Ly thuyet gan bo dai dien cho mot trong nhung khuon kho vung chac nhat va duoc xac nhan tot nhat trong khoa hoc moi quan he. Bat dau tu nghien cuu tien hoa cua John Bowlby ve moi ket noi giua tre so sinh va nguoi cham soc, va duoc mo rong sang cac moi quan he lang man cua nguoi lon vao nam 1987, cac phong cach gan bo du doan su hai long trong moi quan he, do ben, cac kieu mau giao tiep va suc khoe cam xuc voi su nhat quan dang chu y tren nhieu nen van hoa va dan so.

Bao cao toan dien nay tong hop nghien cuu tu hon 50 nghien cuu trai dai 55 nam de cung cap su hieu biet day du ve bon phong cach gan bo nguoi lon: An toan, Lo au-Ban khoang, Ne tranh-Bac bo va So hai-Ne tranh (Vo to chuc). Moi phong cach phan anh cac kieu mau khac biet trong cach moi nguoi nhin nhan ban than, nhin nhan nguoi khac, quan ly su than mat va phan ung voi cac moi de doa moi quan he.

Nhung phat hien chinh:

• Khoang 55-60% nguoi lon the hien gan bo an toan, trong khi 40-45% the hien cac kieu mau khong an toan du doan kho khan moi quan he
• Cac phong cach gan bo co cac dau chi sinh hoc co the do luong, bao gom cac kieu mau kich hoat nao khac biet trong cac trung tam xu ly phan thuong va cam xuc
• Cac kieu mau gan bo khong an toan co the thay doi thong qua lieu phap dua tren bang chung, voi ty le thanh cong 70-80% cho Lieu phap Tap trung vao Cam xuc va 60-70% cho Lieu phap Hanh vi Nhan thuc
• Gan bo so hai-ne tranh, kieu mau phuc tap nhat anh huong den 5-10% nguoi lon, the hien ty le cao nhat cua cac trieu chung roi loan nhan cach va doi hoi dieu tri chuyen mon am hieu chung thuong

Phan I: Nen tang Ly thuyet

Nguon goc cua Ly thuyet Gan bo

John Bowlby da cach mang hoa tam ly hoc phat trien thong qua cong trinh dot pha cua ong ve gan bo, thiet lap rang tre so sinh duoc lap trinh sinh hoc de hinh thanh cac moi ket noi cam xuc voi nguoi cham soc chinh. Dua tren ly thuyet tien hoa, nghien cuu hanh vi dong vat va phan tam hoc, Bowlby de xuat rang gan bo phuc vu mot chuc nang sinh ton quan trong: giu cho tre so sinh de bi ton thuong o gan nhung nguoi lon bao ve.

Nhung dong gop chinh cua Bowlby bao gom:

1. He thong Hanh vi Gan bo: Mot he thong dong luc bam sinh duoc kich hoat khi nhan thay moi de doa, thuc day viec tim kiem su gan gui voi cac hinh tuong gan bo

2. Mo hinh Lam viec Noi tai: Cac bieu dien tinh than ve ban than va nguoi khac duoc hinh thanh thong qua cac trai nghiem gan bo som, huong dan ky vong va hanh vi trong cac moi quan he tuong lai

3. Khai niem Can cu An toan: Nguoi cham soc dap ung cung cap mot ben do an toan va mot can cu an toan tu do tre co the kham pha the gioi

4. Giai doan Nhay cam: 2-5 nam dau tien tao thanh cua so quan trong cho viec hinh thanh gan bo, mac du cac kieu mau co the duoc dieu chinh sau nay trong cuoc song

Bang chung ban dau cua Bowlby den tu cac nghien cuu ve nhung nguoi pham phap vi thanh nien, noi ong phat hien rang nhung nguoi co "benh tam than vo cam" da trai qua su tach biet keo dai voi me ho o ty le cao hon dang ke so voi nhom doi chung.

Tinh huong La cua Ainsworth va Cac Kieu mau Tre so sinh

Mary Ainsworth va cac dong nghiep da van hanh hoa ly thuyet cua Bowlby thong qua Quy trinh Tinh huong La, mot danh gia phong thi nghiem do phan ung cua tre so sinh doi voi su tach biet khoi va doan tu voi nguoi cham soc. Nghien cuu dot pha nay da xac dinh ba kieu mau gan bo cot loi (kieu thu tu duoc them sau):

1. Gan bo An toan (Loai B)

• Su dung nguoi cham soc lam can cu an toan de kham pha
• The hien kho so khi nguoi cham soc roi di
• De dang duoc tran an khi doan tu
• Tu tin vao kha nang san sang cua nguoi cham soc

2. Gan bo Ne tranh (Loai A)

• The hien it kho so khi tach biet
• Ne tranh hoac pho lo nguoi cham soc khi doan tu
• Co ve doc lap nhung sinh ly dang bi cang thang
• Ket qua cua viec cham soc khong dap ung nhat quan

3. Gan bo Lo au-Khang cu (Loai C)

• Cuc ky kho so boi su tach biet
• Kho tran an khi doan tu
• Luan phien giua tim kiem va khang cu tiep xuc
• Ket qua cua viec cham soc khong nhat quan

4. Gan bo Vo to chuc (Loai D)

• Hanh vi mau thuan, mat phuong huong
• Co the dong bang, the hien so hai hoac tiep can lui
• Thuong lien quan den nguoi cham soc dang so hoac bi so hai
• Loai nguy co cao nhat cho cac van de tam ly sau nay

Tinh huong La cho thay cac kieu mau gan bo co the do luong, dang tin cay va du doan ket qua phat trien. Tre em an toan the hien nang luc xa hoi tot hon, trong khi tre em khong an toan the hien nguy co tang cao ve cac van de hanh vi.

Mo rong sang Cac Moi quan he Lang man Nguoi lon

Nghien cuu dot pha cua Hazan va Shaver nam 1987 da bien doi ly thuyet gan bo bang cach cho thay cac kieu mau tre so sinh-nguoi cham soc co su tuong dong trong cac moi quan he lang man cua nguoi lon. Nghien cuu cua ho voi 205 nguoi lon cho thay:

• Tinh yeu lang man ve mat khai niem giong voi gan bo tre so sinh (tim kiem su gan gui, kho so khi tach biet, can cu an toan)
• Cac phong cach gan bo tu bao cao tuong quan voi ca moi quan he thoi tho au voi cha me va chat luong moi quan he hien tai
• Khoang 56% nguoi lon bao cao gan bo an toan, 25% ne tranh va 19% lo au

Nguoi lon an toan mo ta moi quan he tinh yeu quan trong nhat cua ho la hanh phuc, than thien va dua tren su tin tuong. Ho bao cao cac moi quan he dai hon, ky uc am ap ve cha me va tin rang tinh yeu lang man co the keo dai.

Nguoi lon lo au trai nghiem tinh yeu nhu su am anh, dac trung boi su khao khat tuong ho, nhung thang tram cam xuc, su ghen tuong cuc do va noi so bi bo roi. Ho bao cao cac moi quan he lanh nhat hon voi cha me va nghi ngo tinh yeu ben vung.

Nguoi lon ne tranh so su than mat, gap kho khan trong viec tin vao tinh yeu lang man keo dai va trai nghiem nhung bien dong cam xuc. Ho bao cao cac moi quan he lanh nhat hon voi cha me va thoi gian moi quan he ngan hon.

Nghien cuu co ban nay thiet lap rang cac kieu mau gan bo duoc hinh thanh tu thoi tho au tao ra "mo hinh lam viec noi tai" dinh hinh ky vong, cam xuc va hanh vi cua nguoi lon trong cac moi quan he than mat.

Mo hinh Bon Loai

Cac nha nghien cuu da tinh chinh he thong ba loai thanh mo hinh bon loai co nhieu sac thai hon dua tren hai chieu:

Chieu 1: Mo hinh ve Ban than (Tich cuc vs. Tieu cuc)

• Phan anh long tu trong va noi so bi tu choi
• Tich cuc: "Toi xung dang duoc yeu va ho tro"
• Tieu cuc: "Toi khong xung dang va se bi tu choi"

Chieu 2: Mo hinh ve Nguoi khac (Tich cuc vs. Tieu cuc)

• Phan anh su tin tuong vao kha nang san sang va thien chi cua nguoi khac
• Tich cuc: "Nguoi khac noi chung dang tin cay va dap ung"
• Tieu cuc: "Nguoi khac khong dang tin cay va se lam toi ton thuong"

Mo hinh Gan bo Bon Loai

Bon phong cach gan bo dua tren mo hinh noi tai ve ban than (truc doc) va nguoi khac (truc ngang)

Phan II: Bon Phong cach Gan bo Nguoi lon

Phong cach 1: Gan bo An toan

Dinh nghia va Ty le Pho bien

Gan bo an toan dac trung cho nhung ca nhan thoai mai voi su than mat cam xuc, tin tuong doi tac cua ho va duy tri su can bang lanh manh giua su doc lap va su phu thuoc lan nhau. Nghien cuu nhat quan cho thay khoang 55-60% nguoi lon the hien kieu mau gan bo an toan.

Dac diem Tam ly Cot loi

Nhan thuc ve Ban than: Tich cuc

• Cam giac xung dang duoc yeu va ho tro
• Thoai mai voi su de bi ton thuong
• Khong can su xac nhan ben ngoai lien tuc
• Duy tri long tu trong doc lap voi tinh trang moi quan he

Nhan thuc ve Nguoi khac: Tich cuc

• Tin tuong vao thien chi va su dap ung cua doi tac
• Ky vong rang nguoi khac noi chung se dang tin cay
• Khong tham hoa hoa su khong san sang tam thoi
• Xem moi quan he la nguon ho tro

Dau hieu Hanh vi

Nhung ca nhan co gan bo an toan the hien cac kieu mau dac trung trong boi canh moi quan he:

Giao tiep: Bieu dat cam xuc va nhu cau ro rang ma khong co su so hai hay phong thu qua muc; su dung cac phat bieu "toi"; dat cau hoi lam ro truoc khi gia dinh

Quan ly Xung dot: Tiep can bat dong voi su to mo thay vi phong thu; tim kiem su hieu biet va thoa hiep; nhanh chong sua chua ran nut

Than mat: Thoai mai trong viec cho va nhan tinh cam; co the tro nen de bi ton thuong ma khong so bi loi dung; duy tri su than mat the xac ket noi voi su than mat cam xuc

Tu chu: Ho tro so thich doc lap va tinh ban cua doi tac; duy tri ban sac rieng ngoai moi quan he; thoai mai khi o mot minh va o cung nhau

Tin tuong: Khong tham gia giam sat qua muc hay ghen tuong; gia dinh y dinh tich cuc; su tin tuong duoc xay dung phu hop theo thoi gian

Dieu hoa Cam xuc: Quan ly cang thang ma khong bung no hay dong cua; co the tu tran an trong khi tim kiem su ho tro phu hop

Danh sach Nhan dien

Cac chi so gan bo an toan dua tren nghien cuu:

• Cam thay an toan de bi ton thuong cam xuc voi doi tac
• Bieu dat nhu cau ro rang ma khong so bi tu choi
• Tin tuong vao y dinh va su dang tin cay cua doi tac
• Thoai mai ca khi mot minh va trong moi quan he
• Khong co noi so qua muc ve su bi bo roi
• Thao luan bat dong mot cach binh tinh va mang tinh xay dung
• Cam thay doi tac noi chung dap ung nhu cau
• It ghen tuong hoac chiem huu
• Khong can su dam bao lien tuc ve tinh yeu
• Duy tri tinh ban va so thich ngoai moi quan he
• Co kha nang ho tro ma khong cay dang
• Co kha nang nhan ho tro ma khong kho chiu

Nghien cuu Than kinh Sinh hoc

Khoa hoc than kinh hien dai cung cap bang chung sinh hoc cho su an toan gan bo. Mot nghien cuu doc theo doi thanh thieu nien den tuoi truong thanh, su dung hinh anh nao de do phan ung than kinh trong qua trinh nam tay voi doi tac lang man so voi nguoi la, tiet lo nhung phat hien chinh cho nhung ca nhan an toan:

• Tang cuong kich hoat o cac vung xu ly nhan thuc (vo nao truoc tran)
• Tang cuong kich hoat o cac vung xu ly cam xuc (vo nao dai truoc)
• Tang cuong kich hoat o cac vung xu ly phan thuong (the van bung, nhan cau)
• Phan biet lanh manh giua tiep xuc doi tac (kich hoat cao) va tiep xuc nguoi la (kich hoat vua)

Dau hieu than kinh nay goi y rang gan bo an toan co lien quan den su tich hop nhan thuc-cam xuc duoc tang cuong, phan ung khen thuong manh me doi voi cac moi ket noi xa hoi, su phan biet moi de doa/an toan phu hop va xu ly than kinh hieu qua thong tin xa hoi.

Sinh ly Cang thang: Nhung ca nhan an toan the hien cac kieu mau hormone cang thang lanh manh hon, voi muc nen thap hon va phan ung cap tinh phu hop voi cac tac nhan gay cang thang, sau do la su tro ve hieu qua ve muc nen.

Nguon goc Phat trien

Gan bo an toan phat trien thong qua su cham soc nhat quan va dap ung:

• Nguoi cham soc dap ung dang tin cay khi tre so sinh kho so
• Dieu chinh cam xuc (nguoi cham soc nhan ra va xac nhan cam xuc cua tre)
• Ben do an toan khi cang thang
• Can cu an toan de kham pha
• Nuoi day con "du tot" (khong hoan hao, nhung nhat quan san sang)

An toan Dat duoc: Dieu quan trong la, nguoi lon co tuoi tho khong an toan co the phat trien gan bo an toan thong qua cac trai nghiem dieu chinh, bao gom lieu phap, cac moi quan he lang man an toan hoac cac moi quan he co y nghia khac voi nhung ca nhan san sang ve mat cam xuc.

Ket qua Moi quan he

Nghien cuu cho thay gan bo an toan du doan ket qua moi quan he tot hon tren nhieu linh vuc:

• Hai long: Su hai long va hanh phuc moi quan he duoc bao cao cao hon
• On dinh: Thoi gian moi quan he dai hon va ty le ly hon thap hon
• Than mat: Su than mat cam xuc va the chat lon hon
• Xung dot: Giai quyet xung dot mang tinh xay dung hon va sua chua nhanh hon
• Ho tro: Cham soc va cung cap ho tro lan nhau hieu qua hon
• Nuoi day con: Kha nang cao hon trong viec cung cap gan bo an toan cho con cai cua ho

Phong cach 2: Gan bo Lo au-Ban khoang

Dinh nghia va Ty le Pho bien

Gan bo lo au-ban khoang (con duoc goi la lo au-luu tinh) mo ta nhung ca nhan khao khat manh me su than mat va su dam bao nhung an giau noi so sau xa ve su bi bo roi, dan den su canh giac qua muc voi hanh vi cua doi tac va doi khi cac kieu mau quan he bam dinh, doi hoi hoac kiem soat. Khoang 20% nguoi lon the hien gan bo lo au.

Dac diem Tam ly Cot loi

Nhan thuc ve Ban than: Tieu cuc

• Khong chac chan ve gia tri ban than va su xung dang duoc yeu
• Can su xac nhan ben ngoai de cam thay co gia tri
• Long tu trong thap trong moi quan he
• "Toi co du tot khong?" la cau hoi co ban

Nhan thuc ve Nguoi khac: Tich cuc

• Xem doi tac la tuyet voi va ly tuong hoa ho
• Tin rang nguoi khac co nhung gi ho can
• So mat quyen tiep can doi tac ly tuong hoa
• Noi so "Ho tuyet voi, nhung ho co o lai khong?"

Dau hieu Hanh vi

Nhung ca nhan lo au the hien cac kieu mau nhan biet duoc dua tren noi so bi bo roi:

Canh giac Qua muc: Giam sat lien tuc tam trang, kha nang san sang va su dap ung cua doi tac; phan tich tin nhan va giao tiep de tim dau hieu rut lui; nhan thuc qua muc ve cac moi de doa tiem tang doi voi moi quan he

Tim kiem Su dam bao: Cau hoi "Anh/Em con yeu em/anh khong?" thuong xuyen; nhu cau xac nhan bang loi thuong xuyen; co the thu thach doi tac theo cach gian tiep

Ban khoang: Suy ngam rong rai ve tinh trang moi quan he; kho tap trung vao cac linh vuc khac khi moi quan he co ve khong on dinh; suy nghi am anh ve doi tac

Cuong do Cam xuc: Trai nghiem cac dinh cao cam xuc cuc do (khi doi tac dap ung) va vuc sau (khi doi tac xa cach); thay doi tam trang nhanh chong dua tren hanh vi cua doi tac

Bam dinh va Chiem huu: Gian nan voi thoi gian xa nhau; co the tro nen ghen tuong hoac kiem soat; muon danh phan lon hoac tat ca thoi gian cung nhau

Hanh vi Phan doi: Khi bi de doa, co the leo thang cam xuc (khoc, gian du); su dung bieu hien cam xuc de gianh lai su gan gui; kho giao tiep binh tinh khi dang kho so

Cham soc Cuong buc: Tap trung qua muc vao nhu cau cua doi tac trong khi bo qua nhu cau cua minh; su dung viec cham soc de duy tri ket noi; kho thiet lap ranh gioi

Kho Tu tran an: Khong the lam diu lo au ma khong co su dam bao cua doi tac; doi tac tro thanh nguoi dieu chinh cam xuc chinh

Danh sach Nhan dien

Cac chi so gan bo lo au-ban khoang dua tren nghien cuu:

• So doi tac se roi di hoac ngung yeu
• Can su dam bao thuong xuyen ve moi quan he
• Lo lang qua muc ve cam xuc cua doi tac doi voi ban
• Lo au khi doi tac can khong gian hoac doc lap
• Thuong xuyen kiem tra dien thoai de tim tin nhan tu doi tac
• Phan tich loi noi va hanh dong cua doi tac de tim y nghia an giau
• Ghen tuong hoac cam thay bi de doa boi cac moi quan he khac cua doi tac
• Tam trang phu thuoc manh vao kha nang san sang cua doi tac
• Kho tap trung khi moi quan he co ve khong on dinh
• Muon gan gui hon doi tac co ve thoai mai
• Kho chiu neu doi tac khong phan hoi nhanh
• Cam giac yeu doi tac hon ho yeu ban
• Thu thach cam ket cua doi tac theo cach gian tiep
• Bo be nhu cau cua ban than de lam hai long doi tac
• Trai nghiem nhung dinh cao va vuc sau cam xuc du doi trong moi quan he

Phong cach 3: Gan bo Ne tranh-Bac bo

Dinh nghia va Ty le Pho bien

Gan bo ne tranh-bac bo dac trung cho nhung ca nhan uu tien su doc lap va tu cung tu cap, cam thay khong thoai mai voi su than mat cam xuc va co xu huong giam nhe tam quan trong cua cac moi quan he gan gui. Ho duy tri hinh anh ban than tich cuc nhung co hinh anh tieu cuc ve do tin cay cua nguoi khac. Khoang 15-20% nguoi lon the hien gan bo ne tranh-bac bo.

Dac diem Tam ly Cot loi

Nhan thuc ve Ban than: Tich cuc (Phong thu)

• "Toi on khi o mot minh; toi khong can ai"
• Tu hao ve su tu cung tu cap
• Phu nhan hoac giam thieu nhu cau gan bo
• Duy tri su doc lap nhu ban sac co ban

Nhan thuc ve Nguoi khac: Tieu cuc

• "Moi nguoi khong dang tin cay va se lam ban that vong"
• Ky vong nguoi khac se doi hoi hoac xam nhap
• Xem su phu thuoc cam xuc la diem yeu
• Hoai nghi ve dong co cua nguoi khac

Dau hieu Hanh vi

Nhung ca nhan ne tranh-bac bo the hien cac kieu mau khoang cach cam xuc va tu luc:

Khoang cach Cam xuc: Khong thoai mai voi nhung cam xuc de bi ton thuong; giu cuoc tro chuyen o muc be mat; tri thuc hoa thay vi cam nhan; giam thieu tam quan trong cua cac van de moi quan he

Tu luc: Tu giai quyet van de; hiem khi yeu cau giup do; tu hao ve su doc lap khoi nguoi khac; co the xem nhu cau cua doi tac la ganh nang

Ne tranh Than mat: Khong thoai mai voi su gan gui cam xuc hoac the chat sau sac; duy tri nhung buc tuong cam xuc; tiet lo it ve the gioi noi tam; thich cac hoat dong hon la ket noi cam xuc

Chien luoc Vo hieu hoa: Dam nen nhu cau gan bo; rut lui khi doi tac tim kiem su gan gui; tap trung vao khuyet diem cua doi tac de duy tri khoang cach; su dung cong viec, so thich hoac nguoi khac lam co de tranh su than mat

Bieu dat Dong cam Han che: Kho nhan ra hoac phan hoi nhu cau cam xuc cua doi tac; co the bac bo cam xuc cua doi tac la phan ung qua muc; cung cap giai phap logic thay vi ho tro cam xuc

Danh sach Nhan dien

Cac chi so gan bo ne tranh-bac bo dua tren nghien cuu:

• Danh gia su doc lap va tu cung tu cap tren het
• Khong thoai mai khi doi tac den qua gan
• Thich tu giai quyet van de
• Cam thay nghet tho boi nhu cau cam xuc cua doi tac
• Giam thieu tam quan trong cua cac moi quan he lang man
• Kho chia se nhung cam xuc de bi ton thuong
• Xem su phu thuoc cam xuc la diem yeu
• Rut lui khi xung dot tro nen cam xuc
• Khong nghi nhieu ve moi quan he hay phan tich chung
• Uu tien cong viec, so thich hoac ban be hon thoi gian moi quan he
• Khong thoai mai voi viec the hien tinh cam truoc cong chung
• Hiem khi bieu dat tinh yeu hoac su danh gia bang loi
• Nhe nhom khi doi tac ban hoac muon khong gian
• Xem doi tac la "qua can" hoac "qua cam xuc"
• Thong diep tu thoi tho au: "Dung khoc", "Hay manh me", "Tu lo cho ban than"

Phong cach 4: Gan bo So hai-Ne tranh / Vo to chuc

Dinh nghia va Ty le Pho bien

Gan bo so hai-ne tranh (con duoc goi la gan bo vo to chuc) dai dien cho kieu mau gan bo phuc tap va thach thuc nhat. Ca nhan dong thoi khao khat ket noi than mat va so hai no du doi, dan den cac hanh vi moi quan he khong nhat quan va mau thuan. Phong cach nay thuong bat nguon tu cac trai nghiem thoi tho au noi hinh tuong gan bo chinh, nguon an toan, cung la nguon so hai. Khoang 5-10% nguoi lon the hien gan bo so hai-ne tranh/vo to chuc.

Dac diem Tam ly Cot loi

Nhan thuc ve Ban than: Tieu cuc

• "Toi khong xung dang, hong va co ban khong dang duoc yeu"
• Su xau ho sau xa ve ban than
• Cam giac bi hu hong hoac co khuyet diem
• Tin rang khong xung dang nhan tinh yeu

Nhan thuc ve Nguoi khac: Tieu cuc

• "Moi nguoi se lam toi ton thuong, nhung toi can ho mot cach tuyet vong"
• Ky vong su phan boi, that vong va bi bo roi
• Khong the tin tuong bat chap bang chung logic
• Xem nguoi khac la nguy hiem nhung can thiet

Dieu nay tao ra mot be tac khong the giai quyet: nguoi do can ket noi mot cach tuyet vong de ton tai nhung mong doi rang chinh su ket noi do se gay ra ton hai; "noi so khong co giai phap" tao ra cac hanh vi vo to chuc, mau thuan.

Dau hieu Hanh vi

Nhung ca nhan so hai-ne tranh the hien cac kieu mau hanh vi phuc tap nhat, chua dung ca dac diem lo au va ne tranh:

Hanh vi Mau thuan: Tim kiem su gan gui roi hoang loan va day doi tac ra xa; luan phien giua bam dinh (lo au) va rut lui (ne tranh); phan ung khong nhat quan lam doi tac boi roi

Loi tien tri Tu ung nghiem: Hanh dong theo cach khieu khich su tu choi ma ho so ("Toi se roi di truoc khi ban roi di"); pha hoai moi quan he khi chung tro nen gan gui hon; tao ra su hon loan xac nhan ky vong tieu cuc

Roi loan Dieu hoa He than kinh: Phan ung chien/chay/dong bang thuong xuyen; canh giac qua muc voi moi de doa; muc kich thich nen tang cao man tinh; tran ngap cam xuc dot ngot hoac ngat

Phan ly: Tach roi khoi cam xuc hoac khoang khac hien tai trong luc cang thang; "troi di" hoac cam giac khong thuc; khoang trong tri nho trong cac trai nghiem cam xuc

Hanh vi Kiem soat: Hoac kiem soat thu dich/trung phat (gay han, cuong ep) hoac cham soc cuong buc (kiem soat thong qua cuu giup); ca hai dai dien cho no luc quan ly hinh tuong gan bo khong the du doan

Phan ung Cam xuc Cuc doan: Phan ung cam xuc du doi co ve khong can xung voi yeu to kich hoat; leo thang nhanh chong tu binh tinh den khung hoang; kho dieu chinh cuong do cam xuc

Khong co Kha nang Tin tuong: Khong the tin vao nhung dieu tich cuc doi tac noi bat chap bang chung; cho doi "chiec giay kia roi"; quet tim bang chung phan boi

Lua chon Doi tac: Thuong chon doi tac kich hoat noi so cua ho (tai dien chung thuong); co the bi thu hut boi nhung doi tac khong san sang, hon loan hoac gay hai

Danh sach Nhan dien

Cac chi so gan bo so hai-ne tranh/vo to chuc dua tren nghien cuu:

• Khao khat su gan gui cam xuc nhung hoang loan khi thuc su tro nen gan gui
• Day doi tac ra xa sau khi keo ho lai gan
• Lich su chung thuong thoi tho au, lam dung hoac bo be nghiem trong
• Ky vong moi quan he se that bai bat chap su khao khat tuyet vong
• Tham gia vao cac hanh vi tu huy hoai pha huy moi quan he
• Trai nghiem phan ung cam xuc cuc doan co ve khong can xung
• Doi khi phan ly hoac ngat cam xuc hoan toan
• Chon doi tac kich hoat su so hai hoac bat on
• Luan phien giua bam dinh tuyet vong va rut lui
• Kho tin vao nhung dieu tich cuc doi tac noi
• He than kinh lien tuc trong trang thai canh giac
• Kho tu tran an khi bi kich hoat
• Lich su su dung chat, gay han hoac tu gay thuong tich nhu cach doi pho
• Cam giac co ban khong xung dang voi tinh yeu hoac moi quan he doi tac
• Nhieu moi quan he da ket thuc vi hanh vi hon loan
• Cam giac lien tuc bi hieu lam va bi bo roi

Nghien cuu Than kinh Sinh hoc va Lam sang

Hanh vi Kiem soat: Nghien cuu cho thay gan bo vo to chuc du doan kha nang cao nhat cua hanh vi kiem soat trung phat, su dung gay han, cuong ep va kiem soat thu dich de quan ly doi tac. Day dai dien cho roi loan chuc nang moi quan he nghiem trong nhat duoc do luong.

Muc do Roi loan Nhan cach: Nghien cuu xac dinh mot lop gan bo "vo to chuc-dao dong" voi bieu hien lam sang nghiem trong nhat, the hien muc do roi loan nhan cach tong the cao nhat, ty le dac diem roi loan nhan cach ranh gioi cao nhat, ty le dac diem nhan cach kich va chong xa hoi cao nhat, roi loan ban sac nghiem trong nhat va cac trieu chung tam than tong the tang cao.

Chung thuong Phat trien: Gan bo vo to chuc xay ra khi nguoi cham soc chinh dong thoi la nguon an toan VA nguon so hai; mot nghich ly khong the giai quyet cho tre em. Tre khong the phat trien chien luoc gan bo mach lac vi tiep can nguoi cham soc (nguoi nen cung cap su an toan) kich hoat noi so, trong khi chay tron khoi nguoi cham soc kich hoat cang thang gan bo.

Roi loan Dieu hoa Than kinh: Nhung ca nhan co gan bo chua duoc giai quyet the hien than hanh nhan hoat dong qua muc (trung tam so hai lien tuc hoat dong), giam dieu hoa vung truoc tran (kiem soat dieu hanh giam), hormone cang thang nen tang tang cao, he than kinh tu chu bi roi loan (kho dat duoc su binh tinh) va phan ung de doa mac dinh ngay ca trong cac tinh huong an toan.

Nguon goc Phat trien

Gan bo so hai-ne tranh phat trien tu viec cham soc dang so hoac bi so hai:

• Lam dung: Lam dung the chat, tinh duc hoac cam xuc nghiem trong tu nguoi cham soc
• Chung thuong Chung kien: Nguoi cham soc trai qua chung thuong (bao luc gia dinh, mat mat)
• Nguoi Cham soc Bi So hai: Cha me co chung thuong/mat mat chua duoc giai quyet, phan ly hoac the hien su so hai
• Bo be Nghiem trong: Khong san sang cam xuc cuc doan hoac bi bo roi
• Nham lan Vai tro: Cham soc hon loan, khong the du doan khong co kieu mau

Yeu to quan trong: Nguoi nen cung cap su an toan la nguon so hai, tao ra mot nghich ly sinh hoc khong the giai quyet.

Hau qua Moi quan he

Nghien cuu ghi nhan rang gan bo so hai-ne tranh du doan nhung kho khan moi quan he nghiem trong nhat:

• Roi loan chuc nang cao nhat: Van de moi quan he nghiem trong nhat trong tat ca cac phong cach
• Bat on: Kieu mau moi quan he ngan, du doi voi cac chu ky hon loan
• Nguy co bao luc: Nguy co bao luc trong moi quan he than mat tang cao (la thu pham hoac nan nhan)
• Su dung chat: Ty le su dung chat cao hon nhu dieu hoa cam xuc
• Tu gay thuong tich: Ty le tu gay thuong tich va hanh vi tu tu tang cao
• Chung thuong Doi tac: Doi tac thuong phat trien chung thuong thu phat
• Truyen tai Lien the he: Nguy co cao truyen gan bo vo to chuc cho con cai

Phuong phap Dieu tri Dua tren Bang chung

LUU Y QUAN TRONG: Phong cach gan bo nay can su ho tro suc khoe tam than chuyen nghiep am hieu chung thuong. Cac phuong phap tu giup la khong du va co the gay hai. Dieu tri thuong can 2-5+ nam.

Giai doan 1: An toan va On dinh hoa (Thang 1-6)

Uu tien: Thiet lap su an toan the chat va cam xuc

Tim nha tri lieu am hieu chung thuong voi dao tao chuyen mon ve EMDR (Giai cam va Tai xu ly bang Chuyen dong Mat), Somatic Experiencing, He thong Gia dinh Noi tai, dieu tri PTSD phuc tap hoac DBT (Lieu phap Hanh vi Bien chung) neu roi loan dieu hoa cam xuc nghiem trong.

Thiet lap ke hoach khung hoang bao gom so duong day nong khung hoang duoc lap trinh trong dien thoai, cac lien he ho tro dang tin cay cho truong hop khan cap, ke hoach an toan neu dang o trong moi quan he bao luc va danh gia tam than de dung thuoc neu can.

Giai quyet cac moi de doa an toan ngay lap tuc bao gom dieu tri nghien neu co phu thuoc hoat dong, lap ke hoach an toan cho bao luc gia dinh, hop dong an toan va chien luoc doi pho tu gay thuong tich va on dinh nha o neu can.

Xay dung cac ky nang co ban thong qua ky thuat neo, chien luoc chiu dung kho so, nhan biet cam xuc co ban, co ban ve ve sinh giac ngu va dinh duong va thiet lap thu tuc hang ngay.

Giai doan 2: Dieu hoa He than kinh (Thang 3-12)

Muc tieu: Phat trien kha nang chiu dung kich thich cam xuc ma khong leo thang hoac phan ly

Lam viec voi cac phuong phap chuyen mon nhu Somatic Experiencing de giai phong chung thuong duoc giu trong co the, EMDR de tai xu ly ky uc chung thuong, lieu phap thong tin da phe vi de lam viec voi dieu hoa he than kinh va lieu phap tam ly cam giac van dong de xu ly chung thuong tu duoi len thong qua nhan thuc co the.

Cac Thuc hanh Dieu hoa He than kinh Hang ngay: Kich thich hai ben (vo canh buom, di bo, go luan phien), tiep xuc nuoc lanh (mat, tay hoac tam nhanh), vo nhe/hat/am dieu (kich hoat he than kinh tran an), thu gian co tien trienh, neo thong qua nam giac va dong dieu hoa voi nhung nguoi an toan khac (neu co).

Giai doan 3: Xu ly va Tich hop Chung thuong (Thang 6-24)

Muc tieu: Xu ly chung thuong gan bo va phat trien mot cau chuyen mach lac

Xu ly chung thuong gan bo thoi tho au, xac dinh cac yeu to kich hoat chung thuong bang cach lap ban do cac yeu to kich hoat moi quan he voi chung thuong goc, phat trien tich hop tu su de tao ra mot cau chuyen mach lac ve nhung gi da xay ra, thuong tiec ve nhung nhu cau khong duoc dap ung va thuc hanh tiep xuc dan dan voi cac tinh huong kich hoat voi su ho tro cua nha tri lieu.

Giai doan 4: Tai cau truc Mo hinh Lam viec Noi tai (Thang 12-36)

Muc tieu: Phat trien cac mo hinh noi tai an toan hon ve ban than va nguoi khac

Thach thuc cac niem tin cot loi nhu "Toi co ban khong xung dang duoc yeu" thanh "Toi xung dang duoc tot hon; toi co gia tri" va "Moi nguoi se lam toi ton thuong" thanh "Mot so nguoi da lam toi ton thuong; mot so nguoi la an toan." Tich hop cac nhan thuc bi chia re, xay dung long tu bi va phat trien su an toan dat duoc thong qua cac mo hinh lam viec noi tai moi.

Giai doan 5: Xay dung Nang luc Quan he (Thang 18-48)

Muc tieu: Phat trien nang luc cho cac kieu mau moi quan he lanh manh hon

Su dung moi quan he tri lieu lam mo hinh, giao duc doi tac ve gan bo vo to chuc neu dang o trong moi quan he, xem xet lieu phap cap doi song song voi lieu phap ca nhan (neu moi quan he an toan), thuc hanh tinh de bi ton thuong rat dan dan, thiet lap cac thoa thuan an toan va tap trung vao viec sua chua thuong xuyen.

Tien trinh Thay doi

Day la hanh trinh tri lieu dai nhat va thach thuc nhat:

• 0-6 thang: Thiet lap an toan va on dinh hoa
• 6-18 thang: Xu ly chung thuong va dieu hoa he than kinh
• 18-36 thang: Tich hop mo hinh lam viec noi tai
• 3-5+ nam: Xay dung nang luc moi quan he va cung co thay doi

Ky vong Thuc te: Chua lanh LA co the, nhung doi hoi su ho tro chuyen mon nhat quan. Tai phat la binh thuong, duoc mong doi va khong co nghia la that bai. Tien trien khong tuyen tinh; hay mong doi nhung bien dong. "An toan" co the trong khac so voi nhung nguoi khong co lich su chung thuong. Long tu bi va su kien nhan la thiet yeu. Day la cuoc chay marathon, khong phai chay nuoc rut.

Tiem nang Tich cuc: Bat chap nhung thach thuc to lon, nhung ca nhan phat trien su an toan dat duoc thuong the hien nhung suc manh dang chu y, bao gom nang luc sau sac ve su dong cam sau khi thiet lap su an toan, danh gia cao ket noi chan thuc, the hien su kien cuong phi thuong, tro thanh doi tac chan thuc va dam me sau sac khi an toan, va mang lai su khon ngoan sau sac cho nhung nguoi khac dang chiu dau kho.

Phong cach Gan bo: Con duong Phat trien va Chua lanh

Tong quan ve cach moi phong cach gan bo phat trien va con duong dien hinh huong toi su an toan dat duoc

Phan III: Thay doi va Phat trien

Khoa hoc ve Thay doi Gan bo

Mot trong nhung phat hien hua hen nhat trong nghien cuu gan bo la cac phong cach gan bo khong co dinh hay khong the thay doi. Trong khi cac kieu mau duoc hinh thanh tu thoi tho au tao ra xu huong manh, gan bo co the thay doi thong qua cac trai nghiem dieu chinh, lam viec co chu dich va cac moi quan he ho tro.

An toan Dat duoc

An toan dat duoc de cap den nhung ca nhan phat trien gan bo an toan o tuoi truong thanh bat chap nhung trai nghiem thoi tho au khong an toan. Nghien cuu xac dinh nhung ca nhan co su an toan dat duoc thong qua cac tu su mach lac, co suy ngam ve tuoi tho kho khan, bang chung ve viec da xu ly cac trai nghiem qua khu, phat trien gan bo an toan thong qua cac moi quan he sau (doi tac lang man, nha tri lieu, nguoi huong dan) va kha nang cung cap gan bo an toan cho con cai cua ho bat chap lich su khong an toan.

Nghien cuu chi ra rang nhung ca nhan co su an toan dat duoc the hien ket qua moi quan he tuong duong voi nhung ca nhan lien tuc an toan (an toan tu thoi tho au). Dieu nay cho thay rang cac kieu mau gan bo, du on dinh, khong phai la dinh menh.

Tinh de uon cua Than kinh va Gan bo

Khoa hoc than kinh hien dai tiet lo rang nao van duy tri tinh de uon suot cuoc doi, co kha nang tao ra cac duong dan than kinh moi va dieu chinh nhung duong dan hien co. Cac vung nao lien quan den gan bo, bao gom than hanh nhan (xu ly cam xuc), vo nao truoc tran (dieu hoa) va cac mang luoi nao xa hoi the hien su thay doi ve cau truc va chuc nang sau can thiep tri lieu.

Nghien cuu cho thay cac kieu mau gan bo duoc thiet lap trong giai doan thanh thieu nien du doan phan ung than kinh cua nguoi lon, nhung nhung kieu mau nay co the duoc dieu chinh thong qua cac trai nghiem moi nhat quan tao ra cac ket noi than kinh moi.

Co che Thay doi

Nghien cuu xac dinh mot so co che chinh ma thong qua do gan bo co the thay doi:

1. Moi quan he Tri lieu

Ban than moi quan he tri lieu cung cap mot trai nghiem cam xuc dieu chinh. Nha tri lieu am hieu gan bo cung cap su dap ung nhat quan, dang tin cay (can cu an toan), dieu chinh vao trang thai cam xuc cua than chu, sua chua ran nut trong moi quan he tri lieu, cung cap khong gian an toan de de bi ton thuong va lam hinh mau hanh vi gan bo an toan.

Nghien cuu cho thay chat luong lien minh tri lieu du doan ket qua dieu tri, voi gan bo tri lieu an toan tao dieu kien cho su thay doi.

2. Moi quan he Lang man An toan

Mot doi tac an toan co the cung cap cac trai nghiem dieu chinh thong qua kha nang san sang nhat quan, dieu chinh cam xuc, kien nhan voi cac hanh vi khong an toan, lam hinh mau giao tiep an toan, cung cap su dam bao ma khong tao dieu kien cho su phu thuoc va su san long lam viec chung ve moi quan he.

Nghien cuu cho thay moi quan he voi doi tac an toan du doan su chuyen dong huong toi su an toan theo thoi gian, mac du su thay doi doi hoi su tham gia tich cuc cua ca hai doi tac.

3. Chanh niem va Tu nhan thuc

Phat trien kha nang quan sat cac kieu mau gan bo, bao gom nhan ra cac yeu to kich hoat, nhan thuc ve cac phan ung tu dong, kha nang dung lai truoc khi phan ung va hieu biet ve nguon goc cua cac kieu mau, tao ra khong gian cho su thay doi hanh vi co chu dich thay vi kich hoat tu dong.

4. Cong viec Nhan thuc Dieu chinh

Thach thuc va tai cau truc cac mo hinh lam viec noi tai thong qua xac dinh cac niem tin cot loi ve ban than va nguoi khac, kiem tra bang chung ung ho va chong lai cac niem tin, phat trien cac goc nhin can bang hon va thuc hanh cac tu su moi quan he moi dan dan thay doi cac bieu dien gan bo.

Can thiep Dua tren Bang chung

Lieu phap Tap trung vao Cam xuc (EFT)

Co so Bang chung: Ho tro thuc nghiem manh nhat cho su thay doi gan bo. Nghien cuu cho thay 70-75% cac cap chuyen tu kho so sang phuc hoi va 90% cho thay su cai thien dang ke.

Cach Hoat dong: EFT xem kho so trong moi quan he la bat nguon tu nhu cau gan bo khong duoc dap ung va cac kieu mau khong an toan. Lieu phap giup cac cap xac dinh cac chu ky tuong tac tieu cuc, tiep can cac cam xuc gan bo nen tang, bieu dat nhu cau mot cach de bi ton thuong va dap ung nhu cau cua doi tac tao ra nhung khoang khac ket noi an toan.

Cho Ca nhan: EFT co the duoc dieu chinh cho cong viec ca nhan, tap trung vao hieu biet cac kieu mau gan bo, tiep can cac cam xuc bi chan, phat trien long tu bi va chuan bi cho su tham gia moi quan he lanh manh hon.

Lieu phap Nhan thuc Hanh vi (CBT)

Co so Bang chung: Duoc ho tro tot trong viec giam lo au gan bo va ne tranh. Nghien cuu cho thay ty le cai thien 60-70% voi cac giao thuc CBT nham muc tieu.

Cach Hoat dong: CBT nham vao suy nghi, cam xuc va hanh vi duy tri gan bo khong an toan, bao gom thach thuc niem tin tieu cuc ve ban than va nguoi khac, phat trien ky nang dieu hoa cam xuc, thuc hanh cac hanh vi an toan va tiep xuc voi tinh de bi ton thuong va su than mat.

Ky thuat Cu the: Tai cau truc nhan thuc (thach thuc "Toi khong xung dang duoc yeu" hoac "Nguoi ta khong the tin duoc"), thi nghiem hanh vi (kiem tra niem tin thong qua hanh dong), dao tao dieu hoa cam xuc (quan ly lo au ma khong co doi tac) va tiep xuc dan dan voi su than mat hoac doc lap.

Lieu phap Gia dinh Dua tren Gan bo (ABFT)

Co so Bang chung: Dac biet hieu qua cho thanh thieu nien va nguoi lon tre co chung thuong gan bo. Nghien cuu cho thay giam dang ke trong tram cam, xu huong tu tu va lo au.

Cach Hoat dong: ABFT sua chua cac ran nut gan bo giua thanh thieu nien va nguoi cham soc thong qua nam nhiem vu: tai dinh khung moi quan he, lien minh voi thanh thieu nien, lien minh voi cha me, nhiem vu gan bo (xu ly ran nut) va thuc day tu chu.

Lieu phap So do

Co so Bang chung: Hieu qua cho cac kieu mau lien quan den gan bo lau dai, dac biet voi cac dac diem roi loan nhan cach. Nghien cuu cho thay ty le phuc hoi 50-60% ngay ca o nhung nhom dan so khang tri voi dieu tri.

Cach Hoat dong: Lieu phap so do giai quyet cac so do khong thich ung som (cac kieu mau cot loi) duoc hinh thanh thong qua cac nhu cau thoi tho au khong duoc dap ung, bao gom xac dinh so do, hieu nguon goc cua chung, nuoi duong lai co gioi han boi nha tri lieu va phat trien cac phong cach doi pho lanh manh hon.

Ket luan

Ly thuyet gan bo dai dien cho mot trong nhung khuon kho duoc xac nhan thuc nghiem nhat va huu ich nhat trong lam sang trong khoa hoc moi quan he. Tu nen tang tien hoa cua Bowlby thong qua nghien cuu quan sat cua Ainsworth den khoa hoc than kinh hien dai, hon 55 nam nghien cuu xac nhan rang cac trai nghiem gan bo som tao ra cac mo hinh lam viec noi tai dinh hinh cac kieu mau moi quan he nguoi lon voi su nhat quan dang chu y.

Bon phong cach gan bo nguoi lon, An toan, Lo au-Ban khoang, Ne tranh-Bac bo va So hai-Ne tranh (Vo to chuc), moi phong cach phan anh cac kieu mau khac biet ve nhan thuc ban than, nhan thuc nguoi khac, quan ly su than mat va phan ung voi cac moi de doa moi quan he. Cac kieu mau nay co the do luong bang cac cong cu da duoc xac nhan, du doan ket qua moi quan he voi do chinh xac dang ke va co cac dau chi than kinh sinh hoc co the nhan dang.

Ket luan Chinh:

1. Cac kieu mau gan bo la co that va nhat quan: Chung du doan su hai long moi quan he, su on dinh, cac kieu mau xung dot, su than mat, su cham soc va ket qua suc khoe tam than trong hang tram nghien cuu.

2. Nguon goc quan trong, nhung khong phai la dinh menh: Trong khi gan bo hinh thanh thong qua cac moi quan he nguoi cham soc som, su an toan dat duoc cho thay nguoi lon co the phat trien gan bo an toan bat chap nguon goc khong an toan.

3. Thay doi la co the: Cac can thiep dua tren bang chung cho thay ty le thanh cong 60-80% trong viec phat trien cac kieu mau gan bo an toan hon, voi Lieu phap Tap trung vao Cam xuc cho thay co so bang chung manh nhat.

4. Sinh hoc va trai nghiem tuong tac: Gan bo co cac tuong quan than kinh co the do luong, nhung ban than cac kieu mau than kinh nay co the thay doi thong qua cac trai nghiem moi quan he moi va can thiep tri lieu, cho thay tinh de uon cua nao.

5. Su phuc tap doi hoi chuyen mon: Gan bo so hai-ne tranh/vo to chuc, bat nguon tu chung thuong va anh huong den 5-10% nguoi lon, doi hoi dieu tri chuyen mon am hieu chung thuong va dai dien cho kieu mau kho nhat, nhung khong phai la khong the, de chua lanh.

6. Phong ngua quan trong: Hieu biet ve gan bo co the huong dan cac thuc hanh nuoi day con, giao duc moi quan he va can thiep som de thuc day gan bo an toan va pha vo su truyen tai lien the he cua su khong an toan.

7. Hy vong la co co so: Nghien cuu nhat quan cho thay voi nhan thuc, cam ket, ho tro co nang luc va thoi gian, ca nhan co the phat trien su an toan dat duoc va tao ra cac moi quan he thoa man, on dinh bat ke lich su gan bo.

Doi voi nhung ca nhan tim cach hieu va cai thien cac kieu mau moi quan he cua ho, ly thuyet gan bo cung cap ca loi giai thich va con duong phia truoc. Doi voi cac nha tri lieu, no cung cap mot khuon kho toan dien de danh gia, khai niem hoa truong hop va can thiep. Doi voi cac nha nghien cuu, no tiep tuc tao ra nhung cau hoi hieu qua ve ket noi con nguoi, than kinh sinh hoc, phat trien va thay doi.

Khoa hoc la ro rang: gan bo an toan la co the, thay doi la co the dat duoc va cong viec nay la xung dang.

1. Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment. Basic Books.
2. Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Erlbaum.
3. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511-524.
4. Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. Routledge.
5. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.