DEBATE BETWEEN KOHUT (HK) AND KERNBERG (OK) 科胡特与康伯格的争论
作者: 《动医》 / 5415次阅读 时间: 2009年10月04日
来源: www.bapfelbaumphd.com 标签: Kernberg kernberg Kohut kohut KOHUT 康伯格 科胡特
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一共三个部分:

姚小青译本及评注

朱一峰译本及评注

英文原文

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姚小青译本及评注

4I_"c4pE7DM8t0DEBATE  BETWEEN KOHUT (HK) AND KERNBERG (OK)心理学空间 {![:n.PW}/R

QN0?b0_-@1D QW0科胡特和克恩伯格辩论的纠正翻译和分析解读

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姚小青  04/17/2019 心理学空间0B7d9kL5~0\ [a

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Txwx ud5_"H%u%r-G0前言:最近对这篇短短的辩论很感兴趣,于是不自量力把mints的翻译觉得不精准的地方重新翻译了,附上英文原文,愿意和同行们关于这些翻译讨论。括号里的红字是我对俩人的对话的理解和一些解读,这些当然直接影响翻译。心理学空间#S'pb`^]IQ

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OK:Heinz, are you not indulging the patient's grandiose fantasy that he is the superior one, patronizing the therapist? 心理学空间(f Fd1Eb,rG3|fG1E

{8TnY o+i[x\0克恩伯格:海因茨,病人认为自己高人一等,要治疗师屈尊俯就,(难道)你没有沉溺于病人的这种自大幻想吗?心理学空间Q:y Y$i:q/N

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H*q:lV;f!\6]8GH0HK:Of course. The patient must be indulged in this fantasy if he is to experience this developmental stage. His grandiosity must be permitted. This is difficult because for the patient to act out such fantasies alienates the therapist. It is a test of the therapist's capacity for empathy.心理学空间 F2t+P-NWE%`FA\

nT)j2z}0科胡特:当然。如果病人要经历这个发展阶段,他必须沉溺在这种幻想之中。他的自大必须得到允许。(治疗师允许这个)这很困难,因为对病人来讲表现出这样的幻想是为了疏远治疗师。这是在测试治疗师的共情能力。(前面科恩伯格讲的是治疗师沉溺于病人的自大幻想,科胡特回应的是他怎样理解病人需要沉溺,这可能也暗含着科胡特并没有特别多的沉溺于病人的自大幻想的困境,这点上俩人就没有共同的体会。感觉科胡特在柯恩伯格面前并不自信,虽然他明白他的看法是正确的。这点影响了科胡特共情柯恩伯格。我个人也更认同他的看法和处理。这里,科胡特看到了疏远,这是最关键的。治疗师需要看到病人恐惧建立关系!病人在测试治疗师,我很自大/假自体,这就是我,你还依然爱我吗?这是病人的移情,这意味着治疗师的工作已经取得了初步的成功,病人已经把治疗师当作客体了,已经在原来的客体关系里了,然后就有了建立新的客体关系的机会。病人的需要是客体(治疗师,足够好的妈妈)不远离我,需要治疗师连接到这一点,病人就感觉存在于关系里了。病人从治疗师那里感受到被共情,连接感和不被评判,这些是不同于母亲给自己的体验的。这样的客体关系中,自大的假自体自发自然的会慢慢不再需要,自我身份认同就逐渐建立起来,而不再自卑。心理学空间#SH$zC!USG

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7A(Rptii%w0ytn0OK:No, that is not the countertransference problem. The countertransference problem is therapist's fear of the patient's anger. The therapist hesitates to confront the patient's fantasy for fear of provoking his rage. It is a test of whether the therapist can withstand the patient's rage. Indulging the patient's grandiosity only supports a defense against this rage. The rage is generated by the feelings of inferiority that the patient's grandiosity also defends against.

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克恩伯格:不,这不是反移情的问题。反移情问题是治疗师害怕病人的愤怒。治疗师犹豫着不敢面对病人的幻想,害怕激怒他的愤怒。这是在测试治疗师能否忍受病人的愤怒。纵容病人的自大,只会支持他防御这种愤怒。愤怒是由病人的自卑情结引起的,病人的自大也是在防御这种自卑。(前面科胡特认为病人的自大幻想是移情,可是柯恩伯格的反应是很好玩的,他说这不是反移情的问题,然后他讲了反移情是怎样的。这里他转换了话题。当然他讲的治疗师可能有的反移情现象没错的。问题是他不认为病人的自大幻想是移情。后面他也说他的病人没有移情能力。)心理学空间-oG}#@@ M^V T \

.X{ y0e+ql@)bQa0HK:Yes, well certainly that is a persuasive concept, and many eminent clinicians find it so. I formerly accepted it myself. However, I have since come to the conclusion that the patient's rage is reactive. He is angry because in interpreting his grandiosity you have, in reality, attacked his narcissism.

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科胡特:是的,当然,这个概念很有说服力,很多著名的临床医生都这么认为。之前,我自己也接受(这样的观点)。然而,我后来的结论是:病人的愤怒是反应性的。他很生气,因为你对他的自大进行的诠释(分析),实际上你攻击他的自恋

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4t7Q:fl#Q nx0OK:Oh, but he can't enjoy his narcissism since he really feels inferior to the therapist.心理学空间f:q:D:i tb~m

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克恩伯格:哦,但他不能享受他的自恋,因为他真的在治疗师面前感觉自卑。(柯恩伯格为自己辩论。)(这点确实是对的,也是俩人都认同的。自恋人格障碍患者的问题是潜意识里也评判自己的自恋,他们的自卑是身份上觉得自己是有问题的。治疗的目的是帮他们建立起自我身份认同感。)

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k!\[3I;o8u}7b,o0HK:No, I think that is a later capacity. He really does not have the psychic structures necessary to support competitive feelings. To interpret as if he does, only becomes a demand from the therapist to be included in the patient's consciousness.心理学空间,MY5XW sFpGD(m

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科胡特:不,我想这是后面要抓住的东西。他真的没有足够的心理结构来支持竞争的情绪感受。(忽略这点)好像他能做到一样来解释(分析),这只会变成一种来自治疗师的要求,只为了将其列入病人的意识之中。心理学空间a/PUY,[6VD,tl+o

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!D_4F:M'u!`y*J0OK:There is no need for interpretations to be experienced as a demand by the therapist as long as the therapist is neutral.

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克恩伯格:只要治疗师是中立的,就没有必要将解释(分析)认为是治疗师的需求。心理学空间K%R P*Kp)~2V$I8y

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HK:The word is empathic, not neutral. I don't think there is any way to be neutral from your position. Aren't you at risk for feeling like you have failed if you allow the patient to exclude you? Even if feeling excluded did not provoke you, is it not still up to you, for the patient's sake, to prevent him from ignoring and depreciating you?

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g YyeOp MY5Q*u0If I may say so, my model gives the therapist a way to accept what the patient is doing and so provides him with a way to cope with the countertransference.心理学空间iJ3eS|!kt

)ykA8d7UC)B0科胡特:问题是(这里要)共情,而非中立。我不认为你的立场显示有任何中立。如果你允许病人将你排除在外,你有可能感觉到失败吗?即使被排斥的感觉并没有激怒你,为了病人的利益,你得阻止他忽视和贬低你,对吗?可这些您能决定吗?(科胡特强调的是治疗师和病人建立的关系)

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或许我可以这么说,我的治疗模型给了治疗师一种接受病人所做的方法,因此为治疗师提供了一种处理反移情的方法。心理学空间 VC`g+aO

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OK:Wait a minute. What you say about empathy, after all, goes without saying. I have to say that what you are really doing here is advocating complicity with the patient's withdrawal into grandiosity that you are obviously not all that happy with yourself.

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克恩伯格:等一下。毕竟,共情那是自不必说的。我不得不说,你在这里真正做的,是鼓吹和病人退缩到自大的共谋之中,显然你在这种共谋之中,对自己也并不那么满意。

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HK:[Falls silent at this point, permitting Kernberg's grandiosity.]

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h5E6VE7i ?'g+l(c0科胡特:【科胡特保持沉默,允许科恩伯格自大。】心理学空间 f:{g}8K?bx5G#TP

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OK:[continuing] I cannot see that your complicity--call it what you will--your endless patience, is any more than a manipulation, a corrective experience. And one that is not likely to be very corrective since we are talking about severely regressed patients who will interpret your behavior in magical, omnipotent ways.心理学空间 {p!|KLyE

Ril[$Vb+k-nG0克恩伯格:(继续说)我不明白你的共谋(随便你怎么表述),你无尽的耐心,不光是一种操纵,还是一种纠正。而且这不太可能纠正什么,因为我们谈论的是严重退化的患者,他们会用神奇的、无所不能的方式诠释你的行为。(柯恩伯格这里认为他的病人的自大和愤怒是不可想象的,换言之不可能共情的)

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HK:Otto, Otto. You really cannot take empathy for granted. To sustain it is a demanding task that can never be completely successful. It does not simply mean being a good diagnostician. You seem to be overlooking the fact that these patients are constantly testing the therapist over a long period, both with their grandiosity and with their tantrums.心理学空间`;_ K0na#f(n/LQ

na iAl0科胡特:Otto,Otto。你真的不能想当然的理解共情。它是很艰难的任务是永远不可能完全共情的。这不光是要成为一个好的诊断专家(就能做到共情)。你似乎忽视了这样一个事实,即,这些患者在很长一段时间内都在持续不断用他们的自大、他们的愤怒测试治疗师。(科胡特认为病人的自大愤怒是为了测试治疗师,是在建立关系。)心理学空间&Ci8M/h&et-t

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BAr9e1FM0OK:Well, there you have it. We may just be talking about different patients. In what you just said it is clear that you want to let the transference develop. But many of the patients I describe would not be able to tolerate analysis. Those who can tolerate analysis, that is, who can tolerate your "empathy" are already accepting your authority. My patient's tantrums are the real thing.心理学空间WvI|5A

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克恩伯格:好的,现在你可以看到。我们可能只是在谈论不同的病人。你刚才所说的很明显,你想让移情得到发展。但是我描述的许多病人都不能忍受分析。那些能够容忍分析的人,就是那些能够容忍你的“共情”的人,他们已经接受了你的权威。我病人的发脾气是真实的事情。(克恩伯格认为科胡特的病人病情没那么重,能够被共情的病人是能接受分析的病人,病人愿意接受治疗师为权威。言外之意是他的病人不能发展移情,不能被共情,也不能接受分析,是病更重。)心理学空间 j5Ksz`A-i

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HK:But those who have read my work realize that I do not think of these patients as capable of a transference. They experience the analyst as a selfobject. This must be allowed, which means not requiring the patient to take your interpretations lying down, if I may jest a bit here. The goal of treatment with such patients is for them to ultimately be able to experience the analyst as an authority; it cannot be a prerequisite for analysis.心理学空间"S3d T!ZU1Q

9Ct z x+TN5N0科胡特:但是那些读过我的作品的人意识到,我认为这些病人不具备移情能力。他们将分析师体验为自体客体(这里可以理解为病人的自我是虚空的自我中心的,不和任何客体产生关系的自我,也不接受影响的自我)。这些必须要允许的,这些意味着不需要病人接受你的诠释(分析)——如果我可以在这里有一丝的嘲弄的话。(诚然)治疗此类患者的最终目的就是让他们能够将分析师视为权威;(但)这不能成为分析的先决条件。

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Also, you say that these patients will misinterpret my restraint, but I must take issue with your faith in their ability to not misinterpret your interpretations.心理学空间M$FQ xk2O1Tx"D6s)}

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还有,你说,这些病人会误解我的克制(前面克恩伯格说科胡特有无尽的耐心),但我必须对你的信心表示异议,因为他们有能力不误解你的解释(分析)。心理学空间{ D]#w5b {

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-Ne"S)fC0x{,?-@.@0OK:Well, you are simply talking about the art of interpretation: timing, accuracy, and all the rest. 心理学空间{YJt+IH%C

d/u7w9K J"I0克恩伯格:好吧,你只不过是在谈论诠释的艺术:时机,准确性,以及其他的一切。心理学空间7V0P+Nh/_*x:X W ^g

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8R`On(q0HK:Now, there you have it. By insisting on your authority in this way, you are taking the traditional position, that you are right and the patient is wrong, and that the patient should learn to appreciate that fact. But what you are doing here is duing the patient's duation of you. I'm afraid that the more objective you try to be, the more that will prevent the patient from being able to experience an object relationship.

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+NG2n [aS*X0科胡特:现在,在这里你可以看到。你坚持自己权威的方式,是采取传统立场,即,你是对的,病人是错的,病人应该学会欣赏这个事实。但你在这里这么做,是因为病人评价了你(科胡特认为,病人不接受克恩伯格的分析而发脾气,克恩伯格无意识里认为是评价他的)。恐怕你越是客观,病人就越无法能够体验到一种客体的关系。心理学空间ff!{S(? cH-Di V;u

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OK:Resistance to analyzing or to making interpretations takes many forms. You will admit, I'm sure, that you are not the first, nor will you be the last, to offer corrective experience, to use parameters--call it what you will--rather than to endure the rigors of the negative transference. 心理学空间;o7aoy6[9hM)])w y

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克恩伯格:阻抗分析或诠释有很多的形式。你得承认,我肯定,你不是第一个,也不是最后一个,让(病人)感受到被纠正,使用各种规范——随便你怎么叫它——而不是忍受负性移情的压力。

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HK:Obviously we each must work in our own way, and I hope there is something to be gained by such a debate. Analysts usually talk only to other analysts who agree with them, which can create the unfortunate impression that analytic training makes it difficult for us to accept criticism.

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科胡特:很明显,我们每个人都必须以自己的方式工作,我希望通过这样的辩论有所收获。分析师通常只会和意见相同的分析师谈话,这会给人一种不幸的印象,即分析师的培训让我们难以接受批评。心理学空间[:|o$FNHn

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j+jiRR/n9R!C6M0Endnote:心理学空间 p'q lO$O-wHX

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尾注:

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Kernberg gets the last word because Kohut has to respect his narcissism. Kohut has to fall silent at a key point because he obviously can't say to Kernberg that he does not want to injure his narcissism. The point is that since Kohut's views are not that different from Kernberg's, he has to avoid interpreting. He only has id analytic criticisms of Kernberg's id analysis.

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-?[qV.@/x0v L?-M0克恩伯格有了定论,因为科胡特必须尊重他的自恋。科胡特必须在关键时刻保持沉默,因为他显然不能对克恩伯格说他不想伤害他的自恋。关键是,由于科胡特的观点与克恩伯格的观点没有多大的不同,他只是尽量不分析。他分析性批评了克恩伯格分析师身份中的分析。(尾注的作者是觉得科胡特对克恩伯格也没有做到共情,这是科胡特身份中存在的 has id analytic,我个人对这句话赞同前半句,后面我不赞同,我直觉科胡特是不够自信或者说自我身份认同不足够导致的,并不是他自我身份里就喜欢分析别人。)

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Kohut's patients' "grandiosity" and their tantrums are just as

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C8x.p]Te \#k7W*q*v}0iatrogenic as Kernberg's patient's rage. See the case of Miss F in Ego Analysis vs. Self Psychology

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C0d6eo m0{ nv0科胡特的病人的“自大”和他们的发脾气就像科恩伯格病人的愤怒一样是医源性的。参见《自我分析与自体心理学》中的F小姐的案例(这个尾注的作者是认为科胡特和柯恩伯格病人的自大,愤怒都是他们工作不当引起的。其实科胡特在F小姐案例中很坦诚地讲了他怎样犯科恩伯格这样的错误,所以他说病人的愤怒是反应性的,是治疗师没有连接和共情,分析病人,攻击了病人的自恋导致的。这个案例的挫败和经验才让他开始创立自体心理学的。还有病人的自大不是医源性的,病人可都是自恋人格障碍患者啊!)心理学空间5e^Urd%qrA]

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'vHj'\0yu8O0Intersubjectivists are much freer to bash Kernberg. Following Kohut's lead, they bash themselves first--but they see it as a counter- transference issue (hence "intersubjectivity"). This means they still miss (don't pick up on) subtle self-reproaches. They still take

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counterphobic behavior literally and so心理学空间];s9TbEy v5A

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主体间主义者更自由地抨击科恩伯格。在科胡特的带领下,他们首先抨击自己——但他们把这看作是一个反移情的问题(因此是“主体间性的”)。(后面英文不完整,没法很好的理解了)。心理学空间8x[5S3@m-lJ&{8rt+K

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(?5NCW4E2eZ0姚小青,美国Friends University婚姻家庭治疗硕士,生物能治疗,荣格心理,客体关系受训,整合疗法。email: xiaoqingyao@aol.com

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朱一峰 译本及评注

t6FYpFoZR0科胡特:我很乐意进一步了解您的任何想法,以提高这次对话,或者进一步阐述本次对话内容。心理学空间 WhyQIR

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克恩伯格:海因茨,你难道不是在纵容病人的认为自己高人一等、 要治疗师屈尊俯就的夸大幻想吗?      ?心理学空间7JUD,XN n-Z!q\X

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OK:Heinz, are you not indulging the patient's grandiose fantasy that he is the superior one, patronizing the therapist? 

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Q#Ks/I p o"CD F8A0科胡特:当然(可以有)。如果病人要经历这个发展阶段,他必须被允许 在这种幻想之中。他的夸大 必须得到允许。这(允许他的夸大 ,对治疗师来说)很困难,因为病人表现出这样的幻想会疏远 治疗师。这是在测试治疗师的共情能力。

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'c:h)XqS}7`2WV0(科胡特认为如果夸大幻想是患者需要经历的发展阶段,那就需要被允许。病人的夸大会让治疗师有疏远的反移情,这考验治疗师的共情能力)

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克恩伯格:不,这不是反移情的问题。反移情问题是治疗师害怕病人的愤怒。治疗师不愿意面质患者的幻想 ,害怕激怒他的愤怒。这是在测试治疗师是否能够忍受病人的愤怒。纵容病人的夸大 ,只是 支持了治疗师 对这 愤怒的防御。愤怒是由病人的自卑情结引起的,病人的夸大 也是在防御这种自卑。

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(科恩伯格认为这个时候治疗师的反移情不是疏远,而是害怕,害怕病人的愤怒,因此纵容患者的夸大幻想。所以科恩伯格认为这里考验的不是治疗师的共情能力[理解患者的夸大需要],而是治疗师忍受病人愤怒的能力。)

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LtG!{1W0tL@,M0科胡特:是的,当然,这个想法(concept) 很有说服力,很多著名的临床医生都这么认为。之前,我自己也接受(这样的观点)。然而,我后来的结论是:病人的愤怒是反应性的。他很生气,因为你对他的夸大 的诠释,实际上是在攻击他的自恋。

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#S NBA)c'JK!_0(科恩伯格认为患者的愤怒是为了防御自卑,而科胡特认为患者的愤怒是自恋受伤的反应,患者自恋受伤是自己的夸大需要被治疗师攻击了)心理学空间7{:U2B&^2` Q9b0e9k

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克恩伯格:哦,但是他不能享受他的自恋,因为他真得觉得自己低治疗师一等。心理学空间5|:v#ugZMAo'b

y(Q;Y!sM"M0(科恩伯格认为患者还无法享受自恋(夸大),因为患者其实是自卑)

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Wwu%Z mO2c-jo4^0科胡特:是的 ,我想这是后面 要发展的能力(capacity)。他真的 没有足够的心理结构来支持竞争的情绪感受。如果解释他自卑 ,这只会变成一种来自治疗师的要求,只为了将其列入病人的意识之中。心理学空间-s7p'~/eP y

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(科胡特同意患者还没有享受自恋的能力,因为以前夸大幻想是被打压的,所以被压抑了。将其夸大诠释为防御自卑,只会成为一个来自治疗师的要求,要求患者意识到自己自卑)

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?e L8?r s0克恩伯格:只要治疗师是中立的,就没有必要进行诠释(导致被体验为治疗师的需求 。

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5u:S,|Z(cM R(n0(科恩伯格认为,只要治疗师是中立的,就不会想要去打压[例如面质]患者的夸大)心理学空间bB#m6lG/b

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科胡特:这词应该是共情 ,而非中立。我并不认为你的立场之中有任何中立 。如果你允许病人将你排除在外,难道您不是处在感觉已经失败的风险吗 ? 即使被排斥的感觉并没有激怒你,为了病人的利益,是否你仍然不能去阻止他忽视和贬低你 ?如果我可以这么说,我的模型给了治疗师一种接受病人所做作为的方法,并且为治疗师提供了一种处理反移情的方法。心理学空间$mF%n~ UyV

.c H0B2Pt/jU0(科胡特认为,正是因为治疗师共情地了解到患者的内心状态,才不去诠释。正是基于共情,才去做了看似中立的事)

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克恩伯格:等一下。毕竟,你所说的共情是不言而喻的。我不得不说,你在这里真正做的,是鼓吹和病人共谋地退缩到夸大  中,显然你在这种共谋之中,你自己也不会怎么舒服 。心理学空间[h(W6^0|

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(科恩伯格认为这里面的共情是自然的,认为科胡特允许患者的夸大还是一种共谋,并且治疗师也会有反移情)心理学空间K8wmly?

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科胡特:[此时此刻默不作声,允许科恩伯格的夸大 。]

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克恩伯格:(继续说)我看不出来 你的共谋,或 用你的话说 ,你无尽的耐心,除了 是一种操纵,一种矫正性 经验,还能是什么。而且这不太可能非常有矫正(corrective) 性,因为我们谈论的是严重退化的患者,他们会用魔法 的、全能 的方式诠释你的行为。心理学空间 lsw&v,b1\0y!i@B

.l|/yarc0(科恩伯格认为科胡特的所谓耐心其实是共谋,是一种矫正性体验。而且也不会有太多矫正性效果,因为这些患者会有魔法性思维、全能等防御机制心理学空间Ox7i*rGp

\2[[/WX"I|-MX0科胡特:Otto,Otto。你真的不能想当然的理解共情。维持 共情是一项永远不会完全成功的艰巨任务。这不仅仅意味着要成为一个好的诊断专家。你似乎忽视了这样一个事实,即,这些患者在很长一段时间内都在持续不断用他们的夸大 、他们的耍性子 考验 治疗师。心理学空间oB.H#X ]FI

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(科胡特说肯恩伯格有点小看共情,持续保持共情是很难的。)心理学空间7SP0Kl5LE P2YK)i)M

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克恩伯格:好的,现在你明白了 。我们可能只是在谈论不同的病人。你刚才所说的很明显,你想让移情得到发展。但是我描述的许多病人都不能忍受分析。那些能够容忍分析的人,就是那些能够容忍你的“共情”的人,他们已经接受了你的权威。我病人的发脾气,这是真实的事情。心理学空间!|#TbU&M MM r

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(科恩伯格认为科胡特现在终于明白了有些患者就是用夸大、耍性子考验治疗师。因此也许两个人是在说不同类型的患者,科恩伯格所说的患者就是难以开始发展移情)

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科胡特:但是那些读过我的作品的人意识到,我认为这些病人不具备移情能力。他们将分析师体验为自体客体。这意味着不去要求患者毫不反抗地接受你的诠释。如果我这里有些顽皮的话,请允许   。治疗此类患者的最终目的就是让他们能够将分析师视为权威;这不能成为分析的先决条件。

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(科胡特说读过其作品的人会知道,科胡特认为这些病人不会发生科恩伯格所说的(力比多)移情,而是自体客体移情。这些人的治疗目的是要让他们将分析说视为权威[让压抑的理想化移情重新发展])

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还有,你说,这些病人会误解我的克制,但我必须质疑你(对他们不会误解你的诠释之能力)的信心 。

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(科胡特说你说他们会误解我,但同样他们也可能会误解你啊。)心理学空间9l'^(GQ#YL

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@+W"_,DP ]0克恩伯格:好吧,你只不过是在谈论诠释的艺术:时机,准确性,以及其他的一切。心理学空间ciB LOD&~

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b_ TYn/~0科胡特:现在,你已经明白 。你坚持自己权威的方式,采取的是传统立场,即,你是对的,病人是错的,病人应该学会欣赏这一事实。但实际上你之所以在此如是为之,是因为病人贬低了你。恐怕你越是客观,病人就越无法能够体验到一种客体的关系。心理学空间.X/XU J}SxZ-y"?

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克恩伯格:拒绝 分析或者拒绝作出诠释有很多的形式。我敢肯定,你将承认,你不是第一个,也不是最后一个, 提供矫正性 经验,为了利用各种因素——随便你怎么说——而不是忍受负性移情的严酷。心理学空间8OW'k pW[ KR[*z

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(科恩伯格认为科胡特依然是在拒绝分析患者,拒绝对患者作出诠释,而是指在提供矫正性体验,而不是去承受负性移情)心理学空间s!Pp`(V"K FKx

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科胡特:很明显,我们俩 都在 各自的思维方式中  ,我希望通过这样的辩论有所收获。分析师通常只会和意见相同的分析师谈话,这会给人一种不幸的印象,即分析师的培训让我们难以接受批评。心理学空间%]0[R/V@gV

(Gnut)Y^0(科胡特说好吧,两人好像鸡同鸭讲。)心理学空间0gd$v)~*j,M'X$Ra


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原文

DEBATE  BETWEEN KOHUT (HK) AND KERNBERG (OK)

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I'd enjoy getting any of your ideas about how to improve on or further elaborate this dialogue.

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OK: Heinz, are you not indulging the patient's grandiose fantasy that he is the superior one, patronizing the therapist? 心理学空间t~$l ~d

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g-v"]N"{,js0HK: Of course. The patient must be indulged in this fantasy if he is to experience this developmental stage. His grandiosity must be permitted. This is difficult because for the patient to act out such fantasies alienates the therapist. It is a test of the therapist's capacity for empathy.

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&sF"y'M^7M$f0OK: No, that is not the countertransference problem. The countertransference problem is therapist's fear of the patient's anger. The therapist hesitates to confront the patient's fantasy for fear of provoking his rage. It is a test of whether the therapist can withstand the patient's rage. Indulging the patient's grandiosity only supports a defense against this rage. The rage is generated by the feelings of inferiority that the patient's grandiosity also defends against.心理学空间Mty7N7y'n

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z,L1J |(E3cB0HK: Yes, well certainly that is a persuasive concept, and many eminent clinicians find it so. I formerly accepted it myself. However, I have since come to the conclusion that the patient's rage is reactive. He is angry because in interpreting his grandiosity you have, in reality, attacked his narcissism.心理学空间0@-{^ZL d-Z

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T |"zn0y-{| O[bU0OK: Oh, but he can't enjoy his narcissism since he really feels inferior to the therapist.心理学空间rs3p7aT V!S&i[7XE

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I,V8TU(L)soE0HK: No, I think that is a later capacity. He really does not have the psychic structures necessary to support competitive feelings. To interpret as if he does, only becomes a demand from the therapist to be included in the patient's consciousness.心理学空间r2_Ki |/wqx8dB

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OK: There is no need for interpretations to be experienced as a demand by the therapist as long as the therapist is neutral.心理学空间O,f.r$u^5X7f5f

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3@3lB.muX0HK: The word is empathic, not neutral. I don't think there is any way to be neutral from your position. Aren't you at risk for feeling like you have failed if you allow the patient to exclude you? Even if feeling excluded did not provoke you, is it not still up to you, for the patient's sake, to prevent him from ignoring and depreciating you?心理学空间db&V'@0n0]1s!S

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If I may say so, my model gives the therapist a way to accept what the patient is doing and so provides him with a way to cope with the countertransference.

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R0M4YAcK5i ~p0OK: Wait a minute. What you say about empathy, after all, goes without saying. I have to say that what you are really doing here is advocating complicity with the patient's withdrawal into grandiosity that you are obviously not all that happy with yourself.

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"w6d-^g+G9O;w6^0HK: [Falls silent at this point, permitting Kernberg's grandiosity.]

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yn:@ ~0M)W0OK: [continuing] I cannot see that your complicity--call it what you will--your endless patience, is any more than a manipulation, a corrective experience. And one that is not likely to be very corrective since we are talking about severely regressed patients who will interpret your behavior in magical, omnipotent ways.

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b#A[uSJ2uU0HK: Otto, Otto. You really cannot take empathy for granted. To sustain it is a demanding task that can never be completely successful. It does not simply mean being a good diagnostician. You seem to be overlooking the fact that these patients are constantly testing the therapist over a long period, both with their grandiosity and with their tantrums.心理学空间8n"{1wUX&m

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8VV~ n7b,Mm"q+b0OK: Well, there you have it. We may just be talking about different patients. In what you just said it is clear that you want to let the transference develop. But many of the patients I describe would not be able to tolerate analysis. Those who can tolerate analysis, that is, who can tolerate your "empathy" are already accepting your authority. My patient's tantrums are the real thing.心理学空间zJD*l I%BC1Q

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u6`gs y&_+XER0HK: But those who have read my work realize that I do not think of these patients as capable of a transference. They experience the analyst as a selfobject. This must be allowed, which means not requiring the patient to take your interpretations lying down, if I may jest a bit here. The goal of treatment with such patients is for them to ultimately be able to experience the analyst as an authority; it cannot be a prerequisite for analysis.

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?QT8l1s/X |O8[0Also, you say that these patients will misinterpret my restraint, but I must take issue with your faith in their ability to not misinterpret your interpretations.心理学空间*q4zxY;O7q3P

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!F2SE-K\9R\L0OK: Well, you are simply talking about the art of interpretation: timing, accuracy, and all the rest. 心理学空间SjBD2FI!\

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i#mTu,E1p1n0HK: Now, there you have it. By insisting on your authority in this way, you are taking the traditional position, that you are right and the patient is wrong, and that the patient should learn to appreciate that fact. But what you are doing here is duing the patient's duation of you. I'm afraid that the more objective you try to be, the more that will prevent the patient from being able to experience an object relationship.

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OK: Resistance to analyzing or to making interpretations takes many forms. You will admit, I'm sure, that you are not the first, nor will you be the last, to offer corrective experience, to use parameters--call it what you will--rather than to endure the rigors of the negative transference. 

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-E-x ~-}!h_2@8~K0HK: Obviously we each must work in our own way, and I hope there is something to be gained by such a debate. Analysts usually talk only to other analysts who agree with them, which can create the unfortunate impression that analytic training makes it difficult for us to accept criticism.心理学空间#f"I:}_0_@0^$C+us

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Endnote:

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n9t(X)}?r)R0Kernberg gets the last word because Kohut has to respect his narcissism. Kohut has to fall silent at a key point because he obviously can't say to Kernberg that he does not want to injure his narcissism. The point is that since Kohut's views are not that different from Kernberg's, he has to avoid interpreting. He only has id analytic criticisms of Kernberg's id analysis.心理学空间m)D/i3i1_i

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t5Y:W W&HW7f l,N)q0Kohut's patients' "grandiosity" and their tantrums are just as iatrogenic as Kernberg's patient's rage. See the case of Miss F in Ego Analysis vs. Self Psychology心理学空间@G2a[r(V,v

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Intersubjectivists are much freer to bash Kernberg. Following Kohut's lead, they bash themselves first--but they see it as a counter- transference issue (hence "intersubjectivity"). This means they still miss (don't pick up on) subtle self-reproaches. They still take counterphobic behavior literally and so心理学空间^\9} W0k

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TAG: Kernberg kernberg Kohut kohut KOHUT 康伯格 科胡特
«施虐受虐,性兴奋和变态 1991 Sadomasochism, Sexual Excitement, and Perversion 克恩伯格 | Otto F. Kernberg
《克恩伯格 | Otto F. Kernberg》
Kernberg, O.F. (1982). Self, Ego, Affects, and Drives.»