Kada saosećajnost postane pretnja: razlozi otpora klijenata prema terapeutskoj podršci
Sažetak
Saosećanje predstavlja jedan od najznačajnijih činilaca terapijskog odnosa. Možemo ga definisati kao bazičnu brižnosti, sa dubokom svesnošću o sopstvenoj i tuđoj patnji, koja je praćena željom i naporima da se ona ublaži. Cilj rada je razmatranje doprinosećih faktora faktora i efikasnih strategija za upravljanje strahovima, psihološkim blokadama, i otporima koji sprečavaju klijente da prime brigu i saosećanje od strane terapeuta, pristupajući dominantno iz ugla Terapije fokusirane na saosećanje. Rad se fokusira na klijente koji su traumatizovani tokom detinjstva, i koji često zbog toga pokazuju teškoće da prime ili prihvate podršku terapeuta zbog dubokog uticaja traume na poverenje, vezivanje i bazična uverenja o drugima. U radu ćemo se najpre baviti razmatranjem koncepta saosećanja, nakon čega ćemo preći na diskusiju različitih prepreka razvoju saosećanja, uključujući ulogu uverenja klijenta da ne zaslužuje da dobije brigu i toplinu, sumnje u terapeutove namere, strahove od sopstvene emocionalne ranjivosti, itd. Predstavićemo takođe strategije prevazilaženja strahova, blokova i otpora saosećanju koje uključuju: razvoj saosećajnog odnosa u terapijskom okruženju, psihoedukaciju o funkciji saosećanja, rad na uverenjima koja blokiraju saosećanje, rad na postizanju fiziološke smirenosti i ukotvljenosti u sadašnjost, saosećajnu imaginaciju i rad sa stidom i ranim razvojnim traumama. Razumevanje i validacija otpora nisu prepreka već ključan deo terapijskog procesa koji omogućava klijentu da postepeno razvije sposobnost i voljnost da prihvati toplinu i brigu od strane drugih. Rad na otporu unutar terapijskog procesa otvara prostor za razvoj kapaciteta da klijent pruži saosećanje samom sebi i drugim osobama, čime se postiže unapređenje emocionalne regulacije.
Reference
2. Cho-Kain LW, Gunderson J. Borderline Personality Disorder and Resistance to Treatment. Psychiatric Times. 2009 Jul 31;26(8).
3. Aviram A, Westra HA. The impact of motivational interviewing on resistance in cognitive behavioural therapy for generalized anxiety disorder. Psychother Res. 2011 Nov;21(6):698-708. doi: 10.1080/10503307.2011.610832. Epub 2011 Aug 31. PMID: 21878034.
4. Beutler LE, Harwood TM, Michelson A, Song X, Holman J. Resistance/reactance level. J Clin Psychol. 2011 Feb;67(2):133-42. doi: 10.1002/jclp.20753. PMID: 21108314.
5. Button ML, Westra HA, Hara KM, Aviram A. Disentangling the impact of resistance and ambivalence on therapy outcomes in cognitive behavioural therapy for generalized anxiety disorder. Cogn Behav Ther. 2015;44(1):44-53. doi: 10.1080/16506073.2014.959038. Epub 2014 Oct 3. PMID: 25277366.
6. Greenson R. The technique and practice of psychoanalysis: Volume I. London: Routledge; 2016.
7. Sandler J, Holder A, Dare C. Basic psychoanalytic concepts: V. Resistance. Br J Psychiatry. 1970 Aug;117(537):215-21. PMID: 5480678.
8. Horner AJ. Dealing with resistance in psychotherapy. New York: Jason Aronson; 2005.
9. Levitt HM, Williams DC. Facilitating client change: principles based upon the experience of eminent psychotherapists. Psychother Res. 2010 May;20(3):337-52. doi: 10.1080/10503300903476708. PMID: 20419564.
10. Bowlby J. A secure base: Parent-child attachment and Healthy Human Development. New York: Basic Books; 1988.
11. Skourteli MC, Lennie C. The therapeutic relationship from an attachment theory perspective. Counselling Psychology Review. 2011 Mar;26(1):20–33. doi:10.53841/bpscpr.2011.26.1.20.
12. Fonagy P, Luyten P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol. 2009 Fall;21(4):1355-81. doi: 10.1017/S0954579409990198. PMID: 19825272.
13. Liotti G, Gilbert P. Mentalizing, motivation, and social mentalities: theoretical considerations and implications for psychotherapy. Psychol Psychother. 2011 Mar;84(1):9-25; discussion 98-110. doi: 10.1348/147608310X520094. PMID: 22903828.
14. Saypol E, Farber BA. Attachment style and patient disclosure in psychotherapy. Psychother Res. 2010 Jul;20(4):462-71. doi: 10.1080/10503301003796821. PMID: 20552537.
15. Janzen J, Fitzpatrick M, Drapeau M. Processes involved in client-nominated relationship building incidents: Client attachment, attachment to therapist, and session impact. Psychotherapy (Chic). 2008 Sep;45(3):377-90. doi: 10.1037/a0013310. PMID: 22122497.
16. Mallinckrodt B, Jeong J. Meta-analysis of client attachment to therapist: associations with working alliance and client pretherapy attachment. Psychotherapy (Chic). 2015 Mar;52(1):134-139. doi: 10.1037/a0036890. Epub 2014 Nov 3. PMID: 25365151.
17. Taylor PJ, Rietzschel J, Danquah A, Berry K. The role of attachment style, attachment to therapist, and working alliance in response to psychological therapy. Psychol Psychother. 2015 Sep;88(3):240-53. doi: 10.1111/papt.12045. Epub 2014 Nov 11. PMID: 25384637.
18. Gilbert P. Explorations into the nature and function of compassion. Curr Opin Psychol. 2019 Aug;28:108-114. doi: 10.1016/j.copsyc.2018.12.002. Epub 2018 Dec 13. PMID: 30639833.
19. Kirby JN, Gilbert P. Commentary regarding wilson et al. (2018) “Effectiveness of ‘self-compassion’ related therapies: A systematic review and meta-analysis.” all is not as it seems. Mindfulness. 2019 Feb 9;10(6):1006–16. doi:10.1007/s12671-018-1088-8.
20. Gilbert P, Irons C. Focused therapies and compassionate mind training for shame and self-attacking. In: Compassion: Conceptualisations, Research and Use in Psychotherapy. London: Routledge; 2005. p. 263–325.
21. Gilbert P. The compassionate mind. London: Constable & Robinson; 2009.
22. Gilbert P. Compassion focused therapy: Distinctive features. London: Routledge; 2010.
23. Carter CS. Oxytocin pathways and the evolution of human behavior. Annu Rev Psychol. 2014;65:17-39. doi: 10.1146/annurev-psych-010213-115110. Epub 2013 Sep 19. PMID: 24050183.
24. Seppala E, Simon-Thomas E, Brown SL, Worline MC, Cameron CD, Doty JR. The Oxford Handbook of Compassion Science. New York, NY: Oxford University Press; 2017.
25. Finlay‐jones AL. Compassion in Clinical Practice: Current applications and New Directions. Clinical Psychologist. 2017 Jul 1;21(2):59–61. doi:10.1111/cp.12133
26. MacBeth A, Gumley A. Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clin Psychol Rev. 2012 Aug;32(6):545-52. doi: 10.1016/j.cpr.2012.06.003. Epub 2012 Jun 23. PMID: 22796446.
27. Crocker J, Canevello A. Consequences of self-image and compassionate goals. Advances in Experimental Social Psychology. 2012 Dec;229–77. doi:10.1016/b978-0-12-394286-9.00005-6.
28. Hermanto N, Zuroff DC, Kopala-Sibley DC, et al. Ability to receive compassion from others buffers the depressogenic effect of self-criticism: A cross-cultural multi-study analysis. Personality and Individual Differences. 2016 Aug;98:324–32. doi:10.1016/j.paid.2016.04.055.
29. Neff KD, Germer CK. A pilot study and randomized controlled trial of the mindful self-compassion program. J Clin Psychol. 2013 Jan;69(1):28-44. doi: 10.1002/jclp.21923. Epub 2012 Oct 15. PMID: 23070875.
30. Jazaieri H, Jinpa GT, McGonigal K, et al. Enhancing compassion: A randomized controlled trial of a compassion cultivation training program. Journal of Happiness Studies. 2012 Jul 25;14(4):1113–26. doi:10.1007/s10902-012-9373-z.
31. Pace TW, Negi LT, Dodson-Lavelle B, et al. Engagement with Cognitively-Based Compassion Training is associated with reduced salivary C-reactive protein from before to after training in foster care program adolescents. Psychoneuroendocrinology. 2013 Feb;38(2):294-9. doi: 10.1016/j.psyneuen.2012.05.019. Epub 2012 Jul 3. PMID: 22762896.
32. Gilbert P. The origins and nature of compassion focused therapy. Br J Clin Psychol. 2014 Mar;53(1):6-41. doi: 10.1111/bjc.12043. PMID: 24588760.
33. Craig C, Hiskey S, Spector A. Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev Neurother. 2020 Apr;20(4):385-400. doi: 10.1080/14737175.2020.1746184. Epub 2020 Apr 10. PMID: 32196399.
34. Millard LA, Wan MW, Smith DM, Wittkowski A. The effectiveness of compassion focused therapy with clinical populations: A systematic review and meta-analysis. J Affect Disord. 2023 Apr 1;326:168-192. doi: 10.1016/j.jad.2023.01.010. Epub 2023 Jan 14. PMID: 36649790.
35. Mikulincer M, Shaver PR. Attachment in adulthood, second edition: Structure, Dynamics, and change. Guilford Publications; 2016.
36. Knight C. Trauma-Informed Social Work Practice: Practice Considerations and Challenges. Clin Soc Work J. 2015/03//;43(1):25–37. doi: 10.1007/s10615-014-0481-6.
37. Kirby JN, Day J, Sagar V. The 'Flow' of compassion: A meta-analysis of the fears of compassion scales and psychological functioning. Clin Psychol Rev. 2019 Jun;70:26-39. doi: 10.1016/j.cpr.2019.03.001. Epub 2019 Mar 6. PMID: 30884253.
38. Gilbert P, McEwan K, Matos M, Rivis A. Fears of compassion: development of three self-report measures. Psychol Psychother. 2011 Sep;84(3):239-55. doi: 10.1348/147608310X526511. Epub 2011 Apr 13. PMID: 22903867.
39. Gilbert P, Mascaro J. Compassion fears, blocks and resistances: An evolutionary investigation. In: The Oxford handbook of compassion science. Oxford University Press; 2017. p. 399–418.
40. Leighton TD. Faces of compassion: Classic bodhisattva archetypes and their modern expression--an introduction to Mahayana Buddhism. Boston: Wisdom Publications; 2012.
41. Porges SW. The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: W.W. Norton & Company; 2011.
42. Matos M, Petrocchi N, Irons C, Steindl SR. Never underestimate fears, blocks, and resistances: The interplay between experiential practices, self-conscious emotions, and the therapeutic relationship in compassion focused therapy. J Clin Psychol. 2023 Jul;79(7):1670-1685. doi: 10.1002/jclp.23474. Epub 2022 Dec 23. PMID: 36563306.
43. Gilbert P, Clarke M, Hempel S, Miles JN, Irons C. Criticizing and reassuring oneself: An exploration of forms, styles and reasons in female students. Br J Clin Psychol. 2004 Mar;43(Pt 1):31-50. doi: 10.1348/014466504772812959. PMID: 15005905.
44. Matos M, Pinto-Gouveia J, Gilbert P, Duarte C, Figueiredo C. The other as Shamer Scale – 2: Development and validation of a short version of a measure of external shame. Personality and Individual Differences. 2015 Feb;74:6–11. doi:10.1016/j.paid.2014.09.037.
45. Asano K, Tsuchiya M, Ishimura I, et al. The development of fears of compassion scale Japanese version. PLoS One. 2017 Oct 12;12(10):e0185574. doi: 10.1371/journal.pone.0185574. PMID: 29023461; PMCID: PMC5638239.
46. Dentale F, Petrocchi N, Vecchione M, Biagioli C, Gennaro A, Violani C. Factorial structure and construct validity of an Italian version of the Fears of Compassion Scales: A study on non-clinical subjects. Psychol Psychother. 2017 Dec;90(4):735-750. doi: 10.1111/papt.12136. Epub 2017 Jun 22. PMID: 28639407.
47. Pfeiffer S, Peixoto Pereira N, Saraiva de Macedo Lisboa C. Fears of Compassion Scales: Cross-Cultural Adaptation and Validity Evidence for Use in Brazil. Trends Psychol. 2022 Aug 8:1-22. doi: 10.1007/s43076-022-00220-4. Epub ahead of print. PMID: 40479394; PMCID: PMC9360723.
48. Gerbarg PL, Brown RP. The healing power of the breath: Simple techniques to reduce stress and anxiety, enhance concentration, and balance your emotions. Boston, Massachusetts: Shambhala Publications, Inc; 2012.
49. Kabat-Zinn J. Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Bantam Books; 2013.
50. Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion; 1994.
51. Gilbert P, Choden. Mindful compassion. London: Robinson; 2013.
52. Lawrence VA, Lee D. An exploration of people's experiences of compassion-focused therapy for trauma, using interpretative phenomenological analysis. Clin Psychol Psychother. 2014 Nov-Dec;21(6):495-507. doi: 10.1002/cpp.1854. Epub 2013 Jul 24. PMID: 23893917.
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