Shahar Golan, Davidson Larry
Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Psychiatry. 2009 Summer;72(2):154-76. doi: 10.1521/psyc.2009.72.2.154.
We propose Participation-Engagement (PAR-EN) as a philosophically based heuristic for prioritizing interventions in comorbid, complex, and chronic psychiatric conditions. Drawing from 1) the sociologist Talcott Parsons, 2) the continental-philosophical tradition, and 3) our own previous work (Davidson & Shahar, 2009; Shahar, 2004, 2006), we argue that participation in personally meaningful life goals represents a hallmark of mental health. Symptoms and vulnerabilities that impede such participation should therefore be targeted vigorously, whereas others which do not pose such imminent threats should assume a secondary focus, if at all. Winnicott's (1987) notion of the spontaneous gesture, the importance of daily activities as reflecting patients' participation, and the dialectics of interpersonal relatedness and self-definition, are introduced as guidelines for implementing PAR-EN. Implications for clinical assessment and the therapeutic relationship are discussed.
我们提出“参与-投入”（PAR-EN）作为一种基于哲学的启发式方法，用于在共病、复杂和慢性精神疾病中确定干预措施的优先级。借鉴1）社会学家塔尔科特·帕森斯、2）大陆哲学传统以及3）我们自己之前的研究工作（戴维森和沙哈尔，2009年；沙哈尔，2004年、2006年），我们认为参与个人有意义的生活目标是心理健康的一个标志。因此，应该大力针对那些阻碍这种参与的症状和脆弱性，而其他没有构成此类紧迫威胁的症状和脆弱性，如果有必要的话，应作为次要关注点。温尼科特（1987年）的自发姿态概念、日常活动作为反映患者参与的重要性以及人际相关性和自我定义的辩证法，被引入作为实施“参与-投入”的指导原则。还讨论了对临床评估和治疗关系的影响。
