of help: psychiatric medication, CBT and psychotherapy. Each has its own advantages

治療方式：精神科藥物、認知行為療法、以及心理治療。各有其優點

and drawbacks. Medication can be exemplary in a crisis, at points when the mind is so

與缺點。藥物在病發危險期效用最大，因為當心智已

under siege from fear, anxiety or despair that thinking things through cannot be an

飽受恐懼、焦慮、絕望等情緒籠罩時，要病人理性思考已非選項

option. Correctly administered, without requiring any conscious cooperation from us, pills play

只要正確用藥，無須病人有意識地配合，藥物

around with our brain chemistry in a way that helps us get through to the next day – and

會發揮作用於腦內的神經傳導物質，幫助我們撐到隔日，以及

the one after. We may get very sleepy, a bit nauseous or rather foggy in the process, but

往後的日子。服藥過程中，可能感到嗜睡、噁心或思緒混亂，但

at least we're still around – and functioning, more or less. Then there is Cognitive Behavioural

至少我們能挺住過活。再來是認知行為療法

Therapy (CBT), normally administered by psychologists and psychiatrists in six to ten hour-long

通常由心理學家與精神科醫師執行，進行 6 到 10 小時

sessions which teach us techniques for arguing rationally with, and with any luck at points

的療程，指導如何與他人理性討論，有幸的話某階段

controlling, the ghoulish certainties thrown up by our internal persecutors: paranoia,

能控制一連串心魔所拋出的執念：偏執

low self-esteem, shame and panic. Lastly there is psychotherapy, which from a distance looks

低自尊、羞恥及恐慌。最後是心理治療，遠觀彷彿

like it has only drawbacks. Psychotherapy has a very hard time showing its efficacy in scientific

只有缺點，但它經歷了試煉，才證明於科學試驗的成效

trials – and has to plead that its results are too singular neatly to fit the models

並以結果特殊為由，而無法符合

offered by statisticians. Also, It takes up a large amount of time, demanding perhaps two sessions

統計學家的模型。再者，它極費時，大約一週兩次療程

a week for a couple of years – and is therefore by far the most expensive option on the menu.

要持續數年，難怪是最昂貴的醫療方式

Finally, psychotherapy requires active engagement from its patients and sustained emotional effort;

最後，病人必須高度參與療程，並持續改善情緒

one can't simply allow chemistry to do the work. And yet, psychotherapy is, in certain

而不能只仰賴藥物。然而，心理治療在某些

cases, a hugely effective choice, which properly alleviates pain not by magic or chance , but

病例中極具療效，它並非僥倖或神奇地減輕患者痛苦，而是

for three solidly-founded reasons: – Firstly, our unconscious feelings become conscious. A founding

根基於三個理念：首先，我們的感知從無意識變得有意識

idea of psychotherapy is that we get mentally unwell, have a breakdown or develop phobias

心理治療創立的其中一個信念是：人們罹患心理疾病、崩潰、形成恐懼

because we are not sufficiently aware of the difficulties we have been through. Somewhere

源於沒有覺察到過往遭受的困境

in the past, we have endured certain situations that were so troubling or sad, they outstripped

過去，我們曾承受相當困擾或悲傷的事件，它們壓過

our rational faculties and had to be pushed out of day-to-day awareness. For example,

我們的理性機制，甚至平時也沒意識到這些狀況。舉例而言

we can't remember the real dynamics of our relationship with a parent; we can't see

關於和父母的實際互動，我們的記憶很模糊

what we do every time someone tries to get close to us, nor trace the origins of our

每當他人意圖靠近，我們無感於自身的舉動，更別說

self-sabotage or panic around sex. Victims of our unconscious, we can't grasp what

去追溯自我毀滅的根源，或對性的恐懼。作為無意識的受害者，我們無法明白

we long for or are terrified by. In such cases, we can't not be healed simply through rational

所渴求或恐懼之物為何。所以，光從

discussion, as proponents of CBT implicitly propose, because we can't fathom what is

認知行為療法所倡導的「理性討論」是無法治癒的，因為我們首先就沒釐清

powering our distress in the first place. Psychotherapy is a tool for correcting our self-ignorance

痛苦的來源為何。心理治療是扭轉忽視自我的利器

in the most profound ways. It provides us with a space in which we can, in safety, say

它以深度探討的方式進行、提供一個讓人安心

whatever comes into our heads. The therapist won't be disgusted or surprised or bored.

抒發己見的空間。 諮商師絕不會面露反感、驚訝或無聊

They have seen everything already. In their company, we can feel acceptable and our secrets

他們閱歷豐富，在他們的陪伴下，我們感到被接納，隱私

sympathetically unpacked. As a result, crucial ideas and feelings bubble up from the unconscious

得到保護。因此，我們從原本無意識的狀態，察覺到了關鍵的想法與感觸

and are healed through exposure, interpretation and contextualisation.

並經由揭露、詮釋和情境理解的過程中，改善心理狀態

We cry about incidents we didn't even know, before the session started that we'd been through or felt so strongly

接受心理治療前，我們會為一些莫名的事件、遭遇或感觸強烈的事而掉淚

about. The ghosts of the past are seen in daylight and are laid to rest. There is a

療程中，如鬼魅般的過往浮上檯面，而後得到安寧

second reason why psychotherapy can work so well: Transference: Transference is a technical

心理治療有效的第二個原因：移情。它是一個心理學專業術語

term that describes the way, once therapy develops, a patient will start to behave towards

描述病人在療程時，會用他們在過往關係中的方式

the therapist in ways that echo aspects of their most important and most traumatic past

和諮商師互動，這方式反映了病人過去最關鍵或最創傷的層面

relationships. A patient with a punitive parent might – for example – develop a strong

舉例來說，病患的父母若在他們小時經常懲罰，他們可能會強烈認為

feeling that the therapist must find them revolting, or boring. Or a patient who needed

諮商師一定對他們感到反感或無趣。或者當病人孩提時需要

to keep a depressed parent cheerful when they were small might feel compelled to put up

振奮憂傷的父母，長大後就覺得應該換上

a jokey facade whenever dangerously sad topics come into view. We transfer like this outside

幽默的一面來化解任何突來的悲傷話題。我們經常將上述模式轉移到生活中

therapy all the time, but there, what we're doing doesn't get noticed or properly dealt

只是我們沒有意識到、或妥善處理自己的行為

with. However, psychotherapy is a controlled experiment that can teach us to observe what we're

而心理治療就像個控制下的實驗，它教我們覺察當下的行為

up to, understand where our impulses come from – and then adjust our behaviour in

理解衝動所為何來，再調整我們的行為

less unfortunate directions. The therapist might gently ask the patient why they're

朝較好的方向前進。諮商師也許會溫和地問病人：為何這麼深信

so convinced they must be disgusting. Or they might lead them to see how their use of jokey

自己惹人厭惡，或者指引他們發現，自己會用幽默

sarcasm is covering up underlining sadness and terror. The patient thereby starts to spot the distortions

諷刺來掩飾深層的哀傷與恐懼。病人於是注意到了

in their expectations set up by their history – and develops less self-defeating ways

過往如何扭曲了他們對人或事的看法，進而發展出較不激進的方式

of interacting with people in their lives going forward. Then the third reason why psychotherapy works. It is the first good relationship

有利於未來的人際互動。心理治療成功的第三個原因：開始建立良好的人際關係

We are, many of us, critically damaged by the legacy of past bad relationships. When

很多人都在過往不良的關係中，深深受到傷害

we were defenceless and small, we did not have the luxury of experiencing people who

當我們年幼無力對抗時，沒有機會和

were reliable, who listened to us, who set the right boundaries and helped us to feel

可信賴、願意傾聽、保持良好界線的人相處，他們讓我們

legitimate and worthy. However, when things go well, the therapist

感到自身是有意義與價值的。不順遂時，諮商師

is experienced as the first truly supportive and reliable person we've yet encountered.

是我們至今所遇到，第一個可靠又真心支持我們的人

They become the good parent we so needed and maybe never had. In their company, we can regress

他們變成了我們或許此生渴求不到的好父母。在他們的陪伴中，我們得以回到

to stages of development that went wrong and relive them with a better ending. Now we can

以前糟糕的階段，放下它，改變人生的劇本。現在我們能

express need, we can be properly angry and entirely devastated and they will take it

大聲表達需求、適當表達憤怒、就算承受巨大打擊，諮商師都會協助

– thereby making good years of pain. One good relationship becomes the model for

於是過往傷痛成為蛻變的養分。在諮商室建立的好的人際關係，成為

relationships outside the therapy room. The therapist's moderate, intelligent voice

日常生活的模範。諮商師溫和、有智慧的話語

becomes part of our own inner dialogue. We are cured through continuous, repeated exposure

轉變成我們內在對話的一部分。長期浸淫於

to sanity and kindness. Psychotherapy won't work for everyone; one has to be in

覺察與慈悲中，我們得以療癒。心理治療不是人人適用，需要患者

the right place in one's mind, one has to stumble on a good therapist and be in a position

思緒清楚、遇到一位好諮商師

to give the process due time and care. But all that said, with a fair wind, psychotherapy

還要能給予療程時間和關照。儘管如此，在一切條件具足下，心理治療

also has the chance to be the best thing we ever get around to doing.

仍有可能是最佳的治療選擇

If you are interested in trying psychotherapy, The School of Life offers a service in person in London,

如果您有興趣嘗試心理治療，The School of Life 在倫敦提供面對面心理諮商服務

or by Skype around the world. Click on the link for further details.

或透過 Skype 提供世界各地諮商服務。欲知更多資訊，請點擊連結