克莱因派分析师处理投射性认同的技术之精确的解释
时间:2014年08月16日|1432次浏览

Precision of interpretation)   

   
克莱因派分析师处理投射性认同的技术精确的解释

作者:Robert Waska  翻译:胡尚伟

 

Some Kleinians feel it important to be quite precise in what they say to the patient when interpreting PI. They feel it important to avoid general or vague interpretations.

有些克莱因派分析师认为,对投射性认同进行解释时,他们对病人所说的内容的精确性是很重要的。他们觉得,回避概括性或模糊的解释是重要的。

O’Shaughnessy (1983) wrote of her work with a Mr B:

As I tried to work, I felt almost as if Mr B was physically pushing into me: I felt watched in my head, uncomfortable, restricted in what I could say – only obvious familiar interpretations seemed to exist as possibilities. These experiences were my reception of Mr B’s primitive communications and defenses, the interaction between patient and analyst conceptualized and explained by Klein and Bion in terms of projective identification. I tried to put these experiences into words to Mr B. I spoke about his need to get into my mind, his feeling of being located here, his maneuvering of me to give him familiar interpretations, and his relief at interpretations he knew would come. (O’Shaughnessy 1983:282)

O’Shaughnessy makes specific use of her countertransference feelings. She is informed by her countertransference and then proceeds to make concise interpretations based on the information it gives her. She does not remain silent and she does not make broad or generalized interpretations about the PI process. She makes precise, moment-to-moment PI interpretations based on countertransference.

I think this is particularly important when dealing with more disturbed patients. More fully intergrated, neurotic patients can usually find understanding and direction through more general or broad interpretations. They can find reassurance and insight in them and then feel free to expand them to find more specific feelings and thoughts to explore, thus generating a healthy cycle of insight and growth. More disturbed patients can hear a genralized interpretation as a confirmation of their distortions of reality and feel even more persecuted. They can feel abandoned or attacked by the lack of specificity. So, more detailed and precise interpretations of PI, as understood through the countertransference, are much more helpful and healing to the regressed patient who is already lost in the generalization of their fragmented mind.

奥肖内西1983)对她与B先生的工作这样写道:

当我努力工作时,我感觉B先生好像躯体上进入我内部:我感觉在头脑里被注视,很不舒服,限制了我要说些什么——只能尽可能使用非常明显且熟悉的解释。这些就是我接收B先生原始的交流和防御时的体验,这种病人与分析师间的互动用克莱因和比昂的术语来说就是投射性认同。我尽量把这些体验向B先生转化成语言。我说了他需要进入我的脑子里,我被困住的感觉,他控制我给她熟悉的解释,还有解释后缓解他知道会出现。

肖内西特别使用了她的反移情。她基于她的反移情所给予的信息对病人的投射性认同进行了精确的解释。她没有保持沉默,她也没有对投射性认同进行扩展或概括性解释。她基于反移情对投射性认同的解释很精确,此时此地。

我认为,在处理更加困扰的病人时这一点特别重要。更加充分整合的神经症病人可以通过更加概括性或扩展性的解释获得理解和方向。他们从中获得保证和洞察,感觉自由地扩展它们以至于发现需要探索的更加具体的情感和思想,如此形成了洞察和成长的良性循环。更加困扰(严重)的病人听到概括性解释,会把它作为对扭曲现实的确认和更感到被迫害。他们把缺乏具体的东西感觉为被抛弃或被攻击。因此,正如通过反移情获得的,对投射性认同的更加详细和精确的解释,对退行的病人来说,是更有帮助,是有疗愈作用的,这些退行的病人此时已经迷失在他们思维碎片的归纳中。

Betty Joseph (1993) describes the need for the analyst’s PI interpretations to be focued on the moment-to-moment nature of the tranference in a precise manner, to avoid a mutual acting out. She writes:

 We shall only succeed if our interpretations are immediate and direct. Except very near a reasonably successful termination, if I find myself giving an interpretation based on events other than those occuring at the moment during the session, I usually assume that I am not in proper contact with the part of the patient that needs to be understood, or that I am talking more to myself than to the patient. (Joseph 1993:87 italics in original)

While these directives show the proximity of her PI interpretations, Joseph also has technical guides as to what focus on closely. She writes:

the guide in the transference, as to where the most important anxiety is, lies in an awreness that, in some part of oneself, one can feel an area in the patient’s communication that one wishes not to attend to – internally in terms of the effect on oneself, externally in terms of what and how one might interpret. Joselph 1993:111

The countertransference feeling of wanting to avoid a certain area of difficulty with the patient helps center the analyst on what the most current PI anxiety might be. Being precise about exactly what the PI anxiety could be is important to the effectiveness of the interpretive process. The “ I don’t want to talk about it” sensation is guidepost to the analyst as to what the patient is careful to avoid.

贝蒂约瑟夫(1993)认为对投射性认同的精确性解释需要聚焦于移情此时此刻的属性,以避免相互之间的见诸行动。她这样写道:

我们的解释只有是即时的、直接的,才能成功。除了分析要成功地结束的临近时刻之外,如果我针对事件给予解释而非分析过程中所发生的事件,我通常假定我并不适合触碰病人需要被理解的部分,或者我对自己比对病人谈的更多。

尽管这些指导已经显示出了约瑟夫对投射性认同的解释,另外,她还写了关于如何聚焦于投射性认同的严密解释的技术指南。她写道:

最重要的焦虑所在的地方就是移情,对移情解释的指南基于这样的意识,在自体的某部分,一个人感觉能够感受到病人在交流中不希望被人触及的部分——从内在来说是对他自己的影响,从外部来说,一个人解释了什么和如何解释的。

想回避与病人工作的某部分困难的反移情感受有助于使分析师聚焦于投射性认同最当下的焦虑内容。精确的了解投射性认同所涉及的焦虑内容对有效地解释是重要的。“我不想讨论它”的感觉向分析师提示病人小心回避的内容。

Joseph describes her treatment of a young woman who impressed her in the first few weeks by talking a great deal and presenting a wealth of materials, yet it all seemed somehow hollow. Joseph began to get the picture, through the transference, of a woman who tried to fit in with her objects as best as possible, but felt despair at the hope of fever being truly understood. Joseph writes:

she had deeply unconscious despair about ever achieving anything of value and being understood, valued, or cared for. This I tried to convey to her, showing how she projected into me an internal phantasy mother who was felt not to understand, to be apparently incapable of contact; and how she built up a defensive system against recognizing her despair by finding in, accepting, flattering, and adjusting to me or what she phantasied about me.

Joseph goes on to illustrate the difficulty of this type of PI situation. The woman could rarely accept such interpretations because her phantasies disallowed the taking in to such gifts and rejected the image of a giving or understanding object. Nevertheless, the analyst verbally conveyed the intrapsychic dynamic that was occuring the nature of the intrapsychic relationship this patient was projecting.

约瑟夫讲述了一个女个案,她在前几次分析里给约瑟夫留下了深刻的印象,她谈了大量的很丰富的材料,然而所有的这些看起来有些空洞。约瑟夫通过移情获得这样的画面,一个女人努力地尽可能与她的客体相一致,但她在希望得到真正的理解方面感到绝望。约瑟夫写道:

她对于获得有价值的事情和被理解、被珍视或被关心方面有着深层无意识的绝望。这也是我努力传达给她的,向她说明她是如何把一个内在的幻想的妈妈投射给我,她感觉不到这个妈妈的理解,也明显地无法碰触到;还想她说明她是如何建立一套防御体系,比如体谅(fitting in),接纳,讨好和适应我或者她幻想中的我等方式,来拒绝意识到她的绝望。

约瑟夫继续举例来说明(处理)这种投射性认同的困难。这个女人几乎我不能接受任何解释因为她的幻想否认吸收这样的礼物和拒绝给予或理解的客体。然而,分析师用语言传达给她这种内在的动力,即投射性认同机制,也正是这种机制形成了移情。约瑟夫很精确的了解了病人投射给她的这种内在关系的性质。

In investigating patients who are self-destructive, Joseph notices how PI plays a role. She writes:

 a type of “PI” in which despair is so effectively loaded into the analyst that he seems crushed by it and con see no way out. The analyst is then internalized in this form by the patient, who becomes caught up in this internal crushing and crushed situation, and paralysis and deep gratification ensue.

Again, Joseph is very careful, technically, in how to interpret PI. Precision guides her words. There are multiple affects and phantasies operating within the PI mechanism, therefore what is emphasized in the interpretation is a clinically vital decision. Joseph states:

 I believe it is technically extremely important to be clear as to whether the patient is telling us about and communicating to us real despair, depression, or fear and persecution, which he want us to understand and to help him with, or whether he is communicating it in such a way as primarily to create a masochistic situation in which he can become caught up.

Joseph constanly searches for the deeper unconscious aspect of PI. She writes, “if we work only with the part that is verbalized, we do not really take into account the object relationships being acted out in the transference” (1993:158)

通过调查有自我揭露的病人,约瑟夫研究了投射性认同所起的作用。她写道:

有一种投射性认同,绝望被充分地投射到分析师那里以至于他看起来被绝望压垮了,且找不到出口。分析师就以这种形式被病人内化,病人渐渐地沉湎于这种已经被压垮和正在被压垮的情境里,瘫痪,然后是深深地满足。

再一次,约瑟夫非常细心且技巧地解释了投射性认同。用词精确。在这个投射性认同里有多种情感和幻想,因此,在解释中强调什么是临床上的重要取舍。约瑟夫说道:

我认为,在技术上这是及其重要的,就是要明白,病人是否要告诉我们和向我传达真实的绝望、抑郁或恐惧和迫害妄想,这些他是想要我们理解和帮助,或者他用这种方式传达给我们主要是创造一种受虐的情景,而他能渐渐地沉浸于其中。

约瑟夫不断地寻找投射性认同中更深层的无意识方面。她写道:“如果我们只是与可以用语言描述的部分工作,我们就不能真正地考虑到在移情中见诸行动的客体关系”。

She notes that this lack of precision leads to inaccurate technique: Interpretations and understanding remain on the level of the individual associations, as contrasted with the total situation and the way that the analyst and his words are used, we shall find that we are being drawn into a pseudo-mature of more neurotic organization and missing the more psychoic anxieties and defenses… being acted out in the transference.

So, Joseph is once again pointing out how overly generalized interpretations can mask the patient’s real pathology and lead to a mutual acting out, a false sense of cure. This is an unconscious, global agreement between analyst and patient that progress is being made. Issues are only examined in safe,broad, and general ways. Both parties avoid any real or specific focus as a way to escape the mutual anxiety of the patient’s fears and aggressive phantasies that are occuring through a PI process.

I would add that the analyst’s broad or general interpretation might be helpful on occasion if the patient use the broadness as a vehicle to associate and bring in more specifi material. However, if the patient matches the broad interpretation with their own vague or general associations, then it becomes a collaboration in evasive pathology, a PI acting-out progress.

约瑟夫指出,缺乏精确性将导致技术错误:

解释和理解保持在个体自由联想的这个层面上,与整个情景和分析师以及他的话语被应用的方式做比较,我们应该发现,我们正被拖入一种伪成熟或比神经症还神经症的的组织和错过更多精神病焦虑和防御…在移情中见诸行动了。

因此,约瑟夫再次指出过度模糊的解释能够掩饰病人的真正病理且导致一种共谋,虚假的疗愈。这是病人与分析师达成的一种无意识的共谋:病人改善了。这种问题只有用安全、宽泛和概括性的方式才能够检查出来。双方都避免任何真实或特定的焦点,双方用这种方式来避开在投射性认同过程中所出现的病人的恐惧和攻击幻想所引发的共有的焦虑。

我要补充的是,分析师这种宽泛或笼统的解释在某些情况也许有帮助,比如病人把这种笼统性作为一种自由联想和引进更具体的材料的工具。但是,如果病人把这种宽泛的解释和他们自己的模糊或笼统的联想进行匹配的话,那么它就变成了一种回避的共谋,是投射性认同见诸行动了。

 

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

 

标签: 克莱因  投射性认同  临床  解释  精确 

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