理解解离部分与Janina Fisher博士

大家好，我是莎拉·赫斯蒂希，欢迎收听《复杂创伤播客》。

Hi, I'm Sarah Herstich, and welcome to the Complex Trauma Podcast.

我是一名EMDR和躯体创伤治疗师，热衷于帮助人们从创伤的影响中重拾生活。

I'm an EMDR and somatic trauma therapist, and I'm passionate about helping people reclaim their lives from the impact of trauma.

如果你正在努力疗愈，却仍不明白为什么你的身体无法配合，或者为什么你就是无法轻易翻过这一页，那你来对地方了。

If you're working on healing and still wondering why your body won't get on board, or why you can't just move past all of this already, you're in the right place.

我们会探讨你神经系统中真正发生的事情、你一直经历的创伤反应，以及为什么这一切远没有人们说得那么简单。

We talk about what's actually happening in your nervous system, the trauma responses you've been living with, and why none of this feels as easy as people make it sound.

没有速成方案，也不假装这一切很容易，只有坦诚地讨论复杂创伤究竟带来了什么，以及真正恢复自我需要付出怎样的努力。

No quick fixes, no pretending any of this is easy, just honest conversations about what complex trauma does and what it actually takes to feel like yourself again.

让我们开始吧。

Let's get into it.

很多人说，我童年很好，没什么可怕的事情发生过。

So many people say I had a good childhood, nothing terrible really happened.

我只是不怎么记得那些事了。

I just don't remember much of it.

其他人描述自己感到与情绪脱节，或者感觉自己的某些部分不属于同一个人。

Others describe feeling detached from their emotions or like parts of them don't belong to the same person.

如果所有这些——空白的记忆、情感的疏离、碎片化的体验——都是同一种保护机制的不同表现呢？

What if all of that, the blank spaces, the disconnection, the fragmentation were different expressions of the same protective process.

今天，我邀请到了费舍尔博士。

Today, I'm joined by Doctor.

珍娜·费舍尔，创伤与解离领域最顶尖的专家之一，来和我们深入探讨解离、部分工作以及其间的一切。

Janina Fisher, one of the foremost experts in the trauma and dissociation field to talk all about dissociation, parts work, and everything in between.

珍娜·费舍尔是一位持证临床心理学家，曾任哈佛医学院讲师。

Janina Fisher is a licensed clinical psychologist and a former instructor at Harvard Medical School.

她是创伤治疗领域的国际专家，同时也是创伤研究基金会的执行委员会成员和约翰·鲍尔比中心的赞助人。

She's an international expert on the treatment of trauma, and she is an executive board member of the Trauma Research Foundation and a patron of the John Bowlby Center.

费舍尔博士。

Doctor.

费舍尔博士撰写了多部著作，并发表了大量同行评审的期刊文章。

Fisher is the author of a number of books, as well as numerous peer reviewed journal articles.

她的治疗方法——创伤知情稳定治疗，如今已在世界各地推广。

Her treatment model, Trauma Informed Stabilization Treatment is now being taught around the world.

我喜欢珍娜谈论解离和部分工作的方式，我认为这能真正帮助人们理解他们当下的体验，这些体验源于他们所经历的一切。

I love the way that Janina talks about dissociation and parts work, and I think you can really help people make sense of their experience in the here and now as a result of all that they've been through.

好的，我们开始吧。

Okay, let's get into it.

相信你会喜欢这一期的。

Know you're going to enjoy this one.

欢迎回到复杂创伤播客。

Welcome back to the complex trauma podcast.

我非常期待今天的节目。

I'm so excited for today's episode.

我今天邀请到了费舍尔博士。

I'm joined by Doctor.

珍娜·费舍尔对我的临床成长和实践产生了深远影响。

Janina Fisher, who has been such an influential person in my development as a clinician and in my practice.

非常感谢你来到这里，贾妮娜。

So thank you so much for being here, Janina.

哦，我很荣幸。

Oh, my pleasure.

我很荣幸。

My pleasure.

我知道你想聊聊我最喜爱的话题之一，那就是解离。

I know you want to talk about one of my favorite topics, which is dissociation.

是的，是的，当然。

Yes, yes, absolutely.

我知道你是讨论这个话题的完美人选。

I knew that you would be the perfect person to talk about this.

最近在我的Instagram故事里，我一直在纠结解离和羞耻感之间的关系，于是做了一个小投票，结果 overwhelmingly 的人希望了解解离。

And in my Instagram stories recently, put in because I was going back and forth like dissociation or shame and how they overlap, but I put a little poll and overwhelmingly people want to learn about dissociation.

我知道你几十年来一直帮助人们理解解离是一种卓越的生存反应，而不是一种缺陷。

So I know that you've spent decades helping people understand dissociation as a brilliant survival response rather than a flaw.

我想从这里开始，先定义一下什么是解离，它是如何表现的，以及它实际上是神经系统一种极其聪明的生存反应。

And I'd love to just start there to start by defining what dissociation is and how it can show up and how it really is a brilliant survival response of the of the nervous system.

所以

So

对。

Right.

它之所以被污名化和病理化，是因为过去关于多重人格障碍的种种争议。

And it's, you know, it's only been a bad word and pathologized because of the all the controversy about what used to be known as multiple personality disorder.

现在叫分离性身份识别障碍。

And now DID.

所以它背上了坏名声。

So it got a bad I got a bad rap.

嗯。

Mhmm.

实际上，解离是一种心理能力。

This dissociation is actually a mental ability.

这是一种分散注意力的能力，也就是说，当它作为一种心理能力被使用时，而不是仅在创伤情境下使用时，它对于任何顶尖表现者都是至关重要的，因为这就是为什么棒球运动员在失去父母后，

And it's the ability to divide one's attention so that, you know, again, when it's used as a mental ability, instead of having to be used in the context of trauma, it is essential for any peak performer because, you know, that's why the baseball player loses a mother or father.

第二天却依然能击出致胜全垒打的原因——因为我们拥有分散注意力的能力。

And then the very next day, you know, hits the winning home run because we have that ability to divide our attention.

还有医疗人员和急救人员。

And also I think medical personnel and EMTs.

对吧？

Right?

当你需要调用所有这些复杂的信息来救治一个人时，怎么能不感到一丝恐慌呢？

How do you how do you call on all this complex information needed to treat somebody when and not feel a moment of panic.

所以我认为，我们没有意识到的是，这是一种大脑使用的心理能力。

So I I think I think what we don't realize is that it's a mental ability that the brain uses.

我们并不能选择是否要解离。

We don't choose to dissociate or not.

大脑会利用解离来帮助我们表现得更好。

The brain uses dissociation as a way to help us perform better.

那么在创伤和大脑帮助我们在不同情境中生存的能力方面，你能谈谈这一点吗？

And then in terms of trauma and the brain's ability to help us survive in different situations, can you talk some some about that?

你知道，大脑优先考虑生存。

You know, the brain prioritizes survival.

所以，我们通常认为大脑就像我们在日常生活中使用的那样。

So, so, you know, we we like to think of the brain as as, you know, more how we use it in everyday life.

但实际上，大脑负责确保我们的生存，确保我们在无意识的脑层面，为所处的任何环境选择最佳的适应方式。

But in fact, the brain is in charge of ensuring our survival, making sure that we again, unconsciously at a brain level, we choose the best adaptation for whatever circumstances we're in.

它做得相当不错。

It does a pretty good job.

环境可能很糟糕，但大脑在很好地发挥作用。

The circumstances may be terrible, but the brain's doing a good job.

是的，毫无疑问。

Yes, for sure.

对。

Yeah.

它正在做它需要做的事，当然。

It's doing what it needs to do to yeah.

你说得完全对。

Exactly what you said.

帮助我们生存。

Help us survive.

没错。

Right.

没错。

Right.

并且适应。

And adapt.

当然。

Absolutely.

我知道在我的实践中，尤其是，我们经常遇到一些人，他们来的时候说，这些症状正在发生。

I know in in my practice in particular, we see a lot of folks who who come into the practice and say, like, of these symptoms are happening.

这就是正在发生的事情。

This is what's going on.

但我小时候其实挺好的，只是我不太记得童年时期的很多事情了。

And but I had I had a really I had a decent childhood, but I don't remember a lot of my childhood.

你能给我们讲讲，像这样的情况是怎么发生的吗？

Can you can you provide some education around how things like that happen for folks?

好吧，你要记住的是

Well, you know, the thing to remember is

我们并没有压抑的记忆。

that we don't have repressed memories.

脑扫描研究显示，大脑并不会对创伤事件形成清晰的事件记忆。

Memories of trauma as the brain scan studies show, show that the brain does not form clear cut event memories of traumatic events.

所以并不是当事人在压抑记忆。

So it isn't that the person is repressing.

他们根本没有记忆来告诉自己曾经出过问题。

They don't have memories that tell them that something was wrong.

我们还知道，大脑的左半球比右半球更积极。

And we also know that that the left hemisphere of the brain is more positive than the right.

右半球是我们的情感脑。

The right hemisphere is our feeling brain.

左半球是我们思考的脑。

The left hemisphere is our thinking brain.

而思考脑比情感脑要积极得多，这非常有趣。

And the thinking brain is much more positive than the feeling brain, which is very interesting.

你很少会这样想。

You don't often think of it that way.

是的。

Yeah.

当然。

For sure.

当然。

For sure.

所以我认为，在这些情况下，左脑只是在报告它所掌握的事实。

So I think the left brain in those cases is reporting the facts it has.

但你知道，当你逐渐了解客户一段时间后，你会开始发现事情并不完美。

But you know, as you know, after you get to know the client for a while, you begin to see that all was not perfect.

事情并不完全顺利。

All was not totally well.

如果我们不施加压力，不坚持认为他们的童年比他们记忆中的更艰难，那就会成为一个问题。

And if we don't push it, if we don't get into a struggle with the client insisting that they had a much more difficult childhood than they remember, then it's a problem.

但如果我们附和他们，说‘哦，这太棒了’。

But if we join them in saying, oh, that's so wonderful.

你拥有完美的童年。

You had a perfect childhood.

通常，他们会开始说‘是的，但是’，然后更多的信息就会浮现出来。

Usually, they start to say yes, but and then more emerges.

是的。

Yeah.

那对于那些在当下有更具体解离体验、能够明确描述出来的人呢？

And what about what about folks who who have more kind of concrete dissociative experiences in the here and now that they can really, they can really name?

我在想那些会失去时间感、感觉不同自我状态在主导的人。

I'm thinking of people who lose time on that feel like there are different self states in charge.

你能谈谈那些经历这种体验的人身上发生了什么吗？

Can you talk some about like what's happening for people who experience that?

我们对这方面了解得较少，因为解离一直是个负面词汇。

Well, that we know less about because dissociation has been a bad word.

关于这方面的研究并不充分。

There isn't good research on it.

但我们现有的理论——虽然有很多理论，但最科学的是阿诺德·范德哈特及其同事提出的结构化解离模型，该模型认为，由于大脑是碎片化的，大脑会利用这种分裂来帮助我们应对创伤、生存和适应。

But what what the theory that we have, I mean, are many theories, but the most scientific theory we have is the structural dissociation model of Arnold Van der Harte and colleagues, which basically says, because we have a fragmented brain, it's the brain makes use of that augmentation to help us survive and adapt to trauma.

这意味着不仅仅是分离性身份障碍（DID）患者才有碎片化的部分。

So which means it's not just people with DID who have fragmented parts.

而是每一位创伤幸存者都是如此。

It's every trauma survivor.

区别在于，创伤后解离性身份障碍（DID）的症状更为极端，包括——这实际上是为数不多的我引用DSM的时候。

The the difference is that in DID you have a more extreme set of symptoms including, which actually this is one of the few times I quote DSM.

我宁愿不去想它。

Prefer not to think about it.

是的。

Yeah.

对。

Yeah.

我们很多人都这样。

Lots of us.

没错。

Right.

DSM指出，要诊断为DID，必须有两个或更多的人格部分能够控制身体，并在个体意识之外运作。

DSM says that two for a diagnosis of DID, two or more parts of the personality have to be able to take control of the body and operate outside of the individual's consciousness.

这就是为什么会出现时间缺失，因为某些部分可以在个体意识之外接管并运作。

And that's why it's time loss because parts can take over and operate outside of the client's consciousness.

而且尽管我们称之为时间丢失，我认为更准确的理解是像一场政府政变。

And that even though we call it lost time, I think it's really better understood as kind of a government takeover.

对吧？

Right?

如果某个部分接管了身体并在客户无意识的情况下行动，那么客户前额叶皮层的统治就被推翻了。

If a part takes over the body and acts outside the client's awareness, the government of the client's prefrontal cortex is overthrown.

你如何帮助客户理解这一点？

How do you how do you help clients make sense of that?

你知道，这其实并不难。

You know, it's really not that hard.

我的意思是，对于D，我不区分DID与其他类型的碎片化，包括复杂性创伤后应激障碍、边缘型人格障碍、OSDD或DDNOS，取决于具体是哪种。

I mean, with D I don't distinguish DID from the other types of fragmentation whether which include complex PTSD, borderline personality disorder, OSDD or DDNOS depending on which Yeah.

是的。

Yeah.

还有DID。

And and DID.

所以我只是教人们。

So so I just teach people.

我的意思是，我经常向他们讲解结构性解离模型，并问他们：这个模型是否让你有共鸣？

I I mean, often I teach them the structural dissociation model, and I ask them, does this model out bring any bells for you?

你体内有没有这些部分？

Do you any of these parts inside you?

大多数人会说：哦，是的。

And most people go, oh, yeah.

在结构性解离模型中，我认为它是唯一一个将这些部分理解为由生存反应驱动的模型。

And in the structural dissociation model, it's it is I think the only it's the only parts model that understands the parts as being driven by survival responses.

这意味着你有一个左脑的、以语言为主的部分，负责应对日常生活；还有一个右脑的情绪性人格部分。

So it means that you have a left brain, fat based verbal carrying on with whatever life brings us, And a right brain emotional part of the personality.

然后还有由战斗、逃跑、恐惧、顺从和求救驱动力所驱动的子部分。

And then these subparts driven by the fight flight, fear, submission, and cry for help drives.

这对我来说更有意义。

Which makes to me much more sense.

较旧的模型认为这些部分储存着记忆，我们需要帮助它们下载这些记忆。

Older models that that understood the parts as holding memories which we were then supposed to help them download.

是的。

Yeah.

这个理论认为，问题不在于记忆。

This theory says the it's not about memory.

而在于这些部分仍在预期危险。

It's about how the parts are still anticipating danger.

所以，如果有什么事情看起来具有威胁性——无论是共情失败、飞驰的子弹，还是有人表现出攻击性——战斗部分就会以愤怒做出反应。

So if something seems threatening, whether it's an empathic failure, whether it's a speeding bullet, whether it's somebody being, you know, aggressive, the fight part reacts with anger.

同时，战斗部分还主导着不信任、过度警觉，也就是我所说的创伤后偏执。

And also the fight part is in charge of things like mistrust, hypervigilance, what what I call post traumatic paranoia.

你知道的，另一只鞋即将落地，总怀疑自己会被背叛或利用。

You know, the other shoe is going to drop suspecting that they're gonna be betrayed or exploited.

逃跑部分则会逃离。

The flight part can run.

我的意思是，人类确实会逃跑。

I mean, humans do run.

这并不罕见。

It's not unheard of.

但在成年人中，逃避部分更多是通过药物、酒精和饮食失调来逃避。

But but more often in adults, the flight part flees using drugs, alcohol, and eating disorders.

顺从部分，你知道，你需要思考所有涉及顺从的因素，以及我们的客户为何常常别无选择，只能顺从。

The submit part is, you know, you have to think about all the things that that go into submission and how frequently our clients had no other choice but to submit.

没错。

Right.

没错。

Right.

无论是抑郁和羞耻，还是取悦他人和照顾他人，或者感到自己不如人。

And whether it ranges from depression and shame or people pleasing and caretaking or, you know, feeling less than.

顺从部分设计得非常巧妙，而且它还会责怪自己遭受了虐待。

The submit part is really well designed to and also the submit part blames herself for the abuse.

嗯。

Mhmm.

对。

Right.

对。

Right.

对抗的部分不会责怪自己。

The fight part would not blame itself.

我知道。

I know.

所以我认为人们普遍有一种直觉。

So I think there's a kind of intuitive sense that people generally have.

有时候，我只要开始谈论部分，客户就会开始谈论他们的部分。

Sometimes all I need to do is start talking about parts and clients start talking about parts.

然后，偶尔也会有人担心，如果他们承认自己有部分，就意味着他们真的疯了。

And then, you know, occasionally, are people who are afraid that if they acknowledge they have parts, it means they really are crazy.

所以这稍微难一点。

And so that's a little a little harder.

是的。

Yeah.

因为那种刻板印象，我是说，是可以理解的。

Because that stereotype I mean, it's understandable.

最令人惊讶的是，我治疗过的客户中有百分之九十都非常配合。

The most amazing thing is that ninety percent of the clients I've treated have been really receptive.

只有百分之十左右的人持负面态度。

And only ten percent have been, you know, sort of negative.

当我说，你知道的，每当有人声称他们没有部分时，我总会问：你确定吗？

Then when I say you know, I always say to people when they say they have no parts, I say, Are you sure?

你还好吗？

Are you okay?

我现在真的很担心你。

Now I'm really worried about you.

因为我们其他人也都有一些部分。

Because the rest of us all have parts.

我们都有一些部分。

We all have parts.

我们都有一些部分。

We all have parts.

所以我有点担心。

So I'm a little concerned.

对吧？

Right?

这可能是某个令人担忧的问题的一部分。

This is this might be part of some concerning issue.

对吧？

Right?

嗯哼。

Mhmm.

所以当我们将其正常化时，大多数人，我认为只占极小的比例。

So when we normalize it, most people, I would say it's a tiny percent.

我有一个客户，她对‘部分’这个词最为抗拒，但在与我结束治疗后，她找到了另一位治疗师，并给我发了一封邮件抱怨说，这位新治疗师根本不懂‘部分’的概念，这让我特别开心。

And I think one of the clients I had who put up the biggest battle against the word part, Following the ending of her therapy with me, she found another therapist and wrote me an email to complain that the new therapist knew nothing about parts, which I just loved.

我觉得这太棒了。

I thought it was great.

因为她真的把这一点吸收进去了。

Because she really had taken it in.

对吧。

Right.

是的。

Yeah.

对。

Yeah.

那

What did

我听过你提到过‘求救策略’。

that I've heard you talk about the the cry for help strategy.

你能谈谈这个吗？

Can can you talk some about that?

我觉得在我们的工作中，经常能看到这种现象，也许人们无法用语言表达出来。

I think that that's something that that we often see in our work that maybe people don't don't have words for.

没错。

Right.

没错。

Right.

当然。

Absolutely.

你知道吗，孩子最早的一种生存防御方式就是哭着求救。

You know, it's the first survival defense that children have is crying for help.

我认为这些部分具有引发他人帮助的防御反应。

And I see those parts as having, you know, the defensive response of eliciting help.

但他们深受创伤中依恋方面的影响。

But they're being very affected by the attachment aspect of trauma.

对吧？

Right?

对依恋造成的伤害。

The damage done to to attachment.

所以通常我称这些部分为依恋部分。

So usually the attached parts, I call them attached parts.

这是求助反应的体现，但我认为依恋部分奠定了这一切的基础。

It's where it's the cry for help response, but I think attached parts sets it all.

它们一直在努力让别人关心自己。

They they are constantly trying to get people to care about them.

嗯。

Mhmm.

因为我的一位客户说过，她说，你知道，如果有人爱你，你就得到了保护。

Because as my client as one of my clients says, she says, you know, if somebody loves you, you're protected.

如果你是个孩子，却没人爱你，那你就是死路一条。

If you're a kid and nobody loves you, you know, you're dead meat.

是的。

Yeah.

而且这确实是事实。

And and it's true.

这正是最令人难过的地方。

That's the sad thing about it.

所以经常是这样，那会是谁呢？

So often and who was it?

有人刚跟我讲起一个案例，我记得是谁了，是一对夫妻的案例，妻子就像个小孩子，只希望丈夫爱她，对她没有任何期待，永远不会对她生气或失望。

Somebody was just telling me about oh, I remember who it was, about a case like this where the it's a couple's case and the wife is like a little child just just wanting her husband to love her and have no expectations of her and never be mad at her or disappointed in her.

依附的部分希望被特别对待，而你知道，也就是说，在人际关系中。

The attached parts want to be special and often then, you know I mean, you know relationships.

在关系的初期，很容易感到自己是特别的。

It's very easy to feel special in the early stages of a relationship.

五年或十年后，很难再感到特别了。

It's harder to feel special five or ten years later.

嗯。

Mhmm.

是的。

Yeah.

所以这最终成了一个问题。

So so that ends up being a problem.

依附型的人对拒绝也非常敏感。

The attached parts are also super sensitive to rejection.

他们有很强的分离焦虑和被抛弃的恐惧。

They have a lot of separation anxiety and fear of abandonment.

他们往往会把治疗师拉入其中。

And they tend to pull the therapist in.

因为我们就在那里提供帮助。

Because we're there to help.

这些部分一直在说：帮帮我，帮帮我，帮帮我。

And these are parts who are saying help me, help me, help me.

对。

Right.

所以治疗师往往会不由自主地被吸引，然后突然意识到，他们以为这是客户本人，但实际上这只是客户的一个部分，紧紧黏着他们，无法在疗程结束时离开办公室，每天发成千上万条信息，问你还在不在，是否还关心他们。

So so therapists tend to be drawn in and then suddenly realize that this what they think of this as the client, but actually it's a part of the client, is glued to their hip who can't leave the office at the end of sessions, who write a million texts a day asking if you're still there, if you still care.

经过几个月甚至几年后，这让我觉得精疲力尽，也成了真正开展治疗工作的障碍。

And after, you know, after a few months of it or years, this is is just I think overwhelmed and also finding it's a barrier to actually doing work.

嗯。

Mhmm.

因为如果你的客户——或者说是这个依附性部分——整个疗程都在 obsessively 担心被抛弃。

Because if your client, so to speak, or the this attached part spends the whole session obsessing about abandonment.

你正在抛弃她。

You're abandoning her.

我们无法进行治疗工作。

We can't do therapeutic work.

对。

Right.

所以那个部分，还有对抗的部分。

So that and the fight part.

如果对抗的部分在贬低我们，就很难开展任何有意义的工作。

So if the fight part is devaluing us, it's hard to do any meaningful work.

如果依附的部分只是说，你关心我吗？

If the attached part is just said, do you care about me?

你为什么没有回复我的短信？

Why didn't you answer my text?

对。

Right.

对。

Right.

你是不是要走？

Like, are you going anywhere?

是的

Yeah.

是的

Yeah.

对

Right.

对

Right.

没错

Exactly.

是的

Yeah.

你有没有发现，依附部分和冲突部分经常相伴出现、循环往复？

Do you see the the attached parts and fight parts kind of cycling through often hand in hand?

是的

Yeah.

我认为发生的情况是，依附部分的痛苦会触发对抗部分出来反击。

I think I think what happens is the distress of the attached part triggers the fight part to come out fighting.

嗯。

Mhmm.

当我问人们哪个部分最让他们困扰时，这就是我发现的。

And that's what I found when I would ask people which parts give you the most difficulty.

他们几乎总是说依附和对抗。

They would almost always say attach and fight.

他们会描述这个循环：有人伤害了我依附部分的感受，然后我的对抗部分就对他们大发雷霆。

And they would describe that cycle like somebody hurts the feelings of my attached part And then my fight part freaks out at them.

嗯。

Mhmm.

是的。

Yeah.

然后呢？

And then what?

然后呢？

And then what?

我很好奇。

I'm curious.

然后，通常这会促使依附部分变得更加粘人。

And then usually, that triggers the attached part to be even more clingy.

而这，你知道，无论是伴侣、约会对象还是治疗师，你都会看到这个人的实际年龄。

Which again, you know, whether it's a partner, a date or a therapist, you see the chronological age of your of this person.

但你不会想，哦，现在她只有两岁。

And you don't think, oh, right now she's two.

因此，当我们与这个成年人交谈时，不可避免地会以某种方式触动依附部分的情绪。

So invariably, we are going to as we talk to this adult body, we're going to say something in a way that distresses the attached part.

然后，对抗部分就会对我们大喊大叫。

And then the fight part is going to yell at us.

接着，依附部分会抓得更紧。

And then the attached part is gonna cling harder.

然后对抗部分会更加愤怒。

And then the the fight part is going to be even angrier.

嗯。

Mhmm.

是的。

Yeah.

对。

Yeah.

而轻微部分会威胁要离开。

And slight part will threaten to leave.

嗯。

Uh-huh.

对。

Right.

是的。

Yeah.

如果有人在听这个，并且他们真的能产生共鸣，我觉得人们会对你们所分享的关于不同部分及其表现方式和可能传达的信息产生共鸣。

If someone's listening to this, and they really identify with and I think people will with with what you're sharing about, you know, the different parts and how they how they show up and might what might be coming across.

你建议他们该如何应对这种情况呢？

What what would you suggest they they do with that?

你知道，关于解离，很多时候人们都在谈论安全，寻找安全感。

You know, I think that with dissociation, a lot of times people are talking about like safety and find safety.

人们会说：你到底什么意思，安全？

And people are like, what the heck do you mean by by safety?

这到底指的是什么？

Like what what in the world is that?

你建议人们接下来该往哪里走？

Where where would you suggest that people go next?

我同意你关于安全的看法。

Well, I agree with you about about safety.

我们关心的是安全。

We're concerned about safety.

这就像向爱斯基摩人卖冰箱一样。

But it's like selling refrigerators to Eskimos.

对。

Right.

对于那些从未体验过安全的人来说，把安全当作目标简直是不可能的。

As people who've never known safety to have it as a goal.

所以他们只是想感觉好一点，或者减少情绪的起伏和戏剧性的危机。

So they just want to feel better or they want to have less ups and downs or dramatic crises.

你知道，我用的是我自己的创伤知情部分模型，叫做创伤知情稳定化治疗，简称TIST。

You know, I what I do is I use my my own trauma informed parts model, just called trauma informed stabilization treatment or TIST.

之后通常就会顺利多了。

And and and then it's usually pretty easy sailing after that.

你能给我们讲讲这个过程的主要要点吗？

Can you give us like the highlights that the headlines of of what that might look like?

创伤知情稳定化治疗（TIST）是创伤知情的，它融合了多种不同疗法的理念和干预方法，包括内在家庭系统疗法、躯体疗法、临床催眠，甚至一些认知行为疗法的技术。

So, so trauma informed stabilization treatment, or TIST is trauma informed and it combines ideas and interventions from a lot of different modalities, from internal family systems, from somatic therapy, from clinical hypnosis, even some CBT techniques.

而且这是以正念为基础的。

And it's mindfulness based.

所以，当客户基本接受了这个模型后，比如我说了些什么伤害了依附部分，导致依附部分非常不安时，我就会说：‘哦，苏西，我触发了你的依附部分。’

So what we do is once the client has has sort of accepted the the model, Then when the, you know, when let's say I've said something that hurt the attached part and the attached part starts to be very upset, then I would say, oh, so and so, you know, Susie, I triggered your attached part.

注意，你的依附部分现在非常非常不安。

Notice your attached part is very very upset.

因为从早期关于创伤反应的脑扫描研究中，我们知道当人们被触发或感到威胁时，前额叶皮层会关闭，以便让我们调动本能反应。

Because one of the things we know from the very early brain scan research on traumatic responses is that when people are triggered or threatened, the prefrontal cortex goes offline to help us access our instinctive responses.

所以，我根本不知道苏西是否还在这间房间里。

So I don't know that Susie is even in the room.

我只知道这个小小的依附部分因为我说了句话而彻底崩溃了。

All I know is this little attached part is freaking out because I said something.

你要去度假了。

You're going on vacation.

是的。

Yeah.

对。

Right.

对。

Right.

或者我说过我们必须停止。

Or I've said we have to stop.

嗯嗯。

Mhmm.

该结束了。

It's time to wrap up.

是的。

Yeah.

对。

Right.

对。

Right.

所以TIST的核心是帮助人们觉察各部分之间的互动。

And and so so the essence of TIST is helping people to notice the interplay of parts.

对吧？

Right?

注意那种感觉，那是感到被遗弃的那部分的感觉。

So notice that feeling as the feeling of this part who's feeling abandoned.

然后注意愤怒部分或对抗部分的愤怒。

And then and then notice the anger of the angry part or the fight part.

嗯。

Mhmm.

哦，我现在注意到，那个依附部分或小孩部分更担心愤怒部分会把我推开。

And and and oh, I noticed now the the attached part or the little part is getting more worried that the angry part will drive me away.

对吧？

Right?

所以帮助人们觉察——这其实很简单，但需要练习，因为我们大多数人习惯于对想法和感受做出反应，而不是仅仅觉察它们。

So helping people and it's it's very simple, but it does take practice because most of us are used to reacting to what we think and feel rather than just noticing it.

对。

Right.

是的。

Yeah.

所以这是一种正念，但不是指冥想意义上的正念，而是所谓的日常正念——你只是逐 moment 地觉察环境中正在发生什么，以及你对这些所产生的情绪、想法和身体反应。

So it's mindfulness not in the sense of meditation, but what's called everyday mindfulness where you just notice moment by moment what's happening in the environment and what thoughts, feelings, and physical reactions you're having to that.

我只是注意到时间了，而且我知道你日程很忙，我想尊重你的安排。

I'm just aware of the time and I, you know, I wanna honor, you know, your busy schedule.

所以最后一个问题，如果你能给那些意识到自己有解离困扰的人，或者经历过一些人生创伤的人传递一条信息，你会说什么？

So just one last question, if you could, if you had one message to send to folks who recognize that they struggle with dissociation, or just people who have been through some stuff in their life, What what message would would you send them?

嗯，

Well,

我有很多话想说。

I've there's so many.

我知道。

I know.

但很难。

But hard.

是的，我会说，对你如何幸存下来以及这些部分如何帮助你生存保持好奇和兴趣。

Yeah, I would say, be curious and interested in in how you survived and how these parts helped you to survive.

你知道，在这个领域，我认为我们的错误在于过于关注事件本身。

You know, in the field, I think my opinion is that we make a mistake by focusing on events.

因为发生在我们身上的细节并不是我们现在所承受痛苦的根源。

Because the details of what happened to us are not what we suffer from now.

我们所承受的是这些事件带来的影响。

We suffer from the effects of those events.

因此，对你是如何幸存下来的保持好奇，往往能帮助你看到这些部分是如何成为你的生存团队，并让你意识到你确实幸存并适应了，因为很少有创伤幸存者会觉得自己已经挺过来了。

And so being curious about how you survived often helps you to see how the parts were your survival team and helps you appreciate that that you really did survive and adapt because very few trauma survivors feel like it's over and I survived.

嗯。

Mhmm.

对。

Yeah.

非常感谢你分享这些。

Well, thank you so much for that.

也非常感谢你今天抽出时间来和我们讨论这个话题。

And thank you so much for taking the time to come on today and talk some about this.

真的很感谢你的时间，以及你为如此多的人、众多临床医生、还有世界上无数人所付出的努力。

Really appreciate your time and all of the work that you've done for so many people, so many clinicians, so many, you know, people out in the world.

这真的令人惊叹。

It's really incredible.

哦，谢谢你，莎拉。

Oh, thank you, Sarah.

非常感谢你。

Thank you so much.

对于想要更多了解你的人，他们可以在哪里找到你呢？

And for folks who just want to learn more about you, where where can they find you?

他们可以访问 jenninafisher.com。

They can find me at jenninafisher.com.

好的，太棒了。

Okay, awesome.

我会确保在我们的节目笔记中附上这个链接。

Well, I will be sure to link that in our show notes.

再次感谢你抽出时间，下周我们会再回来带来另一期节目。

And again, thank you so much for your time and everyone will be back next week for another episode.

到时候再聊。

We'll talk to you then.

感谢收听《复杂创伤播客》。

Thanks for listening to the Complex Trauma Podcast.

如果这期节目对你有帮助，最好的方式就是分享给需要听到它的人。

If this episode helped, the best thing you can do is share it with someone who needs to hear it.

如果你有空，留下一个评价真的能帮助其他人找到这个播客。

And if you have a minute, leaving a review really does help other people find the podcast.

你可以在Instagram上关注Sarah Herstich LCSW，获取更多节目之间的更新。

You can follow along on Instagram at Sarah Herstich LCSW for more in between episodes.