ACCEPTANCE AND MINDFULNESS IN THE PRACTICE OF DBT
- 세 가지 패러다임 중 수용부터 다루는 것은 가장 역사가 깊고
- 인지행동적 및 변증법적 전략을 효과적으로 사용하기 위한 전제 조건이며
- 저자의 개인 경험에 비추어 보더라도 수용에서부터 시작할 때 환자를 더 효과적으로 도울 수 있고
- 모든 DBT 모듈을 가르침에 있어 수용 중심의 마음챙김 기술이 핵심적이기 때문임.
PRESENT-MOMENT AWARENESS
Perhaps the concept and practice at the core of the acceptance paradigm— the prerequisite for the other acceptance principles—is this one: The present moment is the only moment.
The practice of observing and describing sensations, emotions, urges, distress, behavioral responses, and relationship events as they occur in that moment is a prerequisite for effectively participating in the three other skills modules, in which the patient is attempting to change emotional responses, tolerate distress, and change relationship patterns.
현실을 명확히 보고, 현실을 수용하고, 자기조절함에 있어 치료자 자신에게도 도움이 됨.
NONATTACHMENT
Having acquired the insight that life is inevitably filled with pain, and that resisting or protesting those painful realities causes additional suffering (known respectively as the First and Second Noble Truths of Buddhism), the Buddha then taught that the alleviation of suffering comes from acknowledging and accepting reality as it truly is, while letting go of attachment to beliefs, perceptions, possessions, and states of mind (Third Noble Truth of Buddhism).
경계선 + 반사회성 성격장애 진단을 동시에 지닌 환자를 면담함. 내면의 욕구를 알아차리고 있는 그대로 그 순간에 머묾.
Every session presents us with the opportunity to get hooked (attached), to suffer, to notice that we are hooked—that is, to wake up—and to let go of the attachment so that we can find our balance again.
- Get attached (immediate, involuntarily, automatic).
- “Wake up” to the recognition of being attached. <- KEY POINT
- “Let go” of the attachment, possibly with the assistance of a mindfulness vehicle. <- conscious breath
- See the patient’s reality as it is.
- Intervene strategically to help the patient with his or her attachment and suffering.
INTERBEING
..literally nothing in uniquely "mine."
Whether we choose to notice it or not, the “beginning” and “ending” of therapy are difficult to define; the boundaries between patients and therapists, between patients and their social contexts, between therapists and their DBT teams, and between patient– therapist dyads and society in general are difficult to specify.
Ultimately, the determination of who is manipulating whom becomes less meaningful and useful than adopting a transactional perspective in which both parties are considered responsible and collaboration between them is the preferred direction.(두 아들이 싸울 때 평소와 달리 그저 지켜보며 자신의 반응을 알아차리기만 했을 뿐인데 갈등이 해결됐던 사례에 관한 언급)
환자의 경험이 치료자 자신의 어떤 기억을 촉발시킴. 이 기억의 느낌(stranded 고립된)이 환자가 경험하고 있을 느낌과 유사하다고 판단하여 이를 전달. 환자는 이해받는다는 느낌을 경험.
doing과 being을 때에 맞게 오갈 수 있어야 함.
IMPERMANENCE
정서는 일시적으로 왔다가 사라짐. 이러한 사실을 아는 것이 환자뿐만 아니라 치료자에게도 도움이 됨.
It can alleviate our distress, reduce our suffering, and keep us on track in DBT if we can simply accept that things are always in flux. What seems unchangeable or impenetrable is actually changing.
"This too shall pass."(이 또한 지나가리라.)
인생사 새옹지마지만 if we can accept it, we can experience the gains and losses on the way to a life worth living to be speed bumps rather than brick walls.”
"THE WORLD IS PERFECT AS IT IS."
It does not mean that we approve of the world as it is, or agree with it. It simply means that the world is exactly as it is, exactly as it should be, given everything that came before.
It simply means that everything is caused by what came before.
Karma is a principle arising from Buddhism that rests upon much of the same thinking. It means that everything now was caused by prior deeds. Taking it one step into the future then means that we build our future deed by deed, by today’s choices, thoughts, words, and actions. Every seed planted today has consequences tomorrow.
This principle that the world is perfect as it is finds its way into DBT’s treatment package in several “locations.”
- One of DBT’s clinical assumptions is that, regardless of what may seem to be the case, patients are doing the best they can.
- Another assumption is that regardless of how patients appear to be undermining their own improvement, we assume that they want to improve. <- 최선을 다해서 dysfunctional behavioral이 야기됐는데 여기서 다시 최선을 다하면 improve 될 수 있다고 격려한다는 게 환자 입장에서는 아이러니처럼 들리지 않을지. 희망을 가지라는 추상적인 언급과 다를 게 무엇인지. 저자가 의미하는 바를 잘 이해하지 못하겠음.
- Every behavior now has consequences; actions matter. With each action, each choice, each intervention, we are laying down stones for a path that will lead to the conditions of the future, hopefully to a life worth living.
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