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Converging through difference: A case of empathic incongruence in treatment of an elderly woman with psychosis

机译:通过差异融合:一种心理学治疗一名老年妇女的异常不一致的案例

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Contemporary person-centered psychotherapy often references empathy as a basic component of the therapeutic alliance and, thus, effective treatment, such that nascent clinicians study this basic skill early in training. However, the psychotherapy literature often presumes a collective agreement about how empathy manifests as a clinical tool, in the process institutionalizing the ideal of omnipresent alignment with a client, applied across populations of patients, regardless of their conditions, ages, and personal and cultural characteristics. Misalignments between clinicians and clients have the potential to bely broadly imagined ethics of empathy (and the notion of collective agreement about what it is) by demonstrating the ways tension, difference, and incongruence promote treatment. Through an autoethnography of a 12-month psychotherapy dyad with an elderly woman committed for treatment at a U.S. psychiatric hospital, we discuss how moments of incongruence between clinician and client expand conceptualizations of empathy in treatment of psychosis. Specifically, in this context, deployment of empathy-as-alignment becomes a fallacy of care, risking the effectiveness of treatment through impossible epistemological assumptions of and counterproductive joining with the client. As such, this transtheoretical discussion presents two types of incongruence in the dyad-developmental and subjective-as a backdrop for expressing empathy. This paper makes space for a theory of empathy as the practice of working in genuine and careful service of the client's psychology through acts of incongruence as much as alignment.
机译:当代人以人为本的心理治疗常常将同情作为治疗联盟的基本组成部分,从而有效治疗,使得新生的临床医生早期在训练中研究这一基本技能。然而,心理治疗文献通常会推测关于Empathy如何表现为临床工具的集体协议,在制度化与客户的无所不在对准的理想中,无论他们的条件,年龄和个人和文化特征如何。临床医生和客户之间的错位有可能迫在眉睫的宽容地想象的同情事事(以及集体协议的概念,通过展示张力,差异和不一致的促进治疗方法来阐明。通过一个12个月的心理治疗Dyad的Autoethnogie,与一名致力于在美国精神病院治疗的老年人,我们讨论临床医生与客户之间的不协调的时刻扩大了对精神病治疗的同理心的概念化。具体而言,在这种情况下,移情与对准的部署成为护理的谬误,风险通过与客户的不可能的认识论和反复生成的假设进行治疗的有效性。因此,这一破坏性讨论在二元发展和主观上存在两种类型的不协调 - 作为表达同理心的背景。本文通过不协调的行为使同理心作为工作实践,成为同情的理论,作为对客户心理的真实和仔细服务的做法。

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