前言：以觉知、勇气和爱心待人

序言

以觉知、勇气和爱对待他人

人类是在小团体中进化而来的。我们是社会性生物，他人的存在对我们心理的重要性就如同呼吸对生理的重要性一样基本。

从科学的角度来看，我们知道他人对我们功能的发挥至关重要，但在日常生活中我们也能够感受到这一点的重要性。如果你审视对你来说最重要和最痛苦的事情，很可能会发现这些都与人有关。我们可能因被拒绝、孤独、羞耻或关系问题而感到困扰：但这些都是他人重要性和他人作为我们心理痛苦焦点的例子。我们可能希望成就、创造、贡献或爱人——但这些也都隐含着需要与他人分享。

大多数临床问题反映在我们与他人的关系中。这在病因学上也是成立的：缺乏关爱、人际间的抛弃、忽视和创伤等经历被认为是最具毒性的体验之一，而相反，社会支持、亲密关系和关怀则是最具提升作用的体验。那么，治疗关系的质量与大多数疗法（包括基于证据的疗法）的结果相关也就不足为奇了。

如果社会过程是人类问题发展的核心，我们应该预期在来访与治疗师的关系中看到心理病理现象；而在许多情况下，甚至大多数情况下，确实如此。如果处理不当，这是一个问题，但如果处理得当，则是一个机会，因为治疗师可以在治疗咨询室中直接处理感兴趣的问题行为。

然而，要做到这一点，你需要一套清晰的指导原则。你需要看到社会事件的功能，而不仅仅是它们的形式。大多数来访在心理治疗之外都有重要的社会关系，但这些关系往往不是治愈性的，因为人们无意中强化了错误的事物或支持了无益的规则。如果仅仅与他人在一起就足够的话，人们通常就不需要寻求专业帮助了。我们对他人的自动反应可能并不是他们在治疗上所需要的。治疗师需要真诚，但也需要深思熟虑和策略性。这是一个需要基于原则来平衡的微妙之处。

功能分析心理治疗（FAP）提供了一套简明的指导方针，帮助治疗师关注那些最能预测积极结果的治疗关系特征。在许多情况下，FAP可以作为独立的治疗方法使用，也可以用来支持其他治疗方法的部署和增强——特别是那些来自相同行为根源的方法。

本书将FAP定位为情境行为科学（CBS）的一部分。通过这种方式，它邀请读者将FAP原则与现代行为分析（包括关系框架理论RFT）相协调。这是一个有趣且重要的步骤，为FAP临床医生提供了一套强大的附加概念来应用。它为将条件性社会强化作为治疗议程的一部分赋予了新的面貌。

本书还积极拥抱“觉知、勇气和爱”模型，该模型将更抽象的功能分析与临床相关行为（CRBs）联系起来，并定义了由共同功能分析集定义的领域。并非所有人都会赞同这一步骤，但我知道一线临床医生会赞同，因为它立即使FAP更加生动和聚焦。而这反过来又使FAP变得简单：更容易理解、更容易教学、更容易实施。

本书后半部分清晰地揭示了成长和困难的领域。它展示了如何创造性地和实用地使用这个模型。书中涵盖的一些问题——例如如何结束治疗以及探索所学到的东西——在其他书籍中经常被忽略。仅这些智慧的部分就值得你购买这本书。

随着研究人员和临床医生进一步解构这一模型，我期待看到新的前进路径。我建议你在阅读这本书时，以觉知去发现机会，以勇气彻底探索新领域，并以谦逊的态度获取新技能——带着对人类的爱来进行这一切。如果你这样做，你将在这段旅程中得到改变，正如你服务的人们的生活也会得到改变。

——史蒂文·C·海斯 内华达大学里诺分校基础教授兼临床培训主任

知识点阐述

1. 人类的社会性：

   • 人类是社会性生物，他人的存在对我们心理的重要性如同呼吸对生理的重要性一样基本。我们的幸福和痛苦往往与人际关系密切相关。

2. 临床问题与人际关系：

   • 大多数临床问题反映在我们与他人的关系中。不良的社交经历如缺乏关爱、抛弃、忽视和创伤会对个体造成极大的伤害，而良好的社交支持、亲密关系和关怀则具有显著的积极影响。

3. 治疗关系的重要性：

   • 治疗关系的质量直接影响治疗效果。良好的治疗关系可以帮助治疗师更好地理解和解决来访的问题，从而提高治疗的成功率。

4. 功能分析心理治疗（FAP）：

   • FAP是一种心理治疗方法，强调通过治疗关系中的互动来促进行为改变。FAP认为，治疗师可以通过有意识地创建一个有利于成长的环境，帮助来访识别和改变不适应的行为模式。

5. FAP的原则：

   • FAP提供了一套简明的指导方针，帮助治疗师关注那些最能预测积极结果的治疗关系特征。这些原则包括觉知、勇气和爱，帮助治疗师在治疗过程中保持专注和有效性。

6. FAP的应用：

   • FAP不仅可以作为独立的治疗方法使用，还可以与其他治疗方法结合使用，特别是那些基于行为分析的方法。这种综合方法有助于治疗师根据来访的具体需求灵活选择和应用不同的治疗技术。

7. 情境行为科学（CBS）：

   • 本书将FAP定位为情境行为科学的一部分，这使得FAP与现代行为分析（如关系框架理论RFT）相结合。这种结合为FAP提供了更强大的理论基础和实践工具。

8. “觉知、勇气和爱”模型：

   • 该模型将更抽象的功能分析与具体的临床相关行为联系起来，帮助治疗师更好地理解和应用FAP原则。这种模型使得FAP更加生动和聚焦，从而简化了其理解和应用。

9. 治疗结束和学习总结：

   • 本书特别强调了如何结束治疗以及探索所学到的东西。这些内容在其他书籍中经常被忽略，但却是治疗过程中的重要环节，有助于巩固治疗成果并促进来访的长期发展。

10. 持续学习和创新：

    • 作者鼓励读者在阅读本书时，以觉知去发现机会，以勇气探索新领域，并以谦逊的态度获取新技能。这种态度不仅有助于个人成长，也有助于提高治疗效果和服务质量。

FOREWORD Treating Others with Awareness, Courage, and Love H uman beings evolved in small groups and bands. We are social beings, and the importance of others is as basic to our psychology as breathing is to our physiology. As a scientific matter we know that others are key to our functioning, but we can also feel how important that is in our daily lives. If you look at what is most important to you and what is most painful to you, it is likely that people are involved in both of those reactions. We may be tormented by rejection, or loneliness, or shame, or relationship problems: but all of these are examples of both the importance of others and other people as a focal point of our psychological pain. We may hope to achieve, or create, or contribute, or love—­but these too will implicitly involve people to share with. Most clinical problems are reflected in our relationships with others. This is true etiologically: experiences such as a lack of nurturance, interpersonal abandonment, neglect, and trauma are among the most toxic experiences known, and in the opposite direction, social support, intimacy, and caring are among the most uplifting. Is it any wonder then that the quality of the therapeutic relationship is related to the outcomes of most forms of therapy, including those that are evidence based? If social processes are central to the development of human problems, we should expect to see psychopathology appear in the relationship between clients and therapists; and in many if not most cases, we do. This is a problem if it is not handled correctly, but also an opportunity if it is, since the therapist is able to work directly with the problem behavior of interest in the therapeutic consult- ing room. To do this, however, you need a clear set of guiding principles. You need to see the function of social events, not just their form. Most clients have social relationships of importance outside of psychotherapy, but often these are not curative because people accidentally reinforce the wrong things or support unhelpful rules. If merely being in the presence of others was enough, then people would not usually need to seek out professional help. The automatic reactions that we have to others may not be what they need therapeutically. A therapist needs to be genuine, but also needs to be thoughtful and strategic. That is a tricky balance that needs to be based on principles. What functional analytic psychotherapy (FAP) offers is a small set of clear guidelines that help therapists keep their eye on the features of the therapeutic relationship that most predict positive outcomes. FAP can be used as a stand-­alone treatment in many cases, but it can also be used to support the deployment and augmentation of other treatment methods—­especially those drawn from the same behavioral roots. This book positions FAP as part of contextual behavioral science (CBS). In so doing, it invites the reader to harmonize FAP principles with modern behavioral analysis, including relational frame theory (RFT). That is an interesting and important step that gives the FAP clinician a powerful additional set of concepts to apply. It puts a fresh face on the use of contingent social reinforce- ment as part of the therapeutic agenda. xForeword This book also vigorously embraces the “awareness, courage, and love” model that links more abstract functional analysis and clinically relevant behaviors (CRBs) to domains defined by common sets of functional analyses. Not all will approve of this step, but I know the line clinician will because it immediately makes FAP more vital and focused. And that, in turn, makes FAP simpler: simpler to understand, simpler to teach, and simpler to deploy. The latter part of this elegant book casts a clear light on areas of growth and difficulty. It shows how to use this model in a creative and practical way. Some issues it covers—­such as how to end therapy and to explore what was learned—­are often missed in other books. These wise sections alone are worth the price of admission. As researchers and clinicians further unpack this model I expect to see new pathways forward. My suggestion to you as you read this book is to explore this model with the awareness to see opportunity, the courage to explore new territory thoroughly, and the love of humanity to acquire new skills with humility—­to bring all of that to the task. If you do, you will be changed by the journey, as will the lives of those you serve. —Steven C. Hayes Foundation Professor and Director of Clinical Training University of Nevada, Reno