中国心理健康服务理论现状及对策研究
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摘要
心理健康服务理论是指心理健康服务活动中对一组已知的事实和经验结果的解释所提出的一种一般原则或一组相互关联的一般原则。它既是心理健康服务经验之总结,也是心理健康服务依据之原则。当代心理健康服务理论主要包括心理动力学理论、认知理论、行为主义理论、人本主义理论和整合主义理论等。心理健康服务理论是心理健康服务工作的基础,也是心理健康服务工作发展成熟的标志,因此,心理健康服务理论是构建心理健康服务体系的一项重要内容。西方的心理健康服务理论,经过一百多年的发展,已提出了大大小小的理论近500多种,其间经历了从单一经多元到整合的发展过程。国内则从上世纪80年代起,开始重新引进和学习西方的心理健康服务理论,并在这个过程中创造出本土化和本土的理论,但是国内的总体情况如何,迄今未见有系统的调查。本研究的目的是通过对我国心理健康服务理论现状的调查,提出发展我国心理健康服务理论的对策,从而为构建适合我国国情的心理健康服务体系做出应有的贡献。
本研究由5个分研究组成：研究1通过对2000年1月至2009年10月发表在我国11种心理学学术期刊上的心理健康服务理论文献进行文献计量学分析,以了解我国心理健康服务理论的现状及影响心理健康服务从业者采用理论的因素。研究2对各类学校、医院、社会机构中从事心理健康教育、心理咨询和心理治疗的人员进行问卷调查,从国外理论、本土化理论和本土理论等方面了解我国心理健康服务理论的现状,同时考察影响心理健康服务从业者采用理论的因素。取样方式有三种：(1)在全国性的心理治疗与咨询会议上发放问卷；(2)请国内东北、华北、华东、中南、西南和西北六大行政区的心理学者在当地进行调查；(3)通过邮件、QQ群、心理咨询网在全国范围内进行调查。调查时间从2009年7月至2010年5月,共收回有效问卷2357份。研究3对11位在医院、学校和社会心理咨询机构中从事心理健康服务工作的人员进行深度访谈,以进一步了解我国心理健康服务理论的现状及影响心理健康服务从业者采用理论的因素。研究4通过对我国心理健康服务的一种典型本土理论——点通疗法进行个案研究,以之为例探讨本土理论的特点,及其在产生和发展过程中的影响因素。研究5针对前面4个研究发现的问题,提出了发展我国心理健康服务理论的对策建议。
上述系列研究的结果表明：
1.我国心理健康服务从业者所使用的理论主要来自国外,以认知理论、精神分析/心理动力学理论、人本—存在主义理论和行为主义理论等西方传统理论流派为主。
2.我国心理健康服务从业者所使用的本土化理论中,已产生较大影响的理论主要是认识领悟疗法和意象对话心理疗法。
3.我国心理健康服务从业者所使用的本土理论包含大理论和小理论两个层次。大理论是指对心理健康服务发挥着指导作用的中国传统哲学思想,如儒家思想、道家思想、佛家思想等,其中,儒家思想最常见于心理健康服务从业者所使用的本土理论中。小理论是指我国心理健康服务从业人员从心理健康服务活动实践中总结出来的具体原则,如中国道家认知疗法、中医心理治疗理论、心理疏导疗法、点通疗法等,其中使用最多的是中医心理治疗理论。
4.我国心理健康服务从业人员使用理论时以整合地使用某几种理论为主,所占比例为95.1%,远远高于单一地采用某理论(4.9%)。整合理论中使用最多的理论是认知理论。
5.我国心理健康服务从业人员的专业化程度决定着他们使用理论的类型：专业化程度越高(如受教育程度、心理学、医学及专业知识越多),越倾向于使用整合理论。心理健康服务从业人员认为,自己选择使用何种理论主要受来访者情况、咨询效果及心理健康从业人员自身的专长三个因素影响。
6.点通疗法是我国心理健康服务本土理论的典型个案,它较好地吸收了前人的知识经验,以道家思想、儒家思想、中医经络论等理论为指导,提出了心络学理论,构建了欲望调节、体验推拿、“悟言”点击和健康修塑等方法。从这个案例的情况可以看出,影响我国心理健康服务本土理论产生和发展的因素既包括他人的认可、朋友的鼓励、别人的轻视和攻击这些外部因素；义包括心理健康服务从业人员对疗效的追求、对心理学的兴趣、拥有丰富的知识基础、对责难所持的开放心态、善于学习和批判思考的能力等内部因素。内部因素对本土理论产生和发展的影响比外部因素大。
7.由于目前国内心理健康服务从业人员主要使用的理论是根植于西方文化的,我国心理健康服务从业人员在吸取西方经验时应有所选择,不可盲目照搬。应找出适合于中国人的理论,对不合适的理论进行加工或舍弃。并在此基础上,结合中国文化,联系实际,积极构建本土化理论。此外,我国心理健康服务从业人员应勇于创造本土理论。在探索中国本土理论的过程中,我国心理健康从业人员需要不断完善自身素质,遵循“不唯上、不唯书、只唯实,交换、比较、反复”的指导思想,勤于学习和思考,以批判的眼光发现问题,提出有关心理健康服务的创新性观点,并通过实践不断验证其有效性。
本研究在理论和方法上有所创新：理论创新方面,提出了心理健康服务理论的概念,并将心理健康服务理论划分为国外理论、本土化理论和本土理论三种类型,并依此对我国心理健康服务理论进行分析,探讨了心理健康服务理论的现状及影响我国心理健康服务从业人员采用理论的因素。以点通疗法为典型个案,探讨了我国心理健康服务本土理论的特点及影响其产生和发展的重要因素。在方法创新上,采用多视角、多方法进行研究。注重全国大样本调查与个案剖析相结合,注重量化研究与质性研究相结合,注重吸收国外经验与本国国情相结合,对我国心理健康服务理论的现状及影响我国心理健康服务从业人员使用理论的因素进行了较系统的考察。
本研究较为全面地揭示了目前我国心理健康服务从业人员使用理论的基本状况。未来的研究将比较不同整合理论在实际中的效果；考察国外引进的理论如何进行本土化?如何与中国实际相结合,构建出具有中国特色的心理健康服务理论?如何使本土理论在运用中更加成熟与发展?
Theory of Mental health service is a general principle and a group of general principles having relationship between each other which are generated on the base of the explanation of known facts and experience in mental health service. The theory of mental health is not just the result from practice in mental health service but also the principle which is used to guild the mental health service. A number of theories are included in contemporary mental health service, such as psychodynamic theory, cognitive theory, behavioral theory, humanistic theory and integrating theory. It is an important part of the construction of mental health service as its foundation and the mark of its maturation in development. About 500 kinds of theories have been developed in western mental health service over the past 100 years, and it has been through the process from generating a single theory to integrating multiple theories. It has been started to immigrate western theory of mental health service in China since 1980s, and indigenized theory and indigenous theory have been created during the process of its immigration and study. However, there hasn't systematical research has been run on the overall situation of mental health service in China. We are planning to aim at advancing the method to process Chinese mental health theory by figuring out the current situation of theory of mental health service in China, hoping make our own contribution to construct mental health service theory which could fit to current situation in China very well.
The research is constructed by five parts:First research, the references which had been published in 11 kinds of psychological journals in China were collected and analyzed by bibliometrics, in order to take insight into the current situation of Chinese mental health service theory and the factor which has impact on the choice mental health practitioners made to choose mental health theory. Second research, the questionnaire survey was run on practitioners who are working on mental health teaching, psychological consult and psychological therapy in multiple institutions such as educational institution and social institution in China. The purpose in second research is figure out the current situation of the Chinese mental health service theory by studying on foreign theory, indigenized theory and indigenous theory, in the meantime the factor which has impact on choice mental health practitioner made on picking up the mental health theory in their therapy was also taken our concern. We choose three methods to take samples:first, handed out survey on national psychological therapy and consult conference; second, invited the psychologists to run local research in northeast of china, north china, east china, south-central china, southwest of china and northwest of china; third, collected relevant information in China by email, internet chatting and mental consult website. We got 2357 survey back after 10 months'research from July 2009 to May 2010.3. We took deep interview on 11 practitioners who have devoted in mental health service in hospital, educational institution and social mental consult institution in order to get more knowledge of current situation on Chinese mental health service theory and the factor which has power on mental health practitioners'choice on choosing mental theory to run their therapy.4. Our work on the typical indigenous theory took diantong therapeutics as an example of case study to look into the character of indigenous theory and the factor on its generation and development process.5. We gave the advice on developing mental health service theory in China based on the previous four researches
We got several conclusions from the above five researches:
1. The foreign theories are the main sources of the theory which is practiced by Chinese mental health servicer, and the most frequently used theories are western traditional theories, such as cognitive theory, psychoanalytic/psychodynamic theory, humanistic/existential theory and behavior theory.
2. The imaging communication psychotherapy and cognitive and insight therapy which Chinese mental health servicer have been used as indigenized theory both have powerful influence on Chinese mental health service.
3. The indigenous theories include principle theory and concrete theory. The principle theory is the Chinese traditional philosophy which guilds mental health service in China, such as Confucianism, Taoist theories and Buddhism. The Confucianism is the most popular theory used by mental health servicer in China. The concrete theory is the specific principle which was developed in practice, such as the Taoist cognitive therapy, Chinese medicine therapy, the dredging psychotherapy and diantong therapeutics. And the Chinese medicine therapy is the most frequently used therapy.
4. The most frequently used method by Chinese mental health practitioners is integrating multiple theories (95.1%), and the chance using single theory in therapy is rare (4.9%). And then the cognitive theory is usually used in integrating theories.
5. The degree of specialization mental health practitioners have decides what particular theory is chosen in their therapy. The higher degree of specialization (the degree of their education, the knowledge they have in psychology, medicine and on other expertise), the more they are willing to use integrating theories. Three factors, clients'situation, the effect of consult and expertise of practitioner, have impact on the choice of which theory is going to be chosen by practitioner.
6. Diantong therapeutics is the typical case in Chinese native mental health service. Taoist theories, Confucianism and Luo study of traditional Chinese medicine are the principle theory for diantong therapeutics. It takes advantage from previous research, develops mental network theory and constructs several mental health methods, such as adjusting desire method, experiencing in person, eliciting truth with incisive sentences and shaping soul. From the studying on this case study, we are capable to get conclusion that the factor which has power on the generation and development of mental health service in China includes the external factor, such as the getting acceptance from other people, getting encouragement from friends, suffering the ignorance and attack from other people, and the internal factor, such as the pursuing the effect of the therapy, being interest in psychological knowledge, having sufficient knowledge, keeping mind open to handle censure, the skill of learning and ability of making wise judgment. The internal factors have more power on the generation and development of indigenous theory than external factor does.
7. Because the theory which is used by mental health practitioner frequently is generated in western culture, Chinese practitioners should be careful when taking advantage from western experience on mental health treatment. The proper way to make use of western theory on mental health treatment is to make modification on those which are fitting to Chinese culture and abandon those which are not fitting to Chinese culture, and to construct indigenous theory by concerning Chinese culture and reality. Obviously using foreign theory without thinking whether it fits to Chinese culture is not recommended. In other side, Chinese mental health practitioners should be encouraged to create indigenous theory. When exploring indigenous mental health theory, Chinese practitioners should be willing to improve their own quality, to figure out the potential problem in Chinese mental health service, to contribute new idea on mental health service and prove its effect in practice by following these rules, having doubts when getting the knowledge from previous researches and books, taking the reality as research foundation, making communication and comparison with other researchers and other researches, making adjust on their own research.
The innovativeness in the research on theory and method is below. We advanced the concept of mental health service theory, and sorted it into three types, foreign theory, indigenous theory and indigenized theory. We also made analysis on Chinese mental health service theory and figured out its current situation and the factor which has impact on the choice Chinese practitioner made to choose mental health theory in their practice. And then we took diantong therapeutics as an example of typical study to discuss the character of the indigenous mental health theory and the important factor in its generation and development. In the method innovativeness, we used multiple methods to run the systematical research from multiple views. We run the systematical research by focusing on the combined use of national sample and case study, the quantified study and qualitative study, and learning foreign experience based on native culture.
Our research uncovered the fundamental situation of the theory which is used by mental health practitioner in China. In the future we are willing to make comparison on the practical effect among those different integrating theories, figure out how to indigenize the foreign theories. And we are going to work out how to construct mental health service theory which has Chinese character, and how to improve indigenous theory.
本研究由5个分研究组成：研究1通过对2000年1月至2009年10月发表在我国11种心理学学术期刊上的心理健康服务理论文献进行文献计量学分析,以了解我国心理健康服务理论的现状及影响心理健康服务从业者采用理论的因素。研究2对各类学校、医院、社会机构中从事心理健康教育、心理咨询和心理治疗的人员进行问卷调查,从国外理论、本土化理论和本土理论等方面了解我国心理健康服务理论的现状,同时考察影响心理健康服务从业者采用理论的因素。取样方式有三种：(1)在全国性的心理治疗与咨询会议上发放问卷；(2)请国内东北、华北、华东、中南、西南和西北六大行政区的心理学者在当地进行调查；(3)通过邮件、QQ群、心理咨询网在全国范围内进行调查。调查时间从2009年7月至2010年5月,共收回有效问卷2357份。研究3对11位在医院、学校和社会心理咨询机构中从事心理健康服务工作的人员进行深度访谈,以进一步了解我国心理健康服务理论的现状及影响心理健康服务从业者采用理论的因素。研究4通过对我国心理健康服务的一种典型本土理论——点通疗法进行个案研究,以之为例探讨本土理论的特点,及其在产生和发展过程中的影响因素。研究5针对前面4个研究发现的问题,提出了发展我国心理健康服务理论的对策建议。
上述系列研究的结果表明：
1.我国心理健康服务从业者所使用的理论主要来自国外,以认知理论、精神分析/心理动力学理论、人本—存在主义理论和行为主义理论等西方传统理论流派为主。
2.我国心理健康服务从业者所使用的本土化理论中,已产生较大影响的理论主要是认识领悟疗法和意象对话心理疗法。
3.我国心理健康服务从业者所使用的本土理论包含大理论和小理论两个层次。大理论是指对心理健康服务发挥着指导作用的中国传统哲学思想,如儒家思想、道家思想、佛家思想等,其中,儒家思想最常见于心理健康服务从业者所使用的本土理论中。小理论是指我国心理健康服务从业人员从心理健康服务活动实践中总结出来的具体原则,如中国道家认知疗法、中医心理治疗理论、心理疏导疗法、点通疗法等,其中使用最多的是中医心理治疗理论。
4.我国心理健康服务从业人员使用理论时以整合地使用某几种理论为主,所占比例为95.1%,远远高于单一地采用某理论(4.9%)。整合理论中使用最多的理论是认知理论。
5.我国心理健康服务从业人员的专业化程度决定着他们使用理论的类型：专业化程度越高(如受教育程度、心理学、医学及专业知识越多),越倾向于使用整合理论。心理健康服务从业人员认为,自己选择使用何种理论主要受来访者情况、咨询效果及心理健康从业人员自身的专长三个因素影响。
6.点通疗法是我国心理健康服务本土理论的典型个案,它较好地吸收了前人的知识经验,以道家思想、儒家思想、中医经络论等理论为指导,提出了心络学理论,构建了欲望调节、体验推拿、“悟言”点击和健康修塑等方法。从这个案例的情况可以看出,影响我国心理健康服务本土理论产生和发展的因素既包括他人的认可、朋友的鼓励、别人的轻视和攻击这些外部因素；义包括心理健康服务从业人员对疗效的追求、对心理学的兴趣、拥有丰富的知识基础、对责难所持的开放心态、善于学习和批判思考的能力等内部因素。内部因素对本土理论产生和发展的影响比外部因素大。
7.由于目前国内心理健康服务从业人员主要使用的理论是根植于西方文化的,我国心理健康服务从业人员在吸取西方经验时应有所选择,不可盲目照搬。应找出适合于中国人的理论,对不合适的理论进行加工或舍弃。并在此基础上,结合中国文化,联系实际,积极构建本土化理论。此外,我国心理健康服务从业人员应勇于创造本土理论。在探索中国本土理论的过程中,我国心理健康从业人员需要不断完善自身素质,遵循“不唯上、不唯书、只唯实,交换、比较、反复”的指导思想,勤于学习和思考,以批判的眼光发现问题,提出有关心理健康服务的创新性观点,并通过实践不断验证其有效性。
本研究在理论和方法上有所创新：理论创新方面,提出了心理健康服务理论的概念,并将心理健康服务理论划分为国外理论、本土化理论和本土理论三种类型,并依此对我国心理健康服务理论进行分析,探讨了心理健康服务理论的现状及影响我国心理健康服务从业人员采用理论的因素。以点通疗法为典型个案,探讨了我国心理健康服务本土理论的特点及影响其产生和发展的重要因素。在方法创新上,采用多视角、多方法进行研究。注重全国大样本调查与个案剖析相结合,注重量化研究与质性研究相结合,注重吸收国外经验与本国国情相结合,对我国心理健康服务理论的现状及影响我国心理健康服务从业人员使用理论的因素进行了较系统的考察。
本研究较为全面地揭示了目前我国心理健康服务从业人员使用理论的基本状况。未来的研究将比较不同整合理论在实际中的效果；考察国外引进的理论如何进行本土化?如何与中国实际相结合,构建出具有中国特色的心理健康服务理论?如何使本土理论在运用中更加成熟与发展?
Theory of Mental health service is a general principle and a group of general principles having relationship between each other which are generated on the base of the explanation of known facts and experience in mental health service. The theory of mental health is not just the result from practice in mental health service but also the principle which is used to guild the mental health service. A number of theories are included in contemporary mental health service, such as psychodynamic theory, cognitive theory, behavioral theory, humanistic theory and integrating theory. It is an important part of the construction of mental health service as its foundation and the mark of its maturation in development. About 500 kinds of theories have been developed in western mental health service over the past 100 years, and it has been through the process from generating a single theory to integrating multiple theories. It has been started to immigrate western theory of mental health service in China since 1980s, and indigenized theory and indigenous theory have been created during the process of its immigration and study. However, there hasn't systematical research has been run on the overall situation of mental health service in China. We are planning to aim at advancing the method to process Chinese mental health theory by figuring out the current situation of theory of mental health service in China, hoping make our own contribution to construct mental health service theory which could fit to current situation in China very well.
The research is constructed by five parts:First research, the references which had been published in 11 kinds of psychological journals in China were collected and analyzed by bibliometrics, in order to take insight into the current situation of Chinese mental health service theory and the factor which has impact on the choice mental health practitioners made to choose mental health theory. Second research, the questionnaire survey was run on practitioners who are working on mental health teaching, psychological consult and psychological therapy in multiple institutions such as educational institution and social institution in China. The purpose in second research is figure out the current situation of the Chinese mental health service theory by studying on foreign theory, indigenized theory and indigenous theory, in the meantime the factor which has impact on choice mental health practitioner made on picking up the mental health theory in their therapy was also taken our concern. We choose three methods to take samples:first, handed out survey on national psychological therapy and consult conference; second, invited the psychologists to run local research in northeast of china, north china, east china, south-central china, southwest of china and northwest of china; third, collected relevant information in China by email, internet chatting and mental consult website. We got 2357 survey back after 10 months'research from July 2009 to May 2010.3. We took deep interview on 11 practitioners who have devoted in mental health service in hospital, educational institution and social mental consult institution in order to get more knowledge of current situation on Chinese mental health service theory and the factor which has power on mental health practitioners'choice on choosing mental theory to run their therapy.4. Our work on the typical indigenous theory took diantong therapeutics as an example of case study to look into the character of indigenous theory and the factor on its generation and development process.5. We gave the advice on developing mental health service theory in China based on the previous four researches
We got several conclusions from the above five researches:
1. The foreign theories are the main sources of the theory which is practiced by Chinese mental health servicer, and the most frequently used theories are western traditional theories, such as cognitive theory, psychoanalytic/psychodynamic theory, humanistic/existential theory and behavior theory.
2. The imaging communication psychotherapy and cognitive and insight therapy which Chinese mental health servicer have been used as indigenized theory both have powerful influence on Chinese mental health service.
3. The indigenous theories include principle theory and concrete theory. The principle theory is the Chinese traditional philosophy which guilds mental health service in China, such as Confucianism, Taoist theories and Buddhism. The Confucianism is the most popular theory used by mental health servicer in China. The concrete theory is the specific principle which was developed in practice, such as the Taoist cognitive therapy, Chinese medicine therapy, the dredging psychotherapy and diantong therapeutics. And the Chinese medicine therapy is the most frequently used therapy.
4. The most frequently used method by Chinese mental health practitioners is integrating multiple theories (95.1%), and the chance using single theory in therapy is rare (4.9%). And then the cognitive theory is usually used in integrating theories.
5. The degree of specialization mental health practitioners have decides what particular theory is chosen in their therapy. The higher degree of specialization (the degree of their education, the knowledge they have in psychology, medicine and on other expertise), the more they are willing to use integrating theories. Three factors, clients'situation, the effect of consult and expertise of practitioner, have impact on the choice of which theory is going to be chosen by practitioner.
6. Diantong therapeutics is the typical case in Chinese native mental health service. Taoist theories, Confucianism and Luo study of traditional Chinese medicine are the principle theory for diantong therapeutics. It takes advantage from previous research, develops mental network theory and constructs several mental health methods, such as adjusting desire method, experiencing in person, eliciting truth with incisive sentences and shaping soul. From the studying on this case study, we are capable to get conclusion that the factor which has power on the generation and development of mental health service in China includes the external factor, such as the getting acceptance from other people, getting encouragement from friends, suffering the ignorance and attack from other people, and the internal factor, such as the pursuing the effect of the therapy, being interest in psychological knowledge, having sufficient knowledge, keeping mind open to handle censure, the skill of learning and ability of making wise judgment. The internal factors have more power on the generation and development of indigenous theory than external factor does.
7. Because the theory which is used by mental health practitioner frequently is generated in western culture, Chinese practitioners should be careful when taking advantage from western experience on mental health treatment. The proper way to make use of western theory on mental health treatment is to make modification on those which are fitting to Chinese culture and abandon those which are not fitting to Chinese culture, and to construct indigenous theory by concerning Chinese culture and reality. Obviously using foreign theory without thinking whether it fits to Chinese culture is not recommended. In other side, Chinese mental health practitioners should be encouraged to create indigenous theory. When exploring indigenous mental health theory, Chinese practitioners should be willing to improve their own quality, to figure out the potential problem in Chinese mental health service, to contribute new idea on mental health service and prove its effect in practice by following these rules, having doubts when getting the knowledge from previous researches and books, taking the reality as research foundation, making communication and comparison with other researchers and other researches, making adjust on their own research.
The innovativeness in the research on theory and method is below. We advanced the concept of mental health service theory, and sorted it into three types, foreign theory, indigenous theory and indigenized theory. We also made analysis on Chinese mental health service theory and figured out its current situation and the factor which has impact on the choice Chinese practitioner made to choose mental health theory in their practice. And then we took diantong therapeutics as an example of typical study to discuss the character of the indigenous mental health theory and the important factor in its generation and development. In the method innovativeness, we used multiple methods to run the systematical research from multiple views. We run the systematical research by focusing on the combined use of national sample and case study, the quantified study and qualitative study, and learning foreign experience based on native culture.
Our research uncovered the fundamental situation of the theory which is used by mental health practitioner in China. In the future we are willing to make comparison on the practical effect among those different integrating theories, figure out how to indigenize the foreign theories. And we are going to work out how to construct mental health service theory which has Chinese character, and how to improve indigenous theory.
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