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此時此地:我的觀點|作者:貝蒂 乔瑟夫

王蕾2017-1-24 11:16
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(本文翻译仅供学习使用)

International Journal of psychoanalysisInt J Psychoanal (2013) 94:1–5国际精神分析期刊(2013)

作者介绍:贝蒂 乔瑟夫(Betty Joseph,1917-2013),克莱恩派精神分析师,早期在伯明翰大学接受社会工作训练,继而于伦敦学院攻读经济学。早期在一所儿童诊所从业,也就是在这里,1940年,她开始接受麦克 巴林特的分析。战后,她在伦敦完成了精神分析训练并于1949年成为了英国精神分析协会的一员。后来,她与梅兰妮克莱恩合作并于1951年到1954年之间接受了宝拉 赫曼(Paula Hermann)的深层分析。贝蒂 乔瑟夫延伸和发展了克莱恩的理论,尤其是投射和内摄认同。在克莱恩提出的"整体情境"(total situation)概念上,贝蒂发展出了她自己的独特技术。她将注意力集中在患者和分析师之间此时此地的分析情境并强调分析师的反移情。很多贝蒂的重要论文都收录在《精神病性平衡和精神病性改变》(暂译,Psychic Equilibrium and Psychic Change,1989年出版)

Here and now: My perspective1

此時此地:我的觀點

Betty Joseph

作者:貝蒂 乔瑟夫 译者:王蕾

In this paper the author describes her particular perspective in doing analytic work. She stresses working in the here and now. For example, making interpretations that grow out of what the patient says or does in the sessions, keeping the patient’s history in mind, but not letting it lead interpretations. The analysis tries to understand why something is being said now, in this way, and what impact it may have or be designed to have in the analytic relationship. The term ‘here’ refers to what is going on between patient and analyst in the room while not leaving out the patient’s immediate reality in the outside world, his everyday life. The word ‘now’ implies awareness of time that is not just of the past and future but of the patient’s situation at the moment in analysis, which is constantly shifting. The author believes that by working primarily in the present the patient will feel more anchored, both patient and analyst can observe what is going on, for example how anxiety arises or decreases, how defences are mobilised or lessen. Both analyst and patient experience movement and change rather than relying on more theoretical explanations.

在本文中作者描述了她在精神分析工作中的独特观点。她聚焦在此时此地,例如,针对患者在会谈中的言行举止做出诠释,将患者的个人史保存在心智中而不让其主导诠释。分析要试着理解为什么一些事情会在此时被谈及,以及这些内容将会对分析性关系或者被设计成对分析性关系造成何种影响。"此地"是指正发生在诊疗室的,正发生在患者和分析师之间的,同时并不忽略患者发生在外在世界的即刻现实,他的日常生活。而"此时"着眼于对时间的觉察,并不仅是过去和未来,也同时要包括患者当下在分析中的处境("此时"总是跳跃式的存在)。作者相信通过主要对当下工作,患者将能感觉到有的放矢,不论是患者还是分析师都能经此观察到正在发生什么,比如焦虑是如何上升又如何下降,防御是如何激活或是放松。患者和分析师都将更依靠经验的活动和转化,而不是理论解释。

If I look back over my analytic career I realize that my work has increasingly focused on, or perhaps rather started from, what is going on in the room between patient and analyst. Today I want to think briefly why this is so. What is clear is that this focus allows the patient and analyst to feel more anchored.

如果回顾我精神分析的职业,我意识到我的工作已经更多地聚焦在,或者更确切地说就是在患者和分析师所在的诊疗室里开始发生的。今天,我将简单阐述为何会如此。很清楚的一方面原因是这个焦点使患者和分析师感到更加专注。

By working in the here and now I mean this in a broad, global way but also in a minute way, and it is related to my understanding of psychic reality in the patient and the analyst. I like primarily to make interpretations that grow out of what the patient is saying or doing in the session, with his background and our previous work somewhere in the back of my mind and thus to eschew general explanations. The patient may tell me that her mother was so fragile that even when she was very young she felt that she had to be very protective towards her mother. It may seem from previous experience that this refers to myself, but I suspect this is not of real use to her, nor convincing to me, unless it is being manifested in some way in the session. But it would alert me to examine, for example, whether I was talking a bit carefully, was my tone a bit delicate, etc. and if so as a consequence she might have experienced me, whether consciously or not, as pussyfooting round her rather than interpreting straight. This can then give me a more global viewpoint – I may come to realize that over a series of sessions the patient and I have been talking to each other ‘carefully’ as if each was more comfortable of that way, so that the patient was feeling that interpretations were only ‘interpretations’ and not to be taken too seriously and I was colluding with this.

工作在此时此刻我不仅仅是指宽泛的,整体的方式,同时也是指一种细致的方式,这种方式和我理解患者和分析师的精神现实息息相关。我喜欢主要靠延伸患者在会谈中所做所言,同时结合他的背景和我脑子里保存的我们之前工作的信息来做出我的诠释,这样就可以避免诠释落入俗套。患者可能告诉我说他的妈妈是一个很脆弱的人,甚至患者从很小开始就要承担妈妈的保护者的角色。或许从之前的经验可以推论出她同时指的也是我,但是我怀疑直接告诉她有什么用处,同时也说服不了我,除非这些能够在会谈中以某种方式被阐明。但是这个信息提醒我去测试,比如说,我说话的时候是否有点小心翼翼,我的语气是不是有些柔和,等等,以及当我如此的时候是否会引发她对此的一些体验。有意或无意地,我更多地是小心求证而不是直接诠释。这种做法给我更全面的视角——我是在经过一系列的会谈之后,我和患者都发现我们"小心地"说话会让我们俩都感觉比较舒适,从而患者感受到诠释仅仅只是"诠释"并开始不那么在意诠释,而我也认同了这个观点。

But the statement that the mother was so fragile may of course be stated for some quite other reason, for example, to express understanding she had gained from previous work, to control the analyst and prevent her from being straight and clear. The possibilities are legion and our attempt to understand what is going on in the here and now means trying to understand not only what is actually being said, but why it is being said now and said in this way, what impact it may be designed to have and what impact does it have.

但是"妈妈很脆弱"这种说法可能是因为一些很不一样的原因被呈现,比如说,从以前和她工作里得到的理解可以推出,是为了控制分析师并阻止她说得那么直接和清楚。可能性有很多,而我们试着理解此时此地正在发生什么并不仅仅是指什么正在被言说,还要包括为什么在这个时候被言说和以这种方式被言说,是什么在影响它如此被设计出来,以及这样说会产生什么影响。

When we are using the expression here and now, ‘here’ refers primarily to what is going on between the two participants in the room, but in addition it conveys the immediate, often concrete, reality of the individual’s experience, which may, for example, be focused on his body, the analyst’s room ⁄ - body. This aspect is particularly vivid in patients with strong psychotic anxieties. To give an example, a child patient at a certain point in his analysis, was almost unable to enter the playroom where the shadowy remains of another child’s scribbling remained indelibly crayoned on the wall. To him the shape of the scribbling became volcanoes, ‘here’, my room became an object of terror, and when he managed to come in he was extremely anxious and would stand flat against the opposite wall as far away as possible.

当我们使用"此时此地"这个说法,"此地"最基本的含义是在这个房间里面的两个参与者之间在发生什么,还有表达个体即刻的、具体的以及真实的体验,比如说,聚焦在患者的躯体,分析师的办公室/-身体。这个方面在有强烈精神病性焦虑的患者身上尤其明显。我们来举个例子,一个儿童患者在他分析的某个特定时刻,几乎完全没有办法进到游戏室,原因是游戏室的墙上有另一个孩子用蜡笔涂鸦的擦不掉的模糊痕迹。对于这个患者来说,这个痕迹的形状就像是火山,我的办公室——"此地"——就成了一个恐怖的客体,当他试着要进来时,他就陷入极度的焦虑,然后只能直直地站在离这面墙最远的地方。

The notion of ‘here’ also implies that there is a world outside, and I like to keep this connection somewhere in the back of my mind so that links will occur, or will need to be made, between what is being understood in the consulting room and its implications in the patient’s everyday life. Some patients will resist this linking firmly and try, probably unconsciously, to hold the analyst’s mind fixing it into a kind of emotional pas de deux. This in itself will need understanding and interpreting.

"此地"也被用来暗示存在一个外面的世界,我喜欢在我的心智中保持和某些地方的连接从而联结也能存在,或者联结可以在咨询室里被理解的部分和患者日常生活里发生的部分之间被制作出来。有些患者会顽固地抵抗这样的联结或者试着(通常是潜意识地)把分析师的心智带到一种情绪的双人舞中并让其一直沉浸其中。这种状况就需要被理解并诠释。

The now, when we speak of here and now, implies a sense of time, not just past and future, but an awareness of the patient’s situation at the moment, one that is dynamic, never static, and that changes from moment to moment. The analyst is in a position to witness the movement and thus to gauge the forces operating in the patient, forces however that will find responses in the analyst, which should help in his understanding. Seen from this angle the analyst’s interest will lie in trying to understand the dynamics of change, without using the notions of progress or regression – rather observing that this is the way that this patient operates at this time – a kind of respect for his defences and his need for them.

在我们说"此时此地的"此时",是指时间感,不光光是过去和未来,还要包括对患者当下情境的觉察,这种当下情境是动态的,而不是静态的,每时每刻都在发生变化。分析师处于当下的见证者的位置并估计驱动患者的力量。这些力量会在分析师身上得到回应,并将对他的理解产生促进。从这个角度来看,分析师的兴趣将立足于理解动力的变化,这种理解的方式与其用进步和退步来描述,不如说是观察,这才是患者当时运作的方式,这才是尊重患者所使用的防御机制,以及尊重患者对这些防御机制的需要的做法。

I am very much concerned to try to follow the movement in the session, in the patient’s associations and in his response to interpretations, recognizing the brevity of ‘now’. As the analyst interprets the situation changes, the patient responds, or does not respond, anxiety increases and new defences are quickly mobilized, or there is a moment of relief, tension lessens and one can sense that the patient feels warmth towards the analyst. The nature of the response can help us to see something of the anxiety, for example, that lies behind it. The kind of movement going on in the session means constant change, change in the nature of defences or need for them, change in the perception of the object and change in the feelings towards the object. In this way we have a chance to see in a mini form the stuff that may lead to real stable psychic change. A further advantage of trying to follow in detail and in the present the movement of the patient and his material in the session is that it enables us to contact and begin to understand small quantities of anxiety or excitement as it arises and shifts rather than its accumulating or being evaded and the patient then being confronted with more massive anxiety or panic states later on.

我试着亦步亦趋地跟随会谈的进展、包括患者的联想以及他对诠释的反应,我认识到"此时"的短暂性。当分析师诠释情境转变,患者回应或是不回应,焦虑上升了而新的防御快速变化,或者片刻的解脱,张力变小,而患者可以感受到对分析师有温暖的反应。回应的性质能够帮助我们看到焦虑的一些东西,比如,藏在焦虑背后的东西。这种会谈中的进展意味着持续地改变,改变了防御的性质或对它们的需要,改变了对客体的看法以及对客体的感觉。通过这种方式,我么可以有机会看到非常细微的事件将会带来稳定的现实层面精神状态的变化。试着跟随细节,跟随患者当下的行动以及跟随他在会谈中的素材这样的方式所带来的更进一步的好处是,这让我们能够去接触到,也开始理解一些不常见的焦虑或者兴奋——以便让这些焦虑或兴奋出现并发生改变,而不是等它们积累起来或者被回避,然后在未来迫使患者要去面对更大的焦虑和恐慌。

I am stressing here the importance to me of trying to follow the moment to moment shifts in the session; there is of course always the risk of this leading to the patient feeling too closely followed or even harassed and trapped. Certainly the analyst needs to try to be aware of the possibility of this and be sensitive to the patient’s state of mind and his need for space to elaborate and stretch mentally.

我在这里要强调我试着跟随会谈中每一个时刻的转换这个做法有多重要,当然这也有一定的风险,比如会让患者感觉到跟得太紧或甚至是被烦扰,被困住。。当然分析师需要努力觉察这种可能性并敏感地捕捉患者的精神状态以及他对空间(指心智层面详尽了解和拓展延伸的空间)的需要。

(连载一)

Working in the here and now, I have indicated, of course involves an awareness not only what is going on immediately in the patient but is necessarily dependent on the analyst’s sensitivity, so far as is possible, to what is being evoked in himself. I gave an example of this where the analyst came to recognize that she was pussyfooting round the patient. To me this means that whatever our technical and theoretical knowledge our basic tool is our ability to try to recognize what we actually feel, experience or suspect is going on in ourselves – our psychic reality. In the absence of this capacity something quite fundamental will be lacking, I believe, in relation to our patients and our understanding of them.

我也有提到过对此时此地工作当然不仅仅涉及到当下在患者身上正在发生什么,同时肯定需要依赖于分析师对敏感性,到目前为止,分析师了解在当下被唤起了哪部分还是可能的。我举一个例子来说,分析师察觉到的部分也就是她亦步亦趋跟随患者的部分。这个事情对我来说,不论任何我们的技巧,理论知识,基本工具都是我们试着认识我们的真实感受,经历或者我们自己疑惑的部分的——也就是我们的精神现实——的能力。我相信,缺失这样的能力,我们就缺失和和我们的患者建立关系以及理解他们的基础。

Freud saw transference as being aspects of the patient’s early history being repeated, transferred in his relationship with the analyst. Melanie Klein took this further showing how aspects of the very early relationship of the child with his parents were internalized and built up his inner world of objects, and that aspects of these inner objects were projected into the relationship with the analyst forming the transference. I am suggesting that as we follow the moment to moment shifts in the session we can begin to get an idea of how his past was built up because we can see elements of it being reconstructed in the session. To give a very over-simplified kind of example – the analyst gives what seems to her a straightforward interpretation, the patient responds with anxiety and anger suggesting that he felt that the analyst was rebuking and mocking him, but his angry response evokes in the analyst a sense not only of being grossly misunderstood but of wanting to pressurize or bully the patient into understanding. If this type of situation seems in varying ways to be repeated as the analysis goes on and the analyst is aware of the pull towards this kind of enactment it can give us some idea of the kind of pressures the patient very possibly experienced in his past with, say, a father who actually did or was felt to bully or pressurize the child. And we see how the child probably responded with fear and anger or hostility. This would make the father more upset and hostile and the two would get caught up in a vicious cycle. A cycle that is repeated in the transference but there we may begin to be able to unwind it. (This I shall discuss further in a moment.) Thus fragments of history come alive under our eyes.

弗洛伊德将移情视作了这样一些部分:比如患者重复叙述个人史,将自己的关系转移到分析师身上。梅兰妮克莱恩进一步发展了这一观点,她一方面提出了在亲子关系的非常早期的阶段,孩子如何内化和建立他的内在客体世界,还有一方面是这些内在客体被投射到和分析师的关系中从而形成了移情。我想要说的是要是我们跟随着会谈中的一个时刻转换到下一个时刻我们能够开始得悉他的过去是如何架构的,因为我们能够找到它在会谈里被重建起来的元素。举一个极端简化的例子——分析师给出了一个在她看来非常直接的诠释,患者做出了焦虑和愤怒的反应,说明他感到分析师在指责他,嘲弄他,但是他的愤怒反应不光光激起了分析师感到自己被严重地误解了,而且分析师感到自己想要施压给患者或者逼迫他理解自己的诠释。如果这类的情景在分析进行的过程中以各种各样的形式重复出现,分析师意识到了让我们陷入这种情景的拉力,就可以告诉我们患者非常有可能在过去经常经历这一点压力,比如说,他的父亲事实上逼迫或者施压给孩子或者让孩子感觉到他如是做。并且我们可以看到孩子有可能是如何回应恐惧和愤怒或者敌意的。这将会使父亲更加焦虑和充满敌意,然后两个人就回进入到一个恶性循环里面去。这个循环就在移情中重复了,但这也是我们可能开始能解开它的地方(我待会就做进一步的讨论)因此个人史的片段就在我们的眼皮底下活现了。

I like therefore to try to understand what is being lived out by the patient and the role that I am being asked to play. If what I have learnt about his past comes into my mind and seems relevant at that moment then I like to connect it in my interpretations. It means that the patient’s history so far as it is known, or assumed to be known, is at the back of my mind rather than leading my expectations. Premature linking with history can easily be a defensive move both for patient and analyst. But in the long term I do feel that an understanding of what has gone on in the past, its meaning to the patient and his involvement in it, is not only of great interest to me as his analyst. It is also important to the patient that he can feel that his analyst has a sense of continuity and has his history in his mind. I believe this gives the patient a sense that there can be some flexibility in the understanding and interpretation of his history, and a greater sense of integration of himself.

至今为止,我都很乐于去尝试理解患者上演的是哪一出以及我在里面被要求去演的是什么角色。如果我所知的他的过去出现在了脑子里而且看起来和此时是有关联的,我就会将这个结合到我的诠释里面去。这指的是患者的个人史,到目前为止我们获知的,或者假设我们知道的部分,更多的是放在我的脑子的,而不是主导我的期待。一个不成熟的和个人史的联结很容易变成患者和分析师共同的防御。但是在长程的工作中,我深刻感受到对过去究竟发生了什么的理解,它对于患者的意义以及患者参与到其中的热度,这些不仅仅是我作为他的分析师而抱有很大的兴趣,同时对患者能够感受到他的分析师有连贯性的感知以及分析师是确确实实将他的个人史放在心上的这个部分有着重要的意义。我相信这会给患者一种感觉,就是对于他个人史的理解和诠释将能够有机会更有弹性,而且他会对整合他自己更有触动。

This I think has an important bearing, as I indicated earlier, on the whole issue of psychic change. To my mind real psychic change does not come about through the patient’s recognition of the way he repeats old patterns of behaviour and relating, important as this awareness may be. Psychic change I think must depend on the patient’s ability to feel how and why he experienced or was caught up in certain manoeuvres, anxieties, defences, and this will only come about as he not only repeats his past, but moment by moment reconstructs it in the transference. The process of reconstructing will have an impact on the analyst as he is drawn into the various roles he is required to enact – or rather, since he is the analyst, he needs to become aware of this, to verbalize what is going on rather than enact. I attempted to illustrate this with the example of the child with the bullying father. As the patient experiences an object, the analyst, who does not get drawn into bullying he may begin to feel less angry, more trusting, and thus the analyst will be experienced as more benign and internalized as a more benign object evoking less anxiety and rage in the patient. In this way the vicious cycle can begin to loosen. I believe that this is an import aspect of achieving psychic change – by minute but ascertainable changes that take place within the transference and hence in the patient’s internal world.

正如我早先所说的,我认为在整个精神改变的话题上有一个很重要的指向。在我的想法里,真正的精神改变并不是通过患者对认识他旧的重复发生的行为模式以及这个行为模式代表的意义来发生的,可能这种认识也是重要的。而我认为精神改变必定是依靠患者的感受能力,也就是他是感受自己是如何以及为何经历或者陷入的特定的操控、焦虑、防御的能力;并且这些部分并不仅仅是从他重复的过去中来,而是每时每刻在他的移情中重建出来的。重建的过程将会影响到分析师,因为分析师会被拖下水然后在患者的要求下扮演不同的角色——更进一步来说,从他成为分析师起,他需要意识到这个部分,从而用言语去描述究竟在发生什么而不是一味扮演。我试着用这个被父亲逼迫的孩子的个案来阐明这个观点。当这个患者经历了一个客体——分析师——这是一个并没有被拖下水去逼迫他的人,他可能开始感受到不那么愤怒,更多的信任,因此分析师将会被体验为一个更温和的人,然后被患者作为一个更加温和的客体,唤起更少的焦虑和愤怒的客体内化。通过这样的方式,恶性循环的趋势就能够开始缓和下来。我相信这对于得到精神改变是至关重要的方面——微小的但是可以察觉到的改变将在移情中发生而且也在患者的内在世界发生。

I want to return to the issue of analytic explanations. They, like the patient’s told history, have a place at the back of my mind. I do not like to try to explain to a patient in general, for example, why he is using a particular defence unless I can see what is happening in the transference, how, for example, he has gone silent or become withdrawn and what seems to have resulted from this, what has been achieved by it. My aim is to help both of us to observe and understand the movement rather than my giving my patient what is essentially a more theoretical explanation, however correct this may be. If we give our patients general explanations or show them simply the way they are repeating their past, I suspect we become, in their minds, someone who wants them to change, a needy or a superego figure, rather than an analyst who will really try to enter into their state of mind at that moment. I do not, as I said previously, think that our interpretations are only concerned about what is going on in the room; I like to start from there and be able then, or maybe much later, to understand and to help the patient to understand its relevance to what is going on in his outside life and to his general difficulties and hopes.

我想要回到分析师的解释这个话题上。他们(比如患者说的个人史)都会放在我的心上。我并不喜欢试着泛泛而谈地向患者解释,比如,在我看到他在移情关系中使用某种防御之前我是不会说他为什么要使用某种特定的防御的;也不会在我看到之前说他怎么陷入沉默或是显得退缩,究竟是什么导致了这一切,这种方式又造成了什么等等。我的目标是帮助我们俩一起去观察和理解这些举动而不是我把自以为觉得必要的理论解释(不论这个理论多正确)给出给我的患者。如果我们给我们患者的是泛泛而谈的解释或者是给他们展示"你看,你就是在不断重复你们的过去"这样一种简而化之的做法,我怀疑我们这么做的时候,我们在患者的脑子里就成了一个想要他们改变的人,象征着需要或者超我的部分,而不是一个真正在努力试着进入到他们的状态或者进入他们的内心的分析师。就像我之前说的,我不认为我们的诠释仅仅关心治疗室里面发生了什么;我想做的是从此地开始,接下来或甚至更久的时间之后,我们能够理解患者并帮助患者理解此时此地和他在治疗师以外发生的事情是息息相关的,和他整体的困难和愿望是息息相关的。(编者按:就像温尼科特所说"做出的诠释行不通,通常意味着时机不对或者方式错误,所以我会无条件收回我的诠释。就算我在某个时间点的诠释是对的,只是表达方式不对,我也一样收回。专断的诠释只会留给孩子两种选择:不是把我的话当成教条来接受,就是对这个诠释,对我,对整个情境完全否定"。详见《涂鸦与梦境》,心灵工坊出版社出版)

In this brief contribution I have been stressing the importance of movement; here I am adding the importance of the analyst’s mind being able to move from what is going on in the room to the outside world and the past, but understanding, I am suggesting, needs to start from what is going on here and now.

在这篇短文中,我强调了此时此地的重要性;我延伸了分析师能够通过在治疗室里发生的部分拓展到患者在治疗室外以及过去发生的部分的重要性,但是不论如何,理解就从"此时此地"开始。(编者按:这是敢问路在何方,路在脚下的赶脚^_^)

(本文完结)



王蕾的其他日志

缺席客体(The Absent Object)
此時此地:我的觀點|作者:貝蒂 乔瑟夫
露易丝的案例(第I部分)《Tavistock Clinic》
早年客体关系的皮肤体验