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At any time during the interview information flows at a number of different levels. Three major levels are firstly a “factual” level in which an account is elaborated about the history and the circumstances of the client. At the same time there is a second level of “psychopathology” in which primary raw experience of potential symptoms is communicated by patients. A third level in the interview is the “interpersonal” level. E.g. patients could be talking about an experience of auditory hallucinations on a particular evening, the clinician then has to decide whether to engage the dialogue at the historical-narrative level (What happened before that, or how did you respond to that experience?). Alternatively, the clinician could choose to locate the dialogue at a symptom elaboration cycle (Can you tell me more about those voices, what were they like exactly?).

 

臨床對話涉及三個資訊流動層面。第一是事實層面，案主會分享自己的歷史和處境。第二個層面是精神病層面，案主會描述他/她的患病經過及出現的病徵。面談的第三個層面是「關係層面」。例如病人談及他/她某個晚上經歷幻聽，臨床工作者可以從上述三個談話方向之中三選一，他/她可以關注歷史敘述層面 (問病人出現幻聽之前發生了什麼事？他/她如何回應幻聽的聲音？)。臨床工作者也可以將關注點放在病徵的闡述 (問病人：可不可以多談一點那聲音？那聲音是怎麼樣的？)

A fundamental feature of human existence is the fact that we can exist fully only in the present moment. The brain allows past information and future possibilities to be held together for the selection of action in the present moment. Only the action in the present moment can have an impact on the world. Importantly, it is only in the present that a person can make choices and act on the world. This unique character of the present moment has been appreciated in many traditions. For example, mindfulness practices encourage individuals to focus on the present moment and be detached from past and future cares. In the Present Moment, the unit reaches the height of being. The content of this experience consists of the intentional object, the intentional act, and the experiencing “self”. The “self” is like a vessel, transient and holding the content of experience from moment to moment.

 

人類存在的其中一個特點，是我們只能全然活在當下。大腦可以將過去與未來的資訊匯聚一起，但卻只能在當下作出選擇和行動。在當下採取行動，才能對世界發揮影響。事實上，我們只能在當下作出選擇，影響世界。很多文化傳統都重視「當下」，例如靜觀會鼓勵人遠離過去與將來，聚焦於當下一刻。活在當下，個體的存在可以發揮至高峰，重新與「意向」接軌，經歷何謂「意向客體」、「意向行為」，並與「經驗自我」重遇，這個「經驗自我」其實盛載著短暫、每時每刻的豐富內容。

Propositional language is an information container well-suited for formulating interpersonal scenarios about the current State of Affairs (SOA). SOA have a tentative nature that is not present in perceptual information handling. This tentativeness is important as several competing hypotheses could be entertained at the same time. During the period of tentative deliberation, further information can be obtained and reviewed. This minimizing the risk of premature conclusions. In handling highly complex probabilistic information, the human brain has developed a capacity to tolerate uncertainty instead of concluding with the closest solution. This ability maintains a space for holding back from the most immediate (dominant) concrete interpretation. Inability to hold this tentative deliberation space may contribute to the formation of delusions and delusion-like ideas. 

 

命題式語言是一種資訊容器，適合用作建構人際處境 (即所謂的事態)。知覺系統屬於「即時性」的，而「事態」系統則是「暫時性」的。這種「暫時性」的能力十分重要，它可以同一時間考慮多個競逐的假設。在這個「暫時性」的商議階段，可以收集更多資訊，並更新決定，以減低作出不成熟判斷。「暫時性」涉及複雜的機率計算，人類的大腦有能力忍受這種不認定性，避免倉促下結論。這種能力為人類創造了一片空間，讓我們控制住自己，不作出即時詮釋。沒有能力保持這種「暫時性」，可引致錯誤判斷，產生妄想意念。

One of the basic skills for clinicians involves a switching among three perspectives. In a first-person perspective, the interviewer is fully engaged in the interview process as a participant in a conversation. In empathic understanding Clinicians try to see things from the patient’s point of view. In addition, the clinician “literally” scans the visual environment from the subject’s perceptual viewpoint. In the third-person perspective, the interviewer inspects the interview process as if through the eyes of someone observing the interview from the outside. This third-person perspective enables the interviewer to reflect on the interactional processes taking place between himself and the subject. Intentional and regular switching between these perspectives is a discipline the clinician develops with practice.

 

臨床工作者的其中一個基本技巧，是從(三個)角度中轉換。從第一身角度，訪談者作為一個參與談話的人，他/她全然投入面談過程。其次是同理心角度，臨床工作者嘗試從病人角度了解對方，代入對方的視點，「看見」他/她所看到的環境。最後，從第三者角度出發，反思自己與病人的互動過程。學習刻意和經常轉換角度，是一種臨床工作者需培養的技巧。

Early phenomenologist made a distinction between a “presentation” mode of relating and a “meaning” mode of relating. In the “meaning” mode the object is engaged in a conceptual act, it is related to other semantic concepts and is often not elaborated in its perceptual details. In the presentation mode, the object is engaged in a non-conceptual manner, and intuitive contents (perceptual details) can be fulfilled. It is possible that the two ways of relating are mediated by different brain systems. Ritzel pointed out that meaning act and presentation acts are different because they point to different objects. Meaning points to semantic concepts (as objects) while presentation points to external objects directly.

 

早期現象學家將建立關聯分為兩個主要模式，一是表徵模式， 一是意義模式。意義模式涉及客體的「概念」操作 ，對其他語意概念建立關聯，並不關心觀感細節。表徵模式則涉及客體的「非概念」操作，將「直觀內容」與「觀感細節」建立關聯。這兩種建立關聯的模式，可能由大腦的不同系統協調。Ritzel指出，意義行為與表徵行為是不同的，因為它們指向不同的客體──意義指向「語義概念」 ，而表徵則指向「外在客體」。

“Psychological Bladder Space” is the area into which resides the negative representations distanced from the conscious mind resides. When ideas do not pass through the censorship of the filter, they are deposited into this “Psychological Bladder”. This “Psychological Bladder” has a role to “clean up” the canvas of consciousness. Space for handling unwanted information discarded from the construction of the highly-organized life of the mind is important. In the mind, informational waste-products are created in the pursuit of positive goals, growth, maturation and orderliness in the person. Dysfunctions of the Psychological Bladder Space include significant information leakage to other objects, leading to the building up of an excessive self-dislike, or dislike of some aspects of the world, or displacement of negative-feelings towards representations of other persons.

 

「內心膀胱」是內心的一個範圍，用作儲存負面表徵，作用是與負面表徵保持距離。當意念未能通過過濾審查，便會暫時存放在「內心膀胱」。「內心膀胱」的一個重要角色，就是清理意識中的「油污」。對一個高度組織化的內心，需要有方法處理「不想要的」資訊。在我們的內心系統，「垃圾資訊」會被轉化為正向目標、成長、成熟、富條理的人格特質。如果「內心膀胱」功能失調，「不想要的」資訊或負面情緒會與其他客體混雜一起，結果是負面表徵廣泛影響性格，形式過分討厭自己、討厭別人或討厭世界的某部分。

Phenomenology emphasizes a disciplined assessment of subjective phenomena and in particular the suspension of judgment in the process of attending to, and extracting, primary experiences. It is recognized that a tendency in human thinking is to simultaneously grasp the primary experience and at the same time to generate secondary interpretations. It is important for the clinician to segregate secondary interpretations from primary experiences in the process of describing subjective phenomena. 

 

現象學強調有紀律地評估主體的主觀經歷 ，懸置判斷，只專注於原初經歷，對原初經歷進行探索。人類思想的傾向，是同一時間掌握初始經歷，同一時間進行第二層的詮釋。但對臨床工作者來說，能夠分開對初始經歷的描述、對經驗進行詮釋，卻是一種不可或缺的技巧。

Perception is about sensing in the physical world. Sensations comes to us as concrete experiences bound to our body and constrained by our sensory organs. This constitutes the everyday experience of physical objects in the “external world”. This experience is concrete and direct and is considered as “primordial”. The close coupling of sensory perceptions with the bodily sense organs is the basis for some illusory perceptions.

 

我們對物理世界的感知，統稱為觀感。觀感受著身體與感覺器官的規限，成為我們的實體經驗。在我們日常生活中，對外物理客體的感知，就是觀感經驗。這種經驗是實在和直接的，我們稱這種經驗為「初始經歷」。感知觀感與身體中的感知器官緊密連合， 這是很多觀感幻覺的基礎。