9 结束与新的开始

完成与新的开始

一些东方智慧传统，如某些形式的苏菲主义，非常强调如何圆满地结束一个创造性的行为。如果一个过程能够在最终停止之前充分展开，据说它就达到了完成。与其突然结束导致失去什么，或者只是逐渐消失让人感觉像是零和游戏，不如有机地完成一系列行动来创造新的可能性。据说，每一次的完成都会带来一个新的开始。这让人联想到进化和生命中的过程。选择和变异导致适应，随着一个物种的一代逐渐消逝，可能会出现新的、更适应的迭代。因此，我们选择不为这本书提供正式的结论，希望在我们与读者共同完成这本书的过程中，能够产生新的可能性和新的起点。正如本书所展示的，将慈悲的关注点带入我们的ACT工作，在某种程度上是一个出发点，因此可以激发新方向和干预措施的创造。将CFT（慈悲聚焦疗法）和FAP（功能分析心理治疗）等方法整合到ACT情境中，使我们作为治疗师能够扩展可能的范围，并有望激发关于研究问题、理论和具体干预措施方面的创造力和创新。与其说是在做总结，不如说我们是在开启新的篇章。我们希望提出的问题比回答的问题更多，并且希望我们的社区能继续探讨这些问题。

那么，作为心理治疗师，我们应如何推进对慈悲应用科学的探索呢？持续教育的某些关键要素浮现出来，在这一章中我们将讨论如何将慈悲关注点引入每个方面：督导、培训以及研究和知识发展。因此，在我们共同旅程即将结束之前，让我们讨论这些维度，并反思如何推进将CFT整合进情境行为方法的使命。

慈悲聚焦的情境督导

心理治疗，尤其是对于私人执业的心理治疗师来说，往往是一种孤独的追求。许多治疗师很少有人可以分享他们的职业困难。慈悲聚焦的督导可以是避免感到孤立的重要一步。它还可以为各个专业水平的治疗师提供一个磨练技能并促进个人和职业成长的环境。此外，虽然治疗师通常擅长验证他人的感受和痛苦，并以慈悲之心回应客户的苦难，但在面对自己的困境和评判时，他们往往难以运用这些技能。因此，慈悲聚焦的督导关系为治疗师训练其慈悲心和自我慈悲提供了完美的舞台。

除了帮助治疗师开发新技能和深化知识外，有效的督导还允许他们接触已经拥有的资源。即使是非常熟练的治疗师有时也会遇到瓶颈，从督导会议中获得的新视角会给他们带来益处。这样，督导关系就像治疗关系一样占据着核心位置。

我们认为，在督导中培养慈悲的灵活性涉及督导者和被督导者共同参与各种过程：

• 对督导关系中以及讨论中的客户的情感困扰保持敏感。
• 通过同情和自动的情绪共鸣来应对遇到的痛苦。
• 发展出为了减轻和预防人类痛苦而容忍痛苦的能力。
• 从批判性、谴责性和基于羞耻的思维中解脱出来。
• 创造条件进一步发展和完善共情反应。
• 努力发展对ACT和慈悲聚焦工作至关重要的特定治疗技能和能力。

督导关系在许多方面反映了治疗关系。督导者和被督导者之间存在着一种隐含的等级关系。被督导者经常带着解决难题的需求来找督导者，通常是由于面对无助感和可能对自己专业能力和自我价值的负面评判。有时候，督导中的问题更像是“需要解决的问题”，因为可能存在某种练习或特定干预可以帮助治疗进展。被督导者越熟悉和掌握该方法，这样的“问题”就越少。随着技能水平的提高，督导问题更多地转向于被督导者如何从慈悲的角度接受客户及自己的情绪。

被督导者的需要根据技能水平不同而异，因此明智的督导者会评估被督导者的需求和技能水平。对于初学ACT和功能性情境方法的被督导者，可能需要针对特定技巧和练习进行指导。因此，督导者可能会建议那些在解构方面遇到困难的被督导者尝试一系列技术，例如邀请客户在想法前加上“我有这个想法...”；注意钩子及其后续行为；进行溪流上的叶子练习（Hayes, 2005）；注意到构成当下厌恶体验的不同想法和感觉等等。建议使用比喻，如井中人、公交车上的孩子（最初为公交车上的乘客）、罐头怪物（均见于Hayes等人，1999年），也可能有用。在训练慈悲方面，诸如可视化慈悲自我、慈悲聚焦的椅子工作或系统性视角转换练习等启发性练习可能会有所帮助。在这个阶段，角色扮演客户，先是督导者扮演治疗师，然后越来越多地让被督导者扮演治疗师，都是有益的。

熟悉方法的被督导者

对于那些已经熟悉方法并且对技术有深入了解的被督导者来说，他们需要的技术性建议较少，可能更适合于帮助他们识别客户行为的功能。识别行为前因（无论是物理的还是言语的）以及问题行为和改善后行为的言语和物理后果变得更加重要。目标是帮助被督导者更好地在事件发生时认同客户的体验，并对什么能提供帮助有更好的感知。例如，识别出一个特定的想法，如“我不有趣”，作为在不熟悉的社交情境中退缩的前因，可以帮助被督导者根据需要调整干预措施。被督导者可能会选择处理这个前因，比如通过注意到这个想法是个钩子来解构它，或者改变与陌生人交谈的结果，也许通过将这种行为与客户想要成为的那种人联系起来。

这一阶段的一个重要部分是帮助被督导者注意到自己治疗师行为的前因和后果。这可以通过示范来进行，督导者可以询问被督导者督导行为对他们有什么影响。这有助于被督导者学会在会谈中即时识别和接受情绪。这样，督导者利用了与被督导者与客户之间的治疗关系中出现的过程相似的方法。下面的对话展示了这种干预方式。

督导者: 你认为你的客户退缩的前因是什么？

被督导者: 我不太确定。我们在谈论家庭作业，他突然就关闭了。

督导者: 他做了吗？

被督导者: 没有，他甚至还没有开始做。

督导者: 这有点像我建议你记录客户行为的前因和后果那样？

被督导者: （保持沉默）

督导者: 刚才发生了什么？我感觉你刚才对我关闭了。

被督导者: 我感到内疚，就像在学校里没有完成作业一样。

督导者: 哎呀！那一定很痛苦。那么出现了什么？

被督导者: 我感到被评判了，有点羞愧。

督导者: 对不起让你有这样的感觉。这是个钩子吗？

被督导者: 嗯哼。

督导者: 那你接下来做了什么？

被督导者: 我关闭了，我想是这样。

督导者: 是的，我感觉到了。你会说你咬住了那个钩子吗？而你想成为的那种人会这么行动吗？

被督导者: 不，我希望我能只是说我注意到了这些想法和感受，并且甚至可以把它们看作是我退缩的前因。

督导者: 对。当你这么说的时候，我没有感觉到你在关闭。你觉得类似的情况是不是也在你的客户身上发生了？

被督导者: 说得通。我想我在试图解释这些练习对客户进步的重要性时陷入了困境。

督导者: 结果怎么样？

被督导者: 他继续关闭。

督导者: 所以我们做得很好，注意到了所有这些前因和后果……

被督导者: 如果我当时问他当时出现了什么，我们可能更容易处理这种情况。对吧？

督导者: 试试看会发生什么。

无论治疗师是在寻找能够帮助他们更好地创造接纳、智慧和灵活性环境的督导者，还是在发展自己作为督导者的开放性、勇气和同理心，以及关注被督导者的需求和体验的能力，慈悲和能够转变视角看待情绪体验的能力仍然是核心。在治疗师的情绪反应领域，我们可以找到关于客户价值目标和苦难体验的重要信息。通过保持开放并从我们对自身情绪的习惯性反应中解脱出来，我们可以更接近这些体验。我们特有的换位思考能力，以及培养温暖和关怀情感基调的能力，可以促进对他人心理活动的理解。我们可以想象客户或受训者情绪反应的功能，并将这些信息带入案例构建和具有临床智慧及扎实技巧的干预中。

本章知识点阐述

知识点阐述

1. 完成与新的开始：

   • 在东方哲学中，圆满地完成一个过程不仅标志着结束，也象征着新的开始。这种观点鼓励我们在完成项目或任务后，积极寻找新的机会和可能性。
   • 将慈悲融入ACT工作，不仅是对现有实践的补充，也是开辟新路径的过程。这种方法促进了治疗师的创造力和创新能力，同时也为客户提供更全面的支持。

2. 慈悲聚焦的情境督导：

   • 慈悲聚焦的督导不仅帮助治疗师处理职业中的情感挑战，还促进了他们的个人成长。这种督导方式强调情感共鸣和自我慈悲的重要性，有助于治疗师更好地理解和支持客户。
   • 督导过程中，治疗师可以通过多种方法学习和实践慈悲，包括情感共鸣、容忍痛苦、摆脱批判性思维以及增强共情能力。这些技能对于有效开展ACT和慈悲聚焦工作至关重要。

3. 督导关系的重要性：

   • 督导关系在治疗师的职业发展中扮演着核心角色，类似于治疗关系。它不仅提供了一个学习和发展的平台，还为治疗师提供了支持和反馈，帮助他们在实践中不断进步。
   • 不同技能水平的被督导者需要不同的指导和支持。经验丰富的督导者能够识别被督导者的需求，并提供相应的指导，帮助他们克服职业挑战，提升专业技能。

4. 慈悲聚焦的具体实践：

   • 通过具体的练习和技术，如解构技术、比喻和可视化练习，被督导者可以在督导过程中学习和实践慈悲。这些练习不仅增强了治疗师的慈悲能力，也为他们提供了实际操作的方法。
   • 角色扮演和其他互动活动可以帮助被督导者更好地理解和实施慈悲聚焦的方法，从而在实际治疗中更加有效地应用这些技能。

通过上述知识点可以看出，慈悲聚焦的督导不仅促进了治疗师的专业成长，还提高了他们在实践中应用慈悲原则的能力。这种方法不仅有助于治疗师更好地支持客户，还为他们自身提供了重要的情感支持和发展机会。通过持续的学习和实践，治疗师可以不断进步，成为更加高效和富有同情心的从业者。

知识点阐述

1. 识别行为功能：

   • 在督导过程中，帮助被督导者识别客户行为的前因和后果是非常重要的。这不仅有助于理解客户的行为模式，还能为制定有效的干预策略提供依据。
   • 通过具体的例子，如识别某个想法作为退缩行为的前因，被督导者可以更好地理解客户的行为，并设计相应的干预措施。

2. 自我反思与成长：

   • 督导过程中的一个重要方面是帮助被督导者注意到自己行为的前因和后果。这有助于被督导者提高自我意识，并在实践中不断改进。
   • 通过模拟和反馈，被督导者可以学习如何在治疗过程中即时识别和处理自己的情绪，从而更好地服务客户。

3. 督导关系中的平行过程：

   • 督导者可以利用与被督导者-客户关系中出现的相似过程来指导被督导者。这种平行过程有助于被督导者更好地理解客户的行为，并在实际治疗中应用所学知识。
   • 通过这种方式，督导者可以示范如何处理情绪和行为，从而帮助被督导者在实际工作中更加有效。

4. 慈悲与换位思考：

   • 慈悲和换位思考是督导过程中的核心要素。通过培养这些能力，治疗师可以更好地理解客户的情感体验，并提供更具同情心的支持。
   • 换位思考不仅帮助治疗师更好地理解客户，还促进了治疗师与客户之间的情感连接，增强了治疗效果。

5. 开放性和解构：

   • 保持开放性并从习惯性反应中解脱出来，是治疗师和被督导者都应该具备的能力。这有助于他们在面对情绪和挑战时，能够更灵活地应对。
   • 通过解构技术，治疗师可以更好地处理客户和自己的情绪，从而更有效地进行治疗。

通过上述知识点可以看出，在督导过程中，识别行为功能、自我反思与成长、平行过程的应用、慈悲与换位思考以及开放性和解构都是关键要素。这些方法不仅有助于被督导者的职业发展，也提高了他们在实际治疗中的有效性。通过持续的学习和实践，治疗师可以不断提升自己的专业技能，更好地支持客户。

9 Completion and New Beginnings Some Eastern wisdom traditions, such as certain forms of Sufism, place a great deal of emphasis on how to draw a creative act to a close. If a process is allowed to unfold fully before it finally ceases to be, it is said to reach completion. Rather than coming to an abrupt end, where something is lost, or just fading out, which can feel like a zero-­sum game, organically completing a series of actions creates new possibilities. It is said that with every completion a new beginning becomes possible. This is reminiscent of the processes involved in evolution and in life. Selection and variation result in adaptation, and as one generation of a species fades, new and more adaptive iterations may arise. Therefore, we have chosen not to provide a formal conclusion to this book in the hopes that as we com- plete this book together, with you the reader, we might generate new possibili- ties and new beginnings. As this book has demonstrated, bringing a focus on compassion to our ACT work is, in a way, a point of departure, and therefore can spark the creation of new directions and interventions. Integrating approaches such as CFT and FAP into the ACT context allows us to expand what is possible for us as therapists, and will hopefully spark creativity and inno- vation regarding research questions, theory, and specific interventions. Rather than concluding, we are aiming to begin. We hope that we have raised more questions than we have answered, and that our community carries these ques- tions forward. And how might we all move forward in exploring the applied science of compassion as psychotherapists? Certain key elements of ongoing education present themselves, and in this chapter we will address how to bring a compas- sion focus to each: supervision, training, and research and knowledge develop- ment. So before we come to the end of our journey together, let’s discuss these dimensions and reflect upon how we might forward the mission of integrating CFT into contextual behavioral approaches. Compassion-­Focused Contextual Supervision Psychotherapy, especially for the private therapist, is often a lonely pursuit. Many therapists have few people with whom they can share their professional difficulties. Compassion-­focused supervision can be an important step toward not feeling isolated. It can also provide a context in which therapists at all levels of expertise can hone their skills and grow, both professionally and personally. Furthermore, while therapists are generally adept at validating other people’s feelings and pain and responding with compassion to their clients’ suffering, they often struggle when it comes to applying these skills to their own difficult situations and judgments. The compassion-­ focused supervision relationship thus offers a perfect arena in which therapists can train their compassion and self-­compassion repertoires. In addition to helping therapists develop new skills and deepen their knowl- edge, effective supervision also allows them to contact resources they already have. Even highly skilled therapists can get stuck at times and will benefit from the fresh perspective a supervision session can afford. In this way, the supervi- sion relationship holds the same sort of central position as the therapeutic rela- tionship does. In our view, cultivating compassionate flexibility in supervision involves both supervisor and supervisee collaboratively engaging in a variety of processes: • Being sensitive to emotional distress in the supervision relationship and, through a parallel process, in the clients discussed • Extending sympathy and automatically engaging emotionally with the distress encountered • Developing a capacity to tolerate distress in the service of alleviating and preventing human suffering • Getting unhooked from judgmental, condemning, and shame-­based thinking • Creating conditions to further develop and hone empathic responding • Working to develop specific therapeutic skills and capacities essential to ACT and compassion-­focused work The supervision relationship mirrors, in many aspects, the therapeutic rela- tionship. There is an implied hierarchy between supervisor and supervisee. Supervisees often come to supervisors seeking to solve difficult problems, often as a result of having faced emotions of helplessness and quite possibly negative self-­judgments about their professional abilities and perhaps self-­worth. And at times, supervision issues are “problems to solve” in the sense that there may be an exercise or particular intervention the supervisee could use to help therapy move along. The more the supervisee is familiar with and skilled in the approach, the fewer such “problems” there are to solve. As skill level increases, supervision questions become more about how supervisees can receive their clients’ emo- tions, and their own, from a stance of compassion. Supervisees differ in their needs depending on skill level, so a wise supervi- sor assesses both supervisee needs and level of skill. Supervisees who are new to ACT and the functional contextual approach may need to be oriented toward specific techniques and exercises. Therefore, a supervisor may suggest that a supervisee who struggles with defusion try a range of techniques, such as invit- ing clients to preface thoughts with “I have the thought that…”; noticing hooks and what they do next; doing the Leaves on the Stream exercise (Hayes, 2005); noticing the different thoughts and sensations that make up their aversive expe- rience in the moment; and so on. Suggesting metaphors, such as the Man in the Hole, the Children on the Bus (originally Passengers on the Bus), and the Tin Can Monster (all in Hayes et al., 1999), may also be useful. When it comes to training compassion, evocative exercises such as Visualizing the Compassionate Self, compassion-­focused chair work, or systematic perspective-­taking exercises may prove useful. At this stage, role-­playing clients, first with the supervisor playing the therapist, then, increasingly, with the supervisee playing the thera- pist, is helpful. Supervisees who are familiar with the approach and well-­read in the tech- niques need fewer such technical suggestions and may be better served by guid- ance that helps them identify functions of behaviors that play out for their clients. Identifying antecedents, whether physical or verbal, and the verbal and physical consequences of both problematic and improved behavior, comes into more acute focus. The aim is to help supervisees better identify with clients’ experi- ence as it happens and have a better sense for what could help. For example, identifying that a particular thought, such as “I’m not interesting,” serves as an antecedent for withdrawal in unfamiliar social situations can help the supervisee tailor interventions as needed. The supervisee might then elect to deal with the antecedent, perhaps by defusing from the thought by noticing it as hook, or to change the consequences of speaking to strangers, perhaps by linking this behav- ior, through values, to the kind of person the client wants to be. An important part of this phase is to help supervisees notice the anteced- ents and consequences of their own therapist behaviors. This can be done by modeling, with the supervisor asking the supervisees what effect supervisor behavior has on them. This can help supervisees learn to recognize and receive emotions as they show up in the moment in session. In this way, the supervisor makes use of processes parallel to those showing up in the supervisees’ thera- peutic relationships with clients. This type of intervention is illustrated by the dialogue below. Supervisor: o what do you imagine the antecedents to your client with- S drawing were? Supervisee:I ’m not sure. We were talking about homework and he just shut down. Supervisor:Had he done it? Supervisee:No, he hadn’t even made a start. Supervisor: o a bit like my suggestion that you make a note of client ante- S cedents and consequences? Supervisee:(Remains silent.) Supervisor: hat happened just now? I’m getting a sense that you just shut W down on me. Supervisee:I feel guilty, as if I was at school and hadn’t done my homework. Supervisor:Ouch! That must be painful. So what showed up? Supervisee:I felt judged and a bit ashamed. Supervisor:I’m sorry you felt this. Was that a hook for you? Supervisee:Uh-­huh. Supervisor:And what did you do next? Supervisee:I shut down, I guess. Supervisor: es, I felt that. Would you say you bit the hook? And is that how Y the person you want to be would have acted? Supervisee: o, I wish I could have just said that I noticed those thoughts N and feelings showing up and that I could even see them as ante- cedents to my withdrawal. Supervisor: ight. And as you say that, I don’t feel you shutting down. Do R you think something similar might have been at play with your client? Supervisee: hat makes sense. I guess I got bogged down in trying to explain T how important the exercises were for the client’s progress. Supervisor:And what happened? Supervisee:He stayed shut down. Supervisor:o we’re doing good noticing all of these antecedents and S consequences… Supervisee:I guess if I’d asked him what was showing up for him, we then could have more easily done something with it. Right? Supervisor:See what happens when you do it. Whether therapists are seeking supervisors who might help them better create a context of acceptance, wisdom, and flexibility, or are developing their own ability to serve as supervisors with openness, courage, and empathy and oriented to the needs and experiences of supervisees, compassion and the ability to shift perspective on emotional experiencing remains central. Within the realm of a therapist’s emotional responses we can find a host of important infor- mation about clients’ valued aims and experience of suffering. By remaining open and defusing from our habitual responses to our own emotions, we can draw these experiences closer. Our characteristically human capacity for per- spective taking, and our ability to cultivate an emotional tone of warmth and care, can foster insight into what is going on in the mind of the other. We can imagine the function of the client’s or trainee’s emotional response and bring this information into case formulation and intervention with clinical wisdom and solid technique. The Workshops and Further Training The early twenty-­first-­century culture of training in mindfulness-­, acceptance-­, and compassion-­focused behavior therapies typically involves psychotherapists attending workshops, reading background material, and hopefully seeking further training and supervision in order to deepen and apply their knowledge. As many of us know, workshop experiences can be intensely emotional and sometimes revelatory. When exploring ACT, CFT, and FAP with qualified trainers in a safe environment, many psychotherapists are able to take risks, look at their inner life through a new lens, and open themselves to strong emo- tions that they may have been avoiding or blocking. As therapists, we discover new possibilities through these experiences, and we come away with the chal- lenge of how to build on that learning. Several factors can help us build on the experience of participating in a workshop, attending a conference, or even reading a book, this one included: • Developing a regular personal practice of mindfulness and compassion meditation • Using the techniques we learn on ourselves, including role-­playing, as part of a process of self-­reflection • Seeking qualified trainers and supervisors and establishing ongoing edu- cational relationships with them • Connecting to communities, professional organizations, and local peer groups to create conditions that can further our education and capacities • Using online resources, recordings, social media, and e-­mail discussion groups to facilitate and enhance our personal practice and education All of these experiences become possible as you connect with fellow travel- ers on your journey into compassion-­focused ACT. At the end of this book, we have provided a list of resources that will allow you to pursue these paths. Hopefully this will elucidate ways in which you might choose to take your work further or in new directions. After workshop and training experiences, it can be easy to let new learning slip away as we are pulled back into the flow of life, and get caught up in habit- ual patterns. Sometimes, this might be just what we need. However, for our professional and personal growth, it is important to continue the journey, to keep on asking questions and assimilating new learning. All of the information in the Resources section is aimed at making it easier for you to pursue training and enrichment in ACT and compassion psychology if you wish to do so. Research and Knowledge Development While there is sufficient science to support the approach outlined in this book, many important directions for research in contextual psychology and the science of compassion remain, and endeavors in these fields will further the work. There is already a considerable amount of research supporting the fundamental pro- cesses of compassion and psychological flexibility, drawn from experimental behavioral science, affective neuroscience, developmental psychology, and psy- chotherapy outcome research. However, much work remains to be done. More research and randomized controlled trials regarding the efficacy of compassion-­ focused interventions, and compassion-­ focused ACT in particular, will be important for enhancing understanding and treatment methods. New and exciting directions that are beginning to emerge in research include more spe- cific and conceptually focused assessment tools for compassion, such as the examination of implicit cognition (Ferroni Bast & Barnes-­Holmes, 2014), quali- tative interviews involving compassion and attachment (Gumley, 2013), and assessment of the two psychologies of compassion in the therapeutic dyad. How compassion might be trained at the level of organizations, communities, and societies also is important, and this is actively being explored at the Stanford University Center for Compassion and Altruism Research and Education, the Compassionate Mind Foundation, and the Charter for Compassion, as well as by members of the Association for Contextual Behavioral Science. By reading and engaging with this book, you are already playing a part in the emergence of compassion in the ACT community and in the world. Should you choose, you can expand on this, framing the ideas and questions that have arisen for you during your reading. If it suits your aims, perhaps you might orga- nize these questions around hypotheses for research or ideas for interventions, or as open questions in an online discussion group. The Path Forward Compassion emerges from a heartfelt recognition of the interconnection between all living things. As we are sensitive to the suffering we encounter and are moved to respond to do something about it, we naturally turn to one another for support, companionship, and collaboration. At this point in our evolution and history, there is far less distance than ever before between us, whether we are authors, readers, or researchers. Our communities and the vast networks of dedicated fellow travelers are ever more closely knit together. We hope that as we have shared this journey with you, you will share your journey with us. We are all joined in our common humanity, resting in kindness with the knowledge that we all wish to be happy, to be well, and to find peace and joy, including—­ and especially—­in the face of great challenges. May you become available to your compassionate mind as it becomes avail- able to you. May the conditions that cultivate compassion and well-­being orga- nize themselves around you and your clients. And may you flourish and continue to share your own wisdom, strength, and commitment with those who have come to you for care, with your loved ones, and with yourself. 248What matters most is how well you walk through the fire. —­Charles Bukowski Love and compassion are necessities, not luxuries. Without them, humanity cannot survive. —­Tenzin Gyatso, Fourteenth Dalai Lama