有的主动语态都归到她了。

沈：是的，这是有前提的。这是因为他们已经做了一年的咨询了，他们的咨访关系已经比较牢固了。咨询师不用担心我的些许冒犯会影响到我们的咨访关系，已经建立好了。一年了，已经相互信任了，不会你质疑我我就觉得没有信任感。

郑：Laura居然真的觉得不是自己挑起的，我好吃惊。

李：防御机制在，自己把自己也给糊弄了。

沈：因为她其实一直是倾向于把责任归到他人的，你可以从她之前的很多表述中就看得出来，这是她的一个习惯。

郑：不是说她在有些地方是滞后，其它的地方是正常的吗？

沈：她在建立亲密关系这一块，亲密关系的处理中是比较像小孩子一样的，好像我没办法，你们负责的，你们推导、引导，你们做主的，这都是你们挑起来的，你们应该承担责任，而没有想到这事她自己应该要承担的责任。

【Laura告白，Paul应对】



沈：在这里你们觉得Paul真的没有察觉吗？

李：是你你会怎么说？

沈：我肯定会察觉的，如果来访者这么说我肯定会察觉到的，我肯定会察觉她对我有不一样的感觉，或者说有其它的一层意思。但是这里你们觉得Paul是假装没有察觉到还是真的没有察觉到？我个人倾向于是假装。

郑：我觉得是真的诶。他看起来像是真的懵逼了。

沈：我不这么认为，我觉得是Paul感觉到了，但他不知如何反应所以只能装作自己没有感觉到。我是这么理解的。

许：我也这种感觉。

李：如果你碰到这种咨客，把你不愿提的问题翻过来了，挑明了，你会怎么处理？

沈：我会直面的，我不会用他这个方式。

李：他这个等于是我在知道我装傻。

沈：对对，装傻充楞，我不会用这个方式。至少他第一反应是装傻，可能他之后会调整，但他听到的那0.1秒钟时间他选择的是装傻。但是我在第0.1秒就不会逃避这个问题，我就会跟她谈论这个话题。Paul作为咨询师是有顾虑的，因为咨询师不能和来访者发生以外的关系，他在考虑要不要接，所以我觉得Paul肯定是没有准备好的。然后来访者肯定是对Paul的反应很不舒服的，因为她觉得Paul是装的。

沈：咨询师承认了。咨询师这个问题就是承认我知道你要表达的意思了，那你期待的是什么反应呢？

李：女咨客是把东西翻出来了，但是Paul的第一反应是先阻挡一下，翻过去了。但是他出于咨询的考虑，第二次的时候他又把这个问题再浮出来了。

沈：对，因为他知道咨询师正确的方式是要直面，而不是逃避这个问题。

许：我是感觉这个咨询师是貌似有这个感觉，但不确定Laura指的是她，就是感觉有事要来了，山雨欲来风满楼。

沈：至少这个时候咨询师知道了，他问得也不错，你期盼什么反应？

【Paul以职业操守为由拒绝Laura】


沈：他说这么慢肯定是有原因的，在挣扎。

李：对，他说这么慢感觉一方面是在帮咨客做个澄清，另一方面是在帮助自己做个澄清。想不到办法的话，这个办法比较保险。到这里咨询已经结束了，他不再帮她做任何治疗的效果。

沈：对，要澄清，划清一个界限。我要是咨询中发现这个情况也是要先做一个澄清，然后再跟她探讨问题，不能先探讨这个话题，会造成误解，感觉就是她有希望。他接下去没有探讨因为时间到了，但是接下去会探讨。美国是这样的，心理咨询到时间就结束。它不像我们是一个问题探讨完才结束。

第一集我是完全没有从Laura有点混乱的叙述中听出她喜欢医生。以后再重看，看看能不能分析出来。
第二集他一开始提到Dan是gay我就有点怀疑他也是gay了。医生提到他妈死亡的时候我感觉这个人肯定是对死亡的痛苦和恐惧太深，又不会疏导，所以把这种感情深深压抑下去，不敢面对。他的典型的完美主义者啊，用完美主义的表象掩盖自己的弱点。他不敢承认自己是不完美的这一事实。他害怕做决定，害怕承担责任，我也一样啊。我是如此害怕做决定，如此害怕承担后果。我其实像一个5岁的小女孩啊。
哎呀，第三集的小姑娘和我很像啊，谈论悲伤的事情时会笑，很有自杀倾向，不爱谈论自己，独生女。When she was angry, she wanted her mother to call just so she could get angry with her.
google 了erotic transference，找到这一篇

A Remedy for Family Failure

Now, one very common lack in contemporary families is the failure to treat children with unconditional nurturing guidance and protection. So instead of learning true love in their families, children—through all sorts of family manipulation and game-playing, if not outright abuse—are essentially taught to fear love. And the pain of all this loneliness, guilt, and fear will live on in the unconscious, in a sort of timeless emotional imprisonment, even as the child grows through childhood and adolescence to adulthood.

So, suffering from psychological pain, you will seek out psychotherapy. Through healthy and honest interactions with a psychotherapist, you can learn to think and act in new, emotionally honest ways, different from the psychological defenses created in childhood, and current problems and symptoms can be remedied.

In this profound interaction with the psychotherapist, however, a new problem can emerge.

 
Feeling Special

As you begin to encounter genuine concern for your well-being, the whole experience of psychotherapy can feel overwhelming and intoxicating. Once having felt ignored and misunderstood, and now feeling noticed and understood—and not rejected—you can start to feel special. Moreover, you can begin to believe that the psychotherapist is special as well.

When this happens, everything can take on a feeling of erotic “love.”

You see quote marks around the word love in the last sentence because erotic feelings are really feelings of desire, not love. I want to know more about the psychotherapist’s personal life. I want to know what he or she likes. I want to be with him or her outside the psychotherapy sessions. I want to believe that he or she feels an attraction to me. And so on. That’s desire. It’s desire because it is based in what “I want,” not in what you or someone else needs.

  
        

Think for a moment about the whole purpose of family life and wonder what any infant needs. Well, an infant, born into the world completely helpless, needs protection and guidance in order to grow and develop its own abilities, so that, in maturity, he or she can go out into the world to do good for others. That protection and guidance—which is an aspect of true love—isn’t meant to make you feel “happy”; it’s meant to help you develop your unique talents and grow into a productive member of the whole human family.
        

  

Now, true love does have a function in psychotherapy. Love can be defined as “willing the good of another,” and this is precisely what the psychotherapist is ethically bound to do for all clients. The psychotherapist wills the good of all clients by ensuring that all actions within the psychotherapy serve the client’s need to overcome the symptoms that prevent the client from living a useful and meaningful life.

 
Flirting with Emotional Disaster

As unpleasant as it may be to admit it, erotic “love” is based on infantile needs to be received, accepted, and satisfied. When someone feels intensely received, accepted, and satisfied, then he or she is “in love.” But sooner or later that intensity will be broken. The break doesn’t even have to be the result of malicious neglect; it can simply be the result of a need to attend to other obligations in the world, and, in the person feeling neglected, intense jealousy can flare up.

This explains why “lovers,” friends, and blog readers, with all their personal needs and desires, cannot function psychotherapeutically. And it explains philosophically—above and beyond any laws or professional ethics—why psychotherapists cannot be friends or “lovers” to their clients. If they try, it will lead to psychological disaster, for without the “third person” of the unconscious in the consulting room the psychotherapy will degenerate into emotional chaos.

 
Understanding the Erotic Transference

Erotic “love” within the psychotherapy—technically called an erotic transference—is not necessarily a bad thing, though. That is, it’s not a bad thing if it can be understood as one essential step toward learning true love.

Just as any child who receives gifts from others must first go through a phase of development characterized by a “hoarding” or “clinging” mentality—Mine! Mine!—before learning to share with others, so you, in feeling the enthralling acceptance of your psychotherapist, will at first want to hoard that feeling and claim it as your own personal possession. But that feeling can’t stop there, and your psychotherapist’s job is to make sure it doesn’t stop there.

  
        

Sadly, many psychotherapists are not very competent in dealing with subtle psychodynamic issues. In fact, many psychotherapists feel uncomfortable with a client’s erotic transference. Why? Because many psychotherapists are unconsciously caught up in their own erotic transference with the world around them. And so these incompetent psychotherapists can make a mess of the whole process. Instead of just admitting, “Sure, you’re an interesting and attractive person. But that’s not what this work is all about. So let’s get on with the real work,” they try to hide behind a forced façade of neutrality that only leaves the client exasperated and confused. And if the client tries to speak about his or her feelings, an incompetent psychotherapist will shy away from really exploring the depth and vast unconscious extent of those feelings. Or an incompetent psychotherapist will, for his or her personal satisfaction, “fan the flames” of the client’s desire. Yet none of this is psychotherapy—it’s just more of the same manipulation and game-playing that has brought the client into treatment in the first place.
        

  

So remember why someone goes into psychotherapy: to experience a sense of genuine recognition so as to overcome the lack that disturbs current social functioning. Once all the manipulation, game-playing, and dishonesty that characterize your interpersonal relationships are dissolved through the integrity and honesty of the therapeutic relationship, then you can enter into an honest life of true love for others.

Is a psychotherapist just a “paid friend”
or an “emotional prostitute”?

 
The Real Task of Psychotherapy

Your task in psychotherapy, then, after you experience that intoxicating feeling of unconditional recognition, is to recognize in the transference itself your desire to hoard that feeling. At this point it will be important to talk openly within the psychotherapy about those desires and explore their deepest unconscious significance. Talk about how good it feels to experience recognition and understanding. And talk about how painful it felt to have been unrecognized and criticized as a child.

Assuming you have a competent psychotherapist, resist the temptation to terminate the treatment so as to run from the embarrassment of honest communication. Work through the awkwardness of it all until your desires for the psychotherapist are seen for what they are: an intoxicating attempt to hoard feelings of recognition and understanding.

Then, having understood the profound difference between desire and love, and having worked through the unconscious illusions (i.e., psychological defenses) behind your intense desire for one person, you can proceed to offer genuine love to everyone.

 
Summary

When you are working to overcome the transference, keep in mind this important fact:

  
        

You are not “in love” with your psychotherapist; you are obsessed with the idea that another person can give you what has been missing in your life because of what your parents—especially your father—took away from you in your childhood.

    看in treatment你需要很安静，但决非是那种端一杯咖啡点上蜡烛营造点小资氛围的静。可能你不需要有多么深刻，但是在你发觉许多看似毫不相干的事情突然在你身上有所显示的时候，你就会觉得，它确实有些神奇。可能最神奇的事情就是突然在一个陌生的环境中发现了自己，或者说有许多不能明白的事情豁然开朗起来。的确，片子里过多的心理学技巧在不断堆砌，情节似乎相当散乱。可是，这种状态却给每个人的内心一种推动，或者说是一个冲击。当你完全没有头绪的时候就会停止猜测和估计，而仅仅是任凭片子里的每一句话引导。你不会觉得那个病人就是你，因为你们完全不一样，发生的事情当然是不一样的。他们是病人，而且很严重。或者说，剧情要求他们表现的夸张。但其实，只有从那些夸大的细节中才能发现其实所有的细节，微小的细节都被还原了。其实，所有的病态和不解，都缘自你自己，很真实的自己。
     或许很无聊，很冗长。大段的对话和没有表情的交流，一个极端状态下的冷漠却催生出另一个发人深省。
     难道他们在讲着自己的故事。