治疗师和督导师共情失败的分类
zhuyifeng2018-12-17 09:09
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A Classification of Empathic Failures for Psychotherapists and Supervisors
Edna M. Mordecai, PhD
Boston Institute for Psychotheraipy,, Inc.
Empathic failure is a normal characteristic of all human relationships. In psychotherapy and the supervision of psychotherapy, empathic failures can have a negative effect; however, with appropriate management, these failures can represent an important opportunity for a therapeutic experience. Due to a variety of factors embedded in the transference/countertransference ambience of therapy, empathic failures are often obscured and neglected by therapists and supervisors. This article proposes a classification for six types of empathic failures according to their sources. It suggests the range of failures within each type, and specifies the obscuring factors, the common errors in response, and the possible interventions for each type of empathic failure.
共情失败是人际关系的正常特征。在心理治疗和心理治疗的督导中，共情失败可能具有负面影响；然而，通过适当的管理，这些失败可能意味着一个治疗性体验的重要机会。在移情/反移情治疗环境中，由于各种各样的因素，共情失败常常被治疗师和督导师忽视。本文根据共情失败的来源，对六种类型的共情失败进行了分类。其中提出每种类型的失败领域，指出掩盖元素、常见的错误反应，以及对每种类型的共情失败的可能干预。
At best, our understanding of another person remains partial and imperfect. In psychotherapeutic encounters as well as in clinical supervision, empathic failures occur with regularity. When these failures go unnoticed, they can cause considerable disruption to therapy. An important task of therapy is to attend to injuries that are occasioned by empathic failures. This means that therapists and supervisors must enhance their skills in working through empathic failures in therapy.
即使在最佳情况下，我们对他人的理解仍然会是部分和不完整的。在心理治疗和临床督导中，共情失败会频繁地发生。当这些失败被忽视时，可能对治疗造成相当大的破坏。治疗的一个重要任务是注意由共情失败引起的伤害。这意味着治疗师和督导师必须提高他们的工作技能来修通治疗中的共情失败。
即使在最佳情况下，我们对他人的理解仍然会是部分和不完整的。在心理治疗和临床督导中，共情失败会频繁地发生。当这些失败被忽视时，可能对治疗造成相当大的破坏。治疗的一个重要任务是注意由共情失败引起的伤害。这意味着治疗师和督导师必须提高他们的工作技能来修通治疗中的共情失败。
A variety of factors operating in both therapy and its supervision can serve to obscure the presence of an empathic failure. Because therapeutic encounters occur in an environment of transference and countertransference phenomena, many of the obscuring factors remain unconscious and therefore invisible. This article presents a system for uncovering hidden empathic failures in order to begin their remediation and reduce their negative effects. The article presents the kinds of signs that indicate empathic failure has occurred and it proposes a classification of six types of empathic failures by sources. For each type, the article identifies: (a) the range of failures encompassed, (b) factors that obscure the perception of such failures, (c) therapeutic errors common to the type, and (d) guidance for creating appropriate empathic interventions.
在治疗和督导中运作的各种元素都可以用来掩盖共情失败的存在。因为治疗性相遇发生在移情和反移情现象的环境中，所以许多掩盖因素保持于潜意识中，因此是不可见的。本文提出了一种发现隐性共情失败的系统，以便开始补救和减少其负面影响。文章介绍了共情失败发生的各种信号，并根据来源对六种类型的共情失败进行了分类。对于每种类型，文章辨认：(a)涵盖的失败领域，(b)掩盖感知这种失败的元素，(c)该类型常见的治疗错误，以及(d)指导创建适当的共情干预。
Attention to empathic failures is central to successful therapeutic encounters with our patients as well as with the therapists we supervise. They are not mere peripheral nuisances to be gotten out of the way of the "real" therapy.
对共情失败的关注是我们与患者以及我们指导的治疗师成功进行治疗性相遇的关键。他们不仅仅是相对于“真正的”治疗来说需要排除的外围困扰。
在治疗和督导中运作的各种元素都可以用来掩盖共情失败的存在。因为治疗性相遇发生在移情和反移情现象的环境中，所以许多掩盖因素保持于潜意识中，因此是不可见的。本文提出了一种发现隐性共情失败的系统，以便开始补救和减少其负面影响。文章介绍了共情失败发生的各种信号，并根据来源对六种类型的共情失败进行了分类。对于每种类型，文章辨认：(a)涵盖的失败领域，(b)掩盖感知这种失败的元素，(c)该类型常见的治疗错误，以及(d)指导创建适当的共情干预。
Attention to empathic failures is central to successful therapeutic encounters with our patients as well as with the therapists we supervise. They are not mere peripheral nuisances to be gotten out of the way of the "real" therapy.
对共情失败的关注是我们与患者以及我们指导的治疗师成功进行治疗性相遇的关键。他们不仅仅是相对于“真正的”治疗来说需要排除的外围困扰。
Empathic failures are noted at different levels of awareness. Obvious failures are signaled, either verbally or affectively, by the patient to the therapist. These can be promptly attended. Hidden failures, however, have signals that occur at lower levels of awareness and therefore require higher levels of alertness on the part of therapist and supervisor. Such signals include the following: (a) any signs of physiological distress in the patient such as blushing or restless shifting of position, (b) avoiding contact by falling silent or averting eye contact, (c) hesitancy of speech or very rapid speech, (d) any of the aforementioned signs in the therapist, (e) a sudden or protracted opacity in the flow of associations, (f) excessive boredom or impatience on the part of the therapist, (g) threatened premature termination, (h) threatened or acted out contract violations, (i) feelings of inadequacy on the part of the therapist, and (j) a long stuck phase that does not yield to interventions. The preceding signals are often recognized by the therapist; they may or may not be reported in supervision. Supervisors should always be alert to the possible presence of these signals even when not reported. They must also recognize the significance of certain obscuring factors, as well as certain response errors, as signals that unreported empathic failures are present.
共情失败在不同的认知水平被注意到。明显失败的信号会由患者向治疗师通过言语或情绪发出。这些可以及时处理。然而，隐蔽失败的信号则在较低意识水平下发生，因此需要治疗师和督导师加倍警惕。这些信号包括：(a)患者的任何生理痛苦的信号，例如脸红或不安地移动位置，(b)通过保持沉默或避免眼神接触来避免接触，(c)讲话迟缓或讲话非常迅速，(d)治疗师身上的任何上述征兆，(e)联想中突然或持久的难以理解，(f)治疗师过度无聊或不耐烦，(g)威胁过早终止治疗，(h)威胁或违反合同，(i)治疗师感到不适，和(j)长期停滞不前，无法进行干预。上述信号通常由治疗师识别，它们可能在督导下报告也可能不报告。即使没有报告这些信号，督导师也应该随时警惕这些信号的可能存在。他们还必须认识到某些掩盖元素的重要性，以及某些错误回应，作为未报告的共情失败存在的信号。
共情失败在不同的认知水平被注意到。明显失败的信号会由患者向治疗师通过言语或情绪发出。这些可以及时处理。然而，隐蔽失败的信号则在较低意识水平下发生，因此需要治疗师和督导师加倍警惕。这些信号包括：(a)患者的任何生理痛苦的信号，例如脸红或不安地移动位置，(b)通过保持沉默或避免眼神接触来避免接触，(c)讲话迟缓或讲话非常迅速，(d)治疗师身上的任何上述征兆，(e)联想中突然或持久的难以理解，(f)治疗师过度无聊或不耐烦，(g)威胁过早终止治疗，(h)威胁或违反合同，(i)治疗师感到不适，和(j)长期停滞不前，无法进行干预。上述信号通常由治疗师识别，它们可能在督导下报告也可能不报告。即使没有报告这些信号，督导师也应该随时警惕这些信号的可能存在。他们还必须认识到某些掩盖元素的重要性，以及某些错误回应，作为未报告的共情失败存在的信号。
The following is an outline of the classification by source. Type I and II failures are identified as inherent to the therapeutic situation. These two are not seen as failures on the part of the therapist, but are included because they are often felt by the patient to be empathic failures and must therefore be treated as such by the therapist. Because they are inherent, they are too often overlooked or underestimated in their potential to cause injury to a patient. Through neglect or mismanagement, they can become passively inflicted empathic failures. Types III through VI failures are actively, though often unwit- tingly, inflicted upon the patient by the therapist.
以下是按来源分类的概要。类型I和II的失败被认为为治疗情况所固有的。这两者并不被治疗师视为失败，但被包括在内，因为它们常常被患者感觉为共情失败，因此必须被治疗师认真对待。因为它们是固有的，所以常常被忽视或低估了它们给患者造成的潜在伤害。由于疏忽或管理不善，它们可能成为被动造成的共情失败。III型到VI型失败是由治疗师主动地，尽管常常是无意识的，施加在患者身上。
以下是按来源分类的概要。类型I和II的失败被认为为治疗情况所固有的。这两者并不被治疗师视为失败，但被包括在内，因为它们常常被患者感觉为共情失败，因此必须被治疗师认真对待。因为它们是固有的，所以常常被忽视或低估了它们给患者造成的潜在伤害。由于疏忽或管理不善，它们可能成为被动造成的共情失败。III型到VI型失败是由治疗师主动地，尽管常常是无意识的，施加在患者身上。
1. Type I (living): These failures inhere in the ordinary and extraordinary, but unavoidable, negative experiences of life.
1.类型I（生活）：这些失败源于普通和特别的、但不可避免的负面生活经历。
1.类型I（生活）：这些失败源于普通和特别的、但不可避免的负面生活经历。
2. Type II (contract): These failures inhere in the appropriate administration of the terms of the therapy contract.
2. 类型II（合同）：这些失败源于治疗合同的适当执行。
2. 类型II（合同）：这些失败源于治疗合同的适当执行。
3. Type III (therapist's situational distress): These failures occur when a usually empathic therapist is temporarily facing issues and circumstances that interfere with his or her relationship to the patient.
3.类型III（治疗师的情景痛苦）：这些失败发生在通常共情的治疗师临时面临干扰他或她与患者关系的问题和环境。
3.类型III（治疗师的情景痛苦）：这些失败发生在通常共情的治疗师临时面临干扰他或她与患者关系的问题和环境。
4. Type IV (therapist's chronic pathology): These failures arise in the pathology of the therapist.
4.类型IV（治疗师的慢性病理学）：这些失败发生在治疗师的病理学上。
4.类型IV（治疗师的慢性病理学）：这些失败发生在治疗师的病理学上。
5. Type V (distal): These failures are initiated in circumstances that impinge on the therapy though they are outside of the interpersonal sphere.
5。类型V（远端）：这些失败产生于影响治疗的环境，尽管他们不在人际关系范围内。
6. Type VI (patient's pathology): These failures arise in the patient's pathology. Two kinds of Type VI failures are presented: (a) repetition, in the therapy, of early trauma; and (b) misunderstanding of the more primitive experiences and mental organizations of generally well-functioning patients.
5。类型V（远端）：这些失败产生于影响治疗的环境，尽管他们不在人际关系范围内。
6. Type VI (patient's pathology): These failures arise in the patient's pathology. Two kinds of Type VI failures are presented: (a) repetition, in the therapy, of early trauma; and (b) misunderstanding of the more primitive experiences and mental organizations of generally well-functioning patients.
6.类型VI（患者病理学）：这些失败发生在患者的病理学上。提出两种类型的VI型失败：(a)在治疗中重复早期创伤；(b)对一般功能良好的患者的更原始的经验和精神组织的误解。
EMPATHY IN PSYCHOANALYTIC THEORY
精神分析理论中的共情
精神分析理论中的共情
The concept of empathy has occupied a position of increasing importance in psychoanalytic theory in recent years. Empathy has been viewed from several angles; as one important tool that allows a therapist to know his or her patient, as an impediment to the therapist's neutrality, as an important quality of a caretaker, and as the source of therapeutic interactions. The Glossary of Psy- choanalytic Terms and Concepts of the American Psychoanalytic Association (Moore & Fine, 1971) describes empathy as follows:
近年来，共情概念在精神分析理论中占有越来越重要的地位。共情可以从几个角度来看待：它是使治疗师了解他或她的患者的重要工具，是治疗师中立性的障碍，是照顾者的重要品质，也是治疗互动的源泉。美国精神分析协会的精神分析术语和概念词汇表（Moore & Fine，1971）描述共情如下：
近年来，共情概念在精神分析理论中占有越来越重要的地位。共情可以从几个角度来看待：它是使治疗师了解他或她的患者的重要工具，是治疗师中立性的障碍，是照顾者的重要品质，也是治疗互动的源泉。美国精神分析协会的精神分析术语和概念词汇表（Moore & Fine，1971）描述共情如下：
A special mode of perceiving the psychological state of another person. It is an "emotional knowing" of another human being rather than intellectual understanding. To empathize means temporarily to share, to experience the feelings of the other person. One partakes of the quality but not the quantity, the kind but not the degree of the feelings, (p. 43)
感知他人心理状态的一种特殊方式。它是对另一个人的“情感性知晓”，而不是智力的理解。共情就是暂时地分享、体验他人的感受。一个人分享的是品质而不是数量，是感受的种类而不是程度（第43页）。
The concept of empathy has not always been central in the developing theory of psychoanalysis. Freud (1921) considered empathy a major tool lead- ing to the accurate understanding of others, writing that "empathy . . . plays the largest part in our understanding of what is inherently foreign to our ego in other people" (p. 108). However, Freud considered empathy to be an archaic system of communication that had, to a great extent, been replaced by spoken language.
共情概念在精神分析理论的发展中并不总是居于核心地位。弗洛伊德（1921）认为共情是导致准确理解他人的主要工具，他写道“共情…...在我们理解别人内在于我们的自我是陌生的内容时，发挥了最大的作用”（第108页）。然而，弗洛伊德认为共情是一种古老的交流系统，在很大程度上已经被话语所取代。
Indeed, later theorists (e.g., Hartmann, 1927/1964) expressed extreme cau- tion about the use of empathy. Hartmann saw it as entirely unreliable, unscien- tific, and untestable. Reliance on signs, data, and evidence had gained importance in the attempt to establish psychoanalysis as a scientific endeavor. The scientific approach led psychoanalysts to eschew any information gathered through more primary processes. And, reliance on empathy was not only unscientific, it could lead to a compromise of the rule of neutrality by directing undue attention to feelings.
事实上，后来的理论家（例如，哈特曼，1927/1964）对共情的使用表示了极端的谨慎。哈特曼认为它完全不可靠、不科学、不稳定。在将精神分析作为一项科学事业的尝试中，对迹象、数据和证据的依赖已经变得很重要。科学方法使精神分析学家避开了通过更基本的过程收集的任何信息。而且，依赖共情不仅是不科学的，它还可能通过过度关注情感而导致中立原则的让步。
事实上，后来的理论家（例如，哈特曼，1927/1964）对共情的使用表示了极端的谨慎。哈特曼认为它完全不可靠、不科学、不稳定。在将精神分析作为一项科学事业的尝试中，对迹象、数据和证据的依赖已经变得很重要。科学方法使精神分析学家避开了通过更基本的过程收集的任何信息。而且，依赖共情不仅是不科学的，它还可能通过过度关注情感而导致中立原则的让步。
Object relations theory, on the other hand, returned empathy to a more central place in the theory of human development. The recognition of the role of the human environment in infant development and the importance of an attuned primary caretaker was particularly emphasized by Winnicott (1956/ 1975) and more recently by Stern (1985). They attributed pathology to failures in the "facilitating environment," especially failures by the early caretakers to read and respond accurately to the infant's needs. The experience of neglect as well as the experience of impingement from an unattuned environment causes the development of pathology. Stern emphasized the importance of affective attunement between mother and infant. Without this attunement, the infant experiences uncontainable frustration and confusion. Psychotherapy, in this object relations context, seeks to provide an empathic environment in
which the patient's difficulties can be analyzed in safety.
另一方面，客体关系理论将共情回归到人类发展理论的中心位置。Winnicott(1956/1975)和Stern(1985)特别强调了人类环境在婴儿发育中的作用以及协调一致的主要照顾者的重要性。他们把病理学归咎于“促进性环境”的失败，尤其是早期照顾者不能正确阅读和响应婴儿的需要。来自不协调的环境的被忽视的经历和侵犯的经历导致了病理学的发展。斯特恩强调母婴情感调谐的重要性。没有这个调谐，婴儿会经历无法克服的挫折和困惑。心理治疗，在这种客体关系语境中，寻求提供一个共情性环境，在其中可以安全地分析病人的困难。
另一方面，客体关系理论将共情回归到人类发展理论的中心位置。Winnicott(1956/1975)和Stern(1985)特别强调了人类环境在婴儿发育中的作用以及协调一致的主要照顾者的重要性。他们把病理学归咎于“促进性环境”的失败，尤其是早期照顾者不能正确阅读和响应婴儿的需要。来自不协调的环境的被忽视的经历和侵犯的经历导致了病理学的发展。斯特恩强调母婴情感调谐的重要性。没有这个调谐，婴儿会经历无法克服的挫折和困惑。心理治疗，在这种客体关系语境中，寻求提供一个共情性环境，在其中可以安全地分析病人的困难。
In more recent times, even the more classical drive theorists adopted a less suspicious stance toward the phenomenon of empathy. Kernberg (1984), for instance, maintained that empathy is actually one important key to sustaining the all important neutrality in the face of a patient's regressive aggression. Although, for Kernberg, empathy does not occupy the central place that it does in self psychology, empathy does serve as the handmaiden of the more essential neutrality.
最近，甚至更经典的驱力理论家对共情现象也采取了不那么怀疑的立场。例如，Kernberg（1984）坚持认为，在面对患者的退行性攻击时，共情实际上是维持所有重要中立性的一个重要关键。虽然，对于Kernberg来说，共情并不像它在自体心理学中那样占据中心位置，但是共情确实辅助了更为基本的中立性。
It is the self psychology of Kohut and his followers that focused most intensely on the nature of empathy, the effects of empathic failures, and the role of empathy in therapy. Kohut's theories of the etiology and therapy of psychopathology most specifically centered around the uses, misuses, and abuses of empathy. According to Kohut (1984), it is in the context of parental empathic failures that psychopathology is born. And it is in the context of optimal frustration (bearable empathic failures by a therapist) that internal structure is built and the maturation of selfobjects occurs.
正是Kohut和他的追随者的自体心理学集中于共情的本质、共情失败的影响，以及共情在治疗中的角色。Kohut关于精神病理的病因学和治疗理论主要集中于共情的使用、误用和滥用。Kohut（1984）认为，心理病理就是在父母共情失败的背景下诞生的。在恰到好处的挫折（治疗师的可忍受的共情失败）的背景下，内部结构被建立，自体主体的成熟发生。
正是Kohut和他的追随者的自体心理学集中于共情的本质、共情失败的影响，以及共情在治疗中的角色。Kohut关于精神病理的病因学和治疗理论主要集中于共情的使用、误用和滥用。Kohut（1984）认为，心理病理就是在父母共情失败的背景下诞生的。在恰到好处的挫折（治疗师的可忍受的共情失败）的背景下，内部结构被建立，自体主体的成熟发生。
Bacal (1985) extended Kohut's concept of optimal frustration with his notion of optimal responsiveness. According to Bacal, it is not optimal frustra- tion that causes transmuting effects on internal structure but the effort on the part of the therapist to recognize and repair the failure in an act of optimal responsiveness. It is not in the failure but in the remediation that structure is built and that the capacities of the self are enhanced.
Bacal（1985）扩展了Kohut关于恰当好处的挫折概念，提出恰当好处的回应概念。根据Bacal的说法，引起内部结构变化的不是恰当好处的挫折，而是治疗师在恰当好处的回应行为中识别和修复失败的努力。不是在失败中，而是在补救中，结构被建立，自体的能力被增强。
Bacal（1985）扩展了Kohut关于恰当好处的挫折概念，提出恰当好处的回应概念。根据Bacal的说法，引起内部结构变化的不是恰当好处的挫折，而是治疗师在恰当好处的回应行为中识别和修复失败的努力。不是在失败中，而是在补救中，结构被建立，自体的能力被增强。
A fundamental assumption of this article is that the task of the psychotherapist is to develop an understanding of the patient's "psychic reality" (Schwaber, 1983). Over the course of therapy, the therapist constructs a constantly changing model of the inner reality of the patient (Greenson, 1960). Mfarguiijs (1984) stated that "therapeutic truth [is] a dialectic, a creation of the relationship itself, a continuous corning into being . . ." (p. 1029). In this dynamic vision of psychic reality, "empathy is not merely resonating with the other, but an act of will and creativity" (p. 1032). This requires that the therapist be perpetually open to a dialectic between what is known at any given moment in therapy and what is not yet known. Closure must be avoided regarding our knowledge of each unique patient. An accurate grasp of the patient's realtiy is what makes it possible to create interventions leading to changes in internal structure for that patient.
本文的一个基本假设是心理治疗师的任务是发展对患者的“心理现实”（Schwaber，1983）的理解。在治疗过程中，治疗师构建一个不断变化的患者内在现实的模型（Greenson，1960）。Mfarguiijs（1984）指出，“治疗性真理是辩证的，是关系本身的创造，是连续地逐渐形成。”...(第1029页)。在这个充满活力的精神现实的视野中，“共情不仅仅是与另一个人共鸣，而是一种意志和创造力的行为”（第1032页）。这就要求治疗师在治疗的任何特定时刻都必须对已知的和未知永远辩证地开放。必须避免关闭关于我们对每个独特患者的认识。准确把握患者的现实就能够创建导致患者内部结构变化的干预措施。
Transmuting opportunities occur in therapy and in supervision when empathy is given a central place as both a means of attending and a source of creative intervention. In order to bring about a truly therapeutic effect, it is essential that the therapist steadfastly witness the patient's reality and carefully and courageously share this understanding in an act of "withness." One potent way this is done is by addressing the reality of empathic failures that occur within the therapeutic encounter.
在治疗和督导中，当共情被赋予一个中心位置，既作为参与的手段，又作为创造性干预的源泉时，就会出现机会的转变。为了达到真正的治疗效果，治疗师必须坚定地见证患者的真实情况，并且谨慎和勇敢地以一个“见证”的行为分享这种理解。一个有力的方法是解决在治疗遭遇中发生的共情失败的现实。THE CLASSIFICATION OF EMPATHIC FAILURES
共情失败的分类
共情失败的分类
The following classification is intended to help therapists and supervisors recognize empathic failures and fashion responses that will further the process of therapy.
以下分类旨在帮助治疗师和监督者认识到移情失败和时尚反应，这将进一步的治疗过程。
以下分类旨在帮助治疗师和监督者认识到移情失败和时尚反应，这将进一步的治疗过程。
Type I Failures (Living)
类型I失败（生活）
类型I失败（生活）
These inherent empathic failures reside in the circumstances of our lives. Our patients (and, indeed, we ourselves) often feel angry and abused when the bee stings, when the dog bites, when the car will not start or there is no parking place. Certainly the more serious events of our lives such as poor health, the death of a loved one, the numerous losses of living, often leave us feeling injured and unsupported. In the more regressed states of therapy, patients often blame their misfortunes on the therapist. This can precipitate considerable discomfort in the dyad.
这些固有的共情失败存在于我们生活的环境中。当被蜜蜂叮，被狗咬，汽车发动不起来，或者没有停车位时，我们的病人（甚至我们自己）经常感到愤怒和被虐待。当然，我们生活中更严重的事件，如健康状况不佳、亲人去世、生命中的无数丧失，常常使我们感到受伤和得不到支持。在治疗更退行的状态下，患者常常把自己的不幸归咎于治疗师。这会在两人间引起相当大的不适。
这些固有的共情失败存在于我们生活的环境中。当被蜜蜂叮，被狗咬，汽车发动不起来，或者没有停车位时，我们的病人（甚至我们自己）经常感到愤怒和被虐待。当然，我们生活中更严重的事件，如健康状况不佳、亲人去世、生命中的无数丧失，常常使我们感到受伤和得不到支持。在治疗更退行的状态下，患者常常把自己的不幸归咎于治疗师。这会在两人间引起相当大的不适。
One obscuring factor in a Type I failure is that it goes unnoticed because the patient is ashamed (consciously or unconsciously) to let the therapist know his or her infantile feelings or magical wishes. To compound the matter, the therapist may fail to recognize this shame and ignore the potential for such feelings. Indeed, partial but inadequate awareness of infantile feelings in the patient may actually stimulate the therapist to respond defensively to being blamed for life's inherent difficulties.
I型失败的一个掩盖因素是，它之所以没有被注意到是因为患者羞于（有意或无意）让治疗师知道他或她的幼稚感受或神奇愿望。治疗师可能无法认识到这种羞耻感并忽视这种感觉的潜在可能性，这会让事情复杂化。确实，当由于生活固有困难而被指责时，对患者幼稚情感的部分但不充分的认识实际上可能刺激治疗师进行防御性的回应。
I型失败的一个掩盖因素是，它之所以没有被注意到是因为患者羞于（有意或无意）让治疗师知道他或她的幼稚感受或神奇愿望。治疗师可能无法认识到这种羞耻感并忽视这种感觉的潜在可能性，这会让事情复杂化。确实，当由于生活固有困难而被指责时，对患者幼稚情感的部分但不充分的认识实际上可能刺激治疗师进行防御性的回应。
One response error will take the form of a correction of the patient's "distortion." This can only increase the shame and drive away the opportunity to examine a shifting piece of transference. In these circumstances, it is impor- tant to acknowledge the patient's feelings and at the same time resist the pull to reassure, sympathize, or take an inadequate gratifying action. "Pseudo kindnesses" with a parallel "pseudo gratitude" can turn the Type I error into a further obscurant of the patient's feelings of injury. The response to a Type I failure requires that the therapist accept the limits of life within himself or herself. To be internally acquainted with and accepting of our own primitive, magical, and often denied convictions that we should be protected from harm because of our virtues is sometimes all that is required to guard against compounding a Type I failure. Grandiose defensiveness leads us to believe that logical explanations or inadequate substitute gratifications can be therapeutic. If intervention is actually required, it rarely goes beyond an interested acknowledgement of whatever feelings have been aroused, and a conveying of the message that all feelings—however unreasonable they may seem—are valued in therapy.
一个错误回应的形式是去纠正病人的“歪曲”。这只会增加羞耻感并剥夺了对一个变化中的移情片段进行检查的机会。在这种情况下，必须承认病人的感受，同时抵制安抚、同情或采取不适当的满足行动的诱惑。”“伪善”和“伪感激”可以把I型错误变成对患者受伤感觉的进一步掩盖。对I型失败的回应要求治疗师接受自己的生活局限。熟悉和接受我们自己的原始、神奇、经常被否定的信念（因为我们的美德我们应该受到保护、免受伤害的信念），有时候这些就是防止加剧I型失败所需要的全部。夸大防御使我们相信逻辑上的解释或者不适当的替代性满足是可以有治疗性的。如果确实需要干预，也顶多是有兴趣地承认已经唤起的任何情感，以及传达信息：所有情感——无论它们看起来多么不合理——在治疗中都是有价值。
一个错误回应的形式是去纠正病人的“歪曲”。这只会增加羞耻感并剥夺了对一个变化中的移情片段进行检查的机会。在这种情况下，必须承认病人的感受，同时抵制安抚、同情或采取不适当的满足行动的诱惑。”“伪善”和“伪感激”可以把I型错误变成对患者受伤感觉的进一步掩盖。对I型失败的回应要求治疗师接受自己的生活局限。熟悉和接受我们自己的原始、神奇、经常被否定的信念（因为我们的美德我们应该受到保护、免受伤害的信念），有时候这些就是防止加剧I型失败所需要的全部。夸大防御使我们相信逻辑上的解释或者不适当的替代性满足是可以有治疗性的。如果确实需要干预，也顶多是有兴趣地承认已经唤起的任何情感，以及传达信息：所有情感——无论它们看起来多么不合理——在治疗中都是有价值。
Type II Failures (Contract)
类型II失败（合同）
类型II失败（合同）
These are the failures that arise in the contractual limits of therapy. Specifically, they do not include the empathic failures due to the mismanagement of the frame but only those inherent in the appropriate administration of the contract. Ending the hour precisely on time, charging for missed appointments, limiting phone contacts, and abstaining from sharing personal informa- tion are often felt by the patient to be empathic failures. The very act of charging money for time and relationship is often seen as the crassest kind of insult, revealing the therapist's uncaring nature.
这些都是在合同限制的治疗中出现的失败。具体的，它们不包括由于框架管理不当导致的共情失败，而仅包括那些在合同的适当管理中固有的失败。准时结束一小时时间，对错过的预约收费，限制电话联系，以及避免分享个人信息，这些常常被患者认为是共情失败。为了时间和关系而收费的行为常常会被看作最粗鲁的侮辱，暴露了治疗师冷漠的本性。
这些都是在合同限制的治疗中出现的失败。具体的，它们不包括由于框架管理不当导致的共情失败，而仅包括那些在合同的适当管理中固有的失败。准时结束一小时时间，对错过的预约收费，限制电话联系，以及避免分享个人信息，这些常常被患者认为是共情失败。为了时间和关系而收费的行为常常会被看作最粗鲁的侮辱，暴露了治疗师冷漠的本性。
The obscuring factor in the Type II failure is the guilt and/or grandiosity of the therapist caused by his or her adherence to a contract in which he or she does not completely believe. An unresolved or unconscious need to be a perfectly giving therapist can wreak havoc with an otherwise reasonable therapy contract. Furthermore, therapists often adopt the contract style of a revered supervisor or colleague. At other times they are constrained by the policies of an agency. Whatever the reason for contract discomfort, it can cause important response errors. A tendency to act out a rescue fantasy by fracturing the terms of the contract can lead to disarray, a breach of safety, or a guilty grandiosity in the patient who may feel that he or she has unfairly compromised the therapist. On the other hand, if a therapist clings rigidly to a poorly executed therapy agreement, the patient may experience despair and hopelessness about ever being treated with consideration for his or her needs.
II类失败的掩盖元素是治疗师由于对合同的坚持而产生的内疚和/或夸大，他/她本身对这合同并不完全相信。一个未解决的或潜意识的需要，需要是一个完美给予的治疗师，会破坏合理的治疗合同。此外，治疗师通常采用受人尊敬的上司或同事的合同风格。有时，他们受到机构政策的约束。无论合同令人不舒服的原因是什么，它都可能导致重要的错误回应。通过破坏合同条款来实施救援幻想的倾向可能导致患者混乱、安全受到破坏，或者一个内疚的夸大，患者可能认为他或她已经不公平地损害了治疗师。另一方面，如果治疗师坚持一个执行不善的治疗协议，那么患者可能对于曾经考虑了他或她的需要而体验绝望和无望。
II类失败的掩盖元素是治疗师由于对合同的坚持而产生的内疚和/或夸大，他/她本身对这合同并不完全相信。一个未解决的或潜意识的需要，需要是一个完美给予的治疗师，会破坏合理的治疗合同。此外，治疗师通常采用受人尊敬的上司或同事的合同风格。有时，他们受到机构政策的约束。无论合同令人不舒服的原因是什么，它都可能导致重要的错误回应。通过破坏合同条款来实施救援幻想的倾向可能导致患者混乱、安全受到破坏，或者一个内疚的夸大，患者可能认为他或她已经不公平地损害了治疗师。另一方面，如果治疗师坚持一个执行不善的治疗协议，那么患者可能对于曾经考虑了他或她的需要而体验绝望和无望。
Remediation of Type II failures lies in the careful construction of a contract that feels comfortable to the therapist. It requires that the terms of the contract be routinely brought to awareness as potential sources of empathic failure; Although it is important to make sure the contract is clear, it is equally important that the therapist examine his or her own comfort with the contract. It has to be clear to the therapist that his or her needs for privacy, for protection from impingement, and for safety are legitimate. Remediation includes a vigil on the therapist's own need for the contract to preserve his or her therapeutic vitality as well as on the patient's need for stability and safety.
第二类故障的补救在于精心构建治疗师感到舒服的合同。它要求定期将合同条款作为共情失败的潜在源头引起注意；虽然确保合同明确很重要，但是治疗师检查自己对合同的舒适度同样重要。治疗师必须清楚的是，他或她对于隐私、保护免受攻击以及安全的需求是合法的。补救包括治疗师坚守自己需要合同来保持他或她的治疗活力，以及坚守患者需要稳定和安全。
Type III Failures (Therapist's Situational Distress)
Type III failures are those inflicted when a usually empathic therapist is unable to maintain empathy in a particular situation or at a particular time because of stress in his or her own life. These failures may range from (a) lapses of attention in the therapy hour, (b) being late for an appointment, to (c) forget- ting a piece of essential information about a patient. In the usually attentive and empathic therapist, such lapses cause considerable discomfort and are therefore quite likely to find their way into supervision as explicit issues. In more serious and less discernible cases of Type III failures, the therapist's stress is linked to parallel issues in the patient's material and may therefore be denied or avoided.
类型III失败是当一位通常有共情能力的治疗师在一个特定情况或时刻由于自己生活中的压力而不能保持共情造成的。这些失败可能包括：(a)治疗时注意力不集中，(b)咨询迟到，(c)忘记了一条关于患者的基本信息。在通常专注和共情的治疗师中，这种失误会引起相当大的不适，因此很有可能作为明确的问题进入督导。在类型III失败的更严重和更难辨别的情况中，治疗师的压力与病人材料中的并行问题有关，因此被否认或回避。
Obscuring factors that hide Type III failures can come from the therapist,the patient, or even the supervisor. The therapist's unwillingness or inability to face the issue in his or her own life may be paralleled by the supervisor's reluctance to become therapist to the supervisee. In addition, the therapist may be uncomfortable about a dimly perceived identification with the patient. Even with these powerful obscuring factors in operation, patients are often acutely aware of the therapist's distress and may try to protect the therapist by not acknowledging awareness. At worst, they may blame themselves in a kind of repetition of taking responsibility for parental pathology. At such points, Type III failures can become Type VI failures.
隐藏III型失败的掩盖元素可能来自治疗师、病人、甚至督导师。治疗师不愿意或不能面对自己生活中的问题，可能与督导师不愿意成为被督导者的治疗师平行。此外，治疗师可能对一种对患者模糊感知的认同感到不舒服。即使存在着这些强大的掩盖元素，患者往往敏锐地意识到治疗师的痛苦，并可能试图保护治疗师避免承认。最坏的情况是，他们可能会抱怨自己反复造成父母的病理。在这些点上，类型III故障可以变成VI型失败。
隐藏III型失败的掩盖元素可能来自治疗师、病人、甚至督导师。治疗师不愿意或不能面对自己生活中的问题，可能与督导师不愿意成为被督导者的治疗师平行。此外，治疗师可能对一种对患者模糊感知的认同感到不舒服。即使存在着这些强大的掩盖元素，患者往往敏锐地意识到治疗师的痛苦，并可能试图保护治疗师避免承认。最坏的情况是，他们可能会抱怨自己反复造成父母的病理。在这些点上，类型III故障可以变成VI型失败。
Response errors usually grow out of the therapist's and the supervisor's well-intended attempts at "business as usual." They often take the form of repeated erroneous or slightly off interventions that come from the therapist's, not the patient's, distress. In the worst cases the therapist and supervisor join in pathologizing the patient as unworkable or untreatable. This can cause the therapist to fail to take responsibility for a blatant empathic failure.
错误回应通常产生于治疗师和督导师善意的企图“照常工作”。它们通常采取重复错误的或稍微偏离的干预，这源于治疗师的痛苦，而不是患者的。在最坏的情况下，治疗师和督导师共同把患者病态化为不可工作的或不可治疗的。这可能导致治疗师不能为明显的共情失败负责。
错误回应通常产生于治疗师和督导师善意的企图“照常工作”。它们通常采取重复错误的或稍微偏离的干预，这源于治疗师的痛苦，而不是患者的。在最坏的情况下，治疗师和督导师共同把患者病态化为不可工作的或不可治疗的。这可能导致治疗师不能为明显的共情失败负责。
Remediation can only occur when the therapist and supervisor understand the empathic failure as arising from an aberrant state in the therapist. Failure in the form of distraction, preoccupation, or actual acting out must be owned by the therapist. Whether this owning is to be done explicitly with the patient must be carefully considered. It is important in these instances to keep in mind that for patients who grew up believing that they were responsible for the mistreatment they received, failure to own Type III failure may compound an injury. There can be no corrective action at all until the therapist is able to see his or her part in the failure. If owning, or even apologizing for a failure turns out to be an error, the error will at least then be a visible one.
只有当治疗师和督导师将共情失败理解为由治疗师的异常状态引起的，补救才能发生。以分心、走神或实际付诸行动形式出现的失败必须属于治疗师。是否这明确与患者必须仔细考虑。在这些情况下，重要的是要牢记，对于那些从小就相信自己对受到的虐待负有责任的病人，治疗师没有承担III型失败责任可能加重伤害。除非治疗师能够看到自己在失败中的角色，否则根本无法采取纠正措施。如果承担、甚至为失败道歉的结果证明是一个错误，那么该错误至少将是一个可见的错误。
Type IV failures are inflicted by the therapist due to unresolved and ego syntonic countertransference feelings. Syntonicity makes these failures less visible and therefore less available for correction. The intrusion of chronically unacknowledged and acted out needs of the therapist causes failures that include: (a) persistent misunderstandings of the verbal messages of the patient; (b) misinterpretations of the affects surrounding the patient's communications; (c) flagrantly careless management of the frame; (d) financial or social exploitation of the patient; and (e) at the extreme, sexual abuse of the patient.
IV型失败是由治疗师由于未解决的和自我协调的反移情感受而导致的。自我协调使得这些故障更少可见，因此更不可被校正。治疗师长期未被承认和付诸行为的需求的侵入导致的失败包括：(a)对患者语言信息的持续误解；(b)对患者沟通的情感的错误解释；(c)对框架的明显疏忽管理；(d)对患者经济或社会剥削；以及（e）极端地对病人进行性虐待。
The signals that Type IV errors are occurring must almost always be noticed by the supervisor; they will rarely be reported. Therefore, it is impor- tant to know that beyond the ordinary signals for the other types of failures, additional signals operate in Type IV failures. An immutable quality to the therapy, the sameness of the pathology of the different patients presented, the paucity of actual data of the therapy, and a tendency to talk about theory rather than therapy should all serve as signals. When a supervisor is persistently feeling devalued, ignored, or overvalued, this should also serve as a signal that a Type IV empathic failure may be at work. signal that a Type IV empathic failure may be at work.
发生IV型错误的信号必须总是需要督导师注意，因为它们很少被报告。因此，必须知道，除了用于其他类型的故障的普通信号之外，还有额外的IV型失败信号。治疗的千篇一律，不同患者被呈现相同的病理结构，治疗的实际数据的缺乏，以及谈论理论而不是治疗等等这些倾向都以为着这类信号。当督导师持续地感到被贬值、被忽视或被高估时，这也应该作为IV类共情失败可能在工作的信号。
Type IV failures are often deliberately obscured by therapists who know that what they are doing with patients will not receive approval. They are also deliberately obscured by pathologically narcissistic therapists who consider themselves able to break the rules with impunity. It is essential that such problems be caught and dealt with as early in a therapist's career as possible, for such therapists will rarely seek honest consultation once they are independent practitioners. Blindness to these kinds of failures in our colleagues and reluctance to deal with them when they are obvious is a real obscuring factor. This is a matter that must be addressed by the supervisor, but that always needs to be referred to the therapist's own therapy. Due to the nature of these failures, and the shame and/or grandiosity that may accompany them, it is often difficult to be sure that a referral of the matter to the therapist's therapy is successful. Close monitoring of the fate of the difficulty must continue. Severe or intractable cases of Type IV failures require more drastic methods of remediation. The recent rash of reports of abusing therapists has led to recognition that the abuses of these therapists were often known or at least suspected by members of the therapeutic community. It is likely that these therapists may have been suspected of misconduct in their training. Supervisors must be willing to confront such difficulties. It is essential that remediation be addressed first by the supervisor and then, if necessary, by the professional community in the form of appropriate disciplinary action by professional boards.
IV型失败常常被治疗师故意掩盖，他们知道他们对病人的所作所为得不到认可。他们还被病理性自恋的治疗师故意蒙蔽，他们认为自己能够不受惩罚地违反规则。在治疗师的职业生涯中，尽早发现并处理这些问题是至关重要的，因为这些治疗师一旦成为独立从业者，就很少寻求诚实的谘商。我们同事对这些类型的失败视而不见，并且当这些失败显而易见时也不愿处理它们，这确实是一个掩盖元素。这是一个必须由督导师解决的问题，但往往需要推荐治疗师自己接受治疗。由于这些失败的性质，以及伴随它们的羞耻和/或夸大，常常难以确定推荐治疗师自己接受治疗是否成功。必须继续密切监测这个困难的命运。严重或顽固的IV型失败案例需要更严厉的补救方法。最近大量关于治疗师虐待的报告使人们认识到这些治疗师的虐待行为常常是治疗界成员所知道的，或者至少是被他们怀疑的。很可能这些治疗师在培训过程中被怀疑有不当行为。督导师必须愿意面对这样的困难。至关重要的是，补救措施首先应由督导师处理，然后如有必要，由专业团体以适当的纪律行动的形式由专业委员会处理。
Type V Failures (Distal)
Type IV Failures (Therapist's Chronic Pathology)
类型VI错误（治疗师的慢性病理）
类型VI错误（治疗师的慢性病理）
Type IV failures are inflicted by the therapist due to unresolved and ego syntonic countertransference feelings. Syntonicity makes these failures less visible and therefore less available for correction. The intrusion of chronically unacknowledged and acted out needs of the therapist causes failures that include: (a) persistent misunderstandings of the verbal messages of the patient; (b) misinterpretations of the affects surrounding the patient's communications; (c) flagrantly careless management of the frame; (d) financial or social exploitation of the patient; and (e) at the extreme, sexual abuse of the patient.
IV型失败是由治疗师由于未解决的和自我协调的反移情感受而导致的。自我协调使得这些故障更少可见，因此更不可被校正。治疗师长期未被承认和付诸行为的需求的侵入导致的失败包括：(a)对患者语言信息的持续误解；(b)对患者沟通的情感的错误解释；(c)对框架的明显疏忽管理；(d)对患者经济或社会剥削；以及（e）极端地对病人进行性虐待。
The signals that Type IV errors are occurring must almost always be noticed by the supervisor; they will rarely be reported. Therefore, it is impor- tant to know that beyond the ordinary signals for the other types of failures, additional signals operate in Type IV failures. An immutable quality to the therapy, the sameness of the pathology of the different patients presented, the paucity of actual data of the therapy, and a tendency to talk about theory rather than therapy should all serve as signals. When a supervisor is persistently feeling devalued, ignored, or overvalued, this should also serve as a signal that a Type IV empathic failure may be at work. signal that a Type IV empathic failure may be at work.
发生IV型错误的信号必须总是需要督导师注意，因为它们很少被报告。因此，必须知道，除了用于其他类型的故障的普通信号之外，还有额外的IV型失败信号。治疗的千篇一律，不同患者被呈现相同的病理结构，治疗的实际数据的缺乏，以及谈论理论而不是治疗等等这些倾向都以为着这类信号。当督导师持续地感到被贬值、被忽视或被高估时，这也应该作为IV类共情失败可能在工作的信号。
Type IV failures are often deliberately obscured by therapists who know that what they are doing with patients will not receive approval. They are also deliberately obscured by pathologically narcissistic therapists who consider themselves able to break the rules with impunity. It is essential that such problems be caught and dealt with as early in a therapist's career as possible, for such therapists will rarely seek honest consultation once they are independent practitioners. Blindness to these kinds of failures in our colleagues and reluctance to deal with them when they are obvious is a real obscuring factor. This is a matter that must be addressed by the supervisor, but that always needs to be referred to the therapist's own therapy. Due to the nature of these failures, and the shame and/or grandiosity that may accompany them, it is often difficult to be sure that a referral of the matter to the therapist's therapy is successful. Close monitoring of the fate of the difficulty must continue. Severe or intractable cases of Type IV failures require more drastic methods of remediation. The recent rash of reports of abusing therapists has led to recognition that the abuses of these therapists were often known or at least suspected by members of the therapeutic community. It is likely that these therapists may have been suspected of misconduct in their training. Supervisors must be willing to confront such difficulties. It is essential that remediation be addressed first by the supervisor and then, if necessary, by the professional community in the form of appropriate disciplinary action by professional boards.
IV型失败常常被治疗师故意掩盖，他们知道他们对病人的所作所为得不到认可。他们还被病理性自恋的治疗师故意蒙蔽，他们认为自己能够不受惩罚地违反规则。在治疗师的职业生涯中，尽早发现并处理这些问题是至关重要的，因为这些治疗师一旦成为独立从业者，就很少寻求诚实的谘商。我们同事对这些类型的失败视而不见，并且当这些失败显而易见时也不愿处理它们，这确实是一个掩盖元素。这是一个必须由督导师解决的问题，但往往需要推荐治疗师自己接受治疗。由于这些失败的性质，以及伴随它们的羞耻和/或夸大，常常难以确定推荐治疗师自己接受治疗是否成功。必须继续密切监测这个困难的命运。严重或顽固的IV型失败案例需要更严厉的补救方法。最近大量关于治疗师虐待的报告使人们认识到这些治疗师的虐待行为常常是治疗界成员所知道的，或者至少是被他们怀疑的。很可能这些治疗师在培训过程中被怀疑有不当行为。督导师必须愿意面对这样的困难。至关重要的是，补救措施首先应由督导师处理，然后如有必要，由专业团体以适当的纪律行动的形式由专业委员会处理。
Type V Failures (Distal)
V型失败（远端）
Type V empathic failures have their source outside of the patient-therapist dyad. These failures are actually inflicted first on the therapist and are then passed along to the patient. Careless supervision, which does not guard the self-esteem of the therapist, is a common source of empathic failures. Low staif morale and poorly administered agency policies are also possible causes of supervisor and therapist failures.
V型共情失败的来源不在患者和治疗师之间。这些失败实际上首先影响治疗师，然后传给病人。不用心的督导，这会不顾及治疗师的自尊心，是共情失败的常见来源。士气低落和管理不善的机构政策也是导致督导师和治疗师失败的可能原因。
The obscuring factors for Type V failures often occur in supervision that does not provide the therapist with appropriate nurturance and safety. Super- visors must remember the vulnerable and exposed position of the conscientious therapist/supervisee. Ridicule, gossip, and poorly communicated messages have no place in supervision. Questionable agency policies and low staff morale need to be openly acknowledged as burdens to the therapist.
V型失败的掩盖元素常常发生在没有为治疗师提供适当滋养和安全的督导中。督导师必须记住认真的治疗师/被督导者的脆弱和易受伤的位置。嘲弄、流言蜚语和沟通不畅的信息不应在督导中出现。有问题的机构政策和低落的工作人员士气需要被看作治疗师的负担而公开承认。
Response errors include a kind of defensive attitude on the part of supervisors in interpreting the agency or the senior staff to the supervisees. Failure to acknowledge the difficulties in these areas and the concomitant tendency by the supervisor to pathologize the trainee who is chafing under these factors works against the therapist and the patient. At worst, supervisors who are careless with the frame of supervision will convey their disdain for frame issues, despite any lofty words to the contrary.
错误回应包括督导师在向被督导者解释机构或高级职员时采取的一种防御态度。未能认识到这些领域的困难以及随之而来的病理化受训者(这会让受训者因此烦躁不安）的倾向，这些对治疗师和患者不利。最坏的情况是，那些对督导框架不用心的督导师将传达他们对于框架问题的蔑视，尽管有任何与之相反的崇高言辞。
Remediation of distal failures lies in the supervisor's ability to create a holding and facilitating environment for the supervisee, thereby clearly demonstrating the kind of environment he or she expects the supervisee to provide for the patient. The frame must be kept, confidentiality must be explicitly defined, respect must be shown. Honest appraisals of morale and policy difficulties are also important to the self-esteem and confidence of the therapist. The Type V failure on these parameters bears close resemblance to Type III and Type IV remediations.
远端失败的补救在于督导师能够为被督导者创造一种抱持和促进性环境的能力，从而清楚地表明他或她期望被督导者为患者提供的环境。必须保持框架，必须明确定义保密性，必须显示尊重。诚实地评估士气和政策困难对治疗师的自尊心和信心也很重要。在这些参数上的V型故障与III型和IV型补救非常相似。
Type VI Failures (Patient's Pathology)
VI型失败（患者的病理）
VI型失败（患者的病理）
Type VI failures are those inflicted on the patient due to a misunderstanding of the patient's pathology. Failures emanating from the patient's pathology may take many forms. We look at just two of them: (a) those that occur when an early trauma is reenacted in the therapy, and (b) those that occur because of misjudging the primitive nature of the patient's experience. Identifying the patient's pathology as the source of such failures is in no way meant to place the blame for the failure upon the patient. It is meant, rather respectfully to acknowledge the power of the repetition compulsion in therapeutic interac- tions. It can further help us to discover the presence of pieces of primitive pathology in patients who are generally functioning well.
VI类失败是由于对患者病理的误解而造成的。由病人的病理学引起的失败可以采取多种形式。我们只看其中的两个：（a）那些在治疗中重现早期创伤时发生的，和（b）那些由于误判患者体验的原始性质而发生的。将患者的病理学确定为这些失败的根源绝不意味着将失败归咎于患者。它的意思是，相当尊重地承认在治疗相互作用中强迫性重复的力量。它可以进一步帮助我们发现那些通常功能良好的患者中存在一些原始病理。
Miller (1984) reminded us that the need to repeat early trauma in a therapeutic relationship is a necessary step in remembering and working through that trauma. It is through therapy that the repetition cycle can be broken through empathic interpretation of the reenactment. The patient can experi- ence a new ending to an old story. However, sometimes the patient's compul- sion to repeat is so powerful that no matter how strong the wish to have that different ending, the patient must first induce the therapist to reenact with him or her the affect of the earlier trauma in order to bring it to remembrance. These are the times when usually empathic therapists find themselves acting in a sadistic manner toward the patient, being unnecessarily withholding, scolding the patient for the very behaviors that brought him or her to therapy, or committing small acts of abandonment that can have far-reaching consequences. This kind of response to the force of a repetition compulsion is so common that it may even be wise for therapists of abused or abandoned patients to ask themselves early in the process, "How is this patient likely lo involve me in an act of abuse or abandonment?"
米勒（1984）提醒我们，需要在治疗关系中重复早期创伤是回忆起和修通创伤的必要步骤。正是通过治疗，通过对再次演绎（reenactment)的共情解释，才能打破重复的循环。病人可以体验一个旧故事的新结局。然而，有时病人想要重复的冲动是如此强烈，以至于无论多么强烈地希望拥有不同的结局，病人必然首先诱导治疗师与他或她重新演绎早期创伤的影响，以便唤起记忆。这些时候，通常共情治疗师发现自己以虐待的方式对待病人、不必要地退缩、责备病人的导致他或她接受治疗的行为，或者做出小小的遗弃行为，但可能产生深远的后果。这种对强迫性重复的反应是如此普遍，以至于虐待或遗弃患者的治疗师在治疗过程的早期就问自己：“这个患者会怎样让我卷入虐待或遗弃的行为中？”
The obscuring factors for a Type VI failure are embedded in the patient's inability to remember early trauma in a way that would convey it verbally to the therapist. Caught up in an unconscious exchange, under the sway of powerful forces of projective identification, the usually empathic therapist will need to become exquisitely aware of impulses to harm, insult, abandon, or otherwise humiliate the patient, and to be equally aware of impulses to protect, flatter, or indulge.
VI型失败的掩盖元素存在于患者没有能力想起早期创伤，因而难以将其言语性地传达给治疗师。陷入潜意识的交流中，在投射性认同的强大力量的影响下，通常有共情能力的治疗师将需要变得对伤害、侮辱、遗弃或以其他方式羞辱患者的冲动有准确的觉察，并且同时也意识到保护、奉承或纵容的冲动。
VI型失败的掩盖元素存在于患者没有能力想起早期创伤，因而难以将其言语性地传达给治疗师。陷入潜意识的交流中，在投射性认同的强大力量的影响下，通常有共情能力的治疗师将需要变得对伤害、侮辱、遗弃或以其他方式羞辱患者的冲动有准确的觉察，并且同时也意识到保护、奉承或纵容的冲动。
Response errors are most commonly made when a therapist uses the therapy to express feelings of annoyance at the patient, who seems endlessly to repeat what had seemed to be worked through. Intractable repetition should alert the therapist and supervisor to the meaning of repetition itself in the present situation. The message from the patient is that, despite "correct inter- pretations" and "empathically intended responses," the patient has not felt understood. On the other hand, in defense of his or her self-esteem, the therapist might reverse negative feelings to pseudo empathy. Such responses become repetitions of the times when abusing caretakers expressed unacknowledged regret through meaningless overindulgences. Pseudo empathy may be accepted as a substitute for a real empathic response and thereby destroy any empathic response and thereby destroy any opportunity to get to know the patient's true suffering.
当治疗师使用治疗来表达对看上去无休止地重复似乎已经修通部分的病人的恼怒感时，最常出现错误回应。在当前情况下，倔强的重复应该提醒治疗师和督导师重视重复本身的含义。来自患者的信息是，尽管有“正确的解释”和“共情意图的回应”，患者并没有感觉到被理解。另一方面，为了捍卫他或她的自尊，治疗师可能会将消极情绪逆转为伪共情。这种回应重复了当年虐待照顾者通过无意义的过度放纵表达不被承认的悔恨。伪共情可以被接受为真正的共情回应的替代品，从而破坏任何共情回应，从而破坏任何了解患者真实痛苦的机会。
Remediation of this kind of empathic failure begins when the therapist sets aside judgment in a true empathic advocacy of the patient as he or she tries again, and yet again, to convey in language the early pain that has so far remained unexpressed. This is done through an empathic act of identification.As Miller (1984) wrote, "I distance myself. . . from an unconscious identification with the parent or pedagogue and consciously identify with the parent or pedagogue and consciously identify with the mute child in the patient" (p. 56)
这种共情失败的补救开始于当治疗师将评价放在一边，再次尝试，并且不断尝试，用语言传达迄今为止尚未表达的早期疼痛，来对患者进行真正的共情支持。这是通过一种共情的认同行为来实现的。如米勒（1984）写道：“我让自己…脱离对父母或教育者的潜意识认同，有意识地认同父母或教育者，有意识地认同患者内在的沉默儿童”(第56页)
Type VI failures of the second kind are due to the inability of therapists to be attuned to primitive pathology in generally high functioning patients. When we are working with patients who are frankly psychotic or obviously primitive in other ways, we are more likely to be aware that the experience of the patient is either foreign to us, or will require extraordinary empathic abilities to understand. There is less danger of a hidden empathic failure in those cases because the therapist is, from the start, aware that he or she is not easily able to be in empathy with the patient. In those cases where a primitive experience is at work in a patient who functions competently in most phases of his or her life, it is more difficult to see the pitfalls.
第二类VI型失败是由于治疗师没有能力与一般高功能患者的原始病理同调。当我们与公然地精神错乱或在其他方面明显原始的患者一起工作时，我们更可能意识到，患者的经历不是我们陌生的，就是需要非凡的共情能力来理解。在这些病例中，潜在的共情失败的危险较小，因为治疗师从一开始就意识到他或她不容易与病人产生共情。而当原始经验出现在大部分时候都运作良好的病人身上的情况下，就难以看到陷阱了。
Ogden (1989) proposed that experience is organized in three internal modes. Klein (1948/1975) proposed earlier that experience was organized from either the paranoid/schizoid position or the more oedipal, depressive position. To these, Ogden added the autistic-contiguous position, a mental organization more primitive than either of the others. He proposed that experi- ence is organized in a dialectic between the three modes and that every person, at some times, uses even the most primitive mode. A Type VI failure is most likely to occur when the therapist misunderstands a communication from the autistic-contiguous mode in any patient. The notion that everyone knows this mode at some times promises that this kind of experience is available to the empathic search of therapists who can tolerate it, but can be easily obscured by the terror that such experiences can engender in the therapist. As Ogden (1989) stated:
The autistic-contiguous mode is conceptualized as a sensory-dominated, pre- symbolic mode of generating experience. . . . Anxiety in this mode consists of an unspeakable terror of the dissolution of boundedness resulting in feelings of leaking, falling or dissolving into endless, shapeless space, (p. 81)
Ogden（1989）提出，经验是以三种内部模式组织的。Klein（1948/1975）早些时候提出了，经验要么来自偏执/分裂位态，要么来自更俄狄浦斯、抑郁位态。在此基础上，Ogden还加入了自闭-毗连位态，这个心理组织比其他任何一个都更原始。他提出，经验是以三种模式之间的辩证形式来组织的，而且每个人有时甚至都会使用最原始的模式。当治疗师误解了任何患者的自闭毗连模式的沟通时，VI型故障就最有可能发生。人们都知道这种模式，所以有时候这种体验是可以被能忍受的治疗师共情研究的，但是很容易由于这种体验在治疗师中引发的恐惧而被掩盖。如Ogden(1989)所述：
自闭-毗连模式被概念化为一种感官主导的、前符号的产生体验的模式。…在这种模式中的焦虑包含一种对边界消融的无法形容的恐惧，感觉泄漏、跌落或消融到无尽的、无形的空间中(第81页)。
Ogden（1989）提出，经验是以三种内部模式组织的。Klein（1948/1975）早些时候提出了，经验要么来自偏执/分裂位态，要么来自更俄狄浦斯、抑郁位态。在此基础上，Ogden还加入了自闭-毗连位态，这个心理组织比其他任何一个都更原始。他提出，经验是以三种模式之间的辩证形式来组织的，而且每个人有时甚至都会使用最原始的模式。当治疗师误解了任何患者的自闭毗连模式的沟通时，VI型故障就最有可能发生。人们都知道这种模式，所以有时候这种体验是可以被能忍受的治疗师共情研究的，但是很容易由于这种体验在治疗师中引发的恐惧而被掩盖。如Ogden(1989)所述：
自闭-毗连模式被概念化为一种感官主导的、前符号的产生体验的模式。…在这种模式中的焦虑包含一种对边界消融的无法形容的恐惧，感觉泄漏、跌落或消融到无尽的、无形的空间中(第81页)。
If the therapist is in empathy with the patient, he or she will experience these terrors. When we sense that we have misunderstood, and that our verbal attempts at contact have fallen on deaf ears, our own reluctance to share such a terrifying experience can prevent us from imagining ourselves into the experience of the patient. Obscuring factors arise in unconscious countertransference reactions of fear, revulsion, or disbelief at the signs of primitive pathology
如果治疗师对病人共情，他或她会体验这些恐怖。当我们意识到我们被误解了，并且我们言语上的接触尝试被置若罔闻时，我们自己不愿意共享这种可怕的体验，这会阻止我们想象自己进入病人的体验中。掩盖元素产生于面临原始病理信号时的潜意识反移情反应：由于恐惧、厌恶或怀疑。
Any of the following can signal that we are out of empathy in Type VIb failures: (a) idiosyncratic use of common words, (b) persistent description of feelings in terms of bodily sensations, (c) puzzling hints of thought disorder, and (d) long silences with protestations of emptiness and "nothing to say." It is frightening to glimpse the possibility of malignant regression in an apparently well-compensated patient. We often prefer to formulate these signs as resistance. We too infrequently entertain the possibility that no secondary process translation can convey the patient's experience. We speak, for instance, of well-articulated feelings to people who are experiencing bodily sensations. We interpret silence as resistance, and indeed find many ways to ignore or avoid the "primitive edge of experience" (Ogden, 1989).
以下任何一项都可以表明我们在VI型失败中失去了共情：(a)日常词汇的异常使用，(b)从身体感觉持续描述感受，(c)令人困惑的思维混乱迹象，以及(d)长时间的沉默，表达空虚和“无话可说”。在一个表面补偿良好的患者身上一睹恶性退行是令人可怕的。我们常常倾向于把这些信号看作阻抗。我们极少考虑还有第二种过程转换能够传达患者经验的可能性。比如，我们对那些正在体验身体感觉的人述说清楚的感受。我们把沉默理解为抗拒，并且确实找到许多方法来忽略或回避“体验的原始边缘”（Ogden，1989）。
Type VI failures are often brought to supervision with frustration and exasperation. Careful recognition of signs of primitive pathology is the first step in making useful interventions. At these times it is essential to focus on the creation and maintenance of a holding environment. When a patient is in an autistic-contiguous mode of experience, it is the rhythm and regularity, the sameness of the situation, and the sound of the therapist's voice that make the empathic connection. Efforts to create a holding environment and a ready recognition of the failure of our efforts to do so require a putting aside of theory, an openness to the unknown, and a tolerance for not knowing that is often disorienting, and therefore fearsome, to the therapist, but is at the graving edge of creative empathy.
VI型故障经常把沮丧和愤怒而带入督导。仔细识别原始病理的征兆是进行有效干预的第一步。此时，必须集中精力创建和维护一个抱持环境。当患者处于自闭-毗连的体验模式时，正是节奏和规律、环境的相同性以及治疗师的声音使得共情连接。努力创造一种抱持的环境，并准备好识别我们努力的失败，需要抛开理论，对未知事物开放，以及对未知事物的宽容，这对治疗师来说常常是令人迷失方向的，因此是可怕的，但这是处于创造性共情的黑暗边缘。
SUMMARY
总结
This classification can help therapists and supervisors identify and attend to the effects of empathic failures that stall and even destroy so many therapies. The system will certainly benefit from further refinement, but even in its present form can lead to a more useful recognition of our failures. The classification should go into operation at the earliest hint of an empathic failure. A quick mental review of the common sources of empathic failures will stimulate questions to ourselves and our supervisees about what might have occurred. When we develop an hypothesis about the injury, we will be able to avoid a response error and more deftly move toward a useful intervention. Too many therapies founder unnecessarily on unattended empathic failures. A systematic way to recognize, classify, and begin the work of repair for a variety of empathic failures with a variety of sources and severity of effect should be useful to both therapists and supervisors.
这种分类可以帮助治疗师和督导师识别并注意共情失败的影响，这些失败会阻碍甚至破坏很多治疗。这个系统肯定会从进一步的改进中受益，但是即使以它目前的形式也能够导致对我们的失败有更有用的识别。分类应该在共情失败的最早提示时开始操作。对共情失败的共同根源的快速心理回顾将激发我们和我们的督导师去思考可能发生了什么的问题。当我们建立关于受伤的假设时，我们将能够避免错误回应，并且更灵活地转向有用的干预。太多的治疗不必要地由于未处理的共情失败而失败了。对于治疗师和督导师来说，一个系统化的方法来识别、分类和开始修复各种来源和严重影响的共情失败应该是有用的。