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在首次咨询前20分钟内，完成结构化保密说明、咨询原则传达、半结构化访谈、SCL-90/EPQ施测与简要反馈、四维自杀自伤风险探询，并基于中国常模与临床判断，协同来访者决策是否启动DBT取向咨询，签署知情同意。
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Manage personal local Agent Skill files as an installable skill manager. Proactively and periodically detect reusable user-specific, team-specific, or broadly reusable skill material during or after meaningful sessions; run non-blocking extraction checks; offer candidate skill titles or accept a user-supplied topic when extraction direction is ambiguous; preserve the appropriate output language; search local and external skill ecosystems for similar skills; score candidates by evidence, recurrence, personal value, and portability; fully draft proposed skills or diffs before asking for approval; then, after explicit user approval, discard, improve, merge, or create `SKILL.md` folders.
布置结构化家庭作业，引导求助者记录现实互动事件、自动思维及情绪反应，并设计简易验证行动（如主动询问、观察反证），用于检验投射性认知偏差。适用于已识别出具体非理性信念（如‘别人肯定不喜欢我’）且情绪稳定者。
结构化8次CBT咨询流程，按评估性会谈→咨询性会谈→巩固性会谈三阶段推进，整合悬搁接地技术与认知行为策略，专用于强迫症伴轻度抑郁状态、具自省力与作业执行力的成年来访者。
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| id | 807bcbc6-aa61-56b4-ab15-9377d09054b5 |
| name | DBT疗法初始适配性评估与知情启动 |
| description | 在首次咨询前20分钟内，完成结构化保密说明、咨询原则传达、半结构化访谈、SCL-90/EPQ施测与简要反馈、四维自杀自伤风险探询，并基于中国常模与临床判断，协同来访者决策是否启动DBT取向咨询，签署知情同意。 |
| version | 0.1.0 |
| tags | ["DBT","初始评估","风险筛查","知情同意","SCL-90","EPQ","认知行为疗法","profile:psychology::认知行为疗法","axis:疗法","class:认知行为疗法","kind:child","document_merge_state:active","canonical:true"] |
| triggers | ["来访者主诉情绪痛苦伴多维度功能受损（如躯体化、人际敏感、抑郁焦虑）","SCL-90总分≥160且多个因子分偏高","主观否认近期自杀念头但存在显著情绪痛苦"] |
| examples | [{"input":"来访者自述‘每天头痛、睡不着、看谁都烦，想躲起来’，SCL-90显示躯体化2.8、人际敏感2.9、抑郁3.1、焦虑3.0，EPQ N69，否认自杀念头但说‘活着好累’。","output":"反馈‘这些反应在压力下很常见，我们接下来会一起学习调节身体和情绪的具体方法’；记录‘严重心理问题’；签署DBT知情同意。","notes":"用正常化语言承接症状，将DBT定位为技能训练而非疾病治疗。"}] |
在首次咨询前20分钟内，完成结构化保密说明、咨询原则传达、半结构化访谈、SCL-90/EPQ施测与简要反馈、四维自杀自伤风险探询，并基于中国常模与临床判断，协同来访者决策是否启动DBT取向咨询，签署知情同意。
执行20分钟结构化初始接待：①清晰说明保密原则与法律例外情形；②以生活化举例介绍咨询三原则（积极正向、可自控、生态平衡）及单次时长设置；③开展半结构化访谈，聚焦主诉成因、咨询期待、社会支持与功能水平；④施测SCL-90与EPQ，使用中国常模即时标记异常因子（躯体化、人际敏感、抑郁、焦虑、敌对、偏执），反馈时不标签化；⑤以非评判语气进行‘意念-计划-行为-抑制因素’四维自杀/自伤主观评估；⑥整合数据形成规范临床判断（如SCL-90总分≥160且≥3因子偏高、EPQ N<75、无急性危机、存在保护性因素）；⑦用正常化语言解释DBT为‘可学的情绪与行为调节技能’，共同商议确认适配性；⑧签署DBT取向咨询知情同意书。
确立DBT疗法适用性并完成跨阶段治疗框架启动
references/evidence.mdreferences/evidence_manifest.jsonInput:
来访者自述‘每天头痛、睡不着、看谁都烦，想躲起来’，SCL-90显示躯体化2.8、人际敏感2.9、抑郁3.1、焦虑3.0，EPQ N69，否认自杀念头但说‘活着好累’。
Output:
反馈‘这些反应在压力下很常见，我们接下来会一起学习调节身体和情绪的具体方法’；记录‘严重心理问题’；签署DBT知情同意。
Notes:
用正常化语言承接症状，将DBT定位为技能训练而非疾病治疗。