This paper was presented in a symposium on ‘Countertransference’ held by the Medical Section of the British Psychological Society, London, 1959. The contributions from Freudian and Jungian analysts were published in the British journal of Medical Psychology 33 (9) (1960).
本文在伦敦1959年英国心理学会医学部举办的“反移情”研讨会中公布。来自弗洛伊德学派和荣格学派的分析师为这篇文章做出了贡献,本文发表在英国医学心理学期刊33 (9) (1960).
I gladly accepted the invitation to partake in this symposium, and I think that the memory of the earlier occasion on which Dr Fordham and I exchanged views had its positive share in this readiness.
我欣然接受参与这个讲座的邀请,我想,早些时候,Fordham博士与我交换了意见,就这些记忆在此准备积极分享。
In addition, I welcomed the opportunity for thinking again about a problem that so fundamentally enters into our daily work and for revising my earlier paper on countertransference to which Dr Fordham has referred, comparing my views expressed then (Heimann 1950) with my present views and those of other workers. I like to think that my paper did stimulate discussion. A number of papers have appeared afterwards making important contributions.
另外,我欢迎再次思考日常生活中的根本问题,并修改Fordham博士提到的我之前的关于反移情的文章,比较我当时的观点(Heimann 1950)和我现在以及其他人的观点。我想,我的文章促进了讨论。随后出现的一些论文做出了重要的贡献。
My short paper was prompted by a number of observations which led me to pay much attention to counter-transference problems.
很多意见促使了我的短文,让我更多的关注于反移情的问题。
In supervision I could see how many candidates, misunderstanding Freud’s recommendations (Freud 1910–19) and particularly his comparing the analyst’s attitude with that of the surgeon, endeavoured to become inhuman. They were so frightened and guilty when emotions towards their patients came up, that they warded them off by repression and various denial techniques, to the detriment of their work. But it was not only that they lost sensitivity in the perception of events in the analytic situation, because they were so preoccupied and in a fight with themselves; they also used defences against the patient, by taking flight into theory or the patient’s remote past, and presenting clever intellectual interpretations. Further, they tended to overlook or omit comments on the positive transference with its attendant sexual fantasies, and to select arbitrarily elements of the negative transference, because they then felt safer in reaching the goal of ‘cool detachedness’. That much of the hostility on which they focused was the patient’s reaction to being rejected and misunderstood, escaped them.
在督导中我看到很多新人误解了弗洛伊德的劝告(Freud 1910–19),尤其是他用外科手术来比较分析师的态度,竭力变得不人道。当针对病人的感受出现的时候,他们是如此的恐惧和内疚,他们用压抑和各种否认技术避开这些,伤害则他们的工作。但这不仅仅是他们在治疗情景中失去了对事件觉知的敏感性,因为他们太专注,并周旋其中;而且他们还防御病人,通过谈话遁入理论或病人遥远的过去,同时作出巧妙聪明的诠释。进而,他们往往忽略或遗漏了对随之而来的性幻想的正向移情作出评论,以及选择负移情的武断要素,因为他们在达到“冷酷的超然分离”目标的过程中会感觉安全。这更多的是他们的敌对,将注意力集中于病人对的被拒绝、被误解,逃脱他们的反应的敌对。
Often when a candidate’s interpretations appeared to be quite outside any rapport with his patient, I asked him what he had really felt. It frequently emerged that in his feelings he had appropriately registered the essential point. We could then see that, had hesustainedhis feelings and treated them as the response to a process in his patient, he would have had a good chance of discovering what it was to which he had responded. Naturally, on such occasions the candidate also became aware of his unsolved personal problems which produced his transference to his patient, which he could then take back into his own analysis—one useful aspect of the supervision experience.
通常,当新人的诠释显得与他的病人相去甚远的时候,我问他感受到了什么。在他的感受中经常出现的是,在他们的感受中经常浮现出的是他们恰当的显露出了本性的要点。接下来,我们可以看到,他忍受着他的感受,并且将这些当作对他的病人变化过程的回应,他本可以有一个很好的机会去发现他所回应的是怎样的。自然的,在这种场合,新人也变得开始意识到他自己未解决的问题了,这个问题产生于他对病人的移情之中,他可以将这些带回到他自己的分析中——这是督导体验一个有用的方面。
However, it would be a mistake to regard counter-transference problems merely as the growing pains of the beginner. I have encountered them in my own work, and even very experienced analysts senior to myself have mentioned such difficulties.
然而,仅仅把反移情作为初学者成长的烦恼是一个错误。我在自己的工作中遇到这些,而且即便是对自己非常有经验的资深分析师也提到过这样的困难。
I should like to recapitulate, briefly, the essential points I put forward in my earlier paper.
我想简单的概括我以前文章中提出的要点。
The analytic situation is a relationship between two persons. What distinguishes this relationship from others is not the presence of feelings in one partner, the patient, and their absence in the other, the analyst, but the degree of feeling the analyst experiences and the use he makes of his feelings, these factors being interdependent. The aim of the analyst’s own analysis is not to turn him into a mechanical brain which can produce interpretations on the basis of a purely intellectual procedure, but to enable him to sustain his feelings as opposed to discharging them like the patient.
分析性情景是两个人之间的关系。能从别的人哪儿区分出这种关系的,不是在病人一个合作伙伴中的感受呈现,例如病人(的感受呈现),而且也不是他们在其他人哪儿所缺席的,例如分析师(所缺席的),而是,分析师体验体验到的感受的程度,以及他对他的感受的运用的程度,这些因素相互依存。分析师自己分析的目的并不是把他自己变成一个基于纯粹智力过程的偏见做出诠释的机械的大脑,而是有能力去忍受他的感受,而不是像他的病人那样卸载之。
Along with his freely and evenly hovering attention which enables the analyst to listen simultaneously on many levels, he needs a freely roused emotional sensibility so as to perceive and follow closely his patient’s emotional movements and unconscious phantasies. By comparing the feelings roused in himself with the content of his patient’s associations and the qualities of his mood and behaviour, the analyst has the means for checking whether he has understood or failed to understand his patient. Since, however, violent emotions of any kind blur the capacity to think clearly and impel towards action, it follows that if the analyst’s emotional response is too intense, it will defeat its objective.
无意识幻想。通过比较被唤起于同他的病人相链接的内容的自身感受,以及他感受和行为的品质,分析师获得了检查他是否理解或不能够理解他的病人的能力。然而,由于任何强烈的感受模糊了清晰思维的能力并迫使了行动,由此可见,如果分析师的感受反应过于激烈,其客观性将会落空。
伴随着他自由均匀悬浮的注意力,这种注意力,使得分析师能够在许多层面上同时倾听,他需要自由的唤起感受的敏感性,以感知并紧密跟随病人的感受的活动和For most aspects of his work the experienced analyst has an emotional sensitivity which is extensive rather than intensive, differentiating and mobile, and his feelings are not experienced as a problem. His tools are in good working order. But situations occur in which he notices that he is puzzled in a disturbing way with somewhat intense feelings of anxiety or worry which appear inappropriate to his assessment of the events in the analytic situation. As he waits—which he must do in order not to interfere with an ongoing process in his patient, and in order not to obscure the already puzzling situation still more by irrelevant and distracting interpretations—the moment occurs when he understands what has been happening. The moment he understands his patient, he can understand his own feelings, the emotional disturbance disappears and he can verbalize the patient’s crucial process meaningfully for the patient.
有经验的分析师对于他工作的很多方面有着一种感受的敏锐度,那是广博的,而不是强烈的、鉴别的和变幻无常的,同时,他的感受并不被体验为一种困难。他的工具处于良好的工作状态中。但是,他注意到他以令人不安的方式困惑于几分强烈的焦虑或担忧的感受,当这些发生时,这使得他在分析性情景中对事件进行评估显得不适合了。当他等待——这是他必须做的,为了不干扰在他的病人的持续性的过程,同时为了不模糊本身已经令人费解的情况被更多无关和分散的诠释打断——只有当他明白正在发生着什么的时候。当他明白病人的那一刻,他能够理解自己的感受,情绪困扰消失了,同时他可以用语言描述病人至关重要的过程对病人意味着什么。
I gave an instance of this kind which could be readily described. I could have given others, which would, however, have neeeded a far more lengthy report. I have noticed that Dr Fordham is also familiar with the problem of choosing clinical examples.
我给出了一个可以很容易描述这种类型的实例。我可以给另外的例子,然而报告将会变得更冗长。我注意到,Fordham博士对选择临床案例的问题也很熟悉。
My earlier conclusion was that the counter-transference represents an instrument of research into the patient’s unconscious processes, and that the disturbance in my own feelings was due to a time lag between unconscious and conscious understanding. I did not then attempt to investigate the reasons for this time lag, nor did I attempt to tease out the contributions from the transference to the disturbed feelings, as my main objectives were to lay the ghost of the ‘unfeeling’, inhuman, analyst, and to show the operational signifiance of the counter-transference.
以前我的结论是,反移情代表了一种研究工具,进入病人无意识过程的研究工具,同时困扰我自己感受的是源自于无意识和意识理解之间的时间差。我没有试图再去调查时间差的原因,也没有试图整理来自于移情对不安感受的贡献,因为我主要的目标是铺陈那“无情的”、不人道的幽灵,分析师,并且展现反移情的操作意义。
In passing, I may mention that I have had occasion to see that my paper also caused some misunderstanding in that some candidates, who referring to my paper for justification, uncritically, based their interpretations on their feelings. They said in reply to any query ‘my counter-transference’, and seemed disinclined to check their interpretations against the actual data in the analytic situation.
顺便的,我愿意说,我有理由认为我的文章在一些新人中也引起了一些误会,他们基于他们对自己感受的诠释,不加批判的引用我的文章来辩解。在他们回应任何“我的反移情”的询问时,并且,似乎不愿意根据分析性情景中实际的资料来核对他们的诠释。
In view of the interdependence of the concepts of transference and counter-transference, I would like to take you back for a moment to the pre-analytic era, to the period before Freud discovered the transference. The therapist was in the role of a friendly helper, who encouraged the patient to remember everything that related to her suffering, her hysterical symptoms, and who by hypnosis made such recollecting easier. The violent emotions accompanying the patient’s remembering were directed against her past objects, and after discharging them the patient felt considerably better. This relief, manifest and often highly dramatic, was obviously due to the doctor’s procedure, and proved his usefulness. Patient and doctor were united in their purpose, on the same side, so to speak, against the patient’s past objects, who came up in her memories and to whom she directed the full strength of her affect and impulses.
鉴于移情和反移情概念的相互依存,我想带你回到预分析的时代,回到弗洛伊德发现移情之前的那段时光。治疗师处在友好的助人者的角色之中,他鼓励病人记住与她的痛苦有关的所有事情,她的癔症症状,他通过催眠让这样的回忆变得更加容易。伴随着病人回忆的强烈的感受都是针对她过去的客体,当卸载了这些之后,病人的感觉相当好。这种缓解,明显并常常高戏剧化,显然是由于医生的操作,并且证明了他的价值。病人和医生都团结在他们的目的之中,基于同一阵线,因此去讲述,针对病人过去的客体,那些出现在她记忆中的人,以及她情感与冲动全然指向的人。
Freud’s revolutionary discovery of the transference fundamentally changed the treatment situation. This is the point I wish to emphasize: with the recognition of the transference the demands which his work puts on the analyst have been immeasurably increased.
弗洛伊德对移情的革命性的发现,从根本上改变了治疗情景。这是我想强调的地方:随着对移情的承认,他的著作中对分析师的要去,已经大大增加了。
Hence, as Dr Fordham reminded us, the institution of the training analysis, for which Freud gave explicit recognition to the ‘Swiss school of analysts’. In passing, I wish to point out Jung’s mistake in thinking that Freud did not acknowledge the universality of the transference. What he did stress was the fact that in other forms of therapy the transference was not recognized.
因此,正如Fordham博士对我们的提醒,分析训练机构,对于弗洛伊德明确赞赏的“分析师的瑞士学派”。顺便要提的是,我想指出荣格错误的认为弗洛伊德并没有承认这种移情的普遍性。他所强调的事实是,在其他形式的治疗中移情是不被承认的。
As long as the therapist was merely administering a particular therapeutic agency to his patient—namely, the encouragement to let memories come to the fore and to discharge pent-up affects directed towards her past objects—his ordinary psychiatric training sufficed. But when the patient-doctor relationship became the stage on which the patient acted his violent impulses, unconsciously convinced of their originating actually and really from the activities and behaviour of the analyst, the therapist himself became the therapeutic agency and needed a special training to protect himself and his patient against emotional involvement and reaction to his patient’s acting.
精神病学培训就足够了。但是病人和医生的关系变成了病人扮演他的暴力冲突舞台的时候,无意识地相信来他们都是源自并真的来自于分析师的行为,治疗师本人成为了疗愈性的代理机构,并需要特殊的培训,以保护他自己和他的病人远离情感的卷入,以及对他的病人行为反应。
只要治疗师仅仅是给予他的病人一个特殊的疗愈性的场所——也就是说,鼓励记忆的涌现,以及卸载指向她过去客体的压抑已久的影响——他的普通The concept of the counter-transference was presented by Freud very briefly. He described it as a ‘result of the patient’s influence on the analyst’s unconscious feelings’ and demanded that it should be recognized and overcome. Many analysts regard counter-transference as nothing else than transference on the part of the analyst, and I believe that they feel supported by the fact that Freud referred to it without any definition and coupled with it a warning that was already familiar in respect of transference.
弗洛伊德提出的反移情的概念非常的简单。他将其描述为“病人对分析师无意识情感影响的结果”并强调,这需要被认识和克服。许多分析师认为,出了分析师这部分的移情之外,反移情什么都不是,因此,我相信,他们通过以下的事实而感到了支持,弗洛伊德谈到反移情时,没有任何的定义,并且又加上了一个关于移情的早已熟知的警告。
I hold, as I have mentioned, that as the prefix ‘counter’ would imply, there is a factor additional to transference which is of specific operational significance.
我认为,正如我之前所说的,前缀“counter反”意味着,还有一个对移情的附加的因素,这个因素是一个特殊操作意义。
In the literature, more recently, some attempts have been made to define countertransference. Time does not allow a thorough review, but I would like to mention in some detail Gitelson’s paper (1952). He distinguishes between reactions to the patient as a whole and reactions to partial aspects of the patient. The first occur right at the beginning of the analyst’s contact with a patient and persist during the initial stages of the analysis. Gitelson speaks of the ‘trial analysis’. These reactions, he says, ‘derive their interfering quality from the fact that they emanate from a surviving neurotic ‘transference potential’” (in the analyst). If this is so strong that the analyst cannot resolve it, and if in the trial analysis the patient shows no progressive movements,【1】 the analyst must conclude that he is unsuitable for this particular patient and refer him to another analyst.
在最近的文献中,已经做出了一些对反移情进行定义的尝试。时间不允许通读,但是我想谈一谈Gitelson(1952年)论文的一些细节。他区分了作为整体的对病人的反应与对病人部分面向的反应。第一种情况发生在分析师与病人接触之初,并存续在分析的初始阶段持续。Gitelson所说的“试分析”,这些反应,他说,“获得干扰的品质来自于的事实是,他们源自于(分析中的)残存的神经质的‘移情潜势’。”如果这些太强烈了,以至于分析师不能化解它,而且,如果在试验分析阶段,病人没有呈现出进步的动向【1】,分析师必须断定,他不适合这个病人,并将其转介给另一个分析师。
The second type, the reactions to partial aspects of the patient, appear later within an established analytic situation. They constitute actual counter-transferences. ‘They comprise the analyst’s reaction to: (1) the patient’s transference, (2) the material the patient brings in, and (3) the reactions of the patient to the analyst as a person.’
第二种类型,对病人部分面向的反应,随后出现在建立的分析性情景之中。他们构成了现实的反移情。“他们包括分析师对以下情景的反应:(1)病人的移情;(2)病人带来的材料 ,以及(3)病人对作为一个人的分析师的反应。”
The fact that an analyst is potentially capable of producing the reactions mentioned indicates that he himself is not ‘finally and perfectly analysed’. As Freud has shown, analysis is interminable. But the result of the analyst’s analysis is that he is capable of continuing his analysis. Gitelson uses the expression ‘a spontaneous state of continuing self-analysis’. Every analytic situation presents to the analyst the task ‘to integrate himself rationally in the face of difficulties’. The counter-transference, as defined by Gitelson, represents the activation of unanalysed and unintegrated aspects of the analyst. Since this, however, occurs only episodically, in a recognized specific connection with the patient’s material, and since, moreover, some of the manifestations are grossly symptomatic, there is little danger of the analyst’s overlooking them and failing to analyse his attitudes in himself. Through the analysis of his counter-transference, then, the analyst ‘can re-integrate his position as an analyst and…utilize the interfering factor…for the purpose of analysing the patient’s exploitations of it’.
事实上,一个分析师很可能作出暗示的反应,他自己不是“决定性地和完美地分析”。正如弗洛伊德所表明的,分析是冗长的。但是分析师分析的结果是他有能力继续他的分析。 Gitelson所用表述方式是“持续自我分析的自发状态”。每次分析性情景呈现给分析师的任务是“在面对困难的时候整合他自己的理性”。反移情,如Gitelson所定义的,代表了分析师未活化的和未整合的部分。然而正因为这一点只是偶然的发生在与病人的材料相联系的被认可的特性之中,而且因此,更多的,一些临床表现是严重的症状,分析师忽略了这些,以及未能在此之前对他自己的态度进行分析,这些都是有一些危险的。通过分析他的反移情,那么分析师“可以重新整合他作为分析者的位置…利用干预因素…为了分析病人利用它的目的”。
I have given these points from Gitelson’s paper because of the many valuable clarifications which it presents, and because there is a good deal of common ground between his views and mine. There are also some important differences.
我之所以从Gitelson论文中给出这些观点,是因为这呈现了许多有价值的澄清,并且,因为在我和他的观点之间有很多共同点,也有一些重要的区别。
For those analysts like myself who do not adopt the procedure of starting off with a trial analysis, the first diagnostic interview has to decide not only the patient’s psychiatric diagnosis, but also to answer the two questions: (1) can the patient be helped by analysis?; (2) can he be helped by my analysing him? It may happen that the first question can be answered with a Yes, and the second with a No. In such cases the patient must be referred to another analyst.
对于那些像我这样不采用从试分析开始的分析师,第一次的诊断访谈不仅要决定病人的精神病学诊断,而且要回答以下问题:1)分析可以帮助到病人么?2)通过我对他的分析,他能够被帮助到么?有可能是这样,第一个问题被回答为是,而第二个问题的答案是否。在这样的情况下,病人必须转介到另一个分析师哪儿。
Gitelson’s concept of the ‘surviving neurotic “transference potential”’ in the analyst offers a valid distinction between transference and counter-transference. But, since in the counter-transference, on Gitelson’s showing too, neurotic elements in the analyst are active, I wonder whether the essential factor which makes the difference is a qualitative one. In my view what is crucial is the quantitative aspect. If there is a greater inclination and ability in the analyst to do the necessary self-analysis in the one case rather than in the other, it is because in that particular case his underlying anxieties and the defences engendered against them are less strong. This brings me back to points I made in my earlier paper, where, instead of defining transference and counter-transference in the analyst’s feelings, I focused on their potential usefulness, the criterion lying in their intensity. In other words, from the patient’s point of view it is not of decisive significance from which source the analyst’s feelings arise provided that the analyst does not use defences which would impair his perception. Sustaining his feelings forms part of the process of reintegration (Gitelson 1952) and of understanding his patient (Heimann 1950).
防御机制的条件下,分析师感受的唤起源自于哪里,是不具有决定意义的。维持他的感受构成了整合过程(Gitelson 1952)以及理解他的病人(Heimann 1950)的一部分。
Gitelson关于分析中的“幸存神经质的‘移情潜势’”的概念,为移情和反移情提供了有效区分。但是,由于在反移情中,也基于Gitelson的描绘,神经质的元素在分析中是活跃的,我不知道是否有哪个重要的因素让这些差异是一个定性的因素。在我看来,关键是量化的方面,如果,分析师有更大的倾向和能力在一个个案而不是另一个个案中做一些必要的自我分析,这是因为在特定的情况下,他潜在焦虑和对他们产生的防御不是那么的强。这让我回到了我在以前的文章中提到的,在那里,不是明确分析师的移情和反移情感受,我专注于他们潜在的用途,位于他们的强度的准则。也就是说,从病人的角度来看,在分析师不使用会损害他知觉的Although a conceptual distinction between transference and counter-transference is possible, in the actual experience the two components are fused. It is true that the transference potential shows up very strikingly at the first meetings with a patient or during the trial analysis, as instanced by Gitelson. But I think it is also at work in the later episodes in an established analysis. In my experience, when I have afterwards (with proverbially easy hindsight) scrutinized incidents of counter-transference, successfully used as indication of processes in the patient, I concluded that the time lag between my unconscious and my conscious understanding was due in part to transference factors which I had not recognized at the time.
虽然移情和反移情之间的概念区分是可能的,在实际经验中,这两个成分是融合的。固然,就像Gitelson的实际案例,移情在试分析阶段与病人的第一次会谈中显示了非常惊人潜在可能。但是我认为,这也会出现在分析建立后的时期之中。在我的经验中,当我后来(众所周知的事后诸葛亮)仔细审查事件反移情的偶发事件,成功的用于病人的指示过程,我的结论是,我的无意识与我的意识理解之间的时间差,部分源自于当时我不承认的移情因素。
Several authors have raised the question of whether or not to tell the patient when counter-transference has affected the analyst’s attitude.
几位作者都提出这个问题,当反移情影响了分析师的态度的时候,是否需要告诉病人?
I have expressed the view that a communication of this kind represents a confession of personal matters pertaining to the analyst, and would mean a burden to the patient and lead away from the analysis. Therefore it should not occur.
我曾经表示了这样的观点,这种沟通代表与分析师有关的个人问题的忏悔,同时意味着对于病人的负担,并导致分析的远离,因此它不应该发生。
Gitelson (1952) and Margaret Little (1951) both hold that such communication must be made. Rejecting the notion of confession, Gitelson says: ‘In such a situation one can reveal as much of oneself as is needed to foster and support the patient’s discovery of the reality of the actual inter-personal situation as contrasted with the transference-counter-transference situation.’ Dr Little compares such matters with errors by the analyst about times or accounts. She recommends that the ‘origin in unconscious counter-transference’ should be explicitly mentioned. Further, she deliberates on the possibility that the analysis of the counter-transference might carry the analysis to greater depths, in the same way as the analysis of the transference did. Both authors recommend great caution and are aware of possible abuses and warn against ‘acting out in the counter-transference’.
Gitelson (1952) 和Margaret Little (1951) 都坚持认为这样的沟通必须要做。拒绝了忏悔的理念,Gitelson 说:“在此情景下,人们可以尽可能的泄露自己,需要抚育并且支持病人对人际情景真实的现实的发现,作为与移情-反移情情景的对比。” Little博士通过分析时间和描述比较了这种事情的差错。她建议,“起源于无意识的反移情”应该被明确的提出。此外,她仔细考虑了 反移情的分析可能 会将分析带入到更深的地方,作为移情的分析以相同的方式也如此。两位作者的建议都非常谨慎,并且意识到滥用的可能,并警告“在反移情中的付诸行动。”
That errors the analyst has made need to be stated is hardly a problem. Nor is there a difficulty, except if the analyst’s subjective need to be honest plays, unconsciously, an undue part in it. The error may concern the account, or times or an interpretation.
分析师做的这种错误可以说是一个严重的问题。也不会有困难,除非分析师的主观需求诚实的上演,无意识地,在此之中的不适当的部分。该错误可能与描述,或时间或诠释有关。