0 April, 2011 | 清心流 · 安見閣

BY: 清流

Blog / Portfolio / 千夜谈 / 在美国读心理咨询 / 无穷无尽的职业道德

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来访者是杀人犯

图译1:其实我不反社会……
图译2:问题是其他人都太人渣。

By Nocturn~清流 from 安見閣(blog.anseeing.com)

职业道德是美国职业教育中很重要的一环,作为心理咨询师,从一年级开始就会听到很多职业道德的内容,二三年级更是专门有课开给职业道德。不过美国的职业道德可不是像中国的一样,里面有一堆崇高的口号。美国的职业道德也有基本原则,但更多的是在每种特定情况下应该如何去做的具体规定。你只要照着去做,就是有道德的,反之就是不道德。虽然现实应用中还有很多灰色区域,但总的来说还是挺容易理解和操作的。

比如咨询师的基本道德中,有一条叫做“保密性”,也就是说咨询师有对来访者在咨询室中发生和分享的一切保密的责任,来访者愿意跟谁说是他的事,但绝对不可以从咨询师的嘴里漏出去。于是问题就来了,如果来访者跟你说的内容跟犯罪有关怎么办?比如老师上课给我们举了这样一个例子:有一天,你跟来访者正在跟你探索他的女性情结,他突然跟你说“我两年前杀了我老婆,警察居然以为她是自杀,哈哈~”你怎么办?

我一个同学听到这个例子的第一个反应就是:“这种人我就应该把他从咨询室踹出去!”
“没错,我们可以看到你对这个人已经没有同情心了,所以你最好把他转给别的咨询师。”老师笑着说,“但是你能不能去通知警察他是杀人犯呢?”
同学们开始了激烈的争论,虽然有所谓的“保密性”原则,但咨询师也是人,对于人渣的愤怒基本上是不可遏制的。
最后还是老师打断了讨论:“我们来看咨询师协会的职业道德规定。根据规定,如果来访者已经实施杀人了,我们就不用报了,如果还没有实施杀人,就要报,并且是要报给潜在将会受害的当事人。所以你们一定要记得问他要杀谁,还有那个人的地址电话~“

先不说怎么从嫌疑人嘴里套潜在被害人的地址和电话,看起来,美国职业道德协会对于这类案例的逻辑是这样的:如果人已经死了,报不报也就那么回事了,伸张正义是警察的工作,与咨询师的工作范畴无关;人还没死的话,鉴于生命宝贵,还是要以保护人身安全为优先。

虽然很多同学对这个职业道德规定还有争议,但基本上大家都会遵守来做,被告了的话,可是会被吊销执照的。另一方面来说,这个做法其实还是有合理性的。毕竟,优先尊重还活着的人,不论是犯罪嫌疑人还是潜在的被害者,都比”活着没人理,死了叫得欢”来得好些。

BY: 清流

Blog / Portfolio / 千夜谈

Comments: 1 Comment

Diagnostic Criteria of Personality Disorder in CCMD-3(CCMD-3人格障碍诊断标准 英译版)

PS for my Chinese readers:这学期做了一个独立研究,方向是人格障碍诊断的文化差异。因为CCMD-3没有全英文版,为了研究方便把CCMD-3中的人格障碍诊断标准参考ICD-10和DSM-IV-TR全都翻成英文了。考虑可能有其他英语言国家的研究者会需要,所以发在这里。研究类似方向的朋友欢迎参考交流,普通读者尽请略过此篇。

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I did a study in multicultural diagnosis of personality disorder (PD). Part of the study was to compare the three main mental health diagnostic manuals in the world (DSM-IV-TR, ICD-10, and CCMD-3) for their similarity and difference in PD diagnostic criteria . Since there is no full English version of CCMD-3, I translated the PD part in CCMD-3 into English for my own study according to DSM-IV-TR and ICD-10. I think perhaps someone else may need this too, so I post it here.

This is just a rough translation. I tried to make it precise and accurate, but it’s pretty difficult. So only for your reference. Feel free to contact me through nocturn_s7 at hotmail.com for any question or discussion.

Capella Zhuang

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I marked some of the items when I studied them to help me remember the origin of each of them. (Just mention here so you know the marks are not from CCMD-3. I added them.)

Detailed Marks:

  • “(ICD)” : This item is similar to or straightly from an ICD-10 item.
  • “(ICD/2)” : Part of this item is similar to or straightly from one or several ICD-10 items. (In this case, the underlined words are the CCMD-3 original part.)
  • “(DSM)”: This item is similar to or straightly from a DSM-IV-TR item. (Actually, there is only one item like this.)
  • The items with no mark are CCMD-3 originals.

—————————————————————-

编码:60         人格障碍  Personality Disorder

诊断标准:指人格特征明显偏离正常,使病人形成了一贯的反映个人生活风格和人际关系的异常行为模式。这种模式显著偏离特定的文化背景和一般认知方式(尤其在待人接物方面),明显影响其社会功能与职业功能,造成对社会环境的适应不良,病人为此感到痛苦,并已具有临床意义。病人虽然无智能障碍,但适应不良的行为模式难以矫正,仅少数病人在成年后程度上可有改善。通常开始于童年期或青少年期,并长期持续发展至成年或终生。如果人格偏离正常系由躯体疾病(如脑病、脑外伤、慢性酒中毒等)所致,或继发于各种精神障碍应称为人格改变。

Includes distinct deviate personalities which lead to forming of persistent deviate behavior patterns that are the expression of the individual’s characteristic lifestyle and mode of relating to others. The pattern deviates markedly from certain cultural background and common cognitive style (especially in relating to others), distinctly impacted one’s social and occupational function, has led to maladaption in social environment, and has caused the patient’s clinically significant distress. The maladaptive behavior pattern is difficult to change, though the patient has no mental retardation. Only a few of patients will improve in their adulthood. The disorder usually manifests since childhood or adolescence and continue throughout adulthood. Deviate personality caused by general medical condition (such as brain disease, brain damage, chronic alcohol intoxication and so on) or due to psychotic disorder should be referred as personality change rather than personality disorder.

【症状标准】Diagnostic Criteria

个人的内心体验与行为特征(不限于精神障碍发作期)在整体上与其文化所期望和所接受的范围明显偏离,这种偏离是广泛、稳定和长期的,并至少有下列1项:

The individual’s characteristic and enduring patterns of inner experience and behavior as a whole deviate markedly from the culturally expected and accepted range (or “norm”). Such deviation must be manifested in more than one of the following areas:

(1)认知(感知,及解释人和事物,由此形成对自我及他人的态度和形象的方式)的异常偏离;

cognition (i.e., ways of perceiving and interpreting things, people, and events; forming attitudes and images of self and others);

(2)情感(范围、强度,及适切的情感唤起和反应)的异常偏离;

affectivity (range, intensity, and appropriateness of emotional arousal and response);

(3)控制冲动及对满足个人需要的异常偏离;

control over impulses and gratification of needs;

(4)人际关系的异常偏离。

manner of relating to others.

【严重标准】特殊行为模式的异常偏离,使病人或其他人(如家属)感到痛苦或社会适应不良。

The pattern of deviate behavior has caused distress and social maladaption to the patient or others (i.e. the patient’s family members).

【病程标准】开始于童年、青少年期,现年18岁以上,至少已持续2年。

The disturbance begins in childhood or adolescence and lasts for at least 2 years. The patient is at least 18 years old.

【排除标准】人格特征的异常偏离并非躯体疾病或精神障碍的表现或后果。

The disturbance is not due to general medical condition or psychotic disorder.

60.1偏执性人格障碍Paranoid personality disorder [F60.0]

诊断标准:以猜疑和偏执为特点,始于成年早期,男性多于女性。

characterized by distrust and suspiciousness,  beginning by early adulthood, more common in males.

【诊断标准】Diagnostic Criteria

(1)符合人格障碍的诊断标准;

in conformity with the diagnostic criteria of personality disorder.

(2)以猜疑和偏执为特点,并至少有下列3项:

characterized by distrust and suspiciousness, and present as indicated by three (or more) of the following areas:

①对挫折和遭遇过度敏感;(ICD)

excessive sensitivity to setbacks and rebuffs.

②对侮辱和伤害不能宽容,长期耿耿于怀;(ICD)

unforgiving of insults and injures, persistently bears grudges.

③多疑,容易将别人的中性或友好行为误解为敌意或轻视;(ICD)

suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous

④明显超过实际情况所需的好斗对个人权利执意追求;

distinctly exceeding aggression and obsessive pursue of personal power.

⑤易有病理性嫉妒,过分怀疑恋人有新欢或伴侣不忠,但不是妄想;(ICD/2)

pathological envy, excessive suspicions regarding fidelity of spouse or partner, but doesn’t account for paranoid.

⑥过分自负和自我中心的倾向,总感觉受压制、被迫害,甚至上告、上访,不达目的不肯罢休;

excessive self-importance and self-center, preoccupied with doubts about being oppressed  or suppressed, persistently appeals to higher court or authorities.

⑦具有将其周围或外界事件解释为“阴谋”等的非现实性优势观念,因此过分警惕和抱有敌意。(ICD/2)

perceives external environments and events as “conspiracy” or other unrealistic dominant ideas, hence excessively hostile and hypervigilant.

编码:60.2      分裂样人格障碍 Schizoid personality disorder  [F60.1]

诊断标准:以观念、行为和外貌装饰的奇特、情感冷漠,及人际关系明显缺陷为特点。男性略多于女性。

characterized by eccentric perceptions, behaviors and dresses, emotional coldness, and distinct interpersonal deficits. slightly more common in males.

【诊断标准】Diagnostic Criteria

(1)符合人格障碍的诊断标准;

in conformity with the diagnostic criteria of personality disorder.

(2)以观念、行为和外貌装饰的奇特、情感冷淡,及人际关系缺陷为特点,并至少有下列3项:

characterized by eccentric perceptions, behaviors and dresses, emotional coldness and  interpersonal deficits, and present as indicated by three (or more) of the following areas:

①性格明显内向(孤独、被动、退缩),与家庭和社会疏远,除生活或工作中必须接触的人外,基本不与他人主动交往,缺少知心朋友,过分沉湎于幻想和内省;(ICD/2)

distinctly introvert (isolated, passive, withdrawal), detached from family and society; except for necessary living and working contact, rarely initiates social interaction; lack of close friends, preoccupation with fantasy and introspection.

②表情呆板,情感冷淡,甚至不通人情,不能表达对他人的关心、体贴,及愤怒等;

flat facial expression, emotional coldness, or even unreasonable in dealing with people; unable to express caring, considerate, anger and so on.

③对赞扬和批评反应差或无动于衷;(ICD)

Indifference to either praise  or criticism.

④缺乏愉快感;(ICD/2)

lack of sense of pleasure.

⑤缺乏亲密、信任的人际关系;(ICD/2)

lack of intimate and trustful interpersonal relationship.

⑥在遵循社会规范方面存在困难,导致行为怪异;

difficulty in conforming to social norms, which leads to peculiar behaviors.

⑦对与他人之间的性活动不感兴趣(考虑年龄)。(ICD)

lack of desire for sexual experiences with another person (given age).

编码:60.3      反社会性人格障碍 Dissocial personality disorder  [F60.2]

诊断标准:以行为不符合社会规范,经常违法乱纪,对人冷酷无情为特点,男性多于女性。本组病人往往在童年或少年期(18岁前)就出现品行问题。成年后(指18岁后)习性不改,主要表现行为不符合社会规范,甚至违法乱纪。

characterized by failure to conform to social norms, regularly violating laws and rules, and callous unconcern for others; more common in males. The patient usually has conduct issues before age 18, and the habit is carried into adulthood (after age 18). The main pattern is failure to conform to social norms, or even violating laws and rules.

【诊断标准】

(1)符合人格障碍的诊断标准,并至少有下列3项:

in conformity with the diagnostic criteria of personality disorder, and present as indicated by three (or more) of the following areas:

①严重和长期不负责任,无视社会常规、准则、义务等,如不能维持长久的工作(或学习),经常旷工(或旷课)、多次无计划地变换工作;有违反社会规范的行为,且这些行为已构成拘捕的理由(不管拘捕与否);(ICD/2)

gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations. (i.e. unable to maintain long-term job or school, regular truant from job or school, changing job without planning ahead; violating social norms, and the conduct has constituted the cause of arrest.)

②行动无计划或有冲动性,如进行事先未计划的旅行;

planless or impulsive behaviors (i.e. trip without planning ahead)

③不尊重事实,如经常撒谎、欺骗他人,以获得个人利益;(DSM)

deceitfulness, repeated lying, use of aliases, cunning others for personal profit or pleasure.

④对他人漠不关心,如经常不承担经济义务、拖欠债务、不瞻养子女或父母;

irresponsible to others (i.e. refuse to honor financial obligations, repay debts, or provide for children or parents.)

⑤不能维持与他人的长久的关系,如不能维持长久的(1年以上)夫妻关系;(ICD)

Incapacity to maintain enduring relationships (i.e. unable to maintain marriage for more than 1 year.)

⑥很容易责怪他人,或对其与社会相冲突的行为进行无理辩解;(ICD)

markedly prone to blame  others or to offer plausible rationalizations  for the behavior bringing the subject into social conflict.

⑦对挫折的耐受性低,微小刺激便可引起冲动,甚至暴力行为;(ICD)

very low tolerance to frustration and a low threshold for discharge of aggression, including violence.

⑧易激惹,并有暴力行为,如反复斗殴或攻击别人,包括无故殴打配偶或子女;(ICD/2)

highly irritable, has violent behaviors (i.e. repeated physical fights including beating spouse or children without reason.)

⑨危害别人时缺少内疚感,不能从经验,特别是在受到惩罚的经验中获益;(ICD)

incapacity to experience guilt  and to profit from experience, particularly punishment.

(2)在18岁前有品行障碍的证据,至少有下列3项:

evidences of conduct disorder before age 18 present as indicated by three (or more) of the following areas:

①反复违反家规或校规;

repeatedly violates family or school rules.

②反复说谎(不是为了躲避体罚);

repeated lying (not to avoid physical punishment).

③习惯性吸烟,喝酒;

habitual smoking or drinking.

④虐待动物或弱小同伴;

has been physically cruel to animal or weak peers.

⑤反复偷窃;

repeated stealing.

⑥经常逃学;

is often truant from school.

⑦至少有2次未向家人说明外出过夜;

has stayed out at night without explaining to family members at least twice.

⑧过早发生性活动;

premature sexual activity.

⑨多次参与破坏公共财物活动;

has repeatedly engaged in destroying public property.

⑩反复挑起或参与斗殴;

has repeatedly provoked or engaged in physical fights.

(11)被学校开除过,或因行为不轨而至少停学一次;

has been expelled or suspended from school due to conduct against rules.

(12)被拘留或被公安机关管教过。

has been detained or disciplined by public security.

编码:60.4      冲动性人格障碍(攻击性人格障碍) Impulsive personality disorder [F60.30]

诊断标准:以情感爆发,伴明显行为冲动为特征,男性明显多于女性。

characterized by emotional explosion with distinct impulsive behavior, more common in males.

【诊断标准】

(1)符合人格障碍的诊断标准;

in conformity with the diagnostic criteria of personality disorder.

(2)以情感爆发和明显的冲动行为作为主要表现,并至少有下列3项:

characterized by emotional explosion with distinct impulsive behavior, and present as indicated by three (or more) of the following areas:

①易与他人发生争吵和冲突,特别在冲动行为受阻或受到批评时;(ICD)

marked tendency to quarrelsome behavior and to conflicts with others, especially when impulsive acts are thwarted or criticized.

②有突发的愤怒和暴力倾向,对导致的冲动行为不能自控;(ICD)

liability to outbursts of anger  or violence, with inability to control the resulting behavioral explosions.

③对事物的计划和预见能力明显受损;

distinctly impaired ability to plan and foresee.

④不能坚持任何没有即刻奖励的行为;(ICD)

difficulty in maintaining any course of action that offers no immediate reward

⑤不稳定的和反复无常的心境;(ICD)

unstable and capricious mood.

⑥自我形象、目的,及内在偏好(包括性欲望)的紊乱和不确定;(ICD)

disturbances in and uncertainty about self-image, aims, and internal preferences (including sexual)

⑦容易产生人际关系的紧张或不稳定,时常导致情感危机;(ICD)

liability to become involved in intense and unstable relationships, often leading to emotional crisis.

⑧经常出现自杀、自伤行为。(ICD/2)

recurrent threats or acts of self-harm or suicide.

编码:60.5表演性(癔症性)人格障碍 Histrionic (hysterical )personality disorder [F60.4]

诊断标准:以过分的感情用事或夸张言行吸引他人的注意为特点。

Characterized by excessive emotionality and attention-seeking behavior.

【诊断标准】

(1)符合人格障碍的诊断标准;

in conformity with the diagnostic criteria of personality disorder.

(2)以过分的感情用事或夸张言行,吸引他人的注意为特点,并至少有下列3项:

characterized by excessive emotionality and attention-seeking behavior, and present as indicated by three (or more) of the following areas:

①富于自我表演性、戏剧性、夸张性地表达情感;(ICD)

self-dramatization, theatricality, exaggerated expression of emotions.

②肤浅和易变的情感;(ICD)

shallow and labile affectivity.

③自我中心,自我放纵和不为他人着想;

self-centered, self-indulging without consideration of others.

④追求刺激和以自己为注意中心的活动;(ICD)

continual seeking for excitement and activities in which the patient is the center of attention.

⑤不断渴望受到赞赏,情感易受伤害;

persistent longing for praise, emotionally vulnerable.

⑥过分关心躯体的性感,以满足自己的需要;(ICD/2)

over-concern with physical attractiveness to satisfy one’s own needs.

⑦暗示性高,易受他人影响。(ICD)

suggestibility, easily influenced by others.

编码:60.6      强迫性人格障碍 Anankastic personality disorder [F60.5]

诊断标准:以过分的谨小慎微、严格要求与完美主义,及内心的不安全感为特征。男性多于女性2倍,约70%强迫症病人有强迫性人格障碍。

characterized by excessive need of carefulness, orderliness, and perfectionism, and strong internal sense of insecurity; more common in males (2 times of females), 70% of OCD patients have anankastic personality disorder.

【诊断标准】

(1)符合人格障碍的诊断标准;

in conformity with the diagnostic criteria of personality disorder.

(2)以过分的谨小慎微、严格要求与完美主义,及内心的不安全感为特征,并至少有下列3项:

characterized by excessive demand of carefulness, orderliness, and perfectionism, and strong internal sense of insecurity, and present as indicated by three (or more) of the following areas:

①因个人内心深处的不安全感导致优柔寡断、怀疑,及过分谨慎;

indecisiveness, suspiciousness and exceeding carefulness caused by internal sense of insecurity.

②需在很早以前就对所有的活动作出计划并不厌其烦;

need of repetitively planning ahead for every activity.

③凡事需反复核对,因对细节的过分注意,以致忽视全局;(ICD/2)

repetitively checks everything, preoccupied with details up to the point of ignoring the overall situation.

④经常被讨厌的思想或冲动所困扰,但尚未达到强迫症的程度;

distress caused by recurrent intrusive thoughts and impulses, but hasn’t reach the criteria of obsessive-compulsive disorder.

⑤过分谨慎多虑、过分专注于工作成效而不顾个人消遣,及人际关系;(ICD)

excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships.

⑥刻板和固执,要求别人按其规矩办事;(ICD)

rigidity and stubbornness, insistence by the individual that others submit exactly to his or her way of doing things.

⑦因循守旧、缺乏表达温情的能力。

distinctly conservative, lack of ability to express interpersonal warmth.

编码:60.7      焦虑性人格障碍 Anxious personality disorder [F60.6]

诊断标准:以一贯感到紧张、提心吊胆、不安全,及自卑为特征,总是需要被人喜欢和接纳,对拒绝和批评过分敏感,因习惯性地夸大日常处境中的潜在危险,而有回避某些活动的倾向。

characterized by persistent feeling of tension, anxiety and fear, sense of insecurity, and feelings of inadequacy; need of being liked and accepted, hypersensitive to rejection and criticism; marked tendency in avoiding certain activities due to habitually exaggeration of potential dangers in one’s daily environment.

【诊断标准】Diagnostic Criteria

(1)符合人格障碍的诊断标准;

in conformity with the diagnostic criteria of personality disorder.

(2)以持久和广泛的内心紧张,及忧虑体验为特征,并至少有下列3项:

characterized by persistent and general feeling of tension and feeling of anxiety, and present as indicated by three (or more) of the following areas:

①一贯的自我敏感、不安全感,及自卑感;

persistent self-sensitivity, sense of insecurity and feelings of inadequacy.

②对遭排斥和批评过分敏感;(ICD/2)

hypersensitive to criticism and rejection.

③不断追求被人接受和受到欢迎;

persistently pursues being accepted and welcomed.

④除非得到保证被他人所接受和不会受到批评,否则拒绝与他人建立人际关系;(ICD/2)

unwillingness to become involved with people unless certain of being accepted and not being criticized.

⑤惯于夸大生活中潜在的危险因素,达到回避某种活动的程度,但无恐惧性回避;

habitually exaggerates potential dangers in life to the point of avoiding certain activities, but not due to phobia.

⑥因“稳定”和“安全”的需要,生活方式受到限制。(ICD/2)

restrictions in lifestyle because of need to have security and stableness.

编码:60.8      依赖性人格障碍 Dependent personality disorder [F60.7]

【诊断标准】Diagnostic Criteria

(1)符合人格障碍的诊断标准;

in conformity with the diagnostic criteria of personality disorder.

(2)以过分依赖为特征,并至少有下列3项:

characterized by excessively dependent, and present as indicated by three (or more) of the following areas:

①要求或让他人为自己生活的重要方面承担责任;(ICD/2)

require or allow others to take responsibility for the patient’s important aspect of life.

②将自己的需要附属于所依赖的人,过分地服从他人的意志;(ICD)

subordination of one’s own needs to those of others on whom one is dependent, and undue compliance with their wishes.

③不愿意对所依赖的人提出即使是合理的要求;(ICD)

unwillingness to make even reasonable demands on the people one depends on.

④感到自己无助、无能,或缺乏精力;

feeling helpless, inadequate, or lack of energy.

⑤沉湎于被遗忘的恐惧之中,不断要求别人对此提出保证,独处时感到很难受;(ICD/2)

preoccupation with fears of being abandoned, persistently asking for guarantee, feeling uncomfortable being alone.

⑥当与他人的亲密关系结束时,有被毁灭和无助的体验;

feeling helpless and destroyed when ending an intimate relationship.

⑦经常把责任推给别人,以应对逆境。

push one’s responsibility to others in facing difficulty.

BY: 清流

Blog / Portfolio / 千夜谈

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当下施受法(Tonglen on the Spot)

By Nocturn~清流 from 安見閣(blog.anseeing.com)

对于心理咨询师来说,每天面对别人的痛苦可以说是不可避免的,越是常人避开的难缠问题,就越是要迎头上去,做临床病房的护工、护士更是要整天看着人生的种种痛苦。即使是 对普通人来说,每天的生活中也少不了困难和不快。毕竟,苦乃人生常态,否则苦谛也不会是佛家四谛的第一谛了。

虽然很多流派都有不同的修法来帮助人们应对痛苦,不过我个人感觉真正事发时能够上手就用的练习并不多。当下施受法就是我发现在现场比较好用的一个练习,这个练习我是在 Naropa的冥想课上学到的,专门用于应对生活中的随机、突发事件。修藏传佛教的朋友可能没人不知道施受法,但我觉得佩玛丘卓仁波切讲解的当下施受法更贴近常人的实际生活,而且里面也没含任何特定宗教的内容,不管你信仰为何都不影响做这个练习以及练习效果(我本人就不信佛教,用得也挺顺的)。我把她的讲解翻译在这里,希望对大家能有所帮助。

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From “Tonglen in Daily Life” in《Tonglen, the Path of Transformation》by Pema Chödrön

Translated by Nocturn~清流 from 安見閣(blog.anseeing.com)

当下施受法可以说是施受法的精髓。我自己发现这个方法对我特别有帮助,所以我也愿意将它推荐给我的所有学生。即使决定不做正式的施受法修行,你仍然可以在任何时候做这个练习。而且一旦熟悉了这个练习,你会发现正式的施受法修行也变得对你更容易理解、有意义了。

你可以在生活中的任何情况下做这个练习。如果生活中的某个情景激起了你的慈悲心或者让你自己觉得痛苦,你都可以随时停下来,开始在呼吸中吸入你所见所感的痛苦,然后呼出放松和解脱。这是一个很简单直接的过程。不像其他正式的修法,你不用视觉化什么东西或者遵循特定的步骤。这是一个简单自然的交换过程:你见到痛苦,在吸气时候你将它吸进去,然后转化成放松和解脱呼出来。

我们可以举个例子。假设你正在超市里,看到一位母亲打了她的小女儿。你看到这个情景很痛苦,但是此时你也不好做什么或者说什么。你的第一反应可能是逃避自己的恐惧,试图把这一切忘记。但是这个练习要求你不扭头离开,事实上,你马上就可以开始为这个哭泣的小女孩和她失控生气的母亲做施受法。你可以呼出放松、开放、别的什么具体的事物,比如一个拥抱或者一个友好的词,或者任何当时你觉得你想送出的事物。这个过程并不抽象,而是非常自动自发的。当你能够以这种方式去面对痛苦的场景不逃避的时候,你的心灵将会被打开,成为你慈悲的源泉。

你也可以在情绪强烈,却不知该如何是好的时候做这个练习。比如,假设你正在和你的伴侣或者老板吵架,他们对着你吼,而你却不知该如何反应。这时你可以开始吸入此时的痛苦感觉,同时呼出宽广和放松——为你自己,为那个对着你吼的人,也为所有正在面对类似情景的人。当然,在某个时候你还是必须要对对方做出反应的,但通过这个练习,宽广和温暖将被带入这个情景,而你也能够更有技巧地应对它了。

在你感觉受阻和挫败的时候,你也可以用这个练习来发展慈悲心。比如当一个看来无家可归的酒鬼向你要钱的时候,虽然你很想对他慈悲一点,但却很难控制住自己厌恶的心情,而不得不转身走开。此时,你就可以为自己和所有希望敞开心扉却做不到的人做当下施受法,呼出放松和放下。受阻的感受从来就不是修施受法的障碍,它是这个修法的一部分。你可以把任何让你觉得受阻的事物当作你心中的觉醒之种和你与其他人共同的联系来做练习。

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下面是我的冥想老师Dale Asrael在我上次回国时候给我写的当下施受法的说明。她讲的版本稍微复杂一点点,但其实佩玛写的方法就足够用了。我老师给我写的时候只是又提到两点,一 是感受不到慈悲心的时候可以先回想过去令自己感到慈悲的记忆或场景,二是不要强迫自己去做,如果做的时候感觉越来越费力,可以全部放弃掉再从头开始做。

生活中有许多痛苦,而对于其中的很多我们也许都无力改变,但这并不会妨碍我们抱持善心,关爱自身,关爱他人。

BY: 清流

Blog / Portfolio / 千夜谈

Comments: 3 Comments

FACES conference:内观与咨询的艺术

By Nocturn~清流 from 安見閣(blog.anseeing.com)

这两天去了Faces Conference做志愿者。说是志愿者,其实不过是帮着找找名牌、指指路、传传话筒、拎拎包的工作,除了长期不运动导致我抬椅子抬得胳膊疼以外,还是相当轻松的。其实这还是一个同学帮我联系的,他在这个会上做AV Director(想歪了吧?AV其实是audio & video的意思……),于是就帮我联系了志愿者,我还跟他蹭了宾馆住,跟他学了很多媒体的东西,真是非常感谢。

Faces Conference致力于将内观(mindfulness)、冥想和佛法(Dharma)带入的心理咨询领域,今年的主题是“内观与咨询的艺术”。会议一年开四次,分别在美国的不同城市,邀请在内观的科学研究和咨询实践的相关领域做出杰出贡献的人士介绍他们的经验成果。去年七月我也去了这个会,当时会是在我所在的Boulder召开的。那次会上我见到了杰克·康菲尔德(Jack Kornfield),请他给我的台版《踏上心灵的幽径》签了名,还采访了丹尼尔·西格尔(Daniel Siegel),不过当时不知道在国内是要合影才算“见过”的,只好以后有机会再去跟他们合影吧。

这次会议的主讲人是Sylvia Boorstein、John Briere和Roshi Joan Halifax,还有几位本地相关行业人士参加演讲。另外两位主讲人我之后会发文再提,所以这次只聊一下Roshi。Roshi过去是人类学家,她在1970年参与的LSD研究中遇到了超个人心理学的创始人之一葛罗夫(Stanislav Grof),并和他结婚,因此踏入了超个人领域。虽然他们的婚姻没能走到最后,Roshi还是留在了灵性领域,继续她的佛教修行。现在她已从事了30年的临终关怀工作,是一个禅修中心的创始人,并著有多本与内观、灵性和临终关怀有关的书。

Roshi的讲演有一种特殊的魅力。通常的讲演人或者是激情但容易轻浮,或者是稳重但容易沉闷,Roshi似乎刚好在这两者之间找了一个平衡点。她讲话很有力,但又很平和,让人觉得她说的每句话都是发自肺腑的——也许事实也正是这样。演讲中,Roshi谈到很多普通精神卫生从业人员可能遇到的挑战,以及临终关怀中的特别挑战。现在很多人对做咨询师感兴趣,也许应该参考一下这个行业从业中的一些基本挑战:

– 精疲力尽:工作压力大要求多,累积造成的结果。
– 次级创伤:长期面对痛苦的病人导致自己也开始功能障碍。
– 道德压力:治疗师知道应该怎么做,但因为各种财务社会原因无法去做正确的事。
– 同侪敌意:同侪之间互相排挤倾轧。
– 机构暴力:精神卫生系统内对不同层级工作人员的歧视。

至于临终关怀,美国的文化否认死亡的存在,所以临终关怀从业者其实压力很大,既要面对来访者家人对死亡的否认,又要面对自己对死亡的恐惧。可能很多人都听说过美国的葬礼跟送战友一样,一帮人念个悼词聚聚就完了。我们羡慕人家简洁,人家羡慕我们郑重。我听过不止一个美国咨询师说,美国人怕死怕到不敢提,所以葬礼才草草了事,结果就是遗孀遗孤的悲伤无处发泄,憋成内伤。经过了很多人努力,美国的临终关怀才有所提高。我认识好几个专门做临终关怀的老师,感觉临终关怀在美国人中间逐渐热门起来了,不过对于中国人来说,也许还有很远的距离吧。

Roshi是个大忙人,同时有自己的禅修中心,还参加着多项研究,所以虽然在会后的聚会见到,也没能聊上什么。她演讲时候放了一个BBC人类星球的trailer,我觉得挺好看,就贴在这儿给大家看看好了。

今年10月,Faces Conference还会再邀请Jack Kornfield,同时还有辨证行为治疗(DBT)的创始人玛莎·林丽韩(Marsha Linehan)和接受与实现疗法(ACT)的传承者Kelly G. Wilson。因为两场会时间很近,又在两个不同城市,我最多恐怕也只能去其中一个,感觉真是很可惜。听会的时候,偶尔我商学院的热血还是会激动一下。我觉得这个会议的主题很好,完全可以做得更国际化,形式更多样,为更多人提供沟通、学习、宣传、销售的机会,不过当然,这一切都要看会议公司CEO自己打算怎么做了,我不过是自己在这儿瞎激动而已。