Clinically rethinking CA-studies to improve therapeutic conversation
Clinically rethinking CA-studies to improve therapeutic conversation
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临床重新思考 CA 研究以改善治疗对话
DOI：
10.1558/cam.41910
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
M. Buchholz
中科院分区：
文献类型：
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作者：
M. Buchholz
阅读了 Joanna Pawelczyk、Claudio Scarvaglieri、Thomas Spranz-Fogasy 及其合著者、Liisa Voutilainen 和 Anssi Peräkylä 以及 Peter Muntigl 和 Adam O. Horvath 撰写的五篇论文后，我们很高兴地得出结论，我们的共同项目（通过谈话）更好地了解治疗室中所说和所做的事情正在走上正轨。我是一名训练有素的精神分析师，我自己进行了一些对话分析，我想我知道在收集、组织和分析数据后必须投入多少工作来撰写此类论文，而且我知道这里的一些撰稿人在自己进行心理治疗方面拥有丰富的经验。我很荣幸受邀从临床角度对这些研究进行评论，我的观点仅限于我作为精神分析师和具有多年经验的家庭治疗师的专业经验。让我首先粗略地勾勒出具有结构（水平/垂直）的“治疗空间”的尺寸。 CA 研究最相关的成果之一是对过程的时间顺序视角。我在这里要考虑的第一个维度是水平的，表明社会联系的共享“距离-紧密度”。在大多数情况下，治疗师和患者（或客户）面对面坐着交谈。他们互相交谈，追随对方的目光或头部、面部和身体的动作。特别是，他们互相解读对方的手势，并将这种解读融入到彼此的想象中。协作意义创造的过程开始启动。 Spranz-Fogasy 和他的合著者展示了治疗师如何使用他们称之为“请求示例”的配方来扩展这个水平维度。这个延伸本身就有疗效；它将病人从错误抽象的狭窄影响中解放出来。 Voutilainen 和 Peräkylä 也解决了扩展和缩小之间的差异，对“开放”和“封闭”疗法进行了合理的区分。在“开放式”疗法中，姿势的变化更多，心理活动的灵活性更高；也许有人可能会说治疗师和患者已经准备好进行一种对话舞蹈，而这种对话舞蹈在“封闭”治疗（或疗程）中是缺失的。定义这样一个空间的外边界并不容易。斯卡瓦列里通过一个女人的例子展示了有益的治疗解释如何与文化知识直接联系在一起，她被认为对待她的丈夫像个孩子，但她正试图改变这一点。这种解释中的文化知识超越了水平轴上的治疗空间的限制。第二个维度是垂直的，这里表示深度。鼓励患者讲述他们的（嗨）故事。 “下一个开始”将受邀讲述“他们如何成为历史”
Having read the five papers – by Joanna Pawelczyk, by Claudio Scarvaglieri, by Thomas Spranz-Fogasy and co-authors, by Liisa Voutilainen and Anssi Peräkylä and by Peter Muntigl and Adam O. Horvath – it is a pleasure to conclude that our common project to better understand what is said and done (by talking) in the treatment room is on the right track. I am a fully trained psychoanalyst who has conducted some conversation analysis of my own, and I think I have an idea how much work must be invested in writing such papers after collecting, organizing and analyzing the data, and I know that some of the contributing authors here have considerable experience in doing psychotherapy themselves. It is an honor to be invited to comment on these studies from a clinical point of view, which I restrict to my professional experience as psychoanalyst and as a family therapist with many years of experience. Let me begin my comment with a rough sketch of the dimensions of what can be termed the ‘therapeutic space’ with a structure (horizontal/vertical). One of the most relevant gains by CA studies is a temporal-sequential perspective on process. My first dimension to be considered here is horizontal, indicating the shared ‘distance-closeness’ of social linkages. Therapist and patient (or client) talk, in most situations sitting face-to-face. They address each other and follow each other’s gaze or the movements they make with their heads, their faces and their bodies. In particular, they mutually read each other’s hand gestures and include this reading into their imagination of each other. A process of collaborative meaning making is set in motion. Spranz-Fogasy and his co-authors show how therapists using formulations they name ‘requesting examples’ extend this horizontal dimension. This extension has a curative effect in itself; it liberates the patient from the narrowing effect of false abstractions. Voutilainen and Peräkylä also address this difference between extension and narrowing in making their plausible distinction between ‘open’ and ‘closed’ therapies. In ‘open’ therapies, there are more variations in stance taking, a higher flexibility of mental movement; perhaps one might say therapist and patient are ready for a kind of conversational dance which is missed in ‘closed’ therapies (or sessions). It is not easy to define the outer border of such a space. Scarvaglieri shows how a beneficial therapeutic interpretation is directly linked to cultural knowledge, through an example of a woman who is understood to be treating her husband like a child but is trying to change this. The cultural knowledge in such an interpretation transcends the limits of the therapeutic space along the horizontal axis. The second dimension is vertical, which here indicates depth. Patients are encouraged to tell their (hi)story. Being invited to tell a ‘how-they-became-what-they-are-history’ is Start next available