受苦、轉化與療癒：從日常心理改變過程談「處境結構」取向的治療觀點與架構

Suffering, Transformation, and Healing: a Situational Structure-Based Therapeutic Approach Developed Based on Daily Psychological Change

受苦、轉化與療癒是諮商與心理治療關切的核心議題，本文從日常心理改變過程的探究切入，形成與之相應之治療觀點與架構。藉由存在現象學對受苦與心理改變之實徵研究，受苦轉變乃是受苦者在痛苦的情緒經驗中，發現當下處境與期望處境的矛盾，並決心解決矛盾的過程，轉變過程之本質即在學習處境多義化而展開新籌劃。據此作者發展出處境結構為基礎之治療觀點與架構，以海德格爾（1927/2002）與沙特（1943/2000）之存在現象學闡釋治療觀點，並於文中詳細探究情緒、處境與籌劃的治療意義。本文提出具體之治療架構，包括（1）體察受苦情緒之意義：情緒顯現出處於當下處境之苦，也透露出脫出現有處境之希望，回歸情緒所反映之處境意義方能洞悉處境中的矛盾意涵；（2）改變決心的催化：經由情緒意義之探討，協助個案將自己視為行動之因，而非受處境所決定之果，以激發個案改變決心；（3）開展置身處境之多義化：透過Sartre（Cannon,1991）之「前進—回溯法」探討個案之過往生命處境、現有處境與未來之期望處境，並透過存在焦慮與存在罪惡之探討，使個案對處境之認識出現多義化之觀點；（4）修正原來籌劃：透過對過去—現在—未來之處境的重新理解，探討處境中的兩難限制，形成可具體籌劃的未來。而治療過程也是從非本真朝向本真的過程。

Suffering, transformation, and healing are key aspects of counseling and psychotherapy. In this study, we explored daily psychological change to develop corresponding therapeutic perspectives and frameworks. Empirical existential phenomenology studies on suffering and psychological change have revealed that an individual's perception of suffering arises from the rejection of an existing situation and the unfeasibility of an expected situation to come into being; the disaccord between the existing and expected situations leads to a state of rootlessness. The steps involved in the transformation of suffering into healing are as follows: (1) The sufferer uses emotion as a tool to reflect on the feasibility of the original project and the meaning of the world. (2) The sufferer conceives of the experience of transformation as a process of learning, in which the key is to revise the original project and accept the world as a threat. (3) By perceiving transformation as learning in the context of painful emotions and accepting the new perspectives offered by others, the sufferer discovers that the unfamiliar situation they encounter differs from that encountered in the past and they start resolving the conflict between their past and present; this process includes the individual's willingness to resolve their problems, a new understanding, and acceptance of their past, and a struggle to resolve the contradiction across the three dimensions of time: past, present, and future. (4) After the painful learning process, the sufferer is presented with new situations or possibilities and can commit to a new future. The aforementioned learning process has several therapeutic implications. First, individuals should view suffering as a problem that must be solved and develop an expectation that the problem can be solved. A problem indicates that the existing situation can no longer be explained or managed based on the individuals' previous experience and they must develop another strategy to solve it. Expectation suggests that the sufferer is impatient with their current situation and must find another means to solve their problem. Therefore, at this stage of therapy, emotional exploration and determination should be the central aspects. Second, the process of learning involves a new understanding of the past, an exploration of future expectations, and an integration of the differences across the three dimensions of time. Therefore, therapists should not only help their patients to explore the past but should also discuss with them the past in the context of future expectations. During treatment in the present (now), the differences between the past and future dimensions should be resolved. At this stage, treatment should be focused on facilitating the emergence of ＂polysemy＂ in the patient's situation. Third, learning is a process of problem-solving that involves perceiving previous experiences as false and developing the appropriate strategy to cope with a new situation. Therefore, while promoting the polysemization of their patient's situation, a therapist should also explore how the patient responds to a situation and gradually revise the existing project of their clients. Finally, in the process of learning, the individuals who are suffering perceive and approach their problems based on similar problems encountered by others and their acceptance and recognition of their problems; thus, these individuals consider the external or existing theories as a new framework that enables them to understand everything that happens to them. Therefore, treatment should include the provision of a new perspective and framework to help the sufferer to understand their own experience differently. Therefore, therapists, like others, must facilitate self-reflection among their patients and provide a new framework or formal theory, thus helping the patient to reflect on themselves and use the new framework to understand their situation better. In addition, therapists should recognize, accept, and witness the improvement in their patients as they move toward a different future. In this study, a therapeutic perspective and framework were developed based on the theory of situational structure, which comprises situations and projects. A situational structure is not subjective because it involves people and tools other than oneself. These situations cannot be selected or controlled. However, the situational structure is not objective either because the situation is illuminated for individuals' projection and the situational structure is unique across people and exists only for oneself. We can interpret the world and a situation in a certain manner, always projecting our next step and future. Fischer (1986) argued that a project is a basic unit and core construction of human psychology. Humans can be defined by a series of interrelated and sometimes discrepant projects. A project is ＂action from the past towards the future,＂ and projecting always relates to a situation. In situations, we make decisions and projects for the future; all our actions are bound within situations. Without reflection in our lives, we perceive situations as the cause and determinant of our actions; therefore, we often feel constrained and decisive by situations. Sartre (1943-2000) contended that a situation offers motives rather than causes. We tend to translate our factual understanding of ourselves into our situation. Our understanding of a situation is based on our previous and current experiences and forms the basis for our future actions. In this regard, a situation is a motive for future actions; an individual chooses to perceive a situation in a certain manner and respond to it. Therefore, in therapy, the situation is not considered a determinant of a patient's behavior but rather a motivator. Understanding the deep context motivating their patient's behavior may help therapists decipher what the patient is attempting to respond to through such behavior. Generally, a patient's behavior is a response to their situation, although they may not be aware of it sometimes. The psychological distress associated with a humanistic orientation arises from the conflict between an individual's project and the world in which they reside. Psychological distress may persist if one considers that the individual and the world are in an unchangeable fallen state. Symptoms and psychological distress are regarded as resulting from an individual's lack of patience to remain in an unauthentic state. Therefore, symptoms and psychological distress indicate a desire to pursue authenticity and positive outcomes. Heidegger's uncanny and Sartre's bad faith were used to explore the meaning of suffering and develop a therapeutic approach based on existential phenomenology. This article describes the therapeutic significance of emotion, situation, and project in detail. In addition, a specific framework of treatment is proposed, which includes the following: (1) The meaning of experiencing suffering emotions is explored. Emotions indicate the pain experienced by individuals from remaining in their current situation and the expectation of overcoming the situation. The contradictory meaning of a situation can be understood only by considering the meaning of it vis-à-vis in terms of emotions. (2) A patient's willingness to change must be strengthened. Through a discussion of the meaning of a situation based on emotions, therapists can help their patients view themselves as the cause of their actions, rather than as the result of their situation, and this can enhance the patient's willingness to change. (3) Polysemization of the situation is essential. Through Sartre's progressive-regressive method, therapists can discuss their patients' situations across the three dimensions of time. Furthermore, the patients' understanding of their situations can be polymerized through a discussion of existential anxiety and guilt. (4) The original project must be revised. Based on a new understanding of the past-present-future situation, therapists can discuss the dilemma or conflict in their patients' situations and help develop a framework for the future that the patients can project concretely. Furthermore, healing is a process of transformation from inauthenticity to authenticity.