Here and now

克莱因派分析师处理投射性认同技术之此时此地

作者：Robert Waska   翻译：胡尚伟

In the examining accounts of Kleinian PI interpretations, there are analyst who feel that immediate, here – and- now interpretations best deal with PI. They emphasize the value of being direct and interpreting the moment-to-moment transference aspects of PI, as well as the immediate internal relationship the patient appeared to be dealing with. These analysts value genetic reconstruction as well, but find it helpful only occasionally.

在仔细考察克莱因派分析师对投射性认同的解释，有些分析师觉得即时和此时此地的解释是对投射性认同最好的解释。他们强调对投射性认同的瞬时移情方面和病人要处理的即时的内部关系直接处理和解释的价值。这些分析师重视起源学重构，但只是偶尔有用。

Paula Heimann (1956) feels that if left alone, without interpretation, PI will simply foster greater pathology. She notes that while the patient may introject an idealized vision of the analyst that will then combat the bad internal objects, this is not the analytic goal. If the introjection of an idealized analyst goes unanalyzed, the treatment has merely promoted a greater degree of splitting. Finally, she feels if interpretations are withheld, it pushes the treatment into more of an acting out of primitive object relations rather than a working through of those relations. Therefore, she is always exploring, interpreting, and analyzing the moment-to-moment, here-and-now unfolding of the PI.

波拉海曼（1956）觉得，如果没有解释的话，投射性认同简直就更加病态。她指出，当病人内摄一个要打败坏的内部客体的分析师的理想化观点，这并不是分析的目标。如果内摄的理想化分析师分解了，治疗只是导致了个更大程度的分裂。最后，她认为，如果解释遭受拒绝，它将促使治疗进入原始客体关系见诸行动而不是修通那些关系。所以，她一直探索、解释和分析时时刻刻和此时此刻正在展现的投射性认同。

Heimann explains that to make the interpretation, the analyst has to constantly ask herself or himself, “Why is the patient now doing what to whom?” While she is discussing various manifetations of PI, Heimann calls her interpretations “transference interpretation.” This seems to be an outgrowth of the implicit notion that PI is at times the core of the transference relationship. She writes:

it is the transference interpretation which fully re-instates the past in the present and makes it accessible to the patient’s ego. The patients is not then looking back cooly and intellectually at what he once felt with his parents, but is experiencing his immediate feelings and their phantasy contents towards the analyst as the real and living equivalent of his past life with his original objects who have indeed been intra-psychically preserved. (Heimann 1956:307) 

Another way to clarify the relationship between the transference and PI mechanisms is to examine how the transference becomes known. It is often through the intrapsychic and interpersonal vehicle of PI that the exact nature of the patient’s transfrence phantasies become clear and alive in the c onsulting office.

海曼解释说，为了（对投射性认同）做出解释，分析师需要不断地问她自己或他自己：“为什么这病人现在做了什么对谁？”当她谈论投射性认同的各种表现时，海曼称为“移情解释”。这看起来像是这一模糊概念（投射性认同）的自然产物，投射性认同有时正是移情关系的核心。她这样写道：

正是解释移情才充分得使过去出现了在了现在和病人的自我得以理解。病人不是那么冷漠和聪明地回顾曾经与父母在一起时的感受，而是体验指向分析师的当下的感受和幻想内容，就像包括已经真正地被埋藏在心底的人，真实而鲜活的过去经历重新回来了一样。

这是又一种澄清移情和投射性认同之间的关系的方式，就是考察移情如何被了解的。正是通过投射性认同单人或人际间性工具，病人移情幻想的确切性质在分析室里才变得清晰和鲜活起来。

Herbert Rosenfeld (1958) discussed a patient who had projected a persecutory father into the analyst and then split it off onto a bank manager. These projections protected her from the guilt she felt at having castrated the analyst/father. The patient became anxious and insisted the analyst help her by convincing the bank manager she was trustworthy. Rosenfeld writes:

 I interpreted to her that at that moment she wanted to have a guarantee from me that I remained a friendly father to her, in order to keep me apart from the bank manager, who had become very threatening and frightening. I also showed her that she had suddenly become frightened because I had turned into the bank manager who represented that aspect of herself which had recently been finding out things about him which her father had never known… I showed her that the muddle which she had been making over her money matters represented a hidden attack on the analysis, since she would be unable to pay my fees… I showed her that the main resistance was against recognizing the intense guilt and anxiety about depriving and injuring me. (Rosenfeld 1958:239)

赫尔伯特罗森费尔德谈论一个病人，这个病人把迫害的父亲投射到分析师身上然后又分到了银行经理身上。这些投射使得她免于内疚，因为她阉割了分析师或父亲。病人变得非常焦虑并坚持要分析师通过让银行经理相信她有足够的信誉这种方式来帮助她。罗森费尔写道：

我向她解释，在那一刻她想要我保证我是一个很友好的父亲，这样就可以把我和银行经理区分开来，这个银行经历曾经让她感到威胁和害怕。我也向她呈现，她突然变得害怕，因为我已经变成了银行经理，银行经理代表了她自己的一个面向，而这个面向是她最近发现的，她父亲根本不知道…我还向呈现，她金钱转移方面产生的困惑代表着她对分析师的隐藏的攻击，因为那样的话她就不能够（为分析）付费了…我还向他说明了主要的阻抗是拒绝承认与剥夺我和伤害我有关的强烈内疚感和焦虑。

Rosenfeld goes on to explain that his interpretations of the PI process helped the patient become less anxious and that she then was more in touch with her external realities and how to deal with them. By staying with the here-and-now, present manifestation of PI, he helped the patient work through her PI phantasies and start to deal more with reality.

罗森费尔德继续说明，他对投射性认同的解释有助于缓解病人的焦虑，然后她对外部现实和如何处理现实有了更多地了解。通过针对此时此地和投射性认同当下的表现工作，他帮助病人修通了投射性认同幻想并开始更多地处理现实（方面的事情）。

 I think it would not have been as productive for Rosenfeld to have concentrated on the patient's history and simply interpreted the one-to-one parallel between the patient's view of the parents and of the analyst. Nor would it have helped as much to make a general interpretation about the patient's fear of her own aggression. The here-and-now, in the room nature of his comment was what helped most.

我认为，对于罗森费尔德来说，聚焦于病人的个案史和对个案父母对病人的观点和分析师对病人的观点只是进行一对一的解释是不够有新意的，对病人对她自己攻击的攻击进行笼统性解释也不会有多大的帮助。此时此刻，他评论（在乎）的就是什么最有帮助。

Kernberg et al. (1989) described a PI situation in the initial hours of a new analysis. The patient provocatively wondered if she could make it to her appointments. Kernberg writes:

 at this stage no effort should be made at an in-depth interpretation. The therapist addresses the patient's resistance to the contract by returning to the realistic reasons for the contract, not by interpretation. Interpretive work should be introduced only after the contract has been established. (Kernberg et al. 1989:36)

克恩伯格讲述了头几次分析中一个投射性认同例子。病人挑衅地问她是否可以约会。克恩伯格写道：

在这个阶段，不应该深化解释。治疗师通过返回到协议的现实原因而不是解释，来化解病人对协议的阻抗。协议建立之后，解释工作才可以进行。

He clearly sets a limit on when and how the analyst should proceed in interpreting PI. This would be an example of not focusing on the here-and-now as a guideline to making PI interventions.

克恩伯格清楚地设置了限制：分析师什么时候和如何对投射性认同进行解释。这是一个对投射性认同不聚焦于此时此刻的干预指南。

I would not agree with this stance, as it artificially divides the transference and PI dynamic from the external "realistic reasons for the contract." While it is helpful to address the external environment and to bring reality into the conversation to discuss why the patient can't get to her appointment, to not put them into the context of the transference and PI process via an interpretation seems to be a missed therapeutic opportunity.

我不赞成这种做法，因为这是人为地把移情和投射性认同机制从外部“协议的现实原因”划分出来。尽管处理现实问题和把现实带入到谈话中来讨论为什么病人不能够约会是有帮助的，但是没有通过解释而把这些放到移情和投射性认同的背景中好像是错过了治疗的机会。

While Kernberg believes in not interpreting PI in certain clinical situations, his clinical work and supervisory work can also demonstrate the importance of direct interpretation. One patient would attack the analyst for any comment she made but also attacked her for making no comments. As a result, the therapist became relatively passive. Kernberg writes:

this enraged the patient even more, and he threatened to dismiss the therapist. At this point, the therapist recalled the patient's moving descriptions, during the initial interviews, of fear of his own passivity as he entered into depressive states of mind. The therapist pointed out to the patient that he had cornered her into inaction by his repeated attacks whenever she spoke and thus induced in the therapist the very passivity that he hated in himself. Seeing the therapist as passive allowed the patient to disown this quality in himself. This comment, an interpretation of projective identification, led the patient to speak tearfully of his fear of passivity, and completely defused the request for a new therapist. (Kernberg et al. 1989:99)

尽管克恩伯格在某些临床情境下并不信赖对投射性认同的解释，但是他的临床工作和督导工作还是显示出了解释的重要性。病人可以对分析师做的任何评论进行攻击，也可以对分析师不作评论进行攻击。结果，治疗师变得相对的被动。克恩伯格写道：

这更加激怒了病人，病人威胁说要解雇治疗师（终止分析）。在这点上， 治疗师回忆起，在初始几次分析中，病人对他自己被动性的恐惧所做的动人的描述，当时他陷入了抑郁状态。治疗师向病人指出，他已经把她逼入了只能一再地攻击的死角，无论什么时候她说和这样使得治疗师陷入了他所恨的被动状态。看到治疗师陷入了被动，这使得病人允许他否认在他自己身上的被动性。这种说明，也是对投射性认同的一种解释，让病人能够泪流满面地谈论他对被动和彻底拒绝一个新治疗师的请求的恐惧。

Here, the analyst demonstrates how helpful, in the moment of transference connection, the here-and-now interpretation of PI is. The here-and-now focus on the exact nature of the PI process not only prevented the threatened termination but allowed the patient to access his defended sadness, fear, and anxiety.

在这里，这位分析师展示了，在有移情链接的情况下，对投射性认同的此时此地解释是多么的有帮助。对投射性认同的确切本质进行此时此地的聚焦不仅防止那种威胁性结案而且也允许病人能够接近他防御式的悲伤、恐惧和焦虑。

摘自《临床中的投射性认同》（ "projective identification in the clinical setting" by Robert Waska)

标签： 投射性认同  移情  解释  内摄  分析  临床