认知行为疗法和心理动力学治疗中的治疗师如何反思治疗中隐喻的使用：一项定性研究。
How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study.
机构信息
Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318, Oslo, Norway.
出版信息
BMC Psychiatry. 2022 Jun 27;22(1):433. doi: 10.1186/s12888-022-04083-y.
BACKGROUND
Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD).
METHODS
Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach.
RESULTS
Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth.
CONCLUSIONS
These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts.
TRIAL REGISTRATION
Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.
背景
研究表明隐喻是心理治疗实践不可或缺的一部分。我们想探讨 10 位治疗师如何反思隐喻在治疗中的应用，以及他们如何应对一些接受重度抑郁症（MDD）治疗的患者表达的隐喻。
方法
对 5 名实践精神动力治疗（PDT）的治疗师和 5 名实践认知行为治疗（CBT）的治疗师进行了半结构化定性访谈。使用主题分析方法对转录本进行分析。
结果
我们的分析得出了两个主要主题：隐喻的治疗用途，以及对抑郁患者使用隐喻的矛盾感受。大多数治疗师表示他们在治疗中不会主动倾听隐喻，许多治疗师表示他们很少故意使用隐喻。虽然 PDT 治疗师似乎更关注患者生成的隐喻，CBT 治疗师似乎更关注治疗师生成的隐喻。大多数治疗师不会尝试改变他们评估为无益或有害的患者生成的隐喻。一些治疗师对患者使用的一些隐喻表示强烈的负面感受。PDT 治疗师对工具隐喻和抑郁作为对手的隐喻最为批评。CBT 治疗师对表面和深度的隐喻最为批评。
结论
这些结果提醒我们在治疗中使用隐喻的复杂性，希望能激发治疗师反思自己使用隐喻的方式。对工具、表面和深度以及抑郁作为对手的隐喻进行开放的治疗对话可能是避免医患冲突所必需的。
试验注册
Clinical Trial gov. Identifier：NCT03022071。注册日期：2017 年 1 月 16 日。
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