‫ﺟﺎﻣﻌﺔ اﻟﻘﺎهﺮة‬

‫آﻠﻴﺔ اﻵداب‬
‫ﻗﺴﻢ ﻋﻠﻢ اﻟﻨﻔﺲ‬

‫دور اﻷﺧﺼﺎﺋﻴﻴﻦ اﻟﻨﻔﺴﻴﻴﻦ ﻓﻰ‬

‫ﻣﻤﺎرﺳﺔ اﻟﻌﻼج اﻟﻤﻌﺮﻓـﻲ اﻟﺴﻠﻮآﻲ‬

‫)دراﺳﺔ اﺳﺘﻜﺸﺎﻓﻴﺔ(‬

‫إﻋـــﺪاد‬
‫د‪ /‬ﺟﻤﻌﺔ ﺳﻴﺪ ﻳﻮﺳﻒ‬
‫ﺃﺴﺘﺎﺫ ﻋﻠﻡ ﺍﻟﻨﻔﺱ ﺍﻹﻜﻠﻴﻨﻴﻜﻰ ﻭﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ‬
‫ﻜﻠﻴﺔ ﺍﻵﺩﺍﺏ – ﺠﺎﻤﻌﺔ ﺍﻟﻘﺎﻫﺭﺓ‬

‫‪١‬‬
 ‫دور اﻷﺧﺼﺎﺋﻴﻴﻦ اﻟﻨﻔﺴﻴﻴﻦ ﻓﻰ‬
‫ﻣﻤﺎرﺳــﺔ اﻟﻌــﻼج اﻟﻤﻌﺮﻓـﻰ اﻟﺴﻠﻮآــﻰ‬
‫)دراﺳﺔ اﺳﺘﻜﺸﺎﻓﻴﺔ(‬
‫د‪ /‬ﺟﻤﻌﺔ ﺳﻴﺪ ﻳﻮﺳﻒ‬
‫ﻣﻠﺨـــﺺ‬
‫ـﻴﻴﻥ‬
‫ـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـ‬
‫ـﺔ ﺍﻷﺨﺼـ‬
‫ـﻊ ﻤﻤﺎﺭﺴـ‬
‫ـﻰ ﻭﺍﻗـ‬
‫ـﻭﻑ ﻋﻠـ‬
‫ـﻰ ﺍﻟﻭﻗـ‬
‫ـﺔ ﺇﻟـ‬
‫ـﺔ ﺍﻟﺤﺎﻟﻴـ‬
‫ـﺩﻑ ﺍﻟﺩﺭﺍﺴـ‬
‫ﺘﻬـ‬
‫ﻟﻠﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻓـﻰ ﻋـﻼﺝ ﻋـﺩﺩ ﻤـﻥ ﺍﻹﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﻤـﻊ ﺘﺭﻜﻴـﺯ ﺨـﺎﺹ‬
‫ﻋﻠــﻰ ﻤﺭﻀــﻰ ﺍﻟﻔﺼــﺎﻡ ‪ .‬ﻭﻗــﺩ ﺘــﻡ ﺘﻁﺒﻴــﻕ ﺍﺴــﺘﻤﺎﺭﺓ ﺍﺴــﺘﺒﻴﺎﻥ ﻋﻠــﻰ ﻤﺠﻤﻭﻋــﺔ ﻤــﻥ‬
‫ﺍﻷﺨﺼــﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴــﻴﻴﻥ )‪ ٥١‬ﺃﺨﺼــﺎﺌﻴﹰﺎ( ﻤﻤــﻥ ﻴﻌﻤﻠــﻭﻥ ﺒﻌــﺩﺩ ﻤــﻥ ﺍﻟﻤﺴﺘﺸــﻔﻴﺎﺕ ﺍﻟﺤﻜﻭﻤﻴــﺔ‬
‫ﺍﻟﻜﺒــﺭﻯ ﺒﻤﺩﻴﻨــﺔ ﺍﻟﻘــﺎﻫﺭﺓ ‪ ،‬ﻴﺘــﺭﺍﻭﺡ ﺍﻟﻤــﺩﻯ ﺍﻟﻌﻤــﺭﻯ ﻟﻬــﻡ ﺒــﻴﻥ ‪ ٥٦ – ٢٤‬ﻋﺎﻤــﹰﺎ ﺒﻤﺘﻭﺴــﻁ‬
‫)‪ (٣٧.٣‬ﻭﺍﻨﺤﺭﺍﻑ ﻤﻌﻴﺎﺭﻯ )‪ ، (١١.١‬ﻤﻨﻬﻡ )‪ (١٩‬ﻤﻥ ﺍﻟﺫﻜﻭﺭ ﻭ)‪ (٣٢‬ﻤﻥ ﺍﻹﻨﺎﺙ‪.‬‬

‫ﻻ ﻤﺘﻨﻭﻋــﹰﺎ )ﺠﻤﻠــﺔ ﺃﺴــﺌﻠﺔ‬

‫ﻭﻗــﺩ ﺘــﻡ ﺘﺤﻠﻴــل ﺇﺠﺎﺒــﺎﺕ ﺍﻟﻤﺒﺤــﻭﺜﻴﻥ ﻋــﻥ )‪ (٣٦‬ﺴــﺅﺍ ﹰ‬
‫ﺍﻻﺴﺘﺒﻴﺎﻥ( ﻭﺘﻡ ﻋـﺭﺽ ﻨﺘـﺎﺌﺞ ﻫـﺫﺍ ﺍﻟﺘﺤﻠﻴـل ﻭﻤﻨﺎﻗﺸـﺘﻬﺎ ﻓـﻰ ﻀـﻭﺀ ﺍﻟﺨﺒـﺭﺓ ﺍﻟﻌﻠﻤﻴـﺔ ﻭﺍﻟﺘـﺭﺍﺙ‬
‫ـﻥ‬
‫ـﺩﺩ ﻤـ‬
‫ـﺭﺡ ﻋـ‬
‫ـﻡ ﻁـ‬
‫ـﺎﺌﺞ ﺘـ‬
‫ـﺫﻩ ﺍﻟﻨﺘـ‬
‫ـﻭﺀ ﻫـ‬
‫ـﻰ ﻀـ‬
‫ـﻭﻉ ‪ .‬ﻭﻓـ‬
‫ـﺫﺍ ﺍﻟﻤﻭﻀـ‬
‫ـﻰ ﻫـ‬
‫ـﺎﺡ ﻓـ‬
‫ـﻰ ﺍﻟﻤﺘـ‬
‫ﺍﻟﻨﻔﺴـ‬
‫ـﺎﺕ‬
‫ـﺔ ﺍﻟﻌﻼﺠـ‬
‫ـﻰ ﻤﻘﺩﻤـ‬
‫ـﻠﻭﻜﻰ ﺇﻟـ‬
‫ـﻰ ﺍﻟﺴـ‬
‫ـﻼﺝ ﺍﻟﻤﻌﺭﻓـ‬
‫ـﻊ ﺍﻟﻌـ‬
‫ـل ﺩﻓـ‬
‫ـﻥ ﺃﺠـ‬
‫ـﻴﺎﺕ ﻤـ‬
‫ـﺎﺕ ﻭﺍﻟﺘﻭﺼـ‬
‫ﺍﻟﻤﻘﺘﺭﺤـ‬
‫ﺍﻟﻨﻔﺴﻴﺔ‪.‬‬

‫‪٢‬‬
 Abstract
The role of clinical psychologists in practicing cognitive
behavior therapy :
An exploratory study
Gomaa S. Yousef
The aim of this study is to explore the role of clinical
psychologists who works in mental hospitals in practicing
cognitive behavior therapy with psychiatric patients especially
schizophrenic patients . 51 clinical psychologist , 19 males , 32
, females , aged between 24-56 years old with average 37.3 ±
11.1. answered a questionnaire which assess their qualification
and practicing cognitive behavior therapy for many
psychological disorders , especially schizophrenia . The results
had been discussed in terms of available literature . Many
recommendations had been introduced.

: ‫ﻣﻘﺪﻣــــﺔ‬

‫ﻤﻤﺎ ﻻﺸﻙ ﻓﻴﻪ ﺃﻥ ﺍﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴﻴﺔ ﺃﺼـﺒﺤﺕ ﺘﻭﺍﺠﻬﻨـﺎ ﺒﻤﺸـﻜﻠﺔ ﺼـﺤﻴﺔ ﻋﺎﻤـﺔ ﺇﺫ‬
‫ﺃﻥ ﻤﺩﻯ ﺍﻨﺘﺸﺎﺭﻫﺎ ﻴﻔﻭﻕ ﻤﺎ ﻨﻌﺭﻓﻪ ﻋﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻌﻘﻠﻴﺔ ﻭﺍﻟﻌﻀﻭﻴﺔ ﻓﻬـﻰ ﻓـﻰ ﺍﻟﺤﻘﻴﻘـﺔ ﺃﻜﺜـﺭ‬
‫ ﻏﻴﺭ ﺃﻥ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺃﺭﻗـﺎﻡ ﺩﻗﻴﻘـﺔ ﻓـﻰ ﻫـﺫﺍ ﺍﻟﺸـﺄﻥ‬، ‫ﻓﺭﻭﻉ ﺍﻟﻁﺏ ﺍﻟﻨﻔﺴﻰ ﻭﺍﻟﻌﻘﻠﻰ ﺸﻴﻭﻋﹰﺎ‬
‫ ﻭﺘﺸـﻴﺭ‬. (٩٥ – ٩٣ ‫ ﺹ ﺹ‬، ١٩٩٨ ، ‫ﻼ )ﺃﺤﻤـﺩ ﻋﻜﺎﺸـﺔ‬
‫ﺃﻤﺭ ﻋﺴﻴﺭ ﺇﻥ ﻟﻡ ﻴﻜـﻥ ﻤﺴـﺘﺤﻴ ﹰ‬
‫ﺍﻟﺨﺒﺭﺓ ﺍﻟﻌﻤﻠﻴﺔ ﻭﺍﻟﻤﻼﺤﻅﺎﺕ ﺍﻟﻤﺘﺄﻨﻴﺔ ﺇﻟﻰ ﺘﺯﺍﻴﺩ ﻨﺴـﺒﺔ ﺍﻨﺘﺸـﺎﺭ ﺍﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﻭﺴـﻭﺀ‬
‫ ﻭﻫﻭ ﻓﻴﻤـﺎ ﻴﺒـﺩﻭ ﺃﻤـﺭ ﻤﻨﻁﻘـﻰ ﻴﻨﺴـﺠﻡ‬، ‫ ﻭﺒﺨﺎﺼﺔ ﺍﻟﺸﺒﺎﺏ‬، ‫ﺍﻟﺘﻭﺍﻓﻕ ﻟﺩﻯ ﻗﻁﺎﻋﺎﺕ ﻋﺭﻴﻀﺔ‬
‫ ﻭﻤـﻥ‬، ‫ﻤﻊ ﻤﺎ ﺍﻋﺘﺭﻯ ﺍﻟﺤﻴﺎﺓ ﺍﻟﻤﻌﺎﺼﺭﺓ ﻤﻥ ﺯﻴﺎﺩﺓ ﻓﻰ ﺍﻟﻀﻐﻭﻁ ﻭﻤﺜﻴـﺭﺍﺕ ﺍﻟﻤﺸـﻘﺔ ﻭﺘﻨﻭﻋﻬـﺎ‬
‫ـﺭ‬‫ ﻭﻤـﺎ ﺍﺭﺘـﺒﻁ ﺒـﺫﻟﻙ ﻤـﻥ ﺘﻐﻴ‬، ‫ﺇﻴﻘﺎﻉ ﺴﺭﻴﻊ ﻟﻠﺤﻴﺎﺓ ﻭﺘﻌﻘﺩﻫﺎ ﺠﺭﺍﺀ ﺍﻟﺘﻘﺩﻡ ﺍﻟﺘﻜﻨﻭﻟﻭﺠﻰ ﺍﻟﻤﺫﻫل‬

٣
‫ﻓﻰ ﻤﻨﻅﻭﻤﺔ ﺍﻟﻘﻴﻡ ﻟﺩﻯ ﺍﻟﺸﺒﺎﺏ ‪ .‬ﻭﻜﺎﻥ ﻤﻥ ﺍﻟﻁﺒﻴﻌﻰ ﺃﻥ ﻴﺘﺭﺍﻓـﻕ ﻤـﻊ ﺘﻠـﻙ ﺍﻟﺯﻴـﺎﺩﺓ ﺃﻭ ﻴﺘﺭﺘـﺏ‬
‫ﻋﻠﻴﻬﺎ ﺯﻴﺎﺩﺓ ﺍﻟﻁﻠﺏ ﻋﻠﻰ ﺍﻟﺨﺩﻤﺎﺕ ﺍﻟﻌﻼﺠﻴـﺔ ﻟﻌـﻼﺝ ﺍﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﻭﺒﺨﺎﺼـﺔ ﻤـﻊ‬
‫ﺍﻟﺘﻐﻴﺭ ﺍﻟﻤﻠﺤﻭﻅ ﻓﻰ ﺍﻟﻭﻋﻰ ﺍﻟﺼﺤﻰ ‪ ،‬ﻭﺍﻟﺘﺴـﺎﻤﺢ ﺇﺯﺍﺀ ﺍﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﻭﺘﻘﺒـل ﻓﻜـﺭﺓ‬
‫ﻋﻼﺠﻬﺎ ﻭﺍﻟﺸﻔﺎﺀ ﻤﻨﻬﺎ ‪ ،‬ﻭﺍﻟﺘﻼﺸﻰ ﺍﻟﺘـﺩﺭﻴﺠﻰ ﻟﻠﻭﺼـﻤﺔ ﺍﻟﺘـﻰ ﻟﻁﺎﻟﻤـﺎ ﺍﺭﺘﺒﻁـﺕ ﺒﺎﻟﻤﺼـﺎﺒﻴﻥ‬
‫ﺒﺎﻀﻁﺭﺍﺒﺎﺕ ﻨﻔﺴﻴﺔ ﺃﻴﹰﺎ ﻜﺎﻨﺕ ﻁﺒﻴﻌﺘﻬﺎ ﻭﺩﺭﺠﺘﻬﺎ ‪ ،‬ﻭﻏﻨـﻰ ﻋـﻥ ﺍﻟﺒﻴـﺎﻥ ﺃﻥ ﺍﻟﻌﻼﺠـﺎﺕ ﺍﻟﻁﺒﻴـﺔ‬
‫ﺍﻟﻨﻔﺴﻴﺔ ﻜﺎﻨﺕ ﻭﻻ ﺘﺯﺍل ﺘﺸﻜل ﺍﻟﺨﻴﺎﺭ ﺍﻟﺭﺌﻴﺴﻰ ﻟﻜﺜﻴﺭ ﻤﻥ ﺍﻟﻤﻀـﻁﺭﺒﻴﻥ ﻭﺫﻭﻴﻬـﻡ ‪ ،‬ﻭﻤـﻊ ﺫﻟـﻙ‬
‫ﻓﻤﻥ ﺍﻟﻤﻼﺤﻅ ﺃﻥ ﻫﻨﺎﻙ ﻨﻭﻋﹰﺎ ﻤﻥ ﺍﻟﺘﺸﻜﻙ ﺍﻟﻨﺴﺒﻰ ﻓـﻰ ﺠـﺩﻭﻯ ﺃﻭ ﻗﻴﻤـﺔ ﻫـﺫﻩ ﺍﻟﻌﻼﺠـﺎﺕ ﻤـﻥ‬
‫ﻗﺒل ﺃﻫﺎﻟﻰ ﺍﻟﻤﺭﻀﻰ ﺃﺤﻴﺎﻨﹰﺎ ﻟﻼﻋﺘﻘﺎﺩ ﺒﺄﻨﻬﺎ ﺘﺴـﺒﺏ ﺍﻹﺩﻤـﺎﻥ ﻭﻤﺸـﺎﻜل ﺃﺨـﺭﻯ ‪ ،‬ﺃﻭ ﻟﻤﻼﺤﻅـﺔ‬
‫ﺍﺭﺘﻔﺎﻉ ﻨﺴﺏ ﺍﻻﻨﺘﻜﺎﺱ ﺤﺎل ﺍﻻﻤﺘﻨﺎﻉ ﻋﻥ ﺘﻌﺎﻁﻴﻬﺎ ﺃﻭ ﺍﻟﺘﻭﻗﻑ ﻋﻨـﻪ‪ .‬ﻟـﺫﻟﻙ ﻓـﺈﻥ ﺍﻟﻌـﺎﻤﻠﻴﻥ ﻓـﻰ‬
‫ﻫﺫﺍ ﺍﻟﻤﺠﺎل – ﻭﺒﺨﺎﺼﺔ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ ‪ -‬ﻴﻼﺤﻅـﻭﻥ ﺯﻴـﺎﺩﺓ ﻓـﻰ ﻁﻠـﺏ‬
‫ﺍﻟﺨﺩﻤﺎﺕ ﺍﻟﻨﻔﺴﻴﺔ ‪ ،‬ﺃﻭ ﺒﺎﻷﺤﺭﻯ ﺍﻟﻌﻼﺠـﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﻭﺍﻹﺭﺸـﺎﺩ ﺍﻟﻨﻔﺴـﻰ ﺴـﻭﺍﺀ ﻜـﺎﻥ ﺫﻟـﻙ‬
‫ﺒﺈﻴﻌﺎﺯ ﻤﻥ ﺒﻌﺽ ﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺍﻟﻤﺴﺘﻨﻴﺭﻴﻥ ﺃﻭ ﺒﻌﺩ ﺘﺠﺭﺒـﺔ ﻁﻭﻴﻠـﺔ ﻓﺎﺸـﻠﺔ ﻤـﻊ ﺍﻟﻌﻼﺠـﺎﺕ‬
‫ﺍﻟﺩﻭﺍﺌﻴﺔ ‪ ،‬ﺃﻭ ﻋﻨﺩﻤﺎ ﺘﻜﻭﻥ ﺍﻟﻤﺸﻜﻼﺕ ﺍﻟﻨﻔﺴﻴﺔ ﻤﻥ ﺍﻟﻨﻭﻉ ﺍﻟﺒﺴـﻴﻁ ‪ ،‬ﺍﻟـﺫﻯ ﻴﻌﺘﻘـﺩ ﺃﺼـﺤﺎﺒﻪ ﺃﻨـﻪ‬
‫ﻟﻴﺱ ﺒﺤﺎﺠﺔ ﺇﻟﻰ ﺩﻭﺍﺀ ﺒﻘﺩﺭ ﻤـﺎ ﻫـﻭ ﺒﺤﺎﺠـﺔ ﺇﻟـﻰ ﻨـﻭﻉ ﻤـﻥ ﺍﻟـﺘﻔﻬﻡ ﻭﺍﻟﻤﺴـﺎﻨﺩﺓ ﻭﺍﻟﺸـﺭﺡ‬
‫ﻭﺍﻟﺘﻭﺠﻴﻪ‪.‬‬

‫ﻭﻗﺩ ﻴﻜﻭﻥ ﺍﻟﺸﻌﻭﺭ ﺒﺯﻴﺎﺩﺓ ﺍﻟﻁﻠﺏ ﻋﻠﻰ ﺍﻟﻌﻼﺠﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﺃﻤـﺭﹰﺍ ﺠﻴـﺩﹰﺍ ﻭﻴﻤﺜـل ﺍﻋﺘﺭﺍﻓـﹰﺎ‬
‫ﺒﻘﻴﻤﺔ ﻫﺫﻩ ﺍﻟﻌﻼﺠﺎﺕ ﻭﻤﺎ ﻴﻨﺒﻐﻰ ﺃﻥ ﺘﺤﺘﻠـﻪ ﻤـﻥ ﻤﻜﺎﻨـﺔ ﺒـﻴﻥ ﺍﻟﻤﻜﻭﻨـﺎﺕ ﺍﻟﻌﻼﺠﻴـﺔ ﺍﻟﻤﺨﺘﻠﻔـﺔ‬
‫ﻭﺨﺎﺼﺔ ﻤﻥ ﺠﺎﻨﺏ ﺍﻟﻤﺸﺘﻐﻠﻴﻥ ﺒﺎﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ‪.‬‬

‫ﻣﺸﻜﻠﺔ اﻟﺪراﺳﺔ‪:‬‬

‫‪٤‬‬
‫ﻟﻸﺨﺼﺎﺌﻰ ﺍﻟﻨﻔﺴﻰ ﺍﻹﻜﻠﻴﻨﻴﻜﻰ – ﻤﻨﺫ ﻓﺘﺭﺓ ﻁﻭﻴﻠـﺔ – ﺩﻭﺭ ﻓـﻰ ﺍﻟﻌـﻼﺝ ﺘـﺯﺩﺍﺩ ﺃﻫﻤﻴﺘـﻪ‬
‫ﻭﺘﺘﻌﺩﺩ ﺠﻭﺍﻨﺒﻪ ﻤﻊ ﺍﻷﻴﺎﻡ ‪ ،‬ﻭﻴﺒﺩﻭ ﺃﻥ ﻫﻨﺎﻙ ﺘﺯﺍﻴﺩﹰﺍ ﻓﻰ ﺍﻟﺴـﻨﻭﺍﺕ ﺍﻷﺨﻴـﺭﺓ ﻓـﻰ ﺃﻨـﻭﺍﻉ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﺘﻰ ﻴﻘﺩﻤﻬﺎ ﺍﻷﺨﺼﺎﺌﻰ ﺍﻟﻨﻔﺴﻰ ﺍﻹﻜﻠﻴﻨﻴﻜﻰ ﻭﻓـﻰ ﻤـﺩﻯ ﺍﻨﺘﺸـﺎﺭﻫﺎ ‪ ،‬ﻭﻴﻤﻜـﻥ ﺃﻥ ﻴﺭﺠـﻊ ﻫـﺫﺍ‬
‫ﺠﺯﺌﻴﹰﺎ ﺇﻟﻰ ﺍﻟﺘﺴﻬﻴﻼﺕ ﺍﻟﻭﺍﺴﻌﺔ ﺍﻟﻤﻘﺩﻤﺔ ﻤﻥ ﺃﺠـل ﺍﻟﻌـﻼﺝ ‪ ،‬ﻭﻤـﻊ ﺫﻟـﻙ ﻓـﺈﻥ ﺘﺯﺍﻴـﺩ ﻓـﺭﺹ‬
‫ﺍﻟﻌﻼﺝ ﻻ ﻴﻤﻜﻥ ﺃﻥ ﻴﻘﺩﻡ ﻏﻴﺭ ﺤل ﺠﺯﺌﻰ ﻓﺤﺴـﺏ ﻟﻤﺸـﻜﻠﺔ ﺘﻠﺒﻴـﺔ ﺍﺤﺘﻴﺎﺠـﺎﺕ ﺍﻟﻤﺠﺘﻤـﻊ ﻋﻠـﻰ‬
‫ﺍﻟﻤﺩﻯ ﺍﻟﺒﻌﻴﺩ ﺇﺫﺍ ﻟﻡ ﻴﻭﻀﻊ ﻓﻰ ﺍﻻﻋﺘﺒﺎﺭ ﺃﻴﻀـﹰﺎ ﺍﺘﺨـﺎﺫ ﺍﻟﺘـﺩﺍﺒﻴﺭ ﺍﻻﺠﺘﻤﺎﻋﻴـﺔ ﺍﻟﻤﻼﺌﻤـﺔ )ﻫﻴﺌـﺔ‬
‫ﺍﻟﺼــــــــــــــــــﺤﺔ ﺍﻟﻌﺎﻟﻤﻴــــــــــــــــــﺔ ‪، ١٩٨٥ ،‬‬
‫ﺹ ‪ ، ٥٢‬ﺹ ‪ :٥٧‬ﻤﺘﺭﺠﻡ( ‪ ،‬ﻏﻴﺭ ﺃﻥ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ ﻓـﻰ ﻤﺅﺴﺴـﺎﺕ‬
‫ﺍﻟﺼﺤﺔ ﺍﻟﻨﻔﺴﻴﺔ ﻓﻰ ﻤﺼﺭ – ﻋﻠﻰ ﺴﺒﻴل ﺍﻟﻤﺜﺎل – ﻴﻨﻁﺒﻕ ﻋﻠﻴﻬﻡ ﻤـﺎ ﺠـﺎﺀ ﻓـﻰ ﺘﻘﺭﻴـﺭ ﺍﻟﻠﺠﻨـﺔ‬
‫ﺍﻟﻤﺸﻜﻠﺔ ﻤﻥ ﻗﺒل ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ﻟﺩﺭﺍﺴـﺔ ﻭﻀـﻊ ﺍﻷﺨﺼـﺎﺌﻰ ﺍﻟﻨﻔﺴـﻰ ﻓـﻰ ﻤﺅﺴﺴـﺎﺕ‬
‫ﺍﻟﺼﺤﺔ ﺍﻟﻨﻔﺴﻴﺔ ﻭﺍﻟﺫﻯ ﺼﺩﺭ ﻋﺎﻡ ‪١٩٧٤‬ﻡ ﺤﻴﺙ ﻭﺭﺩ ﻓـﻰ ﺒﻌـﺽ ﺃﺠـﺯﺍﺀ ﻫـﺫﺍ ﺍﻟﺘﻘﺭﻴـﺭ ﻤـﺎ‬
‫ﻨﺼﻪ "ﻋﻠﻰ ﺍﻟﺭﻏﻡ ﻤﻥ ﺃﻥ ﺍﻷﺨﺼـﺎﺌﻰ ﺍﻟﻨﻔﺴـﻰ ﻤﺅﻫـل ﺒﺤﻜـﻡ ﺘﺩﺭﻴﺒـﻪ ﺍﻷﺴﺎﺴـﻰ ﻟﻺﺴـﻬﺎﻡ‬
‫ﺒﺸﻜل ﻓﻌﺎل ﻓﻰ ﻨﺸﺎﻁ ﻤﺅﺴﺴﺎﺕ ﺍﻟﺼﺤﺔ ﺍﻟﻨﻔﺴـﻴﺔ ﻓـﺈﻥ ﺩﻭﺭﻩ ﺩﺍﺨـل ﻫـﺫﻩ ﺍﻟﻤﺅﺴﺴـﺎﺕ ﻤـﺎ‬
‫ﻴﺯﺍل ﻓﻰ ﺤﺎﺠﺔ ﺇﻟﻰ ﻤﺯﻴﺩ ﻤﻥ ﺍﻟﺘﺤﺩﻴﺩ" )ﺍﻟﻤﺭﺠﻊ ﺍﻟﺴﺎﺒﻕ ‪ ،‬ﺹ‪.(٥١‬‬

‫ﻭﻴﻌﻜﺱ ﺫﻟﻙ ﺒﺎﻟﻁﺒﻊ ﺍﻟﻔﺠﻭﺓ ﺒﻴﻥ ﻤﺎ ﻴﻤﻜﻥ ﻟﻸﺨﺼـﺎﺌﻰ ﺍﻟﻨﻔﺴـﻰ ﺍﻹﻜﻠﻴﻨﻴﻜـﻰ ﺍﻟﻘﻴـﺎﻡ ﺒـﻪ‬
‫ﻼ ﺨﺎﺼﺔ ﻓﻰ ﻤﺠﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ‪ ،‬ﻓـﻼ ﻴﻘﺘﺼـﺭ ﺍﻷﻤـﺭ ﻋﻠـﻰ ﺘﻀـﺎﺅل ﺩﻭﺭ‬
‫ﻭﻤﺎ ﻴﻘﻭﻡ ﺒﻪ ﻓﻌ ﹰ‬
‫ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴﻴﻥ ﻓﻰ ﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ﻓـﻰ ﻋﺎﻟﻤﻨـﺎ ﺍﻟﻌﺭﺒـﻰ ﺒـل ﻴﻤﺘـﺩ‬
‫ﻟﻴﺸﻤل ﺫﻟﻙ ﺍﻟﺘﺸﻌﺏ ﻓﻰ ﺃﻨﻭﺍﻉ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ﺍﻟﺘﻰ ﻴﻤﻜـﻨﻬﻡ ﺘﻘـﺩﻴﻤﻬﺎ ﻜﻨﺘﻴﺠـﺔ ﻟﻼﺨـﺘﻼﻑ ﺒـﻴﻥ‬
‫ﺍﻟﻤﺩﺍﺭﺱ ﺍﻟﻌﻠﻤﻴﺔ ﺍﻟﺘﻰ ﻴﻨﺘﻤﻰ ﺇﻟﻴﻬﺎ ﻫﺅﻻﺀ ﺍﻷﺨﺼﺎﺌﻴﻭﻥ ‪ ،‬ﻓﻤـﺎ ﻴـﺯﺍل ﺍﻟـﺒﻌﺽ ﻴـﺭﻭﺝ ﻟﻠﻌـﻼﺝ‬
‫ﺍﻟﺩﻴﻨﺎﻤﻰ ﻭﺍﻟﺘﺤﻠﻴل ﺍﻟﻨﻔﺴﻰ ‪ ،‬ﺒﻴﻨﻤﺎ ﻴﺘﺒﻨﻰ ﺍﻟﺒﻌﺽ ﺍﻵﺨـﺭ ﺍﻟﻤﻨـﺎﺤﻰ ﺍﻟﺴـﻠﻭﻜﻴﺔ ﻭﺘﻌـﺩﻴل ﺍﻟﺴـﻠﻭﻙ‬

‫‪٥‬‬
‫‪ ،‬ﻭﺍﻟﺘﻁﺒﻴﻘﺎﺕ ﺍﻟﺤﺩﻴﺜﺔ ﻟﻠﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ‪ ،‬ﻴﻀﺎﻑ ﺇﻟﻰ ﺫﻟـﻙ ﺃﻥ ﺍﻟـﻨﻅﻡ ﺍﻟﻤﻌﺭﻓﻴـﺔ ﺘﻌﺘﻤـﺩ ﻋﻠـﻰ‬
‫ﺍﻟﺜﻘﺎﻓﺔ ﻭﺍﻟﺤﻀﺎﺭﺓ ﻭﺍﻟﺘﻌﻠﻡ ﺍﻟﺒﻴﺌﻰ ‪ ،‬ﻟﺫﺍ ﻴﺠﺏ ﻋـﺩﻡ ﺍﺴـﺘﻴﺭﺍﺩ ﺍﻟـﻨﻅﻡ ﺍﻟﻤﻌﺭﻓﻴـﺔ ﺍﻟﻐﺭﺒﻴـﺔ ﻭﺇﻨﻤـﺎ‬
‫ﻴﺠﺏ ﺘﻘﻨﻴﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺨﺎﺹ ﺒﺎﻟﻘﻴﻡ ﺍﻷﺨﻼﻗﻴﺔ ﻭﺍﻟﺩﻴﻨﻴـﺔ ﻓـﻰ ﻤﺼـﺭ ﻭﺍﻟـﺒﻼﺩ ﺍﻟﻌﺭﺒﻴـﺔ‬
‫ﻭﺍﻟﺫﻯ ﻴﻼﺌﻡ ﺘﻔﻜﻴﺭﻨﺎ ﻭﻤﻌﺘﻘـﺩﺍﺘﻨﺎ )ﺃﺤﻤـﺩ ﻋﻜﺎﺸـﺔ ‪ ،١٩٩٨ ،‬ﺹ‪ ، (٢٢٦‬ﻭﻤـﻥ ﺍﻟﻤﺘﻔـﻕ ﻋﻠﻴـﻪ‬
‫ﺃﻥ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﻭﻜﺫﻟﻙ ﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﻟـﻡ ﻴﺘﻠﻘـﻭﺍ ﺘـﺩﺭﻴﺒﹰﺎ ﻜﺎﻓﻴـﹰﺎ ﻭﻤﻨﺎﺴـﺒﹰﺎ ﻓـﻰ‬
‫ﺍﻟﻌﻠﻭﻡ ﺍﻻﺠﺘﻤﺎﻋﻴـﺔ ‪ ،‬ﻟـﺫﻟﻙ ﻓـﺈﻥ ﻤﺠﻤﻭﻋـﺔ ﺍﻟﻌﻤـل ﺘـﺭﻯ ﺃﻨـﻪ ﻤـﻥ ﺍﻟﻭﺍﺠـﺏ ﺃﻥ ﻴﺘﻠﻘـﻰ‬
‫ﺍﻷﺨﺼﺎﺌﻴﻭﻥ ﺍﻟﻨﻔﺴﻴﻭﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴﻭﻥ ﻓﻰ ﻤﺨﺘﻠﻑ ﺍﻟﺒﻠﺩﺍﻥ ﺘـﺩﺭﻴﺒﹰﺎ ﻤﻬﻨﻴـﹰﺎ ﺴـﻠﻴﻤﹰﺎ ﻴﻤﻜـﻥ ﺃﻥ ﻴﻘـﺩﻡ‬
‫ﻓﻰ ﺸﻜل ﻤﻘﺭﺭﺍﺕ ﻟﺩﺭﺍﺴﺔ ﻋﻠﻴﺎ ﻻﺤﻘﺔ ﻟﻠﺩﺭﺠﺔ ﺍﻟﺠﺎﻤﻌﻴـﺔ ﺍﻷﻭﻟـﻰ ‪ ،‬ﻋﻠـﻰ ﺃﻥ ﻴﻜـﻭﻥ ﺒﺭﻨـﺎﻤﺞ‬
‫ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻤﺭﻨـﹰﺎ ﻭﺍﻨﺘﻘﺎﺌﻴـﹰﺎ ﻭﺃﻥ ﻴﻜـﻭﻥ ﺍﻟﻤﻀـﻤﻭﻥ ﻭﺍﻻﺘﺠـﺎﻩ ﻤﺅﺴﺴـﻴﻥ ﻋﻠـﻰ ﺍﻟﻤﻌﺭﻓـﺔ‬
‫ﺍﻟﻨﻅﺭﻴﺔ ﻭﻋﻠﻰ ﺍﻟﺨﺒﺭﺓ ﺍﻟﻌﻤﻠﻴـﺔ ﺍﻟﻤﺘﺼـﻠﺔ ﺒﻤﺸـﻜﻼﺕ ﺍﻟﺒﻠـﺩ ﺍﻟـﺫﻯ ﻴﻌﻤـل ﻓﻴـﻪ ﺍﻷﺨﺼـﺎﺌﻰ‬
‫ﻼ‬
‫ﻭﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﺘﻰ ﺒﻠﻐﻬﺎ ﺍﻟﻤﺠﺘﻤﻊ ﻓﻰ ﺍﻟﺘﻨﻤﻴـﺔ ‪ ،‬ﻭﻴﻨﺒﻐـﻰ ﺃﻥ ﻴﻅـل ﺍﻟﺒﺭﻨـﺎﻤﺞ ﺍﻟﺩﺭﺍﺴـﻰ ﻤﺸـﺘﻤ ﹰ‬
‫ﻋﻠﻰ ﺘﺩﺭﻴﺱ ﺍﻟﺘﻘﺩﻴﺭ ﺍﻟﻨﻔﺴﻰ ﻜﺠﺎﻨﺏ ﺭﺌﻴﺴﻰ ﻓﻰ ﺍﻟﺒﺭﻨﺎﻤﺞ ‪ ،‬ﻟﻜـﻥ ﺒﺎﻹﻀـﺎﻓﺔ ﺇﻟـﻰ ﺫﻟـﻙ ﻴﻨﺒﻐـﻰ‬
‫ﺃﻥ ﻴﺘﻌﻠﻡ ﺃﻴﻀـﹰﺎ ﺍﻷﺴـﺎﻟﻴﺏ ﺍﻟﻌﻼﺠﻴـﺔ ﺍﻟﻤﺨﺘﻠﻔـﺔ ‪ ،‬ﻜـﺎﻟﻌﻼﺝ ﺍﻟﻨﻔﺴـﻰ ‪ ،‬ﻭﺍﻟﻌـﻼﺝ ﺍﻟﺠﻤﻌـﻰ ‪،‬‬
‫ﻭﺃﺴﺎﻟﻴﺏ ﺍﻹﺭﺸﺎﺩ ﺍﻟﻨﻔﺴﻰ ‪ ،‬ﻤﻊ ﻗﺩﺭ ﻜﺎﻑ ﻤـﻥ ﺍﻷﺴـﺎﺱ ﺍﻟﻨﻅـﺭﻯ ‪ ،‬ﻭﺫﻟـﻙ ﻟﺘﻤﻜـﻴﻥ ﺍﻟﻁـﻼﺏ‬
‫ﻤــﻥ ﺘﻁﻭﻴــﻊ ﻫــﺫﻩ ﺍﻷﺴــﺎﻟﻴﺏ ﺍﻟﻘﺩﻴﻤــﺔ ﺍﻟﺨﺎﺼــﺔ ﺒــﺎﻟﻌﻼﺝ ﻭﺘﻌﻠــﻡ ﺍﻟﺠﺩﻴــﺩ ﻤﻨﻬــﺎ‬
‫)ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴـﺔ ‪ ، ١٩٨٥ ،‬ﺹ ﺹ‪ ، (٦٠ – ٥٩‬ﻭﻴـﺭﻯ ﺒﻌـﺽ ﺍﻟﺒـﺎﺤﺜﻴﻥ ﻀـﺭﻭﺭﺓ‬
‫ﺃﻥ ﻴﺘﻤﺘﻊ ﺍﻟﻤﻌﺎﻟﺠﻭﻥ ﺍﻟﻨﻔﺴﻴﻭﻥ ﺒﻤﺠﻤﻭﻋﺔ ﻤﻥ ﺍﻟﺼﻔﺎﺕ ﻓـﻰ ﺍﻟﻭﻗـﺕ ﺍﻟـﺭﺍﻫﻥ ‪ ،‬ﻤﻨﻬـﺎ ﺍﻤـﺘﻼﻜﻬﻡ‬
‫ﻟﻜل ﺃﺴﺱ ﺍﺴﺘﺨﺩﺍﻡ ﺃﺴﺎﻟﻴﺏ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﺒﺎﻹﻀـﺎﻓﺔ ﻟﻠﻔﻬـﻡ ﺍﻟﻜﺎﻤـل ﻟﻠﻨﻤـﺎﺫﺝ‬
‫ﺍﻟﻨﻅﺭﻴــﺔ ﺍﻟﻤﻔﺴــﺭﺓ ﻟﻼﻀــﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴــﻴﺔ )ﺒــﺭﺍﻭﻥ ‪ ،‬ﺃﻭﻟﻴــﺭﻯ ‪ ،‬ﻭﺒــﺎﺭﻟﻭ ‪، ٢٠٠٢ ،‬‬
‫ﺹ‪.(٣٦٠‬‬

‫‪٦‬‬
‫ﻭﻗﺩ ﻅﻬﺭ ﻤﺼﻁﻠﺢ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻓـﻰ ﺍﻟﺘـﺭﺍﺙ ﺍﻟﻌﻠﻤـﻰ ﻓـﻰ ﺒﺩﺍﻴـﺔ ﺍﻟﺜﻠـﺙ‬
‫ﺍﻷﺨﻴﺭ ﻤﻥ ﺍﻟﻘﺭﻥ ﺍﻟﻌﺸﺭﻴﻥ ﻭﺃﺼﺒﺢ ﻓﻰ ﻭﻗﺕ ﻗﺼـﻴﺭ ﺍﻟﻌـﻼﺝ ﺍﻟﻨﻔﺴـﻰ ﺍﻟـﺭﺌﻴﺱ ﻓـﻰ ﻤﻌﻅـﻡ‬
‫ﺍﻟﺩﻭل ﺍﻟﻤﺘﻘﺩﻤﺔ )ﻤﻥ ﺨﻼل ‪ :‬ﻨﺎﺼﺭ ﺍﻟﻤﺤﺎﺭﺏ ‪ ، ٢٠٠٠ ،‬ﺹ‪ ، (١‬ﻭﻜﻤـﺎ ﻴﺴـﺘﺩل ﻤـﻥ ﺍﺴـﻤﻪ‬
‫ﻴﻌﺘﺒﺭ ﻫﺫﺍ ﺍﻟﻨﻭﻉ ﻤﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴـﻰ ﻜﻤـﺎ ﻋﺭﻓـﻪ ﻜﻨـﺩﺍل ‪ ١٩٩٣ Kendall‬ﻤﺤﺎﻭﻟـﺔ ﺩﻤـﺞ‬
‫ﺍﻟﻔﻨﻴﺎﺕ ﺍﻟﻤﺴﺘﺨﺩﻤﺔ ﻓﻰ ﺍﻟﻌﻼﺝ ﺍﻟﺴﻠﻭﻜﻰ ﺍﻟﺘﻰ ﺜﺒﺕ ﻨﺠﺎﺤﻬـﺎ ﻓـﻰ ﺍﻟﺘﻌﺎﻤـل ﻤـﻊ ﺍﻟﺴـﻠﻭﻙ ﻤـﻊ‬
‫ﺍﻟﺠﻭﺍﻨﺏ ﺍﻟﻤﻌﺭﻓﻴﺔ ﻟﻁﺎﻟﺏ ﺍﻟﺨﺩﻤﺔ ﺍﻟﻨﻔﺴﻴﺔ ﺒﻬـﺩﻑ ﺇﺤـﺩﺍﺙ ﺘﻐﻴﻴـﺭﺍﺕ ﻤﻁﻠﻭﺒـﺔ ﻓـﻰ ﺴـﻠﻭﻜﻪ ‪.‬‬
‫ﺒﺎﻹﻀﺎﻓﺔ ﺇﻟﻰ ﺫﻟﻙ ﻴﻬﺘﻡ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﺒﺎﻟﺠﺎﻨـﺏ ﺍﻟﻭﺠـﺩﺍﻨﻰ ﻟﻠﻤـﺭﻴﺽ ﻭﺒﺎﻟﺴـﻴﺎﻕ‬
‫ﺍﻻﺠﺘﻤﺎﻋﻰ ﻤﻥ ﺤﻭﻟﻪ ﻤﻥ ﺨـﻼل ﺍﺴـﺘﺨﺩﺍﻡ ﺍﺴـﺘﺭﺍﺘﻴﺠﻴﺎﺕ ﻤﻌﺭﻓﻴـﺔ ﻭﺴـﻠﻭﻜﻴﺔ ‪ ،‬ﻭﺍﻨﻔﻌﺎﻟﻴـﺔ ‪،‬‬
‫ﻭﺍﺠﺘﻤﺎﻋﻴﺔ ﻭﺒﻴﺌﻴﺔ ﻹﺤﺩﺍﺙ ﺍﻟﺘﻐﻴﻴﺭ ﺍﻟﻤﺭﻏﻭﺏ ﻓﻴﻪ )ﺍﻟﻤﺭﺠﻊ ﺍﻟﺴﺎﺒﻕ(‪.‬‬

‫ﻟﻘﺩ ﻜﺎﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ – ﻋﻠـﻰ ﺴـﺒﻴل ﺍﻟﻤﺜـﺎل – ﻤﻨـﺫ ﺃﻜﺜـﺭ ﻤـﻥ ﻋﺸـﺭﻴﻥ ﻋﺎﻤـﹰﺎ‬
‫ﻼ ﺃﻭ‬
‫ﻤﻀﺕ ﻤﻘﺼﻭﺭﹰﺍ ﻋﻠﻰ ﻋﻼﺝ ﺍﻻﻜﺘﺌﺎﺏ ‪ ،‬ﻭﻗـﺩ ﻨﺸـﺭ ﺒﻴـﻙ ‪ Beck‬ﻭﺯﻤـﻼﺅﻩ ‪ ١٩٧٩‬ﺩﻟـﻴ ﹰ‬
‫ﻤﺭﺸﺩﹰﺍ ﻟﻠﻌـﻼﺝ ﺃﻁﻠﻘـﻭﺍ ﻋﻠﻴـﻪ "ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﻟﻼﻜﺘﺌـﺎﺏ" ﻭﺍﻟـﺫﻯ ﻻ ﻴﻘـﺩﻡ ﻟﻸﺨﺼـﺎﺌﻰ‬
‫ﺍﻹﻜﻠﻴﻨﻴﻜﻰ ﻫﺎﺩﻴﺎﺕ ﻤﻔﺼﻠﺔ ﻟﻌﻼﺝ ﺍﻟﻤﺭﻀـﻰ ﻓﺤﺴـﺏ ‪ ،‬ﻭﺇﻨﻤـﺎ ﻴـﺯﻭﺩ ﺍﻟﺒـﺎﺤﺜﻴﻥ ﺒﻤﺸـﺭﻭﻉ ﺃﻭ‬
‫ﺘﺼﻭﺭ ﻋﻼﺠﻰ ﻤﻘﻨﻥ ﻴﺘﻌﻠﻕ ﺒﺩﺭﺍﺴﺎﺕ ﺘﻘﻭﻴﻡ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﻟﻼﻜﺘﺌـﺎﺏ )ﺭﻭﺒـﺭﺕ ﻟﻴﻬـﻰ ‪،‬‬
‫‪،٢٠٠٦‬‬
‫ﺹ ﺹ‪ :٢٨ – ٢٧‬ﻤﺘﺭﺠﻡ(‪.‬‬

‫ﻭﻤﻨﺫ ﺃﻥ ﹲﻨﺸﺭ ﻫﺫﺍ ﺍﻟﺩﻟﻴل ﺃﻅﻬـﺭ ﻋـﺩﺩ ﻜﺒﻴـﺭ ﻤـﻥ ﺍﻟﺩﺭﺍﺴـﺎﺕ ﺍﻟﺘﻘﻭﻴﻤﻴـﺔ ﺃﻥ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﻓﻌﺎل ﻭﻤﺅﺜﺭ ﻤﺜﻠﻪ ﻤﺜل ﺍﻟﻌﻼﺝ ﺍﻟﻁﺒﻰ ﻓـﻰ ﻋـﻼﺝ ﺍﻻﻜﺘﺌـﺎﺏ ﺒـل ﻗـﺩ ﻴﻨﻔـﺭﺩ ﻋﻨـﻪ‬
‫ﺒﻤﻤﻴﺯﺍﺕ ﻭﻗﺎﺌﻴﺔ ﻋﻠﻰ ﺍﻟﻤﺩﻯ ﺍﻟﻁﻭﻴل – ﻟﻴﺱ ﻫﺫﺍ ﻓﺤﺴﺏ ‪ -‬ﺒل ﺃﻥ ﻫﻨـﺎﻙ ﺍﻟﻌﺩﻴـﺩ ﻤـﻥ ﺼـﻭﺭ‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺘﻰ ﺘﻨﺎﺴﺏ ﻨﻭﻋﻴﺔ ﻭﺍﺴﻌﺔ ﻤـﻥ ﺍﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﺘـﻰ ﻴﻤﻜـﻥ ﻋﻼﺠﻬـﺎ ﻤﺜـل‬

‫‪٧‬‬
‫ﺍﻟﻘﻠــﻕ ‪ ،‬ﻭﺘﻌــﺎﻁﻰ ﺍﻟﻤــﻭﺍﺩ ﺍﻟﻨﻔﺴــﻴﺔ ‪ ،‬ﻭﺍﻀــﻁﺭﺍﺏ ﺍﻟﺸﺨﺼــﻴﺔ ﺍﻟﺤﺩﻴــﺔ ‪ ،‬ﻭﺍﻻﻀــﻁﺭﺍﺏ‬
‫ﺍﻟﺒﺎﺭﺍﻨﻭﻴﺩﻯ ‪ ،‬ﻭﺍﻟﺼﺭﺍﻋﺎﺕ ﺍﻟﺯﻭﺍﺠﻴﺔ‪ ،‬ﻭﺍﻟﻐﻀﺏ )ﺍﻟﻤﺭﺠﻊ ﺍﻟﺴﺎﺒﻕ ‪ ،‬ﺹ‪.(٢٩‬‬

‫ﻟﻜﻥ ﻤﺎ ﻴﻨﺒﻐﻰ ﺍﻻﻨﺘﺒﺎﻩ ﺇﻟﻴﻪ ﺃﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺃﻭ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻟـﻴﺱ ﻋﻼﺠـﹰﺎ‬
‫ﻼ ﻜﻰ ﻨﻁﺒﻘﻪ ‪ ،‬ﻓﻴﻨﺒﻐﻰ ﺃﻥ ﻴﻜـﻭﻥ ﺍﻟﻤﻌـﺎﻟﺞ ﺇﻴﺠﺎﺒﻴـﹰﺎ ﻨﺸـﻁﹰﺎ ﻤﺨﻠﺼـﹰﺎ ‪ ،‬ﻤﺨﺒـﺭﹰﺍ ‪ ،‬ﻤـﺅﺜﺭﹰﺍ‬
‫ﺴﻬ ﹰ‬
‫)ﺍﻟﻤﺭﺠﻊ ﺍﻟﺴﺎﺒﻕ ‪ ،‬ﺹ‪ ، (٣٨‬ﻭﻫﻭ ﻤﺎ ﻴﺒﺩﻭ ﻟﺏ ﺍﻟﻤﺸﻜﻠﺔ ﺍﻟﺘـﻰ ﻨﻭﺍﺠﻬﻬـﺎ ﻓـﻰ ﻤﺼـﺭ ﻭﺍﻟﻌـﺎﻟﻡ‬
‫ﺍﻟﻌﺭﺒﻰ ‪ ،‬ﺤﻴﺙ ﻨﻌﺎﻨﻰ ﻤـﻥ ﻨﻘـﺹ ﻭﺍﻀـﺢ ﻓـﻰ ﻋـﺩﺩ ﺍﻟﻤﻌـﺎﻟﺠﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺒﺼـﻔﺔ ﻋﺎﻤـﺔ‬
‫ﻭﺍﻟﻤﺅﻫﻠﻴﻥ ﻤﻨﻬﻡ ﻟﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﺒﺼﻔﺔ ﺨﺎﺼﺔ‪.‬‬

‫ﻭﺇﺫﺍ ﻜﺎﻥ ﺍﻟﻭﺍﻗﻊ ﻴﺸﻴﺭ ﺇﻟﻰ ﻨﻘﺹ ﺤﺎﺩ ﻓـﻰ ﻋـﺩﺩ ﺍﻟﻤﻌـﺎﻟﺠﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺒﺼـﻔﺔ ﻋﺎﻤـﺔ‬
‫ﻭﺍﻟﻤﺅﻫﻠﻴﻥ ﻤﻨﻬﻡ ﻟﻤﻤﺎﺭﺴﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﺒﺼـﻔﺔ ﺨﺎﺼـﺔ ‪ ،‬ﻭﻫـﻡ ﺍﻟﻤﻌـﺎﻟﺠﻭﻥ‬
‫ﺍﻟﺫﻴﻥ ﻜﺎﻥ ﻴﺘﻭﻗﻊ ﻤﻨﻬﻡ ﺃﻥ ﻴﺴﻬﻤﻭﺍ ﻓﻰ ﺤل ﻤﺸـﻜﻠﺔ ﺯﻴـﺎﺩﺓ ﺍﻟﻁﻠـﺏ ﻋﻠـﻰ ﺍﻟﻌﻼﺠـﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ‬
‫ﺴﻭﺍﺀ ﺒﻌﻤﻠﻬﻡ ﻓﻰ ﻤﺭﺍﻜﺯﻫﻡ ﻭﻋﻴﺎﺩﺍﺘﻬﻡ ﺍﻟﺨﺎﺼـﺔ ﺃﻭ ﺒﺘﻌـﺎﻭﻨﻬﻡ ﻤـﻊ ﺍﻷﻁﺒـﺎﺀ ﺍﻟﻨﻔﺴـﻴﻴﻥ ‪ ،‬ﻓـﺈﻥ‬
‫ﺍﻟﻭﻀﻊ ﻻ ﻴﺨﺘﻠﻑ ﻋﻥ ﺫﻟﻙ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻸﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ ﺍﻟـﺫﻴﻥ ﻴﻌﻤﻠـﻭﻥ ﻓـﻰ‬
‫ﻤﺴﺘﺸﻔﻴﺎﺕ ﺍﻟﺼﺤﺔ ﺍﻟﻨﻔﺴﻴﺔ ﺃﻭ ﻋﻠﻰ ﻨﺤﻭ ﺃﺩﻕ ﻤﺴﺘﺸﻔﻴﺎﺕ ﺍﻷﻤـﺭﺍﺽ ﺍﻟﻌﻘﻠﻴـﺔ ‪ .‬ﻭﻤـﻥ ﺍﻟﻤﻌﻠـﻭﻡ‬
‫ﺃﻥ ﻏﺎﻟﺒﻴﺔ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴﻴﻥ )ﺇﺫﺍ ﺠﺎﺯ ﻫـﺫﺍ ﺍﻟﺘﻌﺒﻴـﺭ ﺤﻴـﺙ ﺃﻥ ﺍﻟـﺒﻌﺽ ﻤـﻨﻬﻡ‬
‫ﻴﻌﻤﻠﻭﻥ ﻓـﻰ ﺍﻟﻤﻴـﺩﺍﻥ ﺍﻹﻜﻠﻴﻨﻴﻜـﻰ ﺩﻭﻥ ﺇﻋـﺩﺍﺩ ﺨـﺎﺹ ﻓـﻰ ﻫـﺫﺍ ﺍﻟﻤﺠـﺎل( ﻴﻌﻤﻠـﻭﻥ ﻓـﻰ‬
‫ﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ ﺍﻟﺭﺌﻴﺴﻴﺔ ﺍﻟﻜﺒﺭﻯ ﻟﻸﻤـﺭﺍﺽ ﺍﻟﻌﻘﻠﻴـﺔ ﻓـﻰ ﻤﺼـﺭ ﻭﻤﻨﻬـﺎ ﻤﺴﺘﺸـﻔﻰ ﺍﻟﻌﺒﺎﺴـﻴﺔ ‪،‬‬
‫ﻭﺍﻟﺨﺎﻨﻜﺔ ‪ ،‬ﻭﻤﺼﺭ ﺍﻟﺠﺩﻴـﺩﺓ ‪ ،‬ﻭﺤﻠـﻭﺍﻥ ﻭﺍﻟﻤﻌﻤـﻭﺭﺓ ‪ ،‬ﺒﺎﻹﻀـﺎﻓﺔ ﺇﻟـﻰ ﺒﻌـﺽ ﺍﻟﻤﺴﺘﺸـﻔﻴﺎﺕ‬
‫ﺍﻟﺠﺎﻤﻌﻴﺔ ﺍﻟﻤﻠﺤﻘﺔ ﺒﻜﻠﻴﺎﺕ ﺍﻟﻁﺏ ﻜﻤﺭﻜـﺯ ﺍﻟﻁـﺏ ﺍﻟﻨﻔﺴـﻰ ﺒﺠﺎﻤﻌـﺔ ﻋـﻴﻥ ﺸـﻤﺱ ‪ ،‬ﻭﺍﻟﻘﺼـﺭ‬
‫ﺍﻟﻌﻴﻨﻰ )ﺠﺎﻤﻌﺔ ﺍﻟﻘـﺎﻫﺭﺓ( ‪ ،‬ﻭﻤـﻥ ﺍﻟﻤﻌﻠـﻭﻡ ﺃﻴﻀـﹰﺎ ﺃﻥ ﺤـﻭﺍﻟﻰ ‪ %٧٠ – ٦٠‬ﻤـﻥ ﺍﻟﻤﺭﻀـﻰ‬
‫ﻨﺯﻻﺀ ﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ ﺍﻟﻌﻘﻠﻴﺔ ﻤـﻥ ﺍﻟﻔﺼـﺎﻤﻴﻴﻥ )ﺃﺤﻤـﺩ ﻋﻜﺎﺸـﺔ ‪ ، ١٩٨٩ ،‬ﺹ‪ ، (٢٥٠‬ﻴﻀـﺎﻑ‬

‫‪٨‬‬
‫ﻤـﻥ ﺍﻟﻤﺠﻤـﻭﻉ ﺍﻟﻌـﺎﻡ‬ ‫ﺇﻟﻰ ﺫﻟﻙ ﺃﻥ ﺍﻟﻔﺼﺎﻡ ﻜﻤﺭﺽ ﻋﻘﻠﻰ ﻴﺼـﻴﺏ ﻤـﺎ ﺒـﻴﻥ ‪%٣ – ٠.٨٥‬‬
‫ﻷﻯ ﺸﻌﺏ ﻭﻫﻰ ﻨﺴﺒﺔ ﺨﻁﻴﺭﺓ ﺇﺫﺍ ﺃﺨﺫﻨﺎ ﻓﻰ ﺍﻻﻋﺘﺒـﺎﺭ ﺃﻥ ﻫـﺫﺍ ﺍﻟﻤـﺭﺽ ﻴﺼـﻴﺏ ﺍﻟﻔـﺭﺩ ﻓـﻰ‬
‫ﺴﻥ ﺍﻟﺸﺒﺎﺏ ﻭﺍﻟﻨﻀﻭﺝ ﺃﻯ ﻓﺘﺭﺓ ﺍﻟﻌﻤل ﻭﺍﻟﺩﺭﺍﺴـﺔ ﻭﺍﻻﺯﺩﻫـﺎﺭ ﺍﻟﻔﻜـﺭﻯ ﻤﻤـﺎ ﻴﺠﻌـل ﺍﻟﻔﺼـﺎﻡ‬
‫ﻟﻴﺱ ﻅﺎﻫﺭﺓ ﻤﺭﻀﻴﺔ ﻓﺤﺴﺏ ‪ ،‬ﺒل ﻅـﺎﻫﺭﺓ ﺘـﺅﺜﺭ ﻋﻠـﻰ ﺍﻟﻨﺎﺤﻴـﺔ ﺍﻻﻗﺘﺼـﺎﺩﻴﺔ ﻭﺍﻻﺠﺘﻤﺎﻋﻴـﺔ‬
‫)ﺍﻟﻤﺭﺠﻊ ﺍﻟﺴﺎﺒﻕ( ‪ ،‬ﻫﻨﺎ ﻴﺜﻭﺭ ﺴـﺅﺍل ﻋـﻥ ﺍﻟـﺩﻭﺭ ﺍﻟـﺫﻯ ﻴﻤﺎﺭﺴـﻪ ﺍﻷﺨﺼـﺎﺌﻴﻭﻥ ﺍﻟﻨﻔﺴـﻴﻭﻥ‬
‫ﺍﻹﻜﻠﻴﻨﻴﻜﻴﻭﻥ ﻟﻤﺴـﺎﻋﺩﺓ ﻫـﺅﻻﺀ ﺍﻟﻤﺭﻀـﻰ ‪ ،‬ﻁﺒﻘـﹰﺎ ﻟﺘﺨﺼﺼـﻬﻡ ‪ ،‬ﻟﻠﻭﺼـﻭل ﺇﻟـﻰ ﺍﻟﺘﺤﺴـﻥ‬
‫ﻭﺍﻟﺸﻔﺎﺀ ‪ ،‬ﻤﺘﺠﺎﻭﺯﻴﻥ – ﺒﺎﻟﻁﺒﻊ – ﻤﺴﺘﻭﻯ ﺍﻟﺘﻘﺩﻴﺭ ﺍﻟﺘﺸﺨﻴﺼﻰ ‪.‬‬

‫ﺇﻥ ﻫﺅﻻﺀ ﺍﻟﻤﺭﻀﻰ – ﺒﺎﻋﺘﺭﺍﻑ ﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴﻴﻴﻥ – ﻴﺤﺘـﺎﺠﻭﻥ ﺒﻌـﺩ ﺘﺤﺴـﻨﻬﻡ ﺍﻟﻨﺴـﺒﻰ‬
‫ﺇﻟﻰ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ‪ ،‬ﺤﻴﺙ ﺃﻨﻬﻡ ﻴﻔﻘﺩﻭﻥ ﺍﻟﺜﻘـﺔ ﻓـﻰ ﺃﻨﻔﺴـﻬﻡ ﻋﻨـﺩﻤﺎ ﻴـﺩﺭﻜﻭﻥ ﺃﻨﻬـﻡ ﺃﺼـﻴﺒﻭﺍ‬
‫ﺒﻤﺭﺽ ﻋﻘﻠﻰ ﻭﻴﺨﺸﻭﻥ ﻨﻅﺭﺓ ﺍﻟﻤﺠﺘﻤﻊ ﺇﻟﻴﻬﻡ ﻭﻴﺒـﺩﺃﻭﻥ ﺜﺎﻨﻴـﺔ ﻓـﻰ ﺍﻻﻨﻌـﺯﺍل ﻤﻤـﺎ ﻴﻌﺭﻀـﻬﻡ‬
‫ﻻﻨﺘﻜﺎﺴﺔ ﺃﺨﺭﻯ ﻭﺍﻟﺩﺨﻭل ﻓﻰ ﺩﺍﺌﺭﺓ ﻤﻐﻠﻘـﺔ ﻻ ﺘﻨﺘﻬـﻰ ‪ ،‬ﺨﺎﺼـﺔ ﻭﺃﻨـﻪ ﺒﺈﻤﻜـﺎﻥ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ‬
‫ﺍﻟﻨﻔﺴﻴﻴﻥ ﻤﺴﺎﻋﺩﺓ ﻫـﺅﻻﺀ ﺍﻟﻤﺭﻀـﻰ ﺒﺎﻟﺘـﺩﺭﻴﺏ ﻋﻠـﻰ ﺒﻌـﺽ ﺍﻟﻤﻬـﺎﺭﺍﺕ ﺍﻻﺠﺘﻤﺎﻋﻴـﺔ ﺍﻟﺘـﻰ‬
‫ﻓﻘﺩﻭﻫﺎ ﺃﺜﻨﺎﺀ ﺍﻟﻤﺭﺽ )ﺃﺤﻤﺩ ﻋﻜﺎﺸﺔ ‪ ، ١٩٨٩ ،‬ﺹ‪ ، (٣١٧‬ﻟـﻴﺱ ﻫـﺫﺍ ﻓﺤﺴـﺏ ﺒـل ﺘﻁﺒﻴـﻕ‬
‫ﻋﺩﺩ ﺃﻜﺒﺭ ﻤﻥ ﺍﻷﺴﺎﻟﻴﺏ ﺍﻟﺴﻠﻭﻜﻴﺔ ﻭﺍﻟﻤﻌﺭﻓﻴﺔ ﺍﻟﺘﻰ ﺘﺼـﻠﺢ ﻟﻤﺴـﺎﻋﺩﺓ ﻫـﺅﻻﺀ ﺍﻟﻤﺭﻀـﻰ ‪ ،‬ﻷﻨـﻪ‬
‫ﺒﺭﻏﻡ ﺍﻟﻔﺎﻋﻠﻴﺔ ﺍﻟﻤﺅﻜﺩﺓ ﻟﻠﻌﻘﺎﻗﻴﺭ ﺍﻟﻤﻀﺎﺩﺓ ﻟﻠﺫﻫﺎﻥ ‪ ،‬ﻓﺈﻥ ﻫﻨـﺎﻙ ﻨﺴـﺒﺔ ﺠﻭﻫﺭﻴـﺔ ﻤـﻥ ﺍﻟﻤﺭﻀـﻰ‬
‫)ﺤﻭﺍﻟﻰ ‪ (%٦٠ -١٠‬ﺘﻅل ﻟﺩﻴﻬﻡ ﺃﻋﺭﺍﺽ ﻤﻭﺠﻴـﺔ ﻤﻘﺎﻭﻤـﺔ ﻟﻠﺘـﺩﺍﻭﻯ ‪ ،‬ﻭﻤـﻥ ﺜـﻡ ﻴﻜﻭﻨـﻭﻥ‬
‫ﺒﺤﺎﺠﺔ ﺇﻟﻰ ﻋﻼﺠﺎﺕ ﻨﻔﺴـﻴﺔ ﻴﻤﻜـﻥ ﺃﻥ ﺘﺤﺴـﻥ ﺍﻟﻨـﺎﺘﺞ ﺍﻟﻤﻁﻠـﻭﺏ ) ‪Zimmermann et al.,‬‬
‫‪ (2005‬ﻭﻗﺩ ﺃﺼﺒﺢ ﺍﻷﺨﺼﺎﺌﻴﻭﻥ ﺍﻟﺫﻴﻥ ﻴﻌﻤﻠـﻭﻥ ﻤـﻊ ﺍﻷﺸـﺨﺎﺹ ﺍﻟﻤﺼـﺎﺒﻴﻥ ﺒﺎﻻﻀـﻁﺭﺍﺒﺎﺕ‬
‫ﺍﻟﺨﻁﻴﺭﺓ ﻭﺍﻟﻤﺯﻤﻨﺔ ﺃﻜﺜﺭ ﺍﻫﺘﻤﺎﻤﹰﺎ ﺒﺘﻁﺒﻴﻕ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻋﻠـﻰ ﻤﺭﻀـﻰ ﺍﻟـﺫﻫﺎﻥ‬

‫‪٩‬‬
‫ﻭﻫﻨﺎﻙ ﺘﻘﺎﺭﻴﺭ ﺘﺼﺩﺭ ﺒﺸﻜل ﺸـﻬﺭﻯ ﺘﻘﺭﻴﺒـﹰﺎ ﻋـﻥ ﺩﺭﺍﺴـﺎﺕ ﺠﺩﻴـﺩﺓ ﻟﺘﻘﻴـﻴﻡ ﻓﻭﺍﺌـﺩ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻤﻊ ﺍﻷﺸﺨﺎﺹ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺎﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﺫﻫﺎﻨﻴﺔ )‪.(Glynn, 2006‬‬

‫ـﻼﺝ‬
‫ـﺩ ﺍﻟﻌـ‬
‫ـﻰ ‪ Meta analysis‬ﻓﻭﺍﺌـ‬
‫ـل ﺍﻟﺠﻤﻌـ‬
‫ـﺎﺕ ﻟﻠﺘﺤﻠﻴـ‬
‫ـﻼﺙ ﺩﺭﺍﺴـ‬
‫ـﺩﺕ ﺜـ‬
‫ـﺩ ﺃﻴـ‬
‫ﻭﻗـ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻟﻸﺸﺨﺎﺹ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺎﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﺫﻫﺎﻨﻴﺔ ﺒـﺭﻏﻡ ﺒﻌـﺽ ﺍﻟﺠـﺩل ﺤـﻭل‬
‫ﻗـﻭﺓ ﻨﺘـﺎﺌﺞ ﻫـﺫﻩ ﺍﻟﺩﺭﺍﺴـﺎﺕ ) ‪Gould et al.,2001; Rector & Beck, 2001,Pilling‬‬
‫‪ (et al.,2002‬ﻭﻫﻨﺎﻙ ﻋﻠﻰ ﺍﻷﻗل ﺨﻤﺴـﺔ ﻨﺼـﻭﺹ ﻤﺘﺎﺤـﺔ ﺘﺼـﻑ ﻜﻴﻔﻴـﺔ ﺘﻨﻔﻴـﺫ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻤـﻊ ﺃﺸـﺨﺎﺹ ﺫﻭﻯ ﺍﻀـﻁﺭﺍﺒﺎﺕ ﺫﻫﺎﻨﻴـﺔ ‪(Fowler et al., 1995‬‬
‫‪Chandwick et al., 1996; Nelson , 1997, kingdon & Turkeington ,‬‬
‫)‪ 2004; Morrisson et al., 2004‬ﻭﺘﺄﺴﻴﺴﹰﺎ ﻋﻠﻰ ﺍﻟﺘﻘـﺎﺭﻴﺭ ﺍﻟﻤﺒﻜـﺭﺓ ﻟﺩﺭﺍﺴـﺔ ﺍﻟﺤﺎﻟـﺔ ﻓﻘـﺩ‬
‫ﺘﻁﻭﺭﺕ ﺍﻟﻤﻨﺎﺤﻰ ﺍﻟﻤﻌﺭﻓﻴـﺔ ﺍﻟﺴـﻠﻭﻜﻴﺔ ﺍﻟﻤﺘﺨﺼﺼـﺔ ﻟﻜـﻰ ﺘﺨﻔـﻑ ﻤـﻥ ﺍﻟﻜـﺭﺏ ﺍﻟﻤـﺭﺘﺒﻁ‬
‫ﺒــﺎﻟﻬﻼﻭﺱ ‪ ، Hallucinations‬ﻭﺍﻟﻬــﺫﺍﺀﺍﺕ ‪ ، Delusions‬ﻭﺒﺎﻟﻔﻌــل ﺃﻭﻀــﺤﺕ ﻋــﺩﺓ‬
‫ﺩﺭﺍﺴﺎﺕ ﺃﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻴﺅﺩﻯ ﺇﻟﻰ ﺁﺜﺎﺭ ﺇﻜﻠﻴﻨﻴﻜﻴﺔ ﻭﺍﺴـﻌﺔ ﻋﻠـﻰ ﻜـل ﻤـﻥ ﻋـﺩﺩ‬
‫ﺍﻷﻋﺭﺍﺽ ﺍﻟﻤﻭﺠﺒﺔ ﻭﺸﺩﺘﻬﺎ ‪ ،‬ﻭﺒﺨﺎﺼـﺔ ﺍﻟﻜـﺭﺏ ﺍﻟﻤـﺭﺘﺒﻁ ﺒﺎﻟﻬـﺫﺍﺀﺍﺕ ﻭﺍﻟﻬـﻼﻭﺱ ﺒﺎﻹﻀـﺎﻓﺔ‬
‫ﺇﻟﻰ ﺍﻟﺘﺎﺭﻴﺦ ﺍﻟﻤﺭﻀﻰ )ﺍﻻﻀﻁﺭﺍﺏ ﺍﻟﻨﻔﺴﻰ ﺍﻟﻌـﺎﻡ( ﻓـﻰ ﻨﻬﺎﻴـﺔ ﻓﺘـﺭﺓ ﺍﻟﻌـﻼﺝ ﻭﻓـﻰ ﻓﺘـﺭﺍﺕ‬
‫ﺍﻟﻤﺘﺎﺒﻌــﺔ ; ‪Zimmmermann et al., )(Stahl, 1999; Rector et al. , 2003‬‬
‫‪.2005‬‬

‫ﻭﻓﻰ ﺩﺭﺍﺴﺔ ﺍﺴﺘﻁﻼﻋﻴﺔ ﻜﺎﻨﺕ ﺘﻬﺩﻑ ﺇﻟﻰ ﻓﺤـﺹ ﻓﻌﺎﻟﻴـﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ‬
‫ﺍﻟﺠﻤﻌﻰ ﻋﻠﻰ ﺍﻟﻬﻼﻭﺱ ﺍﻟﺴﻤﻌﻴﺔ ‪ ،‬ﺸﺎﺭﻙ ﻓﻴﻬﺎ ﺃﺤﺩ ﻋﺸـﺭ ﻤﺭﻴﻀـﹰﺎ ﻤـﻥ ﺍﻟﻤﻘﻴﻤـﻴﻥ ﺒﺎﻟﻤﺴﺘﺸـﻔﻰ‬
‫‪ ،‬ﻤﺸﺨﺼﻴﻥ ﺒﺎﻟﻔﺼﺎﻡ ﺍﻟﻤﺯﻤﻥ ﺃﻭ ﺍﻀﻁﺭﺍﺏ ﺍﻟﻔﺼﺎﻡ ﺍﻟﻭﺠﺩﺍﻨﻰ ﻭﺫﻟـﻙ ﻟﻤـﺩﺩ ﻋﻼﺠﻴـﺔ ﻤﺘﻔﺎﻭﺘـﻪ‬
‫)ﺴﺒﻊ ﺠﻠﺴﺎﺕ ﻤﻘﺎﺒل ﻋﺸﺭﻴﻥ ﺠﻠﺴﺔ( ﺃﻭﻀﺤﺕ ﺍﻟﻨﺘـﺎﺌﺞ ﺃﻥ ﺍﻟﻤﺸـﺎﺭﻜﺔ ﻓـﻰ ﻜﻠﺘـﺎ ﺍﻟﻤﺠﻤـﻭﻋﺘﻴﻥ‬

‫‪١٠‬‬
‫ﺍﺭﺘﺒﻁﺕ ﺒﺘﻐﻴﺭﺍﺕ ﺇﻴﺠﺎﺒﻴـﺔ ﺠﻭﻫﺭﻴـﺔ ﻓـﻰ ﻤﻌﺘﻘـﺩﺍﺕ ﺍﻟﻤﺸـﺎﺭﻜﻴﻥ ﺤـﻭل ﺍﻷﺼـﻭﺍﺕ ﺍﻟﺘـﻰ‬
‫ﻴﺴﻤﻌﻭﻨﻬﺎ ‪ ،‬ﻭﺍﻨﺨﻔـﺎﺽ ﻓـﻰ ﺍﻻﺴـﺘﺠﺎﺒﺎﺕ ﺍﻟﺴـﻠﺒﻴﺔ ﻟﻬـﺫﻩ ﺍﻷﺼـﻭﺍﺕ ) ‪Pinkham et al. ,‬‬
‫‪. (2003‬‬

‫ﺇﻥ ﺍﺴﺘﻤﺭﺍﺭ ﺍﻷﻋﺭﺍﺽ ﻴﻌـﺩ ﺃﻤـﺭﹶًﺍ ﻀـﺎﻏﻁﹰﺎ ﻭﻟـﻪ ﻤﺘﺭﺘﺒـﺎﺕ ﻋﻠـﻰ ﻨﻭﻋﻴـﺔ ﺍﻟﺤﻴـﺎﺓ‬
‫‪ Quality of Life‬ﻟﺩﻯ ﻜل ﻤﻥ ﺍﻟﻔﺭﺩ ﻭﺍﻷﺴـﺭﺓ ‪ ،‬ﻤـﻥ ﻫﻨـﺎ ﺘﺒـﺩﻭ ﺍﻟﺤﺎﺠـﺔ ﻤﺴـﺘﻤﺭﺓ ﺇﻟـﻰ‬
‫ﻋﻼﺠﺎﺕ ﺘﺴﺘﻬﺩﻑ ﺍﻷﻋﺭﺍﺽ ﺍﻟﻤﺴـﺘﻤﺭﺓ ﻭﺍﻟﻤﺯﻤﻨـﺔ ‪ ،‬ﻭﻫﻨـﺎﻙ ﺩﻟﻴـل ﻤﺘﻨـﺎﻤﻰ ﻋﻠـﻰ ﻓﻌﺎﻟﻴـﺔ‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻓﻰ ﺨﻔـﺽ ﺍﻷﻋـﺭﺍﺽ ﺍﻟﻤﻭﺠﺒـﺔ ‪ Positive‬ﻭﺍﻟﺴـﺎﻟﺒﺔ ‪Negative‬‬
‫ﺍﻟﻤﺴﺘﻤﺭﺓ ‪ ،‬ﻭﺘﻭﺠﺩ ﺩﺭﺍﺴـﺎﺕ ﻤﻨﻬﺠﻴـﺔ ﻤﻀـﺒﻭﻁﺔ ﺍﻫﺘﻤـﺕ ﺒﻔﺤـﺹ ﻤـﺩﻯ ﻓﻌﺎﻟﻴـﺔ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻟﻠﻔﺼﺎﻤﻴﻴﻥ ﺴـﻭﺍﺀ ﺨـﻼل ﻤﺭﺤﻠـﺔ ﺇﺯﻤـﺎﻥ ﺍﻟﻤـﺭﺽ ﺃﻭ ﺨـﻼل ﺍﻟﻤﺭﺤﻠـﺔ‬
‫ﺍﻟﺤﺎﺩﺓ )‪.(Rector et al. , 2003‬‬

‫ﻤﻤﺎ ﺘﻘﺩﻡ ﻴﻤﻜﻨﻨﺎ ﺃﻥ ﻨﺨﻠﺹ ﺇﻟـﻰ ﺍﻟﺘﺴـﺎﺅل ﺍﻟﺭﺌﻴﺴـﻰ ﺍﻟﺘـﺎﻟﻰ ﻟﻠﺩﺭﺍﺴـﺔ ﺍﻟﺭﺍﻫﻨـﺔ ﻭﻫـﻭ‬
‫" ﻤﺎ ﻤﺴﺘﻭﻯ ﺘﺄﻫﻴـل ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ ﻓـﻰ ﻤﺠـﺎل ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ‪ ،‬ﻭﻤﺩﻯ ﻤﻤﺎﺭﺴﺘﻬﻡ ﻟﻪ ﻓﻰ ﻋﻼﺝ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺎﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﺒﺼـﻔﺔ ﻋﺎﻤـﺔ‬
‫‪ ،‬ﻭﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ﺒﺼﻔﺔ ﺨﺎﺼﺔ " ؟ ‪.‬‬

‫أهـــﺪاف اﻟﺪراﺳــــﺔ ‪:‬‬

‫‪١١‬‬
 ‫ﺘﺴﺘﻬﺩﻑ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﺭﺍﻫﻨﺔ ﻤﺎ ﻴﻠﻰ‪-:‬‬

‫‪ -١‬ﺍﻟﻭﻗﻭﻑ ﻋﻠﻰ ﻤﺴﺘﻭﻯ ﺘﺄﻫﻴـل ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ ﻓـﻰ ﻤﺠـﺎل ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‪.‬‬

‫‪ -٢‬ﺍﻟﺘﻌﺭﻑ ﻋﻠﻰ ﻤـﺩﻯ ﻤﻤﺎﺭﺴـﺔ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ ﻟﻠﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬

‫ﺍﻟﺴﻠﻭﻜﻰ ﻟﻤﺴﺎﻋﺩﺓ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺎﻀـﻁﺭﺍﺒﺎﺕ ﻨﻔﺴـﻴﺔ ﻤﺨﺘﻠﻔـﺔ ﻜـﺎﻟﻘﻠﻕ ﻭﺍﻻﻜﺘﺌـﺎﺏ‬
‫ﻭﺍﻟﻭﺴﻭﺍﺱ ﺍﻟﻘﻬﺭﻯ ﻭﻏﻴﺭﻫﺎ‪.‬‬

‫‪ -٣‬ﺍﺴﺘﻜﺸﺎﻑ ﻤﺩﻯ ﻭﻋﻰ ﻫﺅﻻﺀ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺒﺈﻤﻜﺎﻨﻴـﺔ ﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ﻤﻊ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ‪ ،‬ﻭﻤﺩﻯ ﻗﻴﺎﻤﻬﻡ ﺒﺫﻟﻙ ﺍﻟﺩﻭﺭ ﺒﺤﻜـﻡ ﻋﻤﻠﻬـﻡ ﻓـﻰ ﻤﺴﺘﺸـﻔﻴﺎﺕ‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﻌﻘﻠﻴﺔ ﺒﺎﻋﺘﺒﺎﺭ ﺃﻥ ﻏﺎﻟﺒﻴﺔ ﻨﺯﻻﺌﻬﺎ ﻤﻥ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ‪.‬‬

‫ﻣﻨﻄﻠﻘﺎت اﻟﺪراﺳﺔ‪:‬‬
‫ﺘﺴﺘﻨﺩ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﺭﺍﻫﻨﺔ ﺇﻟﻰ ﻋﺩﺩ ﻤـﻥ ﺍﻟﻤﻨﻁﻠﻘـﺎﺕ ﻭﺍﻟﻤﺒـﺭﺭﺍﺕ ﺍﻟﺘـﻰ ﺘـﺩﻋﻡ ﺃﻫﻤﻴﺘﻬـﺎ‬
‫ﻭﻤﻥ ﺫﻟﻙ ﻤﺎ ﻴﻠﻰ‪-:‬‬

‫‪ -١‬ﺃﻫﻤﻴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻓﻰ ﺍﻟﻭﻗﺕ ﺍﻟـﺭﺍﻫﻥ ‪ ،‬ﻭﺍﺘﺴـﺎﻉ ﺍﺴـﺘﺨﺩﺍﻤﻪ ﺇﻟـﻰ ﻤـﺎ ﻭﺭﺍﺀ‬
‫ﻋﻼﺝ ﺍﻻﻜﺘﺌﺎﺏ ‪ ،‬ﺤﻴﺙ ﻴﺴـﺘﺨﺩﻡ ﺒﻔﺎﻋﻠﻴـﺔ ﻓـﻰ ﻋـﻼﺝ ﺍﻀـﻁﺭﺍﺏ ﺍﻟﻬﻠـﻊ ﻭﺍﻀـﻁﺭﺍﺏ‬
‫ﻜﺭﺏ ﻤﺎ ﺒﻌﺩ ﺍﻟﺼﺩﻤﺔ ‪ ،‬ﻭﺘﻌﺎﻁﻰ ﺍﻟﻤﻭﺍﺩ ﺍﻟﻨﻔﺴـﻴﺔ ﻭﺍﻻﻀـﻁﺭﺍﺏ ﺍﻟﺒﺎﺭﺍﻨﻭﻴـﺩﻯ ﺍﻟﻬـﺫﺍﺌﻰ ‪،‬‬
‫ـﻁﺭﺍﺒﺎﺕ‬
‫ـﻊ ﻤـﻥ ﺍﻻﻀـ‬
‫ـﻴﺔ ‪ ،‬ﻭﻤـﺩﻯ ﻭﺍﺴـ‬
‫ـﻰ ‪ ،‬ﻭﺍﻻﺨـﺘﻼﻻﺕ ﺍﻟﺠﻨﺴـ‬
‫ﻭﺍﻟﺼـﺭﺍﻉ ﺍﻟﺯﻭﺍﺠـ‬
‫ﺍﻟﻭﺠﺩﺍﻨﻴـﺔ ﻭﺍﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﺸﺨﺼـﻴﺔ )ﻟﻴﻬـﻰ ‪ ، ٢٠٠٦ ،‬ﺍﻟﺘﺼـﺩﻴﺭ ‪George et al. ،‬‬
‫‪.(2005‬‬

‫‪١٢‬‬
‫‪ -٢‬ﺯﻴﺎﺩﺓ ﺍﻟﻁﻠﺏ ﻋﻠﻰ ﺍﻟﺨـﺩﻤﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ﻭﺫﻟـﻙ ﻜﻨﺘﻴﺠـﺔ ﻟﺯﻴـﺎﺩﺓ ﺍﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴـﻴﺔ ‪،‬‬
‫ﺨﺎﺼﺔ ﻤﻊ ﺴـﺭﻋﺔ ﺇﻴﻘـﺎﻉ ﺍﻟﺤﻴـﺎﺓ ‪ ،‬ﻭﺯﻴـﺎﺩﺓ ﻤﺜﻴـﺭﺍﺕ ﺍﻟﻀـﻐﻭﻁ ﺍﻟﻨﻔﺴـﻴﺔ ‪ ،‬ﻭﺍﻟﺘﻘـﺩﻡ‬
‫ﺍﻟﺘﻜﻨﻭﻟﻭﺠﻰ ‪ ،‬ﻭﺍﺨﺘﻼل ﻤﻨﻅﻭﻤﺔ ﺍﻟﻘﻴﻡ‪.‬‬
‫‪ -٣‬ﻨﻘﺹ ﺍﻟﻜﻭﺍﺩﺭ ﺍﻟﻤﺩﺭﺒﺔ ﻋﻠﻰ ﺘﻘﺩﻴﻡ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ‪ ،‬ﻭﺍﻟﻨـﺩﺭﺓ ﺍﻟﻭﺍﻀـﺤﺔ ﻓـﻰ‬
‫ﺍﻷﻤﺎﻜﻥ ﺍﻟﻤﺘﺨﺼﺼﺔ ﺍﻟﺘـﻰ ﻴﻤﻜـﻥ ﺃﻥ ﺘﻘـﺩﻡ ﺍﻟﺘـﺩﺭﻴﺏ ﻓـﻰ ﻤﺠـﺎل ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ‪.‬‬

‫‪ -٤‬ﺍﻋﺘﺭﺍﻑ ﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺒﺄﻫﻤﻴﺔ ﺍﻟﻌﻼﺠﺎﺕ ﺍﻟﻤﻌﺭﻓﻴﺔ ﺍﻟﺴﻠﻭﻜﻴﺔ ﻓﻰ ﻤﻘﺎﺒل ﺍﻟﻌﻼﺠﺎﺕ ﺍﻟﺩﻭﺍﺌﻴﺔ ‪،‬‬
‫ﺨﺎﺼﺔ ﻓﻰ ﺃﻤﺭﺍﺽ ﺍﻻﻜﺘﺌﺎﺏ ﻭﺍﻟﻘﻠﻕ ﻭﺍﻟﺭﻫﺎﺏ ﻭﻏﻴﺭ ﺫﻟﻙ‪ ،‬ﺒل ﺃﻥ ﺍﻷﻤﺭ ﻟﻡ ﻴﻌﺩ ﻴﻘﺘﺼﺭ ﻋﻠـﻰ‬
‫ﺍﻷﻤﺭﺍﺽ ﺍﻟﻨﻔﺴﻴﺔ )ﺍﻟﻌﺼﺎﺒﻴﺔ( ‪ ،‬ﺒل ﺘﻌﺩﺍﻫﺎ ﺇﻟﻰ ﻤﺤﺎﻭﻟﺔ ﺍﺴﺘﺨﺩﺍﻡ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻤﻊ‬
‫ﻤﺭﻀﻰ ﺍﻟﺫﻫﺎﻥ ‪ ،‬ﻭﺭﻏﻡ ﺃﻥ ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﻀﺎﺩﺓ ﻟﻠﺫﻫﺎﻥ ﺘﻌﺘﺒﺭ ﻓﻌﺎﻟﺔ ﻓـﻰ ﻋـﻼﺝ ﺍﻷﻋـﺭﺍﺽ‬
‫ﺍﻹﻴﺠﺎﺒﻴﺔ ﺍﻟﺤﺎﺩﺓ ﻟﻠﻔﺼﺎﻡ )ﻋﻠﻰ ﺴﺒﻴل ﺍﻟﻤﺜﺎل( ﻭﻓﻰ ﻤﻨﻊ ﺘﻜﺭﺍﺭ ﺍﻻﻨﺘﻜﺎﺱ‪ ،‬ﻓـﺈﻥ ﻫﻨـﺎﻙ ﻨﺴـﺒﺔ‬
‫ﺠﻭﻫﺭﻴﺔ ﻤﻥ ﺍﻟﻤﺭﻀﻰ ﺍﻟﺫﻴﻥ ﻴﻭﺍﺼﻠﻭﻥ ﺍﻟﺸﻌﻭﺭ ﺒﻤﺸﻜﻼﺕ ﺠﻭﻫﺭﻴﺔ ﺤﺘﻰ ﻋﻨﺩ ﺍﻟﺘﻭﺠﻪ ﻷﻓﻀل‬
‫ﺃﻨﻭﺍﻉ ﺍﻟﻌﻼﺝ ﺍﻟﻔﺎﺭﻤﺎﻜﻭﻟﻭﺠﻰ )‪ ، (Stahl , 1995‬ﻜﻤﺎ ﺘﺸﻴﺭ ﺩﺭﺍﺴﺎﺕ ﺃﺨﺭﻯ ﺇﻟﻰ ﺃﻥ ﻤﺭﻀﻰ‬
‫ﺍﻟﻔﺼﺎﻡ ﺍﻟﺫﻴﻥ ﻴﺘﻠﻘﻭﻥ ﻋﻼﺠﺎﺕ ﺠﺩﻴﺩﺓ ﻟﻠﺫﻫﺎﻥ ‪ ،‬ﻴﺴﺘﻤﺭﻭﻥ ﻓﻰ ﺍﻟﻤﻌﺎﻨﺎﺓ ﻤﻥ ﻋﺠـﺯ ﺍﺠﺘﻤـﺎﻋﻰ‬
‫ﻤﻠﺤﻭﻅ ﻭﻗﺩﺭﺓ ﻭﻅﻴﻔﻴﺔ ﻀﻌﻴﻔﺔ )‪. (Eack et al. 2007‬‬

‫‪ -٥‬ﺇﻤﻜﺎﻨﻴﺔ ﺍﻻﺴﺘﻔﺎﺩﺓ ﻤﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻓـﻰ ﻋـﻼﺝ ﻤﺭﻀـﻰ ﺍﻟـﺫﻫﺎﻥ ﺒﺼـﻔﺔ‬
‫ﻋﺎﻤﺔ ‪ ،‬ﻭﻤﺭﻀﻰ ﺍﻟﻔﺼـﺎﻡ ﺒﺼـﻔﺔ ﺨﺎﺼـﺔ ‪ ،‬ﻭﻗـﺩ ﺃﺼـﺒﺢ ﺍﻷﺨﺼـﺎﺌﻴﻭﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻭﻥ‬
‫ﺍﻟﺫﻴﻥ ﻴﻌﻤﻠﻭﻥ ﻤـﻊ ﺍﻷﺸـﺨﺎﺹ ﺍﻟﻤﺼـﺎﺒﻴﻥ ﺒﺎﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﺨﻁﻴـﺭﺓ ﻭﺍﻟﻤﺯﻤﻨـﺔ ﺃﻜﺜـﺭ‬
‫ﺍﻫﺘﻤﺎﻤﹰﺎ ﺒﺘﻁﺒﻴﻕ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻋﻠﻰ ﺍﻟـﺫﻫﺎﻥ ﻭﻫﻨـﺎﻙ ﺘﻘـﺎﺭﻴﺭ ﺘﺼـﺩﺭ ﺒﺸـﻜل‬
‫ﺸﻬﺭﻯ ﺘﻘﺭﻴﺒﹰﺎ ﻋﻥ ﺩﺭﺍﺴﺎﺕ ﺠﺩﻴـﺩﺓ ﻟﺘﻘﻴـﻴﻡ ﻓﻭﺍﺌـﺩ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻋﻠـﻰ‬

‫‪١٣‬‬
‫ﺍﻷﺸــﺨﺎﺹ ﺍﻟﻤﺼــﺎﺒﻴﻥ ﺒﺎﻻﻀــﻁﺭﺍﺒﺎﺕ ﺍﻟﺫﻫﺎﻨﻴــﺔ )‪ (Glynn , 2006‬ﻜﻤــﺎ ﺴــﺒﻘﺕ‬
‫ﺍﻹﺸﺎﺭﺓ‪.‬‬

‫‪ -٦‬ﻀﺭﻭﺭﺓ ﺇﻴﺠﺎﺩ ﻭﺴﻴﻠﺔ ﻟﺤل ﺒﻌﺽ ﺍﻟﻤﺸـﻜﻼﺕ ﺍﻟﻤﻬﻨﻴـﺔ ﺍﻟﺘـﻰ ﻴﻌـﺎﻨﻰ ﻤﻨﻬـﺎ ﺍﻷﺨﺼـﺎﺌﻴﻭﻥ‬
‫ﺍﻟﻨﻔﺴﻴﻭﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴﻭﻥ ﻓﻰ ﻤﺼﺭ ﻭﺍﻟﻌﺎﻟﻡ ﺍﻟﻌﺭﺒﻰ ﻭﻤﻨﻬﺎ ﻏﻤـﻭﺽ ﺍﻟـﺩﻭﺭ ﺍﻟـﺫﻯ ﻴﻘﻭﻤـﻭﻥ‬
‫ﺒﻪ ﻭﻤﺤﺎﻭﻟﺔ ﺘﻬﻤﻴﺸﻬﻡ ﻤﻥ ﺨﻼل ﺤﺼﺭ ﺩﻭﺭﻫﻡ ﻓﻰ ﺍﻟﺘﻘـﺩﻴﺭ ﺍﻟﺘﺸﺨﻴﺼـﻰ )ﻫﻴﺌـﺔ ﺍﻟﺼـﺤﺔ‬
‫ﺍﻟﻌﺎﻟﻤﻴﺔ ‪ ، ١٩٨٥ ،‬ﺹ‪ ، (٥١‬ﻭﻤﻥ ﺜﻡ ﻓﺈﻥ ﺘﺩﺭﻴﺒﻬﻡ ﻋﻠـﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ‬
‫– ﻜﺄﺤﺩ ﺃﺸﻜﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ – ﺍﻟﺘﻰ ﻴﻤﻜﻨﻬﻡ ﺍﻻﻀـﻁﻼﻉ ﺒﻬـﺎ ‪ ،‬ﻭﺍﻹﺴـﻬﺎﻡ ﻓـﻰ ﻋـﻼﺝ‬
‫ـﺔ‬
‫ـﻔﺎﺀ ﺍﻟﻘﻴﻤـ‬
‫ـﻡ ﻭﺇﻀـ‬
‫ـﺎﺕ ﺫﻭﺍﺘﻬـ‬
‫ـﺔ ﻹﺜﺒـ‬
‫ـﺎﺌﻬﻡ ﺍﻟﻔﺭﺼـ‬
‫ـل ﺒﺈﻋﻁـ‬
‫ـﻴﻴﻥ ﻜﻔﻴـ‬
‫ـﻰ ﺍﻟﻨﻔﺴـ‬
‫ﺍﻟﻤﺭﻀـ‬
‫ﻭﺍﻟﻤﺸﺭﻭﻋﻴﺔ ﻋﻠﻰ ﺍﻟﻤﻬﻨﺔ ﺍﻟﺘﻰ ﻴﻤﺎﺭﺴﻭﻨﻬﺎ‪.‬‬

‫اﻟﻤﻨﻬـــﺞ واﻹﺟـــﺮاءات‪:‬‬
‫ﺘﻘﻊ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ ﻓﻰ ﺇﻁﺎﺭ ﺍﻟﻤـﻨﻬﺞ ﺍﻟﻭﺼـﻔﻰ ﻭﻫـﻰ ﻤـﻥ ﺍﻟﻨـﻭﻉ ﺍﻻﺴﺘﻜﺸـﺎﻓﻰ ﺍﻟـﺫﻯ‬
‫ﻴﺤﺎﻭل ﺇﻟﻘﺎﺀ ﺍﻟﻀﻭﺀ ﻋﻠﻰ ﻭﺍﻗـﻊ ﺍﻟﻤﻤﺎﺭﺴـﺔ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﺔ ﻟﻸﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ‬
‫ﻭﺒﺨﺎﺼﺔ ﻓﻰ ﻤﺠﺎل ﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻭﻜﻰ ‪ ،‬ﻭﻓﻴﻤـﺎ ﻴﻠـﻰ ﻨﻠﻘـﻰ ﺍﻟﻀـﻭﺀ ﻋﻠـﻰ‬
‫ﺍﻟﻤﻜﻭﻨﺎﺕ ﺍﻟﻤﻨﻬﺠﻴﺔ ﻟﻬﺫﻩ ﺍﻟﺩﺭﺍﺴﺔ‪.‬‬

‫) ﺃ ( ﻭﺼﻑ ﺍﻟﻌﻴﻨﺔ ‪:‬‬

‫‪١٤‬‬
‫ﺘﺘﺄﻟﻑ ﻋﻴﻨﺔ ﺍﻟﺩﺭﺍﺴﺔ ﻤﻥ ﻭﺍﺤﺩ ﻭﺨﻤﺴﻴﻥ ﺃﺨﺼﺎﺌﻴﹰﺎ ﻨﻔﺴـﻴﹰﺎ ﻤﻤـﻥ ﻴﻌﻤﻠـﻭﻥ ﻓـﻰ ﺍﻟﻤﺠـﺎل‬
‫ﺍﻹﻜﻠﻴﻨﻴﻜﻰ ‪ ،‬ﻤﻨﻬﻡ ﺘﺴﻌﺔ ﻋﺸﺭ ﺫﻜﺭﹰﺍ ‪ ،‬ﻭﺍﺜﻨﺘﻴﻥ ﻭﺜﻼﺜﻴﻥ ﻤـﻥ ﺍﻹﻨـﺎﺙ ‪ ،‬ﻴﺘـﺭﺍﻭﺡ ﺍﻟﻤـﺩﻯ‬
‫ﺍﻟﻌﻤﺭﻯ ﻟﻬﻡ ﺠﻤﻴﻌﹰﺎ ﺒﻴﻥ ‪ ٥٦ – ٢٤‬ﺴﻨﺔ ﺒﻤﺘﻭﺴـﻁ ﻤﻘـﺩﺍﺭﻩ ‪ ٣٧.٣‬ﻭﺍﻨﺤـﺭﺍﻑ ﻤﻌﻴـﺎﺭﻯ‬

‫‪ ، ١١.١ ±‬ﺤﺼل ﻭﺍﺤﺩ ﻭﺜﻼﺜﻭﻥ ﻤﻨﻬﻡ ﻋﻠـﻰ ﺍﻟﺩﺭﺠـﺔ ﺍﻟﺠﺎﻤﻌﻴـﺔ ﺍﻷﻭﻟـﻰ ﻓـﻰ ﻋﻠـﻡ‬

‫ﺍﻟﻨﻔﺱ ‪ ،‬ﻭﺤﺼل ﺜﻤﺎﻨﻴﺔ ﻋﺸﺭ ﻤﻨﻬﻡ ﻋﻠﻰ ﺩﺒﻠﻭﻡ ﻓﻰ ﻋﻠﻡ ﺍﻟـﻨﻔﺱ ‪ ،‬ﻭﺤﺼـل ﻭﺍﺤـﺩ ﻋﻠـﻰ‬
‫ﺍﻟﻤﺎﺠﺴﺘﻴﺭ ﻭﺁﺨﺭ ﻋﻠﻰ ﺍﻟﺩﻜﺘﻭﺭﺍﻩ‪ ،‬ﺘﺘﺭﺍﻭﺡ ﻤﺩﺓ ﺍﻟﻌﻤـل ﻓـﻰ ﻤﻬﻨـﺔ ﺍﻷﺨﺼـﺎﺌﻰ ﺍﻟﻨﻔﺴـﻰ‬

‫ﺒﻴﻥ ﺴﻨﺔ ﻭﺍﺤﺩﺓ‪ ،‬ﻭ‪ ٣٢‬ﺴﻨﺔ ﺒﻤﺘﻭﺴﻁ ﻗـﺩﺭﻩ ‪ ١٣.٧‬ﻭﺍﻨﺤـﺭﺍﻑ ﻤﻌﻴـﺎﺭﻯ ‪ ١٠.٢ ±‬ﺴـﻨﺔ‬

‫‪ ،‬ﻴﻌﻤﻠﻭﻥ ﺠﻤﻴﻌﹰﺎ ﻓﻰ ﻤﺴﺘﺸـﻔﻴﺎﺕ ﺍﻟﺼـﺤﺔ ﺍﻟﻨﻔﺴـﻴﺔ ﺍﻟﺭﺌﻴﺴـﻴﺔ ﻭﻫـﻰ ‪ :‬ﺩﺍﺭ ﺍﻻﺴﺘﺸـﻔﺎﺀ‬

‫ﻟﻠﺼﺤﺔ ﺍﻟﻨﻔﺴﻴﺔ ﺒﺎﻟﻌﺒﺎﺴﻴﺔ ‪ ،‬ﻤﺴﺘﺸﻔﻰ ﻤﺼﺭ ﺍﻟﺠﺩﻴﺩﺓ ﻟﻠﺼـﺤﺔ ﺍﻟﻨﻔﺴـﻴﺔ ‪ ،‬ﻤﺭﻜـﺯ ﺍﻟﻁـﺏ‬
‫ﺍﻟﻨﻔﺴﻰ ﺒﺠﺎﻤﻌﺔ ﻋﻴﻥ ﺸﻤﺱ ‪ ،‬ﻭﻗﺴﻡ ﺍﻟﻁﺏ ﺍﻟﻨﻔﺴﻰ ﺒﻜﻠﻴﺔ ﻁﺏ ﺍﻟﻘﺼﺭ ﺍﻟﻌﻴﻨﻰ‪.‬‬

‫)ﺏ( ﻭﺼﻑ ﺃﺩﺍﺓ ﺍﻟﺩﺭﺍﺴﺔ‪:‬‬

‫ﺘﺘﻜﻭﻥ ﺃﺩﺍﺓ ﺍﻟﺩﺭﺍﺴﺔ )ﺍﺴﺘﻤﺎﺭﺓ ﺍﺴﺘﺒﻴﺎﻥ( ﻤﻥ ﺠﺯﺌﻴﻥ ﺃﻭﻟﻬﻤﺎ ﻋﺒـﺎﺭﺓ ﻋـﻥ ﻤﺠﻤﻭﻋـﺔ ﻤـﻥ‬
‫ﺍﻟﺒﻴﺎﻨﺎﺕ ﺍﻷﻭﻟﻴﺔ ﻜﺎﻟﻨﻭﻉ ‪ ،‬ﻭﺍﻟﻌﻤﺭ ‪ ،‬ﻭﺍﻟﻤﺅﻫـل ﺍﻟﺩﺭﺍﺴـﻰ ‪ ،‬ﻭﻤـﺩﺓ ﺍﻟﻌﻤـل ﻭﻤﻜﺎﻨـﻪ ‪...‬‬
‫ﺍﻟﺦ‪ ،‬ﻭﺜﺎﻨﻴﻬﻤﺎ ﻭﻫﻭ ﺍﻟﺠﺯﺀ ﺍﻷﺴﺎﺴﻰ ﺍﻟﺨﺎﺹ ﺒﻤﻭﻀﻭﻉ ﺍﻟﺩﺭﺍﺴـﺔ ﺍﻟﺭﺍﻫﻨـﺔ ﻭﻴﺘﻜـﻭﻥ ﻤـﻥ‬
‫ﻻ ﻤﺘﻨﻭﻋﹰﺎ ﻤﺎ ﺒﻴﻥ ﺃﺴﺌﻠﺔ ﻤﻐﻠﻘـﺔ ﺍﻟﻨﻬﺎﻴـﺔ ‪ ،‬ﻭﺃﺨـﺭﻯ ﻤﻔﺘﻭﺤـﺔ ‪ ،‬ﻭﺜﺎﻟﺜـﺔ ﺃﺴـﺌﻠﺔ‬
‫‪ ٣٧‬ﺴﺅﺍ ﹰ‬
‫ﺍﺨﺘﻴﺎﺭ ﻤﻥ ﻤﺘﻌﺩﺩ ‪ ،‬ﻭﻜﻠﻬﺎ ﺘـﺩﻭﺭ ﺤـﻭل ﻤـﺩﻯ ﺩﺭﺍﺴـﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ‬
‫ﻭﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻴﻪ ﻭﻤﻤﺎﺭﺴﺘﻪ ﻤﻊ ﺇﻓﺭﺍﺩ ﺠﺯﺀ ﺨـﺎﺹ ﻟﻤـﺩﻯ ﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ﻤﻊ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ‪ ،‬ﻭﻗـﺩ ﻤـﺭﺕ ﻋﻤﻠﻴـﺔ ﺒﻨـﺎﺀ ﺍﺴـﺘﻤﺎﺭﺓ ﺍﻻﺴـﺘﺒﻴﺎﻥ ﺒﻌـﺩﺓ‬
‫ﻤﺭﺍﺤل ﻨﺠﻤﻠﻬﺎ ﻓﻴﻤﺎ ﻴﻠﻰ‪-:‬‬

‫‪١٥‬‬
 ‫‪ -١‬ﺍﻻﻁﻼﻉ ﻋﻠﻰ ﺍﻟﺘﺭﺍﺙ ﺍﻟﺨﺎﺹ ﺒﺎﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻭﺘﻁﺒﻴﻘﺎﺘﻪ ﺍﻟﻤﺨﺘﻠﻔﺔ‪.‬‬

‫‪ -٢‬ﻭﻀﻊ ﻤﺠﻤﻭﻋﺔ ﻤﺘﻨﻭﻋﺔ ﻤﻥ ﺍﻷﺴﺌﻠﺔ ﺍﻟﻤﺒﺩﺌﻴﺔ ﺍﻟﺘﻰ ﺘﺤﻘﻕ ﺃﻫﺩﺍﻑ ﺍﻟﺩﺭﺍﺴﺔ‪.‬‬

‫‪ -٣‬ﻋﺭﺽ ﻫﺫﻩ ﺍﻷﺴﺌﻠﺔ ﻓﻰ ﺼﻭﺭﺘﻬﺎ ﺍﻟﻤﺒﺩﺌﻴـﺔ ﻋﻠـﻰ ﻋﺸـﺭﺓ ﻤﺤﻜﻤـﻴﻥ ﻤـﻥ ﺃﻋﻀـﺎﺀ‬
‫ﻫﻴﺌﺔ ﺍﻟﺘﺩﺭﻴﺱ ﺒﻘﺴﻡ ﻋﻠﻡ ﺍﻟﻨﻔﺱ – ﺒﺂﺩﺍﺏ ﺍﻟﻘﺎﻫﺭﺓ ﻹﺒﺩﺍﺀ ﺍﻟﺭﺃﻯ ﻓﻴﻬﺎ‪.‬‬

‫‪ -٤‬ﺘﻡ ﺘﻔﺭﻴﻎ ﺍﻟﻤﻼﺤﻅﺎﺕ ﺍﻟﺘﻰ ﺃﺴﻔﺭﺕ ﻋﻨﻬﺎ ﻫﺫﻩ ﺍﻟﺨﻁـﻭﺓ ﻭﺍﻟﺘـﻰ ﺘﻤﺜﻠـﺕ ﻓـﻰ ﺤـﺫﻑ‬
‫ﺒﻌﺽ ﺍﻷﺴﺌﻠﺔ ﺨﺎﺼﺔ ﺍﻟﺘﻰ ﺘﻨﻁﻭﻯ ﻋﻠﻰ ﺃﻗـﺩﺍﺭ ﻤﺨﺘﻠﻔـﺔ ﻤـﻥ ﺍﻟﺘﻜـﺭﺍﺭ ‪ ،‬ﻭﺤـﺫﻑ‬
‫ﺍﻻﺴﺘﺒﻴﺎﻥ ﺍﻟﺫﻯ ﻭﻀﻊ ﻓﻰ ﻨﻬﺎﻴﺔ ﺍﻻﺴﺘﻤﺎﺭﺓ ﻭﻫﻭ ﻋﺒـﺎﺭﺓ ﻋـﻥ ﺒﻨـﻭﺩ ﻴﺠـﺎﺏ ﻋﻨﻬـﺎ‬
‫"ﺒﻨﻌﻡ" ﺃﻭ "ﻻ" ﺒﺎﻋﺘﺒﺎﺭ ﺃﻥ ﻤﺎ ﻓﻴـﻪ ﻤﺘﻀـﻤﻥ ﻓـﻰ ﺍﻟﺠـﺯﺀ ﺍﻷﻭل ﻭﺇﻀـﺎﻓﺔ ﺒﻌـﺽ‬
‫ﺍﻟﺘﻔﺼﻴﻼﺕ ﻓﻴﻤﺎ ﻴﺘﻌﻠﻕ ﺒﺎﻟﺒﻴﺎﻨﺎﺕ ﺍﻷﻭﻟﻴﺔ ﺃﻭ ﺍﻷﺴـﺌﻠﺔ ﺍﻟﺭﺌﻴﺴـﻴﺔ ‪ ،‬ﻭﺇﻋـﺎﺩﺓ ﺘﺭﺘﻴـﺏ‬
‫ﺒﻌﺽ ﺃﺠﺯﺍﺀ ﺍﻻﺴﺘﻤﺎﺭﺓ ﻭﺃﺨﻴﺭﹰﺍ ﺘﺤﻭﻴـل ﺒﻌـﺽ ﺍﻷﺴـﺌﻠﺔ ﺍﻟﻤﻔﺘﻭﺤـﺔ ﺇﻟـﻰ ﺃﺴـﺌﻠﺔ‬
‫ﺍﺨﺘﻴﺎﺭ ﻤﻥ ﻤﺘﻌﺩﺩ ‪ ،‬ﻭﻗـﺩ ﺘـﻡ ﺇﺠـﺭﺍﺀ ﺠﻤﻴـﻊ ﺍﻟﻤﻼﺤﻅـﺎﺕ ﺍﻟﺘـﻰ ﺃﻭﺼـﻰ ﺒﻬـﺎ‬
‫ﺍﻟﻤﺤﻜﻤﻭﻥ‪.‬‬

‫‪ -٥‬ﺘﻡ ﺇﻋﺎﺩﺓ ﺍﻻﺴﺘﻤﺎﺭﺓ ﺒﻌﺩ ﺇﺠﺭﺍﺀ ﻫﺫﻩ ﺍﻟﺘﻌﺩﻴﻼﺕ ﺇﻟﻰ ﺨﻤﺴـﺔ ﻤـﻥ ﺍﻟﻤﺤﻜﻤـﻴﻥ ﺍﻟﻌﺸـﺭﺓ‬
‫ﻹﺒﺩﺍﺀ ﺍﻟﺭﺃﻯ ﻭﻗﺩ ﻋﺒﺭﻭﺍ ﺠﻤﻴﻌﹰﺎ ﻋﻥ ﻤﻭﺍﻓﻘﺘﻬﻡ ﻋﻠﻰ ﻤﺎ ﺘﻡ ﺇﺩﺨﺎﻟﻪ ﻤﻥ ﺘﻌﺩﻴﻼﺕ‪.‬‬

‫‪ -٦‬ﺘﻡ ﺇﻋﺩﺍﺩ ﺍﻻﺴﺘﻤﺎﺭﺓ ﻓﻰ ﺼﻭﺭﺓ ﻨﻬﺎﺌﻴﺔ ﻭﻁﺒﺎﻋﺘﻬﺎ ﻭﺘﺠﻬﻴﺯﻫﺎ ﻟﻠﺘﻁﺒﻴﻕ‪.‬‬

‫)ﺝ( ﺍﻟﺨﺼﺎﺌﺹ ﺍﻟﺴﻴﻜﻭﻤﺘﺭﻴﺔ ﻷﺩﺍﺓ ﺍﻟﺩﺭﺍﺴﺔ‪:‬‬

‫)‪ (١‬ﺍﻟﺜﺒــﺎﺕ‪:‬‬

‫‪١٦‬‬
‫ﺘﻡ ﺤﺴﺎﺏ ﺜﺒﺎﺕ ﺃﺴﺌﻠﺔ ﺍﻻﺴـﺘﻤﺎﺭﺓ ﺒﻁﺭﻴﻘـﺔ ﺇﻋـﺎﺩﺓ ﺍﻟﺘﻁﺒﻴـﻕ ﻋﻠـﻰ ﺜﻼﺜـﺔ ﻋﺸـﺭ‬
‫ﺃﺨﺼﺎﺌﻴﹰﺎ ﻨﻔﺴﻴﹰﺎ ﻤﻥ ﺍﻟﻌﺎﻤﻠﻴﻥ ﺒﺩﺍﺭ ﺍﻻﺴﺘﺸﻔﺎﺀ ﻟﻠﺼـﺤﺔ ﺍﻟﻨﻔﺴـﻴﺔ ﺒﺎﻟﻌﺒﺎﺴـﻴﺔ )‪ ٣‬ﺫﻜـﻭﺭ‬
‫ﻭ ‪ ١١‬ﺇﻨﺎﺙ( ﻭﺘﻡ ﺍﺴﺘﺨﺩﺍﻡ ﺃﻜﺜﺭ ﻤﻥ ﻁﺭﻴﻘﺔ ﻟﺤﺴﺎﺏ ﺜﺒـﺎﺕ ﺍﻷﺴـﺌﻠﺔ ﻁﺒﻘـﹰﺎ ﻟﻁﺒﻴﻌﺘﻬـﺎ‬
‫ﻻ ﺘﺭﺍﻭﺤـﺕ ﻨﺴـﺏ‬
‫ﺤﻴﺙ ﺘﻡ ﺍﺴﺘﺨﺩﺍﻡ ﻨﺴﺒﺔ ﺍﻻﺘﻔﺎﻕ ﻟﺤﺴﺎﺏ ﺜﺒﺎﺕ ﺃﺜﻨـﻰ ﻋﺸـﺭ ﺴـﺅﺍ ﹰ‬
‫ﺍﻻﺘﻔــــــــــــــــــــــــــــــــــــــــﺎﻕ‬
‫ﺒﻴﻥ ‪ %٧٦.٩٢‬ﻭ ‪ ، %١٠٠‬ﻜﻤﺎ ﺘـﻡ ﺍﺴـﺘﺨﺩﺍﻡ ﻤﻌﺎﻤـل ﺍﻟﺘﻭﺍﻓـﻕ ﻟﺤﺴـﺎﺏ ﺜﺒـﺎﺕ‬
‫ﺃﺭﺒﻌﺔ ﺃﺴﺌﻠﺔ ﻭﺘﺭﺍﻭﺡ ﻤﻌﺎﻤل ﺍﻟﺘﻭﺍﻓـﻕ ﺒـﻴﻥ ‪ ٠.٧٨‬ﻭ ‪ ، ٠.٩٢‬ﻭﻜـﺫﻟﻙ ﺘـﻡ ﺤﺴـﺎﺏ‬
‫ﻻ ﻭﺘﺭﺍﻭﺤـﺕ ﻤﻌـﺎﻤﻼﺕ ﺍﻻﺭﺘﺒـﺎﻁ‬
‫ﻤﻌﺎﻤل ﺍﺭﺘﺒﺎﻁ ﺒﻴﺭﺴﻭﻥ ﻟﻌﺩﺩ ﺃﺤـﺩ ﻋﺸـﺭ ﺴـﺅﺍ ﹰ‬
‫ﺒﻴﻥ ‪ ٠.٨٥‬ﻭ ‪ ، ٠.٩٥‬ﻭﺠﻤﻴﻊ ﻤﻌﺎﻤﻼﺕ ﺍﻟﺜﺒـﺎﺕ ﺍﻟﺴـﺎﺒﻘﺔ ﻤﺭﺘﻔﻌـﺔ ﻭﺘﻁﻤـﺌﻥ ﺇﻟـﻰ‬
‫ﺍﺴﺘﺨﺩﺍﻡ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻻﺴﺘﺒﻴﺎﻥ ﻓﻴﻤﺎ ﺃﻋﺩﺕ ﻟﻪ‪.‬‬

‫)‪ (٢‬ﺍﻟﺼـــﺩﻕ ‪:‬‬

‫ﺘﻡ ﺘﻘﺩﻴﺭ ﺼﺩﻕ ﺍﻷﺩﺍﺓ ﺒﻁـﺭﻴﻘﺘﻴﻥ ‪ :‬ﺍﻷﻭﻟـﻰ ﻁﺭﻴﻘـﺔ ﺍﻟﺘﻜﺎﻤـل ﺍﻟﻤﺘﺒـﺎﺩل ﻭﻁﺭﻴﻘـﺔ‬
‫ﺍﻻﺘﻔﺎﻕ ﻤـﻊ ﺘﻭﻗـﻊ ﻤﻌﻘـﻭل )ﺴـﻭﻴﻑ ﻭﺁﺨـﺭﻭﻥ ‪ ، ١٩٨٧ ،‬ﺹ‪ (١٥‬ﻭﺍﻟﻤﻘﺼـﻭﺩ‬
‫ﻻ ﻤـﻥ ﺘﻌﺎﺭﻀـﻬﺎ ﺃﻭ ﺘﻨﺎﻗﻀـﻬﺎ ﺩﺍﺨﻠﻴـﹰﺎ ﺃﻯ ﺃﻥ‬
‫ﺒﺎﻟﺘﻜﺎﻤل ﺍﻟﻤﺘﺒﺎﺩل ﻫﻭ ﺘﻜﺎﻤل ﺍﻟﺒﻨﻭﺩ ﺒﺩ ﹰ‬
‫ﺘﻜﻭﻥ ﻤﺠﻤﻭﻋﺔ ﻤﻥ ﺍﻹﺠﺎﺒﺎﺕ ﺍﻟﺼﺎﺩﺭﺓ ﺭﺩﹰﺍ ﻋﻠـﻰ ﺍﻷﺴـﺌﻠﺔ ﺍﻟﺘـﻰ ﺘﺘﻨـﺎﻭل ﺍﻟﺠﻭﺍﻨـﺏ‬
‫ﺍﻟﻤﺨﺘﻠﻔﺔ ﻟﻤﺠﺎل ﻭﺍﺤـﺩ ﻤﻠﺘﻘﻴـﺔ ﻓﻴﻤـﺎ ﺒﻴﻨﻬـﺎ ﻋﻠـﻰ ﺘﻜـﻭﻴﻥ ﺼـﻭﺭﺓ ﺨﺎﻟﻴـﺔ ﻤـﻥ‬
‫ﺍﻟﺘﻨﺎﻗﺼﺎﺕ ﺍﻟﺩﺍﺨﻠﻴﺔ ‪ ،‬ﻭﺃﻤﺎ ﺍﻻﺘﻔﺎﻕ ﻤـﻊ ﺘﻭﻗـﻊ ﻤﻌﻘـﻭل ﻓﺎﻟﻤﻘﺼـﻭﺩ ﺒـﻪ ﺃﻥ ﺘﻜـﻭﻥ‬
‫ﺍﻹﺠﺎﺒﺎﺕ ﻤﺘﻔﻘﻪ ﻤﻊ ﺘﻭﻗﻌﺎﺕ ﻴﻤﻠﻴﻬﺎ ﻤﻨﻁﻕ ﺍﻷﺤﺩﺍﺙ ﺃﻭ ﺘﻤﻠﻴﻬـﺎ ﻨﺘـﺎﺌﺞ ﺒﺤـﻭﺙ ﺴـﺎﺒﻘﺔ‬
‫ﺤﻭل ﺠﻭﺍﻨﺏ ﺃﺨﺭﻯ ﻤﻥ ﺍﻟﻅﺎﻫﺭﺓ ﺍﻟﺘﻰ ﻨﻘﻭﻡ ﺒﺩﺭﺍﺴﺘﻬﺎ )ﺍﻟﻤﺭﺠﻊ ﺍﻟﺴﺎﺒﻕ(‪.‬‬

‫‪١٧‬‬
‫ﻭﻤﻥ ﺫﻟـﻙ ﻋﻠـﻰ ﺴـﺒﻴل ﺍﻟﻤﺜـﺎل ﺃﻥ ﺍﻟـﺫﻴﻥ ﻟـﻡ ﻴﺤﺼـﻠﻭﺍ ﻋﻠـﻰ ﺘـﺩﺭﻴﺏ‬
‫ﻤﺘﺨﺼﺹ ﻓـﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻭﻟـﻡ ﻴﺩﺭﺴـﻭﻩ ﺩﺭﺍﺴـﺔ ﻨﻅﺎﻤﻴـﺔ ﻻ‬
‫ﻴﻌﺭﻓﻭﻥ ﺍﻟﺠﻬـﺎﺕ ﺃﻭ ﺍﻟﻤﺅﺴﺴـﺎﺕ ﺍﻟﺘـﻰ ﺘﻘـﺩﻡ ﺘـﺩﺭﻴﺒﹰﺎ ﻤﺘﺨﺼﺼـﹰﺎ ﻓـﻰ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻓﻰ ﻤﺼﺭ ‪ ،‬ﻜﺫﻟﻙ ﻓﺈﻥ ﺍﻟﺫﻴﻥ ﺃﺠﺎﺒﻭﺍ ﺒـﺄﻥ ﺘـﺩﺭﻴﺒﻬﻡ ﻓـﻰ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻟﻴﺱ ﻜﺎﻓﻴﹰﺎ ‪ ،‬ﻨﻔﻭﺍ ﺃﻥ ﻴﻜﻭﻨﻭﺍ ﻗـﺩ ﻤﺎﺭﺴـﻭﻩ ﻋﻠـﻰ ﻨﺤـﻭ ﻭﺍﺴـﻊ ﺃﻭ‬
‫ﺍﺴﺘﺨﺩﻤﻭﻩ ﻟﻌﻼﺝ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ‪ ،‬ﻭﻴﻤﻜﻥ ﺍﻟﺘﺄﻜﺩ ﻤـﻥ ﻤﺯﻴـﺩ ﻤـﻥ ﺼـﺩﻕ ﺃﺴـﺌﻠﺔ‬
‫ﺍﻻﺴﺘﺒﻴﺎﻥ ﻋﻨﺩ ﻋﺭﺽ ﻨﺘﺎﺌﺞ ﺍﻟﺩﺭﺍﺴﺔ‪.‬‬

‫) ﺩ ( ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﻁﺒﻴﻕ ‪:‬‬

‫ﺘﻡ ﺘﻁﺒﻴﻕ ﺃﺩﺍﺓ ﺍﻟﺩﺭﺍﺴﺔ ﺘﻁﺒﻴﻘﹰﺎ ﻓﺭﺩﻴﹰﺎ ‪ ،‬ﺤﻴﺙ ﺘـﻡ ﺘﻭﺯﻴـﻊ ﺍﻻﺴـﺘﻤﺎﺭﺓ ﻋﻠـﻰ ﺍﻟﻤﺒﺤـﻭﺜﻴﻥ‬
‫ﻭﺘﺭﻜﺕ ﻟﻬﻡ ﺤﺭﻴـﺔ ﺍﻹﺠﺎﺒـﺔ ﻋﻨﻬـﺎ ‪ ،‬ﻭﻗـﺩ ﺍﺴـﺘﻌﺎﻥ ﺍﻟﺒﺎﺤـﺙ ﺒـﺒﻌﺽ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ‬
‫ﺍﻟﻨﻔﺴﻴﻴﻥ* ﻓﻰ ﺍﻟﻭﺼﻭل ﺇﻟﻰ ﺍﻟﻤﺒﺤﻭﺜﻴﻥ ﻭﻏﻨﻰ ﻋﻥ ﺍﻟﺒﻴـﺎﻥ ﺃﻥ ﻋـﺩﺩ ﺍﻻﺴـﺘﻤﺎﺭﺍﺕ ﺍﻟـﺫﻯ‬
‫ﺘﻡ ﺘﻭﺯﻴﻌﻪ ﺃﻜﺒﺭ ﻤﻤﺎ ﺘـﻡ ﺍﻟﺤﺼـﻭل ﻋﻠﻴـﻪ ﺤﻴـﺙ ﻟـﻡ ﻴﺴـﺘﺠﺏ ﺒﻌـﺽ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ‬
‫ﺍﻟﻨﻔﺴﻴﻴﻥ ‪ ،‬ﻜﻤﺎ ﺘﻡ ﺍﺴﺘﺒﻌﺎﺩ ﺒﻌﺽ ﺍﻻﺴﺘﻤﺎﺭﺍﺕ ﺍﻟﺘﻰ ﺒﻬﺎ ﻨﻘﺹ ﻓﻰ ﺍﻟﺒﻴﺎﻨﺎﺕ‪.‬‬

‫)ﻫـ( ﺃﺴﺎﻟﻴﺏ ﺍﻟﺘﺤﻠﻴل ﺍﻹﺤﺼﺎﺌﻰ‪:‬‬

‫*‬
‫ﺃﺘﻭﺠﻪ ﺒﺨﺎﻟﺹ ﺍﻟﺸﻜﺭ ﺇﻟﻰ ﻜل ﻤﻥ ﺍﻷﺴﺘﺎﺫﺓ‪ /‬ﺴﺎﻤﻴﺔ ﺃﺒﻭ ﺍﻟﻌﻼ ﻭﺍﻷﺴﺘﺎﺫ‪ /‬ﺇﺒﺭﺍﻫﻴﻡ ﻋﺘﺭﻴﺱ ﻭﺍﻷﺴﺘﺎﺫﺓ ‪ /‬ﺁﻤﺎل ﺤﺴﻴﻥ ﻟﻠﻤﺴﺎﻋﺩﺓ ﻓﻰ‬
‫ﻫﺫﺍ ﺍﻟﺨﺼﻭﺹ‪.‬‬

‫‪١٨‬‬
‫ﺃﺨﻀﻌﺕ ﺍﻟﺒﻴﺎﻨﺎﺕ ﻟﺘﺤﻠﻴل ﺇﺤﺼﺎﺌﻰ ﺒﺴـﻴﻁ ﺘﻤﺜـل ﻓـﻰ ﺤﺴـﺎﺏ ﺍﻟﺘﻜـﺭﺍﺭﺍﺕ ﻭﺍﻟﻨﺴـﺏ‬
‫ﺍﻟﻤﺌﻭﻴﺔ ﻟﻌﺩﺩ ﻤﻥ ﺍﻷﺴﺌﻠﺔ ﺒﺎﻹﻀﺎﻓﺔ ﺇﻟﻰ ﺒﻌﺽ ﺍﻻﺴﺘﺠﺎﺒﺎﺕ ﺍﻟﻜﻴﻔﻴﺔ ﺍﻟﺘﻰ ﺘﻡ ﺭﺼﺩﻫﺎ‪.‬‬

‫ﻋﺮض اﻟﻨﺘﺎﺋﺞ وﻣﻨﺎﻗﺸﺘﻬﺎ‪:‬‬

‫ﺘﻨﻘﺴﻡ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻟﺒﺤﺙ ﺩﺍﺨﻠﻴﹰﺎ ﺇﻟﻰ ﺜﻼﺜﺔ ﺃﻗﺴـﺎﻡ ‪ :‬ﺍﻷﻭل ﺨـﺎﺹ ﺒﻭﺍﻗـﻊ ﺩﺭﺍﺴـﺔ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻭﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻴﻪ ‪ ،‬ﻭﺍﻟﺜﺎﻨﻰ ﺨـﺎﺹ ﺒﻤـﺩﻯ ﻤﻤﺎﺭﺴـﺔ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ‬
‫ﻟﻠﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﺒﺼـﻔﺔ ﻋﺎﻤـﺔ ‪ ،‬ﻭﺍﻟﺜﺎﻟـﺙ ﻤﺘﻌﻠـﻕ ﺒﻤـﺩﻯ ﻤﻤﺎﺭﺴـﺔ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ‬
‫ﺍﻟﻨﻔﺴﻴﻴﻥ ﻟﻠﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻤﻊ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ﺒﻭﺠﻪ ﺨﺎﺹ‪.‬‬

‫ﻭﻴﺒﺩﺃ ﺍﻟﻘﺴﻡ ﺍﻷﻭل ﺒﺎﻟﺴـﺅﺍل ﻋـﻥ ﺩﺭﺍﺴـﺔ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﻟﻠﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ﺩﺭﺍﺴﺔ ﻨﻅﺎﻤﻴﺔ ﻭﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ ﺍﻟﺘﻰ ﺘـﻡ ﻓﻴﻬـﺎ ﺫﻟـﻙ ‪ ،‬ﻭﺫﻟـﻙ ﻨﻅـﺭﹰﺍ ﻻﺨـﺘﻼﻑ‬
‫ﺍﻟﺠﺎﻤﻌﺎﺕ ﺍﻟﺘﻰ ﺘﺨﺭﺝ ﻤﻨﻬﺎ ﻫـﺅﻻﺀ ﺍﻷﺨﺼـﺎﺌﻴﻭﻥ ﻭﺍﻟﺘﻔـﺎﻭﺕ ﻓـﻰ ﺩﺭﺠـﺔ ﺍﻟﻌﻨﺎﻴـﺔ ﺒﺘـﺩﺭﻴﺱ‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﺴـﻭﺍﺀ ﻓـﻰ ﺍﻟﻤﺭﺤﻠـﺔ ﺍﻟﺠﺎﻤﻌﻴـﺔ ﺍﻷﻭﻟـﻰ )ﺍﻟﻠﻴﺴـﺎﻨﺱ( ﺃﻭ ﻋﻠـﻰ‬
‫ﻤﺴــﺘﻭﻯ ﺍﻟﺩﺭﺍﺴــﺎﺕ ﺍﻟﻌﻠﻴــﺎ ‪ ،‬ﻭﻗــﺩ ﺃﺠــﺎﺏ ‪ ٢٥‬ﺃﺨﺼــﺎﺌﻴﹰﺎ ﻤــﻥ ﺠﻤﻠــﺔ )‪ (٥١‬ﺇﺨﺼــﺎﺌﻴﹰﺎ‬
‫)‪ (%٤٩.٠٢‬ﺒﺎﻹﻴﺠﺎﺏ ‪ ،‬ﻓﻰ ﻤﻘﺎﺒل )‪ (%٥٠.٩٨‬ﻟﻡ ﻴﺘﻠﻘـﻭﺍ ﻫـﺫﻩ ﺍﻟﺩﺭﺍﺴـﺔ ﺍﻟﻨﻅﺎﻤﻴـﺔ ﺴـﻭﺍﺀ‬
‫ﻓﻰ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ ﺍﻷﻭﻟﻰ ﺃﻭ ﻓﻰ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻌﻠﻴﺎ ‪ .‬ﻭﻋﻨـﺩ ﺴـﺅﺍل ﺍﻟـﺫﻴﻥ ﺩﺭﺴـﻭﺍ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻋﻥ ﺍﻟﻤﺭﺤﻠﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ ﺍﻟﺘﻰ ﺩﺭﺴـﻭﻩ ﻓﻴﻬـﺎ ﺃﺠـﺎﺏ ‪ (%٥٦) ١٤‬ﺒـﺄﻥ ﺫﻟـﻙ‬
‫ﻜﺎﻥ ﻓﻰ ﻤﺭﺤﻠﺔ ﺍﻟﻠﻴﺴﺎﻨﺱ ‪ ،‬ﺒﻴﻨﻤﺎ ﺫﻜـﺭ ‪ (%٥٢) ١٣‬ﺃﻥ ﺫﻟـﻙ ﻜـﺎﻥ ﻓـﻰ ﺍﻟﺩﺭﺍﺴـﺎﺕ ﺍﻟﻌﻠﻴـﺎ‬
‫)ﻴﻼﺤﻅ ﺃﻥ ﻫﻨﺎﻙ ﺤﺎﻟﺘﻴﻥ ﺩﺭﺴﺘﺎ ﺫﻟﻙ ﻓـﻰ ﻜـل ﻤـﻥ ﺍﻟﻠﻴﺴـﺎﻨﺱ ﻭﺍﻟﺩﺭﺍﺴـﺎﺕ ﺍﻟﻌﻠﻴـﺎ( ‪ ،‬ﻭﻟﻤـﺎ‬
‫ﻜﺎﻨﺕ ﺩﺭﺍﺴﺔ ﻤﻘﺭﺭ ﺃﻭ ﺠﺯﺀ ﻤﻥ ﻤﻘﺭﺭ ﻓﻰ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴـﻰ ﻋﻤﻭﻤـﹰﺎ ﺃﻭ ﻓـﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ﺨﺼﻭﺼﹰﺎ ﻫﻰ ﻤﺠﺭﺩ ﻤﺩﺨل ﻟﺘﺤﺼـﻴل ﺍﻟﻤﻌﻠﻭﻤـﺎﺕ ﺘﻭﻁﺌـﺔ ﻟﻤﺯﻴـﺩ ﻤـﻥ ﺍﻟﺘﺨﺼـﺹ‬
‫ﻻ‬
‫ﻭﺍﻟﺘﻌﻤﻕ ﻓﻴﻪ ﻓﻘﺩ ﺤﺎﻭﻟﻨﺎ ﺴﺒﺭﻏﻭﺭ ﻫﺫﻩ ﺍﻟﻨﻘﻁـﺔ ﺒﻤﺯﻴـﺩ ﻤـﻥ ﺍﻷﺴـﺌﻠﺔ‪ ،‬ﺤﻴـﺙ ﻭﺠﻬﻨـﺎ ﺴـﺅﺍ ﹰ‬

‫‪١٩‬‬
‫ﻟﻬﺅﻻﺀ ﺠﻤﻴﻌﹰﺎ ﻋﻥ ﻤﺩﻯ ﺤﺼﻭﻟﻬﻡ ﻋﻠﻰ ﺩﻭﺭﺍﺕ ﺘﺩﺭﻴﺒﻴـﺔ ﻤﺘﺨﺼﺼـﺔ ﻓـﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ﻭﺫﻟﻙ ﻟﻌﻠﻤﻨﺎ – ﺒـل ﻭﻤﺸـﺎﺭﻜﺘﻨﺎ – ﻓـﻰ ﺘﻘـﺩﻴﻡ ﻤﺜـل ﻫـﺫﻩ ﺍﻟـﺩﻭﺭﺍﺕ ﻓـﻰ ﺒﻌـﺽ‬
‫ـﺫﻩ‬
‫ـل ﻫـ‬
‫ـﻰ ﻤﺜـ‬
‫ـﻠﻭﺍ ﻋﻠـ‬
‫ـﺄﻨﻬﻡ ﺤﺼـ‬
‫ـﺎﺌﻴﹰﺎ( ﺒـ‬
‫ـﺎﺏ ‪ ٢٩) %٥٦.٨٦‬ﺃﺨﺼـ‬
‫ـﺩ ﺃﺠـ‬
‫ـﺎﺕ ‪ ،‬ﻭﻗـ‬
‫ﺍﻟﻤﺅﺴﺴـ‬
‫ﺍﻟﺩﻭﺭﺍﺕ ‪ ،‬ﻭﻤﻥ ﺃﺠل ﺍﻟﻭﻗﻭﻑ ﻋﻠـﻰ ﻤﺴـﺘﻭﻯ ﻫـﺫﻩ ﺍﻟـﺩﻭﺭﺍﺕ ﻭﺩﺭﺠـﺔ ﺘﺨﺼﺼـﻬﺎ ﻭﺃﻤـﺎﻜﻥ‬
‫ﻻ ﻴﺸﻤل ﻋﺩﺓ ﺒﻴﺎﻨـﺎﺕ ﻤﻁﻠﻭﺒـﺔ ﺃﻭﻟﻬـﺎ ﺨـﺎﺹ ﺒﻌـﺩﺩ ﺍﻟـﺩﻭﺭﺍﺕ ﺍﻟﺘـﻰ‬
‫ﺘﻘﺩﻴﻤﻬﺎ ﻓﻘﺩ ﻭﺠﻬﻨﺎ ﺴﺅﺍ ﹰ‬
‫ﺤﺼل ﻋﻠﻴﻬﺎ ﻜل ﻤﺘﺩﺭﺏ ‪ ،‬ﻭﺘﺭﺍﻭﺡ ﺍﻟﻌﺩﺩ ﺒﻴﻥ ﺩﻭﺭﺓ ﻭﺍﺤـﺩﺓ ﻭﺨﻤـﺱ ﺩﻭﺭﺍﺕ ﻜﺤـﺩ ﺃﻗﺼـﻰ ‪،‬‬
‫ﻭﻜﺎﻨﺕ ﻤﺩﺓ ﻫﺫﻩ ﺍﻟﺩﻭﺭﺍﺕ ﺘﺘﺭﺍﻭﺡ ﺒﻴﻥ ﺜﻼﺜﺔ ﺃﻴـﺎﻡ ﻭﺃﺴـﺒﻭﻋﻴﻥ )ﺒﺎﺴـﺘﺜﻨﺎﺀ ﺤﺎﻟـﺔ ﻭﺍﺤـﺩﺓ ﻓﻘـﻁ‬
‫ﻜﺎﻨﺕ ﺍﻟﻤﺩﺓ ﺴﺘﺔ ﺸﻬﻭﺭ ﻹﺤﺩﻯ ﺍﻷﺨﺼﺎﺌﻴﺎﺕ ﺍﻟﺘـﻰ ﺴـﺎﻓﺭﺕ ﻟﻠﺨـﺎﺭﺝ(‪ .‬ﺒﻴﻨﻤـﺎ ﻜﺎﻨـﺕ ﺍﻟﻤـﺩﺓ‬
‫ﺍﻟﻐﺎﻟﺒﺔ ﻫﻰ ﺃﺴﺒﻭﻉ ﻭﺍﺤﺩ ﻓﻘﻁ ‪ ،‬ﺃﻤﺎ ﻋﻥ ﺍﻟﺠﻬـﺎﺕ ﺍﻟﺘـﻰ ﻗـﺩﻤﺕ ﻫـﺫﻩ ﺍﻟـﺩﻭﺭﺍﺕ ﻓﻘـﺩ ﺠـﺎﺀﺕ‬
‫ﻤﺴﺘﺸﻔﻰ ﺍﻟﻌﺒﺎﺴﻴﺔ ﻋﻠﻰ ﺭﺃﺱ ﻫﺫﻩ ﺍﻷﻤﺎﻜﻥ )ﻤﻊ ﻤﻼﺤﻅـﺔ ﺃﻥ ﻤﻌـﺩ ﻫـﺫﻩ ﺍﻟﻭﺭﻗـﺔ ﻗـﺩ ﺸـﺎﺭﻙ‬
‫ﻓﻰ ﺘﻘﺩﻴﻡ ﺩﻭﺭﺓ ﻋﺎﻤﺔ ﻟﻤﺩﺓ ﺜﻼﺜﺔ ﺸـﻬﻭﺭ ﻭﻗـﺩﻡ ﻤﻨﻔـﺭﺩﹰﺍ ﺩﻭﺭﺓ ﻟﻤـﺩﺓ ‪ ٦٠‬ﺴـﺎﻋﺔ ﻓـﻰ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻓﻰ ﺍﻟﻤﻜﺎﻥ ﺴـﺎﻟﻑ ﺍﻟـﺫﻜﺭ ﻟﻌـﺩﺩ ﻤـﻥ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﻭﺍﻷﻁﺒـﺎﺀ‬
‫ﺍﻟﻨﻔﺴﻴﻴﻥ( ﻴﻠﻰ ﺫﻟﻙ ﺭﺍﺒﻁﺔ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﻭﺒﻌـﺽ ﺍﻟﻤﺭﺍﻜـﺯ ﺍﻟﺨﺎﺼـﺔ ‪ ،‬ﺜـﻡ ﻤﺭﻜـﺯ‬
‫ﺍﻟﻁﺏ ﺍﻟﻨﻔﺴﻰ ﺒﺠﺎﻤﻌـﺔ ﻋـﻴﻥ ﺸـﻤﺱ ﻭﻤﺭﻜـﺯ ﺍﻹﺭﺸـﺎﺩ ﺍﻟﻨﻔﺴـﻰ ﺒﺠﺎﻤﻌـﺔ ﻋـﻴﻥ ﺸـﻤﺱ ‪،‬‬
‫ﻭﻤﺴﺘﺸﻔﻰ ﺍﻟﺼﺤﺔ ﺍﻟﻨﻔﺴﻴﺔ ﺒﻤﺼﺭ ﺍﻟﺠﺩﻴﺩﺓ ‪ ،‬ﻭﺍﻟﻤﺠﻠـﺱ ﺍﻟﻘـﻭﻤﻰ ﻟﻠﻁﻔﻭﻟـﺔ ﻭﺍﻷﻤﻭﻤـﺔ ﻭﺃﻤـﺎﻜﻥ‬
‫ﺃﺨﺭﻯ ﻤﺘﻔﺭﻗﺔ )ﻭﻴﻼﺤﻅ ﺃﻥ ﻫﺫﻩ ﺍﻷﻤﺎﻜﻥ ﺫﻜﺭﺕ ﻤﺭﺓ ﻭﺍﺤـﺩﺓ ﻓﻘـﻁ ﻜﻤـﺎ ﺃﻥ ﺒﻌـﺽ ﺍﻟـﺩﻭﺭﺍﺕ‬
‫ﻟﻡ ﺘﻜﻥ ﻤﺘﺨﺼﺼﺔ ﺒﺎﻟﻜﺎﻤل ﻓﻰ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﺭﻏـﻡ ﺃﻥ ﺍﻟﺴـﺅﺍل ﻜـﺎﻥ ﻤﻭﺠﻬـﹰﺎ‬
‫ﻟﻬﺫﺍ ﺍﻷﺴﻠﻭﺏ ﺍﻟﻌﻼﺠﻰ ﺘﺤﺩﻴﺩﹰﺍ( ‪ ،‬ﻭﻴﺄﺘﻰ ﺃﺴـﺎﺘﺫﺓ ﻋﻠـﻡ ﺍﻟـﻨﻔﺱ ﻋﻠـﻰ ﺭﺃﺱ ﺍﻟﻤـﺩﺭﺒﻴﻥ ﺍﻟـﺫﻴﻥ‬
‫ﻗﺩﻤﻭﺍ ﻫﺫﻩ ﺍﻟﺩﻭﺭﺍﺕ ‪ ،‬ﻴﻠﻴﻬﻡ ﺍﻷﻁﺒﺎﺀ ‪ ،‬ﻭﺃﺨﻴﺭﹰﺍ ﺘﺘﻨـﻭﻉ ﺍﻷﻤـﺭﺍﺽ ﺍﻟﺘـﻰ ﺘـﻡ ﺍﻟﺘـﺩﺭﻴﺏ ﻋﻠـﻰ‬

‫‪٢٠‬‬
‫ﻋﻼﺠﻬﺎ ﺒﻴﻥ ﺍﻻﻜﺘﺌﺎﺏ ‪ ،‬ﻭﺍﻟﻘﻠﻕ ‪ ،‬ﻭﺍﻟﻭﺴـﻭﺍﺱ ‪ ،‬ﻭﺍﻟﻔﺼـﺎﻡ ‪ ،‬ﻭﺍﻟﻤﺨـﺎﻭﻑ ‪ ،‬ﻭﺃﻤـﺭﺍﺽ ﺃﺨـﺭﻯ‬
‫‪ ،‬ﻭﺃﻜﺜﺭ ﻤﻥ ﻤﺭﺽ ‪ ،‬ﻭﺍﻻﻋﺘﻤﺎﺩ ﻋﻠﻰ ﺍﻟﻤﻭﺍﺩ ﺍﻟﻨﻔﺴﻴﺔ ﻭﺍﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﺠﻨﺴﻴﺔ‪.‬‬

‫ﻭﺍﻟﻤﻭﻗﻑ ﺍﻟﺴﺎﺒﻕ ﻓﻰ ﺠﻤﻠﺘﻪ ﻴﻜﺸﻑ ﻋـﻥ ﻨﻘـﺹ ﻭﺍﻀـﺢ ﻓـﻰ ﻤـﺩﻯ ﺘﺄﻫﻴـل ﻫـﺅﻻﺀ‬
‫ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﻓﻰ ﻤﺠﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ‪ ،‬ﺤﻴـﺙ ﺃﻥ ﺃﻜﺜـﺭ ﻤـﻥ ‪ %٥٠‬ﻤـﻥ ﺍﻟﻌﻴﻨـﺔ‬
‫ﻟﻡ ﻴﺩﺭﺴﻭﺍ ﻫﺫﺍ ﺍﻟﻨﻭﻉ ﻤﻥ ﺍﻟﻌﻼﺝ ﺩﺭﺍﺴﺔ ﻨﻅﺎﻤﻴﺔ ‪ ،‬ﻭﻫﻭ ﻤﺎ ﻴﻌﻨﻰ ﺃﻨﻬـﻡ ﻟـﻥ ﻴﺴـﺘﻁﻴﻌﻭﺍ ﺍﻟﻭﻓـﺎﺀ‬
‫ﺒﻤﺘﻁﻠﺒﺎﺕ ﻫﺫﺍ ﺍﻟﻌﻼﺝ ‪ ،‬ﻭﺭﺒﻤﺎ ﺍﻷﺴﺎﻟﻴﺏ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻷﺨـﺭﻯ ‪ ،‬ﻭﻫـﻭ ﻤـﺎ ﻴﻌﻨـﻰ ﺃﻴﻀـﹰﺎ ﺃﻨﻬـﻡ‬
‫ﺴﻴﻅﻠﻭﻥ ﻋﻨﺩ ﺤﺩﻭﺩ ﺍﻟﻤﺴﺎﻋﺩﺓ ﻓﻰ ﻋﻤﻠﻴﺎﺕ ﺍﻟﺘﻘـﺩﻴﺭ ‪ Assessment‬ﻭﻫـﻭ ﺍﻟـﺩﻭﺭ ﺍﻟـﺫﻯ ﻴﻨﻅـﺭ‬
‫ﺇﻟﻴﻪ ﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴﻴﻭﻥ ﺒل ﻭﺍﻟﻤﺘﺨﺼﺼﻭﻥ ﻓـﻰ ﻋﻠـﻡ ﺍﻟـﻨﻔﺱ ﻋﻠـﻰ ﺃﻨـﻪ ﺩﻭﺭ ﺘﻘﻠﻴـﺩﻯ ﻴﻨﺒﻐـﻰ‬
‫ﺘﺠﺎﻭﺯﻩ ‪ ،‬ﻭﺃﻨﻪ ﻟﻡ ﻴﻌﺩ ﻜﺎﻓﻴﹰﺎ ﻟﻠﺤﺼﻭل ﻋﻠﻰ ﺍﻟﺘﻘﺩﻴﺭ ﺍﻟﺭﺴﻤﻰ ﻭﺍﻻﻋﺘـﺭﺍﻑ ﺍﻟﻤﻬﻨـﻰ ‪ ،‬ﻭﻫـﻭ ﻤـﺎ‬
‫ﻴﺴﺎﻋﺩ ﻋﻠﻰ ﺇﻴﺠﺎﺩ ﻤﺸﻜﻼﺕ ﻤﻬﻨﻴﺔ ﺘـﺅﺜﺭ ﻓـﻰ ﻤـﺩﻯ ﻨﻤـﻭ ﻫـﺅﻻﺀ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ‪،‬‬
‫ﻭﺘﺅﺜﺭ ﺃﻴﻀﹰﺎ ﻋﻠﻰ ﺍﻟﻌﻼﻗﺎﺕ ﺩﺍﺨل ﻓﺭﻴﻕ ﺍﻟﻌﻤل ﻭﺘـﻨﻌﻜﺱ ﺃﺨﻴـﺭﹰﺍ ﺒﺎﻟﺴـﻠﺏ ﻋﻠـﻰ ﺍﻟﻤﺭﻀـﻰ ‪.‬‬
‫ﻓﺈﺫﺍ ﻤﺎ ﻨﻅﺭﻨﺎ ﺇﻟﻰ ﺃﻭﻟﺌﻙ ﺍﻟﺫﻴﻥ ﺩﺭﺴﻭﺍ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﺩﺭﺍﺴـﺔ ﻨﻅﺎﻤﻴـﺔ ‪ ،‬ﻭﺍﻟـﺫﻴﻥ‬
‫ﺤﺼﻠﻭﺍ ﻋﻠﻰ ﺩﻭﺭﺍﺕ ﺘﺩﺭﻴﺒﻴﺔ ﻓﻴﻪ ‪ ،‬ﺴﻨﺠﺩ ﺃﻥ ﺍﻟﻭﻀـﻊ ﻟـﻴﺱ ﻤﺭﻀـﻴﹰﺎ ﺇﻟـﻰ ﺤـﺩ ﻜﺒﻴـﺭ ﻓـﻰ‬
‫ﻀﻭﺀ ﺍﻟﺯﻴﺎﺩﺓ ﺍﻟﻤﻀﻁﺭﺩﺓ ﻓﻰ ﻋﺩﺩ ﺍﻟﻤﺭﻀﻰ ﺍﻟﻨﻔﺴﻴﻴﻥ ﻭﺍﻟﺘﺯﺍﻴـﺩ ﺍﻟﻭﺍﻀـﺢ ﻓـﻰ ﺍﻟﻁﻠـﺏ ﻋﻠـﻰ‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ﻜﻤﺎ ﺴﺒﻘﺕ ﺍﻹﺸﺎﺭﺓ‪ ،‬ﺃﻀﻑ ﺇﻟﻰ ﺫﻟﻙ ﺃﻥ ﻫﺫﻩ ﺍﻟـﺩﻭﺭﺍﺕ ﻻ ﺘﺒـﺩﻭ ﻜﺎﻓﻴـﺔ ﺴـﻭﺍﺀ‬
‫ﻤﻥ ﺤﻴﺙ ﻋﺩﺩﻫﺎ ﺃﻭ ﻤﻥ ﺤﻴﺙ ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺍﻟﺘـﻰ ﺍﺴـﺘﻐﺭﻗﺘﻬﺎ ‪ ،‬ﻭﻴﻜﻔـﻰ ﻫﻨـﺎ ﺃﻥ ﻨﺸـﻴﺭ ﺇﻟـﻰ‬
‫ﺃﻥ ﺍﻟﻘﺎﻨﻭﻥ ﺍﻟﻤﻨﻅﻡ ﻟﻤﻬﻨﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ﻭﻫﻭ ﺍﻟﻘـﺎﻨﻭﻥ ﺭﻗـﻡ )‪ (١٩٨‬ﻟﺴـﻨﺔ ‪ ١٩٥٦‬ﻗـﺩ ﻨـﺹ‬
‫ﻻ( ﻓﻰ ﺍﻟﻤﺎﺩﺓ )‪ (١‬ﻋﻠﻰ ﻤﺎ ﻴﻠـﻰ "ﻓﻴﻤـﺎ ﻴﺘﻌﻠـﻕ ﺒﺎﻟﻔﺌـﺎﺕ ﺍﻟﺘـﻰ‬
‫ﻓﻰ ﺍﻟﻔﻘﺭﺓ )ﻫـ( ﻤﻥ ﺍﻟﺠﺯﺀ )ﺃﻭ ﹰ‬
‫ﻴﺭﺨﺹ ﻟﻬﺎ ﺒﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ" ﺍﻟﺤﺎﺼﻠﻴﻥ ﻋﻠـﻰ ﻤﺅﻫـل ﻋـﺎل ﻓـﻰ ﻋﻠـﻡ ﺍﻟـﻨﻔﺱ ﻤـﻥ‬
‫ﺇﺤﺩﻯ ﺍﻟﺠﺎﻤﻌﺎﺕ ﺃﻭ ﺃﺤﺩ ﺍﻟﻤﻌﺎﻫﺩ ﻓﻰ ﻤﺼﺭ ﺃﻭ ﻓﻰ ﺍﻟﺨـﺎﺭﺝ ﻭﺃﻋـﺩﻭﺍ ﺃﻨﻔﺴـﻬﻡ ﻟﻠﺘﺨﺼـﺹ ﻓـﻰ‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ﻟﻤﺩﺓ ﺴﻨﺘﻴﻥ ﻋﻠﻰ ﺍﻷﻗل ﺒﺄﺤﺩ ﻤﻌﺎﻫـﺩ ﺍﻟﻌـﻼﺝ ﺍﻟﻨﻔﺴـﻰ ﺃﻭ ﺒﻤﺅﺴﺴـﺎﺘﻪ ﻭﺍﻟﺘـﻰ‬
‫ﺘﻘﺩﻤﺕ ﺒﻬﺎ ﺍﻟﻠﺠﻨﺔ ﺍﻟﻤﺫﻜﻭﺭﺓ ﺃﻭ ﻴﻜﻭﻥ ﺘﺤﺕ ﺇﺸﺭﺍﻓﻬﺎ ﻭﺒﻌـﺩ ﺍﺠﺘﻴـﺎﺯﻩ ﺍﻤﺘﺤﺎﻨـ ﹰﺎ ﺃﻤـﺎﻡ ﺍﻟﻠﺠﻨـﺔ"‬

‫‪٢١‬‬
‫)ﻤﺼﻁﻔﻰ ﺴﻭﻴﻑ ‪ ، ٢٠٠١ ،‬ﺹ‪ ، (٤٨ – ٤٧‬ﻭﻨﺤﻥ ﻫﻨـﺎ ﻻ ﻨﺸـﻴﺭ ﺇﻟـﻰ ﺍﻟﺠﺎﻨـﺏ ﺍﻟﺭﺴـﻤﻰ‬
‫ﻭﻫﻭ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺍﻟﺘﺭﺨﻴﺹ ‪ ،‬ﺒﻘﺩﺭ ﻤﺎ ﻴﻌﻨﻴﻨﺎ ﻓﺘـﺭﺓ ﺍﻟﺘـﺩﺭﻴﺏ ﺍﻟﻼﺯﻤـﺔ ﻟﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻨﻔﺴﻰ ﺒﺼﻔﺔ ﻋﺎﻤﺔ ‪ ،‬ﻭﻫﻭ ﺒﺎﻟﻁﺒﻊ ﻤﺎ ﻴﻨﻁﺒـﻕ ﻋﻠـﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﺒﺎﻋﺘﺒـﺎﺭﻩ‬
‫ﻀﻤﻥ ﻤﻨﻅﻭﻤﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ‪.‬‬

‫ﻭﻤﻥ ﺍﻟﻨﺘﺎﺌﺞ ﺍﻟﻤﻬﻤﺔ ﺍﻟﺘﻰ ﻴﻨﺒﻐﻰ ﺍﻟﻭﻗﻭﻑ ﺃﻤﺎﻤﻬﺎ ﻓـﻰ ﻫـﺫﺍ ﺍﻟﻘﺴـﻡ ﺃﻥ ﺍﻟﻐﺎﻟﺒﻴـﺔ ﺍﻟﻌﻅﻤـﻰ‬
‫)‪ ٢٧‬ﺃﺨﺼﺎﺌﻴﹰﺎ( ‪ %٩٣.١٠‬ﻋﺒﺭﻭﺍ ﻋﻥ ﻋﺩﻡ ﺭﻀﺎﻫﻡ ﻋـﻥ ﻫـﺫﺍ ﺍﻟﺘـﺩﺭﻴﺏ ﻭﺃﻨـﻪ ﻏﻴـﺭ ﻜـﺎﻑ‬
‫ﻟﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ‪ ،‬ﻜﻤﺎ ﺃﺒﺩﻯ ‪ %٩٦.٠٨‬ﻤـﻥ ﺍﻟﻌﻴﻨـﺔ ﺍﻟﻜﻠﻴـﺔ ﺭﻏﺒـﺘﻬﻡ ﻓـﻰ‬
‫ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﻤﺯﻴﺩ ﻤﻥ ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻭﺫﻟـﻙ ﻤـﻥ ﺃﺠـل ﺼـﻘل‬
‫ﻤﻬﺎﺭﺍﺕ ﺍﻟﺘﺩﺭﻴﺏ ﻟﺩﻴﻬﻡ ‪ ،‬ﻭﺯﻴﺎﺩﺓ ﺨﺒﺭﺘﻬﻡ ﺒﻬﺫﺍ ﺍﻟﻨﻭﻉ ﻤـﻥ ﺍﻟﻌـﻼﺝ ﻭﺘﺤـﺩﻴﺙ ﻤﻌﻠﻭﻤـﺎﺘﻬﻡ ﻓـﻰ‬
‫ﻤﺠﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‪.‬‬

‫ﻭﻜﺎﻥ ﻻﺒﺩ ﻤﻥ ﺍﻟﺘﻌﺭﻑ ﻋﻠﻰ ﻤﺩﻯ ﺍﻫﺘﻤـﺎﻤﻬﻡ ﺍﻟﻔﻌﻠـﻰ ﺒﺎﻟﻤﺸـﻜﻠﺔ ﺍﻟﺘـﻰ ﻴﻌـﺎﻨﻭﻥ ﻤﻨﻬـﺎ‬
‫ﻭﻤﺩﻯ ﻭﻋﻴﻬﻡ ﺒﺎﻟﻤﻌﻭﻗﺎﺕ ﺍﻟﺘﻰ ﺘﺤﻭل ﺩﻭﻥ ﺤﺼﻭﻟﻬﻡ ﻋﻠﻰ ﻤﺜل ﻫـﺫﺍ ﺍﻟﺘـﺩﺭﻴﺏ ﺍﻟـﺫﻯ ﻴﺭﻏﺒـﻭﻥ‬
‫ﻓﻴﻪ ‪ ،‬ﻭﻗﺩ ﺃﺠﺎﺏ ‪ ٢١) %٤١.١٨‬ﺃﺨﺼﺎﺌﻴﹰﺎ( ﺒـﺄﻨﻬﻡ ﻴﻌﺭﻓـﻭﻥ ﺍﻷﻤـﺎﻜﻥ ﺍﻟﺘـﻰ ﻴﻤﻜـﻥ ﺃﻥ ﺘﻘـﺩﻡ‬
‫ﺍﻟﺘﺩﺭﻴﺏ ﻓﻰ ﻫﺫﺍ ﺍﻟﻤﺠﺎل ﻭﺫﻟﻙ ﻤﻘﺎﺒـل ‪ ٢٨) %٥٤.٩٠‬ﺃﺨﺼـﺎﺌﻴﹰﺎ( )ﺒﺎﻹﻀـﺎﻓﺔ ﺇﻟـﻰ ﺤـﺎﻟﺘﻴﻥ‬
‫ﻟﻡ ﺘﺠﻴﺒﺎ ﻋﻥ ﻫﺫﺍ ﺍﻟﺴﺅﺍل( ﻻ ﻴﻌﺭﻓﻭﻥ ﻫﺫﻩ ﺍﻷﻤـﺎﻜﻥ ﻭﻟﻠﺘﺄﻜـﺩ ﻤـﻥ ﺠﺩﻴـﺔ ﻫـﺫﻩ ﺍﻟﻤﻌﺭﻓـﺔ ﺘـﻡ‬
‫ﺘﻭﺠﻴﻪ ﺴﺅﺍل ﻋﻥ ﺘﺤﺩﻴﺩ ﻫﺫﻩ ﺍﻷﻤﺎﻜﻥ ﻭﻜﺎﻨﺕ ﺍﻹﺠﺎﺒﺎﺕ ﻜﺎﻟﺘﺎﻟﻰ ) ﻥ = ‪ ٢١‬ﺃﺨﺼﺎﺌﻴﹰﺎ(‪.‬‬
‫‪%٨٠.٩٥‬‬ ‫)‪(١٧‬‬ ‫‪ -١‬ﺭﺍﺒﻁﺔ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺍﻟﻤﺼﺭﻴﺔ‬
‫‪%٤٧.٦٢‬‬ ‫)‪(١٠‬‬ ‫‪ -٢‬ﻤﺭﻜﺯ ﺍﻟﺒﺤﻭﺙ ﺍﻟﻨﻔﺴﻴﺔ ﺒﺠﺎﻤﻌﺔ ﺍﻟﻘﺎﻫﺭﺓ‬
‫‪%١٤.٢٩‬‬ ‫)‪(٣‬‬ ‫‪ -٣‬ﻤﺭﻜﺯ ﺍﻟﺒﺤﻭﺙ ﺍﻟﻨﻔﺴﻴﺔ ﺒﺠﺎﻤﻌﺔ ﻋﻴﻥ ﺸﻤﺱ‬
‫‪%٩.٥٢‬‬ ‫)‪(٢‬‬ ‫‪ -٤‬ﻤﺴﺘﺸﻔﻰ ﺍﻟﻌﺒﺎﺴﻴﺔ‬
‫‪%٢٣.٨١‬‬ ‫)‪(٥‬‬ ‫‪ -٥‬ﺒﻌﺽ ﺍﻟﻤﺭﺍﻜﺯ ﺍﻟﺨﺎﺼﺔ‬

‫‪٢٢‬‬
‫ﺃﻤﺎ ﻤﻌﻭﻗﺎﺕ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺘﺩﺭﻴﺏ ﻤﻨﺎﺴـﺏ ﻓـﻰ ﻤﺠـﺎل ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ‬
‫ﻓﻴﻠﺨﺼﻬﺎ ﺍﻟﺠﺩﻭل ﺍﻟﺘﺎﻟﻰ ‪-:‬‬
‫ﺠﺩﻭل )‪(١‬‬
‫ﻤﻌﻭﻗﺎﺕ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺘﺩﺭﻴﺏ ﻤﻨﺎﺴﺏ ﻓﻰ ﻤﺠﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‬

‫‪%‬‬ ‫ﻙ‬ ‫ﺍﻟﻤﻌﻭﻗﺎﺕ‬ ‫ﻡ‬

‫‪٢٩.٤١‬‬ ‫‪١٥‬‬ ‫ﻗﻠﺔ ﺍﻹﻤﻜﺎﻨﺎﺕ ﺍﻟﻤﺎﺩﻴﺔ‬ ‫‪١‬‬
‫‪١٧.٦٥‬‬ ‫‪٩‬‬ ‫ﺍﻻﻨﺸﻐﺎل ﻓﻰ ﺍﻟﻌﻤل ﻭﻋﺩﻡ ﺘﻭﺍﻓﺭ ﺍﻟﻭﻗﺕ‬ ‫‪٢‬‬
‫‪١٧.٦٥‬‬ ‫‪٩‬‬ ‫ﻗﻠﺔ ﺍﻷﻤﺎﻜﻥ ﺍﻟﺘﻰ ﺘﻘﺩﻡ ﺍﻟﺘﺩﺭﻴﺏ‬ ‫‪٣‬‬
‫‪٩.٨٠‬‬ ‫‪٥‬‬ ‫ـﻰ‬
‫ـﻭل ﻋﻠـ‬
‫ـﻔﻴﺎﺕ ﻟﻠﺤﺼـ‬
‫ـﺌﻭﻟﻴﻥ ﺒﺎﻟﻤﺴﺘﺸـ‬
‫ـﺎﺱ ﺍﻟﻤﺴـ‬
‫ـﺩﻡ ﺤﻤـ‬
‫ﻋـ‬ ‫‪٤‬‬
‫ﺍﻟﺘﺩﺭﻴﺏ‬
‫‪٧.٨٤‬‬ ‫‪٤‬‬ ‫ﻗﻠﺔ ﻋﺩﺩ ﺍﻟﻤﺩﺭﺒﻴﻥ ﺍﻟﻤﺅﻫﻠﻴﻥ‬ ‫‪٥‬‬
‫‪٥.٨٨‬‬ ‫‪٣‬‬ ‫ﻋﺩﻡ ﺍﻟﻤﻌﺭﻓﺔ ﺒﻤﻭﺍﻋﻴﺩ ﺍﻟﺩﻭﺭﺍﺕ ﻭﺃﻤﺎﻜﻨﻬﺎ‬ ‫‪٦‬‬
‫‪٥.٨٨‬‬ ‫‪٣‬‬ ‫ﺍﻗﺘﺼﺎﺭ ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﺍﻟﺠﺎﻨﺏ ﺍﻟﻨﻅﺭﻯ ﻋﺎﺩﺓ‬ ‫‪٧‬‬
‫‪٣.٩٢‬‬ ‫‪٢‬‬ ‫ﻋﺩﻡ ﺘﻭﻓﺭ ﻤﺼﺎﺩﺭ ﺒﺎﻟﻠﻐﺔ ﺍﻟﻌﺭﺒﻴﺔ ﻴﻤﻜﻥ ﺍﻟﺭﺠﻭﻉ ﺇﻟﻴﻬﺎ‬ ‫‪٨‬‬
‫‪١.٩٦‬‬ ‫‪١‬‬ ‫ﻋﺩﻡ ﺍﻹﻋﻼﻥ ﻋﻥ ﺍﻟﺩﻭﺭﺍﺕ ﺒﺸﻜل ﻤﻨﺎﺴﺏ‬ ‫‪٩‬‬
‫‪١.٩٦‬‬ ‫‪١‬‬ ‫‪ ١٠‬ﻫﺫﺍ ﺍﻟﻌﻼﺝ ﻏﻴﺭ ﻤﺘﺎﺡ ﻓﻰ ﻤﺼﺭ‬
‫‪١.٩٦‬‬ ‫‪١‬‬ ‫‪ ١١‬ﺍﻟﺩﻭﺭﺍﺕ ﻏﻴﺭ ﻤﻨﺎﺴﺒﺔ‬
‫‪١.٩٦‬‬ ‫‪١‬‬ ‫‪ ١٢‬ﻨﻘﺹ ﺍﻟﺩﺍﻓﻌﻴﺔ‬
‫‪١.٩٦‬‬ ‫‪١‬‬ ‫‪ ١٣‬ﺘﻘﺩﻡ ﺍﻟﻌﻤﺭ ﻭﻋﺩﻡ ﺠﺩﻭﻯ ﺍﻟﺘﺩﺭﻴﺏ‬
‫‪١.٩٦‬‬ ‫‪١‬‬ ‫‪ ١٤‬ﺘﻔﻀﻴل ﺃﻨﻭﺍﻉ ﺃﺨﺭﻯ ﻤﻥ ﺍﻟﻌﻼﺝ ﻜﺎﻟﺘﺤﻠﻴل ﺍﻟﻨﻔﺴﻰ‬
‫‪٢١.٥٧‬‬ ‫‪١١‬‬ ‫‪ ١٥‬ﺃﺨﺭﻯ‬
‫‪١٧.٦٥‬‬ ‫‪٩‬‬ ‫‪ ١٦‬ﻏﻴﺭ ﻤﺒﻴﻥ‬

‫‪٢٣‬‬
‫ﻭﺘﻨﻁﻭﻯ ﺍﻟﻨﺘﺎﺌﺞ ﺍﻟﺴﺎﺒﻘﺔ ﻋﻠﻰ ﺒﻌـﺽ ﺍﻟﺠﻭﺍﻨـﺏ ﺍﻹﻴﺠﺎﺒﻴـﺔ ﻟﻌـل ﺃﻫﻤﻬـﺎ ﺫﻟـﻙ ﺍﻟـﻭﻋﻰ‬
‫ﺒﻭﺠﻭﺩ ﻤﺸـﻜﻠﺔ ﺘﺘﻌﻠـﻕ ﺒﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻭﺍﻻﻋﺘـﺭﺍﻑ ﺒـﺎﻟﻨﻘﺹ ﻓـﻰ‬
‫ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻴﻪ ﻭﻤﺎ ﻴﻌﺘﺭﺽ ﺴﺒﻴل ﺫﻟﻙ ﺍﻟﺘﺩﺭﻴﺏ ‪ ،‬ﺇﻻ ﺃﻥ ﺍﻟﺠﺎﻨـﺏ ﺍﻟﺴـﻠﺒﻰ ﺍﻟـﺫﻯ ﺘﺤﻤﻠـﻪ ﻫـﺫﻩ‬
‫ﺍﻟﻨﺘﺎﺌﺞ ﻫﻭ ﻜﺜﺭﺓ ﺍﻟﻤﻌﻭﻗﺎﺕ ﺍﻟﺘﻰ ﺃﺒﺩﺍﻫﺎ ﺍﻷﺨﺼﺎﺌﻴﻭﻥ ﺍﻟﻨﻔﺴـﻴﻭﻥ ‪ ،‬ﻭﺍﻟﺘـﻰ ﺘﺘﻌﻠـﻕ ﺒﺎﻷﺨﺼـﺎﺌﻴﻴﻥ‬
‫ﺃﻨﻔﺴﻬﻡ ﻤﺜل ﻨﻘﺹ ﺍﻟﺩﺍﻓﻌﻴﺔ ﻭﺍﻟﻴﺄﺱ ﻓﻰ ﺘﺤﺼﻴل ﺍﻟﺘـﺩﺭﻴﺏ ﻨﺘﻴﺠـﺔ ﺍﻟﺘﻘـﺩﻡ ﻓـﻰ ﺍﻟﻌﻤـﺭ ﻭﻗـﺭﺏ‬
‫ﺘﺭﻙ ﺍﻟﻌﻤل ﻭﺍﻟﺘﻘﺎﻋﺩ ‪ ،‬ﻭﻤﻊ ﺫﻟﻙ ﻓﻬﻨﺎﻙ ﻋﻘﺒﺎﺕ ﻭﻋﻭﺍﺌﻕ ﻴﻤﻜﻥ ﺍﻟﺘﻐﻠـﺏ ﻋﻠﻴﻬـﺎ ﺇﺫﺍ ﻤـﺎ ﺘـﻭﻓﺭﺕ‬
‫ﺍﻟﺭﻏﺒﺔ ﻓﻰ ﻤﻭﺍﺼﻠﺔ ﺍﻟﺘﺨﺼﺹ ﻓـﻰ ﻫـﺫﺍ ﺍﻟﻤﺠـﺎل ‪ ،‬ﻭﺇﻥ ﻜـﺎﻥ ﺫﻟـﻙ ﺒﺤﺎﺠـﺔ ﺇﻟـﻰ ﺘﻜـﺎﺘﻑ‬
‫ﺍﻟﺠﻬﻭﺩ ﻤﻥ ﺠﺎﻨﺏ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﻭﺍﻟﻤﺅﺴﺴـﺎﺕ ﺍﻟﺘـﻰ ﻴﻌﻤﻠـﻭﻥ ﺒﻬـﺎ ‪ ،‬ﻭﺍﻟﻤﺅﺴﺴـﺎﺕ ﺍﻷﺨـﺭﻯ‬
‫ﺍﻟﺘﻰ ﺒﺎﺴﺘﻁﺎﻋﺘﻬﺎ ﺘﺩﺒﻴﺭ ﺍﻟﻨﻔﻘﺎﺕ ﺍﻟﻤﺎﺩﻴﺔ ﺃﻭ ﺘﻘﺩﻴﻡ ﺘـﺩﺭﻴﺏ ﻨـﻭﻋﻰ ﻤﺘﻁـﻭﺭ ﻭﻤـﻥ ﺫﻟـﻙ ﻋﻠـﻰ‬
‫ﺴﺒﻴل ﺍﻟﻤﺜﺎل ﺃﻗﺴﺎﻡ ﻋﻠـﻡ ﺍﻟـﻨﻔﺱ ﻭﻤﺭﺍﻜـﺯ ﺍﻟﺒﺤـﻭﺙ ﺍﻟﻨﻔﺴـﻴﺔ ﻭﻤﺭﺍﻜـﺯ ﺍﻟﺨﺩﻤـﺔ ﺍﻟﻨﻔﺴـﻴﺔ ‪،‬‬
‫ﻭﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ ﺍﻟﺘﻰ ﺘﺘﻴﺢ ﻓﺭﺹ ﺍﻟﺘﺩﺭﻴﺏ ﺍﻟﻌﻤﻠﻰ ﻟﺘﻭﻓﺭ ﺍﻟﻤﺭﻀـﻰ ﺒﻬـﺎ‪ .‬ﻭﻟﻌـل ﺍﻟﺠﻬـﻭﺩ ﺍﻟﺘـﻰ‬
‫ﺘﺒﺫل ﺍﻵﻥ ﺒﺎﻟﺘﻌﺎﻭﻥ ﺒﻴﻥ ﻤﺭﻜﺯ ﺍﻟﻁﺏ ﺍﻟﻨﻔﺴﻰ ﺒﺠﺎﻤﻌﺔ ﻋﻴﻥ ﺸﻤﺱ ‪ ،‬ﻭﻗﺴـﻡ ﻋﻠـﻡ ﺍﻟـﻨﻔﺱ ﺒﻜﻠﻴـﺔ‬
‫ﺍﻵﺩﺍﺏ ﺠﺎﻤﻌﺔ ﺍﻟﻘﺎﻫﺭﺓ ﺘﻬﺩﻑ ﺇﻟﻰ ﺘﻭﻓﻴﺭ ﻨﻭﻉ ﻤﻥ ﺍﻟﺘـﺩﺭﻴﺏ ﺍﻟﻤﻨﺎﺴـﺏ ﺍﻟـﺫﻯ ﻴﺅﻫـل ﺍﻟـﺭﺍﻏﺒﻴﻥ‬
‫ﻓﻰ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺘﺭﺨﻴﺹ ﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴـﻰ ‪ ،‬ﻭﻓـﻰ ﺍﻟﻭﻗـﺕ ﻨﻔﺴـﻪ ﺘـﻭﻓﻴﺭ ﻜـﻭﺍﺩﺭ‬
‫ﺘﺩﺭﻴﺒﻴﺔ ﺘﻘﻭﻡ ﺒﻬﺫﻩ ﺍﻟﻤﻬﻤﺔ ﻟﻠﺘﻐﻠﺏ ﻋﻠﻰ ﻤﺸﻜﻠﺔ ﻨﻘﺹ ﺍﻟﻤﺩﺭﺒﻴﻥ ﻭﻨﻘﺹ ﺃﻤﺎﻜﻥ ﺍﻟﺘﺩﺭﻴﺏ‪.‬‬

‫ﻓﺈﺫﺍ ﺍﻨﺘﻘﻠﻨﺎ ﻟﻠﻘﺴﻡ ﺍﻟﺜﺎﻨﻰ ﻤﻥ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻻﺴـﺘﺒﻴﺎﻥ ﻭﺍﻟﺘـﻰ ﺘـﺩﻭﺭ ﺤـﻭل ﻤـﺩﻯ ﻤﻤﺎﺭﺴـﺔ‬
‫ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﻟﻠﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﺒﺎﻟﻔﻌل ﻓـﻰ ﻋـﻼﺝ ﺃﻤـﺭﺍﺽ ﻨﻔﺴـﻴﺔ ﻤﺘﻨﻭﻋـﺔ‬
‫ﺴﻨﺠﺩ ﺃﻥ ﺍﻟﺫﻴﻥ ﺃﺠﺎﺒﻭﺍ ﺒﺎﻹﻴﺠﺎﺏ ﻋﻥ ﺴﺅﺍل ﺒﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻓـﻰ ﺍﻟﻭﻗـﺕ‬
‫ﺍﻟﺤﺎﻀﺭ )‪ (٢٣‬ﺃﺨﺼﺎﺌﻴَﹰﺎ )‪ (%٤٥.١٠‬ﻓﻰ ﻤﻘﺎﺒـل )‪ (٢٨‬ﺃﺨﺼـﺎﺌﻴﹰﺎ ﺃﻜـﺩﻭﺍ ﺃﻨﻬـﻡ ﻻ ﻴﻤﺎﺭﺴـﻭﻨﻪ‬
‫)‪ ،(%٥٤.٩٠‬ﻭﻋﻨﺩﻤﺎ ﺴﺄﻟﻨﺎ ﺍﻟﺫﻴﻥ ﺃﺠﺎﺒﻭﺍ ﺒﺎﻹﻴﺠـﺎﺏ ﻋـﻥ ﻨـﻭﻉ ﺍﻷﻤـﺭﺍﺽ ﺍﻟﺘـﻰ ﻋﺎﻟﺠﻭﻫـﺎ‬

‫‪٢٤‬‬
‫ﻭﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﻭﺍﻷﺴﺎﻟﻴﺏ ﺍﻟﻌﻼﺠﻴﺔ ﺍﻟﻤﺴـﺘﺨﺩﻤﺔ ﺃﺴـﻔﺭﺕ ﺍﻹﺠﺎﺒـﺎﺕ ﻋـﻥ ﻗﺎﺌﻤـﺔ ﺍﻷﻤـﺭﺍﺽ‬
‫ﺍﻟﺘﺎﻟﻴﺔ‪-:‬‬

‫ﺠﺩﻭل )‪(٢‬‬

‫ﻗﺎﺌﻤﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻨﻔﺴﻴﺔ ﺍﻟﺘﻰ ﻋﺎﻟﺠﻬﺎ ﺍﻷﺨﺼﺎﺌﻴﻭﻥ ﺍﻟﻨﻔﺴﻴﻭﻥ ﺒﺎﺴﺘﺨﺩﺍﻡ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‬

‫‪%‬‬ ‫ﻙ‬ ‫ﺍﻷﻤﺭﺍﺽ‬ ‫ﻡ‬

‫‪٧٣.٩١‬‬ ‫‪١٧‬‬ ‫ﻗﻠﻕ‬ ‫‪١‬‬
‫‪٩١.٣٠‬‬ ‫‪٢١‬‬ ‫ﺍﻜﺘﺌﺎﺏ‬ ‫‪٢‬‬
‫‪٣٤.٧٨‬‬ ‫‪٨‬‬ ‫ﻤﺨﺎﻭﻑ‬ ‫‪٣‬‬
‫‪٥٦.٥٢‬‬ ‫‪١٣‬‬ ‫ﻭﺴﻭﺍﺱ ﻗﻬﺭﻯ‬ ‫‪٤‬‬
‫‪٣٠.٤٤‬‬ ‫‪٧‬‬ ‫ﺍﻀﻁﺭﺍﺒﺎﺕ ﺸﺨﺼﻴﺔ‬ ‫‪٥‬‬
‫‪٢٦.٩‬‬ ‫‪٦‬‬ ‫ﻓﺼﺎﻡ‬ ‫‪٦‬‬
‫‪٥٢.١٧‬‬ ‫‪١٢‬‬ ‫ﺃﻤﺭﺍﺽ ﻤﺘﻨﻭﻋﺔ )ﻜﺭﺏ ﻤﺎ ﺒﻌﺩ ﺍﻟﺼﺩﻤﺔ ‪ ،‬ﺍﻟﻬﻠـﻊ ‪ ،‬ﺍﻟﺨﻠﺠـﺎﺕ ‪،‬‬ ‫‪٧‬‬
‫ﺍﻹﺩﻤﺎﻥ‪ ،‬ﺍﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﺠﻨﺴﻴﺔ ‪ ،‬ﻤﺸﻜﻼﺕ ﺃﺴﺭﻴﺔ ‪ ،‬ﺼـﻌﻭﺒﺎﺕ‬
‫ﺘﻌﻠﻡ(‪.‬‬

‫ﻭﻤﻥ ﺍﻟﻤﻼﺤﻅ ﺃﻥ ﺍﻻﻜﺘﺌﺎﺏ ﻴﺄﺘﻰ ﻋﻠﻰ ﺭﺃﺱ ﺍﻟﻘﺎﺌﻤﺔ ﻴﻠﻴﻪ ﺍﻟﻘﻠـﻕ ﺜـﻡ ﺍﻟﻭﺴـﻭﺍﺱ ﺍﻟﻘﻬـﺭﻯ‬
‫ﺜﻡ ﺍﻟﻤﺨﺎﻭﻑ )ﻭﻫﻰ ﻤﺠﻤﻭﻋﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﺘـﻰ ﺘﻨﺘﻤـﻰ ﺇﻟـﻰ ﺍﻻﻀـﻁﺭﺍﺒﺎﺕ ﺍﻟﻌﺼـﺎﺒﻴﺔ( ﻴﻠـﻰ‬
‫ﺫﻟﻙ ﺍﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ ‪ ،‬ﺜﻡ ﺍﻟﻔﺼﺎﻡ ﻭﺃﺨﻴـﺭﹰﺍ ﻨﺴـﺏ ﻀـﺌﻴﻠﺔ ﻤـﻥ ﺃﻤـﺭﺍﺽ ﻤﺘﻌـﺩﺩﺓ ﺘـﻡ‬
‫ﺠﻤﻌﻬﺎ ﺘﺤﺕ ﻤﺴﻤﻰ "ﺃﻤﺭﺍﺽ ﻤﺘﻨﻭﻋﺔ"‪.‬‬

‫‪٢٥‬‬
‫ﺃﻤﺎ ﻋﻥ ﻋﺩﺩ ﺍﻟﺤﺎﻻﺕ ﻓﺘﺭﺍﻭﺡ ﺒﻴﻥ ﺤﺎﻟـﺔ ﻭﺍﺤـﺩﺓ ﻭ‪ ٥٠‬ﺤﺎﻟـﺔ ﻭﺍﻟﺸـﺎﺌﻊ ﻫﻨـﺎ ﺃﺭﺒـﻊ ﺃﻭ‬
‫ﺨﻤﺱ ﺤﺎﻻﺕ ‪ ،‬ﻭﻗﺩ ﺫﻜﺭ ﺍﻟﻤﺴـﺘﺠﻴﺒﻭﻥ ﻋـﺩﺩﹰﺍ ﻤـﻥ ﺍﻷﺴـﺎﻟﻴﺏ ﺍﻟﺘـﻰ ﺍﺴـﺘﺨﺩﻤﻭﻫﺎ ﺒﻌﻀـﻬﺎ ﻻ‬
‫ﻴﺩﺨل ﺒﺎﻟﺘﺤﺩﻴﺩ ﺘﺤـﺕ ﻤﺴـﻤﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻭﻤـﻥ ﺫﻟـﻙ ﺍﻹﺭﺸـﺎﺩ ﺍﻟﻨﻔﺴـﻰ‬
‫ﻭﺍﻹﺭﺸﺎﺩ ﺍﻟﻌﺎﻡ ‪ ،‬ﻜﻤﺎ ﺫﻜﺭ ﺒﻌﻀـﻬﻡ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺩﻭﻥ ﺘﺤﺩﻴـﺩ ‪ ،‬ﺃﻤـﺎ ﺍﻷﺴـﺎﻟﻴﺏ ﺍﻟﺘـﻰ‬
‫ﺘﻨﺘﻤﻰ ﺇﻟﻰ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺃﻭ ﺍﻟﻌﻼﺝ ﺍﻟﺴﻠﻭﻜﻰ ﻓﻜـﺎﻥ ﻤﻨﻬـﺎ ‪ ،‬ﺘﻌـﺩﻴل ﺍﻟﻤﻔـﺎﻫﻴﻡ ‪ ،‬ﺍﻟﺘـﺩﻋﻴﻡ ‪،‬‬
‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻋﻨﺩ ﺒﻴﻙ ‪ ،‬ﺘﻭﻜﻴـﺩ ﺍﻟـﺫﺍﺕ ‪ ،‬ﺍﻟﺘـﺩﺭﻴﺏ ﻋﻠـﻰ ﺍﻟﺘﻭﺍﺼـل ‪ ،‬ﺍﻟﻀـﺒﻁ‬
‫ﺍﻟﺫﺍﺘﻰ ‪ ،‬ﺍﻻﺴﺘﺭﺨﺎﺀ ‪ ،‬ﺍﻟﻌﻼﺝ ﺒﺎﻟﻠﻌﺏ ‪ ،‬ﺍﻟﺘﻨﻔﻴﺭ ‪ ،‬ﺍﻟﺘﺤﺼـﻴﻥ ﺍﻟﺘـﺩﺭﻴﺠﻰ ‪ ،‬ﺍﻻﻗﺘﻔـﺎﺀ ‪ ،‬ﺍﻟﺘـﺩﺭﻴﺏ‬
‫ﻋﻠﻰ ﺍﻟﻤﻬﺎﺭﺍﺕ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ‪ ،‬ﺍﻟﻤﻤﺎﺭﺴﺔ ﺍﻟﺴـﺎﻟﺒﺔ ‪ ،‬ﻤﻤﺎﺭﺴـﺔ ﺍﻷﻨﺸـﻁﺔ ﺍﻟﺴـﺎﺭﺓ ‪ .‬ﻭﻴﻠﺘﻘـﻰ ﻤـﺎ‬
‫ﺴﺒﻕ ﻤﺎ ﻴﺅﻜﺩﻩ ﺭﻭﺒﺭﺕ ﻟﻴﻬﻰ )‪ (٢٠٠٦‬ﻤـﻥ ﺃﻥ ﺍﻟﻌﺩﻴـﺩ ﻤـﻥ ﺍﻟﻤﻌـﺎﻟﺠﻴﻥ ﻴﺴـﺘﺨﺩﻤﻭﻥ ﺃﺴـﺎﻟﻴﺏ‬
‫ﻤﺘﺸﺎﺒﻬﻪ ﻭﻴﻘﺘﺭﺏ ﺍﻟﻤﻌﺎﻟﺠﻭﻥ ﺍﻟﻤﻌﺭﻓﻴﻭﻥ ﻤﻥ ﺍﻟﻌﻼﺝ ﺍﻟﺴـﻠﻭﻜﻰ ﺒﺎﺴـﺘﺨﺩﺍﻡ ﺍﻟﺘﻌـﺭﺽ ﻟﻠﻤﺜﻴـﺭﺍﺕ‬
‫ﺍﻟﻤﺨﻴﻔﺔ ‪ ،‬ﻭﺍﻻﻗﺘﺩﺍﺀ ﻭﺍﻻﺴﺘﺭﺠﺎﻉ ﺍﻟﺴﻠﻭﻜﻰ ‪ ،‬ﻭﺍﻟﺘﺩﺭﻴﺏ ﻋﻠـﻰ ﺍﻻﺴـﺘﺭﺨﺎﺀ ‪ ،‬ﻭﺠﺩﻭﻟـﺔ ﺍﻟﻨﺸـﺎﻁ‬
‫ﻭﺘﺤﺩﻴﺩ ﺍﻟﻤﻬﺎﻡ ﺍﻟﻤﺘﺩﺭﺠﺔ ﻭﺍﻟﺘﺩﺭﻴﺏ ﺍﻟﺘﻭﻜﻴﺩﻯ ‪ ،‬ﻭﻤﻬـﺎﺭﺍﺕ ﺍﻹﻨﺼـﺎﺕ ﻭﺍﻟﺘﺨﺎﻁـﺏ ‪ ،‬ﻭﺍﻟﺘـﺩﻋﻴﻡ‬
‫ﺍﻟﺫﺍﺘﻰ ‪ ،‬ﻜﻤﺎ ﻴﻤﺘﻠﻙ ﺍﻟﻤﻌﺎﻟﺞ ﺍﻟﺴﻠﻭﻜﻰ ﻤﺠﻤﻭﻋﺔ ﻤﻥ ﺍﻷﺴـﺎﻟﻴﺏ ﺍﻟﻘﻭﻴـﺔ ﺍﻟﻤﺸـﺘﻘﺔ ﻤـﻥ ﺍﻟﻨﻤـﻭﺫﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﻭﺘﺸﻤل ﺘﻭﺠﻴﻪ ﺃﻭ ﻤﺭﺍﻗﺒﺔ ﺍﻟﺘﻔﻜﻴﺭ ‪ ،‬ﻭﺘﺒﻭﻴﺏ ﺍﻷﻓﻜـﺎﺭ ﺍﻟﺴـﻠﺒﻴﺔ ﻓـﻰ ﻓﺌـﺎﺕ ﻭﺍﻟﺘﺭﺘﻴـﺏ‬
‫ـﻤﻨﻴﺔ ﻭﻏﻴﺭﻫــــــﺎ‬
‫ـﺎﺕ ﺍﻟﻀـــــ‬
‫ـﺩ ﺍﻻﻓﺘﺭﺍﻀـــــ‬
‫ـﺎﺒﻁ ﻭﺘﺤﺩﻴـــــ‬
‫ﺍﻟﻬـــــ‬
‫ـﺫﻩ‬
‫ـﺔ ﻫـ‬
‫ـﺩ ﻤﻤﺎﺭﺴـ‬
‫ـﺎﻥ ﻋﻨـ‬
‫ـﺔ ﺍﻹﺘﻘـ‬
‫ـﻰ ﺩﺭﺠـ‬
‫ـﻜﻠﺔ ﻓـ‬
‫ـﻰ ﺍﻟﻤﺸـ‬
‫ـﻥ ﺘﺒﻘـ‬
‫)ﺹ ﺹ ‪ ، (٣٤ – ٣٣‬ﻭﻟﻜـ‬
‫ﺍﻷﺴﺎﻟﻴﺏ ‪ ،‬ﻭﺍﻟﻌﺎﺌﺩ ﺍﻟﺫﻯ ﺘﺤﻘﻕ ﻤﻨﻬﺎ ﻓﻰ ﻅل ﻨﻘﺹ ﺍﻟﺘﺩﺭﻴﺏ ﻭﺘﻭﺍﻀـﻊ ﺍﻟﺘﺄﻫﻴـل ﺍﻟـﺫﻯ ﻜﺸـﻔﺕ‬
‫ﻋﻨﻪ ﺍﻟﻨﺘﺎﺌﺞ ﺍﻟﺴﺎﺒﻘﺔ ‪ ،‬ﻏﻴﺭ ﺃﻨﻪ ﻴﻤﻜﻥ ﺍﻋﺘﺒﺎﺭ ﺫﻟﻙ ﻤﺠﺭﺩ ﺒﺩﺍﻴﺔ ﻴﻤﻜـﻥ ﺍﻻﻨﻁـﻼﻕ ﻤﻨﻬـﺎ ﻭﺍﻟﺒﻨـﺎﺀ‬
‫ﻋﻠﻴﻬﺎ‪.‬‬

‫‪٢٦‬‬
‫ﺃﻤﺎ ﺍﻟﺫﻴﻥ ﺃﺠﺎﺒﻭﺍ ﺒﺄﻨﻬﻡ ﻻ ﻴﻤﺎﺭﺴﻭﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻓـﻰ ﺍﻟﻭﻗـﺕ ﺍﻟﺤﺎﻀـﺭ‬
‫ﻓﻘﺩ ﺘﻡ ﺴﺅﺍﻟﻬﻡ ﻋﻥ ﺍﻟﺴﺒﺏ ﻓﻰ ﺫﻟﻙ ﻓﻜﺎﻨﺕ ﺍﻹﺠﺎﺒﺎﺕ ﻜﻤﺎ ﻴﻭﻀﺤﻬﺎ ﺍﻟﺠﺩﻭل ﺍﻟﺘﺎﻟﻰ‪-:‬‬
‫ﺠﺩﻭل )‪(٣‬‬
‫ﺃﺴﺒﺎﺏ ﻋﺩﻡ ﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‬

‫‪%‬‬ ‫)ﻥ=‬ ‫ﺍﻟﺴﺒﺏ‬ ‫ﻡ‬

‫‪(٢٨‬‬
‫‪٦٧.٨٦‬‬ ‫‪١٩‬‬ ‫ﺘﺄﻫﻴﻠﻰ ﻟﻴﺱ ﻜﺎﻓﻴﹰﺎ‬ ‫‪١‬‬
‫‪٥٣.٥٧‬‬ ‫‪١٥‬‬ ‫ﻅﺭﻭﻑ ﺍﻟﻌﻤل ﻓﻰ ﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ ﻻ ﺘﺴﻤﺢ‬ ‫‪٢‬‬
‫‪٢١.٤٣‬‬ ‫‪٦‬‬ ‫ﻫﺫﺍ ﺍﻟﻌﻼﺝ ﻻ ﻴﺼﻠﺢ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺘﻰ ﺃﺘﻌﺎﻤل ﻤﻌﻬﺎ‬ ‫‪٣‬‬
‫‪١٧.٨٦‬‬ ‫‪٥‬‬ ‫ﻼ‬
‫ﻷﻨﻪ ﻴﺴﺘﻐﺭﻕ ﻭﻗﺘﹰﺎ ﻁﻭﻴ ﹰ‬ ‫‪٤‬‬
‫‪١٤.٢٩‬‬ ‫‪٤‬‬ ‫ﻷﻨﻪ ﻤﻜﻠﻑ‬ ‫‪٥‬‬
‫‪١٠.٧١‬‬ ‫‪٣‬‬ ‫ﻷﻥ ﺍﻷﻁﺒﺎﺀ ﻻ ﻴﺴﻤﺤﻭﻥ ﺒﺫﻟﻙ‬ ‫‪٦‬‬
‫‪٣.٥٧‬‬ ‫‪١‬‬ ‫ﺃﺨﺭﻯ‬ ‫‪٧‬‬

‫ﻭﺇﺫﺍ ﻤﺎ ﺘﺨﻁﻴﻨﺎ ﻋـﺩﻡ ﻜﻔﺎﻴـﺔ ﺍﻟﺘﺄﻫﻴـل ‪ ،‬ﺒﺎﻋﺘﺒـﺎﺭﻩ ﻴﻌﺒـﺭ ﻋـﻥ ﺩﺭﺠـﺔ ﻤـﻥ ﺍﻟﺼـﺩﻕ‬
‫ﻭﺍﻻﻋﺘﺭﺍﻑ‪ ،‬ﻓـﺈﻥ ﺒﻘﻴـﺔ ﺍﻷﺴـﺎﻟﻴﺏ ﺘﺒـﺩﻭ ﻭﺍﻫﻴـﺔ ﺇﻟـﻰ ﺤـﺩ ﻜﺒﻴـﺭ ‪ ،‬ﻷﻥ ﻅـﺭﻭﻑ ﺍﻟﻌﻤـل‬
‫ﺒﺎﻟﻤﺴﺘﺸﻔﻴﺎﺕ ﻗﺩ ﺴﻤﺤﺕ ﻟﻠﺒﻌﺽ ﺒﺎﻟﺤﺼﻭل ﻋﻠﻰ ﺘﺩﺭﻴﺏ ﻓـﻰ ﻫـﺫﺍ ﻟﻤﺠـﺎل ﻜﻤـﺎ ﻗـﺩﻤﻨﺎﻩ ﻓـﻰ‬
‫ﻤﺴﺘﺸﻔﻰ ﺍﻟﻌﺒﺎﺴﻴﺔ ﻟﻌﺩﺩ ﻤﻥ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ‪ ،‬ﻭﻗـﺩ ﺘﺤﻤﻠـﺕ ﺍﻟﻤﺴﺘﺸـﻔﻰ – ﺃﻭ ﺠﻬـﺔ ﻤـﺎ‬
‫ﺘﺘﺒﻌﻬﺎ ﺍﻟﻤﺴﺘﺸﻔﻰ – ﺘﻜﺎﻟﻴﻑ ﺘﻨﻔﻴﺫ ﻫﺫﻩ ﺍﻟﺩﻭﺭﺍﺕ ‪ ،‬ﺒل ﺃﻥ ﻋـﺩﺩﹰﺍ ﻤـﻥ ﺍﻷﻁﺒـﺎﺀ ﺍﻨﺘﻅﻤـﻭﺍ ﻓﻴﻬـﺎ ‪،‬‬

‫‪٢٧‬‬
‫ﻼ‬
‫ﻭﻏﻨﻰ ﻋﻥ ﺍﻟﺒﻴﺎﻥ ﺃﻥ ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠـﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻻ ﻴﺴـﺘﻐﺭﻕ ﻭﻗﺘـﹰﺎ ﻁـﻭﻴ ﹰ‬
‫ﻼ ‪ ،‬ﺃﻤـﺎ ﺩﻋـﻭﻯ ﺃﻨـﻪ ﻏﻴـﺭ‬
‫ﻤﻘﺎﺭﻨﺔ ﺒﺄﻨﻭﺍﻉ ﺃﺨﺭﻯ ﻤﻥ ﺍﻟﻌﻼﺝ ﻜﺎﻟﻌﻼﺝ ﺒﺎﻟﺘﺤﻠﻴل ﺍﻟﻨﻔﺴـﻰ ﻤـﺜ ﹰ‬
‫ﻤﻨﺎﺴﺏ ﻟﻸﻤﺭﺍﺽ ﺍﻟﺘﻰ ﻴﺘﻌﺎﻤل ﻤﻌﻬﺎ ﺒﻌﺽ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﻓﻬﻰ ﺩﻋـﻭﻯ ﻤـﺭﺩﻭﺩ ﻋﻠﻴﻬـﺎ ﺒﺄﻨـﻪ ﻻ‬
‫ﻴﻭﺠﺩ ﻋﻼﺝ ﻤﻌﺭﻓﻰ ﺴﻠﻭﻜﻰ ﻫﻜﺫﺍ ﻴﻘﺩﻡ ﺩﻓﻌﺔ ﻭﺍﺤﺩﺓ ﺃﻭ ﺃﻥ ﻫﻨـﺎﻙ ﺃﺴـﻠﻭﺒﹰﺎ ﻭﺍﺤـﺩﹰﺍ ﻓﻘـﻁ )ﻟﻴﻬـﻰ‬
‫‪ ، ٢٠٠٦ ،‬ﺹ‪ (٣٩‬ﺒل ﺍﻟﻤﻌﺭﻭﻑ ﺃﻥ ﻫﻨﺎﻙ ﻁﻴﻔﹰﺎ ﻭﺍﺴـﻌﹰﺎ ﻤـﻥ ﺍﻷﺴـﺎﻟﻴﺏ ﻭﺍﻟﻔﻨﻴـﺎﺕ ﺍﻟﻤﻌﺭﻓﻴـﺔ‬
‫ﻭﺍﻟﺴﻠﻭﻜﻴﺔ ﺍﻟﺘﻰ ﻴﻤﻜﻥ ﺍﻻﺨﺘﻴﺎﺭ ﻤﻥ ﺒﻴﻨﻬﺎ ﻭﻤﺎ ﻴﺘﻨﺎﺴﺏ ﻤﻊ ﺍﻷﻤـﺭﺍﺽ ﺍﻟﻨﻔﺴـﻴﺔ ﺍﻟﻤﺨﺘﻠﻔـﺔ ‪ ،‬ﺒـل‬
‫ﻻ ﻭﻨﻤـﺎﺫﺝ ﺴـﻴﻜﻭﻟﻭﺠﻴﺔ ﺃﺨـﺭﻯ‬
‫ﺃﻥ ﺍﻟﻤﻌﺭﻭﻑ ﺃﻴﻀﹰﺎ ﺃﻥ ﺍﻟﻤﻌﺎﻟﺠﻴﻥ ﺍﻟﻤﻌـﺭﻓﻴﻴﻥ ﻴـﺩﺨﻠﻭﻥ ﺃﻋﻤـﺎ ﹰ‬
‫ﻤﻥ ﺨﺎﺭﺝ ﻫﺫﺍ ﺍﻟﻨﻅﺎﻡ ﻓﻰ ﺃﻋﻤـﺎﻟﻬﻡ ﻭﺒﺸـﻜل ﻤﺘﻜﺎﻤـل )ﺍﻟﻤﺭﺠـﻊ ﺍﻟﺴـﺎﺒﻕ( ﻭﻫـﻭ ﻤـﺎ ﻴﻔﻌﻠـﻪ‬
‫ﺍﻟﻤﻌﺎﻟﺠﻭﻥ ﺍﻟﺴﻠﻭﻜﻴﻭﻥ ﺃﻴﻀﹰﺎ‪.‬‬

‫ﻭﺘﺄﻜﻴﺩﹰﺍ ﻟﺒﻌﺽ ﻤﺎ ﻭﺭﺩ ﻓﻰ ﺍﻟﺠﺩﻭل ﺍﻟﺴﺎﺒﻕ ﻋﻥ ﺩﻭﺭ ﺍﻷﻁﺒـﺎﺀ ‪ ،‬ﻓﻘـﺩ ﺘـﻡ ﺍﻟﺴـﺅﺍل ﻋـﻥ‬
‫ﻤﺩﻯ ﻗﻴﺎﻡ ﺍﻷﻁﺒﺎﺀ ﺒﺘﺤﻭﻴل ﺤﺎﻻﺕ ﺇﻟـﻰ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﻟﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ﻤﻌﻬﺎ ‪ ،‬ﻭﻗـﺩ ﺃﺠـﺎﺏ ‪ (%٤٣.١٤) ٢٢‬ﺒﺎﻹﻴﺠـﺎﺏ ﻭﺫﻟـﻙ ﻤﻘﺎﺒـل ‪(%٥٦.٨٦) ٢٩‬‬
‫ﻨﻔﻭﺍ ﺫﻟﻙ ‪ ،‬ﻭﻗﺩ ﺘﻭﺠﻬﻨﺎ ﻟﻬﺅﻻﺀ ﺒﺎﻷﺴﺒﺎﺏ ﺍﻟﺘﻰ ﺘﻘﻑ ﺨﻠﻑ ﻫـﺫﺍ ﺍﻟﻤﻭﻗـﻑ ﻤـﻥ ﺠﺎﻨـﺏ ﺍﻷﻁﺒـﺎﺀ‬
‫ﻓﺠﺎﺀﺕ ﺍﻟﻨﺘﺎﺌﺞ ﻜﻤﺎ ﻴﻠﺨﺼﻬﺎ ﺍﻟﺠﺩﻭل ﺍﻟﺘﺎﻟﻰ‪.‬‬
‫ﺠﺩﻭل )‪(٤‬‬
‫ﺃﺴﺒﺎﺏ ﻋﺩﻡ ﺘﺤﻭﻴل ﺍﻷﻁﺒﺎﺀ ﻟﻠﺤﺎﻻﺕ ﺇﻟﻰ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﻻﺴﺘﺨﺩﺍﻡ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‬
‫ﻤﻌﻬﺎ‬

‫‪%‬‬ ‫ﻙ‬ ‫ﺍﻟﺴﺒﺏ‬ ‫ﻡ‬

‫‪٢٨‬‬
 ‫‪٥٧.٨٦‬‬ ‫‪٢٢‬‬ ‫ﻟﺘﻔﻀﻴﻠﻬﻡ ﺍﻟﻌﻼﺝ ﺍﻟﺩﻭﺍﺌﻰ‬ ‫‪١‬‬
‫‪٩.٧٢‬‬ ‫‪١٥‬‬ ‫ﻷﻥ ﻅﺭﻭﻑ ﺍﻟﻌﻤل ﻻ ﺘﺴﻤﺢ ﺒﺫﻟﻙ‬ ‫‪٢‬‬
‫‪٢٧.٥٩‬‬ ‫‪٨‬‬ ‫ﻟﻌﺩﻡ ﻤﻌﺭﻓﺘﻬﻡ ﺒﺎﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‬ ‫‪٣‬‬
‫‪٢٠.٦٩‬‬ ‫‪٦‬‬ ‫ﻻﻋﺘﻘﺎﺩﻫﻡ ﺒﺄﻥ ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﻏﻴﺭ ﻤﺅﻫﻠﻴﻥ‬ ‫‪٤‬‬
‫‪٣.٤٥‬‬ ‫‪١‬‬ ‫ﺃﺨﺭﻯ‬ ‫‪٥‬‬

‫ﻭﺭﺒﻤﺎ ﻴﻜﻭﻥ ﺘﻔﻀﻴل ﺍﻷﻁﺒـﺎﺀ ﻟﻠﻌـﻼﺝ ﺍﻟـﺩﻭﺍﺌﻰ ﻤﻨﺴـﺠﻤﹰﺎ ﻤـﻊ ﺘﺨﺼﺼـﻬﻡ ﻭﻁﺭﻴﻘـﺔ‬
‫ﺇﻋﺩﺍﺩﻫﻡ ﻭﺍﻟﺭﻏﺒﺔ ﻓﻰ ﺘﺤﻘﻴﻕ ﺘﺤﺴﻥ ﺃﺴﺭﻉ ﺨﺎﺼـﺔ ﻓـﻰ ﺍﻟﺤـﺎﻻﺕ ﺍﻟﺤـﺎﺩﺓ ﻭﺍﻟﺸـﺩﻴﺩﺓ ‪ ،‬ﻭﻟﻜـﻥ‬
‫ﺍﻟﻤﺴﺘﻘﺭ ﺍﻵﻥ ﺃﻨﻪ ﺒﺭﻏﻡ ﻓﻌﺎﻟﻴﺔ ﺍﻟﻌﻼﺠﺎﺕ ﺍﻟﺩﻭﺍﺌﻴﺔ ﻓﺈﻥ ﺍﻟﺤﺎﺠﺔ ﺇﻟﻰ ﻋـﻼﺝ ﻨﻔﺴـﻰ ﻟﻠﺘﻌﺎﻤـل ﻤـﻊ‬
‫ﺍﻷﻋﺭﺍﺽ ﺍﻟﻤﻭﺠﺒﺔ ﻭﺍﻟﺴﺎﻟﺒﺔ ﺍﻟﻤﺴﺘﻤﺭﺓ ﻭﺍﻟﻤﺯﻤﻨـﺔ ‪ ،‬ﻭﺍﻷﻋﻁـﺎﺏ ﺍﻟﻤﻌﺭﻓﻴـﺔ ﺍﻟﻤﺘﺒﻘﻴـﺔ ﻭﺍﻟﻜـﺭﺏ‬
‫ﺍﻟﻤﺭﺘﺒﻁ ﺒﺎﻟﻬﻼﻭﺱ ﻭﺍﻟﻬﺫﺍﺀﺍﺕ ﺘﺒﺩﻭ ﻤﺘﺯﺍﻴﺩﺓ‪.‬‬

‫‪(Zimmermann , et al. , 2005 , George et al . , 2005 , Penades et al. ,‬‬

‫)‪2006 ; Dickerson , 2000‬‬

‫ﺃﻤﺎ ﺒﻘﻴﺔ ﺍﻷﺴﺒﺎﺏ ﻓﻴﻤﻜﻥ ﺘﻔﻬﻤﻬﺎ ﻭﺍﻟﻌﻤل ﻋﻠﻰ ﺇﺯﺍﻟﺘﻬﺎ ‪ ،‬ﻓـﻰ ﻀـﻭﺀ ﻤـﺎ ﻨﻼﺤﻅـﻪ ﻤـﻥ‬
‫ﺘﻐﻴﺭ ﻓﻰ ﻤﻭﻗﻑ ﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴﻴﻴﻥ ﺘﺠﺎﻩ ﻤﻬﻨﺔ ﺍﻷﺨﺼﺎﺌﻰ ﺍﻟﻨﻔﺴﻰ ﺒـل ﻭﺴـﻌﻴﻬﻡ ﺇﻟـﻰ ﺍﺴـﺘﻘﻁﺎﺏ‬
‫ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﺤﺎﺼﻠﻴﻥ ﻋﻠﻰ ﺩﺭﺍﺴﺎﺕ ﻋﻠﻴﺎ )ﻜﺩﺒﻠﻭﻡ ﻋﻠﻡ ﺍﻟـﻨﻔﺱ ﺍﻟﺘﻁﺒﻴﻘـﻰ( ﻟﻠﻌﻤـل ﻤﻌﻬـﻡ ﻓـﻰ‬
‫ﻤﺭﺍﻜﺯﻫﻡ ﻭﻋﻴـﺎﺩﺍﺘﻬﻡ ﺍﻟﺨﺎﺼـﺔ ‪ ،‬ﻤـﻥ ﻫﻨـﺎ ﻓـﺈﻥ ﺍﻟﻤﺸـﻜﻠﺔ ﺍﻷﺴﺎﺴـﻴﺔ ﺘﻜﻤـﻥ ﻓـﻰ ﺭﻏﺒـﺔ‬
‫ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﻭﺩﺍﻓﻌﻴﺘﻬﻡ ﻟﻠﺘﺩﺭﻴﺏ ﻋﻠﻰ ﻫﺫﺍ ﺍﻟﻨﻭﻉ ﻤﻥ ﺍﻟﻌﻼﺝ ﻭﻤﻤﺎﺭﺴﺘﻪ‪.‬‬

‫‪٢٩‬‬
‫ﻭﻓﻰ ﺍﻟﻘﺴﻡ ﺍﻟﺜﺎﻟﺙ ﻭﺍﻷﺨﻴﺭ ﻤﻥ ﺍﺴﺘﻤﺎﺭﺓ ﺍﻻﺴـﺘﺒﻴﺎﻥ ﺩﺍﺭﺕ ﺍﻷﺴـﺌﻠﺔ ﺤـﻭل ﻤـﺩﻯ ﺘﺄﻫﻴـل‬
‫ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ﻭﻤﻤﺎﺭﺴﺘﻬﻡ ﻟﻠﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻤـﻊ ﻤﺭﻀـﻰ ﺍﻟﻔﺼـﺎﻡ ‪ ،‬ﺤﻴـﺙ‬
‫ﺃﺠﺎﺏ ‪ (%٥.٨٨) ٣‬ﺒﺎﻹﻴﺠﺎﺏ‪ ،‬ﺒﻴﻨﻤﺎ ﻨﻔﻰ ﺫﻟﻙ ‪ ٤٨‬ﺃﺨﺼﺎﺌﻴﹰﺎ )‪.(%٩٤.١٢‬‬

‫ﻭﻗﺩ ﺘﺭﺍﻭﺡ ﻋﺩﺩ ﺍﻟﺩﻭﺭﺍﺕ ﺍﻟﺘﺩﺭﻴﺒﻴﺔ ﺍﻟﺘﻰ ﺤﺼل ﻋﻠﻴﻬـﺎ ﻫـﺅﻻﺀ ﻤـﻥ ﺩﻭﺭﺓ ﻭﺍﺤـﺩﺓ ﺇﻟـﻰ‬
‫ﺜﻼﺙ ﺩﻭﺭﺍﺕ ‪ ،‬ﻭﺘﺭﺍﻭﺤﺕ ﻤﺩﺓ ﻫﺫﻩ ﺍﻟﺩﻭﺭﺓ ﺒـﻴﻥ ﺃﺴـﺒﻭﻉ ﻭﺃﺴـﺒﻭﻋﻴﻥ ‪ ،‬ﺒﻴﻨﻤـﺎ ﺤﺎﻟـﺔ ﻭﺍﺤـﺩﺓ‬
‫ﺤﺼﻠﺕ ﻋﻠﻰ ﻫﺫﺍ ﺍﻟﺘﺩﺭﻴﺏ ﻀﻤﻥ ﺩﺭﺍﺴﺔ ﻓﻰ ﻟﻨﺩﻥ ﻟﻤﺩﺓ ﺴﺘﺔ ﺸﻬﻭﺭ ‪ ،‬ﻭﻗـﺩ ﺸـﺎﺭﻙ ﻓـﻰ ﺘﻘـﺩﻴﻡ‬
‫ﻫﺫﺍ ﺍﻟﺘﺩﺭﻴﺏ ﺃﺴﺎﺘﺫﺓ ﻋﻠﻡ ﺍﻟﻨﻔﺱ ﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴﻴﻭﻥ ‪ ،‬ﻭﻗﺩ ﺍﻋﺘﺒـﺭﺕ ﻏﺎﻟﺒﻴـﺔ ﺍﻟﻌﻴﻨـﺔ ﺃﻨﻬـﻡ ﻏﻴـﺭ‬
‫ﻤﺅﻫﻠﻴﻥ ﺃﺴﺎﺴﹰﺎ ﻟﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻤـﻊ ﻤﺭﻀـﻰ ﺍﻟﻔﺼـﺎﻡ ﻭﺃﻨﻬـﻡ ﺒﺤﺎﺠـﺔ‬
‫ﻤﺎﺴﺔ ﺇﻟﻰ ﻤﺜل ﻫﺫﺍ ﺍﻟﺘﺩﺭﻴﺏ ﻭﻋﻠﻠﻭﺍ ﺫﻟﻙ ﺒﺄﻨﻪ ﻏﺎﻟﺒﻴﺔ ﺍﻟﻤﺭﻀـﻰ ﺍﻟـﺫﻴﻥ ﻴﺘﻌـﺎﻤﻠﻭﻥ ﻤﻌﻬـﻡ ﻤـﻥ‬
‫ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ )‪ (%٣٣.٣٣‬ﻭﺍﻟﺘﻌـﺭﻑ ﻋﻠـﻰ ﺃﺴـﺎﻟﻴﺏ ﺠﺩﻴـﺩﺓ )‪ (%٢٣.٥٣‬ﻭﻋـﺩﻡ ﻜﻔﺎﻴـﺔ‬
‫ﺍﻟﺘﺩﺭﻴﺏ ﺍﻟﺴﺎﺒﻕ )‪ (%١٧.٦٥‬ﺃﺴﺒﺎﺏ ﺃﺨﺭﻯ )‪.(%١.٩٦‬‬

‫ﺃﻤﺎ ﺍﻟﺫﻴﻥ ﺃﺠﺎﺒﻭﺍ ﺒﻼ ﻓﻘﺩ ﺒﺭﺭﻭﺍ ﺫﻟﻙ ﺒﻌﺩﻡ ﺘﻭﺍﻓﺭ ﺍﻟﺨﺒـﺭﺓ ﻓـﻰ ﻫـﺫﺍ ﺍﻟﻤﺠـﺎل ‪ ،‬ﻭﻷﻨﻬـﻡ‬
‫ﻻ ﻴﺘﻌﺎﻤﻠﻭﻥ ﻤﻊ ﺤﺎﻻﺕ ﺍﻟﻔﺼﺎﻡ )ﺍﻟﺫﻴﻥ ﻴﻌﻤﻠﻭﻥ ﻓـﻰ ﺃﻗﺴـﺎﻡ ﺍﻷﻁﻔـﺎل ﻋﻠـﻰ ﺴـﺒﻴل ﺍﻟﻤﺜـﺎل( ‪،‬‬
‫ﻭﻗﺩ ﺃﺠـﺎﺏ ﺨﻤﺴـﺔ ﺃﺨﺼـﺎﺌﻴﻴﻥ )‪ (%٩.٨٠‬ﻋـﻥ ﺴـﺅﺍل ﻴﺘﻌﻠـﻕ ﺒﻤـﺩﻯ ﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻤﻊ ﻤﺭﻀـﻰ ﺍﻟﻔﺼـﺎﻡ ﻓـﻰ ﺍﻟﻭﻗـﺕ ﺍﻟـﺭﺍﻫﻥ ﺒﺎﻹﻴﺠـﺎﺏ ‪ ،‬ﻭﺘـﺭﺍﻭﺡ ﻋـﺩﺩ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﺘﻰ ﺘﻡ ﺍﻟﺘﻁﺒﻴﻕ ﻋﻠﻴﻬﺎ ﺒﻴﻥ ﺜﻼﺙ ﻭﺨﻤﺱ ﺤـﺎﻻﺕ ‪ ،‬ﺍﺴـﺘﺨﺩﻤﺕ ﻤﻌﻬـﺎ ﺃﺴـﺎﻟﻴﺏ ﻤـﻥ‬
‫ﻗﺒﻴل ﺘﻐﻴﻴﺭ ﻤﻔﻬﻭﻡ ﺍﻟﺫﺍﺕ ‪ ،‬ﻭﺘﺄﻜﻴﺩ ﺍﻟـﺫﺍﺕ ‪ ،‬ﻭﺍﻟﺘـﺩﺭﻴﺏ ﻋﻠـﻰ ﺍﻟﺘﻭﺍﺼـل ‪ ،‬ﻭﺍﻟﺘـﺩﻋﻴﻡ ﻭﺘﻌـﺩﻴل‬
‫ﻨﻤﻁ ﺍﻟﺘﻔﻜﻴﺭ ‪ ،‬ﻭﺘﺸﺘﻴﺕ ﺍﻻﻨﺘﺒﺎﻩ‪.‬‬

‫ﺃﻤﺎ ﺍﻟﺫﻴﻥ ﻻ ﻴﻤﺎﺭﺴﻭﻥ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻤـﻊ ﻤﺭﻀـﻰ ﺍﻟﻔﺼـﺎﻡ ﻓﻘـﺩ ﺃﺭﺠﻌـﻭﺍ‬
‫ﺫﻟﻙ ﻟﻸﺴﺒﺎﺏ ﺍﻟﺘﺎﻟﻴﺔ ‪:‬‬

‫‪٣٠‬‬
 ‫ﺠﺩﻭل )‪(٥‬‬

‫ﻤﻌﻭﻗﺎﺕ ﺘﻁﺒﻴﻕ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻋﻠﻰ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ‬

‫‪%‬‬ ‫ﻙ‬ ‫ﺍﻟﻤﻌﻭﻗﺎﺕ‬ ‫ﻡ‬

‫‪٧١.٧٤‬‬ ‫‪٣٣‬‬ ‫ﻷﻥ ﺘﺄﻫﻴﻠﻰ ﻟﻴﺱ ﻜﺎﻓﻴﹰﺎ‬ ‫‪١‬‬
‫‪٣٩.١٣‬‬ ‫‪١٨‬‬ ‫ﺍﻷﻁﺒﺎﺀ ﻻ ﻴﺤﻭﻟﻭﻥ ﺍﻟﺤﺎﻻﺕ‬ ‫‪٢‬‬
‫‪٢٣.٩١‬‬ ‫‪١١‬‬ ‫ﺍﻟﻌﻼﺝ ﺍﻟﺩﻭﺍﺌﻰ ﺃﻓﻀل‬ ‫‪٣‬‬
‫‪١٣.٠٤‬‬ ‫‪٦‬‬ ‫ﺍﻟﻅﺭﻭﻑ ﻓﻰ ﻤﺼﺭ ﻻ ﺘﺴﺎﻋﺩ ﻋﻠﻰ ﻤﻤﺎﺭﺴﺔ ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ‬ ‫‪٤‬‬
‫‪٦.٥٢‬‬ ‫‪٣‬‬ ‫ﻷﻥ ﺍﻷﻁﺒﺎﺀ ﻴﻌﺘﺭﻀﻭﻥ ﻋﻠﻰ ﺫﻟﻙ‬ ‫‪٥‬‬
‫‪٦.٥٢‬‬ ‫‪٣‬‬ ‫ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﻻ ﻴﺼﻠﺢ ﻟﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ‬ ‫‪٦‬‬
‫‪٢٣.٩١‬‬ ‫‪١١‬‬ ‫‪ ١٦‬ﻏﻴﺭ ﻤﺒﻴﻥ‬

‫ﺭﺒﻤﺎ ﻴﺒﺩﻭ ﺍﻟﻤﻭﻗﻑ ﻓﻴﻤﺎ ﻴﺘﻌﻠـﻕ ﺒﻤﻤﺎﺭﺴـﺔ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﻟﻠﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ‬
‫ﺍﻟﺴﻠﻭﻜﻰ ﻤﻊ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ﻤﻨﻁﻘﻴﹰﺎ ﺇﻟﻰ ﺤـﺩ ﻜﺒﻴـﺭ ﻭﺫﻟـﻙ ﻨﻅـﺭﹰﺍ ﻟﺤﺩﺍﺜـﺔ ﺍﻟﺩﺭﺍﺴـﺎﺕ ﺍﻟﺘـﻰ‬
‫ﺤﺎﻭﻟﺕ ﺘﻘﻴﻴﻡ ﻓﻌﺎﻟﻴﺔ ﺍﻷﺴﺎﻟﻴﺏ ﺍﻟﻤﻌﺭﻓﻴﺔ ﺍﻟﺴﻠﻭﻜﻴﺔ ﻤـﻊ ﻤﺭﻀـﻰ ﺍﻟﻔﺼـﺎﻡ ‪ ،‬ﺤﻴـﺙ ﻅـل ﺍﻷﻤـﺭ‬
‫ﻓﻰ ﺍﻟﺒﺩﺍﻴﺔ ﻗﺎﺼﺭﹰﺍ ﻋﻠﻰ ﻤﺭﻀﻰ ﺍﻻﻜﺘﺌـﺎﺏ ﺜـﻡ ﺒـﺩﺃ ﻴﻤﺘـﺩ ﻟﻴﺸـﻤل ﺃﻤﺭﺍﻀـﹰﺎ ﺃﺨـﺭﻯ ﻜـﺎﻟﻘﻠﻕ‬

‫‪٣١‬‬
‫ﻭﺍﻟﻤﺨﺎﻭﻑ ﻭﺍﻟﻭﺴﻭﺍﺱ ﺍﻟﻘﻬﺭﻯ ﻭﺍﻻﻋﺘﻤﺎﺩ ﻋﻠﻰ ﺍﻟﻤﻭﺍﺩ ﺍﻟﻨﻔﺴـﻴﺔ ‪ ،‬ﻭﺭﺒﻤـﺎ ﻴﺭﺠـﻊ ﺫﻟـﻙ ﺠﺯﺌﻴـﹰﺎ‬
‫ﺇﻟﻰ ﺃﻥ ﺍﻟﺘﻌﺎﻤل ﻤﻊ ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ﻴﺘﺴﻡ ﺒﺎﻟﺼـﻌﻭﺒﺔ ﺨﺎﺼـﺔ ﻓـﻰ ﺍﻟﻁـﻭﺭ ﺍﻟﺤـﺎﺩ ‪ ،‬ﻭﻨﻅـﺭﹰﺍ‬
‫ﻷﻥ ﻏﺎﻟﺒﻴﺔ ﺍﻟﻤﺭﻀﻰ ﻴﻜﻭﻨﻭﺍ ﻓﺎﻗﺩﻯ ﺍﻻﺴﺘﺒﺼـﺎﺭ ﻭﻫـﻭ ﺃﺤـﺩ ﺃﻫـﻡ ﺸـﺭﻭﻁ ﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ‪ ،‬ﻭﻤﻥ ﺜﻡ ﻓﻌـﺎﺩﺓ ﻤـﺎ ﻴﺘـﺄﺨﺭ ﺤﺘـﻰ ﺘﺘﺤﺴـﻥ ﺍﻟﺤـﺎﻻﺕ ﻨﺴـﺒﻴﹰﺎ ﻭﺘﺴـﺘﻘﺭ ‪،‬‬
‫ﻴﻀﺎﻑ ﺇﻟﻰ ﺫﻟﻙ ﺃﻨﻪ ﺭﻏـﻡ ﺍﻟﻨﺘـﺎﺌﺞ ﺍﻟﻤﺒﺸـﺭﺓ ﻻﺴـﺘﺨﺩﺍﻡ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻤـﻊ‬
‫ﻤﺭﻀﻰ ﺍﻟﻔﺼﺎﻡ ‪ ،‬ﻓﺈﻨﻪ ﻤﺎ ﻴﺯﺍل ﻫﻨﺎﻙ ﺒﻌـﺽ ﺍﻟﺠـﺩل ﺤـﻭل ﺍﺴـﺘﺨﺩﺍﻤﻪ ) ‪Dickerson 2000‬‬
‫‪.(; Kingdon & Hansen , 2004‬‬

‫ﻭﺭﺒﻤﺎ ﻜﺎﻥ ﺍﻟﻤﻭﻗـﻑ ﺒﺎﻟﻨﺴـﺒﺔ ﻻﺴـﺘﺨﺩﺍﻡ ﺍﻟﻌـﻼﺝ ﺍﻟﻤﻌﺭﻓـﻰ ﺍﻟﺴـﻠﻭﻜﻰ ﻤـﻊ ﻤﺭﻀـﻰ‬
‫ﺍﻟﻔﺼﺎﻡ ﻓﻰ ﻀﻭﺀ ﻨﺘﺎﺌﺞ ﺍﻟﺩﺭﺍﺴﺎﺕ ﺍﻟﻤﺘﺎﺤﺔ ﺩﺍﻋﻴﹰﺎ ﻟﻠﻤﺯﻴﺩ ﻤـﻥ ﺍﻟـﺩﻋﻡ ﻟﻼﺴـﺘﻔﺎﺩﺓ ﻤـﻥ ﻤـﻭﺍﻁﻥ‬
‫ﻗﻭﺓ ﻫﺫﺍ ﺍﻷﺴﻠﻭﺏ ﻓﻰ ﺘﺤﺴـﻥ ﺒﻌـﺽ ﺠﻭﺍﻨـﺏ ﺍﻟﻘﺼـﻭﺭ ﻟـﺩﻯ ﺍﻟﻤﺭﻀـﻰ ﻜﺎﻟﺘـﺩﺭﻴﺏ ﻋﻠـﻰ‬
‫ﺍﻟﺘﻭﺍﺼل ‪ ،‬ﻭﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﺍﻟﻤﻬﺎﺭﺍﺕ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﺘﻘﻠﻴل ﻤـﻥ ﺍﻟﻬـﻼﻭﺱ ﻭﺍﻟﻬـﺫﺍﺀﺍﺕ ‪ ،‬ﻭﻫـﻭ‬
‫ﻤﺎ ﻴﻤﻜﻥ ﻟﻸﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴﻴﻴﻥ ‪ -‬ﺇﺫﺍ ﺘﻡ ﺘﺄﻫﻴﻠﻬﻡ ‪ -‬ﻤﻥ ﺍﻹﺴﻬﺎﻡ ﻓﻴﻪ‪.‬‬

‫اﻟﺘﻮﺻﻴـــﺎت‪:‬‬
‫‪ -١‬ﺍﻟﻌﻨﺎﻴﺔ ﺒﺘﺄﻫﻴل ﺍﻷﺨﺼﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﺍﻹﻜﻠﻴﻨﻴﻜﻴـﻴﻥ ﻓـﻰ ﻤﺠـﺎل ﺍﻟﻌـﻼﺝ ﺍﻟﻨﻔﺴـﻰ ﺒﺼـﻔﺔ‬
‫ﻋﺎﻤﺔ ﻭﻓﻰ ﻤﺠﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﺒﺼﻔﺔ ﺨﺎﺼﺔ ﺒﺎﻋﺘﺒـﺎﺭﻩ ﻤـﻥ ﺍﻷﺴـﺎﻟﻴﺏ ﺍﻟﺘـﻰ‬
‫ﺘﺄﻜﺩﺕ ﻓﺎﺌﺩﺘﻬﺎ ﻤﻊ ﻋﺩﺩ ﻜﺒﺭ ﻤﻥ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻨﻔﺴﻴﺔ‪.‬‬

‫‪ -٢‬ﺍﻻﻫﺘﻤﺎﻡ ﺒﺘﺩﺭﻴﺏ ﺍﻷﺨﺼـﺎﺌﻴﻴﻥ ﺍﻟﻨﻔﺴـﻴﻴﻥ ﻟﺘﻭﺠﻴـﻪ ﻤﺯﻴـﺩ ﻤـﻥ ﺍﻻﻫﺘﻤـﺎﻡ ﻨﺤـﻭ ﻤﺭﻀـﻰ‬
‫ﺍﻟﻔﺼﺎﻡ ﺒﺎﻋﺘﺒﺎﺭﻫﻡ ﻴﺸﻜﻠﻭﻥ ﺍﻟﻐﺎﻟﺒﻴﺔ ﺍﻟﻌﻅﻤﻰ ﻤﻥ ﻨﺯﻻﺀ ﻤﺴﺘﺸﻔﻴﺎﺕ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻨﻔﺴﻴﺔ‪.‬‬

‫‪٣٢‬‬
‫‪ -٣‬ﺍﻹﺴﺭﺍﻉ ﻓﻰ ﺇﻨﺸﺎﺀ ﻤﺭﺍﻜﺯ ﻤﺘﺨﺼﺼﺔ ﺘﺘﻴﺢ ﺍﻟﺘﺩﺭﻴﺏ ﻋﻠﻰ ﺍﻟﻌـﻼﺝ ﺍﻟﻨﻔﺴـﻰ ﺒﺼـﻔﺔ ﻋﺎﻤـﺔ‬
‫ﻭﺍﻟﻌﻼﺝ ﺍﻟﻤﻌﺭﻓﻰ ﺍﻟﺴﻠﻭﻜﻰ ﺒﺼـﻔﺔ ﺨﺎﺼـﺔ ﺒﺎﻋﺘﺒـﺎﺭﻩ ﻤـﻥ ﺍﻷﺴـﺎﻟﻴﺏ ﺍﻟﺤﺩﻴﺜـﺔ ﻭﺍﻟﺘـﻰ‬
‫ﺘﻨﺎﺴﺏ ﻁﺒﻴﻌﺔ ﺍﻟﻌﺼﺭ ﻭﻨﻭﻋﻴﺔ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻨﻔﺴﻴﺔ ﺍﻷﻜﺜﺭ ﺍﻨﺘﺸﺎﺭﹰﺍ‪.‬‬

‫‪ -٤‬ﺇﻴﺠﺎﺩ ﺤﻠﻭل ﻋﻤﻠﻴﺔ ﻟﻤﺸـﻜﻠﺔ ﺍﻟﺘﻜـﺎﻟﻴﻑ ﺍﻟﻤﺎﺩﻴـﺔ ﺍﻟﻤﻁﻠﻭﺒـﺔ ﻟﻠﺘﺄﻫﻴـل ﻓـﻰ ﻤﺠـﺎل ﺍﻟﻌـﻼﺝ‬
‫ﺍﻟﻨﻔﺴﻰ ‪ ،‬ﺒﺘﻘﺩﻴﻡ ﺍﻟﻤﻨﺢ ﺃﻭ ﺍﺒﺘﻜﺎﺭ ﻨﻅﺎﻡ ﻟﻠﺘﻘﺴﻴﻁ ‪ ،‬ﺃﻭ ﺇﻴﺠﺎﺩ ﺤـﻭﺍﻓﺯ ﻟﻠﻤﺘﻔـﻭﻗﻴﻥ ﺘﺘﻤﺜـل ﻓـﻰ‬
‫ﺘﻘﺩﻴﻡ ﺍﻟﺘـﺩﺭﻴﺏ ﻤﺠﺎﻨـﹰﺎ ﻟﻬـﻡ ‪ ،‬ﻭﻜـﺫﻟﻙ ﺍﻻﺴـﺘﻌﺎﻨﺔ ﺒﺄﺼـﺤﺎﺏ ﺍﻟﻤﺴﺘﺸـﻔﻴﺎﺕ ﻭﺍﻟﻤﺭﺍﻜـﺯ‬
‫ﺍﻟﺨﺎﺼﺔ ﻟﺩﻋﻡ ﻋﻤﻠﻴﺎﺕ ﺍﻟﺘﺩﺭﻴﺏ ﻭﺘﻤﻭﻴﻠﻬﺎ‪.‬‬

‫‪ -٥‬ﺘﻘﺩﻴﻡ ﺤﻭﺍﻓﺯ ﻤﺎﺩﻴﺔ ﻭﻭﻅﻴﻔﻴﺔ ﻟﻸﺨﺼﺎﺌﻴﻴﻥ ﺍﻟـﺫﻴﻥ ﻴﺤﺼـﻠﻭﻥ ﻋﻠـﻰ ﺘـﺩﺭﻴﺏ ﻤﻨﺎﺴـﺏ ﻓـﻰ‬
‫ﻤﺠﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ ﻟﺘﺸﺠﻴﻊ ﺍﻟﻤﺯﻴﺩ ﻤـﻨﻬﻡ ﻋﻠـﻰ ﺍﻟﺴـﻌﻰ ﻨﺤـﻭ ﺍﻟﺤﺼـﻭل ﻋﻠـﻰ ﻫـﺫﺍ‬
‫ﺍﻟﺘﺩﺭﻴﺏ‪.‬‬

‫‪ -٦‬ﺍﻟﻌﻤل ﻋﻠﻰ ﺘﻭﺜﻴﻕ ﺍﻟﺘﻌﺎﻭﻥ ﺒﻴﻥ ﺃﻗﺴﺎﻡ ﺍﻟﻁﺏ ﺍﻟﻨﻔﺴﻰ ﺒﻜﻠﻴـﺎﺕ ﺍﻟﻁـﺏ ﻭﺃﻗﺴـﺎﻡ ﻋﻠـﻡ ﺍﻟـﻨﻔﺱ‬
‫ﺒﻜﻠﻴﺎﺕ ﺍﻵﺩﺍﺏ ﻤﻥ ﺃﺠل ﺇﻴﺠﺎﺩ ﻨﻭﻉ ﻤـﻥ ﺍﻟﺘـﺩﺭﻴﺏ ﺍﻟﻤﺘﻜﺎﻤـل ﺍﻟـﺫﻯ ﻴﻘـﺩﻡ ﻟﻸﺨﺼـﺎﺌﻴﻴﻥ‬
‫ﺍﻟﻨﻔﺴﻴﻴﻥ ﻭﺍﻷﻁﺒﺎﺀ ﺍﻟﻨﻔﺴﻴﻴﻥ ﻓﻰ ﻤﺠﺎل ﺍﻟﻌﻼﺝ ﺍﻟﻨﻔﺴﻰ‪.‬‬

‫‪ -٧‬ﺇﻨﺸﺎﺀ ﻗﺎﻋﺩﺓ ﺒﻴﺎﻨﺎﺕ ﺘﻜﻭﻥ ﻤﺘﺎﺤﺔ ﻟﻠﺠﻤﻴﻊ ﺘﺤﺘﻭﻯ ﻋﻠـﻰ ﻤﻌﻠﻭﻤـﺎﺕ ﻋـﻥ ﺃﻤـﺎﻜﻥ ﺍﻟﺘـﺩﺭﻴﺏ‬
‫ﻭﻤﻭﺍﻋﻴﺩ ﺍﻟﺩﻭﺭﺍﺕ ﺍﻟﺘﺩﺭﻴﺒﻴﺔ ‪ ،‬ﻤﻊ ﺇﺤـﺩﺍﺙ ﻨـﻭﻉ ﻤـﻥ ﺍﻟﺘﻨﺴـﻴﻕ ﺒـﻴﻥ ﺍﻟﺠﻬـﺎﺕ ﺍﻟﻘﺎﺌﻤـﺔ‬
‫ﺒﺎﻟﺘﺩﺭﻴﺏ ﻟﻼﺴﺘﻔﺎﺩﺓ ﺍﻟﻤﺘﺒﺎﺩﻟﺔ ﻤﻥ ﺍﻟﺨﺒﺭﺍﺕ ﻭﺍﻟﺴﻌﻰ ﻨﺤﻭ ﻤﺯﻴﺩ ﻤﻥ ﺍﻟﺘﺨﺼﺹ‪.‬‬

‫‪٣٣‬‬
 ‫ﺃﻭ ﹰﻻ ‪ :‬ﺍﻟﻤﺭﺍﺠﻊ ﺍﻟﻌﺭﺒﻴﺔ‪:‬‬

‫‪ -١‬ﺃﺤﻤﺩ ﻋﻜﺎﺸﺔ ‪ ، (١٩٩٨) ،‬ﺍﻟﻁﺏ ﺍﻟﻨﻔﺴﻰ ﺍﻟﻤﻌﺎﺼﺭ ‪ ،‬ﺍﻟﻘﺎﻫﺭﺓ ‪ :‬ﺍﻷﻨﺠﻠﻭ ﺍﻟﻤﺼﺭﻴﺔ‪.‬‬

‫‪ -٢‬ﺒﺭﺍﻭﻥ ‪ ،‬ﺕ‪ .‬ﺃ ؛ ﺃﻭﻟﻴﺭﻯ ‪ ،‬ﺕ‪ .‬ﺃ ؛ ﺒﺎﺭﻟﻭ ‪ ،‬ﺩ‪ .‬ﻫــ )‪ ، (٢٠٠٢‬ﺍﻀـﻁﺭﺍﺏ ﺍﻟﻘﻠـﻕ ﺍﻟﻌـﺎﻡ‬
‫‪ ،‬ﺘﺭﺠﻤﺔ ﻤﺤﻤﺩ ﻨﺠﻴﺏ ﺍﻟﺼﺒﻭﺓ ﻓـﻰ ‪ :‬ﺩﻴﻔﻴـﺩ ﺒـﺎﺭﻟﻭ )ﻤﺤـﺭﺭ( ﻤﺭﺠـﻊ ﺇﻜﻠﻴﻨﻴﻜـﻰ ﻓـﻰ‬
‫ﺍﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴﻴﺔ ‪ :‬ﺩﻟﻴل ﻋﻼﺠـﻰ ﺘﻔﺼـﻴﻠﻰ ‪ ،‬ﺍﻟﻘـﺎﻫﺭﺓ ‪ :‬ﺍﻷﻨﺠﻠـﻭ ﺍﻟﻤﺼـﺭﻴﺔ ‪ ،‬ﺹ‬
‫ﺹ ‪.٤٦٨ – ٣٣٥‬‬

‫‪ -٣‬ﻟﻴﻬﻰ ‪ ،‬ﺭﻭﺒﺭﺕ )‪ ، (٢٠٠٦‬ﺩﻟﻴل ﻋﻤﻠﻰ ﺘﻔﺼـﻴﻠﻰ ﻟﻤﻤﺎﺭﺴـﺔ ﺍﻟﻌـﻼﺝ ﺍﻟﻨﻔﺴـﻰ ﺍﻟﻤﻌﺭﻓـﻰ‬

‫ﻓﻰ ﺍﻻﻀﻁﺭﺍﺒﺎﺕ ﺍﻟﻨﻔﺴﻴﺔ )ﻤﺤﺭﺭ( ‪ ،‬ﺘﺭﺠﻤـﺔ ‪ ،‬ﺠﻤﻌـﺔ ﺴـﻴﺩ ﻴﻭﺴـﻑ ‪ ،‬ﻤﺤﻤـﺩ ﻨﺠﻴـﺏ‬
‫ﺍﻟﺼﺒﻭﺓ ‪ ،‬ﺍﻟﻘﺎﻫﺭﺓ‪ :‬ﺩﺍﺭ ﺇﻴﺘﺭﺍﻙ ﻟﻠﻁﺒﺎﻋﺔ ﻭﺍﻟﻨﺸﺭ ﻭﺍﻟﺘﻭﺯﻴﻊ‪.‬‬

‫ـﺭﻴﺔ‬
‫ـﺩﺍﺭ ﺍﻟﻤﺼـ‬
‫ـﺎﻫﺭﺓ ‪ :‬ﺍﻟـ‬
‫ـﺎﺩﻯ ‪ ،‬ﺍﻟﻘـ‬
‫ـﻰ ﺍﻟﻌﻴـ‬
‫ـﻡ ﺍﻟﻨﻔﺴـ‬
‫ـﻭﻴﻑ )‪ ، (٢٠٠١‬ﻋﻠـ‬
‫ـﻁﻔﻰ ﺴـ‬
‫‪ -٤‬ﻤﺼـ‬
‫ﺍﻟﻠﺒﻨﺎﻨﻴﺔ‪.‬‬

‫ـﻭﺙ‬
‫ـﺭ ‪ :‬ﺒﺤـ‬
‫ـﻰ ﻤﺼـ‬
‫ـﺒﺎﺏ ﻓـ‬
‫ـﺩﺭﺍﺕ ﻭﺍﻟﺸـ‬
‫ـﺭﻭﻥ )‪ ، (١٩٨٧‬ﺍﻟﻤﺨـ‬
‫ـﻭﻴﻑ ﻭﺁﺨـ‬
‫ـﻁﻔﻰ ﺴـ‬
‫‪ -٥‬ﻤﺼـ‬
‫ﻤﻴﺩﺍﻨﻴﺔ ﻓﻰ ﻤﺩﻯ ﺍﻨﺘﺸﺎﺭ ﺍﻟﻤﻭﺍﺩ ﺍﻟﻤﺅﺜﺭﺓ ﻓﻰ ﺍﻟﺤﺎﻟـﺔ ﺍﻟﻨﻔﺴـﻴﺔ ﺩﺍﺨـل ﻗﻁـﺎﻉ ﺍﻟﻁـﻼﺏ ‪،‬‬
‫ﺍﻟﻘﺎﻫﺭﺓ ‪ :‬ﺍﻟﻤﺭﻜﺯ ﺍﻟﻘﻭﻤﻰ ﻟﻠﺒﺤﻭﺙ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﺠﻨﺎﺌﻴﺔ‪.‬‬

‫‪ -٦‬ﻨﺎﺼﺭ ﺍﻟﻤﺤﺎﺭﺏ )‪ ، (٢٠٠٠‬ﺍﻟﻤﺭﺸـﺩ ﻓـﻰ ﺍﻟﻌـﻼﺝ ﺍﻻﺴـﺘﻌﺭﺍﻓﻰ ﺍﻟﺴـﻠﻭﻜﻰ ‪ ،‬ﺍﻟﺭﻴـﺎﺽ ‪:‬‬

‫ﺩﺍﺭ ﺍﻟﺯﻫﺭﺍﺀ‪.‬‬

‫‪ -٧‬ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴـﺔ )‪ ، (١٩٨٥‬ﺩﻭﺭ ﺍﻷﺨﺼـﺎﺌﻰ ﺍﻟﻨﻔﺴـﻰ ﺍﻹﻜﻠﻴﻨﻴﻜـﻰ ﻓـﻰ ﻤﺅﺴﺴـﺎﺕ‬

‫ﺍﻟﺼﺤﺔ ﺍﻟﻨﻔﺴﻴﺔ ‪ ،‬ﺘﺭﺠﻤﺔ ‪ ،‬ﺯﻴﻥ ﺍﻟﻌﺎﺒﺩﻴﻥ ﺩﺭﻭﻴـﺵ ﻓـﻰ ‪ :‬ﻤﺼـﻁﻔﻰ ﺴـﻭﻴﻑ ﻭﺁﺨـﺭﻴﻥ‬

‫‪٣٤‬‬
– ٥١ ‫ ﺩﺍﺭ ﺍﻟﻤﻌـﺎﺭﻑ ﺹ ﺹ‬:‫ ﺍﻟﻘـﺎﻫﺭﺓ‬،‫)ﻤﺤﺭﺭ( ﻤﺭﺠﻊ ﻓﻰ ﻋﻠـﻡ ﺍﻟـﻨﻔﺱ ﺍﻹﻜﻠﻴﻨﻴﻜـﻰ‬
.٦١

:‫ ﺍﻟﻤﺭﺍﺠﻊ ﺍﻷﺠﻨﺒﻴﺔ‬: ‫ﺜﺎﻨﻴ ﹰﺎ‬

8- Chandwick , P.P. , Birchwood , M. & Trower, P. (1996)

Cognitive therapy for delusions , voices, and paranoia , New
York : Wiley.
9- Dickerson , F.B. (2000). Cognitive behavioral psychotherapy for
schizophrenia : a review of recent empirical studies,
Schizophrenia Research ; 43 , 71 , 90.
10- Each , S.M, Hoarty , G.E., Greenwald , D.P., Hogarty, S.S &
Keshavan , M.S. (2007) . Cognitive enhancement therapy
improves emotional intelligence in early course schizophrenia :
Preliminary effects., Schizophrenia Research . , vol. 89, 1 – 3 ,
308 – 311.
11- Fowler , P., Garety , P. & Kuipers , E. (1995) Cognitive
behavior therapy for psychosis : theory and practice , New
York : John Wiley.

٣٥
12- George , S., Bandopadhay , S. & Cowan , C. (2005) A case
report of informal cognitive therapy of delusions by a carer : a
novel treatment paradigm ? European Psychiatry , vol. 20, 11,
80 – 81.
13- Glynn , S.M. (2006). Kingdon and Turkington's cognitive
therapy of schizophrenia , Cognitive and Behavioral Practice ,
vol. 13, 1, 105 – 106.
14- Gould, R, Mueser , K., Bolton , E., Mays , V. & Goff , D. (2001)
. Cognitive therapy for psychosis in schizophrenia : An effect
size analysis , Schizophrenia Research , 84, 2-3, 335 – 342.
15- Kingdon , D. & Hansen , L. (2004) . Cognitive therapy for
psychosis , New York : the medicine publishing company ltd.
16- Kingdon , D. & Turkeington , D. (2004) . Cognitive therapy of
schizophrenia , New York : the Guilford press.
17- Morrison , A. , Renton , J., Dunn , H. , Williams , S. & Bentall,
R. (2004) . Cognitive therapy for psychosis : A formulation –
based approach ., New York : Brunner – Rutledge.
18- Nelson , H. (1997) . Cognitive behavioral therapy with
schizophrenia : A practice manual , cheltenham : Nelson
thorns.

19- Penades , R., Catalan , R., Salamero , M., Boget, T. puig , O.,
Guarch , J. & Gasto , C. (2006) . cognitive remediation therapy
for outpatients with chronic schizophrenia : A controlled and
randomized study, Schizophrenia Research, vol. 87,1-3,323–
331.

٣٦
20- Pilling , S. , Bebbington , P., Kuipers. E., Garety . P., Geddes ,
T., Orbach , G.& Morgan , C. (2002). Psychological treatments
in schizophrenia : 1. Meta – analysis of family intervention and
cognitive behavior therapy , Psychological Medicine , 32, 763
– 782.
21- Pinlham , A.E., Penn , D.I., Perkins , D.O. & Lieberman J.
(2003) Implications for neural basis of social cognition for the
study of schizophrenia , Am . J. Psychiatry , 160 , 815 – 824.
22- Rector N.A, & Beck , A.T. (2001) . Cognitive behavioral
therapy of schizophrenia : an empirical review : J. New. Ment .
Dis, 189 , 278 – 287.
23- Rector, N. A. ; Seeman , M.V. & Segal, Z.V. (2003) Cognitive
therapy for schizophrenia : A Preliminary randomized
controlled trial , Schizophrenia Research , vol. 63 , 1, 1 -11.
24- Stahl , S.M. (1991) . Selecting atypical antipsychotic by
combining clinical experience with guidelines from clinical
trials , J. Clin. Psychiatry , 60 , 31 – 41.
25- Zimmermann , G. , Favrod , J. Trieu , V.H. & Pomini , V. (2005)
. The effect of cognitive behavioral treatment on the positive
symptoms of schizophrenia spectrum disorders : A meta –
analysis , Schizophrenia Research , vol. 77, 1, 1-9.

٣٧