本堂课 我们来讲讲性史记录和评估 In this segment, we'll discuss sexual history taking & assessment.
和其他领域的咨询一样 Just as in other areas of counseling,
重要的是要记住在性咨询中 it's important to remember regarding sexuality counseling,
评估和干预是相互交织的 that assessment and intervention are intertwined.
在整个评估干预过程中 Across the processes of assessment intervention,
你要做历史记录 这点与生物-心理-社会评估没有什么不同 you will do history taking, not dissimilar from that of bio-psychosocial evaluation.
历史记录本身就可以被视为一种干预 History taking in and of itself can be viewed as an intervention
它有助于来访者了解和整理自己的记忆 that helps the client to understand and adjust their own personal memory.
相反地 当来访者除了讲述具体信息 如首次性经历的年龄 Conversely, as someone who's relaying their sexual history in addition to concrete information,
还讲述其每段性史时 such as age of first sexual experience,
评估其向咨询师或治疗师传递这些信息的方式很重要 it is important to assess the ways that the information is communicated to the counselor or the therapist.
非语言线索可以传达很多信息 这些信息在评估中很重要 And nonverbal cues can communicate a lot of information that are important in terms of assessment.
信息在初次接触时就开始传递 This information begins to be conveyed in the first contact.
以前初次接触更多是通过电话 Traditionally, this was over the phone more frequently,
现在是通过网络 now first contact occurs online.
了解对方在第一封电子邮件 或第一条消息中提到了什么或没提到什么 这非常重要 It's significant to know what the person does or does not mention in their initial email, or message.
作为一名咨询师 额外接受性方面的培训的好处之一是 One of the benefits of having extra training in the area of sexuality as a counselor
虽然很多人找你是想解决性以外的问题 is that many people will come to you with a non sexual complaint.
但在治疗或评估过程中 And in the course of treatment or the course of evaluation,
会逐渐发现 性是他们所面临的挑战的一部分 it will become clear that sexuality is a component of the challenge,
对于来访者披露的有关性的信息 你要能够接受 you will be able to have the capacity to tolerate the revelation of sexual information.
我们将在后面讲到PLISSIT模型 And as we will discuss later with the PLISSIT model,
届时你将能够引导来访者进行一些非常有用的干预措施 you'll be able to help guide people towards some very useful interventions.
在性史记录方面 In terms of sex, sexual history taking,
重要的是不仅要考虑行为 it's important to account not only for behaviors,
还要考虑到这个人生活中所持有的信仰 but beliefs and attitudes that the person has or has received
或其所接受的性方面的态度 over the course of their life regarding sexuality.
我们之前讨论过的一个例子就是对自慰的态度 An example we've discussed before is attitudes about masturbation
以及关于自慰的信息 and messages regarding masturbation.
其它重要的信仰和态度包括 Other beliefs and attitudes important to consider are those
宗教相关的方面 例如美国文化中对婚前性行为的态度 related to religion and a good example of that in American culture attitudes around premarital sex.
评估包括对不同类型评估工具的使用 Assessment may include the use of different kinds of assessment instruments
就像在其他咨询领域一样 你可以使用经过验证的筛选工具来更好地了解来访者 just as in other areas of counseling, you may use a validated screening tool to get a better sense,
尤其是那些无法用语言来表达他们的体验的来访者 especially for certain clients who are not as able to put their experience in words.
这可能会帮助你更好地了解问题的范围 This may help you get a better sense of the scope of the problem.
评估 尤其是早期阶段的评估 And one of the most important parts of assessment,
最重要的部分之一是 我们正在一起创造一种共同语言 and especially in the early stages is co-creating a shared language.
这不仅仅是治疗师和单个来访者之间的共同语言 This is not just the shared language between the therapist and the client.
在开展伴侣咨询时 在伴侣和治疗师之间也要使用一些共同语言 If you're working with a couple of shared language between the couple and the therapist,
并确定个人/伴侣和治疗师一起要应对的挑战 and a shared framing of the challenges that the individual or couple of therapists agreed to address.
在初次接触期间 解决以下问题可能会有所帮助 During the initial contact, it can be helpful to address the following questions.
为什么现在来咨询？什么事件导致你在此时寻求帮助？ Why now? What events led to you seeking help at this point in time?
这可能会有帮助 因为能透露更多信息 这些信息往往可能是 This can be helpful and that it will elucidate further information about maybe a crisis
需要你更多去倾听的危机 that led to listen more often times,
如果是在做伴侣咨询的话 可能就是讨论离婚 if you're working with a couple it's a discuss a discussion about divorce within a couple
或是某种危机 that happened or some sort of crisis,
压死骆驼的最后一根稻草 比如婚外情 such as an affair that led to the last straw, so to speak.
所以他们在这个时候来寻求帮助 And now we're seeking help.
关于咨询的过程和结果 What expectations does each individual or partner have
个体或伴侣双方都有什么期待？ about the process and outcome of counseling?
有时 了解人们以前是否接受过咨询或治疗是很有帮助的 It's helpful to understand sometimes if people have been in counseling or therapy before.
我自己喜欢问 如果他们过去接受过心理治疗 I like to ask people, if they've been in therapy in the past,
哪些是他们喜欢的 哪些有用 哪些没用 what they've liked, what has worked, what hasn't worked,
他们希望从新的治疗关系中得到什么 what they're hoping to honor from new therapeutic relationship.
如果来访者本人并没有做过心理咨询 This can also help to dispel some myths,
她/他对心理治疗或咨询的期待多数是受媒体影响的 if expectations are related to portrayals of therapy or counseling, media,
问这个问题也有助于消除来访者所听到的关于咨询的不实信息 and the person does not actually have their own experiences.
通常来说 流行文化中对心理治疗和咨询的描述并不是很准确 Often, the way that therapy and counseling is portrayed in popular culture is not very accurate.
在这个阶段 设定明确的期待 It's very important at this point to work to set clear expectations.
以及去除对心理咨询领域的不实信息是很重要的 And to dispel any myths in these areas.
也可以具体问他们为什么选择了你 这也很有帮助 It can also be helpful to ask why they're seeking help with you in particular,
或者如果你是在一个临床诊所的话 问他们为什么选择这里的环境 这个地点 or why if you're in a clinic setting like this context, like this place,
这样可以以一种更间接的方式来了解他们的希冀和期待 because this can be a more indirect way to get at some of their hopes and expectations,
也能消除任何不切实际的期待 and again, dispel any unrealistic expectations.
你作为咨询服务的提供者 这也给你提供了一个机会详述你的背景 It's also helpful in terms of giving you as the provider and opportunity to explain your background.
例如 人们来到我的诊所会看到 For example, people will come to my practice and see that
我有博士学位 就会推测我是心理学家 I have a doctoral degree and assume that I am a psychologist,
有的人也会认为我是精神科医生 or in some instances, a psychiatrist.
花时间向人们解释 And it's very helpful to take time to explain to people
我的背景和接受过的训练 what my background and training are
以及我能提供的服务 这些是非常有帮助的 and the kinds of services that I can offer.
如果你决定要同他们工作的话 也许初次接触最重要的就是 Perhaps the most important part of the initial contact is
和个人或伴侣建立连接 joining with the individual and couple if you decide to work with them.
这不仅适用于性咨询 也适用于一般咨询 This is true not just for sexuality counseling, but for counseling in general.
这一方面在性问题上更加重要 So, this is heightened regarding issues of sexuality
因为人们来到咨询室时 because people often come in with heightened feelings of shame,
常常会因为透露自己如此私密的信息而感到格外羞耻 内疚 沮丧 愤怒 尴尬 guilt, frustration, anger, embarrassment, about revealing such intimate information about themselves.
在这一阶段 与个人或伴侣建立连接也很重要 It's also important to join with the individual or couple at this point,
因为通常 人们已经独自挣扎了很长时间 because oftentimes, people have struggled on their own for an extended period.
从以往来看 伴侣通常会等上几年才来寻求治疗 不过现在有所改变 Historically speaking, couples would wait several years typically before seeking therapy, though this is changing.
最近的研究表明 平均等待时间为两年 And more recent studies show that the average length is two years.
根据我自己的执业经验 等待的时间还在缩短 In my own practice, I would say that this is decreasing.
我认为有不同的因素在起作用 And there are I think, different factors that play into this,
比如在美国接受心理健康治疗的污名化程度降低了 as getting mental health treatment has become less stigmatized in the United States.
以及在新冠疫情期间 冲突变得更加激烈 And conflicts have become heightened during the Covid-19 pandemic
因为人们被迫与伴侣待在家里 when people have been forced to stay in their homes with their partners.
建立连接是很重要的 因为通常来说 人们来做咨询 治疗 But it's important to join as people often come to counseling, therapy,
是因为他们已经别无选择 失去了希望 because they've run out of options and they've lost hope.
所以与他们面对面 确认他们的挫折感受 And it's important to meet with them to validate that frustration,
给他们带来一点希望 这很重要 and to offer a bit of hope, though,
不过设定现实的期待也是非常重要的 it's very important here to set realistic expectations
不要承诺能给他们提供不可能的东西 and not to promise that you can offer them impossible things.
你并不能抹去一段婚外情或消除过去发生的事情 You can't erase an affair, or things that have happened in the past,
但你可以提供现实的期待和现实的希望 but you can provide realistic expectations and realistic hopes
这将推动人们朝着共同努力解决问题的方向前进 that will move people in the direction of working together toward a solution.
我在这里放了一个案例公式模板 I've included here a sample case formulation template,
如果你认为有帮助的话 可以使用它 feel free to use this, if it's helpful.
这种建构不仅在 This kind of framing can be helpful again,
处理性问题时有用 not just when working with sexual problems,
也适用于平常接待伴侣来访者 but when working with couples in general.
了解每个人对问题的看法很重要 It's important to get the perspective of each person on the problem,
一些治疗师会从每个人的角度了解这种看法 及其对伴侣各方的个人意义 some therapists are to get this perspective and an individual meaning with each partner.
其他人也会这样做 Others will do this in tandem.
你要及时确定自己的咨询风格和实操手段 And you will decide in time what works for you both stylistically and pragmatically.
理想情况下 当面对伴侣来访者时 Ideally speaking, when working with couples,
我喜欢在治疗早期先进行个体咨询 I like to have an individual session usually early in the treatment.
通常 第一次咨询我会跟伴侣双方一起 Typically, I'll see a couple together for the first session
第二次和第三次会分别见伴侣中的一方 然后再一起见 and see an individual for the second and third sessions and then meet again,
虽然由于时间安排和成本的不同 though, this isn't always feasible,
这一方法并不总适用 depending on scheduling and cost.
但这可能会很有启发 It can be very revealing.
稍后我们会通过一个案例来说明这一点 And we'll go over a case example a bit later that demonstrates this,
它能很好地揭示伴侣各方是如何构建问题的 but it can be very revealing how each partner frames the problem.
初次咨询时 强调知情同意也很重要 It's also important in the first session to address issues surrounding informed consent.
在美国 尽管每个州都有一些细微差别 In the United States, informed consent rules are generally consistent across states
各州的知情同意规则基本一致 though there are some nuances in each state.
例如 保密原则的例外 For example, limits to confidentiality,
通常包括自伤和伤人的威胁 typically include threats to harm self, others,
或虐待 忽视儿童 or the abuse or neglect of children,
在一些州 保密的例外情况还包括财产损失 though in some states, this is also extended to the damage of property.
即 如果有人意图自杀 杀人或损坏财产 So if someone is suicidal, homicidal or damaging property,
他们的保密权可能就会被法律解除 their coming confidentiality may be violated by law.
性史记录可以展示出非常非常多的信息 Sexual history taking can be very, very revealing.
在接待伴侣来访者时 And again, in working with couples,
分开进行性史记录是最理想的 this is one of the things that is ideal to do separate.
换言之 伴侣一方的性史中的某些部分 So in other words, there are some aspects of a sexual history
另一方可能并不熟悉 甚至可能并不知道 that one partner may possess and the other may not be familiar with and may not know.
所以如果我们一起做性史记录的话 结果会适得其反 And so it can be really counterproductive if we're working together,
因为如果他们不想在伴侣面前谈论某件事 或谈论自己的态度 信仰或其它事情 and I don't have a full history of one partner
会导致我没有掌握伴侣一方的完整性史 because they don't want to talk about an event or attitude or belief or something in front of their partner.
做性史记录 重要的是创造并维持一个不加评判的环境 For the sexual history taking, it's important to create and maintain a non-judgmental environment.
这就是为什么在整个课程中 This is why, throughout this course,
我一直在强调要了解自己的偏见 I've really stressed the importance of understanding your own biases,
并更好地处理这些偏见 and getting a better handle on where those things are.
所以当人们来到你的咨询室时 So that when people come in your office,
他们会告诉你一些事情 这些事情可能会触动你 and they tell you things that maybe are buttons for you or
碰到你的痛处 如果你能提前意识到 they hit a nerve that you're able to have some awareness
那么当他们提起这些事情时 你就可以调整你自己的 so that you can modulate your own body language and verbal language,
肢体语言和口头语言 when people bring things up.
当人们在治疗中提到敏感话题 It's important when people are bringing sensitive issues,
尤其是围绕性的话题时 especially surrounding sexuality, into therapy
我们要能够调整自己的内在体验和外在表达 这很重要 that we are able to modulate our own internal experiences and external expressions.
来访者可能会有所预期 认为当自己告诉你一些通常不会被讨论的话题 People may anticipate that you will react with disgust or surprise or shock
或忌讳的话题时 你会感到厌恶 惊讶或震惊 when they tell you about things that are not typically discussed or taboo subjects.
因此如果你能够接受这些信息 聆听这些故事 And so it's important and therapeutic and a kind of intervention in another itself
且没有表现出大惊小怪 或是他们预期会看到的那些反应 to be able to tolerate that information and to be able to listen to those stories
这很重要 并且也是有治疗作用的 这本身就是一种干预 without gasping or providing them with that, that anticipated reaction.
在其它类型的虐待案例中也是如此 This is also true in terms of other kinds of instances of abuse.
如果你倾听过那些经历过身体创伤的来访者的故事 So people working in areas where you've experienced hearing people's stories of physical trauma,
或经历过其它类型的虐待的来访者 你就会熟悉接受他们提供的这些信息有多重要 or other instances of abuse will be familiar with the importance of being able to tolerate that information.
要避免让分享故事的人感觉他们必须 Without shifting the dynamic so that the person revealing the story feels that
照顾咨询师或治疗师的情绪 因为他们的故事太可怕了 they have to take care of the counselor or therapist because the story is just so horrible
怕咨询师或治疗师无法接受 that the counselor or the therapist can't tolerate it.
还有一些其它方式可以帮助你营造一种不加评判的环境 Other way that you can help to convey a non-judgmental environment,
尤其是如果你要接待不同性别认同和性取向的来访者时 especially if you'll be working with people across the spectrum of sexuality in terms of gender and sexual orientation,
你可以通过咨询室里的陈设来达到目的 is by the things that you have in your office.
比如说 在我的咨询室里 So, for example, in my office,
有一个书架 虽然没摆上我全部的藏书 I have a bookshelf, and it doesn't contain my full library.
但我放的书是经过挑选的 But I'm very specific about what I include to show that
传达了我想展示的信息 即 我有知识和经验去接待不同背景的来访者 I have knowledge and experience and working with people from a variety of backgrounds,
以及不同身份认同的来访者 and with a variety of identities.
与此相关的一点是 选择合适的语言很重要 Related to this, it's also important to choose the appropriate language and to do kind of balancing
并且要在匹配来访者语言和提供专业科学的语言之间平衡好 between matching client language and providing professional scientific language.
尤其是在最初的接触中 So especially in initial contacts,
用词不要过于随意 这是一条很好的准则 it's usually a good rule of them not to be overly casual.
但是也要避免用词过于科学化 Though, it's helpful to not be overly scientific,
尤其是当来访者不理解你所用词语的含义时 especially if your client doesn't understand the meaning of the words that you're using.
例如 使用“性交”一词可能会使治疗师与个人或伴侣疏远 For example, using the word "intercourse" might distance the therapist from the individual or couple,
我们用的是 "性行为" 这个词 这跟文化有关 we're using the term "sex", and again, this is very culturally bound.
每种文化的用词都是独一无二的 And this will be unique to each culture.
在美国文化中 使用“性行为”这个词更日常 但仍然是专业的 But in American culture using "sex" is more casual word that still is professional,
又不会过于随意 不像勾搭或上床 and not so casual as saying things like hooking up or fucking,
这些词太随意了 尤其是对早期的咨询来说 which would be considered overly casual, especially in an early session.
使用开放式问题很有帮助 Use of open-ended questions are really helpful.
在整个咨询过程中都是如此 This is true, again, across counseling sessions.
开放式问题很有帮助是因为 Open-ended questions are helpful
它提供了一些结构 人们经常带着极大的焦虑来咨询 because it provides some structure people oftentimes come in with a great deal of anxiety.
并不是每个人都能自由地谈论他们的问题 And not everyone is able to just start talking freely about their problems.
所以问问题很重要 So it's important to be able to ask questions,
通过提出开放式问题而不是封闭式问题 but by offering open ended questions as opposed to closed, yes, no questions,
为人们提供了谈话走向正确方向的机会 really provides people with the opportunity to steer the conversation in a direction
这对于厘清他们的问题 挑战或者是寻求治疗的原因都是有意义的 that makes sense for their problem or their challenge or what brings them into therapy.
使用这些问题时 还有一点比较重要的是 It's also important when using these questions,
要将性活动和性行为正常化 to frame them in ways that normalize sexual activity and sexual behaviors.
即 如果你和有药物滥用或其他禁忌行为的来访者一起工作过 And so this is something that if you've worked with people who abuse substances or other taboo subjects,
你会假设这些正在发生 对吧 it's important to assume that things are happening, right.
例如 如果你和某人谈论他坚持用药的情况 Example would be if you're talking to someone about, say, their medication adherence,
医生经常会遇到这样的情况 这时医生不会问 你少服了一剂吗 this is one that doctors use quite frequently rather than saying, do you miss a dose?
而是会问 一周有多少天你会少服一剂 You ask them, how many days a week do you miss a dose
这种措辞结构上的变化 是在假设大多数人都会错过用药 and that change in frame assumes that most people miss doses
如果一个人必须每天用药 大多数人都会忘记服用一两次 将这种行为正常化 if you have to take medication every day, most people miss and normalizes that,
可以让他们在承认自己错过用药时 减少羞耻感 so that there is less shame, associated with acknowledging that they've missed some doses,
他们就会更加诚实 and they can be more honest.
你也就能获得更多准确的信息 This will give you some more accurate information.
所以 在性方面 与其问别人你青春期时是否自慰 So, in terms of sexuality, rather than asking someone did you masturbate as a teenager,
换成问 你第一次是怎么了解到自慰的 you might say, how did you first learn about masturbation?
最后是结构 同样地 And then in terms of structure, again,
这也适用于历史评估 或针对不同类型的挑战和问题的整个咨询过程 this is true in taking assessment or across counseling for different kinds of challenges and problems.
但一般来说 从最不敏感的信息过渡到最敏感的信息是一条很好的准则 But it's generally a good rule of them to move from least sensitive information to most sensitive information.
所以在开始阶段 在第一次谈话初期 So in the beginning stages, the beginning of the initial conversation,
你可能会想更随意一点 you might want to be a bit more casual with people,
确保能让他们放松一些 make sure that you're able to put them somewhat at ease,
从设定明确的期待开始 这样有助于降低焦虑 and start by one, setting clear expectations so that that helps to lower the anxiety of it,
开始时只询问一般信息 人们以前也回答过 and asking just general information, questions that people have answered before
比如你结婚多久了 你在哪里长大的 such as how long have you been married? Where did you grow up?
从一般信息问到最敏感的信息 general information to the most sensitive information.
询问性史 So asking about sexual history,
特别是询问性虐待史 and especially asking about history of sexual abuse,
把这些放在后面的谈话中问 这很重要 is important to put that later in the conversation,
因为这样来访者会更放松 更容易提供准确的信息 so that someone is more at ease and more likely to give you accurate information.
他们不仅更可能提供更准确的信息 Not only ae they more likely than to give you more accurate information,
而且可能更能容忍和调节情绪 but they're likely more able to tolerate and to regulate.
到那时 治疗师已经与来访者或伴侣建立了一些连接 And the therapist by then has done some joining with the client or couple
如果再次出现任何失控 就能够提供帮助 and will be able to help if there is any dysregulation to ground things again.
所以这个三角形 我自己一般是从最不敏感问到最敏感 So this triangle here, I like to think of least sensitive to most sensitive,
建立一些基础之后再回来 but then I like to come back out, right with some grounding.
最后回到不那么敏感 更目标导向的咨询状态 And then moving back to less sensitive and more goal-oriented at the end.
在这张幻灯片上 我提供了一些基本信息 这些信息很重要 On this slide, I've included general information that is important to get
在记录性史时要去询问 when you're taking a sexual history.
大家不必严格按照这个顺序来问 This is not in a rigid order.
我鼓励你根据个人或伴侣的实际情况以及他们来咨询的原因 And I would encourage you to change the order depending on the individual or couple,
调整顺序 and the reason they come in.
例如 这里我列出了当前的功能和满意度 So for instance, here I've listed current function and satisfaction,
性功能和满意度 sexual function and satisfaction.
也就是 在当前的性关系中 个人或伴侣各方是否能表现得令人满意 So is the individual or each partner able to perform satisfactorily in the current sexual relationship?
如果主诉是关于性的 那么从这一点开始问可能就是有用的 This may make sense to start with if the complaint is sexual,
如果主诉或最初的主诉不是关于性的 从这里开始可能就行不通了 it may not make sense to start here, most likely will not make sense to start here,
大概率是行不通的 if the chief complaint or initial complaint is not sexual.
从最不敏感的信息问到最敏感的信息 And again, in terms of working from least sensitive to most sensitive information.
在这种情况下 你可能想先谈谈感情史 In that case, you might want to talk first about the relationship history.
每段感情持续了多久 So the duration of the relationship,
关系中的重大事件 major events in the relationship,
如结婚 离婚 分居 怀孕等等 marriage, divorce, separation, pregnancies, and so on and so forth.
伴侣性功能和满意度 Partner function and satisfaction,
也就是 伴侣双方都能够刺激并满足对方吗 so is each partner able to stimulate and satisfy the other?
如果你的来访者是一对伴侣 So this is important, again,
这一点也很重要 if you're working with a couple,
这个问题不仅有助于确定其性功能失调是否跟情境有关 and this will help to suss out not only if the in terms of sexual dysfunctions if this is situational,
还有助于提供伴侣各方 but it will help to give information about each partner's perspective of
对关系中各方面的看法 how things are going in the relationship.
强调避孕的影响很重要 It's important to address effects of contraception.
我们会特别讨论激素避孕的影响 Again, we discuss the impact of hormonal contraception in particular,
以及其对性欲的影响 and how this may impact libido.
如果在伴侣在交往中有过怀孕 If there have been pregnancies during your relationship,
那么影响性满意度的因素有 伴侣间的性生活频率 the effects that these have had on the sexual satisfaction are the frequency of sex in the couple.
疾病 其它药物 衰老以及与衰老所带来的正常性反应变化 illness, other medications, aging and normal sexual response changes associated with aging.
同样 在接待伴侣来访者时 Again, in working with couples,
跟双方单独交流可能会有帮助 it can be helpful here to interview each person individually.
应特别注意强奸 Special attention should be paid to incidences of rape,
猥亵 和其它创伤性事件 流产 molestation, and other traumatic events, miscarriages.
这些信息更有可能会在与咨询师或治疗师单独会话时提到 And it is more likely that this information will be brought to the counselor or therapist
而不会在与伴侣同时会话时谈起 in an individual session than in a couple session.
在很多情况下 来访者伴侣都知道 Though there are often instances in which the couple comes in with this knowledge,
双方都对他们的主诉有一个认识 both partners have this knowledge and that is the chief complaint is,
举个例子 她讨厌和我做爱 that she has an aversion to having sex with me
是因为她在我们恋爱之前有过性创伤 because she had this sexual trauma before our relationship, as an example.
最后 当前的性问题和困难 And finally, current sexual concerns and difficulties.
这依然取决于个人或伴侣来咨询的原因 So, again, depending on what brings the individual or a couple to you,
这个问题可能从逻辑上来说适合一开始就问 this might be a place that is more or less logical to start.
这也是伴侣向治疗师询问性功能基本问题的机会 This is also an opportunity for the couple to ask the therapist about sexual function in general.
再次说一下 在美国文化中 Again, in American culture,
很多人所了解的医学信息并不准确 assuming that many people have inaccurate medical information,
特别是关于性反应 什么是常态 especially regarding sexual response, what is normative,
什么是正常的性欲 等等 what is a normal libido, and so on, and so forth.
所以这对他们来说 是一个从了解准确医学信息的人那里 So this is an important opportunity for them to get good information from someone
获得好的信息的重要机会 who is a reliable source of accurate medical information.
在获取更详细的性史时 And then in terms of getting a more detailed history.
了解问题的出现时间和严重程度很重要 It's important to get the onset duration and severity of the problem,
回想一下精神障碍诊断与统计手册和修订版中 针对不同的性功能障碍的内容 again, thinking back to the DSM and the modifiers, for the different sexual dysfunctions.
强调成因很重要 例如孩子出生 患病 It's important to address contributing factors, such as the birth of a child and illness.
了解他们之前为了解决这个问题所做的所有尝试也很重要 And it's important to get a full history of previous attempts to solve the problem.
如前所述 了解个人或伴侣各方 As discussed, it's crucial to get for the individual or each individual within the couple
性发育的详细历史很重要 the detailed history about their sexual development.
所以回想一下 生命周期中的性发育那节课 So thinking back to sexual development across the lifespan,
就像我鼓励你反思自己的性发育一样 去鼓励来访者 and encouraging your clients as I've encouraged you to reflect on your own development,
反思他们童年时得到的性信息 家庭信仰体系 文化和宗教信仰体系 the early messages that you got in childhood, family belief systems, cultural religious belief systems.
青春期的性经历 第一次自慰 青春期开始的时间 Sexual experiences in adolescence, first masturbation, onset of puberty.
青春期是提前还是推迟 Was puberty onset early or delayed,
这对青少年早期约会经历有什么影响 what impact does this have on the person in adolescence for early dating experiences,
对性经历有什么影响 for sexual experience?
再次强调 在这里提出开放式问题会很有帮助 And, again, it can be helpful here to ask open-ended questions,
提出使性行为正常化的问题 并邀请来访者向你提问 to ask questions that normalize sexual behavior and to invite your clients to ask you questions.
在我们的文化中 当被问及第一次性经历时 So when asked about first sexual experience in our culture,
通常 人们回答时会扯些别的 会说 oftentimes people will kind of waffle when they give you an answer and say,
你说的性经历是什么意思 well, what do you mean for sexual experience?
是问我第一次给别人手淫 口交 The first time that I gave somebody a handjob, or a blowjob,
还是第一次进行插入式性爱 or the first time I had penetrative sex,
文化态度和价值观通常将性定义为插入式性行为 所以通过问这个问题 and so that can be a helpful point of discussion to talk about cultural attitudes and values
可以引出这方面的讨论 that often define sex as penetrative sex.
这让你有机会告诉他们 所有这些都属于性行为 And it gives you the opportunity to give them information about all of this experience being sexual.
当人们被要求 This is especially true in terms of childhood when people
反思童年期的性发育时尤其如此 are asked to reflect on sexual development and to go back to childhood.
通常情况下人们的反应是 你什么意思 Oftentimes the reaction is what do you mean?
童年没有性 There was no sex in childhood.
这是一个禁忌话题 It's a taboo subject.
因此 在这里重要的是 告诉他们你问的问题是什么意思 So it's important here to educate about what you mean when you ask the question.
你可以解释说 我是想问 你早期获得的信息是什么 关于你自己的身体 或普遍意义上的身体 So what I mean is, what were early messages that you got about your body, or bodies in general,
或性别信息 关于女孩应该做什么 男孩应该如何表现 or gender messages, about what girls should do, or how boys should behave.
然后了解成年的性史 And then getting a history of adulthood.
这对人们来说通常更易懂一些 This, this is usually a bit more intuitive for people.
因为他们经常需要向他们的全科医生 Oftentimes, they've had to do some version of this with their general practitioner,
或妇科医生讲述自己所有的性经历 性伴侣 or gynecologist in terms of explaining different experiences, they've had partners.
在这里 重点是 如果你从某人那里得到这样的答案 Here, it's important if those are the kinds of answers that you're getting from somebody,
比如 在询问过去的性关系或约会历史时 like, for example, you ask about past sexual relationships or dating history.
如果有人回答 哦 我约会过男人和女人 我和他们都做过爱 And if someone just says, Oh, I date men and women and I have sex with both. Okay.
好 现在就是提出更多开放式问题的时候了 This is a time to ask more open-ended questions.
可以更好地了解这个人的各种关系 And to get a better sense of the kinds of relationships,
关系的质量 the quality of the relationships,
这个人对他们关系的感受 他们双方的感受 how a person felt, about their relationships, how they feel.
回顾他们的关系时 Looking back at their relationships,
人们经常会有未尽事宜 oftentimes, there's unfinished business and
他们会比较现在的关系和过去的关系 people will compare their current relationship to past relationships.
在接待伴侣来访者时 这一点很重要 And it's also important here in terms of working with couples,
尤其是获取关于婚外情的信息 especially to get information about any extra marital relationships.
这可能非常有挑战 Now, this can be very challenging.
如果你正在接待一对伴侣来访者 在单人会面时一方提起自己有过婚外情 If you're working with a couple, and this comes up during an individual session.
这时不同的治疗师会遵循不同的准则 Different therapists have different rules.
我想说 一般来说 制定准则是很有帮助的 And I would say that, in general, it can be helpful to have rules.
这有助于在与伴侣的第一次咨询中就设定明确的期待 And this can be helpful to set these clear expectations in the initial session with your couple
告诉他们我是否会保守秘密 that I do or do not hold secrets.
换言之 如果在个人咨询中谈到了伴侣另一方不知道的事情 So in other words, if something in our individual session comes up that the other person doesn't know,
你愿意保守这些秘密吗 are you willing to hold that information?
这很微妙 对吧 So this can be more nuanced too, right?
如果有人在个人咨询中告诉我他们受到了性侵犯 If someone tells me in individual session that they were sexually assaulted,
他们不想让伴侣知道 and they don't want their partner to know,
或者他们小时候被亲戚猥亵过 or that they were molested in childhood by a relative,
他们不想让伴侣知道 and they don't want their partner to know,
因为还和家人有联系 because we still have contact with the family,
我可以说 好吧 这个秘密我可以保密 I may say, okay, that is a secret that we can hold.
但是我鼓励你考虑一下 And I would encourage you to consider the potential benefit of
把这些信息告诉你的伴侣可能会有哪些益处 bringing this information into the relationship,
不过 对我个人来说 作为一名接待伴侣来访者的治疗师 though, for me personally, as a therapist working with couples,
我不会保守外遇的秘密 I will not hold the secret of an affair,
因为我认为不告诉另一方出轨是无法解决伴侣之间的问题的 because I see it as counterproductive to addressing the couple problem.
而有一些治疗师在个人咨询中听到出轨这件事 So in other words, some therapists are willing to hear about the affair in the individual session.
如果那个人说 我不能告诉我的伴侣 And if the individual says I could never tell my partner,
这会终结一切 我知道后果会很糟糕 this will end everything, I know will go terribly.
治疗师可能就会说 好吧 我们不告诉你的伴侣 The therapist may say, okay, we won't tell the partner.
我鼓励你们现在思考一下这个问题 This is something that I encourage you to do some reflecting on now.
因为如果你接待伴侣来访者 就会遇到这个挑战 Because if you work with couples, this challenge will come up.
所以对你愿意保密的信息帮来访者设定明确的期待非常有帮助 也很重要 And it's very helpful and very important to set clear expectations about what information you're willing to hold.
治疗师会为来访者保守哪些秘密 And what secrets are secrets that the therapist will hold with and for the clients
哪些事你不愿意做 以及你认为哪些事对治疗适得其反 and what you're not willing to do and what you think is counterproductive to the therapy.
再次强调 这确实与设定实际的目标和期待有关 And then again, this relates really to setting realistic goals and expectations.
人们认为问题会消失吗 So do people think that the problem is going to go away?
人们是否经常失去希望 Do people, have people lost hope oftentimes,
其实挑战并不在于人们来接受治疗 the challenge is not that people come to therapy
并且认为一切都会被神奇地修复 and think that everything is going to be fixed magically,
而在于他们真的放弃了希望 不期待任何改变 but that they really have given up hope and don't expect anything to change.
因此 在寻找解决方案时 So it's important to really evaluate their interests,
真正评估他们的利益和认同很重要 their buy-in, in terms of working toward a solution.
说到使用不同的工具 评估工具 In terms of using different tools, assessment tools.
我怕有人不熟悉家谱图 For anyone unfamiliar with genograms,
所以在这里列出了基本的家谱图符号 I've included here basic genograms symbols.
这是一个用于收集信息的评估工具 This is an assessment tool useful for gathering information
直观地展示不同的信息 and visually representing different messages,
态度以及个人历史中 代际间发生的重大事件 attitudes and major events that happened intergenerationally in someone's own personal history,
这对伴侣或个人的第一次咨询很有帮助 and this can be really helpful for couples or individuals in the first session.
他们可以通过家谱图直观地看到不同的信息 以及随着时间的推移而出现的挑战 So that they can visually see the different messages, challenges that have occurred over time.
性家谱图是利用了家谱图这个工具 So for the sexual genogram, this is just taking the tool,
重点放在性方面 the genogram and focusing on sexuality.
包括性信息 性别虐待 外遇 So, again, sexual messages, gendered abuse, affairs.
我在这里放了一个示例 So I've included a sample here.
正方形代表男人 So the squares represent men,
圆圈代表女人 the circles represent women,
图形中的X表示此人已过世 the x across means that the person is deceased.
这只是一个简单的示例 双方框里的人 And this is just a simple sample that shows the person with the two boxes,
代表你咨询室里的来访者 this is your person in your therapy room.
这张图里我们可以看到 来访者的父母 And so we can see the parents of the person in your therapy office
有几次婚外情 had several extramarital affairs,
可以设想一下 他们来找你咨询 and that they are now you can imagine, maybe in your office,
是因为他们觉得自己关系中待解决的问题与他们父母的关系有关 they're there because they feel like they have unresolved challenges related to their parental relationship there.
举个例子 我有一个来访者 父亲二十年前去世 母亲最近去世 As an example, I'll take a client whose father died 20 years ago, mother recently died,
现在在反思并且担心 and so is now reflecting and concerned that the kinds of conflicts
在自己婚姻关系中的冲突镜映了父母间的一些冲突 that they're having in their own marital relationship are mirroring some of the conflicts that their parents had.
所以这个人担心自己的配偶有外遇 And the person is concerned that their spouse is having an affair.
那么我们可以看到 如果让他的配偶也来咨询 And now we can see if we bring spouse into therapy,
他们就会了解到一些信息 that they got certain messages,
即 配偶家里不讨论性 sex was not discussed in their home, rolling up,
女方的母亲以及外祖母 women in the mother's family and maternal grandmother,
都待在家里 他们现在都了解了这一信息 they both got the message that they were to stay at home.
而女方现在置身职场 And now she is in the work environment.
所以她就认为丈夫会感到威胁 And she's assuming that her husband feels threatened by her.
这就给他们的关系带来了问题 And so that's creating problems in their relationship.
这只是一个示例 Again, this is just a sample.
但这真的很有帮助 因为家族史 性史都很复杂 And this can be really helpful because family histories, sexual histories are very complex.
它存在于人们的思想和情感世界中 And they exist in people's minds and in their emotional worlds.
它不仅是一种非常有用的评估工具 And it can be a very helpful not only assessment tool,
本身也是一种干预手段 but intervention in and of itself.
可以帮助个人或伴侣看到他们 To help the individual or couple see in front of them
经历过的所有挑战 或经过代际传递的 all the challenges that they have either lived through or through the intergenerational transmission
二手或三手的创伤和挑战 of trauma and challenges experienced second or third hand.
我在这里提供了另一个经过验证的筛选工具示例 I've included here another sample of a validated screening tool.
有许多经过验证的筛选工具专门用于伴侣咨询 There are many validated screening tools that are specific for working with couples,
还有很多是针对性问题的 and there are many that are specific for working sexual problems.
这是一个二元性沟通量表 This is the dyadic sexual communication scale,
是一种评估个人及其伴侣如何就性进行沟通的工具 and it's a tool that helps to assess how individuals and their partners communicate about sex.
这些工具也很有用 Again, these tools can be helpful.
你可以把量表交给来访者 让他们在非咨询时间做好带来 也可以在咨询当中做 You can give them to your clients to do out of session and bring in or now
具体怎样做取决于他们是否信任电子邮件和电子邮件的安全性 depending on people's comfort with email and email security.
人们可以把做好的量表发给你 或者如果你有一个安全的在线门户 People can send them to you or if you have a secure portal online,
人们可以通过它在线提交 那么你就可以事先得到这些信息 people can submit them through that and you can have this information beforehand.
然后在下一次咨询中 讨论结果和意义 And then in the next session, discuss the results and the meaning.
如果你选择对个人或伴侣使用评估工具 If you choose to use assessment tools with individuals or couples,
与他们分享这些结果非常非常关键 it's really, really vital to share these results with them.
有时会发生的一个重大失误是 评估工具已经给了来访者 A big misstep that sometimes happens is the tool is given,
来访者在咨询结束后填写好了 the person completes it out of session,
但是在下次咨询之前发生了别的事 and then something else happens between sessions.
然后下次咨询时都在讨论 And then we spend the whole session talking about this,
这个新出现的危机 而没有去讨论评估结果 this new crisis and never acknowledged the results,
又或者评估结果让治疗师感到不舒服 or the results make the therapist uncomfortable at where they're,
因为这个结果在某种程度上是消极的 they're negative in some way.
治疗师很担心 And the therapist is concerned about
这会影响个人或伴侣对治疗效果的信心 how that may impact the individual or couples buy-in to the therapy.
但是分享信息是非常重要的 否则做评估还有什么意义呢 But it's very important to share the information because otherwise, really, what's the point?
同样重要的是要认识到 就最有效的筛查工具而言 It's also important to acknowledge that in terms of most validated screening tools,
尤其是在美国广泛使用的那些经过验证的筛查工具 especially more widely used validated screening tools in the United States,
一些抑郁症筛查工具非常常用 some of the depression screening tools are very commonly used.
有一些好奇的来访者 可能自己已经算过得分了 And for your more curious clients, they will probably have already scored this themself.
因此 就其结果进行非常坦率和明确的对话是很重要的 And so it's important to have a very frank and explicit conversation about the results
这样可以消除他们的迷思 so that you can dispel any myths.
例如 我最近让某人填写了一份解离体验清单 So for instance, I recently asked somebody to fill out a dissociative experiences inventory.
在下次咨询时她说 我们来谈谈评估结果吧 And she came to our next session and said, so let's talk about the results.
因为我对她有点了解 我就问她 你自己查过了吗 And knowing her a bit I said, did you look them up yourself.
她确实查过了 所以我们讨论了她对自己得分的解释 And she had, so we had a discussion about her interpretation of her own scoring,
以及她的分数意味着什么 and what that meant.
这样的对话完全不同于如果我刚才只是说 这是你的分数 And that was a very different conversation than if I had just said, this is your score.
它意味着什么 对吗 And this is what it means, right,
因为她自己已经做了一些研究 she had already done some of that work herself.
所以打破她关于分数意味着什么的预设很重要 So it was important to break down her assumption about what that score meant,
而不是 我进来 假装很了解她的经历 instead of me, just coming in and pretending to be the expert of her experience,
然后说 数字是这个 所以意味着那样 and say, the number was this, therefore that.
这是另一个示例 性满意度调查 This is another sample, the sexual satisfaction survey,
这个量表你在网上也可以做 you can actually do this online,
每次测试需要付费 在线生成报告 you can pay for each time that you run the report online.
同样 使用这些量表有一些好处 And again, there, there is some benefit to using these scales,
一些来访者发现这些非常有用 非常有效 some of your clients will find these really helpful, really validating.
不要对量表过分解读 这很重要 So it's important to not read all the way into this or
不要让经过验证的工具成为 not have the validated tool become the entire assessment,
对问题的全部评估或全部解读 or the entire framing of the problem.
你可以看到 这里把这个量表拆开了 So you can see here that this inventory is broken down.
它是非常以问题为导向的 And it's very problem-oriented.
所以它某种程度上可能是有害的 And so it can be harmful in some ways.
因为如果一个人拿到了结果 第一反应就是 If the person gets their results, and it's like,
哦 天哪 一切都是问题 一切都很糟糕 oh, my goodness, everything is a problem. Everything is terrible.
那我还有烦恼的必要吗 Why am I even bothering?
同样 如果你要使用这些工具 So again, if you're going to use these tools,
有选择地使用是非常重要的 it's very important to use them selectively.
并且要说明你使用它们的背景 And to give context to why you're using them,
以及它们如何能帮助你 and how they will contribute to your understanding
以及个人或伴侣去理解问题 and the individual or couples' understanding of the problem.
为了说明了解个人对问题的看法有多重要 As an example of the importance of getting individual perspectives on the problem,
我在这里举一个简和山姆的例子 I have included here a case example of Jane and Sam.
假设一对异性恋伴侣来咨询 他们叫简和山姆 So a heterosexual couple come into your office, Jane and Sam.
在山姆看来 简再也不想做爱了 And from Sam's view, Jane never wants to have sex anymore.
她对自己的事业和孩子更感兴趣 She's more interested in her career and the children.
在简看来 山姆不想再和我在一起了 And from Jane's view. Sam doesn't want to be with me anymore.
他每天晚上工作到很晚 He stays late at work every night.
也许她怀疑他有外遇 And maybe she's suspecting that he's having an affair.
你的工作就是在第一次咨询时 和伴侣一起 Your job is in that initial session, to join with a couple,
在伴侣和你之间创造一种共同语言 to create a shared language between the couple and yourself
创造一种共同观点 这也将对你们的共同目标产生影响 and to co-create this shared view which will then influence your shared goals.
所以在这里 共同的观点不是简不想做爱 山姆有外遇 So the shared view isn't that Jane doesn't want to have sex, Sam is having an affair.
而是 从第一个孩子出生起 我们一直没有精力 The shared view is that we haven't had the energy or really been able to
也抽不出时间做爱 make time for sex since the birth of our first child.
那么之后 你们的目标是什么呢 So then what might your goals look like after that?
你们的目标可能是优先考虑性 Your goals might look like prioritizing sex.
重新构建你们的叙事 可以是 Your narrative reframing might be about,
“哇 自从我们有了孩子 "wow, since we started having children,
我们都觉得压力更大了 要多多工作 we both felt more pressure to work more,
因为托儿费用很高 because childcare is very expensive,
或者孩子去的学校很贵 or the school that we send our children to is very expensive.
所以我们都觉得面临着压力 需要赚更多钱 So we both feel like we're under this pressure to provide more financially,
那么我们在努力想要增加收入的时候 and where has our marital relationship and our sexual relationship gone,
我们的婚姻关系和性关系去哪儿了” as we've both worked to try to increase our income?"
所以你可以在这里看到 评估和干预是交织在一起的 And so you can see here that both the assessment and the intervention are intertwined.
因此 在创造共同语言的初次咨询中 评估和干预 So the assessment and the intervention in that initial session of creating that shared language,
了解性史（可以通过性家谱图） revealing the sexual history (maybe through a sexual genogram),
共同创造可实现的目标 比如定一个约会之夜 co-creating the solvable goals, maybe a date night.
这也可以作为你给这对伴侣布置的家庭作业 And that might be a homework assignment that you give to the couple.
正如我之前所说 许多干预措施 As I said previously, with many of the interventions,
都是基于认知行为疗法的 they rely on cognitive behavioral therapy.
所以家庭作业真的很有帮助 So homework can be really helpful.
用这种方式来给每次咨询收尾非常有用 And it can be really helpful way to end each session
即 给人们一些具体和有形的东西 by giving people something concrete and tangible,
尤其是刚刚谈了 especially after talking about very,
一堆有的没的杂乱无章的内容 花了一小时 一个半小时 kind of ineffectively messy and laden subjects for an hour or an hour and a half,
总之就是整整一次咨询的时间 however long your sessions with your clients are.
布置家庭作业可以把这些落到实处 It can be really grounding.
而且给人们布置具体的家庭作业是以最终目标为导向的 And feel very goal-directed to give people concrete homework.
PLISSIT模型就是这样做的 The PLISSIT model is a model that very much does this.
这个模型是杰克·阿农提出的 This is borrowing from Jack Annon's work.
你们可以看到 我给PLISSIT模型的前三个阶段加了一个框 And you can see here that I've put a box around the first three stages of the PLISSIT model.
给予许可 有限信息和具体建议 So permission giving limited information and specific suggestions.
作为一名咨询师 这些是你的领域 也是你的执业范围 As a counselor, this is your area, and your scope of practice.
除非你接受过伴侣治疗 创伤治疗等类型的高阶培训 The intensive therapy is unless you have advanced training
否则强化治疗 in providing these kinds of couple therapy, trauma therapy,
是超出你的执业范围的 this would be out of your scope of practice.
好消息是 据估计大约90%的性主诉 The good news is that people estimate that about 90% of sexual complaints
可以在前三个阶段内解决 can be resolved within these first three stages.
给予许可 就是允许来访者去谈论性方面的挑战 给予肯定和共情 So permission giving, permission to talk about sexual challenges, reassurance and empathy,
以及承认性是人类经验中不可缺少的组成部分 and acknowledgement that sexuality is an integral part of human experience.
再强调一次 这就是以将人类性体验正常化的方式 So, again, this is framing your questions and your statements in ways that normalize
来构建你的问题和陈述 允许人们谈论禁忌话题 what is normal human sexual experience, giving people permission to talk about taboo subjects.
这是通过以这种方式构建问题和陈述来实现的 That's something that is achieved by framing questions and statements in this way.
这比仅仅说 And it's much more effective than just saying,
“我允许你谈论禁忌的事情”更有效 "I give you permission to talk about taboo things."
通过问这些问题 通过使用恰当的语言 But by asking these kinds of questions, by using the appropriate language,
治疗师或咨询师就是在做榜样 告诉来访者这是可以讨论的 the therapist or counselor is modeling, that this is okay to talk about.
提供有限的信息 Providing limited information,
这可能是你在其他领域的实践中已经做过的事情 this is something that you probably already do in your practice in other areas,
包括提供心理教育或阅读治疗 so providing psychoeducation or bibliotherapy,
也就是给人们提供可能有用的书 或者有用的讲义 giving people books that might be helpful, or handouts that might be helpful.
这真的非常非常重要 This is really, really important.
正如我所说 在向人们提供关于性方面的医学准确信息方面 As I said, in terms of giving people medically accurate information about sex,
包括他们的性器官是怎样的 什么是正常的性功能 正常的性反应 their sexual organs, what is normal sexual function, normal sexual response.
这是消除关于 "什么是正常" 的各种迷思和刻板印象的机会 And this is the opportunity to dispel different myths and stereotypes about what is normal.
人们会把自己与色情作品中看到的相比较 这很让人担忧 There has been a lot of concern about people comparing themselves to what they see in pornography
尤其是通过色情片首次接触 and especially with young adults having their first exposure to sexuality
性和性行为的年轻人 他们所获取的关于 and to sex through pornography and getting information that is very distorted
正常性行为 正常性反应的信息是非常扭曲的 about what is normal sexual behavior and what is normal sexual response.
因此 提供有限的信息是非常重要和有力的 So it's very important and very powerful to give limited information.
提供有限的信息的原因是 And the reason the information is limited is because
应该提供当时所需要的特定信息 it should be specific to the information that is necessary in that moment.
所以大家在这门课上得到的是相反的 你们得到的就是广泛的信息 So you're here in this course getting the opposite, you're getting expansive information.
这样你就可以建立自己的知识储备和自己的工具包 And that is so that you have the ability in your own knowledge and your own toolkit
根据个人或伴侣来咨询的内容 to access the specific limited information that is necessary,
使用当下所需的特定的有限信息 depending on what the individual or couple is bringing in to your office.
具体建议 And specific suggestions.
所以 我们从特定信息讲到具体建议 So again, moving from the specific information to specific suggestions,
我们给出的家庭作业一定要在限定范围内 非常有针对性 so very, very limited, homework, very focused homework.
你可以在YouTube上找到这里列出的这些练习 So you can look some of these things up on YouTube.
并评估哪些对你自己的工作有用 比如感官焦点 And assess what makes sense for your own practice in terms of learning more about sensate focus,
这是一项非常具体的家庭作业 一种行为干预 which is a specific kind of homework, behavioral intervention,
这对有性主诉的伴侣来访者来说是很有帮助的 that can be quite helpful for couples coming in with sexual complaints.
再说一次 具体的作业非常有帮助 And again, it can be very helpful to have homework that is specific
因为人们在来接受治疗时 感觉无法承受 because people come into therapy, feeling very overwhelmed
感觉他们的问题是无孔不入的 是整体的 压倒性的 没有希望 and feeling like their problem is so pervasive or global or overwhelming and hopeless,
所以为某人提供非常清晰的参数 对他们应该实现的目标 that it can be a very powerful intervention in and of itself to give somebody very clear parameters
或者他们应该在咨询间隔期完成的作业来说 regarding a goal that they're supposed to achieve
本身就是一种非常强大的干预手段 or an assignment that they are supposed to complete between sessions
听起来有点矛盾 有一项很常见的作业是 A very common assignment given that is, paradoxically,
给没有性生活的伴侣布置一个不做爱的作业 这一作业的效果通常都很好 usually very successful for couples who are not having sex, is to not have sex.
这实际上是感官焦点的一部分 That's, that's actually part of sensate focus.
布置了这个作业之后 人们通常都会做爱 And in that stage, people often have sex.
看起来他们的家庭作业失败了 Now, that's a failure of the homework.
但这其实是治疗生效的重要步骤 But it's an important thing to bring into the session.
它推动了治疗 所以对治疗来说这不是失败 And it moves the therapy along. It's not a failure in therapy.
然后是强化治疗 And then the intensive therapy.
所以对于那些有严重创伤的来访者 So for the people who come to your office with significant trauma,
特别是那些可能符合创伤后应激障碍标准的人 especially, and people that might meet criteria for post traumatic stress disorder,
我现在有一位来访者就是因为过去的性创伤 在性行为中会出现解离症状 people who are, I have someone in my practice now who dissociates during sex because of past sexual trauma.
接待这类来访者需要高阶培训 That kind of work requires advanced training.
所以如果你没有接受过这类培训的话 And so those are the kinds of people that you want to refer out of your practice
你就需要把这类来访者转介给别人 if you do not have this kind of training.
转介的其它原因包括 Other reasons to refer people out of your practice,
不一定是因为超出了你的执业范围 and not necessarily away from your practice,
而是我们之前提到过的转介给医疗机构 这很常见 but, but the referrals that we discussed previously, are most commonly to medical providers.
所以 如果有来访者的咨询内容是很明确的关于性的主诉 So the first thing you want to do if someone is coming in with an explicit sexual complaint,
你首先要转介他们去咨询的人就是他们的全科医生 the first referral that you want to make is to their general practitioner.
如果有来访者延迟射精 早泄 一般性盆腔疼痛 性欲低下 而且是新发的 So if someone has delayed ejaculation, premature ejaculation, general pelvic pain, low libido, and it's a new onset,
你可以建议让他们接受全面的医学检查 以排除任何医学原因 especially, you want to refer them for a full medical workup to rule out any medical causes.
最后 我想让你来做一项家庭作业 And finally, I want to close with your own assignment.
我希望你花十到十五分钟 So I want you to complete your own sexual genogram.
画一下自己的性家谱图 I want you to take about 10 to 15 minutes to do this.
如果你过去没有画过家谱图 If you haven't completed a genogram in the past,
这可能会花更长时间 it might take you a little bit longer.
你可以返回有不同家谱图符号的那一页幻灯片 或谷歌搜索一下如何画 You can go back to the slide with the different genograms symbols or Google this.
我希望你们画完之后 反思一下画的过程中是什么感觉 But I want you to do this and to then reflect on what it was like to do this.
反思一下你是否学到了什么 If there was anything that you learned or anything
有没有更加了解你自己 以及你对性的态度和观念 that makes a little bit more sense about yourself, and your attitudes, beliefs about sexuality.