今日主題:Psychotherapy-- Expanding the shrinks  精神療法--垂死掙扎

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Psychotherapy-- Expanding the shrinks

The popularity of CBT is freezing out more traditional forms of therapy

THE unexamined life may not be worth living, but the overexamined life can be difficult, too. Many people are turning to a relatively young branch of “talking therapy”, called Cognitive Behavioural Therapy (CBT) to get them through the (day and) night. CBT, which teaches people to bypass unhelpful thoughts, has been elbowing aside the talk-about-your-childhood psychoanalysis favoured by believers in Freud and Jung. Up to 43% of all therapy courses in Britain are now CBT, and the practice is increasing: around 6,000 new therapists have been trained since 2007 and CBT absorbs much public funding. In 2012, 213m went on a National Health Service programme delivering CBT, while 172m was spent on all other forms of psychoanalysis and psychotherapy.
不經任何檢驗的生活是無意義的,但是檢驗過多的生活也並非容易。現在很多人都比較青睞近來出現的“談話治療”,又稱“認知行為治療”(CBT),借其順利 度過(白天或)晚上。認知行為治療(CBT)主要引導患者除去無用的想法,現人氣已經大大超過了之前曾得到佛洛德和榮格支持者的大力吹捧的“說說童年”心 理分析療法。現如今,英國有超過43%的心理療法課程都採用認知行為治療方法(CBT),且它的實際運用也越來越普遍:自2007年起,CBT行業已培養 6000名治療專家,並吸收了不少社會資金。2012年,在政府投資的全面健康服務專案中,CBT占2.13萬英鎊,而其它精神療法總共才得到1.72萬 英鎊。

The growing popularity of CBT was consolidated in 2007, when the government adopted the treatment as standard. Three things had swayed it. The newish practice had accumulated a body of evidence proving it worked (students of Freud and Jung have been slower to move from couch to lab). It was very good at getting patients back to the office: a 1997 study found people with psychological problems had significantly higher employment rates after CBT than after traditional psychoanalysis. It was also speedy, getting results after just ten one-hour sessions (psychoanalysis can, expensively, take a lifetime). So CBT therapists were trained up and given all the plum NHS jobs, consigning other therapies largely to private practice.
2007年,在政府宣佈CBT為標準治療法後,它的人氣再度上漲,地位得以堅實鞏固。CBT雖然出現時間較近,但已有大量證據證明它的功效(佛洛德和榮格 的學生就沒能這麼迅速地從診察台轉移到研究室,著手深入調查研究。)此療法在幫助患者重就業方面效果顯著:1997年的研究結果顯示,接受CBT療法的群 體的就業率要比接受傳統精神療法高得多。並且,該療法週期也短的多,每次治療一小時,持續十次就可以看到效果(而那些精神療法或許會足足耗費一生)。正因 如此,國家大力培養CBT治療師,並且分配他們NHS(英國國民保健系統)的全部美差,同時還允許他們可以自由行動。

As a result couch-based psychotherapy, once dominant, now caters mostly to the rich—an hour's session costs between 50 ($80) and 500—and is geographically skewed: there are more psychoanalysts in NW3, a posh London postcode, says Phillip Hodson, a fellow of the British Association for Counselling and Psychotherapy, than in the counties of Devon and Somerset combined. CBT therapists, via GP referrals and hospital departments, can now reach anyone nationwide for free. Private practice psychoanalysis is also set to struggle as evidence-based results and regulation become more important. In 2007 non-NHS therapists resisted a proposed regulatory body, claiming it would squash creativity—a mistake in a profession so easily infiltrated by quacks.
結果,這種以診查為主的心理治療法盛行後,如今主要是為了迎合富貴人家—小時的診療收費達50至500英鎊—且它的地理分佈也是極為不平衡:英國心理諮詢 和心理治療協會會員菲利浦•哈德森(Phillip Hodson)稱,在繁華地帶的NW3地區的心理治療師比德文郡和薩默賽特兩鄉村合計還多。CBT治療師在全科醫生和醫院有關部門的引薦下,如今已經可以 為全國人民免費治療。個人所開展的心理治療法也在努力成為有理可循的治療法,因此制定有關規定顯得更加重要。2007年,一名非NHS的心理治療師強烈反 對政府所出臺得一套規章制度,認為這會抑制大家的創新力——這是職業通病,卻極易被江湖郎中給佔便宜。

Meanwhile the CBT boost has expanded the British therapy industry: since 2007, spending on psychotherapy has moved from 3% to 7% of Britain's mental health budget-the difference mostly spent on CBT. In shrink-happy America, by contrast, the psychotherapy industry is declining. In 1998, 15.9% of America's depression and anxiety cases were referred to therapists. In 2007 that was down to 10.5%. The British therapy boom is also a triumph for consumer choice: a recent survey showed patients preferred therapy to medication by a ratio of three to one.
與此同時,CBT的大興又促進了英國心理治療行業的發展:自2007年以來,國民在精神療法上的支出由原來只占心理健康總支出的3%升至7%,而多出來的 部分主要用於CBT治療。而相反,在幸福指數下滑的美國,心理治療行業卻日漸下滑。早在1998年,15.9%的憂鬱和焦慮患者都會求助心理治療師。而到 了2007年,這個人數降至10.5%。英國心理治療行業的大興再次表明現今顧客為大的世道:近期一項調查結果顯示,相比藥物治療,75%的患者更傾向於 心理治療。

Peter Fogarty of University College, London argues that CBT has entered a virtuous circle: money pours into research, evidence accumulates, more financial support is given to the newly credible treatment and other forms of psychotherapy are excluded. Even if they are not, the complexity of the NHS means it may be hard to switch gears. Policymakers will not be keen to disentangle CBT from the vast NHS machinery, nor to write off years spent training new therapists.
倫敦大學學院的教授彼特. 福格蒂認為CBT開始了良性迴圈:大量資金投入相關研究,研究又積累更多真實資料,帶來可靠的研究結果,而後這種新的可靠治療得到更多財政補助,得到進一 步推廣,漸漸地把其它心理療法給淘汰了。即使這些療法沒被淘汰,在NHS這樣複雜交錯的系統裡,它們也很難翻身,扭轉當前局勢。當局者根本不希望把CBT 從龐大的NHS體系中剔除,也不希望這麼多年只是在白白地培養新的心理治療師。

CBT is no panacea, and psychoanalysis has been shown to be better in treating illnesses like eating disorders. It is finally launching studies to measure its effectiveness in an effort to regain some ground. Either way, it appears the stereotype of the buttoned-up Brit, unwilling to delve into his or her subconscious, may be eroding.
CBT不是萬靈丹,實踐也證實,精神分析法在治療飲食紊亂等問題上比CBT更見效。CBT最終是會激起社會研究熱潮,促進其它治療法大力研究自身治療效 果,以說服大眾,保住自己的一席之位。不管怎樣,這顯示了英國以往沉默寡言和保守不前的內質,不願意深入研究自己潛意識的想法,而如今這種特質正在不斷褪去。

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