第九章哀痛咨询

•Chapter9GriefCounseling•哀痛咨询Supportingthebereaved:theoryandpractice支持未亡人：理论与实践•Whydoweneedmodelsofgrieving?AnnDentoutlinesthetheoriesandexplainshowtheycanbeusefulforpractitionerssupportingthebereaved•为什么我们需要哀痛模式？•安娜概要地描述了这方面的理论，并解释了它们如何能有助于支持未亡人的工作者。Introduction•AlthoughSigmundFreudpioneeredthestudyofmourning,itisonlyinthelast30yearsorsothatbereavementresearchhasrealprominence.Researchershavenowgivenusseveralnewmodelsandinsightstoguideandhelpthebereaved.Butwhydoweneedmodels?Afterall,peoplehavebeenbereavedsincehumanlifebeganandhavegenerallyrecoveredwithoutthehelpofanymodelofgrieving.导言•尽管弗洛伊德早已经是悼念研究的先驱者，但是直到最近30年左右，丧亲的研究才有了真正的进展。研究者现在已经给了我们几种新的模式和洞察，去引导和帮助未亡人。但是为什么我们需要模式呢？毕竟自从有人类生活以来，人类就有了丧亲之痛，而且一般来说他们在没有哀痛模式帮助的情况下就恢复过来了。Introduction•Wenowrecognizethatgriefreactionscanhavephysical,emotional,cognitive,behavioral,sexualandspiritualcomponents,varyinginlengthanddisruptiveness.Adequateandappropriatesupportmayalleviatetheprobabilityoffutureill-healthandcomplications.Thisisnottosaythatallbereavedpeoplewillneedhelp,northatgriefshouldbepathologised.However,whenprofessionalsareinvolvedinsupportingthebereaved,theyneedaknowledgebasefromwhichtopracticeandscientificknowledgeprovidesaparticularlysolidbase.Personalexperienceandintuitionareimportantbuttheyhavetwomajorlimitationsasabasisofunderstanding:first,apractitioner’sexperiencemaybetoorestrictedtomakevalidgeneralisationsaboutnewsituations,andsecond,personalexperiencesmaybecolouredbysubjectivevaluesandprejudices.导言•我们现在认识到，哀痛反应可以有身体的，情感和情绪的，认知的，行为的，性生活的，以及精神的要素，其延续的时间长度和破坏性都各不相同。充分和适当的支持可以降低未来健康损害和并发症的可能性。这并等于说，所有的未亡人都需要帮助，也并非说，哀痛应该并视为病态。然而，当专业人员涉入对未亡人的支持时，他们需要在一定知识的基础上开展实践，而科学的知识则能够提供具体的坚实的基础。个人的经验和直觉是重要的，但是作为理解的基础它们具有2个重大的局限：第一，某个工作者的经验对于作出一个有效的普遍性的概括也许过于受限。第二，个人的经验也许会染上主观的价值和偏见的色彩。Introduction•Ihavechosenfivebereavementmodelsthatmayenhanceoursensitivitytowhathappenswhenweworkwiththebereaved.Sinceallthemodelsoutlinedareconcernedwithloss,theycanbeusedwithotherlife-changingeventsinvolvingloss,suchasdivorce,redundancy(layoff)andillness.导言•我选出了5种哀痛模式，它们也许可以在我们为未亡人服务时，提高我们对于所发生事件的敏感性。由于这里描述的所有模式都围绕丧失这一主题，因此它们可以被用于所有关于丧失的生活剧变事件，诸如离婚，下岗（redundancy(layoff)）和疾病。1Stagesandphases•JohnBowlby’stheoryonattachment(19611)wouldseemtounderpinthebasisforunderstandingbereavement.Bowlbyprovidesanexplanationforthecommonhumantendencytodevelopstrongaffectionalbonds.Heviewsattachmentasareciprocalrelationshipthatoccursasaresultoflong-terminteractions,startingininfancybetweenachildanditscaregivers.Hesuggeststhatgriefisaninstinctiveuniversalresponsetoseparation.Stagesandphases阶段和相位•鲍比的依恋理论似乎是理解哀痛的基础。对于人类常见的发展出强烈情感纽带的倾向，鲍比提供了一种解释。他将依恋视为一种相互作用的关系，它们是一种长期互动的结果，始于婴儿时期孩子与照护者之间的互动。他提示说，哀痛是对于分离的本能的普遍反应。1Stagesandphases•BothBowlby(19612)andParkes(19723)suggestthatgriefisapredictableorderlypatternofresponsestoadeath.Parkessuggeststhatgrievingisaprocess,asequenceofreactionstothedeathofasignificantlovedone.Theinitialshock,resultinginnumbness,canlastfordays,especiallywhenadeathissuddenleadingontointensegrief.Physicalsymptomssuchastightnessinthechest,shortnessofbreath,lossofappetiteandinsomniaarecommon.Lackofconcentrationandrestlessnessmayalsobeexperienced,aswellasfeelingsofisolationandloneliness.Stagesandphases阶段和相位•鲍比和帕克都认为，哀痛是一种对于死亡的可预测的，有序的反应模式。帕克认为，哀痛是一个过程，是对一位所挚爱者的死亡所产生的反应序列。最初的震惊，导致麻木，可以持续数日，特别是当死亡非常突然，导致了强烈的哀痛时。身体的症状，诸如胸部发紧，气短，食欲不振，失眠是常见的症状。注意力难以集中和躁动不安也可能被体验到，还可能包括被隔离和孤独感。1Stagesandphases•Interspersedwiththesereactionsmaybefeelingsofanger,guiltandfear.Angermayfocusondifferentareas,dependingonaperson’scircumstances;guiltisfrequentlyassociatedwith‘ifonlyIhad...or‘ifonlyIhadn’t’.Theexpressionandacknowledgementofangerandguiltmaybringsomerelief,asmayreassurancethattheseare‘normal’reactions.Whensuchfeelingsaresuppressed,thebereavedpersonmayexhibitsignsofconstantirritationand/orphysicaltension.Fearcanmanifestitselfasinsecurity,adesiretoescapefromreality,andanxietyoverapparenttrivialities,leadingsometimestopanicattacksinwhichtheanxietyandfearareoverwhelminganddisruptnormalliving.Stagesandphases阶段和相位•与这些反应间或同时出现的可以有愤怒，负罪和恐惧。愤怒也许注目于不同的领域，取决于该人所处的环境；负罪感频繁地与“如果我当时那样…”或“如果我当时没有那样…”联系在一起。对于愤怒和负罪感的表达和承认也许会带来一些解脱，如同“这是正常反应”的宽慰所带来的效应。当这样的情感被压抑时，未亡人可能会展现出持续的烦躁和/或身体的紧张。恐惧可以表现为不安全感，想从现实生活逃避的愿望，以及明显微不足道小事的焦虑，有时候甚至导致惊恐发作，在这样的发作中，焦虑和恐惧会占据压倒性地位，以至于正常生活遭到破坏。2Tasksforthebereaved•WilliamJWordeninthe1980s4formulatedaslightlydifferentmodelofgrievingtothoseofBowlbyandParkes.Describinggriefasaprocessandnotastate,Wordensuggestedthatpeopleneedtoworkthroughtheirreactionsinordertomakeacompleteadjustment.InWorden’stasksofbereavement,griefisconsideredtoconsistoffouroverlappingtasks,requiringthebereavedpersontoworkthroughtheemotionalpainoftheirlosswhileatthesametimeadjustingtochangesintheircircumstances,roles,statusandidentity.Thetasksarecompletewhenthebereavedpersonhasintegratedthelossintotheirlifeandletgoofemotionalattachmentstothedeceased,allowingthemtoinvestinthepresentandthefuture.2Tasksforthebereaved未亡人的任务•WilliamJWordeninthe1980s4formulatedaslightlydifferentmodelofgrievingtothoseofBowlbyandParkes.Describinggriefasaprocessandnota