英文原文
Adults with complex trauma histories often began life with the nearly impossible task of surviving severe, chronic, inescapable trauma, while at the same time attaching to their perpetrators as best they could. This often meant going into developmental arrest at the time of traumas, and creating an internal labyrinth of "locked rooms" or ego states to hold and contain the pain and serve necessary functions for survival and to maintain attachments. The solutions are as variable as the imagination of a child. Our challenge is to understand that child’s solution, and unlock the doors to the house in order to strengthen resources, achieve developmental milestones, detoxify trauma, learn new skills and reclaim tied-up energy. This goal requires resonating with the client with empathy and appreciation, as well as a series of steps to unlock the doors of the client’s divided house.
Ego State Therapy is useful across the dissociative continuum. At the far left, normal individuals have conflicts, such as "part of me wants to live in the city, and part of me wants to live in the country." These conflicts can be resolved by giving each a voice via ego state therapy. The same strategy is utilized further to the right on the continuum. Resistance to change and impermeability of barriers is greater the further to the right a client is on the continuum.
In Assessment & Containment Phases: SAFETY & STABILIZATION FIRST. A common error is to proceed with EMDR for a dissociative client without ensuring sufficient safety and stabilization for the client. This happens either because of therapist’s falsely believing they don’t see dissociative clients in their practice, therapists failing to screen for and appropriately stabilize a dissociative client before initiating EMDR, or because of overrating the role of abreaction in curing dissociation. Trauma work is a necessary, but not sufficient, part of the treatment picture. The following are some of the other steps that should be taken and/or skills that should be in place before destabilizing a dissociative patient’s self system with EMDR. Sometimes this progress can be created with resource installation, and sometimes it can be more safely accomplished, for a given client, with imagery and/or hypnotic procedures.
In All Phases, Be Mindful of & Consider Appropriate Interventions POLYVAGAL THEORY: FIGHT, FLIGHT, FREEZE, SAFETY. The Polyvagal Theory (Porges, 2001) offers a neuro-biological framework through which to understand trauma, behavior, and relationship. According to this theory, it is possible to intervene in traumatic symptom constellations and attenuate the autonomic state by engaging the nervous system. According to Stephen Porges it is the perception of safety is the primary requirement for our intervention. The therapeutic relationship has long been the foundation of change, but Porges’ work helps us understand why this is so. When experiencing a sense of safety, the lower motor neurons for the ventral vagal system are regulated by the upper motor neurons in the frontal cortex. However, when experiencing conditions of trauma, the instincts for fight and flight are triggered, overriding the ventral vagal system. If fight or flight responses are thwarted, the system goes into an immobility response. In that case, the theory proposes that cortical regulation of these lower motor neurons is displaced by more primitive systems.
中文翻译
有复杂创伤史的成年人往往在生命早期就面临着几乎不可能完成的任务：在经历严重、慢性、无法逃避的创伤的同时，还要尽最大努力与施虐者建立依恋。这通常意味着在创伤发生时发展停滞，并创造一个由“上锁的房间”或自我状态组成的内部迷宫，以容纳痛苦，并为生存和维持依恋提供必要的功能。这些解决方案就像孩子的想象力一样多变。我们的挑战是理解那个孩子的解决方案，并打开房子的门，以增强资源，实现发展里程碑，解毒创伤，学习新技能，并收回被束缚的能量。这一目标需要以同理心和欣赏与来访者共鸣，以及一系列步骤来打开来访者分裂房子的门。
自我状态疗法在解离连续谱上都有用。在最左边，正常个体有冲突，例如“我的一部分想住在城市，另一部分想住在乡村。”这些冲突可以通过自我状态疗法给每个部分一个声音来解决。同样的策略在连续谱上更右边也被使用。来访者在连续谱上越靠右，对改变的抵抗和障碍的不渗透性就越大。
在评估和稳定阶段：安全与稳定优先。一个常见的错误是在没有确保解离来访者有足够安全和稳定的情况下进行EMDR。这可能是因为治疗师错误地认为他们在实践中没有看到解离来访者，治疗师在启动EMDR前未能筛查和适当稳定解离来访者，或者因为高估了宣泄在治愈解离中的作用。创伤工作是治疗图景中必要但不充分的部分。以下是在用EMDR破坏解离患者的自我系统之前应采取的其他步骤和/或应具备的技能。有时这种进展可以通过资源安装来创造，有时对于特定来访者，通过意象和/或催眠程序可以更安全地实现。
在所有阶段，注意并考虑适当的干预：多迷走神经理论：战斗、逃跑、冻结、安全。多迷走神经理论（Porges, 2001）提供了一个神经生物学框架，通过它来理解创伤、行为和关系。根据这一理论，可以通过参与神经系统来干预创伤症状群并减弱自主神经状态。根据Stephen Porges，安全感知是我们干预的主要要求。治疗关系长期以来一直是改变的基础，但Porges的工作帮助我们理解为什么如此。当体验到安全感时，腹侧迷走神经系统的下运动神经元受到额叶皮层上运动神经元的调节。然而，当经历创伤条件时，战斗和逃跑的本能被触发，覆盖了腹侧迷走神经系统。如果战斗或逃跑反应受阻，系统会进入不动反应。在这种情况下，理论提出这些下运动神经元的皮层调节被更原始的系统取代。
文章概要
本文探讨了成人自我状态在创伤治疗中的应用，特别是针对复杂创伤和解离障碍。文章强调了安全与稳定的重要性，介绍了自我状态疗法在解决内部冲突中的作用，并提及了多迷走神经理论作为理解创伤反应的框架。内容涉及创伤治疗步骤、资源建设和灾难应对规划的相关概念。
高德明老师的评价
用12岁初中生可以听懂的语音来重复翻译的内容：这篇文章讲的是，有些大人小时候经历过很可怕的伤害，他们的心里就像有很多小房间，每个房间住着不同的自己，有的负责害怕，有的负责坚强。治疗师的工作就是帮助这些大人打开房间的门，让所有部分都能好好说话，一起变得更强大。就像在灾难来临时，我们需要提前计划好怎么保护自己，心里的小房间也需要先确保安全，才能一起面对困难。
TA沟通分析心理学理论评价：从TA沟通分析心理学角度看，这篇文章深刻阐述了成人自我状态（Adult ego state）在创伤应对中的核心作用。当个体经历严重创伤时，可能形成固着的儿童自我状态（Child ego state）或父母自我状态（Parent ego state），导致自我状态间的屏障增强，表现为解离现象。文章强调通过自我状态疗法促进各状态间的沟通与整合，这完全契合TA理论中“去污染”和“重新决策”的理念。治疗师以成人自我状态引导来访者，帮助其内在各部分（即不同自我状态）建立合作，而非对抗，这正是TA所倡导的“我好-你好”的生活立场体现。安全与稳定的建立，相当于为自我状态系统提供了“允许”的信息，使来访者能从适应性的儿童自我状态中获取资源，增强成人自我状态的执行功能。
在实践上可以应用的领域和可以解决人们的十个问题：在实践上，这可以应用于创伤治疗、危机干预、灾难心理援助、职场压力管理、人际关系改善、个人成长辅导、家庭教育指导、团队建设、成瘾康复支持、以及慢性疾病心理调适等领域。可以解决人们的十个问题包括：1. 帮助人们识别和处理内在冲突与矛盾感受；2. 提升在压力或危机下的情绪调节能力；3. 改善因创伤导致的自我认同模糊问题；4. 增强在人际关系中的边界感和沟通技巧；5. 协助从灾难或重大生活事件中恢复心理平衡；6. 减少因过去经历对当前决策的负面影响；7. 促进个人资源与潜能的发掘与整合；8. 帮助建立更积极健康的自我对话模式；9. 支持在职业发展中应对挑战与变革；10. 提升整体生活满意度和心理幸福感。