奥格登《投射认同与心理治疗技术》 第4章
时间:2016年04月25日|2143次浏览|1次赞

王静华按:这是李孟潮老师在2016年2月份开始的《心之母体》微课上提供的1982年版的奥格登的《投射认同与心理治疗技术》,不同的同学翻译了不同的章节,其中第二章“投射认同概念”请访问羽毛之:http://www.psychspace.com/home/space-15701-do-blog-id-4855.html。我翻译了第4章“不同精神分析技术的对比”和第5章“母性过度投射认同带来的发展性影响”。投射认同是一个非常常见的心灵间、主体间交流过程,作为咨询师或者是分析师,仔细理解并体会、体验着在会谈期间发生的心灵互动,并纳入到咨询框架内,才会心怀慈悲地构建分析空间,形成个人意义,并帮助来访者内化,从而拥有了自己的心灵空间和心理辩证过程,也促进生活空间、人际空间、关系空间的打开,达到更好地生活的目标。




CONTRASTING PSYCHOANALYTIC —APPROACHES=不同精神分析技术的对比
翻译:王静华 Mar, 2016
概要:比较了“克莱因学派”、“英国中间学派”、“经典理论”和“近代精神分析小组”是如何认识及处理投射性认同。克莱因学派在处理投射性认同的方式就是通过语言进行诠释,但作者认为对于相对健康的患者这是有用的,但是对于人格障碍的病人,这反而会导致病人远离治疗师。温尼科特是英国中间学派的代表者,处理治疗性退行时方法受到诟病,但奥格登认为温尼科特的早期二元关系理论是其理解投射性认同的基本框架。经典理论从弗洛伊德开始就将移情和反移情割裂开,并认为反移情是治疗师自身缺陷导致,限制了在经典理论背景下投射性认同的发展。尽管如此, 经典精神分析技术也开始引入相互作用关系的视角,例如“控制理论”。近代精神分析团体发展出“参与阻抗”技术来处理投射性认同,这个模式使用的非解释模式来处理投射性认同。这种方式是基于这样的一个理解:自恋性固着的病人(包括边缘性人格障碍病人和精神分裂病人)是没有能力接受和整合任何未被他自身感觉和经验的部分。因此是通过治疗师具身化这个投射性认同的角色并与病人对话,从而修正并返还给病人。

Until recently very few therapists or analysts outside of the Kleinian group have used either the term or the concept of projective identification in their clinical thinking. However, inasmuch as the phenomena addressed by this concept (uncon¬scious projective fantasies in interplay with congruent feelings evoked in the recipient) are an aspect of all psychotherapeutic work, each school of psychoanalytic thought has, over time, developed methods of handling this facet of the therapeutic interaction. In the present chapter, the relationship between the technical approach presented in this volume (see in particular chapters 2 and 3) and the principles of technique espoused by analysts of the classical, Kleinian, British Middle, and Modern Psychoanalytic Groups will be discussed.
直到最近,除克莱因学派之外的治疗师或分析师,才在临床上使用投射性认同这个术语或概念。但是,由这个概念引发的现象(无意识的投射性幻想与受到投射的人内在被诱发的感觉之间相互影响和调谐)会在所有精神分析治疗工作中发生,因此随着时间的推进,每一个精神分析学院已发展不同的方法来处理治疗性关系中的这个方面。在本章中,将对本书描述的技术性方法(参见第2章和第3章)与经典精神分析坚持的技巧原则之间的关系进行讨论,涉及:Klein克莱因, British Middle 英国中间派和Modern Psychoanalytic Groups近代精神分析团体。

THE KLEINIAN APPROACH克莱因学派
Because projective identification was first described by Melanie Klein (1946), it is commonly, though erroneously, as¬sumed that it is inextricably linked with Kleinian theory (see, for example, Meissner, 1980).  Projective identification has no inher¬ent connection with any aspect of specifically Kleinian meta¬psychology or clinical theory (for example, the Kleinian notion of the primacy of the death instinct, its assumptions concerning the infant’s capacity for fantasy activity from the earliest days and weeks of life, and the idea that the Oedipus complex and superego develop in the first year of life). 
投射性认同是由Klein于1946年首先提出来的,所以会被错误地认为它与Klein理论息息相关、不可分割(参见,Meissner,1980)。但是投射性认同和克莱因理论超个人心理学或临床理论并没有内在的联系(例如,克莱因理论中重要的死本能概念,它假设婴儿一出生并在生命的早期就具有幻想的能力,而且在生命的第一年就开始发展恋母情结和超我。)
Similarly, it is often incorrectly assumed that there is a necessary link between the clinical application of the concept of projective identification and Kleinian technique. In Kleinian technique (Klein, 1948,1961; Segal, 1964,1967), almost all inter¬ventions are made in the form of the interpretation of the unconscious fantasy underlying the principal anxiety of the session. In contrast with classical technique, these interpretations do not begin by addressing the more conscious and preconscious defensive aspects of the material. Instead, the content of the underlying unconscious fantasy is interpreted directly,the ra¬tionale being that it is these unconscious fantasies that are producing the central anxiety of the session and that the analyst would be remiss not to talk with the patient about what is bothering him (Klein, 1948). Moreover, these interpretations of unconscious fantasy (psychological manifestations of instinctual drives and defenses against these drive derivatives) are almost always transference interpretations and are offered from the very outset of therapy: "In my own experience I have not had a case in which I did not interpret the transference from the start'* (Segal, 1967,p. 174).
类似地,还经常错误地假设投射性认同的临床应用和克莱因理论技术有必然的联系。克莱因理论技术(Klein克莱因, 1948,1961; Segal西格, 1964,1967),几乎所有的干预都是对无意识幻想的解释,这些无意识幻想源于对话中的原始焦虑。与经典技术不同,这些诠释开始并不关注资料中更加意识化和前意识化中防御性的部分。反而,这些资料中的潜在的无意识幻想会被直接解释,其原理在于认为这些无意识幻想制造了对话的核心焦虑,不与患者讨论这些幻想是如何困扰着他是分析师的疏忽。再者,这些无意识幻想的解释(本能驱力和防御的临床表现而不是驱力衍生物?)几乎总是移情性解释,并在治疗开始的时候就要给出:“在我的经验中,我无一例外地从一开始就诠释这种移情!”

What gives the Kleinian mode of handling projective identi¬fication its distinctive mark is the fact that for the Kleinians,the therapist's communication of his understanding of what has been projected into him is done almost exclusively in the form of verbalized transference interpretations. One of the problems with this is that a patient's reliance upon projective identification as a predominant mode of communication, defense, and object- relatedness is frequently a reflection of the fact that he is currently unable to make use of verbal symbols either intra- psychically (as a part of an internal dialogue) or interpersonally. As a result, he can neither comprehend nor utilize interpretations offered in a verbalized form.
这就给出了克莱因学派在处理投射性认同的独特方式,治疗师在表达其对投射到他内在的部分的理解,无一例外地就是使用语言来诠释这种移情。这样产生的问题之一就在于、患者之所以主要使用投射性认同的方式进行沟通、防御和形成客体关系,通常恰恰反应了一个事实:患者目前没有能力利用这些语言符号,无论是在内在心理(内在对话的一部分)还是人际间。因此,患者既不能理解,也不能利用通过口头语言给出的诠释。
【王静华注:克莱因喜欢用“投射到…里”而不是“投射到…上”。她曾经以脚注的形式,很谨慎地说明了这个问题:“我用的是‘把…投射到某个人里’,我只能用这种方式来传达我想要说明的这个无意识过程。  p.19-20   《投射性认同和内摄性认同》】
When the therapist relies entirely on verbal interpretations to deal with preverbal phenomena, one of the following out¬comes often develops: (1) the relatively healthy patient may attempt to accommodate by translating his preverbal experience in the transference into the terms of a phase of development in which experience was verbally symbolized (for example, the Oedipal level of development); (2) the more disturbed patient will frequently experience acceptance of the therapist's inter¬pretation as equivalent to becoming the therapist, thereby losing his sense of himself as a separate person. As a result these sicker patients often defensively distance themselves from the therapist with resultant feelings of loneliness and disconnectedness.
当治疗师完全依赖口头解释来处理前语言期症状时,经常会导致如下的结果:(1)相对健康的患者也许会尝试将他在移情中的前语言期体验转化到使用象征性语言的发展期(例如,俄期);(2)人格障碍比较严重的患者通常把治疗师的解释体验为治疗师的体验,因而失去了作为一个分离的人的他自己的体验。结果,这些更严重的病人经常防御性地远离治疗师,这让他们感到孤独且缺乏联结。


THE BRITISH MIDDLE GROUP英国中间学派
In contrast with the Kleinians, certain members of the British Middle Group (Balint, Guntrip,Khan, and Winnicott) employ a largely noninterpretive technique during much of their work with very disturbed patients. Even this subgroup of the British Middle Group is rather heterogeneous and has not de¬veloped a mutually agreed-upon set of principles to accompany their object-relations theories of development. However, Win¬nicott (1954, 1963) has written in considerable detail about the management of regression in the course of the treatment of pre- Oedipal disturbances, and it is on his work that I will focus for the purposes of comparing analytic modes of handling projective identification. Winnicott feels that the cumulative trauma (Khan, 1963) resulting from repeated maternal impingements (Win¬nicott, 1952) makes it necessary for the infant or child to develop a defensively split sense of self consisting of a "true self” and a "false self (Winnicott, 1960b). The false-self personality organi¬zation is that aspect of self that represents the sum of the defensive, self-protective, compliant adjustments that were de¬veloped in response to the mother’s intrusion into the infant's spontaneous activity. Such intrusions or "impingements^ inter¬rupt the child's personal sense of "going on being" (Winnicott, 1963), that is, his sense of permanence and continuity of existence over time. The true self (those aspects of self that reflect the development of the child's unique qualities and individuality) becomes walled off and isolated from the functioning of the defensive false self. The latter aspects of self are often instrumen¬tal in achieving high levels of adaptation in academic and profes¬sional settings (Ogden, 1976), but these accomplishments are felt to be empty victories that leave the person feeling lonely, direc¬tionless, and unfulfilled (Fairbairn, 1940;、Guntrip, 1969). Analy¬sis of the earliest phases of development involve "a regression in search of the self" (Winnicott, 1954). 
与克莱因学派相反,在英国中间学派中相当一部分成员(Guntrip,Khan, and Winnicott)在与特定的人格障碍患者工作时更多地是使用非解释性技术。实际上英国中间学派的这个分支的技术迥异而且并没有依据其发展的客体关系理论达成与之一致的、并被彼此认可的一套原则。不过,温尼科特(1954,1963)已经写了大量关于在治疗前俄期混乱患者的过程中处理退行的细节。对此,我将聚焦在比较不同的处理投射性认同的分析模式。温尼科特认为不断重复的来自母亲的侵入(Win¬nicott, 1952)导致了累积的创伤(Khan, 1963),因而对于婴儿或孩子而言就必须发展出一种防御性的自体分裂,分裂成“真自体”和“假自体”(Winnicott, 1960b)。假自体是自体中代表防御性的、自我保护性、服从性的部分,这是母亲不断侵入婴儿自主性活动的结果。这类侵入或侵犯打断了儿童“将要成为”的个体感,也就是持续的永存性和一致性。真自体(自体中反应儿童独特品质和个体发展的方面)就和防御性假自体的运作阻断、隔离开。假自体通常有助于在学术或者专业领域上取得高成就(Ogden, 1976),但是这些成就令其感觉空洞,仅会感到孤独、失去方向并且没有成就感(Fairbairn, 1940;、Guntrip, 1969)。早期发展的分析涉及到“寻回自体的退行”(Winnicott, 1954)。
In the course of successful management of regression, the patient is able to relinquish reliance on false-self modes of defense (for example, endless compliance) by means of transfer¬ring onto the analyst the role of "caretaker” of, or "protective shield” for, the true self.
在成功地处理退行的过程中,患者需要有能力放弃使用防御性的假自体模式(例如,无限顺从),将真自体转化为分析师的“照顾者”或者“保护者”的角色上。
 In that setting of extreme emotional dependence, psychological development may proceed along lines different from the development of a defensive false-self person¬ality organization. In this phase of work the analyst must provide the facilitating environment that was absent in the patient's childhood. Winnicott (1954) states that: "In the extreme case the therapist would need to go to the patient and actively present good mothering.,’ Further, he notes: I have found chat the patient has needed phases of regression to dependence in the transference, these giving experience of the full effect of adaptation to need that is in fact based on the analyst's (mother’s) ability to identify with the patient (her baby). In the course of this kind of experience there is sufficient quantity of being merged in with the analyst to enable the patient to live and to relate without the need for [pathological] projective and introjective identificatory mechanisms. (Winnicott, reported by Khan, 1975, p. 27) 
在极度情感依赖性的场景中,心理发展也许沿着不同于防御性的假自体人格结构的路线。在这个阶段的工作中,分析师必须提供病人童年期缺失的促进性环境。温尼科特(1954)年说到:“在极端的个案中,治疗师需要走近患者并积极地给予母亲般的养育。他进一步注明:我发现,病人需要在移情关系中退行到依赖阶段,在这些阶段通过分析师(母性)识别并认同患者的婴儿部分,就给以患者更加具适应性的经验。与分析师经历足够多这样的体验,就能使得病人活现出并建立关系,而没有必要使用(病态的)投射性和内摄性认同机制。
I would view the management of regression described above as based on a choice made by the analyst to participate fully in one of the patient’s most fundamental unconscious fantasies that has become the basis of a powerful projective identification in the therapeutic relationship. The patient's unconscious fantasy of finding the longed-for good-enough mother in the analyst and the cared-for baby in himself is enacted interpersonally by means of a projective identification in which the internalized good- enough mother is in fantasy embodied by, and safely preserved in, the analyst, while the patient experiences himself as the loved and well-cared-for baby. 
我认为上面描述的对退行的管理,是基于分析师做出选择、选择充分参与到患者最深层的无意识幻想中,这些无意识幻想已经在治疗关系中构建了强大的投射性认同。病人的无意识幻想会在关系中呈现出渴望分析师是足够好的妈妈和他自己作为被照顾的婴儿,通过投射性认同,分析师被内化为足够好的妈妈并被安全地保留,此时病人就会体验到自己是一个被爱、被照顾的婴儿。
Balint (1968) correctly points out the way in which the regressed patient frequently becomes "addicted" to this good- enough mothering and sabotages the efforts of other aspects of himself to achieve a state of mature independence. Moreover, the patient will inevitably feel intensely angry and disappointed when the therapist stumbles in his efforts to provide good- enough mothering. Although this irrational aspect of the trans-ference can be analyzed, the patient is not unjustified in his feeling that he has been tantalized by the illusion that good- enough mothering for himself as an infant can be found in the present adult therapeutic relationship. The analyst who has participated as recipient of this projective identification may develop corresponding feelings of anger at the patient for being unappreciative of the special lengths to which he is going in the therapy.
 Balint(1968)准确地指出这会使退行的病人常常“沉醉”在这种足够好的抚育中而妨碍病人自身努力成为一个独立的成熟的个体。而且,当分析师在提供足够好的抚育的努力中出现差错时,病人将不可避免地感到无比的愤怒和失望。尽管这种移情的不理性是能够被分析的,病人也还是有足够的理由感到他被这种错觉所耍弄,也就是在目前这种成人的治疗性关系中他自己被当成一个婴儿。作为投射性认同的接受者、分析师参与其中,也可能会对病人感到愤怒,因为病人似乎在治疗中对于治疗所达到的深度有些不知好歹。
Despite these reservations about Winnicott’s approach to the management of therapeutic regression, his contribution to the theory of the development of the early mother-infant dyad remains the essential framework for my own understanding of the clinical handling of projective identification. The rationale for much of the understanding of and response to the clinical phenomena presented in this volume is based on an outgrowth of Winnicott*s ideas regarding the holding environment (1945, 1948,1960a), impingement (1952),mirroring (1967,1971), the capacity to be alone (1958), countertransference hatred (1947), and the objective countertransference (1947). From these ideas are derived the concepts of: (1) the centrality of coun¬tertransference analysis in the conduct of psychotherapy, and the use of the countertransference as a vehicle for understanding the transference; (2) the importance of the provision of a therapeutic setting in which the patient feels free to spontaneously explore his interpersonal environment, yet safe in the knowledge that there is an internal sanctuary (a private internality) to which he can retreat; and (3) psychological growth involving in the earliest stages, a two-person process in which the separate presence of one (the mother-therapist) is barely if at all recognized—much less appreciated—by the other (the infant-patient).
尽管对温尼科特处理治疗性退行的方式持保留态度,但是他对于早期母婴二元关系的理论成为我个人理解处理投射性认同的基本框架。对在本卷所呈现的临床现象理解和回应的基本原理都是基于温尼科特的思想,例如:抱持性环境(1945,1948,1960a)、侵入(1952)、镜映(1967,1971)、独处的能力(1958)、反移情中的恨和客体反移情(1947)。从这些思想中就可以获得这些概念:(1)心理治疗中反移情分析是核心和反移情作为理解移情的载体;(2)治疗设置的重要性,病人会觉得可以自由地探索其内在世界,但也能撤回到内在的避难所(个体内在的);(3)心理成长会触及到最早期的阶段,在二人关系中,(妈妈-治疗师)很难被(婴儿-病人)视为不同的存在,更不用说感激了。

CLASSICAL ANALYSIS经典分析
Although not directly addressing the entire set of phe¬nomena encompassed by the concept of projective identification, important classical contributions to our thinking about the inter¬personal effects of one's unconscious psychological state include Anna Freud’s (1936) concept of identification with the aggressor, Warren Brodeys (1965) notion of 'externalization,0 Martin Wangh*s (1962) "evocation of a proxy," and Sandler s (1976a, 1976b) "role actualization.” On the whole, however, classical analysts have been slow to address the concept of projective identification,partially because it is difficult to conceptualize within the context of a theory that isolates the transference from the countertransference.
虽然没有直接提出关于投射性认同的一整套现象,经典理论的重要贡献是潜意识中的人际间因素,包括安娜弗洛伊德(1936)对攻击者的认同,Warren Brodeys(1965)的“具身化”,Martin Wangh(1962)的"evocation of a proxy," 和 桑德勒(1976a, 1976b) "role actualization”。可是总的来说,经典分析对投射性认同这个概念的处理是缓慢的,部分原因是因为在将移情从反移情中割裂出来的理论背景下是很难对此进行概念化。
Classically, transference is defined in terms of the distortion of a present object representation on the basis of experience in a previous object relationship; one's feelings about a present object are altered in accordance with feelings originating in a previous relationship (Freud, 1912a, 1914a, 1915d). Thus, transference is conceptualized as an intrapsychic event that can be defined without reference to the way in which that event influences or is affected by the personality system of another person.
经典理论中移情的定义是过去客体关系经验对当前客体的扭曲。一个人在早期关系体会的感受和情绪会影响对当前客体的感受(弗洛伊德,1912a,1914a, 1915d)。因而,移情被概念化为一个心灵事件,这种定义方式没有考虑到心灵事件会影响另一个人的人格,也受其影响。
Similarly, countertransference is regularly viewed as an intrapsychic event generated by the analyst that is the counter¬part of the transference, that is, the distortion of the analyst’s view of and feelings about the patient based on the displacement and projection onto the patient of feelings arising in earlier relationships: "Countertransference is a transference reaction of an analyst to a patient’’(Greenson, 1967, p. 348).
类似地,反移情被视为分析师的心灵事件,是对移情的反应,也就是分析师对病人的观点和感觉的变形,是在早期关系中形成、通过转移并投射进病人:“反移情是分析师对病人的移情。”(格林森, 1967, p.348)
Freud, wary of the dangers inherent in the analyst's personal contribution to the psychoanalytic situation, and consequently to the psychoanalytic movement, took a cautious view of coun¬ter trans fere nee:We have become aware of the "countertransference," which arises in [the analyst] as a result of the patient’s influence on his unconscious feelings, and we are almost inclined to insist that he shall recognize the countertransference in himself and overcome it. (1910,p. 144) 
弗洛伊德认为反移情是危险的,导致精神分析过去一直对反移情持谨慎态度:我们已经认识到,反移情、分析师的反移情是由于病人触动其无意识感受,我们几乎都倾向于坚持治疗师应识别他自身的反移情并克服它。
Annie Reich (1951,1960,1966),in what is one of the most fully developed contributions to the classical concept of coun¬tertransference, builds upon Freud.s comments and conceptual¬izes countertransference as the interfering influence of "the analyst’s own unconscious needs and conflicts on his understand¬ings or technique” (1951, p. 26). Although she feels that coun¬tertransference feelings are inevitable, Reich sees these as sources of disruption of the analyst's capacity for empathy, trial identification, and evenly suspended attention. 
Annie Reich (1951,1960,1966),充分发展了反移情的经典概念,反移情是分析师自身无意识需要和冲突对其理解或技术的干扰。尽管Reich认为反移情是不可避免的,但是她也认为这些是妨碍分析师共情的能力、试验性认同,乃至均匀悬浮注意的原因。
The concept of countertransference in classical theory has become dynamically disconnected from that of transference, and there is little recognition of the component of countertrans¬ference that is complementary, to the transference, the part of the countertransference that is "the patient’s creation" (Heimann, 1950). Without an understanding of this aspect of coun¬tertransference, there are no terms with which to conceptualize a process in which the therapist is pressured to participate in and experience aspects of the patient’s internal object world. One regularly encounters in case presentations at scientific meetings and in the classical literature, the tacit assumption that a thor¬ough analysis of the clinical material under discussion is possible without a single reference to what it feels like for the analyst to be with the patient or what the analyst has learned from the countertransference.  
(海曼, 1954)在经典理论,反移情在动力上被认为与移情完全无关,这种理解没有认识到反移情也是移情的补充,反移情中有一部分是由“病人创造的”。没有理解到反移情的这个特点,就不可能概念化出这样的过程:分析师被迫参与并经历病人内在客体世界。在科学会议和经典文献中的案例呈报中经常会遇到,在对临床资料的充分分析时,心照不宣的假设是不去提及分析师与病人在一起时感觉上是怎样的或者是分析师从反移情中了解到了什么。
Of course, there is much diversity of opinion with regard to countertransference within the classical analytic group. Although the views of Reich and Greenson are representative, there have been important contributions to the classical literature in which the countertransference (including the transferential level of the analyst's responses to the patient) is viewed as having a poten¬tially constructive influence on the analytic process.(See, for example, Loewald, 1971,and particularly Boyer and Giovacchini, 1967, for their sensitive attentiveness to countertransference issues in their classical analytic treatment of schizophrenic pa¬tients.) Maxwell Gitelson.s (1952) comments capture the thrust of a more encompassing classical view of countertransference, in which he acknowledges the potentially enriching influence of countertransference analysis on the two-person analytic process. 
当然,在经典分析队伍中,关于反移情有众多不同的意见。虽然瑞奇和格林森的观点被认为具有代表性,但它们对经典文献的重大贡献是认为反移情(包括分析师对病人的过渡性反应)对分析过程具有潜在的建构性影响。例如,参考Loewald, 1971,尤其是,Boyer and Giovacchini, 1967,在他们对精神分裂症病人进行的经典分析时敏锐地注意到反移情。Maxwell Gitelson.s (1952)对反移情有更具包容性的经典分析视角,他承认反移情分析在二人分析中具有潜在更富成效的影响。
The analyst must deal with [countertransferences] in himself, and together with his patient, he must deal with these when they intrude into the analytic situation.…To the extent to which the analyst is himself open to their analysis and integration, he is in a real sense a vital participant in the analysis with the patient. It is this which constitutes the analyst's real contact with the patient and which lets the patient feel that he is not alone. (1952, p. 10)
分析师必须处理他自身的反移情,并能和他的病人一起处理,当他们进入到一个分析性场景中他必须处理这些…分析师能够将他自身对分析和整合保持开放,在和病人的分析中分析师是被真实感受到的重要参与者。建构分析师与病人的真实接触,会让病人感觉到他不是孤单的。
Despite the awareness of Gitelson,Loewald, Boyer, Giovac¬chini, and others of the interactional context of the coun¬tertransference, there have been few efforts among classical analysts to generate a corresponding set of conceptualizations that might facilitate the analyst's thinking with regard to the specifics of the dynamic relationship between the transference and the countertransference. Recently, Weiss and Sampson (Weiss, 1971; Weiss et al., 1980) have proposed a "control mastery" theory (an outgrowth of classical ego psychology) that represents a significant contribution to this task.  The patient is seen by these analysts as unconsciously creating "test” situations in the interactions with the therapist that present the analyst with the same genetically determined psychological traumas that the patient is unconsciously attempting to master in the treat¬ment. In this way the patient "turns passive into active’” that is, the patient shifts from the position of the passive participant to rhat of the active one in a re-creation of the original traumatizing interaction. 
尽管Gitelson, Loewald, Boyer, Giovac¬chini 等对反移情交互性作用的发展,但是经典精神分析师鲜有付出努力发展一系列相应的概念化理论来促进分析师思考关于在移情和反移情之间的动力性关系特性。最近,Weiss and Sampson (Weiss, 1971; Weiss et al., 1980) 提出了“控制理论”(经典自我心理学的一个分支)就代表了对这一任务的重大贡献。这些分析师看到病人无意识地在与治疗师的互动中创造了一个“测试性”场景,向分析师呈现了类似的遗传性心理创伤,然后病人无意识地试图在治疗中控制。按照这种方式,病人“变被动为主动”,也就是病人从被动参与者转换为在这个再造的原初创伤性互动中的主动参与者。
In a "test” the patient creates an interpersonal situation in which he can unconsciously make an appraisal of the danger entailed in proceeding toward the realization of a specific uncon¬scious wish or goal Specifically, this appraisal involves the patient's unconscious assessment of whether he will be re¬traumatized by the therapist (as he was by his parents in his early development) if he were to diminish his reliance upon the defenses developed in response to the early trauma. . Weiss and Sampson emphasize the growth-seeking (problem-solving) motivation for the patient's creation of a test situation (as opposed to a wish for drive discharge). By means of a test, the patient unconsciously observes the analyst’s ability to manage these genetically determined conflicts and selectively internalizes particular modes of mastery that are demonstrated in the analyst's method of handling the test situa¬tion. The patient in this way utilizes the test situation to "discon- firm pathogenic beliefs'* that arose from his efforts to manage early trauma which are currently interfering with his pursuit of repressed developmental strivings (Bush, 1981). The introduc¬tion of this type of interactional point of view into classical technique represents an important advance in that it begins to create a perspective from which the countertransference can become data for understanding the transference. Implicit in this perspective is the idea that the qualities of many of the uncon¬scious tests are understood by the analyst in part on the basis of the nature of the emotional strain that he finds himself experi¬encing with the patient. The patient often utilizes his uncon¬scious capacities for accurate assessment of reality to design tests that take the analyst’s psychological vulnerabilities as their focus, and this can create considerable emotional strain for the analyst. 
在“测试”场景,病人在其创造的人际互动场景中无意识地对危险做出评估,推动实现一个特定的无意识愿望或目标。特别是,如果病人准备不再依赖早期创伤中所发展的防御方式时,这个评估就会涉及到病人会无意识地评估他是否会被治疗师再度创伤(这在早期是被他的父母创伤的)。Weiss and Sampson强调病人创造测试场景的动机是源于成长-探寻(问题解决),并不是期望被抛弃。通过一个测试,病人无意识地观察分析师管理这些遗传性冲突的能力,并选择性地内化分析师在测试场景展现的特定的控制模式。病人以这种方式利用测试场景来放弃致病信念,这些信念是他早期应对创伤所使用的方式,现在妨碍了他追求一直被压抑的发展性努力。在经典技术中引入这种相互作用的视角是一个重要的进步,它开始对反移情创造了一个更具穿透性的观点,反移情可以成为理解移情的资料。这个观点暗示了无意识测试的特性能够被分析师理解,部分是因为分析师发现他自身正和病人经历着情绪张力。病人经常利用他的无意识准确地评估现实来设计测试聚焦在分析师的心理缺陷处,这就在分析师那里创造了强烈的情绪张力。
A major difference between the control-mastery pcr- specitve and the theory of projective identification lies in the relative lack of emphasis in the former on the patient’s uncon¬scious projective fantasy of what he is "doing to” the analyst. Moreover, since these analysts have developed their ideas in the context of work with relatively healthy patients, unconscious blurring of self-object boundaries is not an essential feature of the form of interaction that they describe. 
控制性观点和投射性认同理论的主要区别在于前者没有强调病人无意识的关于他“打算去做”的投射性幻想。再者,既然这些分析师是在与相对健康的病人工作中发展了他们的思想,自体-客体边界的无意识混淆并不是他们描述的互动模式的基本特征。

THE MODERN PSYCHOANALYTIC GROUP 近代精神分析团体
Finally, I will briefly focus on a specialized technique termed "joining the resistance'* that Nelson et al. (1968) and Spotnitz (1976) describe as an aspect of the analysis of narcissistic disor¬ders. Although the members of the Modern Psychoanalytic Group do not conceptualize the clinical problems that they are addressing in terms of projective identification, 1 feel that their work involves a noninterpretive mode of handling projective identification. 
最后,我将简单介绍一个专项技术“参与阻抗”,Nelson et al. (1968) and Spotnitz (1976) 描述其是自恋性障碍分析中的一个方向。尽管近代精神分析团体的成员并没有以投射性认同来概念化临床问题,但是我认为他们在处理投射性认同以非解释性模式进行工作。
The technique of joining a resistance is based on ”the therapist’s utterance of statements which are consistent with the patient’s irrational and defensive beliefs whether or not these beliefs are openly stated as such” (Sherman, 1968, p. 102,his italics). These analysts believe that the narcissistically fixated patient (including the borderline and schizophrenic patient) is unable to accept and integrate anything that is not felt to be an extension of himself. The analyst’s interpretations are experi¬enced as threatening and intrusive elements of non-self and therefore must be repelled. Rather than using verbal interpreta¬tion, these analysts assume various roles that correspond to the patient’s unconscious defensive stances. 
参与阻抗技术需要治疗师的表达和陈述方式与病人的不合理和防御性信念保持一致,不论这些信念是否曾被如此表达过。这些分析师认为,自恋性固着的病人(包括边缘性人格障碍病人和精神分裂病人)是没有能力接受和整合任何未被他自身感觉和经验的部分。分析师的解释被体验非自体的、威胁性的、侵入性,因而必须被反击。并非使用语言解释,这些分析师会承担不同的角色来对应病人不同的无意识防御位置。
In this way, the patient is confronted in the therapy with externalized reflections of aspects of his own internal world. As the therapist becomes the embodiment of a defensive aspect of the patient, an interaction develops in which the patient has to contend with this aspect of himself in the person of the analyst. Spotnitz (1976) discusses the analyst's use of the coun¬tertransference in delineating for himself the nature of what is being projected into him. 
通过这种方式,病人就以治疗性的方式面对他内在世界外化的反射。由于治疗师具身化病人的防御,病人就不得不去应对在分析师上活现出来的他自身的这个部分、并与之互动。Spotnitz (1976)论述分析师使用反移情就可以描绘出究竟是什么被投射到分析师里。
In the course of interactions in which resistance has been joined, these authors contend, the patient is able to observe himself and accept his own understanding of (interpretation of) the aspect of himself represented by the therapist in a way that would not have been possible had the interpretation come from the analyst (non-self). This differs from psychodrama and role- playing therapies in that the role the therapist takes in joining a resistance is not determined by the problematic external life situation faced by the patient but by the nature of the patient's unconscious resistance. 
这些作者说到,在参与阻抗互动的过程中,病人是能够观察他自己的并接受他自己在治疗师呈现部分的理解,以这种方式进行是不可能有来自于分析师(非自体)的解释。与心理剧以及角色扮演治疗不同,治疗师参与到阻抗,并不是由病人遭遇的有问题的外部生活状况决定的,而是由病人无意识阻抗的特性决定的。
A brief example from the work of Herbert Strean (1968) may serve to illustrate the resistance joining technique. Strean presents an excerpt from the treatment of a characterologically disturbed woman, frightened of being sexually exploited by men, all of whom she experienced as "animal-like” and overwhelming. This was understood as a projection of the patient's own intense, unconscious pre-Oedipal demands. The analyst was felt to be so selfish, demanding, and exploitative that the patient (Nancy) was on the verge of disrupting this, her fourth, therapy. 
Herbert Strean (1968)用一个简短的例子来说明参与阻抗技术。Strean从对一位人格障碍的女性治疗中摘录一段,该女性对与男性发生性行为感到恐惧,她对此的体验是“动物一般”、淹没性的。这可被理解为是病人自身强烈的、无意识的前俄狄浦斯需求的投射。分析师感到他自己是自私的、苛责的、剥削的,病人(Nancy)处在破坏第四次治疗的边缘。
[The analyst] told the patient . . • that he always liked to learn about his failures. Could she cell him what was wrong with him? "There must be something wrong with me to provoke you to leave!" Nancy responded triumphantly, "Yes,... you are a highly demanding spoiled brat, interested only in money and in sexual gratification ...” Rather than interpret Nancy's projection her analyst said,"Maybe you’re right. How do you think I got that way?”
"You got that way because you were a disturbed child... You expect your patients to feed you all the time ...”
[分析师]告诉病人他好像总是感到他犯错误了。 她是否可以告诉他究竟哪儿出了问题吗?“一定是我做错了什么、冒犯你、让你离开!”,Nancy趾高气扬地回应到,“是的,…你就像一个充满渴求的乳臭未乾的顽童,只会对钱和性事感兴趣…”。分析师并没有解释Nancy的投射而是回答:“也许你是对的。你认为我怎么会这样呢?”“你这样是因为你是一个焦虑的孩子…你期望你的父母一直喂养你…”
Nancy was complimented for her excellent diagnostic think¬ing and was asked what kind of a therapeutic plan should be devised for her therapist. "There you go again, always demanding something . . . You should be deprived and frustrated and given little …”
Nancy被称赞其出色的判断并被征询她建议治疗师哪种类型的治疗计划。“你又来了,总是要求…你应该被剥夺、挫折并且只给你一点点…”
Nancy continued her treatment. She gave the therapist strong doses of silence and then would interpret: "I know you are suffering, you are yearning to be fed, but this is good for you.” When the therapist thought he would enact the role of a suffering, deprived child,Nancy would interrupt him and say’ "That's enough now! Curb your impulses. I'll let you talk when you deserve to do so.”
Nancy继续她的治疗。她让治疗师不断地沉默、接着解释到:“我知道你正在承受痛苦,你呻吟着渴求被喂养,但这对你很好。”,当治疗师说他觉得自己正像一个承受痛苦并被剥夺的孩子,Nancy打断并说道:“够了!控制你的冲动!当你该说的时候我会让你说的!”
Nancy was enacting the role of the frustrating parent who was putting the necessary controls on the demanding child. Because the therapist played the role of the child for Nancy, she was in reality treating the infantile part of her own character disorder, (pp. 184-185).
 Nancy正在扮演的令人沮丧、控制孩子需求的父母。因为治疗师扮演了Nancy的孩子的那面,她就能真实处理她自身人格障碍中婴儿部分。
As is clear from this excerpt, role playing by the analyst is used to steer the therapeutic interaction. This differs from classical analysis which attempts to allow the transference to unfold at its own pace and in its own way with as little inter¬ference as possible. The modern analyst, on the basis of his assessment of the type of interaction that is needed by the patient, will "provoke a significant emotional interaction” of a specific type ”to focus upon the consequent evolution of various roles and the meaning which grows from this process" (Sherman, 1968,p. 104). 
从这个治疗片段可以看到,治疗师扮演的角色激起了治疗性的互动。不同于经典精神分析,它允许移情以它自己的步伐、自己的方式展开,尽可能少的干预。近代分析师,根据他对病人需要何种互动方式的评估,将激起某个特定类型的意义重大的情感性互动,来集中于相应地推动在这个过程中产生出来的不同角色和意义的演化。(Sherman, 1968,p. 104).
I feel that this group of analysts, although using a different set of terms and not addressing the patient's unconscious fantasy of extrusion and control, are describing a way of returning to the patient a modified version of an unconscious defensive aspect of the patient that has been externalized by means of projective identification.
我认为这些分析师,尽管使用了一套不同的术语并且没有针对病人的无意识幻想,但却给出了一种返还给病人修正过的无意识防御的方式,这部分通过投射性认同外化。
In evaluating role playing techniques designed to process projective identifications, one must keep in mind that the thera¬pist pays a price for introducing manipulation into the therapeu¬tic interaction in that the entire therapeutic interaction may lose its feeling of realness, genuineness, and honesty. It has been my experience that when enactment of the containment process is attempted (chapter 3), it is essential that the patient be clear that he is being invited by the therapist to engage in a type of play. When this is the case, as it usually seems to be in the work presented by the Modern Psychoanalytic Group, the framework of the therapy, the integrity of the therapist, and the dignity of the patient are all maintained.
评估处理投射性认同的角色扮演技术时必须记住,治疗师可能会因操纵治疗互动而付出代价,因为整个的治疗互动可能失去真实、真诚和诚实。根据我的经验,需要使用保护性过程(见第3章),有必要让病人清楚地意识到他正在被治疗师邀请进入一次游戏。如这个例子,正如通常在近代精神分析团体的工作中所呈现的,治疗性的框架、治疗师的诚实以及病人的自尊都需要得到维护。

标签: 投射认同  克莱因  温尼科特 

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