结论

结论

至于方法，可能有一百万种甚至更多，但原则却寥寥无几。 掌握原则的人可以成功地选择自己的方法。 忽视原则而尝试方法的人肯定会遇到麻烦。 —哈林顿·埃默森

有人说FAP（功能分析心理治疗）归根结底是一种在治疗关系中与来访相处的方式。可以这样想：当一个人做到了这本书中所包含的所有事情时，一种人际关系的方式就会浮现出来。正如伯特兰·罗素在本书开头引用的话所说：“没有知识的爱，或者没有爱的知识，都无法造就美好的生活。”这种相处方式平衡了开放、共情、同情的态度（“爱”）和功能性思考及情境行为科学（CBS）的知识（“知识”）。目标是建立一种治疗关系，这种关系能够随着当下的流动而变化，总是问：“这个人在这个时刻需要什么？”

以下是Gareth写的一首诗，描述了这种态度： 《FAP治疗师的祈祷》 愿我看到并听到自己。 愿我看到并听到面前的这个人。 愿我记得站在成长边缘的感觉。 愿我保持开放，并通过我的开放邀请同样的开放。 愿我能听到过去在现在说话， 以及对未来渴望的声音。 愿我能接受不知道下一步是什么， 并与这个人站在一起， 帮助他们找到下一步。 愿我敢于冒险，无论大小， 提出下一步的建议， 愿我提供挑战，无论大小， 而不强加我的观点。 愿我在我的观点起伏时继续倾听。 愿我欢迎一切出现的事物， 根据需要给予关心或安慰， 或勇气或同志之情。 愿我现在就谈论这些， 沉浸在我们之间真实而简单的关系中， 无论是温暖还是冷淡。 愿我发现并感受并服务于 对这个人重要的东西， 这个独特的人 以及他们所属的宇宙的一部分。 愿我尽可能了解这个人走过的路， 以便我能像一个充满爱心的小说家一样讲述他们的真相。 愿我表达那些已沉默的真相。 愿我慷慨地传达我的情感， 而不给对方施加压力。 愿我的同情心使这个人自由。 愿我的同情心使我自由。 愿我做好自己的工作， 并将这一切奉献给自己。

在这本书中，我们概述了FAP的基本理念和实践。我们认真对待书名（以及这本书所属系列的名称），尽可能简洁明了地呈现我们的内容。我们的许多展示反映了我们在研讨会、教室、团体或个人咨询中教授FAP的方式。我们既包括了理论也包括了实践，涵盖了我们认为临床医生最渴望的核心临床教学。

同时，我们抵制了将FAP和治疗过程描绘得比实际情况更简单的冲动。这不会对你有任何好处。正如我们在开头所写的，理论和书本身并不是治疗。应用我们提供的理念和实践取决于你自己，而且有很多方法可以做到这一点。我们试图简化事物，但这并不意味着工作是容易的。我们给出的理念指明了方向，并为你如何践行FAP提供了极大的灵活性。归根结底是这样的：如果你

1. 以CBS（情境行为科学）的态度对待治疗；
2. 从功能的角度理解治疗过程中发生的事情；
3. 参与到有意识、勇敢且充满爱的治疗互动中；并且
4. 利用你的互动来塑造你认为与来访的临床问题功能相关的行为，那么你就是在进行FAP。

在实践中，你的最终指南应该是治疗过程本身以及你与来访的互动，还有你对工作环境的理解。FAP就是关于这个过程。那里有什么是真实的？这项工作不是完美的，也很少完成。它是被实践的。它不是事先规划好的。它是活生生的。我们不向来访发号施令——我们与他们建立联系。正是在这种联系中，改变的过程得以发生。

结论

不可避免地，我们在FAP实践中有些方面没有充分涵盖。在实际操作或向咨询者传授时，我们可能有一些内容没有在这里提及。如果您需要帮助，请随时联系FAP社区。 愿您的实践因FAP的原则而丰富。在这篇结论的剩余部分，我们将为您提出一些建议和祝愿，以帮助您将这些原则融入到您的实践中。

有意识的练习

有些练习方式比其他方式更有效。特别是，单纯花费时间进行练习并不是技能发展的最重要因素。重要的是你有意识地练习（Ericsson, Krampe, & Tesch-Römer, 1993）：

• 关注挑战你表现的具体行为和情境。
• 练习你希望改进的地方。
• 监测你的练习结果，并根据观察到的情况调整你的练习。

这个过程不必复杂。实际上，你越能使练习过程简单化，就越有可能在繁忙的职业生活中坚持下去。选择一个目标并用最少的有意识练习来实施，比花数小时准备找到完美的目标更为有效。选个目标就开始吧。练习的过程会比你开始时的思考更有指导意义。

考虑以下有意识练习的例子： 假设你想更加直接地询问来访在当下发生的CRB（临床相关行为）。决定何时练习这一点。也许你会对所有来访都进行这种练习，或者只针对那些你难以提问的来访。

当你刚开始时，为了更好地适应练习，可以想出几个问题来帮助你询问CRB：“你刚才感觉如何？”“现在发生的事情是否像与她在一起时发生的事情一样？”等等。

上述整个计划过程可能只需要五分钟。有了计划后，记得要实际去做练习。在笔记本电脑、治疗记录板或白板上简单的视觉提醒可能就足够了：“练习”或“引发”。

每次有意练习之后，或在周末反思一下练习情况。哪些做得好？下一周你想改进什么？ 不要因为错误而气馁。你可以从错误中学到的东西不亚于成功。把学到的东西融入到有意识的练习中，并重复。每周花五分钟反思你的有意识练习，经过几个月甚至几年的积累，会对你的表现产生巨大的影响。本书每章末尾提供了关键事项的总结，这可以作为你FAP实践能力的检查清单。

咨询小组

与其他专业人士一起练习可能是学习FAP最流行的方式。你可以组建或加入现有的FAP咨询小组，或将FAP原则融入到现有的咨询工作中。与其他专业人士分享FAP的学习，为你提供了一个在与同事的真实互动中练习这些原则的机会。

任何FAP咨询小组中最重要的、不可妥协的实践是真实性和关注彼此之间的实际关系过程。你应该了解彼此的1s和2s，并且应该互相练习脆弱的披露。房间里的大象应该被讨论。所有成员都应该致力于走出舒适区，以提高技能。同时，请记住每个人都是从他们所在的位置开始的，脆弱性应该是自愿且自由选择的。

以下是小组咨询的一些其他有用的实践：

• 分享日志（例如风险日志），并通过电子邮件或社交媒体简短地口头或书面反馈伙伴的日志。
• 案例展示和角色扮演。
• 现场过程工作（例如，在咨询小组中处理回避、冲突等）。
• 体验式练习和事后讨论。

显然，这个话题值得更多的讨论，这里无法详尽。越来越多的FAP培训师和从业者已经开始咨询小组，可以提供指导和其他资源。

FAP的未来

FAP正在通过世界各地许多个人和组织的努力不断发展，包括由Jonathan Kanter、Mavis Tsai和Bob Kohlenberg领导的华盛顿大学西雅图分校的社会连接科学中心。

FAP要想成功发展，需要三件关键的事情：

1. 科学：正如我们在引言中提到的，支持FAP作为一种干预措施的科学（而不是基本的学习原则本身）还不够成熟。FAP不符合传统的“循证治疗”标准。这对FAP从业者和研究人员来说仍然是一个挑战。
2. 创新：我们需要开发FAP原则的创新应用（例如，协议、手册、具体流程），这些应用易于科学评估，并明确指出FAP原则最有可能增加临床价值的地方和方式。
3. 社区：由于社区是创新和科学的基础，我们希望这本书能够激励FAP社区创新其原则，并创建所需的科学研究来验证这种治疗方法。我们希望社区能够积极地将FAP发展成更具影响力和价值的东西。

愿我们相互支持。

知识点阐述

1. FAP的基本原则

   • 定义：FAP（功能分析心理治疗）是一种基于情境行为科学（CBS）的心理治疗方法，它强调在治疗过程中关注行为的功能性，并通过治疗关系促进改变。
   • 重要性：FAP不仅关注症状的表面处理，还深入探讨行为背后的功能，从而帮助来访从根本上解决问题。
   • 具体实践：
     • 功能性思考：理解来访行为背后的动机和功能，而不是仅仅关注行为本身。
     • 情境行为科学：运用CBS的原则，考虑行为发生的背景和环境，以更全面地理解问题。
     • 治疗关系：建立一种开放、共情、富有同情心的治疗关系，为来访提供支持和安全感。

2. 治疗关系的重要性

   • 定义：治疗关系是指治疗师与来访之间的互动和连接，它在治疗过程中起着核心作用。
   • 重要性：良好的治疗关系能够增强来访的信任感，促进治疗效果，有助于来访更好地参与治疗过程。
   • 具体实践：
     • 共情和理解：努力理解来访的情感和经历，展现出真正的关心和支持。
     • 开放性和透明度：保持开放的态度，鼓励来访分享他们的想法和感受。
     • 灵活应对：根据来访的需求和情况，灵活调整治疗策略和方法。

3. FAP的实际应用

   • 定义：FAP的应用不仅仅是遵循一套固定的步骤，而是要在具体的治疗情境中灵活运用其原则和方法。
   • 重要性：FAP的灵活性使得治疗师能够针对每个来访的具体情况进行个性化的干预。
   • 具体实践：
     • 持续学习：不断学习和更新关于FAP及其相关领域的知识，以提高治疗技能。
     • 实践反思：在实际工作中反思和评估自己的治疗过程，找出改进的地方。
     • 个性化干预：根据每个来访的具体情况制定个性化的治疗计划，确保治疗的有效性。

4. 治疗过程中的自我成长

   • 定义：治疗不仅是帮助来访成长的过程，也是治疗师自身成长的机会。
   • 重要性：治疗师通过不断地自我反思和学习，可以在专业和个人层面上获得成长。
   • 具体实践：
     • 自我反思：定期进行自我反思，了解自己在治疗过程中的表现和感受。
     • 寻求反馈：积极寻求同事和来访的反馈，以改进自己的治疗技巧。
     • 持续发展：通过参加培训、阅读专业文献等方式，不断提升自己的专业水平。

通过以上知识点的阐述，我们可以看到FAP不仅是一种治疗方法，更是一种与来访相处的方式。它强调治疗关系的重要性，注重行为的功能性分析，并鼓励治疗师在实践中不断学习和成长。这种综合性的方法有助于治疗师更好地理解来访，提供有效的支持，并促进双方的成长和发展。

知识点阐述

1. 有意识的练习

   • 定义：有意识的练习是一种专注于特定技能提升的方法，它要求个体明确目标、监测进展并根据反馈调整策略。
   • 重要性：这种方法能够显著提高专业技能，因为它确保了练习是有目的、有针对性的，而不是机械重复。
   • 具体实践：
     • 设定具体目标：确定你要改进的具体行为或技能。
     • 制定计划：为达到这些目标制定具体的练习步骤。
     • 执行和反馈：按照计划执行练习，并定期评估进展，根据结果调整练习方法。

2. 咨询小组的作用

   • 定义：咨询小组是由多个专业人士组成的团体，旨在通过共享经验和相互支持来促进个人和集体的专业成长。
   • 重要性：这样的小组提供了一个安全的环境，让参与者可以尝试新的方法，获得即时反馈，并在真实的人际互动中实践FAP原则。
   • 具体实践：
     • 建立信任：确保小组成员之间建立起信任和开放的关系。
     • 定期会议：定期举行会议，讨论案例、分享经验、进行角色扮演等。
     • 透明沟通：鼓励成员坦诚地表达自己的感受和想法，即使这些内容可能令人感到不适。

3. FAP的未来发展

   • 定义：FAP的未来发展是指该疗法在科学、创新和社区支持下的持续进步和发展。
   • 重要性：随着更多研究的支持和新应用的发展，FAP有望成为一种更为广泛接受和有效的治疗方法。
   • 具体实践：
     • 科学研究：继续进行实证研究，以验证FAP的有效性和适用性。
     • 创新应用：开发新的工具和技术，使FAP原则更容易应用于不同的临床情境。
     • 社区建设：加强FAP社区的建设，促进知识共享和合作，共同推动这一领域的发展。

通过以上知识点的阐述，我们可以看到FAP不仅是一种治疗方法，也是一个不断发展的领域。它强调有意识的练习、团队合作的重要性以及持续的科学研究。这些原则和实践不仅有助于提高治疗效果，还能促进治疗师个人和职业的成长。此外，FAP社区的建设和支持对于推动这一领域的发展至关重要。

Conclusion As to the methods, there may be a million and then some, but principles are few. The [person] who grasps principles can successfully select his [or her] own methods. The [person] who tries methods, ignoring principles, is sure to have trouble. —­Harrington Emerson Some have said that FAP boils down to a way of being with a client in a therapeutic relationship. Think of it like this: when one does all the things contained in these pages, a way of being in relationship emerges. Echoing the Bertrand Russell quote that opened this book—­“Neither love without knowledge, nor knowledge without love can produce a good life”—­this way of being bal- ances the “love” of an open, empathic, compassionate stance with the “knowledge” of functional thinking and contextual behavioral science (CBS). The aim is a therapeutic relationship, one that flows with the moment, always asking, “What is needed for this person in this moment?” Here is a poem, written by Gareth, that describes this stance: The FAP Therapist’s Prayer May I see and hear myself. May I see and hear this person in front of me. May I remember what it feels like to stand on the edge of growth. May I be open, and through my openness invite the same. May I hear the past speaking in the present and the longing for a future. May I accept not knowing what the next step is and stand with this other person as they find their next step. May I take risks, big and small, to suggest the next step, may I offer challenges, big and small, without imposing my opinion. May I continue to listen as my opinions rise and fall. May I welcome whatever arises, with concern or comfort or courage or camaraderie, as is needed. May I speak to this, here and now, slipping into the pool of what is real and simple between us, whether it is warm or cold. May I find and feel and serve what matters to this person, this unique person and their piece of the universal. May I know the road this person walks, as best as one can, so I can speak their truth like a loving novelist. May I voice the truths that have fallen silent. May I communicate my affection, generously, without obligating the other to me. May my compassion set this person free. May my compassion set me free. May I do my own work and offer all of this to myself. In this book we’ve laid out the basic ideas and practices of FAP. We have taken the title of the book (and of the series in which this book belongs) to heart: we have made our presentation as simple and clear as possible. Much of our presentation mirrors the way we teach FAP in workshops, class- rooms, and group or individual consultations. We included both the theoretical and practical, bottom-­line clinical teaching that we believe clinicians most crave. At the same time, we resisted the urge to portray FAP and the process of therapy as being simpler than they really are. That wouldn’t be doing you any favors. As we wrote at the beginning, neither the theory nor the book is the therapy itself. It’s up to you to apply the ideas and practices we have provided, and there are lots of ways to do that. We tried to make things simpler, but that does not mean the work is easy. The ideas we’ve given point the way and grant great flexibility in how you walk the FAP way. The bottom line is this: if you are

1. taking a CBS stance toward therapy;
2. understanding what happens in the therapy process in terms of function;
3. participating in an aware, courageous, and loving therapeutic interaction; and
4. using your interaction to shape the behaviors that you determine are functionally related to the client’s clinical issues, then you are doing FAP. As you practice, your ultimate guide should be the process of therapy and your interaction with your client and your grasp of the contexts in which you are working. FAP is about that process. What is real there? The work is not perfected, and rarely is it completed. It is practiced. It is not laid out ahead of time. It is lived. We don’t dictate to our clients—­we relate. Relating is where the change process lies. It’s inevitable that there are aspects of the FAP practice we have not covered adequately. There are things we do in practice or teach to consultees that we’ve not thought to cover here. Please do reach out to the FAP community if and when you need help. May your practice be enriched by the principles of FAP. The remainder of this conclusion offers a few suggestions and wishes as you carry these principles forward into your practice. DELIBERATE PRACTICE There are ways of practicing that are more effective than others. In particular, time spent in prac- tice by itself is not the most important factor for skill development. It matters that you practice deliberately (Ericsson, Krampe, & Tesch-­Romer, 1993): • Attend to specific behaviors and contexts that challenge your performance. • Practice the desired improvements. • Monitor the outcomes of your practice and adapt your practice based on what you observe. This process need not be complicated. In fact, the simpler you can make the practice process the more likely you are to persist with it amidst the demands of a busy professional life. Picking something and working on it with the minimal deliberate practice for viable implementation is more effective than spending hours preparing and finding just the right target. Pick something and go. The process of practice will be more instructive than your contemplation at the outset. Consider this example of deliberate practice: Let’s say you want to work on inquiring more directly about CRB as it happens in the moment. Decide when you will practice this. Perhaps you will practice it with all clients, or perhaps with only those with whom you struggle to inquire. To orient yourself to the practice as you first begin, come up with a couple of questions to help you inquire about CRB: “What did you feel just then?” “Is what is happening right now like what happens with her?” And so forth. The entire planning process above might take five minutes. After you have a plan, remember to actually do the practice. A simple visual reminder on your laptop or therapy clipboard or white- board might be sufficient: “practice” or “evoke.” After each session in which you deliberately practice, or at the end of the week, reflect on how the deliberate practice went. What went well? What would you like to improve for next week? Don’t be discouraged by mistakes. You can learn as much from mistakes as from success, if not more. Incorporate what you learn into the deliberate practice and repeat. Five minutes of reflection about your deliberate practice per week, compounded over months and years of practice, can make an immense difference in your performance. At the end of each chapter in this book, we offered summaries of the key things to do and remember. These may serve as a checklist of competencies for your practice of FAP. CONSULTATION GROUPS Practicing with other professionals is probably the most popular way to learn FAP. You might form or join an existing FAP consultation group or integrate FAP principles into your existing consulta- tion work. Sharing the learning of FAP with other professionals offers the opportunity to practice the principles in the context of genuine interactions with your colleagues. The most important, nonnegotiable practices that must be part of any FAP consultation group are authenticity and attending to the actual process of relating to each other. You should know the 1s and 2s of each other, and you should practice vulnerable disclosure with each other. Elephants in the room should be discussed. All members should be committed to stepping outside of their comfort zones in service of building skills. At the same time, keep in mind that everyone starts where they are, and vulnerability should be consensual and freely chosen. Here are some other useful practices for group consultation: • Sharing logs (for example, risk logs) and briefly reflecting—­verbally or in writing via e-­mail or social media—­on a partner’s log • Case presentation and role-­playing • In vivo process work (for example, processing avoidance, conflict, and so forth in the consultation group) • Experiential exercises and debriefing conversations Obviously this topic warrants much more discussion than can be provided here. A growing number of FAP trainers and practitioners who have started consultation groups can provide guid- ance and other resources. THE FUTURE OF FAP FAP is evolving through the efforts of many people and organizations worldwide, including the Center for the Science of Social Connection led by Jonathan Kanter, Mavis Tsai, and Bob Kohlenberg at the University of Washington in Seattle. There are three key things that FAP needs in order to evolve successfully:
5. Science: As we noted in the introduction, the science supporting FAP as an interven- tion (not the basic learning principles themselves) is underdeveloped. FAP does not meet conventional criteria for “evidence-­based treatment” status. That continues to be a challenge for FAP practitioners and researchers.
6. Innovation: We need to develop innovative applications (for example, protocols, manuals, specific processes) for FAP principles that lend themselves to scientific evalu- ation and that pinpoint where and how FAP principles are most likely to add clinical value.
7. Community: Because community is the foundation for innovation and science, our hope is that this book will inspire the FAP community to innovate its principles and create the scientific research that is needed to validate this approach to therapy. We hope the community will actively evolve FAP into something more impactful and valuable. May we be there for each other.