性和身体虐待(otto Kernberg)
lechi01 作者: lechi01 / 2647次阅读 时间: 2016年8月13日

Incest as trauma has received much recent attention, and psychoanalytic study of its victims indeed illustrates the basic dynamic of internalization of an object relation dominated by hatred. In exploring these psychodynamics we have to keep in mind that the sadomasochistic component of sexual excitement permits the recruitment of aggression in the service of love. But this is a response that, when a sexual response is overwhelmed by rage and hatred, may be transformed into sexual sadomasochism in which love is recruited in the service of aggression. That is, sexual intercourse may become a symbolic gratification of sadomasochistic tendencies, replicating in the sexual area the interactions I have described in relationships dominated by hatred.


乱伦作为创伤近期获得了很多关注,精神分析对其受害者的研究阐明了一个内化的、被恨控制的客体关系的基本动力。在探索这些心理动力中我们必须记住:性兴奋时的施虐受虐部分让爱在性中补偿了恨。但当一个性反应被愤怒和恨淹没时,这会转化为性施虐受虐,在其中爱被用于服务攻击。性交会成为一种施虐受虐倾向的象征性满足,在性领域中复制我之前描述的在被恨所控制的关系中的互动。心理学空间E#D^ `:A2~ q j5V;D

Not all sexual abuse is experienced as aggressive; unconscious infantile sexuality, the excitement, gratification, and triumph resulting from breaking oedipal barriers, and the guilt such triumph produces, complicate the psychological effects of sexual abuse. Nevertheless, the distortion of superego structures brought about when cross-generational (in particular, parent-child) incest occurs destroys the potential for integrating sadistic parental images into the superego. The conflict between sexual excitement and guilt is thus transformed into one between frail idealization and overwhelming aggression, creating a truly traumatic situation in which libidinal and aggressive strivings can no longer be differentiated. The unconscious identification with the victimizer and the victim may become confused. The repetition compulsion of incest victims who transform their later sexual life into a chain of traumatophilic experiences often makes it difficult to determine whether the patient was the victim or the victimizer.心理学空间mJI}+S D


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In the clinical situation, such incest victims reactivate the identification wit the victim-victimizer dyad and unconsciously attempt to reproduce the traumati situation in order to undo it and to recover the ideal object behind th persecutor. In addition, the repetition compulsion expresses the desire for revenge the rationalization of hatred of the seducer, and the potential sexualizatio of the hatred in the form of efforts to seduce the seducer. The psychoanalytic treatment of incest victims who have had sexual experiences with forme therapists sometimes repeats these experiences with uncanny clarity. Unconsciou envy of the current therapist, not involved in the chaotic mixture of hatred and sexuality in which the patient experiences himself as hopelessly mired, is another source of negative therapeutic reactions.心理学空间|3]0NJl

在临床情景中,这样的乱伦受害者再次激活了对受害-施害配对的认同,潜意识地试图再次创造创伤情景来消除它,恢复迫害者背后的理想化客体。另外,强迫性重复表达了想要报复,合理化对诱惑者的恨,以诱惑引诱者的形式潜在地将恨性欲化。对有与之前的治疗师有性经历的乱伦受害者的动力学治疗中有时候异常清晰地重复了这些体验。潜意识嫉妒当下的治疗师(不包括卷入混乱的恨和性欲混合,在其中患者体验自己为无助地陷入泥潭)是另一种负性治疗反应的来源。心理学空间 QhE8qM

Recent research by Paris (1994b) confirms the importance of a history of sexual abuse in patients with borderline personality disorder as well as their tendency toward dissociative reactions. Paris also points out that a predisposition to dissociative reactions does not seem to be secondary to sexual trauma. In clinical practice, both types of problems are seen together with some frequency. Some borderline patients present dissociative reactions in the form of amnesias, depersonalization states, and even multiple personalities, of which the patients are cognitively aware but which are affectively split.

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Paris(1994b)最近的研究确认了性虐待历史在边缘人格障碍以及他们倾向于解离反应的重要性。Paris也指出,解离反应倾向并不就是性创伤的次发反应。在临床实践中,两种问题类型经常会一起看到。一些边缘患者呈现健忘、人格解体状态、甚至多重人格等形式的解离反应,患者能在认知上对此有觉察,但情感上是分裂的。心理学空间 f)Z.Qun*V)U

What is often striking in such dissociative states is the patient’s remarkable indifference to what seems to be a dramatic psychopathological phenomenon: Indeed, some patients present an almost defiant affirmation of the “autonomy” of their split-off personalities while refusing to consider any personal responsibility for these phenomena. Often, the mutual dissociation of alternate personality states raises the question of why some apparently not incongruous personality states appear to be split from each other.心理学空间:aS-C.t+_M



In my experience, when the clinician asks how the patient’s central personality, her sense of awareness, concern, and responsibility, relates to these split-off personality states, this immediately triggers a new development in the transference. Many patients develop a paranoid reaction to such inquiry; this evolves into a specific transference disposition in which the therapist appears as a persecutory figure in contrast to other persons in the patient’s life, including other therapists, who are idealized as helpful, tolerant, nonquestioning, admiring, and supportive. The patient’s alternate personality states take on more specific meanings in relation to such split object representations, permitting a clarification of the function of such split states in the transference. In short, approaching the patient from the position of an assumed observing, central, “categorical” self illuminates hidden splits in the transference and permits exploration of the unconscious dynamics involved in the split personality state that are obscured by the usual, apparently untroubled enactment of such states.心理学空间)kMm&O$xP/I&~

在我的经验中,当治疗师询问患者的中心人格、她的意识、担心和责任等与这些分离的人格状态是怎样的关系时,这会立即触发一个新的移情发展。很多患者对此提问会发展出一个偏执反应;这发展成一种特殊的移情倾向,在其中治疗师表现为一个迫害者角色,相反于来访者生活中的其他人,包括其他治疗师,他们被理想化为有帮助的、宽容的、不会质疑的、赞赏的和支持的。患者交替的人格状态呈现更多这些分裂的客体表象的特殊意义,可以在移情中澄清这分裂状态的功能。简而言之,从一个假设的观察、中心、“绝对”的自体来面对患者,会阐明在移情中隐藏的分裂,可以探索分裂人格状态中的潜意识动力,而这动力之前被通常的表面上没缘由的激活所掩盖。心理学空间6fzu2TGR ka

The patient now may be tempted to angrily accuse the therapist of not believing in the existence of his multiple personalities. The therapist’s concerned and neutral stand—being interested in the patient’s experience, not questioning its authenticity, but at the same time evaluating the implications for the patient’s central self-experience—gradually permits the patient to increase his self-observing function in contrast to the previous defensive denial of concern and what might be called blind enactment of dissociative states.

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患者现在会被引诱谴责治疗师不相信他的多重人格的存在。治疗师关心和中立的态度逐步让来访者增加他的自我觉察功能,对患者的体验感兴趣,不质疑其真实性,但而不是之前的防御性否认担心和被称为盲目地解离状态的行动化。心理学空间T X \9o'E8l'l*VV(^

In severe personality disorders, the approach I have just outlined transforms what appears to be a dreamlike, often apparently affectless dramatization into a concrete object relation in which intense rage and hatred emerge, split off from other idealized object relations. Once the emergence of mutually split-off peak affect states in the context of split-off primitive object relations becomes evident in the transference, the intepretive integration of these developments may proceed.心理学空间uW-o`\;c1h



This approach contrasts with a tendency on the part of some therapists to explore each dissociated personality state while respecting its split-off condition, bypassing the defensive denial of concern about this condition. I believe that such an approach tends to prolong the dissociative condition itself unnecessarily and may aggravate it.心理学空间(N kq ZW!T_


When such dissociative reactions occur in the context of real or fantasied past incest or sexual abuse, a similar defensive denial of concern for the nature of the dissociative process may often be observed. Such a development contrasts markedly with cases in which, under psychoanalytic exploration, repressed memories of past sexual abuse, including incest, are uncovered, leading to a traumatic emotional reaction that colors the psychotherapeutic relationship for perhaps several months and is gradually worked through. In this latter case, characteristics of a post-traumatic stress syndrome may emerge in the psychotherapeutic relationship; the patient shows great concern for himself, intense ambivalence in relation to the abuser, and ambivalence regarding his own past and present sexuality. The elaboration of such a traumatic recovery of memory contrasts sharply with the long-term repetitive evocation of past traumatic sexual experiences in the context of a present-day expression of hatred, disgust, and revulsion linked to the patient’s sexual life in general or to all persons of the gender of the traumatizing agent.

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In such cases, particularly when traumatic sexual memories appear repeatedly in the context of dissociative ego states, a characteristic lack of concern, denial, or dramatic indifference toward the dissociative process may also be present. The patient may insist on engaging the therapist as a “witness” or support figure in the struggle against a hated and feared sexual object. In the transference, the therapist may be identified with either the abusing object or a conspiratorial helper (for example, the “innocent bystander” mother, who, in subtle or not-so-subtle ways, protected an incestuous father).心理学空间i*H/q%REh



Here again, the world seems to be split between those who side with the traumatizing object and those who support the patient’s wishes for a vengeful campaign against that object. Because of the current cultural concerns about sexual abuse, the patient’s split world of object relations may be rationalized in a conventional ideology that confirms and maintains his condition as a victim.心理学空间^ ktY6F%~%_+Gj+kRj


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I have found it very helpful to ask the patient what keeps the hatred alive in his life and what its functions are in his current conflicts. When the fact of past sexual abuse is unclear, even in the patient’s mind, the patient may insistently demand the therapist’s confirmation of his suspicions. The therapist’s stance— that the patient’s experiences are real in their present quality and that the patient himself will eventually be able to clarify and gain understanding of and control over the internal past—often raises the same intensity of suspicion and rage in the transference as do attempts to clarify the relation between the patient’s central self-experience and a dissociative state. In other words, the patient may not be able to tolerate the therapist’s concerned but neutral position, which runs counter to the overriding need to divide the world into allies and enemies. The therapist’s consistent interpretation of the patient’s need to maintain such split relations will eventually, under optimal conditions, permit more specific focus on the enactment of the relationship between victimizer and victim, with frequent role reversals, in the transference. This permits analysis of the patient’s unconscious identification with the victimizer as well as with the victim role as the major dynamic that maintains the characterologically anchored hatred.



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A positive consequence of such a therapeutic approach is the gradual liberation of the patient’s sexual life from its infiltration by unrecognized, unmetabolized hatred. The revulsion against sexuality in victims of early sexual abuse has many roots: The invasion of their psychic and physical boundaries is experienced as a violent attack; the transformation of a person in a parental function into a sexual abuser is experienced as sadistic treason, in addition to disorganizing the early buildup of an integrated if primitive superego. The reprojection of early persecutory superego precursors in the form of paranoid tendencies intensifies yet more the aggressive implications of a sexual attack and weakens the capacity for any trusting relationship.

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Unconscious guilt arising from the activation of the patient’s own sexual impulses in the context of sexual seduction and abuse increases this revulsion against all sexuality and the temptation to reproject such guilt feelings, thus reinforcing the patient’s paranoid approach to sexual objects and repression of sexual wishes, fantasies, and experiences. If traumatized victims of concentration camps or torture have to reencounter awareness of their own sadistic tendencies as they discover their unconscious identification with both victim and victimizer, the victims of sexual abuse have to reencounter an awareness of their own sexuality in unconscious identification with both the self and the object of the traumatic experience. The treatment cannot be completed if such a reencounter has not been achieved. Stoller’s (1985) understanding of the nature of erotic excitement as an early fusion of sensuous experience and unconscious identification with an aggressive object—in other words, the erotic roots of polymorphous perverse sadomasochism—is relevant in this connection. At some point, a toned-down, tolerable sadomasochistic tendency should become available for retranslation into a language of erotic fantasies, opening up the polymorphous perverse component of adult genital sexuality.心理学空间{ M/r7v{APRJ J


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——(摘自KERNBERGHatred as a Core Affect of Aggression》 朱一峰译)心理学空间(]#i2n:W,M8HsE


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