Precision of interpretation)   


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.


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.





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.






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.


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。


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)






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.






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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