8 把当下的力量带入此刻

第8章

将注意力引向当下 我们正在从固定名词的世界转向流动动词的世界。 — 凯文·凯利

你已经与詹妮弗合作了一个月。她来找你时，正经历长期的抑郁和社交孤立。她有一份稳定的工作，但工作能力远低于她的潜力。然而，用她自己的话说，她一直在自我破坏。她经常整个周末都独自在家看电视，几乎持续感到内疚和羞愧，但又因为太痛苦而无法行动。她直到滞纳金和信用问题堆积起来才去支付账单。

在治疗初期，你了解到詹妮弗年轻时遭受了重大的背叛。这些背叛让她从本能上认识到分享情感是危险的。她还内化了一种非常严厉的自我批评的声音。你和詹妮弗达成共识，学习打破这种声音——以及她维持的那堵墙——很可能是治疗的重要部分，帮助她朝着与他人建立更多联系的目标前进。

鉴于詹妮弗对脆弱性的恐惧程度，你的方法非常温和。你允许时间与空间来建立信任。同时，詹妮弗非常感激你的努力，并且在早期的家庭作业中非常努力。事实上，你甚至觉得被她的赞美所吸引。与此同时，很明显，詹妮弗有许多避免当下脆弱性的方法。你专注于在房间里营造一种安全感，并逐渐提高对她这些回避行为的认识。

本周，就像在处理长期问题的治疗过程中经常发生的那样，她的情绪有所下降。詹妮弗进入房间时明显更加退缩和焦虑。

“你今天感觉怎么样？” “我还好。嗯，不，我有点难熬。” “我看出来了。你看起来紧张、戒备。发生了什么？” “这周很难过。这就是我的结局。我知道这不合逻辑……好吧，那么今天我们打算谈些什么？”她露出一个紧张的假笑，耸了耸肩，好像在说，让我们继续吧。

你深吸了一口气。“你想继续，但离开你的感受似乎很不自然。我想了解更多你现在的感觉。你愿意慢下来，告诉我更多吗？”

“我不知道。”她紧张地环顾四周。“我觉得……空虚。但谈论这个没有好处。”

你记得詹妮弗面临着大量的自我批评——令人崩溃的自我批评。你注意到她在推开你。

“我不认为你是有意这样做的，但我感觉到你现在在推开我。我也想知道你是否有很多自我批评，以及你是否想隐藏那个糟糕的自己。这是在发生吗？”你温柔地说道。

“你说得对。对不起。我不是有意要推开你。”她露出羞愧的表情。

“没关系，你知道，如果你想推开我也没关系。我能理解。”

她深吸了一口气。然后她用更低的声音说道：“实际上，在某种程度上我是这样的。我不想沉浸在消极情绪中；我已经花了很多时间在那里。我不需要安慰或任何东西。我想向前走。这才是我现在需要的。所以并不是我想推开你，而是我不想让你只关注我有多糟糕。”

突然间一切都清楚了。这是一个请求，而不是体验性回避。

“啊……嗯，这很有道理。现在我很高兴我逼你解释了一下。我觉得刚刚有些事情在我脑中豁然开朗了。就像是有时候你在这里试图做的事情是勇敢地继续前进，朝着你关心的事情前进？是这样吗？”

“是的。”

“这就像是你是一个马拉松运动员，而我有时成了你耳边的那个声音，说‘哦，这太痛苦了’。而你真正想要的是继续跑下去。”

“但这不是你的错！”

“我感谢你这么说。我认为这不是我的错。我以为你需要安抚和时间来处理你的情绪。我承担责任。我没有理解到你也想继续前进。我总是希望你能把这类事情明确告诉我。我很高兴你现在明确了。你之所以停滞不前，不是因为你当下的感受，而是因为你害怕我会让你以一种不对劲的方式停留在那里。”

她现在直视着你。

从FAP的角度来看，"我的来访的问题是如何在治疗过程中体现的？" 是你可以问的最重要的问题之一。"我是否在治疗上解决了这些问题？" 是另一个重要的问题。对于詹妮弗来说，她表现出来的是不愿意表达自己的需求，害怕伤害或让治疗师失望。

尽管我们都有一个幻想，认为自己是完美的技术专家，但临床工作的现实往往是很模糊的。随着治疗的展开，有时我们需要放慢节奏，深入那些看起来太可怕的感觉，澄清挥之不去的困惑，或者处理一些未说出口但能感受到的紧张。这些步骤不仅是为了保持治疗过程的推进，也是因为阻碍治疗过程的东西往往是阻碍来访在生活中前进的原因，并且是来访寻求治疗的理由。根据FAP规则，这种探索、功能性思考、注意和引发代表了规则1（注意到CRB）和规则2（引发CRB）。

在上面与詹妮弗的例子中，这种探索是至关重要的。治疗师最初假设抑制情绪是关键的CRB1。然而，回顾起来，詹妮弗其实对自己的情绪非常开放。她所抑制的是一个请求，希望以不同的方式推进治疗，而不是花一个小时进行一场感觉像是专注于情感怜悯的聚会。她最初的陈述——她确实想推开治疗师——是一个重要的2级行为——虽然摇摆不定且不确定，但仍然是2级行为。治疗师随后意识到了自己的错误。探索带来了这种清晰度。詹妮弗和治疗师的脆弱性以及对功能性思维的承诺使这一切成为可能。通过这种方式，詹妮弗和治疗师也学到了关于连接的一个更深层次的教训：即使存在误解，但在寻找理解的过程中坚持下去所产生的连接比完全理解更加坚韧。然而，整个过程之所以能够开始，是因为治疗师愿意深入探究正在发生的事情——并且她一直在推动。

什么是引发？

阅读下面的问题和陈述，想象一位督导或亲密朋友正在对你这样说：

• 你现在对我有什么感觉？
• 你现在在避免对我说什么？
• 我们之间似乎有一个模式，我想和你分享，因为我觉得它又出现了。
• 我不确定这是否是正确的话，但它感觉是对的。我想让你知道……
• 你现在需要我为你做什么？
• 你怎么才能在这个时刻打开自己，感受到我对你的重视和欣赏？
• 我现在害怕惹你生气，不知道你能否注意到你的语气？
• 我注意到今天你没有怎么看着我，我觉得我们之间的连接不如以前那么紧密。我希望和你建立联系。你能看着我吗？

“引发”这个词来自拉丁语evocare，意思是“呼唤”或“召唤”，基于动词vocare，“发声”。引发就是用你的声音召唤出某种行为。这些问题和陈述是具有引发性的，因为它们呼唤出一种不同的行为，即使这种行为仅仅是意识到正在发生的事情：“注意我们现在之间正在发生的事情。”

这种将注意力引向当下的做法通常需要勇气，因为它让人感到不舒服。这样做往往会有一种自然的强度。判断或拒绝的刺激是即时的。不确定性是可感知的。情感是原始的。将注意力带到当下比谈论过去的经验或未来可能性要脆弱得多。

在实践FAP时，目标是以策略性、敏感于案例概念化的方式使用引发性的问题和陈述，并随着时间的推移进行监控，以确保它们导向治疗目的。具体来说，我们的目标是在当下引发出对特定来访当前生活中的成长或恢复至关重要的确切行为。有效的引发需要清晰的功能性思维，而大胆地引发则需要你有信心这样做是治疗性的。只有功能性思维才能给你这种信心。但是引发也会影响功能性分析，因为它会召唤出行为和披露，让你能够探索当下正在发生的事情。记住，虽然我们作为治疗师的目标是策略性的，但我们并不总是正确的。因此，引发通常是探索的开始，向着似乎重要的事情移动。在引发的时刻，所有FAP的元素都汇集在一起：信任、脆弱性、勇气、同情心和功能性思维。

在本章中，我们描述了一些常见的引发原则。

当你看到潜在的CRB

巧妙地引发需要注意到可能是CRB的行为，正如规则1所述。在詹妮弗的例子中，治疗师注意到詹妮弗情绪激动，在这种情绪背景下，她似乎想要远离这种情绪，并且也希望治疗师远离它。

因此，引发就是要召唤出不同的东西。本质上，引发往往会中断已经在发生的事情。它是破坏性的。这种中断可以有多种形式，强度也会有很大差异。当你想到引发时，想象一个介于温和打断和大胆面对之间的连续体。

温和的打断就像一只柔软的手慢慢伸向前方：“我可以让你慢下来吗？”它平衡了请求许可的温柔和打断的果断。尽管它是温和的，但它的中断可能会令人惊讶：“我可以让你慢下来吗？我认为你现在可能害怕说出你真正想说的话。”

相比之下，大胆的面对就像一把抓住注意力的拳头：“让我在这里停下来。”它抓住了这一刻，但并不必剥夺选择权，因为在下一刻你可以强有力地把选择权还回去：“让我在这里停下来。你真正想要的是什么？”

治疗的不同时刻需要在这个连续体上的不同位置。一如既往，重要的是要问自己这个问题：我的引发在这个时刻起什么作用？

以被听见、看见和感受到的方式引发

引发不仅仅体现在所说的话语上，它在多个层面上发挥作用。通常，最有效的引发不仅通过内容本身，还通过表达这些内容时的面部表情、手势和身体姿态来实现。

想象一下，你正在与一个来访合作，他倾向于沉浸在自己的思绪中，反复讲述同一个关于他受到不公正对待的故事，仿佛你从未听过这些故事，也从未多次表达过对他痛苦的理解。假设他的2级行为包括放慢速度、深呼吸、描述他的感受，并表达他的需求。在这种情况下，你的引发可能在多个层面上体现这些2级行为：

• 你向前倾身坐在椅子上，进行眼神交流。
• 你的手做出一个温和的手势打断。
• 你深深地吸了一口气到腹部。
• 你专注于你的意图：用你的语气传达你对来访痛苦的同情，同时也更有效地交谈。
• 最后，你的话到了：“我真的很想帮助你超越痛苦，我在想你是否一遍又一遍地讲同样的故事，因为你没有深刻地感受到你所讲述的痛苦，或者因为你没有感受到我对你说的话的认可。你愿意放慢速度，每次说一句话时，注意到你身体中的内脏感觉吗？”

引发的形式

引发是由其功能定义的，而不是形式。然而，引发确实倾向于采取几种常见的形式，考虑这些形式有助于理解其可能性范围。在接下来的部分中，我们将探讨这些形式：

• 描述你所注意到的
• 提示来访注意
• 请求和邀请
• 大胆的请求
• 表达同理心和爱

描述你所注意到的

描述你在当下注意到的事情是一种非常基本的引发CRB（临床相关行为）的方式：“我注意到当你说到那一点时，你看向了别处。”这种陈述所引发的意识有时足以促使CRB的变化，或者开启有用的探索。

提示来访注意

另一种基本的引发CRB的方式是提示来访分享他们所注意到的。这会引导他们的注意力，可能会中断回避行为，同时也会引发自我披露。考虑一个典型的治疗问题：“你现在有什么感觉？”这往往能引发来访分享他们所注意到的东西。你也可以单独引发注意：“你能注意到你现在的感觉吗？你不必告诉我；只是自己注意并体验它。”这不是一个学术上的区别。对于某些来访来说，纯粹关注意识和个人体验可能是他们所需要的，而试图引发自我披露可能会让他们感到过于不适和危险。随着时间的推移，你可以逐步与这样的来访采取进一步的步骤，但开始时纯粹关注意识和体验可能比要求他们分享他们所注意到的东西更有效。

分享亲密且脆弱的经历，特别是关于情感的，对许多人来说是困难的，但它能带来许多人渴望在关系中的连接感。有时候，一个强有力的FAP过程可以完全围绕着来访和治疗师之间来回分享当下的体验展开。FAP治疗师Tore Gustafsson称这种做法为“情感镜像”。以下是一个简短的例子：

来访： “我感到一阵羞愧。当我告诉你这件事时，我的脸颊发红。”

治疗师： “我感觉到你的不适，而且你没有移开目光。这让我对你感到温柔。我的胃里有一种温暖的感觉。”

来访： “你说那话时，我感到自己颤抖了一下。我有一部分想要推开你。但是被看到、被关心的感觉真是太好了。”

治疗师： “我很高兴你没有推开我。我也有部分感到不舒服。我注意到我的手有些不安。然而当我看着你时，我感觉其他的一切都消失了。我感到平静。”

请求和邀请

有时，仅仅陈述你所注意到的内容就足以引发CRB。在其他时候，你可能会加上具体的请求或邀请；例如，“我注意到你没有看着我。我想和你建立联系，因为你说的事情感觉非常重要。所以——我知道这很难——你能在说话的时候看着我吗？”这样的邀请直接命名并请求2级行为。

大胆的请求

我们将大胆的请求作为一个单独的类别，基于它们引起的中断强度或所邀请的变化程度。当然，这种程度是完全情境化的。因此，对于某些来访或治疗师来说，前一节中的示例请求可能已经相当大胆。由于其强度，大胆的请求应该谨慎使用；否则，它们的影响会减弱，或者有很高的风险使治疗变得令人反感。对大胆请求的回应应该具有这样的质量：“我愿意这样做只是因为你建立了大量的善意和信任，并且我知道你所说的对我是有益的。”虽然有意愿回应，但这种意愿已经被推向极限。

这里有一个在需要高度敏感的情境中提出大胆请求的例子。来访几周来一直在反复思考自杀，不愿意承诺继续生活，但仍然持续参加治疗。治疗师注意到最近的治疗会谈围绕着来访的自杀念头进行，这种方式似乎没有成效；实际上，治疗师发现来访在会谈中的行为模式与他在生活中避免承担责任和回避处理挑战性问题（如婚姻失败和职业停滞）的模式相似。因此，带着最大的同理心和共鸣，治疗师说：“我想对你提出一个大胆的请求。我意识到当我这样说时，我要求的是很多。我注意到我们一直在围绕自杀的问题打转。你不想放弃结束生命的念头。但我看到的核心问题是另一件对你来说更可怕的事情：你真的害怕面对婚姻中的问题，并且感觉自己的工作陷入了死胡同。谈论自杀某种程度上更容易。所以我的请求是：我们可以停止表现得好像是否自杀才是这里真正的问题，而是专注于让你想要自杀的原因吗？你愿意和我一起探讨这个问题吗？”

表达同理心和爱

接受同理心和爱同样可以像任何请求一样引发反应。一个简单的、富有同情心的反馈——例如“那一定非常痛苦”——可以引发一系列潜在的1级行为：否认、怀疑、愤世嫉俗、各种形式的回避等。也可能会有平行的2级行为出现，这些行为来自于承认或公开接受治疗师的同理心或关爱。

平衡勇气与爱

再次强调，上述类别（描述你所注意到的、提示来访注意、请求和邀请、大胆的请求、表达同理心和爱）仅建议了一些你在会谈中可以引发行为的方式。各种形式的行为也可能实现所需的功能。我们还发现，平衡勇气与爱是治疗性引发的另一个重要品质。

注意，在前面关于自杀的例子中，治疗师在提出大胆请求之前，先承认了来访的视角——她要求来访面对比自杀更让他害怕的事情。这种前置是一种重要的FAP引发原则：只要引发要求来访表现出勇气，它就应该明确地基于同理心和爱的角度。承认来访的视角、可能的情绪影响或请求许可都是表达同理心和爱的方式。反过来，传达同理心和爱可以改变请求的功能，将其从更具威胁性的要求（“做这个，否则...”）转变为更具吸引力的邀请，朝着有意义的方向前进。考虑以下例子的区别：

• 我知道这是一个大胆的请求，可能会让你感到不舒服，但我真的很希望你能挖掘一些可以与我分享的关键反馈。（对比：“我希望你能挖掘一些可以给我的关键反馈。”）
• 我听到你现在说你感到多么孤独。你说得对，我无法确切知道你的感受。但我想让你知道，我真的想理解。你愿意告诉我更多吗？（对比：“现在告诉我更多。”）
• 我能感受到这对你说起来有多困难。我们再讨论这个话题一会儿好吗？（对比：“让我们再多谈谈这个。”）

作为补充，如果来访以防御、抗拒或回避的方式做出反应，一个很好的经验法则是放大你的同理心和爱的表达，以增加引发的吸引力功能。通过将引发直接与来访的目标联系起来，也可以达到类似的效果。

放慢节奏与允许

进一步说，无论引发采取何种形式，即使它是坚定或强烈的，通常也不应该感觉像是强迫。引发应当感觉像是邀请、建议、鼓励或合作。前一节中的陈述是这种非强制性引发的好例子。我们在实践FAP时的假设是，自愿参与和选择通常是有效治疗的基础。我们不是在强迫来访，也不是将他们置于厌恶控制之下（“做这个，否则会有不好的事情发生”）。我们不是要求来访按照我们的说法去做，因为我们认为他们应该这样做。我们希望来访根据自己的价值观和经验选择对他们来说正确的事情。如果我们确实需要施加压力或进行对质，那通常是为了策略性地帮助来访更接近选择。

因此，记住这一点很有用：选择往往是在时间的宽裕中产生的，尤其是在涉及情感、困惑或冲突的情况下。我们必须提供时间——通过沉默、倾听等方式。这不是无限制的宽裕；你的存在将来访保持在当下，并邀请他们感受那些尚未完全感受到的情绪，思考那些尚未完全思考的问题，以及做出那些尚未完全做出的选择。为此，你的存在可能需要或多或少地突出，以及或多或少地活跃。

例如，有时在提出大胆请求之后保持沉默是最好的策略。让沉默创造空间，使影响得以深入。沉默也可能令人感到压抑——延续了熟悉的模式或困惑吞噬来访的局面，或者使得未说出口的想法埋得更深。在这种情况下，你需要再次引发；例如，“你现在有什么想法可能很难告诉我？你现在在避免对我说什么？”

沉默本身也是具有引发作用的。注意沉默的功能：它引发了什么？同时注意你在沉默和填补沉默时的1级行为和2级行为。如果你倾向于说得太多——或者太少——你可能会错过塑造来访行为的宝贵机会。

练习

除了上述较为非结构化、基于过程的引发方式外，你还可以使用各种有结构或无结构的练习来引发CRB。生命史练习、FAP会话衔接表以及各种评估——实际上，治疗过程或结构的任何方面——都可以引发CRB。在第12章中，我们提供了一些练习样本，正是出于它们的引发价值。这些练习与其他引发方式的区别在于，它们往往是有些结构化的。

引发的长列表

下面提供了一个长长的示例问题和陈述列表，你可以用来引发CRB。它们被组织成意识、勇气和爱（ACL）的功能类别，以及第4章概述的每个子类。然而，大多数问题在广泛的分析功能范围内都是有用的。（实际上，许多问题可以归入一个或两个其他ACL类别。）请不要把这些例子视为规则2的“脚本”，直接逐字用于来访——尽管有时我们提供的语言可能是完美的匹配。相反，我们希望这些列表能激发你思考如何在具体情境下为特定来访引发CRB。我们也希望它们能激励你以大胆而勇敢的方式引发CRB，同时也能关注来访的需求。

当下的身体感觉、思维和情绪的意识

• 你现在能不能放慢速度，深呼吸一下，然后与你的身体连接？
• 你能真正注意到并意识到听到我这样说时，你的身体是什么感觉吗？
• 你现在能否找到自己行为中好的、纯净的和坚强的部分？
• 你能注意到你现在的感觉吗？
• 我注意到我不确定你在说话时是否在跟踪我的思路。我注意到我没有像我希望的那样专注，因为你似乎不太与我或你说的话相连接。你能看到这一点吗？
• 你告诉我，对你来说很难弄清楚自己的感觉。如果我列出一些你可能有的感觉，你会不会只是注意并留意哪些情绪词汇适合你？
• 你在说话时有一瞬间的情绪闪现。你意识到了当时的感觉吗？
• 你注意到我在给你反馈后你很快就转移话题了吗？我感觉你在敷衍我。

价值观、需求、目标和身份的意识

• 你知道你现在从今天的会谈中需要或想要什么吗？
• 在这一刻，对你来说什么是真正重要的和有意义的？
• 当你在和我说话时，你是否意识到你来这里的原因以及你想解决的问题？
• 你渴望的是什么？
• 目前你觉得最难接近的目标是什么？
• 你学到了哪些最重要的技能，你希望在生活中继续实施？
• 在哪些方面，你对自己取得的进步感到失望？
• 我很难理解这对你来说重要的是什么。你能帮我理解吗？

对他人的意识

• 你觉得我现在是什么感觉？
• 我想知道你能否更多地关注我的脸、表情和眼睛。真的注意到我。
• 你能做些什么来改善我们的关系？
• 你对我有哪些看似不恰当的反应？
• 你觉得我对你的进展有什么感觉？
• 你是否意识到我是如何对你所说的话做出反应的？
• 你似乎非常关注我现在是如何反应的。你注意到了什么？
• 你似乎在人际关系中很习惯冲突，并且你也以这种方式与我互动。你觉得这对我来说，以及关心你的人会是怎样的体验？
• 你知道，让关系良好运作的一部分是关注对方。你在哪些方面意识到自己对我的影响？

勇气：选择体验脆弱性和情感

• 今天来治疗的路上，你在想什么或感受什么？
• 在外面的候诊室等我的时候，你在想什么或感受什么？
• 人们有不同的方式来抑制自己的感情。一个来访告诉我她从一千开始倒数七。另一个则屏住呼吸。你是怎么抑制你的感情的？
• 根据你的面部表情，或者缺乏表情，我很难知道你的感受。你能描述一下你身体内的感觉吗？
• 你对我刚才说的话有什么反应？[...对我的解释？...作为你的治疗师？...对议程设定？...对结构化的治疗？...对家庭作业任务？]
• 让我们花五分钟真正谈谈我们现在这一刻的感受，从心底里谈。
• 你现在感觉怎么样？
• 随着治疗关系的结束临近，你对结束这段关系有什么想法和感受？
• 听到我的反馈对你来说是什么样的体验？
• 听到我说这些对你来说很痛苦。我想承认这一点。你能告诉我更多关于这种感觉吗？
• 我觉得你现在说话非常小心。你在避免说什么？如果你不那么小心，你会说什么？
• 我知道我们的分歧对你来说很难接受。你愿意继续和我讨论这个问题吗？
• 你看起来很生气，但你的话并没有反映出这一点。如果你把愤怒用语言表达出来会怎样？
• 你能表达出你愤怒之下的伤痛吗？这样我能更容易理解你为什么对我感到不满。
• 我们越来越亲近对你来说意味着什么？
• 你刚刚和我分享了一些你通常不会告诉别人的事情，这对我来说意义重大，但你表现得好像这没什么大不了的。你对你刚才说的内容有什么感觉？
• 我希望你能放慢速度，再对我说一遍。你能感受到你说的话吗？

勇气：自我披露

• 有什么话题对我们来说很难谈论？
• 你不想谈论什么？
• 你很难表达自己哪方面的内容？
• 在会谈之间，你遇到了什么困难？
• 你发现了什么让你感到痛苦的事情？
• 我们在一起的时间里，最难的部分是什么？
• 你的哪些行为倾向于在关系中带来亲密感？哪些行为会减少亲密感？你对我们在这里观察这些行为有什么感觉？
• 你很难向我透露关于自己的什么事情？
• 在哪个方面，你对自己取得的进步感到失望？
• 会谈期间发生了什么让你难以管理自己的情绪？
• 你和我之间的互动中最突出的是什么？
• 什么样的情况、想法或行为会让你容易感到[插入问题]，你可以如何处理这些问题，以减少你最初来时经历的问题的发生概率或严重程度？
• 什么时候你觉得和我最亲近？
• 因为我们一起工作，你经历了哪些强大的体验？
• 从你的心底，当你告别时，对你来说最脆弱的是什么？
• 你对治疗有什么遗憾，或者你希望有什么不同的地方？
• 你有什么负面的反馈想要和我分享吗？
• 你似乎真的把治疗放在了优先位置。你能告诉我你和我的治疗关系对你意味着什么？

勇气：请求满足需求

• 你不想谈论什么？
• 我们现在可以做什么来建立连接？
• 你现在需要我为你做什么？
• 你想改变治疗中的哪些方面？
• 有哪些领域是我们需要继续讨论的？
• 你希望我如何改变？
• 你很难对我说什么？
• 你希望我做哪些不同的事情？
• 我听到你说的话中有一个需求，但我不太清楚。你能帮我理解吗？
• 我注意到你现在非常努力地照顾我。谁来照顾你呢？
• 我怎么能更好地照顾你？
• 我觉得对你来说，甚至有点害怕，在这里提出你需要的东西。尽管害怕，你愿意向我提出吗？
• 我觉得你现在的情绪压倒了一切。你觉得需要什么？

爱：提供安全与接纳

• 你能向我表达接纳吗？你真的爱我并接受我的哪些方面，以及我与你互动的方式？
• 你现在让我觉得有点害怕。有没有办法让你不那么吓人，同时仍然保持真实的感觉？

爱：表达理解、肯定和同理心

• 你觉得现在有什么是我觉得重要的？
• 你什么时候觉得和我最亲近？
• 你喜欢并感激我的哪些方面？你会永远记住我的哪些方面？
• 你现在的倾听对我来说意义重大。通常你非常专注于讲述你的故事，所以当我感觉到你在认真听我说时，这对我来说非常重要。

爱：给予所需

• 你能做些什么来改善我们的关系？
• 我觉得如果……会帮助我更好地与你建立联系。
• 我想知道你对我们工作的看法。你能告诉我吗？
• 似乎愤怒是你最常有的情绪，而这可能会把人推开。你能以一种让我们更亲近的方式向我表达你的愤怒吗？
• 对我来说很难告诉你这些，因为我不想让你感到与我疏远。但有时你表达情感的方式非常强烈，这让我害怕。我想继续与你在一起，如果你能降低声音并稍微慢一点说话，我会觉得很有帮助。你怎么看？
• 我注意到你刚刚改变了话题。我们能回到刚才的话题吗？
• 我注意到你在说这些话的时候没有看着我。你能看着我吗？

爱：相互披露

• 你生我的气吗？
• 我做了什么让你感到不舒服？
• 有哪些事情我觉得自己做得不够敏感？
• 有哪些事情我做过伤害了你或让你感到生气？
• 你什么时候觉得和我最亲近？
• 我想让你知道，我尊重你对这件事的愤怒。我很抱歉我所做的事。你愿意让我试着修复这个局面吗？
• 你愿意和我妥协吗？
• 似乎当你对某事不满时，你倾向于责怪别人，包括我。我们能否各自看看我们在当前冲突中的贡献？
• 宽恕他人的错误是维持亲密关系的重要能力。我知道你现在对我非常生气，并且想要离开这段关系。但这只是重复了你对所有关心你的人所做的事情。这次你愿意做些不同的事情吗？你愿意努力原谅我的错误吗？

自爱：自我接纳

• 你难以表达自己的哪些方面？
• 你现在能接受自己哪些方面？
• 你喜欢并感激自己的哪些方面？
• 似乎你现在对自己非常苛刻。在这种情况下，你能欣赏自己所做的哪些事情？

自爱：接受他人的爱

• 听到我对你的赞赏，你的身体感觉如何？
• 你能接受我对你的赞赏吗？
• 你现在对我赞赏的接受程度如何？

自爱：自我关怀

• 你现在需要我为你做什么，才能帮助你照顾自己？
• 在这一刻，你能如何照顾自己？
• 如果你想让今天的会谈对你最有滋养和支持，你会怎么安排它？

回应来访的1级行为

当你引发（evoking）时，你是在当下召唤某种东西。你进入行为流中，并以某种方式改变它的方向。当然，这条流有自己的动量。它不会立即遵从你的建议。它可能会把你冲倒，或者绕过你并在下游造成混乱，或者默默地顺从然后立即恢复原状。

因此，引发仅仅是第一步，而当我们试图引发时，我们常常发现自己在与希望改变的行为的动量作斗争。考虑以下来访1级行为（CRB1）的例子：

• 来访有十几种方法来远离她的焦虑体验。
• 来访在面对任何行动路径时都会陷入焦虑的反对。
• 来访坚信某些类型的事情“根本不能”做，并且会争辩不要尝试去做。
• 当她感到脆弱时，来访会用各种讨人喜欢的自嘲笑话来掩盖她的焦虑。

在所有这些例子中，CRB1的功能都是为了推开、逃避或避免来访认为厌恶的东西。当这种行为实现了其功能时，CRB1就会得到强化。

当CRB1作为引发的回应出现时，关键的问题是：接下来会发生什么？ 一种可能是，CRB1对你来说是厌恶的，或者以其他方式将你拉向一个不那么治疗的方向。（记住，在这个上下文中，“治疗”的定义是引发2级行为CRB2。）事实上，你可能会通过某种方式强化来访的CRB1而产生反治疗的效果。这种情况并不罕见。

示例

想象一个青少年来访，她的日常生活中常常因为情绪波动而无法完成重要的任务。在治疗中，双方同意的核心2级行为（CRB2）是尽管有来来去去的情绪，也要去做重要的事情：

治疗师：所以，你的家庭作业是要进行一次非常重要的对话。我想听听进展如何。

来访：我真的不想谈这个。

治疗师：为什么呢？（敏感地询问）

来访：我只是觉得太压倒性了。（开始流泪）

治疗师：（身体前倾）告诉我更多。

在这个场景中，治疗师可能会被从核心的2级行为和相应的引发中拉走，转而关注她自己1级行为中的回避——即避免可能更具挑战性的未完成的家庭作业话题。关注情绪可能是有效的，但在回到家庭作业之前，作为治疗师我们并不总是能完成这个循环。在这种情况下，治疗师可能会无意中强化来访的回避行为，并在会谈结束时意识到几乎没有超出现状的成果。

以一种看似挑战来访但实际未能引发2级行为的方式回应1级行为同样是无效的： 治疗师：所以，你的家庭作业是要进行一次非常重要的对话。我想听听进展如何。

来访：我真的不想谈这个。

治疗师：真遗憾。但我们必须谈。

来访：好吧。随便。

治疗师：那么进展如何？

来访：还好。

治疗师：（等待）

相比之下，尽管来访试图引导你远离并避免话题，尽管对你或来访来说这一刻可能是令人厌恶的，仍然有一种方法可以温和地保持引发而不强迫或强化来访的1级行为。这种技能本质上在于停留并在可能的情况下使这一刻尽可能吸引人，从而使来访愿意与你一起留在那里找到对他来说是2级行为的行为。例如： 治疗师：所以，你的家庭作业是要进行一次非常重要的对话。我想听听进展如何。

来访：我真的不想谈这个。

治疗师：是的。我能看出你的情绪。你愿意告诉我发生了什么吗——无论是什么？这次对话非常重要。而且有很多利害关系。

在这里，治疗师平衡了验证、请求许可以及强调家庭作业的重要性，同时重复了引发。这种温和而坚持的重复引发可能是对1级行为最简单的回应。在这种情况下，治疗师现在可能在寻找任何轻微的迹象，表明来访愿意谈论家庭作业或关于发生的事情的情绪。通过这种方式，治疗师逐渐塑造出更完全发展的2级行为： 治疗师：是的。我能看出你的情绪。你愿意告诉我发生了什么吗——无论是什么？这次对话非常重要。而且有很多利害关系。

来访：（流泪）

治疗师：看起来无论发生了什么都非常痛苦。

来访：是的。

治疗师：没关系。慢慢来。

来访：我感到很尴尬。

治疗师：告诉我发生了什么。

这样的时刻往往需要逐步展开，治疗师和来访共同塑造一个广泛的、灵活的2级行为。应该有一种探索体验的感觉，充满同理心。下面是一个扩展的例子，展示了逐步引导到与情感表达相关的2级行为的过程： 治疗师：你现在这样看着我（眼睛向上看，略微低头）。我想知道你是否能更直接地看着我。这会让我感觉更连接。

来访：好的。（看着治疗师）

治疗师：你现在感觉怎么样？

来访：焦虑。我不知道为什么我会焦虑。

治疗师：你怎么知道自己是焦虑的？

来访：我更加紧张。

治疗师：你在哪儿感到紧张？

来访：身体上。我的整个身体都很僵硬。看着你比以前更难了。（稍微移开视线）

治疗师：我在请你更直接地看着我。

来访：这样可以吗？好些了吗？

治疗师：你看起来更有情绪了。

来访：是的，我很伤心。当我开始想到昨晚看的那场演出时，有悲伤，哭泣——我现在这里，有些地方有眼泪……

治疗对话

治疗师：你在笑。当你笑的时候会发生什么？这会阻止你流泪吗？

来访：是的，我想是这样。

治疗师：你看，你正在这样做，你在让你的悲伤消失。当你微笑甚至有点笑的时候，很难感到悲伤。

来访：确实如此。

治疗师：这是一种非常有效的技巧。我想更多地了解你的悲伤。你现在在身体上是如何体验这种悲伤的？你感觉到了什么？基本的感觉是什么：喉咙里有块东西，胸口沉重？你感觉到了什么？

来访：嗯，我不确定我感受到了什么。

治疗师：你注意到身体上的感觉了吗？

来访：我注意到呼吸变浅了。

治疗师：你做得很好，保持自我，不笑——不去想太多。你在屏住呼吸吗？

来访：是的，我在屏住呼吸。

治疗师：如果你让自己哭出来会怎么样？

来访：没什么。我不明白为什么我做不到。我只是会感到难过。我不明白为什么我不能那样做。

治疗师：实际上，你比很多男性做得更好。你有时会让自己流泪，甚至抽泣。我认为如果你能更深入地接触自己的感受，并且更加表达出来，你会感到更加自由。对我来说，你情感表达中的一个大问题是不一致，就是微笑。我希望你做的第一件事就是停止这样做。你知道，当我和我的来访一起工作时，他们说一些悲伤的事情却开始微笑，这让我作为接收者感到很困难。我不知道对你来说是什么感觉；这似乎是在否定自己，是一种非常有效地切断自己与情感联系的方式。我想知道这是怎么来的。你是否必须对父母微笑，让他们知道一切都没问题？我检查一下你的呼吸情况。

来访：呼吸很浅。我的胸部和腿都在出汗。我很焦虑。

治疗师：你焦虑的是什么？有什么话你想说但没有说出来？直接说出来吧。

来访：你说我的笑容切断了我与情感的联系。我在想我不想被切断与情感的联系。我不想把自己关在一个盒子里。我的父母把我关在了一个盒子里。

治疗师：当我听到你说你的父母把你关在一个盒子里时，我感到很难过。

来访：这确实令人难过。

治疗师：你能说“我感到难过”吗？

来访：我感到难过。

治疗师：试着说“当我想到我的父母把我关在一个盒子里时，我感到难过。”

来访：你要我说这个？

治疗师：并且尽量不要笑。

来访：当我想到我的父母把我关在一个盒子里时，我感到难过。

治疗师：再说一遍。

来访：当我想到我的父母把我关在一个盒子里时，我感到难过。

治疗师：我也为你父母把你关在一个盒子里而感到难过。你的声音很低沉。用你自己的声音说出来，就像你真的那样感觉一样。

来访：我为我的父母把我关在一个盒子里而感到难过。

治疗师：你注意到身体上有什么变化吗？

来访：我感到紧绷，我没有呼吸，也没有真正动弹。那是我自己的声音吗？不是吗？你注意到了什么？

治疗师：我想知道你在做什么来切断自己与情感的联系。你没有笑，这很好，但你还是紧绷着。我真的很惊讶你听起来多么压抑。我想这正是你告诉我的……被关在一个盒子里，被药物控制。你表面下似乎有很多悲伤。看起来你正在尽一切努力把它留在那里。

来访：我咬紧牙关。这真是疯了。

治疗师：我觉得你对自己太苛刻了，因为你并不疯狂。你觉得呢？你在这样的环境中长大，你的父母给你用药，因为他们觉得你对他们来说太多了。你以为你会怎么做？疯狂地表达情绪？还没到时候。

来访：我对自己太苛刻了。我想尝试去感受这些情绪……我想表达出来。

治疗师：我也希望你能这样做。

来访：（短暂哭泣）

邀请成长或改变

在之前的例子中，请注意，引发2级行为（CRB2）并不像提供一个深思熟虑的选择那么简单。这不是意志力或选择的问题。相反，引发CRB2是关于创造一个足够具有挑战性、充满同情心并且足够自觉的环境，以便新的事物能够出现。在整个过程中，治疗师保持同情心，同时专注于引发CRB2。通常来说，对1级行为（CRB1）或者从事CRB1的人抱有同样的同情心是非常重要的。这是一个关键点！这种立场抵消了我们对于“问题”行为感到沮丧或失望的倾向。为什么这很重要？来访往往对自己的CRB1感到充分的沮丧和冲突。在这种情况下，我们的挫败感并不能带来任何新的或破坏性的变化。此外，从CRB1转变为CRB2的门槛往往充满了恐惧或脆弱——这种厌恶往往会引发回避。我们的目标是使这条路径尽可能吸引人。

同时，对CRB1的同情态度并不意味着以宽泛意义上的宽容或容忍。我们可以同情背后的历史和功能，同时意识到它长期以来带来的可怕代价。我们的目标是帮助个人认识到他们有能力通过经历脆弱走向CRB2。

当然，这种平衡同情、接受与坚定引发之间的特定风格或语气因来访而异。许多治疗师倾向于偏向一方或另一方——要么过于温柔和同情，要么过于严厉和要求过高——结果往往是：他们没有引发太多的变化。对于所有来访，你应该根据功能性思维和对正在发生的事情的观察来指导自己。问自己你的引发是如何起作用的。你是否过于宽容或是过于严厉？相应地调整。

在1中看到2

当面对冲突的CRB1流动或即将出现的CRB2时，“在1中看到2”是一个非常宝贵的概念。考虑这个例子：

治疗师：你现在感觉怎么样？

来访：没什么。我希望你能跳出窗外。

治疗师：我知道你对我生气了。我能理解为什么吗？

来访：祝你好运。

治疗师：嗯，我认为过去几周我们试图做的事情并没有奏效。然后在这种情况下，我一直在以一种让你感到非常沮丧的方式挑战你。现在你的工作情况真的恶化了。所以你坐在那里想，治疗再次变得有意义了吗？

来访：差不多。

治疗师：这确实糟糕，没有办法绕过它。我很抱歉。

在这个例子中，即使没有上下文，也可能倾向于将来访的首次陈述视为一种攻击性、回避性的CRB1。这确实让治疗师感到反感，在很多情况下也是无效的。然而，治疗师认识到，来访仅仅出现在治疗中（而不是在酒类商店），以及在这种情况下她与他的言语交流，实际上是CRB2。换句话说，如果这种行为没有发生，来访的生活会更糟。

反过来，治疗师回应来访的陈述，好像这是准确表达愤怒的CRB2。治疗师旨在通过反映这种愤怒来加强这一陈述，并通过询问他是否可以探索她为何生气来进一步激发来访的脆弱参与。

再次，来访以一种模糊但符合其情绪的方式回应——同时也邀请治疗师继续前进。在这尖锐的陈述中同样存在CRB2。治疗师提供了基于事件的验证性解释，承认自己在这种情况中的贡献。随后，来访最终给出了一个更加中立、甚至可能是同意的回应。从此，讨论继续朝着建设性的方向发展。

如果治疗师对来访的反应中的厌恶CRB1方面作出更直接的回应，或者如果他无法在1中看到2，结果很可能不会那么建设性。

忽视——何时以及如何

除了温和地阻止或引发2级行为（CRB2）以回应1级行为（CRB1），你可能还会遇到想要忽视1级行为的冲动。例如，如果来访含糊地寻求安慰，而寻求安慰是一种1级行为，治疗师可能会忽略这个请求，并回应消息的另一部分。或者如果来访在下班后发送一条关于令人沮丧事件的信息，治疗师可能会忽略这条信息。

当来访对你提出具体请求和/或期望得到回复时，忽视通常效果不佳。对于社会敏感的人类来说，明显的忽视会带来不确定性，随之而来的是焦虑或烦躁。这种不确定性是因为忽视很少附带解释；例如，“我将忽略你刚才说的话。”忽视本质上是模糊的：他是否忽视了我的信息？为什么他这样做？他认为这是1级行为吗？这对我来说似乎是合理的。还是他只是忙？我做错什么了吗？他生我的气了吗？这种未说出口的不确定性常常侵蚀信任。它会产生一种特殊的偏执感；例如，“你是不是通过忽视我的回应来对我进行行为矫正？”

然而，如果有明确的、共同的理由来忽视，其功能可能完全不同。考虑以下情况：“当你在周末发送宣泄信息时，因为我很忙，而且这些信息通常是关于你逃避应该做的事情，我们同意我不予回复。”或者“有时我无法提供你需要的一切，也没有人能做到。因此，有时我可能不会回复你的信息，因为生活中的事情会妨碍。当这种情况发生时，你愿意接受这一点并处理吗？”

此外，在某些情况下，忽视可以起到实际作用：例如，如果你有很多其他内容需要回应，你无法回应所有内容，或者专注于特定的事情可能是有效的，或者来访并没有特别要求你回复某个项目。从行为学的角度来看，忽视可能是“最不强化的反应”，因此确保1级行为没有被强化。原则之外，一如既往，在忽视之前，我们应该问自己这样做对来访实际上会有什么影响。

如果没有明确的理由说明忍受失望的价值，那么破坏信任的成本将超过来访偶然发现被忽视的治疗益处的可能性。响应性太重要了；不响应则过于令人困惑。在大多数情况下，当预期有回应时，更优的治疗立场是以诚实和成人社交技能来应对回应的预期。

命名模式并走出模式

在与治疗师的咨询中，我们一次又一次地发现，当治疗陷入困境时，有一种特殊的引发方法非常有用。用FAP（功能性分析心理治疗）术语来说，“陷入困境”意味着治疗关系不再对来访的有问题的行为模式产生治疗性影响。相反，治疗师的行为已经被来访的反应（或其他因素）塑造到了一个程度，以至于治疗不再具有治疗性。

考虑以下例子：

• 每次你建议行为改变时，来访都会对你生气，现在你已经放弃了建议改变。
• 你们一遍又一遍地挣扎于相同的治疗方案，但来访“不懂”，你也不知道为什么。
• 你们彼此都很喜欢对方，但总有一种挥之不去的感觉，觉得没有什么真正改变。

这些例子归结为一点：行为没有改变。这不是进步缓慢的问题，而是治疗陷入了困境。

当这种情况发生时，你需要做一些不同的事情。从功能上讲，你需要改变自己的行为以引发不同的结果。听起来很简单，对吧？在这种情况下，我们通常推荐的方法叫做“命名模式并走出模式”。接下来的部分描述了涉及的步骤。

第一步：描述模式

第一步是使用基本且非评判性的行为术语，准确描述你和来访参与的行为模式。此时还不需要与来访分享。这个描述只是为了你自己。

有时候，行为模式可能是一个相对稳定的保持模式，但更多时候，模式更像是一个循环：这一阶段导致下一阶段，然后循环回到开始。循环的棘手之处在于，循环中的某一部分可能看起来像是逃离循环，但实际上它只是陷入循环的另一部分。考虑一下从治疗师角度写的行为模式的例子： 首先，我们试图塑造你会遵循的承诺，以推动你朝着目标前进，并摆脱无成效的回避。我们激发动力。然后你往往会以某种方式未能达到。接着你对治疗感到沮丧，错过了一次会话，并质疑整个过程。然后我感觉不好，然后我们谈论绝望，最终我们通常会到达一个感觉更加连接的点。然后我们再次充满希望。然后我们再次塑造承诺……循环重复。在过去三个月里，我们重复了三次这个循环。

描述模式时，应足够详细，以便捕捉到模式。你的描述应该足够详细和准确，以至于读过之后，你和来访都会点头表示认同：是的，这就是我们之间发生的事情。

第二步：从来访的角度审视

接下来，从来访的角度审查你写的描述。必须避免将责任归咎于来访。它应该传达出现状有一个100%合理的解释——一种感觉，“当然会发生这种情况，因为这反映了你的行为是如何由你的历史塑造的，这也是你向我寻求帮助的原因。”

你的描述是否传达了这种感觉？

例如，我们可以将上面的例子扩展如下：

首先，我们试图塑造你会履行的承诺，以推动你朝着目标前进，并摆脱无成效的回避。我们激发动力。然后你在某些方面往往会达不到预期。这是可以理解的，因为我认为我们在估计可行的事情上还不够好；我们往往过于雄心勃勃。你还在与许多困难的情绪作斗争。接着你对治疗感到沮丧，错过了一次会话，并质疑整个过程。这再次是可以理解的——尽管我认为这是自毁性的——因为在实际效果上，治疗还没有让你取得太多进展。然后我感觉不好，然后我们谈论绝望，通常我们会到达一个感觉更加连接的点。然后我们再次充满希望。然后我们再次塑造承诺……我们有最好的意图。我们认为我们不会再犯同样的错误。而这个循环重复了。在过去三个月里，我们已经重复了三次这个循环。

你需要在描述中添加哪些验证？ 接下来，更广泛地考虑来访会如何听到你对模式的描述。来访的自我批评思维会提出什么异议或解释？会有羞耻感吗？绝望感？还是害怕你放弃治疗？添加一些直接回应这种声音的验证或保证：

• 我担心说这些会让你认为我要放弃我们的治疗，但实际上我是重申我的承诺。
• 我想承认我在这件事中的责任。你对这个过程感到失望和沮丧是合理的。
• 我预计你可能会觉得这个模式让人感到绝望。但我想通过命名这个模式，我们可以开始走出它。

第三步：发现其他回避

通常，主要被回避的是指出陷入困境的模式，而直接命名这个模式是最重要且最具破坏性的前进步骤。然而，有时还有其他不明显的回避点，在最初描述陷入困境的模式时并没有清晰地显现出来。解决这些回避点可能是至关重要的。

为了解决这种可能性，请考虑以下问题：

• 在这个来访身上，有什么是你没有谈论或接受的？
• 你或来访是否未能履行彼此的承诺？
• 关系中是否有显著的未表达的挫败感或失望？
• 你们中的一方是否关闭了沟通渠道，拒绝讨论另一方认为重要的事情？
• 来访是否抵制你的输入？
• 你是否抵制或未能理解来访的输入？
• 对于这个来访，你还有一些未接受的感受是什么？

如果你发现了某个重要的回避点，应该感到幸运。反思这个回避点是如何融入到陷入困境的模式中的。大约九成的情况下，它会以非常明确的方式融入。例如，治疗师可以这样构建她对治疗陷入困境的看法：

首先，我们试图塑造你会履行的承诺，以推动你朝着目标前进，并摆脱无成效的回避。我们激发动力。然后你在某些方面往往会达不到预期。这是可以理解的，因为我认为我们在估计可行的事情上还不够好；我们往往过于雄心勃勃。你还在与许多困难的情绪作斗争。接着你对治疗感到沮丧，错过了一次会话，并质疑整个过程。这再次是可以理解的——尽管我认为这是自毁性的——因为在实际效果上，治疗还没有让你取得太多进展。然后我感觉不好，然后我们谈论绝望，通常我们会到达一个感觉更加连接的点。然后我们再次充满希望。然后我们再次塑造承诺……我们有最好的意图。我们认为我们不会再犯同样的错误。而这个循环重复了。在过去三个月里，我们已经重复了三次这个循环。

我认为我们一直在回避的一个问题是认识到我们还没有明确地知道什么会使你的生活更有意义和回报。部分原因是由于你头顶上的破产阴影以及工作是否会持续到秋天的不确定性。我认为这些问题隐秘地削弱了我们试图建立的所有动力。

也许你会想，治疗师不能说这样的话，或者我不能这样说！如果你觉得在处理你一直回避的事情时受到限制，试着反思以下问题：

• 如果你不关心成为一个“好治疗师”，而是作为一个富有同情心的人处于最佳状态，你会对这个来访说什么？例如，如果来访是你的亲密朋友或家人，你会说什么？你会怎么说？
• 如果你不受治疗计划、治疗原则、案例概念化等的约束，你认为来访现在最需要的是什么？
• 如果你能解决一个单一的问题，会对这个来访产生最大的影响是什么？

现在问自己这些问题：

• 我回避这个话题，或回避像对亲密朋友那样说话，对我和来访的关系有什么作用？
• 换句话说，当我回避那个话题时，我会做什么？我感觉如何？我在想什么？接下来会发生什么？这种回避模式的成本是什么？

第四步：承担责任

如果你还没有这样做，回答这个简单的问题：你做了什么导致关系陷入困境？在前一步中识别的回避可能是你贡献的一部分。然后将你的回答融入到对情况的理解中。

考虑以下例子： 首先，我们试图塑造你会履行的承诺，以推动你朝着目标前进，并摆脱无成效的回避。我们激发动力。然后你在某些方面往往会达不到预期。这是可以理解的，因为我认为我们在估计可行的事情上还不够好；我们往往过于雄心勃勃。你还在与许多困难的情绪作斗争。接着你对治疗感到沮丧，错过了一次会话，并质疑整个过程。这再次是可以理解的——尽管我认为这是自毁性的——因为在实际效果上，治疗还没有让你取得太多进展。然后我感觉不好，然后我们谈论绝望，通常我们会到达一个感觉更加连接的点。然后我们再次充满希望。然后我们再次塑造承诺……我们有最好的意图。我们认为我们不会再犯同样的错误。而这个循环重复了。在过去三个月里，我们已经重复了三次这个循环。

我认为我们一直在回避的一个问题是认识到我们还没有明确地知道什么会使你的生活更有意义和回报。部分原因是由于你头顶上的破产阴影以及工作是否会持续到秋天的不确定性。我认为这些问题隐秘地削弱了我们试图建立的所有动力。 我认为我对这种模式的贡献在于想要相信在这种情况下，仅仅激活你的积极性就足够了，仿佛你可以通过某种方式克服一切。但显然，我们需要更多。

注意在承担责任时出现的任何反应——防御性、羞耻感、绝望等。为了面对这种情况并推进治疗，你是否愿意体验这些感受？

第五步：还有什么需要摆在桌面上？

当一段关系陷入困境时，大约95%的情况下，首先需要的是治疗师和来访共同审视这一情况，并寻求理解原因。因为这种理解通常来自对话，所以不要过早地执着于某个具体的解决方案。早期所需要的是愿意审视模式，并面对伴随这种意愿而来的情感。

接下来，了解这种模式的成本。完成以下句子：如果这种模式继续下去，最可能的结果是……例如：

• 如果这种模式继续下去，最可能的结果是我们都会感到越来越沮丧。我们将一事无成，而你将带着又一次觉得自己不够好且没有人能帮助你的经历离开。

最后，考虑为什么打破这种模式是有价值的。考虑来访渴望成为什么样的人以及来访重视什么。考虑你真正相信来访必须学习什么才能前进。基于治疗师之前步骤中的观点，考虑以下补充：

• 首先，我们试图塑造你会履行的承诺，以推动你朝着目标前进，并摆脱无成效的回避。我们激发动力。然后你在某些方面往往会达不到预期。这是可以理解的，因为我认为我们在估计可行的事情上还不够好；我们往往过于雄心勃勃。你还在与许多困难的情绪作斗争。接着你对治疗感到沮丧，错过了一次会话，并质疑整个过程。这再次是可以理解的——尽管我认为这是自毁性的——因为在实际效果上，治疗还没有让你取得太多进展。然后我感觉不好，然后我们谈论绝望，通常我们会到达一个感觉更加连接的点。然后我们再次充满希望。然后我们再次塑造承诺……我们有最好的意图。我们认为我们不会再犯同样的错误。而这个循环重复了。在过去三个月里，我们已经重复了三次这个循环。
• 我认为我们一直在回避的一个问题是认识到我们还没有明确地知道什么会使你的生活更有意义和回报。部分原因是由于你头顶上的破产阴影以及工作是否会持续到秋天的不确定性。我认为这些问题隐秘地削弱了我们试图建立的所有动力。
• 我认为我对这种模式的贡献在于想要相信在这种情况下，仅仅激活你的积极性就足够了，仿佛你可以通过某种方式克服一切。但显然，我们需要更多。
• 你一次又一次地说你关心自由。但我们一次又一次地陷入了这种模式，而这恰恰是自由的对立面。我希望我们能找到一种方法走出这种模式。我的一部分认为这种模式实际上是在面对失败，愿意从失败中学习。我认为其中一部分也是关于愿意面对你头上的那些更大的问题。

第六步：准备开场陈述

综合考虑前几步的内容，你现在将准备一个简短的、一到两分钟的开场陈述，用于开始与来访讨论并坦诚地谈论陷入困境的模式。

为了帮助你开始，这里有一个模板，你可以用来构建你的开场陈述。你不必严格遵循这个措辞（除非你觉得它对你很有效）：

1. 我想谈谈我在治疗过程中注意到的一些事情。我想和你分享这些，以便得到你的反馈。
2. 我注意到的是，我们似乎陷入了一种模式。这种模式是[描述模式]。
3. 我在这个模式中的贡献是[描述你的贡献]。
4. 我认为如果我们继续这种模式，它的代价是[描述代价]。
5. 我希望我们可以退一步，讨论这个模式，从而找到另一种前进的方式。
6. 在讨论这个模式时，我认为我们可能需要面对[指出你一直在回避的事情]。
7. 通过退一步，跳出这个模式，我认为我们可以朝着[指出回报]前进。
8. 你对我的描述有什么看法？我非常重视你的诚实观点。

练习几次你的陈述，并确保在表达时平衡勇气和关爱。请注意，有时仅仅请求进行关于过程的对话就可能让来访感到非常紧张，所以不要轻易提出这个请求。提供来访需要听到的验证，减少威胁感。同时，不要让你的努力去验证来访的观点和传达安全和开放性削弱了你请求打破不良模式的清晰度和直接性。

以下是一个简短但涵盖了所有重要点的开场陈述示例：

• 我想谈谈我觉得我们之间一直发生的一个模式。我注意到，在过去的几周里，我给了你很多要做的事情。我有一种紧迫感，想要给你一些事情去做。然后你最终只做了很少我建议的事情，你仍然感到困扰，并且仍然急切地觉得你需要做一些不同的事情。接着我又回到了试图紧急给你更多事情做的轨道上。我认为我们退一步来弄清楚这一点非常重要。否则，我担心你会继续感到沮丧，而我们也无法取得进展。更重要的是，我认为我们陷入的这种循环——你和我——可能更广泛地存在于你的生活中。你能认出它吗？一种紧迫感，以及抓住你应该做的事情，但却无法真正实现你所追求的变化。当然，我也通过助长你的紧迫感，与你一起陷入了这种模式中。好处是现在我至少稍微了解了你生活中的感受。我有种预感，要打破这个模式，我们需要逐渐放慢速度，体验一些不同或不舒服的感觉。你怎么看待我说的话？你是否认同我所说的内容？

第七步：进行对话

下一步是实际与来访进行对话。虽然你可能已经练习过开场陈述，但一旦开始与来访交谈，重点应放在当下和与来访的连接上，而不是努力记住你要说的脚本。如果你开始你的开场陈述，感觉不对劲，可以自由放弃它，转而谈论你觉得更核心的内容：“你知道，当我这样说的时候，我意识到我不完全知道什么最重要，或者如何解决这个问题。我只是知道我们需要谈谈这个。我们现在所做的似乎并没有让我们达到我们想要的目标。”

一旦你开始了对话，无论采取何种形式，放手并倾听。有可能来访会在你的邀请下立即或在对话过程中表现出CRB1。如果这种情况发生，接受它，以同情心回应，并坚持你打破现状的目标。要有耐心。有时你可能需要多次尝试，甚至跨越多个会话，才能创造一个有成效的转变。

第八步：跟进

对话后的跟进与最初的对话一样重要。如果你和来访都对对话及其带来的压力或不确定性感到不安，可能会倾向于在一次激烈的对话后回到相对舒适的区域。你打算纠正的模式可能会重新出现在治疗过程中。经验法则是：在一次打破常规的对话后，重新审视对话和你与来访达成的承诺；在每次会话中以及每当相关的CRBs或T1s或T2s出现时，都要跟进这些承诺，直到这样做显然不再必要为止。

总结

• “唤起”意味着在治疗中引起CRB，以便为你和来访提供塑造更有效反应（CRB2）的机会。
• 唤起是由功能性思维指导的。
• 勇气和同情之间的平衡确保了唤起对于来访来说是吸引人的，而不是强制性的或令人反感的。
• 通常，对CRB1和CRB2同样保持同情是很重要的。
• 看到1中的2：注意那些表面上看似无效的行为中可能存在的适应性和治疗功能。

知识点阐述

1. 将注意力引向当下

   • 定义：在治疗过程中，引导来访将注意力集中在当前的感受和体验上，而不是过去的事件或未来的担忧。
   • 重要性：这种方法有助于来访更好地理解和处理他们当下的情绪和行为模式，从而促进更深层次的自我意识和改变。
   • 具体实践：
     • 观察和反馈：注意来访在会谈中的非言语行为（如肢体语言）和言语内容，及时给予反馈。
     • 引导表达：鼓励来访表达当前的感受和想法，即使这些感受可能让他们感到不适。
     • 建立安全环境：创造一个安全和支持的环境，让来访感到可以自由地表达自己。

2. 识别和处理回避行为

   • 定义：回避行为是指来访为了避免面对某些情绪或情境而采取的行为模式。
   • 重要性：识别和处理回避行为可以帮助来访逐步克服恐惧和防御机制，从而实现更深层次的情感处理和成长。
   • 具体实践：
     • 观察和记录：仔细观察来访的言行，记录下他们的回避行为。
     • 温和询问：温和地询问来访关于他们的回避行为，了解背后的原因。
     • 逐步引导：通过逐步引导，帮助来访面对和处理那些被回避的情绪和情境。

3. 建立信任关系

   • 定义：建立治疗师和来访之间的信任关系，是治疗成功的关键因素之一。
   • 重要性：信任关系有助于来访感到安全和支持，从而更愿意开放自己，积极参与治疗过程。
   • 具体实践：
     • 倾听和共情：认真倾听来访的需求和感受，展示共情和理解。
     • 尊重和接纳：尊重来访的感受和选择，接纳他们的现状。
     • 透明沟通：保持透明的沟通，确保来访了解治疗过程和目标。

4. 处理自我批评

   • 定义：自我批评是指来访对自己持有负面评价和苛责的态度。
   • 重要性：处理自我批评有助于来访减少内心的痛苦，提高自尊和自信，从而促进心理健康。
   • 具体实践：
     • 识别自我批评：帮助来访识别并意识到他们的自我批评声音。
     • 挑战负面思维：引导来访质疑和挑战这些负面思维，寻找更积极的替代观点。
     • 培养自我同情：教导来访如何对自己展现更多的同情和关爱。

5. 平衡支持与推动

   • 定义：在治疗过程中，治疗师需要在提供支持的同时，适当推动来访面对和处理困难情绪和情境。
   • 重要性：平衡的支持与推动有助于来访在感到安全的同时，逐步克服障碍，实现个人成长。
   • 具体实践：
     • 适时干预：在适当的时机进行干预，帮助来访面对和处理困难情绪。
     • 鼓励自主：鼓励来访自主探索和解决问题，增强他们的自我效能感。
     • 灵活调整：根据来访的反应和需求，灵活调整支持和推动的程度。

通过这些知识点，我们可以更好地理解如何在治疗过程中应用将注意力引向当下、识别和处理回避行为、建立信任关系、处理自我批评以及平衡支持与推动的原则。这些内容不仅有助于治疗师更好地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 识别和处理来访问题

   • 定义：在治疗过程中，识别来访问题如何体现在治疗过程中，以及是否已经治疗性地解决了这些问题。
   • 重要性：这是FAP的核心问题，帮助治疗师了解来访的实际问题及其在治疗中的表现形式。
   • 具体实践：
     • 观察行为：注意来访在会谈中的行为模式，特别是那些可能反映其问题的行为。
     • 功能分析：通过功能性思维分析这些行为背后的原因和意义。
     • 针对性干预：根据分析结果，制定具体的干预措施来解决来访的问题。

2. 引发（Evoke）的概念

   • 定义：引发是指通过提问和陈述来唤起来访的具体行为，特别是在当下情境中重要的行为。
   • 重要性：引发有助于揭示来访的真实感受和需求，促进更深层次的自我认识和治疗进展。
   • 具体实践：
     • 提问技巧：使用开放式问题和陈述来引导来访表达内心的感受和想法。
     • 功能性思维：确保引发的问题和陈述是有目的的，并且与来访的治疗目标一致。
     • 持续监控：在治疗过程中不断评估引发的效果，并根据需要进行调整。

3. 引发的类型

   • 温和打断：通过温和的方式中断来访的行为模式，例如：“我可以让你慢下来吗？”
   • 大胆面对：直接指出来访的行为模式，并要求他们面对自己的真实感受，例如：“让我在这里停下来。你真正想要的是什么？”
   • 具体实践：
     • 选择合适的方法：根据来访的具体情况和治疗阶段，选择合适的引发方法。
     • 平衡温柔与果断：在温和打断和大胆面对之间找到平衡，既要尊重来访的情感，又要促使他们面对问题。

4. 功能性思维

   • 定义：功能性思维是指在治疗过程中，通过分析行为的功能和意义来指导治疗决策。
   • 重要性：功能性思维帮助治疗师更好地理解来访的行为模式，从而制定更有效的治疗计划。
   • 具体实践：
     • 持续观察：在每次会谈中持续观察来访的行为和反应。
     • 功能分析：分析这些行为背后的功能，例如，来访为什么会有这样的行为，这对他们的生活有什么影响。
     • 制定策略：根据功能分析的结果，制定具体的治疗策略和干预措施。

5. 信任与脆弱性

   • 定义：在治疗过程中，建立治疗师和来访之间的信任关系，同时鼓励来访展现脆弱性。
   • 重要性：信任和脆弱性是治疗成功的关键因素，有助于来访更开放地表达自己，促进治疗进程。
   • 具体实践：
     • 建立信任：通过倾听、共情和支持，建立治疗师和来访之间的信任关系。
     • 鼓励脆弱性：创造一个安全的环境，让来访感到可以自由地表达自己的感受和需求。
     • 持续支持：在治疗过程中持续提供支持，帮助来访克服障碍，实现个人成长。

通过这些知识点，我们可以更好地理解如何在治疗过程中应用识别和处理来访问题、引发、功能性思维以及信任与脆弱性的原则。这些内容不仅有助于治疗师更好地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 多层面的引发

   • 定义：引发不仅仅是通过言语，还包括非言语的行为如面部表情、手势和身体姿态。
   • 重要性：多层面的引发能够更有效地影响来访的感受和行为，促进更深层次的沟通。
   • 具体实践：
     • 肢体语言：使用肢体语言来增强言语的效果，例如前倾、眼神接触、手势等。
     • 语气和语调：通过语气和语调传达同情和支持，使来访感到被理解和接纳。
     • 同步呼吸：与来访同步呼吸，帮助他们放松并集中注意力。

2. 描述你所注意到的

   • 定义：通过描述你观察到的来访行为来引发他们的意识。
   • 重要性：这种方法可以帮助来访意识到自己的行为模式，从而促进改变。
   • 具体实践：
     • 具体描述：明确指出来访的具体行为，例如“我注意到你刚才看向了别处”。
     • 反馈效果：观察来访的反应，并根据需要调整你的描述方式。

3. 提示来访注意

   • 定义：鼓励来访关注他们当前的感受和体验，而不是立即分享。
   • 重要性：这有助于来访建立自我意识，减少防御机制，从而更容易进入治疗过程。
   • 具体实践：
     • 引导注意：提出问题或建议，引导来访关注当前的感受，例如“你能注意到你现在的感觉吗？”
     • 尊重隐私：允许来访在准备好时再分享他们的体验，避免强迫。

4. 请求和邀请

   • 定义：通过具体的请求或邀请来引发来访的行为变化。
   • 重要性：这种方式可以直接促进来访的行为改变，并增强治疗师与来访之间的连接。
   • 具体实践：
     • 明确请求：清晰地提出请求，例如“你能在说话的时候看着我吗？”
     • 提供支持：在请求的同时提供支持和理解，例如“我知道这很难，但我相信你能做到”。

5. 情感镜像

   • 定义：通过共享治疗师和来访的情感体验来建立深层连接。
   • 重要性：情感镜像有助于建立信任和共情，促进更深层次的治疗进展。
   • 具体实践：
     • 共享体验：治疗师分享自己的感受，例如“我感觉到你的不适，这让我感到温柔”。
     • 相互反馈：鼓励来访也分享他们的感受，形成双向的情感交流。

通过这些知识点，我们可以更好地理解如何在治疗过程中应用多层面的引发、描述观察、提示注意、请求和邀请以及情感镜像的原则。这些内容不仅有助于治疗师更好地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 大胆的请求

   • 定义：大胆的请求是指那些因其强烈的中断或变化要求而被区分出来的请求。
   • 重要性：这类请求能够促使来访面对深层次的问题，但如果使用不当，可能导致治疗变得令人反感。
   • 具体实践：
     • 谨慎使用：由于其高强度，应谨慎使用大胆的请求，确保其不会削弱效果或引起来访的反感。
     • 建立信任：在提出大胆请求之前，确保已经建立了足够的信任和善意。
     • 同理心引导：在提出请求时，要清楚地表达出同理心和理解，表明请求是为了来访的利益。

2. 表达同理心和爱

   • 定义：通过表达同理心和爱来引发来访的反应。
   • 重要性：这种表达可以激发来访的情感反应，促进更深层次的沟通。
   • 具体实践：
     • 简单反馈：使用简单的、富有同情心的反馈，如“那一定非常痛苦”，来引发来访的反应。
     • 承认感受：承认来访的感受，让来访感到被理解和接纳。
     • 开放接受：鼓励来访公开接受治疗师的同理心和关爱，从而产生积极的行为变化。

3. 平衡勇气与爱

   • 定义：在治疗过程中，平衡勇气和爱是成功引发的重要品质。
   • 重要性：通过平衡勇气和爱，可以将引发转化为更具吸引力的邀请，而不是威胁性的要求。
   • 具体实践：
     • 前置同理心：在提出大胆请求之前，先表达对来访感受的理解和同理心。
     • 改变请求方式：将请求转化为更具吸引力的形式，如“我希望能了解更多”而非“现在告诉我更多”。
     • 应对防御：如果来访表现出防御或回避，可以通过增强同理心和爱的表达来缓解这种情况。
     • 目标导向：将引发与来访的具体目标联系起来，使其更具意义和吸引力。

通过这些知识点，我们可以更好地理解如何在治疗过程中应用大胆的请求、表达同理心和爱以及平衡勇气与爱的原则。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 放慢节奏与允许

   • 定义：在治疗过程中，通过放慢节奏和给予空间，促进来访自然地表达和探索。
   • 重要性：这种方式有助于减少来访的防御心理，让他们更愿意开放和分享。
   • 具体实践：
     • 提供时间：通过沉默、倾听等方法，给来访提供足够的时间来处理情感和思考。
     • 非强制性：确保引发行为感觉像是邀请和建议，而不是强迫。
     • 平衡沉默：在适当的时候使用沉默，但也要注意不要让沉默变得压抑或阻碍沟通。

2. 练习

   • 定义：使用结构化或非结构化的练习来引发来访的行为变化。
   • 重要性：这些练习可以帮助来访更好地理解和体验他们的感受、需求和目标。
   • 具体实践：
     • 生命史练习：通过回顾个人历史，帮助来访发现重要的生活事件和模式。
     • FAP会话衔接表：使用表格记录会话中的关键点，帮助来访跟踪进展。
     • 评估工具：使用各种评估工具来了解来访的状态和需求。

3. 引发的长列表

   • 定义：一系列问题和陈述，用于引发来访的行为变化。
   • 重要性：这些问题和陈述可以帮助治疗师引导来访进入更深层次的自我探索。
   • 具体实践：
     • 当下的身体感觉、思维和情绪的意识：
       • 通过引导来访关注身体感觉，帮助他们更好地理解当前的情感状态。
       • 通过提问，帮助来访识别和表达他们的感受。
     • 价值观、需求、目标和身份的意识：
       • 通过询问来访的需求和目标，帮助他们明确自己的价值观和追求。
       • 通过探讨来访的身份和意义，帮助他们建立更清晰的自我认知。

通过这些知识点，我们可以更好地理解如何在治疗过程中应用放慢节奏与允许的原则、使用不同的练习以及通过一系列问题和陈述来引发来访的行为变化。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 对他人的意识

   • 定义：通过提问和引导，帮助来访意识到他人（如治疗师）的感受和反应。
   • 重要性：这种意识有助于提高来访的同理心，促进更健康的人际关系。
   • 具体实践：
     • 关注细节：鼓励来访关注他人的面部表情、眼神和身体语言。
     • 改善关系：询问来访可以采取哪些行动来改善彼此的关系。
     • 反思反应：引导来访思考他们的行为如何影响他人，并反思这些影响。

2. 勇气：选择体验脆弱性和情感

   • 定义：鼓励来访勇敢地面对和表达自己的脆弱性和情感。
   • 重要性：这种勇气有助于来访更深入地了解自己，促进情感的释放和治愈。
   • 具体实践：
     • 开放对话：在会谈中创造一个安全的空间，让来访能够自由表达自己的感受。
     • 描述感受：鼓励来访详细描述他们的情感体验，特别是那些难以言表的感受。
     • 处理冲突：帮助来访识别和表达他们在冲突中的真实感受，而不是压抑或掩饰。

3. 勇气：自我披露

   • 定义：鼓励来访分享他们内心深处的想法和感受，即使这些内容可能让他们感到不舒服。
   • 重要性：自我披露有助于建立信任，促进更深层次的治疗关系。
   • 具体实践：
     • 识别难点：询问来访哪些话题或内容对他们来说很难谈论。
     • 探索需求：帮助来访识别和表达他们在治疗过程中的需求。
     • 回顾进步：讨论来访在治疗过程中遇到的挑战和取得的进步。

4. 勇气：请求满足需求

   • 定义：鼓励来访主动提出他们的需求，并请求治疗师或其他人满足这些需求。
   • 重要性：这种勇气有助于来访学会为自己发声，建立更健康的人际关系。
   • 具体实践：
     • 明确需求：引导来访清晰地表达他们的需求。
     • 寻求支持：鼓励来访请求必要的支持和帮助。
     • 处理恐惧：帮助来访克服提出需求时的恐惧和不安。

5. 爱：提供安全与接纳

   • 定义：通过提供安全和接纳的环境，帮助来访感到被理解和接纳。
   • 重要性：这种爱的氛围有助于来访放下防备，更开放地参与治疗过程。
   • 具体实践：
     • 表达接纳：鼓励来访表达他们对治疗师的接纳和感激。
     • 调整行为：引导来访在保持真实的同时，调整可能让人感到不适的行为。
     • 创建安全空间：确保治疗环境是一个安全、无评判的空间，让来访感到舒适。

通过这些知识点，我们可以更好地理解如何在治疗过程中应用对他人的意识、勇气的选择、自我披露、请求满足需求以及提供安全与接纳的原则。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 爱：表达理解、肯定和同理心

   • 定义：通过提问和反馈，表达对来访的理解、肯定和同理心。
   • 重要性：这种表达有助于建立信任，增强来访的安全感和被接纳的感觉。
   • 具体实践：
     • 倾听与认可：表明你正在倾听来访，并认可他们的感受和经历。
     • 正面反馈：指出来访的具体行为或特质，表达对其的认可和欣赏。
     • 情感共鸣：通过同理心表达，让来访感受到被理解和接纳。

2. 爱：给予所需

   • 定义：通过提问和建议，提供来访所需要的支持和帮助。
   • 重要性：这种给予有助于满足来访的需求，促进治疗关系的发展。
   • 具体实践：
     • 改进关系：询问来访可以采取哪些行动来改善你们之间的关系。
     • 情感支持：提出具体的建议，帮助来访以更健康的方式表达情感。
     • 直接反馈：给出直接的反馈，帮助来访调整行为，使其更具建设性。

3. 爱：相互披露

   • 定义：通过提问和对话，促进双方的相互披露，增强透明度和信任。
   • 重要性：这种披露有助于解决冲突，增进理解和包容。
   • 具体实践：
     • 坦诚交流：鼓励来访表达他们的不满和需求。
     • 责任分担：引导双方共同探讨他们在冲突中的责任。
     • 宽恕与修复：提出修复关系的建议，并请求来访的谅解。

4. 自爱：自我接纳

   • 定义：通过提问和反思，帮助来访接受和欣赏自己。
   • 重要性：自我接纳有助于提高自尊和自信，促进个人成长。
   • 具体实践：
     • 自我表达：鼓励来访表达他们难以启齿的部分。
     • 自我肯定：引导来访发现并欣赏自己的优点和成就。
     • 情境分析：帮助来访在特定情境下找到值得欣赏的地方。

5. 自爱：接受他人的爱

   • 定义：通过提问和反馈，帮助来访接受来自他人的爱和赞赏。
   • 重要性：接受他人的爱有助于建立健康的自我形象，增强人际关系。
   • 具体实践：
     • 身体感受：引导来访关注接受赞赏时的身体感受。
     • 接受程度：探讨来访对他人赞赏的接受程度。
     • 情感共鸣：帮助来访感受并接受来自他人的积极情感。

6. 自爱：自我关怀

   • 定义：通过提问和建议，帮助来访学会自我关怀。
   • 重要性：自我关怀有助于提升来访的生活质量和幸福感。
   • 具体实践：
     • 即时需求：询问来访当前需要什么来照顾自己。
     • 自我照顾：提供具体的自我照顾建议。
     • 滋养体验：帮助来访创造一个滋养和支持性的治疗体验。

7. 回应来访的1级行为（CRB1）

   • 定义：处理来访在引发过程中表现出的逃避、抗拒等行为。
   • 重要性：正确应对CRB1有助于保持治疗的有效性和方向。
   • 具体实践：
     • 识别行为：识别来访的具体1级行为及其功能。
     • 保持焦点：即使面对来访的抵抗，也要保持治疗的焦点。
     • 灵活应对：根据来访的行为调整策略，避免反治疗效果。
     • 情感支持：提供情感支持，帮助来访感到安全和被接纳，从而减少逃避行为。

通过这些知识点，我们可以更好地理解如何在治疗过程中应用爱的表达、相互披露、自我接纳、接受他人的爱、自我关怀以及有效应对来访的1级行为。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 处理1级行为（CRB1）

   • 定义：1级行为是指来访在面对治疗目标时表现出的逃避、抗拒或回避行为。
   • 重要性：正确处理1级行为对于保持治疗的有效性和方向至关重要。如果处理不当，可能会强化来访的逃避行为，导致治疗效果不佳。
   • 具体实践：
     • 识别行为：识别来访的具体1级行为及其功能。
     • 保持焦点：即使面对来访的抵抗，也要保持治疗的焦点，避免被来访的情绪或行为带偏。
     • 灵活应对：根据来访的行为调整策略，避免反治疗效果。例如，通过温和而坚持的方式重复引发，而不是强硬地要求来访改变。
     • 情感支持：提供情感支持，帮助来访感到安全和被接纳，从而减少逃避行为。

2. 温和而坚持的引发

   • 定义：通过温和而坚持的方式重复引发，鼓励来访逐步进入2级行为。
   • 重要性：这种方法有助于建立信任，使来访感到被理解和接纳，从而更愿意开放和参与。
   • 具体实践：
     • 验证感受：首先验证来访的情绪，表示理解他们的感受。
     • 请求许可：请求来访允许进一步探讨，尊重他们的意愿。
     • 强调重要性：强调当前讨论内容的重要性，增加来访的参与动机。
     • 逐步引导：通过逐步引导，让来访逐渐进入2级行为，而不是强制或命令。

3. 探索体验

   • 定义：通过细致的提问和同理心，引导来访深入探索他们的体验。
   • 重要性：这种探索有助于来访更好地了解自己的情绪和行为模式，促进自我觉察和个人成长。
   • 具体实践：
     • 详细提问：通过具体的提问，帮助来访详细描述他们的感受和体验。
     • 同理心：用同理心的态度倾听来访的回答，让他们感到被理解和接纳。
     • 逐步深入：逐步深入探讨，帮助来访逐步揭示深层次的情感和问题。
     • 情绪支持：在来访情绪激动时提供支持，让他们感到安全和被接纳。

4. 情感表达

   • 定义：通过引导来访表达他们的情感，帮助他们更好地处理和理解自己的情绪。
   • 重要性：情感表达有助于来访释放压抑的情绪，促进情感的释放和治愈。
   • 具体实践：
     • 创造安全空间：确保治疗环境是一个安全、无评判的空间，让来访感到舒适。
     • 鼓励表达：鼓励来访表达他们的情感，无论是正面还是负面。
     • 逐步引导：通过逐步引导，帮助来访逐步表达他们的情感，避免过度压力。
     • 情绪支持：在来访情绪激动时提供支持，让他们感到安全和被接纳。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效处理来访的1级行为，通过温和而坚持的方式引发2级行为，以及如何通过探索体验和情感表达促进来访的个人成长。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 情感表达与抑制

   • 定义：情感表达是指个体通过言语或非言语方式展示内心的情感状态，而情感抑制则是指个体通过各种方式（如微笑、回避等）来掩盖或压制真实的情感。
   • 重要性：正确的情感表达有助于个体更好地处理和理解自己的情绪，促进心理健康和个人成长。情感抑制则可能导致情感压抑，影响个体的心理健康。
   • 具体实践：
     • 识别情感：帮助来访识别并命名他们的情绪，例如悲伤、愤怒、焦虑等。
     • 身体感受：引导来访关注身体上的感受，如呼吸、肌肉紧张等，以更好地连接情感。
     • 逐步释放：通过逐步引导，帮助来访逐渐释放压抑的情感，避免一次性过度压力。

2. 治疗师的角色

   • 定义：治疗师在治疗过程中扮演多种角色，包括倾听者、引导者、支持者和教育者。
   • 重要性：治疗师的角色对于建立信任关系、提供情感支持和指导来访走向个人成长至关重要。
   • 具体实践：
     • 验证感受：通过同理心和理解，验证来访的情感体验，让来访感到被理解和接纳。
     • 鼓励表达：鼓励来访表达他们的真实感受，无论是正面还是负面。
     • 逐步引导：通过逐步引导，帮助来访逐步探索和表达深层情感，避免过度压力。
     • 提供支持：在来访情绪激动时提供支持，让他们感到安全和被接纳。

3. 情感一致性

   • 定义：情感一致性是指个体的外在表现（如面部表情、言语）与其内在情感状态相一致。
   • 重要性：情感一致性有助于个体更好地理解自己的情感状态，并促进他人对其情感的理解和支持。
   • 具体实践：
     • 识别不一致：帮助来访识别他们在情感表达中的不一致，如微笑掩盖悲伤。
     • 探讨原因：探讨导致情感不一致的原因，如过去的经历、家庭环境等。
     • 逐步调整：通过逐步引导，帮助来访调整情感表达，使其更加一致。

4. 创伤与情感表达

   • 定义：创伤是指个体经历的严重心理或生理伤害，可能会影响其情感表达和处理能力。
   • 重要性：创伤后的个体可能需要特别的支持和指导，以帮助他们处理和表达复杂的情感。
   • 具体实践：
     • 创造安全空间：确保治疗环境是一个安全、无评判的空间，让来访感到舒适。
     • 逐步探索：通过逐步探索，帮助来访逐步揭示和处理创伤相关的情感。
     • 情感支持：在来访情绪激动时提供支持，让他们感到安全和被接纳。
     • 长期视角：认识到创伤恢复是一个长期过程，需要持续的支持和指导。

通过这些知识点，我们可以更好地理解如何在治疗过程中帮助来访识别和表达他们的情感，以及如何处理情感抑制和不一致的问题。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 同情与坚定的平衡

   • 定义：在治疗过程中，治疗师需要在同情和坚定之间找到平衡，既要理解和支持来访的情绪，也要引导来访面对和处理他们的行为模式。
   • 重要性：这种平衡有助于建立信任关系，使来访感到被理解和接纳，同时推动他们走出舒适区，实现个人成长。
   • 具体实践：
     • 同理倾听：通过倾听和反馈，表明对来访情感的理解和认同。
     • 设定界限：明确治疗过程中的期望和规则，帮助来访认识到自己的责任。
     • 逐步引导：根据来访的具体情况，逐步引导他们面对和处理困难情绪和行为。

2. 在1中看到2

   • 定义：这是一种认知技巧，即在表面上看似消极或抵抗的行为（CRB1）中识别出潜在的积极意图或变化的迹象（CRB2）。
   • 重要性：这种视角转变有助于治疗师更好地理解来访的真实需求和动机，从而采取更有效的干预措施。
   • 具体实践：
     • 情境分析：仔细分析来访的行为背景和历史，寻找其中的积极因素。
     • 情感验证：通过验证来访的情感体验，让他们感到被理解和接纳，从而更愿意开放。
     • 鼓励探索：鼓励来访深入探讨他们行为背后的真正原因，促进自我觉察和个人成长。

3. 功能性思维与观察

   • 定义：功能性思维是指关注行为的功能和目的，而非仅仅关注行为本身。观察则是指治疗师持续关注来访的行为和情绪变化。
   • 重要性：这种方法有助于治疗师更有效地识别和应对来访的行为模式，从而制定更有效的治疗计划。
   • 具体实践：
     • 行为分析：分析来访行为背后的功能，如逃避、寻求关注等。
     • 实时反馈：在治疗过程中提供即时反馈，帮助来访认识到自己的行为模式及其影响。
     • 灵活调整：根据来访的具体反应和进展，灵活调整治疗策略。

通过这些知识点，我们可以更好地理解如何在治疗过程中邀请来访进行成长或改变。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 忽视策略的适用性和风险

   • 定义：忽视是指在治疗过程中，治疗师选择不回应或不直接处理来访的某些行为或请求。
   • 重要性：忽视可以在某些情况下有效，尤其是在来访表现出1级行为（如寻求安慰）时。它可以作为一种“最不强化的反应”，防止1级行为被强化。
   • 具体实践：
     • 明确理由：在忽视之前，治疗师应确保有明确的理由，并且这些理由能够被来访理解。
     • 避免误解：忽视可能会引起来访的不安和困惑，因此需要谨慎使用，避免破坏信任。
     • 替代方案：如果忽视不是最佳选择，治疗师应考虑其他方法，如直接回应或引导对话。

2. 命名模式并走出模式

   • 定义：这是一种识别和打破治疗中陷入困境的模式的方法。通过明确描述行为模式并采取新的行动，治疗师可以帮助来访走出困境。
   • 重要性：这种方法有助于打破僵局，使治疗重新变得有效。
   • 具体实践：
     • 描述模式：治疗师应详细描述当前的行为模式，确保描述准确且非评判性。
     • 从来访角度看问题：治疗师应从来访的角度审视描述，确保描述合理且能被来访认同。
     • 采取新行动：一旦模式被清晰描述，治疗师应采取新的行动，以打破现有的模式。

3. 治疗关系的重要性

   • 定义：治疗关系是指治疗师和来访之间的互动和联系。
   • 重要性：良好的治疗关系是治疗成功的关键。忽视或不当的回应可能会破坏这种关系，导致治疗效果下降。
   • 具体实践：
     • 建立信任：治疗师应通过一致的回应和真诚的沟通建立信任。
     • 透明度：在采取任何行动之前，治疗师应确保来访了解原因和目的，以减少误解。
     • 灵活调整：治疗师应根据来访的具体情况和反应灵活调整治疗策略。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效地使用忽视策略，以及如何通过命名模式并走出模式来打破治疗中的困境。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 模式识别与命名

   • 定义：模式识别是指治疗师识别并明确描述来访和治疗过程中反复出现的行为模式。
   • 重要性：通过识别和命名模式，治疗师可以帮助来访意识到他们行为的循环性质，从而打破这一循环。
   • 具体实践：
     • 详细描述：使用非评判性的语言详细描述行为模式，确保描述准确且易于理解。
     • 从来访角度看问题：从来访的角度审视描述，确保描述合理且能被来访认同。
     • 添加验证：在描述中加入验证或保证，以应对来访的自我批评和可能的负面情绪。

2. 避免回避

   • 定义：避免回避是指治疗师识别并处理治疗过程中可能存在的其他回避点，这些回避点可能没有在最初的模式描述中显现出来。
   • 重要性：处理这些回避点有助于全面理解治疗困境，并找到新的突破点。
   • 具体实践：
     • 自我反省：治疗师应自我反省，识别自己在治疗过程中可能回避的问题。
     • 开放沟通：鼓励来访开放沟通，探讨可能被忽视或回避的话题。
     • 共同面对：与来访一起面对这些回避点，寻找解决方案。

3. 治疗师的角色转变

   • 定义：治疗师的角色不仅仅是遵循治疗原则和技术，还需要作为富有同情心的人来支持来访。
   • 重要性：这种角色转变有助于建立更深的信任关系，并使治疗更加人性化。
   • 具体实践：
     • 真诚沟通：治疗师应以真诚和同理心与来访沟通，而不是仅仅遵循治疗手册。
     • 灵活调整：根据来访的具体情况和需求，灵活调整治疗方法。
     • 关注来访需求：优先考虑来访当前最需要的支持和帮助，而不是拘泥于固定的治疗计划。

4. 回避模式的成本

   • 定义：回避模式是指治疗师或来访在治疗过程中有意或无意地回避某些话题或行为。
   • 重要性：识别和处理回避模式对于打破治疗困境至关重要，因为这些模式会阻碍治疗进展。
   • 具体实践：
     • 识别成本：反思回避模式对治疗关系和个人成长的影响。
     • 直面问题：勇敢地面对并处理这些回避点，即使这可能会带来短期的不适。
     • 促进成长：通过直面回避模式，促进来访和治疗师之间的信任和成长。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效地识别和命名模式，处理回避点，并采取更人性化的治疗方式。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 承担责任的重要性

   • 定义：承担责任是指治疗师主动承认自己在治疗过程中对困境的贡献。
   • 重要性：通过承担责任，治疗师能够建立更真实的信任关系，让来访感受到被理解和尊重。
   • 具体实践：
     • 自我反省：治疗师应反思自己在治疗过程中可能存在的行为或态度，这些行为或态度可能导致关系陷入困境。
     • 开放沟通：向来访坦诚自己的反思结果，并将其纳入对当前情况的理解中。
     • 情感管理：面对可能出现的负面情绪（如防御性、羞耻感、绝望），并愿意接受这些情感作为成长的一部分。

2. 共同审视与理解

   • 定义：共同审视与理解是指治疗师和来访一起审视当前的困境，并努力理解其原因。
   • 重要性：通过对话和共同探讨，双方可以更深入地理解问题的本质，从而找到解决之道。
   • 具体实践：
     • 避免过早定论：不要过早地执着于某个具体的解决方案，而是保持开放的态度，进行深入的对话。
     • 倾听与反馈：治疗师应倾听来访的观点，并提供反馈，确保双方都在同一页面上。
     • 逐步推进：逐步推进对话，确保双方都有机会表达自己的想法和感受。

3. 模式的成本

   • 定义：模式的成本是指如果当前的行为模式继续下去，可能带来的负面影响。
   • 重要性：识别和理解模式的成本有助于增强改变的动力，使双方都意识到改变的紧迫性。
   • 具体实践：
     • 明确后果：清晰地描述如果模式继续下去，最可能的结果是什么。
     • 情感共鸣：通过描述可能的后果，引发来访的情感共鸣，增强改变的决心。
     • 未来展望：讨论如果改变模式，可能会带来哪些积极的变化。

4. 打破模式的价值

   • 定义：打破模式的价值是指通过改变当前的行为模式，来访可以获得的长远利益。
   • 重要性：明确打破模式的价值有助于增强来访的动机，使其更愿意投入改变。
   • 具体实践：
     • 价值观探索：探索来访的个人价值观和目标，了解他们真正渴望实现的目标。
     • 学习与成长：强调通过改变模式，来访可以学到新的应对策略，促进个人成长。
     • 长远视角：从长远的角度来看待改变的意义，帮助来访看到未来的可能性。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效地承担责任，共同审视困境，并通过识别模式的成本和价值来推动治疗的进展。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

知识点阐述

1. 开场陈述的重要性

   • 定义：开场陈述是治疗师为引入和讨论当前困境模式而准备的一段简短讲话。
   • 重要性：有效的开场陈述能够设定对话的基调，使来访感到被理解和尊重，从而促进更深入的交流。
   • 具体实践：
     • 明确目标：清晰地说明为什么要讨论这个模式，以及希望通过讨论达到什么目的。
     • 自我反思：承认自己在模式中的角色和贡献，展示真诚和责任感。
     • 情感共鸣：表达对来访感受的理解和同情，减少防御性。
     • 开放式提问：鼓励来访分享他们的看法和感受，增强互动性。

2. 对话中的灵活性

   • 定义：在对话中保持灵活性是指根据实际情况调整对话内容和方式，而不是僵硬地遵循预先准备的脚本。
   • 重要性：灵活的对话有助于建立更真实和有意义的交流，使双方都能更自然地表达自己的想法和感受。
   • 具体实践：
     • 关注当下：专注于当前的互动，而不是死记硬背的台词。
     • 倾听和响应：认真倾听来访的回应，并根据他们的反馈调整对话方向。
     • 接纳变化：如果原计划不奏效，愿意改变策略，寻找新的方法。

3. 持续跟进的重要性

   • 定义：持续跟进是指在初次对话后，继续关注和讨论相关问题，确保承诺得到落实。
   • 重要性：跟进有助于巩固对话成果，防止旧模式的复发，并推动治疗进程向前发展。
   • 具体实践：
     • 定期回顾：在每次会话中回顾之前的对话和承诺，检查进展情况。
     • 持之以恒：即使面临挑战，也要坚持跟进，直至取得明显进展。
     • 灵活调整：根据实际情况调整跟进策略，确保其有效性。

4. 唤起与功能性思维

   • 定义：唤起是指在治疗中引发来访的反应，以促进更有效的应对策略（CRB2）。功能性思维是指从行为的功能角度理解来访的行为。
   • 重要性：通过唤起和功能性思维，治疗师可以帮助来访识别和改变无效的行为模式，促进个人成长和发展。
   • 具体实践：
     • 识别行为功能：分析来访行为背后的功能，理解其动机和目的。
     • 引导有效应对：引导来访发展更有效的应对策略，替代无效的行为。
     • 平衡勇气与同情：在唤起过程中，保持勇气和同情的平衡，确保来访感到支持和理解，而不是受到压力或排斥。

通过这些知识点，我们可以更好地理解如何在治疗过程中有效地准备和进行开场陈述，保持对话的灵活性，并通过持续跟进和功能性思维来促进治疗的进展。这些内容不仅有助于治疗师更有效地开展工作，也有助于来访在治疗过程中获得更好的体验和支持。

CHAPTER 8 Call Forward into the Moment We are moving away from the world of fixed nouns and toward a world of fluid verbs. —­Kevin Kelly You’ve been working with Jennifer for a month. She came to you struggling with long-­ standing depression and social isolation. She has a stable job but is working well below her capabilities. However, as she puts it, she continuously self-­sabotages. She often spends whole weekends at home alone, watching television, feeling almost continuously guilty and ashamed but in too much pain to mobilize. She avoids paying bills until late fees and credit issues pile up. Early in treatment you learned that Jennifer suffered major betrayals when she was young. She learned from those betrayals, at a visceral level, that sharing her emotions is dangerous. She also internalized a very harsh self-­critical voice. You agreed with Jennifer that learning to break down that voice—­and the wall she maintains—­will likely be an important part of treatment, moving her toward goals of feeling more connected with others. Given the amount of fear that Jennifer reports about being vulnerable, you are gentle in your approach. You allow time and space to build trust. At the same time, Jennifer is extremely appreciative of your efforts and works hard on early homework assignments. In fact, you feel somewhat seduced by her praise. At the same time, it is clear that Jennifer has a range of ways of avoiding vulnerability in the moment. You focus on building a sense of safety in the room and gradually build awareness of these avoidance moves. This week, as often happens a few months into therapy dealing with long-­standing issues, there is a drop in her mood. Jennifer is markedly more withdrawn and anxious when she enters the room. “How are you feeling today?” “I’m okay. Well, no, I’m having a hard time.” “I see that, I think. You look tense, guarded. What’s going on?” “It’s been a hard week. This is where I end up. I know it’s not rational… Okay, so what are we going to talk about today?” She flashes a tense, fake smile and raises her shoulders as if to say, Let’s move on. You take a slow breath. “You want to move on, and it feels unnatural to leave your feelings. I want to know more about what you’re feeling right now. Would you be willing to slow down and tell me more?” “I don’t know.” She glances around nervously. “I feel…empty. But it doesn’t do any good to talk about it.” You remember that Jennifer struggles with a ton of self-­criticism—­crippling self-­ criticism. You notice she is pushing you away. “I don’t think you mean to do this, but I have the sense you’re pushing me away right now. I’m also wondering if you’re feeling a lot of self-­criticism, and if you want to hide your terrible self from me. Is that happening?” You speak kindly, tenderly. “You’re right. I’m sorry. I don’t mean to push you away.” She flashes a look of shame. “It’s okay, you know, if you do want to push me away. It makes sense to me.” She takes a deep breath. Then she speaks with a lower voice. “Actually I do, in a way. I don’t want to dwell on the negative; I spend enough time there. I don’t need reassurance or anything. I want to move forward. That’s what would be helpful for me right now. So it’s not that I want to push you away, but I don’t want you to just focus on how bad I’m feeling.” Something is suddenly clear. This is about a request, not experiential avoidance. “Ah…well that makes a lot of sense. Now I’m glad I pushed you to explain that. I think something else just clicked for me. It’s like sometimes what you’re trying to do here is be brave, keep moving toward what you care about? Is that it? “Yes.” “It’s like you’re a marathoner, and sometimes what I’ve done is become the voice in your ear saying, Oh, this is so painful. When what you really want is to just keep running.” “But it wasn’t your fault!” “I appreciate that. I don’t think it was my fault. I thought you needed soothing and the time to process your emotion. And I take responsibility. I didn’t understand that you also want to just move forward. I always want you to make that sort of thing clear to me. I’m glad you are making it clear to me now. You weren’t stuck because of how you’re feeling, but because you’re dreading that I’m going to make you dwell in a way that doesn’t feel right.” She’s looking at you squarely now. F rom the FAP perspective, “How are my client’s issues showing up in the therapy process?” is one of the most important questions you can ask. “Am I addressing these issues therapeuti- cally?” is another. With Jennifer, what shows up is a reticence to make her needs known, to risk hurting or disappointing the therapist. Despite the fantasy that we are all perfect technicians, the reality of clinical work is that things are often murky. As therapy unfolds, sometimes we have to slow down the moment, to press into a feeling that seems too scary, to clarify a confusion that lingers, or to address some unspoken but felt tension. These steps are necessary not just to keep the process of therapy moving, but also because what blocks the process is sometimes what blocks the client in his or her life and is the reason the client is seeking treatment. In terms of the FAP rules, this mix of exploration, functional thinking, noticing, and evoking represents rules 1 (notice CRB) and 2 (evoke CRB). In the example with Jennifer above, this exploration is crucial. The therapist starts with the assumption that holding back emotion is the key CRB1. In retrospect, however, Jennifer was very open about her emotion. What she was holding back was a request to move therapy forward in a different way rather than spending an hour in what would feel like an emotion-­focused pity party. Her initial statement, that she does want to push the therapist away, is a crucial 2—­wobbly and uncertain, but a 2 nonetheless. The therapist in turn realizes her error. The exploration leads to this clarity. The vulnerability of both Jennifer and the therapist and the commitment to thinking func- tionally allow this to happen. In this way, Jennifer and the therapist also learn a deeper lesson about connection: that there is more resilient connection in the tenacity to find understanding, despite misunderstanding, than in perfect understanding. This entire process started, however, because the therapist was willing to push deeper into what was happening—­and she kept pushing. WHAT IS EVOKING? Read through the questions and statements below, imagining that a supervisor or close friend is saying each one to you: What do you feel about me right now? What are you avoiding saying to me right now? There seems to be a pattern that plays out between us, and I want to share it with you because I think it’s happening again. I’m not sure if this is the right thing to say, but it feels right. I want you to know that… What do you need from me right now? How can you open up to how much I value and appreciate you in this moment? I’m feeling afraid of making you angry right now, and I wonder if you can notice your tone? I notice you’re not looking at me much today, and I don’t feel as connected to you. I’d like to connect with you. Can you look at me? The word “evoke” comes from the Latin word evocare, which means to “call out” or “summon,” and is based on the root verb vocare, “to voice.” To evoke is to call forward with your voice. These questions and statements are evocative, then, in the sense that they call forward a different behav- ior, even if that behavior is simply awareness of what is happening: “Notice what is happening between us right now.” This kind of calling forward into the present often takes courage because it is uncomfortable. There tends to be a natural intensity to orienting attention in this way. The stimulus of judgment or rejection is immediate. The uncertainty is palpable. The emotion is raw. Bringing attention to the present is a much more vulnerable endeavor than talking about things from a distance, that is, experiences of the past or the possible future. When practicing FAP, the aim is to use evocative questions and statements not in a reckless way, but rather in a way that’s strategic, sensitive to case conceptualization, and monitored over time to ensure they lead to therapeutic ends. Specifically, we aim to evoke, in the moment, the exact behavior that matters for a given client’s growth or recovery at this point in his life. Evoking effectively requires clear functional thinking, and to evoke boldly you must have confidence that you are doing so therapeutically. Only functional thinking can give you that confidence. But evoking also informs the functional analysis because it calls forward behavior and disclosure and allows you to explore what is happening in the moment. Remember, while we aim to be strategic as therapists, we will not always be right. So evoking is often just the beginning of an exploration, a moving toward something that seems to matter. In evocative moments, all the elements of FAP come together: trust, vulnerability, courage, compassion, and functional thinking. In this chapter, we describe some of the common principles of evoking. WHEN YOU SEE A POTENTIAL CRB Evoking skillfully requires noticing behavior that is potentially CRB, as rule 1 states. In the example of Jennifer, the therapist notices that Jennifer is emotional, and that in the context of feeling emo- tional she seems to want to move away from the emotion and keep the therapist away from it as well. The evoking, then, is to call something different forward. Inherently, evoking tends to inter- rupt what is already happening. It is disruptive. This disruption can take a lot of different forms and vary widely in intensity. When you think of evoking, imagine a continuum between gentle inter- ruption and bold confrontation. The gentle interruption is like a soft, extended hand slowing reaching forward: “May I slow you down?” It balances the gentleness of asking for permission with the assertiveness of interruption. Even though it is gentle, its disruption may be startling: “May I slow you down? I think you are perhaps terrified to say what you are really thinking right now.” In contrast, bold confrontation is like a fist that grabs attention: “Let me stop you there.” It takes the moment, but it need not take away choice, because in the next moment you can power- fully give choice back: “Let me stop you there. What is it that you really want?” Different moments in therapy will require different positions on this continuum. As always, it’s important to ask yourself this: How does my evoking function in this moment? EVOKING IN WAYS THAT ARE HEARD, SEEN, AND FELT Evoking functions at many levels beyond the words that are spoken. Often the most effective evoking disrupts not just through content but through how that content is voiced, meaning the facial expressions, hand gestures, and body posture that accompany the words. Imagine that you’re working with a client who tends to get lost in his head, telling the same circular stories about a situation in which he was wronged as though you haven’t already heard these stories and communicated your understanding of his pain multiple times. Imagine his 2s involve slowing down, breathing, describing how he’s feeling, and voicing his needs. In this situa- tion, your evoking might embody these various 2s at numerous levels: You sit forward in your chair and make eye contact. Your hand comes forward in a gentle gesture of interruption. You breathe deeply into your belly. You focus on your intentions: to communicate with your tone the empathy you feel for the client’s pain as well as to talk in a more productive way. Finally, your words arrive: “I really want to help you move beyond your pain, and I’m wondering if you’re telling me the same story over and over again because you aren’t deeply feeling the anguish of what you’re telling me, or because you’re not receiving my validation of what you’re saying. Would you be willing to slow down and notice the visceral sensations you’re feeling in your body, one sentence at a time, as you talk to me and as I respond?” FORMS OF EVOKING Evoking is defined by its function, not its form. However, evoking does tend to take a few common forms, and it’s useful to consider these in order to understand the range of possibilities. In the fol- lowing section we will consider these forms: Describing what you notice Prompting clients to notice Requesting and inviting Bold requests Expressing empathy and love Describing What You Notice Describing what you notice happening in the moment is a very basic way of evoking CRB: “I noticed that you looked away from me when you said that.” The awareness the statement prompts is sometimes sufficient enough to prompt, in turn, a shift in CRB. Or it opens up a useful exploration. Prompting Clients to Notice Another basic way to evoke CRB is to prompt clients to share what they notice. This directs their attention, which may disrupt avoidance, and also evokes self-­disclosure. Consider a prototypi- cal therapeutic question: What are you feeling right now? This tends to evoke sharing of what the client notices. You could also evoke noticing alone: “Can you notice what you’re feeling right now? You don’t have to share anything with me; just notice and experience it on your own.” This isn’t an academic distinction. For some clients, a pure focus on awareness and private experience may be exactly what they need, and attempting to evoke self-­disclosure might take them too far out of their comfort zone and feel too perilous. You might take these further steps with such clients over time, but starting with pure awareness and experiencing might be more effective than asking them to also share what they notice. Sharing intimate, vulnerable experience, especially about emotions, is difficult for many people, yet it leads to a sense of connection that many people crave in their relationships. Sometimes a robust FAP process can unfold entirely around the process of sharing, back and forth, moment by moment, what both client and therapist are experiencing. FAP therapist Tore Gustafsson calls this “affective mirroring.” Here’s a brief example: Client: I feel a flash of shame. I feel my cheeks flushing as I say this to you. Therapist: I feel your discomfort, and that you’re not looking away. This makes me feel tender toward you. There’s a warm feeling in my stomach. Client: I feel myself shudder as you say that. Part of me wants to push you away. But it feels so nice to be seen, to be cared for. Therapist: I’m happy you’re not pushing me away. Part of me is uncomfortable too. I notice my hands are restless. And yet as I look at you, I feel everything else fading away. I feel peaceful. Requesting and Inviting Sometimes stating what you notice suffices to evoke CRB. At other times you might add a specific request or invitation; for example, “I’ve noticed that you’re not looking at me. I want to feel connected to you because what you’re talking about feels very important. So—­and I know this is hard—­can you look at me right now as you talk?” Such invitations name and request the 2 directly. Bold Requests We distinguish bold requests as a separate category based on the intensity of the disruption or the degree of change they invite. Of course, this degree is entirely contextual. Therefore, for some clients or therapists, the example request in the previous section may be quite bold. Because of their intensity, bold requests should be used sparingly; otherwise their impact is diminished or there is a high risk that therapy will become aversive. The response to a bold request should have the quality of “I’m only willing to do this because you’ve built up a lot of good will and trust and because I know you’re right that this is good for me.” There is willingness to respond, but it is strained to the limits. Here’s an example of a bold request in a challenging context in which a great deal of sensitivity to the client is required. The client has been ruminating about suicide for weeks and is unwilling to commit to life but nevertheless continues to come to therapy. His therapist notices that recent therapy sessions have revolved around the client’s suicidal rumination in a way that seems unpro- ductive; in fact, the therapist has noticed that the client’s in-­session behavior parallels his pattern of avoiding commitment and avoiding active coping with challenging issues, such as his failing mar- riage and stalled career. So, with the utmost empathy and attunement, the therapist says, “I want to make a bold request of you. And I recognize that when I say this, I’m asking for a lot. I notice that we keep going round and round about suicide. You don’t want to give up the idea of checking out. But what I see at the core of that is something else that I think is scarier for you: you’re really scared to face the problems in your marriage and feeling like you’re in a dead-­end job. There’s a way in which talking about suicide is easier. So this is my request: Can we stop acting as though whether to commit suicide is the real problem here, and instead focus on what’s making you want to kill yourself? Would you be willing to stay in that conversation with me?” Expressing Empathy and Love Receiving empathy and love can be just as evocative as any request. A simple, empathic reflection—­such as “That must be so painful”—­can evoke a range of potential 1s: dismissal, skepti- cism, cynicism, various forms of avoidance, and so on. There might also be parallel 2s that come forward from acknowledging or openly receiving the therapist’s empathy or caring. BALANCING COURAGE AND LOVE Again, the above categories (describing what you notice, prompting clients to notice, requesting and inviting, bold requests, expressing empathy and love) only suggest some of the ways you can evoke behavior in session. Various forms of behavior may also accomplish the desired function. We have also found that balancing courage and love is another quality that is important for evoking therapeutically. Notice that in the earlier example about suicide, the therapist prefaces her bold request with an acknowledgment of the client’s perspective—­that she’s asking the client to face what he fears more than suicide. This prefacing is an example of an important general principle of evoking in FAP: to the extent that evoking demands courage of the client, it should clearly come from a per- spective grounded in empathy and love. Acknowledging the client’s perspective or the likely emo- tional impact the evoking may have or asking for permission are all ways of expressing empathy and love. In turn, communicating empathy and love can change how the request functions, transform- ing it from a more aversive demand (“Do this or else”) into a more inviting invitation to move toward something meaningful. Consider the differences in these examples: • I know this is a bold request and it might make you uncomfortable, and I’d really like you to dig for some critical feedback you could share with me. (Compare with “I want you to dig for some critical feedback to give me.”) • I hear you saying how alone you feel right now. You’re right that I can’t know exactly how you feel. And I want you to know that I do want to understand. Would you be willing to tell me more? (Compare with “Tell me more right now.”) • I can feel how difficult this is for you to talk about. Is it okay if we stay with this topic for a while longer? (Compare with “Let’s talk about this some more.”) As a corollary, if a client reacts with defensiveness, resistance, or avoidance, a good rule of thumb is to amplify your empathy and expression of love in order to increase the appetitive func- tion of the evoking. You can achieve a similar effect by linking the evoking directly to the client’s goals. SLOWING DOWN AND ALLOWING Going further, whatever form evoking takes, even if it is firm or striking, in general it shouldn’t feel like forcing. Invoking should feel like inviting, suggesting, encouraging, or collaborating. The state- ments in the previous section are good examples of such noncoercive evoking. Our assumption in practicing FAP is that voluntary participation and choice are, as a rule, the foundation of effective therapy. We are not coercing or placing clients under aversive control (“Do this or else something bad will happen.”). We are not asking clients to do what we say because we say they should. We want clients to choose what is right for them based on their values and their experience. If we ever force or confront, it’s typically strategic, in service of getting the client more in touch with choice. It’s useful to remember, then, that often the medium in which choice arises is spaciousness of time, especially if emotion, confusion, or conflict is involved. We must provide time—­through silence, through listening, and so on. This isn’t untethered spaciousness; your presence holds clients in the moment and invites them to feel what they haven’t fully felt, think what they haven’t fully thought, and choose what they haven’t fully chosen. To that end, your presence may need to be more or less prominent and more or less active. Sometimes, for example, the single best strategy is to hold your tongue after making a bold request. Let silence create space in which influence sets in. Silence can also be stultifying—­ perpetuating the space in which a familiar pattern or confusion consumes clients, or in which unspoken thoughts are buried even more deeply. In these cases, you need to evoke again; for example, “What are you thinking right now that might be hard to tell me about? What are you avoiding saying to me right now?” Silence itself is evocative. Pay attention to the function of silence: What does it evoke? Pay attention as well to your T1s and T2s when it comes to silence and filling silence. If you tend to talk too much—­or not enough—­you are leaving valuable opportunities to shape client behavior on the table. EXERCISES Besides the more unstructured, process-­based forms of evoking described above, you can also make use of various exercises, structured or unstructured, to evoke CRB. The life history exercise, FAP session bridging form, and various assessments—­in fact, any aspect of the therapy process or structure—­can all evoke CRB. In chapter 12, we offer a sampling of exercises precisely for their evocative value. The only thing that sets these exercises apart from other ways of evoking is that they tend to be somewhat structured. A LONG LIST OF EVOKING Below we offer a long list of sample questions and statements you can use to evoke CRB. They are organized into the functional classes of awareness, courage, and love (ACL) and the subcategories of each outlined in chapter 4. However, most of them are useful across a broad range of functional analyses. (In fact, many of them could be fit into one or both of the other ACL classes.) Please don’t view these examples as rule 2 “scripts” to employ verbatim with clients—­although there may be times when the language we provide is a perfect fit. Rather, we hope these lists will stimulate you to think of ways to evoke CRB for specific clients in context. We also hope they will inspire you to evoke CRB in bold and courageous ways while also being attuned to the needs of clients. Awareness of Present-­Moment Bodily Sensations, Thoughts, and Feelings Can you slow down right now, take a deep breath, and connect with your body? Can you really notice and become aware of what it feels like in your body to hear this from me? Can you find what’s good and pure and strong in your own behavior right now? Can you notice what you’re feeling right now? I notice that I’m not sure if you’re tracking me as you’re talking. I notice that I’m not as tuned in as I’d like to be because you don’t seem very connected to me or to what you’re saying. Can you see that? You’ve told me that it’s hard for you to figure out what you’re feeling. How about if I name some feelings that you might be having? Your job is to just pay attention and notice when an emotion word feels like it fits. There was this momentary flash of emotion as you were talking. Were you aware of what you were feeling? Did you notice that you quickly moved on when I gave you that feedback? I had the sense you were brushing me off. Awareness of Values, Needs, Goals, and Identity Do you know what you need or want right now, from today’s session? What feels really vital and meaningful for you in this moment? As you’re talking to me, are you aware of why you’re here and what you’re trying to work on? oasis-ebl|Rsalles|1490374181 What do you long for? What goal feels the most difficult to approach right now? What are the most important skills you’ve learned that you want to keep implementing in your life? In what areas do you feel disappointed about the progress you’ve made? I’m having a hard time following what’s important to you in this. Can you help me understand? Awareness of Others What do you think I’m feeling? I am wondering if you could pay more attention to my face, my expression, and my eyes right now. Really notice me. What could you do to improve our relationship? What are some seemingly inappropriate reactions you’ve had to me? What do you think I’m feeling about your progress? Are you aware of how I’m reacting to what you’re saying? You seem very tuned in to how I’m reacting right now. What are you noticing? It seems that you’re comfortable with a lot of conflict with your relationships, and you’re interacting with me in that way. What do you think it’s like for me and other people who care about you? As you know, part of making relationships work well is being tuned in to the other person. How aware are you of how you’re impacting me in terms of… ? Courage: Choosing to Experience Vulnerability and Emotion What were you thinking or feeling on your way to therapy today? What were you thinking or feeling while you were waiting for me out in the waiting room? People have different ways of suppressing their feelings. One client told me that she counts backward from one thousand by sevens. Another one holds his breath. What do you do to suppress your feelings? It’s hard for me to know what you’re feeling based on your facial expression, or lack of it. Can you describe the visceral sensations you’re having? What’s your reaction to what I just said? […to the rationale I just gave?…to me as your therapist?… to agenda setting?…to structured therapy?…to the homework assignment?] Let’s spend five minutes really talking about how we’re feeling right now, in this moment, from the heart. What are you feeling right now? What thoughts and feelings are you having about the end of this therapy relationship as it approaches? What’s it like for you to hear my feedback? It’s painful for you to hear me say that. I want to acknowledge that. Can you tell me more about how it feels? I have the sense that you’re being very careful about your words right now. What are you avoiding saying? If you were less careful, what would you say? I know our disagreement is hard for you to stay with. Are you willing to keep talking with me about this? You seem angry but your words don’t reflect that. What if you put your anger into words? Can you express the hurt beneath your anger? That would make it easier for me to hear what you’re upset with me about. What does it bring up for you that we’re getting closer? It means a lot to me that you just shared something with me that you don’t usually tell people, but you’re acting like it’s not a big deal. What are your feelings about having told me what you just said? I’d like you to slow down and say that to me again. Can you feel what you’re saying? Courage: Offering Self-­Disclosure What would be hard for us to talk about? What do you not want to talk about? What do you have a hard time expressing about yourself? What’s difficult for you between sessions? What’s happened that’s been painful for you to discover? What are the hardest parts of our time together? Which of your behaviors tend to bring closeness in your relationships? What do you tend to do that decreases closeness in your relationships? How would you feel about us watching for those behaviors in here? What’s hard for you to tell me about yourself? In what area do you feel disappointed about the progress you’ve made? What happens during sessions that makes it hard for you to manage your feelings? What stands out to you most about your interactions with me? What situations, thoughts, or behaviors make you vulnerable to feeling [insert presenting problems here], and how can you deal with them to decrease the likelihood or severity of what you were experiencing when you first came in? When do you feel closest to me? What powerful experiences have you had because of our work together? From your heart, what’s most vulnerable for you to say to me as you say good-­bye? What regrets do you have about the therapy or what would you like to have gone differently? Is there any negative feedback you’d like to share with me? It seems that you’re really making therapy a priority. Can you tell me what your therapy relationship with me means to you? Courage: Asking for a Need to Be Met What do you not want to talk about? What can we do to connect right now? What do you need from me right now? What do you want to change about your therapy? What’s an area that’s important for us to continue talking about? How do you wish I would change? What’s hard for you to say to me? What do you wish I’d do differently? I hear a need in what you’re saying, but it’s not quite clear to me. Can you help me understand? I notice that you’re working really hard to take care of me right now. Who takes care of you? How can I take better care of you? I think it’s very hard for you—­scary even—­to ask for what you need here. Would you be willing to ask me despite your fear? I have the sense that your anger is overwhelming everything else right now. What do you think is needed? Love: Providing Safety and Acceptance Can you express acceptance to me? What do you really love and accept about me and how I interact with you? You seem kind of scary to me right now. Is there a way you can be less scary while still remaining true to what you feel? Love: Expressing Understanding, Validation, and Empathy What do you feel is important for me to know right now? When do you feel closest to me? What do you like and appreciate about me? What will you always remember about me? It means a lot to me that you’re listening to what I have to say right now. Often you’re very focused on telling me your story, so it means a lot to me when you tune in to my input. Love: Giving What Is Needed What could you do to improve our relationship? I feel like it would help me connect with you if… I’m wondering what you appreciate about our work. Would you tell me? It seems that anger is your go-­to emotion, and it can really push people away. Can you express your anger to me in a way that brings us closer? It’s hard for me to tell you this because I don’t want you to feel distanced from me. But you express your feelings in a really intense way sometimes, and it scares me. I want to stay present with you, and it would be helpful for me if you lowered your voice and slowed down a bit. What do you think? I noticed that you just changed the topic. Can we go back? I notice that you’re not looking at me as you say that. Can you look at me? Love: Reciprocal Disclosure Are you upset with me? What do I do that bothers you? What are some things I’ve done that you felt were insensitive? What are some things that I’ve done to hurt you or make you feel angry? When do you feel closest to me? I want you to know that I respect your anger about this. I’m sorry about what I did. Are you willing to let me try to repair the situation? Would you be willing to compromise with me? It seems that when you’re unhappy with something, you tend to blame other people, including me. Can we each look at what we’re contributing to this conflict we’re having? The ability to forgive another person’s mistakes is essential in maintaining close relationships. I get that you’re really mad at me and want to walk away from our relationship right now. But that would just be a repeat of what you’ve done with everyone else who’s cared about you. Are you willing to do something different this time? Will you work on forgiving me for my mistakes? Self-­Love: Self-­Acceptance What do you have a hard time expressing about yourself? What can you accept in yourself right now? What do you like and appreciate about yourself? It seems like you’re being really hard on yourself right now. What can you appreciate about what you’re doing in this situation? Self-­Love: Accepting Love from Others What does it feel like in your body to hear this appreciation from me? Can you accept my appreciation of you? How accepting of my appreciation are you right now? Self-­Love: Self-­Care What do you need from me right now that would help you take care of yourself? How can you take care of yourself in this moment? If you were to make our session today the most nourishing and supportive for yourself, how would you approach it?

RESPONDING TO CLIENT 1S When you evoke, you call something forward in the moment. You step into the stream of behavior and divert it in some way. Of course, the stream has its own momentum. It doesn’t comply imme- diately to your suggestion. It might bowl you over. It might twist around you and create havoc downstream. It might silently conform and then immediately resume its course. To evoke then is merely the first step, and often when we evoke we find ourselves contending with the momentum of the behavior we are seeking to change. Consider these examples of client CRB1: • The client has a dozen ways of distancing from her experience of anxiety. • The client plunges into anxious objections to any path of action. • The client believes rigidly that one “simply can’t” do certain types of things and argues with suggestions to try doing them. • The client feels anxious and offers various charming, self-­deprecating jokes when she is vulnerable. The CRB1 in all these examples functions to push away, escape, or avoid something that is aversive for the client. The CRB1 is reinforced when the behavior accomplishes that function. When a CRB1 occurs in response to evoking, then, the key question is: what happens next? One possibility is that the CRB1 is aversive to you or otherwise pulls you away in a less thera- peutic direction. (Remember, in this context “therapeutic” is defined as evoking CRB2.) In fact, you might have a countertherapeutic effect by somehow reinforcing the client’s CRB1. This is not unusual. Here’s an example. Imagine a teenage client whose daily life problems revolve around not com- pleting important tasks because of her tendency to get wrapped up in her emotions. In therapy, the mutually agreed-­upon core CRB2 is to do what’s important despite feelings that come and go: Therapist: So, your homework was to have a really important conversation. I’d like to hear how it went. Client: I really don’t want to. Therapist: Why not? (Sensitively.) Client: I just feel so overwhelmed. (Tearing up.) Therapist: (Leaning forward.) Tell me more. Here the therapist may be getting pulled away from the core CRB and the corresponding evo- cation, instead engaging in her own T1 of avoiding the possibly more challenging topic of the avoided homework. Attending to the emotion might be functional, before looping back to address the homework, but as therapists we don’t always close the loop. The therapist in this situation may be absentmindedly reinforcing the client’s avoidance, and she may kick herself at the end of the session when she realizes that very little outside of the status quo has been accomplished. Responding to CRB1 in a contentious way that seems to challenge the client to step up but in fact fails to evoke CRB2 can be just as dysfunctional: Therapist: So, your homework was to have a really important conversation. I’d like to hear how it went. Client: I really don’t want to. Therapist: Too bad. We gotta. Client: Fine. Whatever. Therapist: So how did it go? Client: Fine. Therapist: (Waiting.) In contrast, despite a client’s attempts to steer you away and avoid, despite the aversiveness of the moment for you or the client, there is a way of gently staying with the evoking without forcing it or reinforcing the client’s 1. Much of the skill is essentially lingering and making the moment as appetitive as possible, such that the client becomes willing to stay there with you to find the behav- ior that is a 2 for him. For example: Therapist: So, your homework was to have a really important conversation. I’d like to hear how it went. Client: I really don’t want to. Therapist: Yeah. I can see your emotion. Are you willing to tell me what happened—­whatever it was? This was such an important conversation. And so much is at stake. Here the therapist balances validation, asking for permission, and highlighting the importance of the homework while repeating the evocation. Such a gentle and insistent repetition of the evoca- tion is probably the simplest response to a CRB1. In this context, the therapist may now be looking for any slight movement toward talking about the homework or the emotion about what happened. In this way, the therapist shapes the gradual movement toward a more fully developed CRB2: Therapist: Yeah. I can see your emotion. Are you willing to tell me what happened—­whatever it was? This was such an important conversation. And so much is at stake. Client: (Tears up.) Therapist: It looks like whatever happened was really painful. Client: Yes. Therapist: It’s okay. Take your time. Client: I feel so embarrassed. Therapist: Tell me what happened. Moments like this often have to unfold gradually, with a broad, flexible sense of the CRB2 that you and the client are shaping. There should be a sense of exploring the experience, with empathy. Here is an extended example of an exploration that gradually leads to a CRB2 related to emotional expression. Therapist: You’re looking at me like this (eyes looking up, tilted down). I’m wondering if you can look at me more directly. That would help me feel more connected. Client: All right. (Looking at the therapist.) Therapist: What are you feeling right now? Client: Anxious. I don’t know why I’m anxious. Therapist: How do you know you’re anxious? Client: I’m more tense. Therapist: Where do you feel tense? Client: Physically. My whole body is rigid. Looking at you is harder than it’s been before. (Looking away slightly.) Therapist: I’m asking you to look at me more directly. Client: How’s this? Is it better? Therapist: You do look more emotional. Client: Yeah, I’m sad. When I start to think about the play I saw last night, there’s sadness, crying—­there’s tears here, in me, now…somewhere. Therapist: You’re smiling. What happens when you smile? Does it block your tears? Client: Yeah, I guess. Therapist: See, you’re doing it, you’re making your sadness go away. It’s hard to be sad when you’re smiling and kind of laughing. Client: It’s true. Therapist: It’s a very effective technique. I’d like to hear more about your sadness. How do you experience it in your body right now? What are you feeling? Get basic: A lump in your throat, a heaviness in your chest? What do you feel? Client: Hmm. I’m not sure what it is I’m feeling. Therapist: Do you notice the sensations in your body? Client: I notice shallower breathing. Therapist: You’re doing a good job of staying with yourself and not smiling—­not going into your head. Are you holding your breath? Client: Yeah, holding my breath. Therapist: What would happen if you would just let yourself cry? Client: Nothing. I don’t understand why I can’t do it. I’d just get sad. I don’t get it. I don’t know why I can’t do that. Therapist: You actually do that better than a lot of men. You let yourself get teary, sob at times. I think you’d feel much more liberated if you were in touch even more with your feelings and were more expressive. The big thing for me about your emotional expression is the incongruence, the smiling. The first thing I want you to do is to cut that out. You know that when I am working with my clients and they’re saying sad things and start grinning, it’s difficult to be on the receiving end of that. And I don’t know what it feels like for you; it seems invalidating for you, a very effective way of cutting yourself off from your feelings. And I’m wondering how that came about. Did you have to smile for your parents, and let them know everything’s okay? I’m checking to see how you’re breathing. Client: Shallow. I’m sweating in my chest and legs. I’m anxious. Therapist: What’s percolating that you’re anxious about? What do you need to say that you’re not saying? Just blurt it out. Client: You said my smile cuts me off from my feeling. I was thinking I don’t want to be cut off from my feelings. I don’t want to put myself in a box. My parents contained me in a box. Therapist: I feel sad when I hear you say your parents put you in this box. Client: It is sad. Therapist: Can you say “I feel sad?” Client: I feel sad. Therapist: Say “I feel sad when I think about my parents putting me in a box.” Client: You want me to say that? Therapist: And try not to smile. Client: I feel sad about my parents putting me in a box. Therapist: Say that again. Client: I feel sad about my parents putting me in a box. Therapist: I feel sad too about your parents putting you in a box. Your voice is really low. Say it in your own voice like you mean it. Client: I feel sad that my parents put me in a box. Therapist: What do you notice in your body? Client: I’m tight, I’m not breathing, I’m not really moving. Was that my own voice? No? What do you notice? Therapist: I’m wondering what you’re doing to cut yourself off from your feelings. You’re not smiling, which is really good, but you’re constricted. I’m really struck by how subdued you sound. I guess that’s exactly what you’re telling me about…being put in a box, being medicated. You seem to have so much grief under the surface. It seems like you’re doing everything you can to keep it there. Client: I’m clenching my teeth. This is fucking crazy. Therapist: I think you’re a little hard on yourself, because you’re not fucking crazy. What do you expect? You grew up in this environment with your parents. They medicated you because you were a little too much for them. And what do you think you’re going to do, emote like crazy? Not yet. Client: I am so hard on myself. I’d like to try and get to the emotion…I want to emote. Therapist: I want you to. Client: (Cries briefly.) Inviting Growth or Change Notice in the previous example that evoking CRB2 is not as simple as offering a deliberate choice. It is not a matter of willpower or choice. Instead, evoking CRB2 is a matter of creating a context that is challenging enough, compassionate enough, and aware enough for something new to emerge. The therapist is compassionate throughout, while remaining focused on evoking CRB2. It is often important to be just as compassionate toward CRB1 (or the person engaging in CRB1) as we are toward CRB2. This is a critical point! This stance counteracts our tendency to be frustrated or disappointed with “problem” behavior. Why does this matter? Clients are often amply frustrated and conflicted with their CRB1. In that case, our own frustration doesn’t offer anything new or disruptive. In addition, the threshold at which CRB1 turns into CRB2 is often riddled with fear or vulnerability—­aversion that tends to evoke avoidance. Our aim is to make that pathway as appetitive as possible. At the same time, this stance of compassion toward CRB1 does not mean being soft or tolerant in any broad sense of CRB1. We can empathize with the history and the function behind CRB1 and, at the same time, remain aware of the terrible cost it has wrought over time. Our goal is to help the person recognize that he or she is able and capable of stepping through the experience of vul- nerability toward a CRB2. Of course, the particular style or tone of this balance between compassion, acceptance, and firm evoking varies between clients. Many therapists tend to err on one side or the other—­either too soft and compassionate or too harsh and demanding—­with similar results: they don’t evoke much change. With all clients you should be guided by functional thinking and observation of what is happen- ing. Ask yourself how your evoking is functioning. Are you being too lenient or too harsh? Adjust accordingly. See the 2 in the 1 When navigating the conflicted flow of CRB1 or emerging CRB2, to “see the 2 in the 1” is an invaluable concept. Consider this example: Therapist: What are you feeling right now? Client: Nothing. I want you to take a leap out the window. Therapist: I know you’re angry at me. Can I see if I understand why? Client: Good fucking luck. Therapist: Well, I think that basically what we’ve been trying to do these last few weeks is not working. And then in that context, I kept challenging you in a way that must have felt really frustrating. And now things have really fallen apart at your job. So you’re sitting there going, How the fuck is therapy worthwhile again? Client: Pretty much. Therapist: It’s crap, there’s no way around it. I’m sorry. In this example, there might be a tendency to see—­even without context—­the client’s first statement as an aggressive, avoidant CRB1. It was indeed aversive for the therapist, and in many contexts it would have been ineffective. The therapist, however, recognizes that the client’s mere presence in therapy (rather than being at the liquor store) and her verbal engagement with him, in this context, is CRB2. In other words, the client’s life would be worse if this behavior were not happening. In turn, the therapist responds to the client’s statement as though it is a CRB2 of accurately expressing anger. The therapist aims to reinforce this statement by reflecting the anger and, in turn, evoke further vulnerable engagement with the client by asking if he can explore why she is angry. Again, the client responds in a vague, aggressive way—­congruent with her emotion—­but also in a way that invites the therapist to proceed. And again, there is a CRB2 in that prickly statement. The therapist offers a validating, event-­based explanation of the client’s anger, admitting his own contribution to the situation. The client then finally offers a more neutral, perhaps even agreeable, response. From here, the discussion continues to move in a constructive direction. If the therapist had responded more directly to the aversive CRB1 aspects of the client’s response, or had he been unable to see the 2 in the 1, the outcome would likely have been much less constructive. Ignoring—­W hen and How Besides gently blocking or evoking 2s in response to 1s, you may experience the impulse to ignore 1s. For instance, if the client vaguely asks for reassurance, and seeking reassurance is a 1, the therapist might ignore that request and respond to another part of the message. Or if the client sends a message venting about frustrating events after-­hours, the therapist might ignore the message. Ignoring does not work well when the client is making a specific request of you and/or is expecting a response. For socially attuned human beings, conspicuous ignoring creates uncer- tainty, and anxiety or irritation may follow. The uncertainty arises because ignoring rarely comes with an explanation; for example, “I’m going to ignore what you just said.” Ignoring is intrinsically vague: Is he ignoring my message? Why is he doing that? Is he considering it a 1? It seemed reasonable to me. Or is he just busy? Did I do something wrong? Is he angry at me? This kind of unspoken uncertainty often corrodes trust. It creates a special kind of paranoia; for example, “Are you doing behavior modification on me by ignoring my response?” However, if there is a clear, shared rationale for ignoring, the function may be quite different. Consider this: “When you send me venting messages on the weekend, because I’m quite busy, and because those messages are generally about you avoiding doing what you need to do, we agree that I won’t respond.” Or “Sometimes I can’t provide everything you need, nor can anyone else. So from time to time I may not reply to your messages, because life gets in the way. When that happens, are you willing to work on accepting that?” In addition, ignoring can sometimes work pragmatically: for example, if there is plenty of other stuff to respond to, you simply can’t respond to everything or it may work to focus on specific things or perhaps the client hasn’t specifically requested that you respond to a given item. And there is a behavioral rationale for ignoring: ignoring may be the “least-­reinforcing response,” and as such it ensures that a 1 is not reinforced. Principles aside, as always, before ignoring we should ask how doing so will actually function for the client. Without a clear rationale for the value of enduring the disappointment, the cost of breach of trust outweighs the potential that the client will stumble upon the therapeutic benefit of being ignored. Responsiveness is too important; nonresponsiveness is too confusing. In the majority of cases, when a response is expected, the superior therapeutic stance is to address the expectation of response with honesty and adult social skills. NAME THE PATTERN AND STEP OUT OF IT In our consultations with therapists, we have found, again and again, that there is a special kind of evoking that is useful when therapy is stuck. In FAP terms, “getting stuck” in therapy means the therapeutic relationship is no longer exerting a therapeutic influence on the client’s patterns of problematic behavior. Instead, the therapist’s behavior has been shaped by client responses (or other factors) to the point that the therapy is no longer therapeutic. Consider these examples: • The client becomes angry at you every time you suggest behavior change, and now you’ve given up on suggesting change. • You struggle through the same protocol over and over again, but the client doesn’t “get it” and you don’t know why. • You both like each other a lot, but there is a nagging sense that nothing is really changing. These examples all boil down to this: behavior isn’t changing. It’s not a matter of progress being a slow, gradual grind, rather the therapy is stuck. When this happens, you need to do something different. Functionally speaking, you need to vary your own behavior in order to evoke something different. Sounds simple, right? The approach we typically recommend in this situation is called “name the pattern and step outside it.” In the sections that follow, we describe the steps involved. Step 1: Describe the Pattern The first step is to describe—­using basic and nonjudgmental behavior terms—­exactly what the pattern of behavior is that that you and the client engage in. You are not going to share this with the client yet. You are writing this description just for yourself. Sometimes there can be a relatively stable holding pattern of behavior, but more often than not the pattern is more of a cycle: this phase leads to that phase that in turn loops back to the beginning. The tricky thing about cycles is that some part of the cycle might present itself as an escape from the cycle, but in reality it’s just another part of the stuck cycle. Consider this example of a pattern of behavior written from the therapist’s perspective: First we try to shape commitments that you will follow through on to move you toward your goals and activate out of unproductive avoidance. We drum up motivation. Then you tend to fall short in some way. Then you feel frustrated with therapy and miss a session and question the whole enterprise. Then I feel bad, and then we talk about hopelessness, and we usually arrive at a point where we feel more connected. Then we get hopeful again. Then we shape commitments again…and the cycle repeats. We’ve repeated this cycle three times in the last three months. Describe the pattern at whatever level of detail is sufficient to capture it. Your description should be detailed and accurate enough that, having read it, both you and the client would give a head nod of recognition: yes, that’s what happens between us. Step 2: Take the Client’s Perspective Next, from the client’s perspective, review the description that you wrote. It must avoid laying blame on the client. It should convey that there is a 100 percent reasonable explanation for the current situation—a sense of, “Of course this is what happens, because this reflects exactly how your behavior was shaped by your history, and it is exactly why you are seeking help from me.” Does your description convey that sense? For example, we might expand the example from above in the following way: First we try to shape commitments that you will follow through on to move you toward your goals and activate out of unproductive avoidance. We drum up motivation. Then you tend to fall short in some way. This is understandable, because I think we’re not great yet at estimating what is doable; we tend to get too ambitious. You’re also still struggling with a lot of difficult emotion. Then you feel frustrated with therapy and miss a session and question the whole enterprise. Again, that makes sense—­even though I think it’s self-­ defeating—­because empirically therapy hasn’t moved you forward much yet. Then I feel bad, and then we talk about hopelessness, and we usually arrive at a point where we feel more connected. Then we get hopeful again. Then we shape commitments again…We have the best of intentions. We think we won’t make the same mistake again. And the cycle repeats. We’ve repeated this cycle three times in the last three months. What validation do you need to add to your description? Next, consider more broadly how the client will hear your description of the pattern. What objections or explanations will his self-­critical mind give? Will there be shame? Hopelessness? Fear that you are giving up on therapy? Add some validation or assurance that responds directly to that voice: I’m afraid that saying this will make you think I’m giving up on our therapy, but I’m actually reaffirming my commitment. I want to own my part in what has happened. You’re right to be disappointed and frustrated with this process. I expect you may find this pattern to feel hopeless. But I think that by naming the pattern we can begin to step out of it. Step 3: Find Other Avoidance Often, the main thing that is being avoided is calling out the stuck pattern, and naming the pattern directly is the most important, disruptive step forward. However, sometimes there are other points of avoidance that don’t come clearly into focus with the initial description of the stuck pattern. Addressing this avoidance can be critical. To address this possibility, consider these questions: What are you not talking about or accepting in relation to this client? Are you or the client failing to meet your commitments to each other? Is there significant unspoken frustration or disappointment in the relationship? Has one of you shut down or refused to address something the other considers important? Is the client resisting your input? Are you resisting or failing to understand the client’s input? What else do you feel about this client that you are not accepting? If there is something important that you are avoiding facing, consider yourself lucky that you’ve discovered it. Reflect on how that avoided thing fits into the stuck pattern. About nine times out of ten it will fit in a very clear way. For example, the therapist might build on her perspective of where therapy is stuck in this way: First we try to shape commitments that you will follow through on to move you toward your goals and activate out of unproductive avoidance. We drum up motivation. Then you tend to fall short in some way. This is understandable, because I think we’re not great yet at estimating what is doable; we tend to get too ambitious. You’re also still struggling with a lot of difficult emotion. Then you feel frustrated with therapy and miss a session and question the whole enterprise. Again, that makes sense—­even though I think it’s self-­ defeating—­because empirically therapy hasn’t moved you forward much yet. Then I feel bad, and then we talk about hopelessness, and we usually arrive at a point where we feel more connected. Then we get hopeful again. Then we shape commitments again…We have the best of intentions. We think we won’t make the same mistake again. And the cycle repeats. We’ve repeated this cycle three times in the last three months. I think one thing we’ve been avoiding dealing with is recognizing that we don’t have a clear bead on what’s going to make your life more meaningful and rewarding right now. Part of this is related to the bankruptcy hanging over your head and the uncertainty about whether your job will continue past the fall. I think these issues insidiously under- mine all the motivation we try to build. Perhaps you’re thinking, Therapists just can’t say things like that, or I can’t say that! If you feel con- stricted by such thoughts about addressing the things you’ve been avoiding, try reflecting on the following: If you weren’t concerned with being a “good therapist,” and you were at your best as a compassionate human being, what would you say to this client? For example, if the client was a close friend or family member, what would you say? How would you say it? If you weren’t constrained by a treatment plan, therapy principles, case conceptualization, and so forth, what would you think is the most important thing the client needs right now? What single issue, if you could resolve it, would make the biggest difference for this client? Now ask yourself these questions: How does my avoidance of this topic, or of saying what I would say to a close friend, function for me and for the client in our relationship? In other words, what do I do when I am avoiding that topic? How do I feel? What do I think? What happens next? What is the cost of that pattern of avoidance? Step 4: Take Responsibility If you haven’t done so already, answer this simple question: What have you done to contribute to the relationship being stuck? The avoidance identified in the prior step might be a key part of your contribution. Then incorporate your response into your understanding of the situation. Consider this example: First we try to shape commitments that you will follow through on to move you toward your goals and activate out of unproductive avoidance. We drum up motivation. Then you tend to fall short in some way. This is understandable, because I think we’re not great yet at estimating what is doable; we tend to get too ambitious. You’re also still struggling with a lot of difficult emotion. Then you feel frustrated with therapy and miss a session and question the whole enterprise. Again, that makes sense—­ even though I think it’s self-­defeating—­because empirically therapy hasn’t moved you forward much yet. Then I feel bad, and then we talk about hopelessness, and we usually arrive at a point where we feel more connected. Then we get hopeful again. Then we shape commitments again… We have the best of intentions. We think we won’t make the same mistake again. And the cycle repeats. We’ve repeated this cycle three times in the last three months. I think one thing we’ve been avoiding dealing with is recognizing that we don’t have a clear bead on what’s going to make your life more meaningful and rewarding right now. Part of this is related to the bankruptcy hanging over your head and the uncertainty about whether your job will continue past the fall. I think these issues insidiously undermine all the motivation we try to build. I think my contribution to this pattern has been wanting to believe that the simpler path of just getting activated under these circumstances is enough for you, that somehow you’ll be able to gut your way through. But clearly more than that is needed. Notice any reactions—­defensiveness, shame, hopelessness, and so forth—­that come up as you take responsibility. In order to face the situation and move the therapy forward, are you willing to have these feelings? Step 5: What Else Needs to Be on the Table? When a relationship is stuck, about 95 percent of the time the first thing that’s needed is for the therapist and client to collaboratively look at it and seek to understand why. Because that understanding typically develops from a dialogue, don’t become overly invested in a specific solu- tion too early. What is needed early on is the willingness to look at the pattern, facing whatever feelings come with that willingness. Next, get in touch with the cost of the pattern. Complete the following sentence: If this pattern continues, the most likely outcome is that… For example: If this pattern continues, the most likely outcome is that we’ll both feel more and more frustrated. We won’t get anywhere, and you’ll walk away with another experience in which you weren’t enough and nobody could help you. Finally, consider why it will be worthwhile to break the pattern. Consider what the client aspires to be and what the client values. Consider what you genuinely believe the client must learn to move forward. Building on the therapist perspective from earlier steps, consider the following additions: First we try to shape commitments that you will follow through on to move you toward your goals and activate out of unproductive avoidance. We drum up motivation. Then you tend to fall short in some way. This is understandable, because I think we’re not great yet at estimating what is doable; we tend to get too ambitious. You’re also still struggling with a lot of difficult emotion. Then you feel frustrated with therapy and miss a session and question the whole enterprise. Again, that makes sense—­even though I think it’s self-­ defeating—­because empirically therapy hasn’t moved you forward much yet. Then I feel bad, and then we talk about hopelessness, and we usually arrive at a point where we feel more connected. Then we get hopeful again. Then we shape commitments again…We have the best of intentions. We think we won’t make the same mistake again. And the cycle repeats. We’ve repeated this cycle three times in the last three months. I think one thing we’ve been avoiding dealing with is recognizing that we don’t have a clear bead on what’s going to make your life more meaningful and rewarding right now. Part of this is related to the bankruptcy hanging over your head and the uncertainty about whether your job will continue past the fall. I think these issues insidiously undermine all the motivation we try to build. I think my contribution to this pattern has been wanting to believe that the simpler path of just getting activated under these circumstances is enough for you, that somehow you’ll be able to gut your way through. But clearly more than that is needed. You’ve said again and again that you care about your freedom. But again and again we keep getting caught in this pattern, which is the opposite of freedom. What I want is that we find a way to step out of this pattern. Part of me says the pattern is genuinely about facing failure, being willing to learn from failure. And I think part of it is about being willing to face the bigger questions looming over your head. Step 6: Prepare Your Opening Statement Pulling together everything you’ve considered in the previous steps, you’ll now prepare a brief, one-­to-­two-­minute opening statement that you’ll say to the client to begin addressing and talking openly about the stuck pattern. To get you started, here’s a template of sorts that you can use to construct your opening state- ment. You shouldn’t stick to this exact wording (unless it works well for you):

1. I want to talk about something I’ve been noticing in our therapy. I want to share it with you so that I can get your input.
2. What I’ve been noticing is that we seem to be in a pattern. The pattern is [describe the pattern].
3. What I’ve contributed to this is [describe your contribution].
4. I think the cost of this pattern, if we let it continue, is that [describe the cost].
5. I want us to step back and talk about this pattern so we can find another way forward.
6. In talking about the pattern, I think we may have to face [name something you’ve been avoiding].
7. In turn, I think the reason to step back, to step out of this pattern, is that then we can move toward [name the payoff].
8. What’s your view on what I’m describing? I would really value your honest perspective. Rehearse your statement a few times and make sure that you balance courage and love while delivering it. Be aware that sometimes a mere request to engage in dialogue about the process can be quite intense for clients, so don’t make this request lightly. Offer the validation your client will need to hear you clearly, with less sense of threat. At the same time, don’t let your efforts to validate the client’s perspective and communicate safety and openness undermine the clarity and directness of your request to disrupt the dysfunctional pattern. Here’s an example of an opening statement that’s quite brief but covers all of the important points: oasis-ebl|Rsalles|1490374209 I want to talk about this pattern that I think keeps happening between us. What I’ve noticed is that during the last few weeks I’ve been giving you lots of ideas about what to do. I feel this kind of urgency to give you stuff to do. And then you end up doing very few of the things I suggest during the week, and you still feel distressed, and you still feel urgently like there’s something you need to do differently. And then I jump back on the train of trying to urgently give you stuff to do. I think it’s really important that we step back and figure this out. Otherwise I fear you’ll continue to be frustrated and we won’t move forward. More importantly, I think this loop that we are stuck in—­you and I—­is probably some- thing that happens more broadly in your life. Do you recognize it? A sense of urgency, and of grabbing after what you should do but not being able to actually embody the change you are grasping for. Of course I’ve contributed to this by feeding your urgency, buying into it right alongside you. The upside is that now I know what it feels like to be in your life, at least somewhat. And I have a hunch that what it will take to break this pattern is gradually slowing down and feeling something different or uncomfortable. What do you think about what I’m saying? Do you recognize what I’m talking about? Step 7: Have the Conversation The next step is to actually have the conversation with your client. Although you’ve hopefully rehearsed your opening statement, once you begin talking to the client, focus on the moment and connecting with your client rather than trying to remember the script you set out to deliver. If you start into your opening statement and it doesn’t feel right, feel free to abandon it and speak to what seems more to the core: “You know, as I say this, I realize I don’t quite know what matters most, or how to solve it. I just know we need to talk about this. What we’ve been doing doesn’t seem to be getting us where we want to go.” Once you’ve opened the conversation, whatever form that takes, let go and listen. It’s possible that the client will engage in CRB1 in response to your invitation, either immediately or as the conversation proceeds. If this happens, accept it, respond with compassion, and stick to your goal of disrupting the status quo. Be persistent. Sometimes you’ll have to approach the conversation multiple times, perhaps across multiple sessions, to create a productive shift. Step 8: Follow Up Follow-­up to the conversation is just as important as the initial conversation. If both you and the client are uncomfortable with the conversation and the pressure or uncertainty of change, there might be a tendency to shift back into a relative comfort zone after an intense dialogue. The pattern you set out to correct could drift back into the therapy process. The rule of thumb is this: After a disruptive conversation, revisit the conversation and the commitments both you and the client have made to shift the process; follow up on these commitments in every session and whenever relevant CRBs or T1s or T2s happen until doing so is clearly no longer necessary. SUMMARY • “Evoking” means calling forward CRB in therapy in order to give you and the client the opportunity to shape more effective responses (CRB2). • Evoking is guided by functional thinking. • The balance between courage and compassion ensures that evoking remains appetitive for clients rather than coercive or aversive. • It’s often important to be just as compassionate toward CRB1 as CRB2. • See the 2 in the 1: notice the adaptive, therapeutic function in the behavior that might seem ineffective on its surface.