个人中心治疗

以人为中心治疗（Person-Centered Therapy）是由卡尔·罗哲斯（Carl Rogers）于二十世纪四、五年代在美国所创立的一个心理治疗取向，或会被称为「非指导式治疗」、「当事人中心治疗法」。与精神分析学派有很大的分别，强调人的正面成长和发展，并且非常着重治疗师本身的态度如「一致」（Congruence）、「真诚」（Genuineness）、「无条件正向看重」（Unconditional Positive Regard）和「同理心／共情理解」（Empathic Understanding）等，而非治疗的技巧。
而且罗哲斯亦提出治疗应由案主洞察自己的问题，而非如传统精神分析治疗等由治疗师主导治疗过程。

**主要概念**
以人为中心治疗强调以下六个概念：
#真诚的治疗关系：治疗师与案主之间的关系建立在无批判性及无强制指导性的治疗环境下。
#积极回应 (positive feedback) ：治疗师的真诚，而非假装关注案主个人的问题。
#无条件正向看重 (unconditional positive regard)：对案主的陈述，不带批判性的态度，亦不作反对或赞成，仅去接纳和认同、关怀案主。治疗师在咨商过程中，应给案主正向感受。
#同理心/共情理解 (empathic understanding)：治疗师倾听案主自述后，站在案主的角度，设身处地的体会案主的内心世界。
#沟通：事主能够接收到治疗师的理解和接纳。
#真挚一致性：咨商师能感受到案主内在感受，并咨商师能同感且如实替代案主表达出其感受。

**起源与发展**
以人为中心治疗的理论主要源于1940年代罗吉斯所提出的人本主义心理学，当中不少概念来自存在主义的观点，例如强调人的自由意志和责任，强调人生的意义等。
罗吉斯相信人本身是自己的专家，并且自身有能力去理解和解决自己的困难和个人成长。
在起初的阶段，以人为中心治疗被称为「非指导性辅导」 （non-directive counseling），强调治疗师本身的专业素养及同理、并指出治疗关系是决定治疗效果的最重要因素。而精神分析学派一向重视的分析理论和技巧，则被罗杰斯所批评。
之后，到了1950年代，以人为中心治疗被称为「案主中心治疗(Client-centered therapy)」，强调在辅导过程中，以案主为中心的理念。而且在此阶段的「案主中心治疗」着重案主本身的世界观多于澄清事主的感受。
从1950年代后期开始，直到1970年代，罗吉斯开始将理论扩展，提出治疗中所需的特质和元素，并且进行大量的研究去支持「案主中心取向」的假设。
1980年代开始，「案主中心治疗」开始被称为以人为中心治疗，反映出该理论已不再局限于心理治疗的领域上，其取向被广泛扩展到医学教育、教育理论、思维设计、行销、企业管理、工业、小组、解决分争，甚至是世界和平等领域或议题上。
罗吉斯所强调的案主自我治愈 (self-healing) 的能力，已经成为现今心理治疗上其中一项非常重要的基础理论，以及医学教育中以学生/学员为中心的自主学习基石理论之一。因此，现今无论治疗师采取何种理论取向，都非常强调以案主为治疗中心的信念，并且相信事主有能力作出决定和改变。

**治疗目标**
主要目标为使事主更加独立并有更大程度的整合。
罗吉斯亦提出了四个指标以示自我实现的程度：
*对经验的开放程度
*对自己的信任程度
*自我评估的内在动力
*继续成长的意愿

**人的本质**
罗吉斯在他早期的著作里已经不断强调信任事主本身的能力来促进其个人成长，而且罗吉斯亦指出治疗师只需以真实的、关顾的、不带批判性的态度去理解和与事主沟通，事主就会发生显著的改变和成长。
以下五点综合罗吉斯对人的本质的看法：
*基本上，人具有社会性、向善向上的倾向，人性是理性和切合实际的。人有力争上游的潜能，不仅会设法维持自己的生命，同时也在追求自我实现，以及提升生活的经验。
*人与人之间即使潜能有差别，但每一个人都会尽力改善自己的生活。
*人基本上是自发的，所以每个人均有机会发展和运用自己的各种能力，以引导其生活。
*如果人处在一个不受批评与威胁的环境中，并且能客观的省视自己的问题时，他即能对未来作出建设性的抉择。
*人基本上是建设性的、可信赖的、善良的。

**应用**
除了应用到个别与团体咨商外，以人为中心导向还被扩大利用于训练专业及半专业的人事服务工作者，此一治疗法对训练实务工作者非常有用，因为它的方法相当安全而保守。它强调与当事人站在一起而非在当事人面前来为他作解释。因此，这个治疗法比那些居于指导地位的治疗者对当事人作解释、诊断、探索潜意识、分析梦境、急切地进行人格改变的方法要更加安全。对鲜少咨商心理学、人格动力学及精神病理学等学识背景的人，这种治疗法也能保证当事人不会受到心理伤害。
这个治疗法的基本概念很直接而且浅显易懂；他们鼓励个人发展内在力量，而非否定个人，也非将控制与力量集中在一个权威独裁的结构中。它所使用的核心技巧，可以在助人专业中使用；这个技巧也是本书所讨论到其他治疗系统中的必备基础；如果咨商员缺乏这种关系与沟通技巧，他们在对当事人实施治疗时就不会达到显著效果。
此外，以人为中心导向也可应用在危机处理方面。许多助人专业（例如，看护、医疗、教育、牧师等）都是各种危机处理的第一线，生活中可能导致危机的事件例如，意外怀孕、罹患疾病、失去心爱的人等等，即使协助者未受过专业的心理健康训练，如果他们能表现上述几种态度的话，还是可以帮上许多忙的。当人们处于危机中，第一步的处理方式就是给他们机会，并使他们能够完全地表达自己的感受与想法，这时敏锐地倾听与了解就非常重要。虽然一个人的危机不可能因为与协助者一两次的接触就得以化解。但是，这样的接触却能为后来开放自己并接受协助而铺路。如果陷于危机中的人没有感受到为人所了解与接纳，情况将会更糟，以致于这个人可能对「回到正常情况｣感到失望，尔后也不会再寻求协助。真诚的支持、关怀和不占为己有的温暖能够建起一座桥梁，使人们愿意设法渡过难关，化解危机，在困难中的人不需要「事情会好转｣等虚伪的保证，但是与一个表现出真正关怀的人作心理上的接触却能令人感到好过些。

**多元文化观点下的以人为中心治疗**
大卫‧肯恩对以人为中心治疗在多元文化下的影响做出注解：「地球这个由千万人组成的国际大家庭，都受到罗杰斯著作的影响，以及她的同事与许多同僚的影响。他们的同僚把他及他们创新的思想与计划散播在世界每个角落。」
以人为中心治疗在多元文化下的贡献之一，是它在跨文化人类关系上的冲击。许多国家都在研究有关个人中心的理论与实务。以下是一些例子：
1.在许多欧洲国家，以人为中心治疗不只在咨商上，同时也在教育、跨文化沟通、降低族群、政治间紧张情势有着巨大的影响。
2.1970年代，罗杰斯与他的伙伴开始举办工作坊推动跨文化沟通。之后在1980年代更是在世界各地举办大型工作坊。
3.罗杰斯离世前不久，在莫斯科主持两场研讨会，他公开和苏联专业人员进行密集研讨会的经验沟通，证明他们所关心的事情，与美国专业人员团体的事情是一样的。更重要的是，心里气氛在其他国家所能产生的结果，在苏联也会产生一样的效果。

**限制与批评**
1.咨商师误解以人为中心治疗，过于重视倾听与同理心，而没有达到真正的心理治疗效果，意即咨商师只给予个案支持，而没有去着手解决他们的问题。
2.咨商师以个案为中心，却失去了自己的个性及独特性。若咨商师太注重个案本身，而将自己的一切隐藏在非指导的方式中，造成互动过程减少了坦诚，将使咨商师无法积极影响个案。
3.应重视咨商师「教导」的角色，每个人都有成长潜力与自我实现倾向的假定不一定正确，也不是每个个案都能信任自己内在的方向感，因此咨商师应使用语言或非语言行为引导及影响个案，使其达成目标。
4.以人为中心治疗法应更强调咨商师于咨商技术上的系统化训练，而非一直着重咨商师本身的态度。

**参见**
人本主义心理学
*临床心理学
*同理心

**外部连结**
 The Association for the Development of the Person Centered Approachdate=20100108134120 - The British Association for the Person Centred Approach

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