I'm Danielle Kurzweil.

我是丹妮爾-庫茲韋爾。

I'm honored to join Alex Virchus as co-host for this podcast, an important resource for therapists interested in growing their understanding of and ability to treat CPTSD and dissociative disorders.

我很榮幸能與亞歷克斯-維爾丘斯（Alex Virchus）一起擔任這個播客的共同主持人，這對於有興趣加深瞭解並提高治療 CPTSD 和分離性障礙能力的治療師來說，是一個重要的資源。

I've benefited gratefully from this podcast, being able to join this discussion rather than just passively learning through books and workshops, interacting with the information, asking questions, sharing our own real-time experiences and creating community to pool knowledge.

我從這個播客中受益匪淺，能夠加入討論，而不只是被動地通過書本和研討會學習，與資訊互動，提出問題，分享我們自己的實時經驗，並創建社區來彙集知識。

Like with our guest today, Kathy Steele.

就像我們今天的嘉賓凱西-斯蒂爾一樣。

Kathy has contributed substantially to the work of improving therapist competency and providing effective trauma treatment, which you can read about in her website that's linked below.

凱西為提高治療師的能力和提供有效的創傷治療做出了巨大貢獻，您可以在下面鏈接的她的網站上閱讀到相關資訊。

Today we'll be discussing her work, which builds upon the work of Paul Gilbert and Giovanni Ligati to create clear and practical guidelines for therapists and utilizing a collaborative treatment model alongside their clients.

今天我們將討論她的工作，她的工作以保羅-吉爾伯特和喬瓦尼-利加蒂的工作為基礎，為治療師制定了清晰實用的指導原則，並與客戶一起利用合作治療模式。

Kathy is compassionate, impressively clear about very difficult topics and brings to us immediately actionable and practical tips for connecting compassionately with our clients and ourselves as we do this highly challenging work.

凱西富有同情心，對非常棘手的問題有著非常清晰的認識，併為我們帶來了立即可操作的實用技巧，讓我們在從事這項極具挑戰性的工作時，能夠以富有同情心的方式與客戶和自己建立聯繫。

Enjoy.

請慢用

I was wondering if you could also give our listeners an overview of this collaborative model of therapeutic alliance that you talk about.

我想知道，您是否也能向聽眾們概述一下您所說的這種治療聯盟合作模式。

Relationship between therapist and their client.

治療師與客戶之間的關係。

Right.

對

And I came upon this just through my own struggles as a therapist to help that subset of clients.

作為一名治療師，我在幫助這部分客戶的過程中也遇到了很多困難。

It's not every client, but a small subset of clients that really struggled with dependency.

不是每個客戶都是這樣，但有一小部分客戶確實在依賴性問題上掙扎。

It's like they needed the therapist all the time.

他們好像一直都需要治療師。

And sometimes, you know, the more available the therapist became, the more dysregulated the client became and just needed the therapist more and more.

有時，你知道，治療師越有空，客戶就越不正常，就越需要治療師。

And so it was a vicious cycle.

是以，這是一個惡性循環。

So that's what got me interested in what are we trying to do in creating attachment with clients and what can go wrong with that.

是以，我開始關注我們在與客戶建立依戀關係時要做什麼，以及這樣做會出什麼問題。

And there are other, there's lots of things that could go wrong, but I want to focus on this particular thing because I think it's something that many therapists struggle with because by our nature, we are helpers.

還有其他很多可能出錯的地方，但我想重點談談這件事，因為我認為這是很多治療師都會糾結的問題，因為從本質上講，我們是幫助者。

And by our nature, we respond with compassion and sometimes with urgency when somebody's in distress.

根據我們的天性，當有人陷入困境時，我們會以同情的態度做出反應，有時甚至是緊迫的反應。

And so how to manage something that's very natural for us, but yet not get into a role where there's so much dependency on the therapist for the client that the client is becoming dysregulated.

是以，如何管理對我們來說非常自然的事情，但又不至於讓客戶對治療師產生過多的依賴，以至於客戶變得失調。

And the reason that more extreme dependency is not good, well, there are many reasons, but one of them is because in trauma, a client not only wants to be connected, but also needs to defend against relationship because relationship was what was and so when we're just paying attention to the needs of the client to connect, we're not always paying attention to the needs of the client to protect, right?

更極端的依賴性並不是好事，原因有很多，但其中之一是因為在創傷中，客戶不僅希望與人建立聯繫，還需要保護關係，因為關係就是過去，所以當我們只關注客戶建立聯繫的需求時，我們並不總是關注客戶保護自己的需求，對嗎？

And the general thinking has been, well, if they can connect enough, this will gradually, this need for defense will gradually go down, but that often doesn't happen because there is often dissociation between the part of the self that's trying to connect and the part of the self that's going, oh no, that's too dangerous, right?

一般的想法是，如果他們能夠建立起足夠的聯繫，這種防禦需求就會逐漸減少，但這往往不會發生，因為在試圖建立聯繫的那部分自我和 "哦，不，那太危險了，對不對？"的那部分自我之間往往存在分離。

And so it's very important, I think, for the therapist to modulate the intensity of the relationship as best we can.

是以，我認為治療師儘可能地調節關係的強度是非常重要的。

And we do that through a kind of collaborative model.

我們通過一種合作模式來實現這一目標。

Now, that is not my own work.

現在，這不是我自己的作品。

That work comes from several people in the field.

這項工作來自該領域的多位專家。

The two that come to mind are Paul Gilbert, who wrote a lot about compassion-focused therapy, and Giovanni Liotti, who was an Italian psychologist and researcher, psychiatrist, who did, both of them did a lot of work on the idea that in addition to attachment, there are other ways to connect that are built in for us.

我想到的兩位是保羅-吉爾伯特（Paul Gilbert）和喬瓦尼-利奧蒂（Giovanni Liotti），前者寫了很多關於以同情為中心的療法的文章，後者是一位意大利心理學家、研究員和精神病學家。

They're evolutionary prepared, right?

他們是進化的準備，對嗎？

And so, for example, for parents, there is this intuitive sense of caring for infants.

是以，舉例來說，對於父母來說，他們有一種照顧嬰兒的直覺。

We may not know exactly what to do, but we've got the instinct to care for young children and infants in the same way that animals have that instinct.

我們可能不知道具體該怎麼做，但我們有照顧幼兒和嬰兒的本能，就像動物有這種本能一樣。

So this idea of caretaking is built in, and that's a way of connecting, but it's not about really attachment.

是以，這種 "照顧 "的想法是內在的，也是一種聯繫的方式，但它與真正的依戀無關。

It's about kind of rescue and caregiving.

這是一種救助和照顧。

And there are other ways, like you can connect relationally through playfulness, or through sexuality, or through competition, where you're sort of judging, am I better than or less than everybody else, kind of putting yourself on a ladder.

還有其他一些方式，比如你可以通過遊戲、性生活或競爭來建立關係，在競爭中你會評判 "我是比別人強還是比別人差"，把自己放在一個階梯上。

And all of those are built in evolutionary prepared ways of organizing ourselves in relationships and in groups.

所有這些都是在進化過程中形成的，是我們在人際關係和群體中組織自己的方式。

And when traumatized clients have difficulty with attachment, when attachment doesn't work for them because it's dangerous, they may move to some of these other strategies.

當受到創傷的客戶在依戀方面遇到困難時，當依戀因為危險而對他們不起作用時，他們可能會轉而採用其他一些策略。

And one of the strategies that I hope that therapists can use is a collaborative strategy.

我希望治療師可以使用的策略之一就是合作策略。

And that strategy is about basic understanding of each other.

而這一戰略涉及到對彼此的基本瞭解。

Now, we think about understanding each other and sharing and working on goals.

現在，我們考慮的是相互理解、分享和為目標而努力。

We can think of, well, a team at work collaborates on a goal, right?

我們可以想一想，一個團隊在工作中合作實現一個目標，對嗎？

But there's a lot of other things that are going on besides explicitly cognitively saying we have this goal in mind that we're working toward.

但是，除了在認知上明確表示我們有這個目標，我們正在努力實現這個目標之外，還有很多其他的事情要做。

Collaboration at its most basic level is about do I feel safe with you or not, right?

最基本的合作就是我和你在一起是否感到安全，對嗎？

Because if I don't feel safe, I can't collaborate.

因為如果我沒有安全感，我就無法合作。

And so we could think about what Stephen Porges talks about with the polyvagal theory, and his idea of activating the ventral vagal system as being important in collaboration, because collaboration does activate the ventral does.

是以，我們可以考慮斯蒂芬-波爾格斯（Stephen Porges）所說的多迷走神經理論，以及他關於激活腹側迷走神經系統對合作很重要的觀點，因為合作確實會激活腹側迷走神經系統。

And so if we think about collaboration, again, it's not only explicit, let's work on these therapeutic goals together.

是以，如果我們考慮合作，那麼合作就不僅僅是明確的，讓我們一起努力實現這些治療目標。

But it's about the felt sense of do I get you?

但這是一種 "我懂你嗎 "的感覺。

Do I understand you?

我聽懂了嗎？

And do you get me?

你明白我的意思嗎？

And on that nonverbal level, and then we build the more explicit, let's together work in therapy based on that.

在這種非語言層面上，我們再建立更明確的治療方法，在此基礎上共同開展治療。

The reason we want to use collaboration is because the client's attachment system is really over activated in some way, whether that is through desperately seeking attachment, or whether that is sort of desperately avoiding attachment.

我們之所以要使用協作，是因為客戶的依戀系統確實在某種程度上被過度激活了，無論是通過拼命尋求依戀，還是拼命避免依戀。

Clients get triggered when their attachment system is activated.

當客戶的依戀系統被激活時，他們就會被觸發。

So the idea is to try not to further activate the client's attachment system, because it's really dysregulated already, but to use the collaborative approach to kind of calm it down a little bit, right?

是以，我們的想法是儘量不要進一步激活客戶的依戀系統，因為它確實已經失調了，而是用合作的方式讓它稍微平靜下來，對嗎？

And I don't know if this is super different than the way we really approach attachment in a with a lot of clients.

我不知道這是否與我們與許多客戶真正接觸依戀的方式超級不同。

But I think we have to really understand when we're thinking about attachment, what is the goal of attachment?

但我認為，當我們思考依戀問題時，我們必須真正明白，依戀的目的是什麼？

The goal of attachment is to have a felt sense of security, so that I can come and go, whether my attachment figure is in front of me, or away on a my grandmother, who I was very close to, she's been dead for 20, 30 years, a long time.

依戀的目的是要有一種安全感，這樣我就可以來去自如，無論我的依戀對象是在我面前，還是在我的祖母身邊。

But I still hold her, right?

但我還是抱著她，對嗎？

I still have that figure internally.

我現在還記得這個數字。

And so the idea is not to have the therapist there literally all the time, but to be able to take that, that representation in.

是以，我們的想法並不是讓治療師一直都在那裡，而是讓他們能夠接受這種代表。

And a lot of that I had a felt sense of my own grandma.

我對自己的祖母有很多感覺。

That's right.

這就對了。

That's right.

這就對了。

Many of us have a felt sense of lots of other people.

我們中的許多人都對許多其他人有一種感覺。

Right?

對不對？

And sometimes we have a felt sense that's really bad.

有時，我們會有一種非常糟糕的感覺。

And that's difficult.

這很困難。

Right?

對不對？

But the felt sense of a positive enough figure is what secure attachment is really about.

但是，對一個足夠積極的人物的感覺才是安全依戀的真正意義所在。

And sometimes we get confused, we, we think, well, I need to be available all the time, call me when you need me.

有時候，我們會感到困惑，我們會想，我需要一直在你身邊，你需要我的時候就給我打電話。

Right?

對不對？

That's not really how secure attachment works.

安全依戀並不是這樣起作用的。

Secure attachment is saying, I'll be here when I say I'll be here.

安全附件就是說，我說到時就到。

So it's consistent.

所以是一致的。

It's predictable.

這是可以預見的。

And it helps the client.

這對客戶也有幫助。

Let's together, here's the collaborative model.

讓我們一起來，這就是合作模式。

Let's together figure out what makes it so hard for you when I'm not here.

讓我們一起想想，我不在的時候，是什麼讓你如此難受。

And let's help you build some skills around that.

讓我們幫你掌握一些相關技能。

So that's a, that's a beginning structure.

所以，這是一個，一個開始的結構。

And then my guess is you have some questions about that.

然後，我猜你會有一些相關的問題。

I do.

我是這麼想的。

I do.

我是這麼想的。

I was wondering, um, what does consultation with therapists around this issue look like?

我想知道，圍繞這個問題與治療師進行的諮詢是什麼樣的？

Um, I know that you work with therapists directly and help them with this.

我知道你直接與治療師合作，幫助他們解決這個問題。

And, um, you know, for, for therapists out there who were looking for this kind of guidance, also other, other consultants who might want to support in this way.

而且，嗯，你知道，對於那些正在尋找這種指導的治療師，以及其他可能希望以這種方式提供支持的諮詢師。

Um, you know, what are some of those elements?

其中有哪些要素？

What are some of those conversations that, um, come up some of the typical conversations and, you know, and I'm also thinking about those therapists who don't have access to consultation to give the type of things that they can do on their own.

我也在想，那些沒有機會進行諮詢的治療師，他們能做什麼呢？

Yeah.

是啊

Yeah.

是啊

Well, I, I think that, you know, therapists come in with this issue and they feel distressed.

好吧，我認為，你知道，治療師來諮詢這個問題時，他們會感到很苦惱。

They feel guilty because they don't think they're giving enough or they feel exhausted because they feel like I'm giving all I can give and the client still isn't getting better.

他們感到內疚，因為他們認為自己付出的還不夠多；他們感到精疲力竭，因為他們覺得我已經盡我所能，但客戶仍然沒有好轉。

And so therapists, uh, be become distressed and they, they may feel urgent.

是以，治療師會感到痛苦，他們可能會感到緊迫。

I've got to do something.

我必須做點什麼。

And I think when those three things, one of those three things happens that it's a, it's a flag.

我認為當這三件事中的一件發生時，就是一面旗幟。

It's a red flag for me to say, Ooh, I'm getting activated in my caretaking system.

對我來說，"哦，我的看護系統要被激活了"，這是一個警示。

Right.

對

Um, so it's a matter of really learning to stop and reflect.

嗯，所以這是一個真正學會停下來反思的問題。

Where am I?

我在哪裡？

Am I feeling burnt out?

我是否感到疲憊不堪？

Well, maybe I'm giving too much or maybe I'm giving too much of one thing and not or relatively constant is not helpful.

也許是我給的太多了，也許是我給了太多的東西，而不給或相對固定的東西是沒有用的。

And, and that's the thing.

這就是問題所在。

If it were helpful, maybe we could go with it and tolerate it and, and, and work with it a bit.

如果它有幫助，也許我們可以接受它，容忍它，並與它合作一下。

But, um, in general, it actually, uh, creates this, what, um, John Bowlby called insecure dependency where, um, any sign that the therapist is going to go away or not be available, the client gets more and more panicked.

但是，嗯，一般來說，它實際上，嗯，創造了這個，嗯，約翰鮑爾比所謂的不安全的依賴，嗯，任何跡象表明，治療師將消失或不可用，客戶變得越來越恐慌。

Right.

對

And so it doesn't calm it down.

是以，它並沒有平靜下來。

It actually activates it.

它實際上激活了它。

So when I feel the urge to caretake, to rescue, to be more available than I'm available for other clients, um, when my family might complain, you're, you're never here.

所以，當我有衝動去照顧、去拯救、去比我對其他客戶更隨叫隨到的時候，嗯，當我的家人可能會抱怨說，你，你從來都不在這裡。

You're is aware.

你是知道的。

Um, when you feel, when I feel burnt out, like I don't want to do this work anymore, it's not enjoyable.

嗯，當你感覺到，當我感覺到倦怠時，就像我不想再做這項工作了，這並不令人愉快。

Um, and sometimes when I feel trapped, like I can't stop what I'm doing because I think the client needs it, but I can't tolerate continuing to do it.

嗯，有時當我感到被困住時，就像我不能停止我正在做的事情，因為我認為客戶需要它，但我不能容忍繼續這樣做。

Right.

對

So you get this trapped sort of double bind.

是以，你會陷入一種雙重束縛。

I think those are the things to look out for.

我認為這些都是需要注意的。

Are there different sensations when it's, um, the other, um, sort of side of that coin, when someone, um, might be more rejecting or avoidant?

如果是，嗯，硬幣的另一面，當某人，嗯，可能更排斥或迴避時，會有不同的感覺嗎？

You mean the therapist or the client?

你是指治療師還是客戶？

Client.

客戶。

The client.

客戶

Yeah.

是啊

I mean, that's the opposite.

我的意思是，這恰恰相反。

It feels like the opposite of the, the, the pulling in.

這種感覺與 "拉近"、"拉近"、"拉近 "恰恰相反。

It is, um, you know, I might show up to every session, but you, you can't possibly help me.

是這樣的，嗯，你知道，我可能每次都會來，但你，你不可能幫我。

That's right.

這就對了。

Um, that is a different issue, but again, collaboration is important because if somebody comes in and says, I'm desperate, I'm suicidal, but nothing has ever helped me.

嗯，這是一個不同的問題，但同樣，合作也很重要，因為如果有人進來說，我很絕望，我有自殺傾向，但沒有任何東西能幫助我。

And I don't think you can help me.

我覺得你幫不了我。

What happens in the therapist?

治療師會怎麼做？

The therapist thinks I'm a, I'm a trauma therapist.

治療師認為我是個創傷治療師。

I can help where nobody else has helped.

我能在別人幫不上忙的地方提供幫助。

So we get a little narcissistic.

所以我們有點自戀。

Yeah.

是啊

Or we, we get, you know, if not narcissistic, we get our caretaking, uh, activated, like, well, I'll work really, really hard and try to find a way.

或者我們，我們變得，你知道，如果不是自戀的話，我們得到我們的照顧，呃，激活，就像，好吧，我會工作真的，真的很努力，並試圖找到一種方法。

And so it becomes the therapist work rather than the client's work.

於是，這就成了治療師的工作，而不是客戶的工作。

So what I might say to a client like that is, well, I can imagine that you don't think I can help you.

是以，我可能會對這樣的客戶說：好吧，我可以想象你認為我幫不了你。

I don't know if I can help you, but what's really important is that we find a way to work together toward your goals.

我不知道我是否能幫到你，但真正重要的是，我們能找到一種方法，一起朝著你的目標努力。

So tell me something about what you want to accomplish.

那就說說你的目標吧。

And then I can get curious about what hasn't worked and why.

然後，我就會對哪些方法沒有奏效以及原因感到好奇。

And then I can figure out, is there, uh, an internal lock to getting the work done or, uh, what, what actually is happening there?

然後我就能搞清楚，完成工作是否有內部障礙，或者，那裡到底發生了什麼？

That's such wonderful language.

這是多麼美妙的語言。

Um, I do something similar.

嗯，我也做過類似的事情。

Uh, my consultant, one of the first things that he recommended that I do when I started working with him was to keep a little notebook by the side of my table for things that went sideways in therapy.

我的顧問建議我做的第一件事，就是在桌邊放一個小本子，記錄治療過程中出現的偏差。

Ah, yeah.

啊，是的。

Great idea.

好主意。

That was such like a flood of relief.

這真是如釋重負。

Like, okay, they're supposed to go sideways.

比如，好吧，它們應該是橫著走的。

I'm supposed to make mistakes.

我應該犯錯誤。

Things are supposed to feel awkward.

事情就應該是尷尬的。

Um, I'm supposed to get confused, lost.

嗯，我應該感到困惑，迷茫。

I don't know what I'm doing half the time or where we're going.

我有一半時間不知道自己在做什麼，也不知道我們要去哪裡。

And I've been doing this work 40 years and I still don't know where we're going half the time.

我從事這項工作已經 40 年了，但有一半時間我仍然不知道我們要去哪裡。

Right.

對

And I think it's really important to take the pressure off about getting it right because it's about relationship and relationship is, you know, just being human.

我認為，卸下壓力，把事情做好真的很重要，因為這關係到人際關係，而人際關係，你知道，就是做人。

Of course we want to do a good job.

我們當然想把工作做好。

Of course we do.

我們當然知道。

That's not the question, but not to beat ourselves up when things go sideways because, um, we can't be prepared for it.

問題不在於此，而在於當事情發生偏差時，我們不要自暴自棄，因為，嗯，我們無法為此做好準備。

Sometimes we can't even control our own reactions and it's really normal in a therapist.

有時，我們甚至無法控制自己的反應，這在治療師身上很正常。

You use a lot of really, um, wonderful language, you know, especially when you're talking about curiosity and getting curious with both with yourself and on our own, or maybe as we're preparing for a session and also in session with clients.

你用了很多非常精彩的語言，尤其是當你談到好奇心，以及對自己和自己的好奇心時，或者當我們在準備療程和與客戶進行療程時。

I'm wondering, is that something in consultation that you, um, even role play with therapists or is that something that, I know that we can, we can certainly over plan and that's not helpful.

我想知道，在諮詢過程中，你甚至會與治療師進行角色扮演，還是說，我知道我們可以，我們當然可以過度計劃，但這是沒有幫助的。

It's not helpful to go into a session with a script.

帶著劇本去參加會議是沒有幫助的。

Some of that language might not be accessible, especially since we, I mean, I think a lot of us have, um, you know, sort of maybe not so helpful responses to the feeling of conflict, for example, or there might be some automatic words that come out and we're like, well, that's not exactly how I meant to phrase it, but to have at the ready because we've this session, but to have some of those, um, and you, I mean, and I am, I am thinking about some of the graphs and the tables that you have, but you know, I wonder if there's, um, uh, a way, you know, that, that therapists can, can practice that outside of session as well as in session.

有些語言可能不容易理解，尤其是我們，我的意思是，我想我們很多人對沖突的感覺都有一些，嗯，你知道的，可能不是那麼有用的反應，比如，可能會有一些自動的詞出來，我們就會想，嗯，這不是我想表達的意思、但是，我想知道，是否有一種方法，你知道，治療師可以在會話之外以及在會話中進行練習。

So we're not always sort of floundering.

是以，我們並不總是一籌莫展。

Yeah.

是啊

Right.

對

I mean, I, I think floundering is part of the process.

我的意思是，我認為掙扎是這個過程的一部分。

And I think as you do therapy longer, you learn ways of saying things that are empathic, but perhaps also limit setting, um, uh, something like that.

我認為，隨著治療時間的延長，你會學會說一些能引起共鳴的話，但也許也會設置一些限制，嗯，嗯，諸如此類。

Um, yeah, that fits for you.