Freud 1912e 对开业从事精神分析的医生的建议
作者: 斑鸠 译 / 2814次阅读 时间: 2016年2月16日
来源: 精神分析理论与临床 标签: 弗洛伊德 精神分析
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对开业从事精神分析的医生的建议
Recommendation to physicians pracstising psycho-analasis(1912e)
德文及德文译本 Ratschläge für den Arzt bei der psychoanalytischen Behandlung (1912)

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译者:斑鸠

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The technical rules which I am putting forward here have been arrived at from my own experience in the course of many years after unfortunate results had led me to abandon other methods. It will easily be seen that they (or at least many of them) may be summed up in a single precept. My hope is that observance of them will spare physicians practising analysis much unnecessary effort and guard them against some oversights. I must however make it clear that what I am asserting is that this technique is the only one suited to my individuality; I do not venture to deny that a physician quite differently constituted might find himself driven to adopt a different attitude to his patients and to the task before him.心理学空间\9W@U;Ox u$s$F p

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我正要提出的这些技术规则,是在那些令人遗憾的结果促使我放弃了其他的方法之后,在许多年的过程中,从我自己的经验里总结得出的。这会很容易看到,它们(或者至少是它们中的许多)是用一个单一的规则总结出来的。我的希望是,对这些规则的遵守会节省开业从事精神分析的医生的许多精力,并且会防止他们的一些疏忽。然而,我必须澄清,我正在主张的东西是这个仅适合我个人的技术。我不敢否认说,一个(理论)构成十分不同医生可能会感觉自己受到驱使而对他的病人和他眼前的任务采取一种不同的态度。心理学空间w%za/a D p+yW(c

%|)?+@"iw*n mP%H0(a) The first problem confronting an analyst who is treating more than one patient in the day will seem to him the hardest. It is the task of keeping in mind all the innumerable names, dates, detailed memories and pathological products which each patient communicates in the course of months and years of treatment, and of not confusing them with similar material produced by other patients under treatment simultaneously or previously. If one is required to analyse six, eight, or even more patients daily, the feat of memory involved in achieving this will provoke incredulity, astonishment or even commiseration in uninformed observers. Curiosity will in any case be felt about the technique which makes it possible to master such an abundance of material, and the expectation will be that some special expedients are required for the purpose.

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这第一个问题,是在一天之中治疗超过一个病人的分析师面临的问题,对他来说似乎是最困难的问题。那是一个记住所有的数不清的名字、日期、详细的回忆和由疾病引起的产物之任务,而这些产物是每个病人在治疗的成年累月的过程中传达的;还是一个不把这些产物与其他病人在治疗下同时或先前产生的相似材料相混淆的任务。如果我们每天需要分析6个、8个或者更多的病人,那么,完成这个任务所需要的记忆之壮举会在无知的观察者中引起怀疑、惊讶甚至同情。无论如何,对于能够掌控如此多的材料的技术,(我们)都会感到好奇,并且会预想,为了这个目的会需要一些特殊的策略。

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The technique, however, is a very simple one. As we shall see, it rejects the use of any specialexpedient (even that of taking notes). It consists simply in not directing one’s notice to anything in particular and in maintaining the same ‘evenly-suspended attention’ (as I have called it) in the face of all that one hears. In this way we spare ourselves a strain on our attention which could not in any case be kept up for several hours daily, and we avoid a danger which is inseparable from the exercise of deliberate attention.心理学空间g_fLT~'Y

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然而,这是一个非常的简单的技术。如同我们会看到的,它拒绝使用任何特殊的策略(即使是谈话记录的策略)。这个技术仅仅在于:尤其不要把我们的注意力引向任何东西和在面对我们听到的所有的东西时保持相同的“均匀-悬浮注意力”(如同我已经称呼它的)。以这个方式,我们避免了我们的注意力上的紧张,我们的注意力无论如何不可能每天都保持几个小时,并且我们避免了一种危险,这种危险和故意的注意是分不开的。心理学空间zw7y%|.J1S(D

"~P"J1_7d H+x.ig0For as soon as anyone deliberately concentrates his attention to a certain degree, he begins to select from the material before him; one point will be fixed in his mind with particular clearness and some other will be correspondingly disregarded, and in making this selection he will be following his expectations or inclinations. This, however, is precisely what must not be done. In making the selection, if he follows his expectations he is in danger of never finding anything but what he already knows; and if he follows his inclinations he will certainly falsify what he may perceive. It must not be forgotten that the things one hears are for the most part things whose meaning is only recognized later on.心理学空间1@[H)o,mH7C

R;Y{5e6c7w0因为,任何人一旦故意地把他的注意力集中到某个程度,他就会从他眼前的材料开始挑选;一个点将会特别清晰地固定在他的脑海中,并且,一些其他的点会被相应地忽视,在做这个选择时他将会跟随他的预期或者爱好。然而,这恰恰是不允许做的。在这个选择时,如果他跟随他的预期,那么,他就处在除了发现他已经知道的东西而决不会发现任何东西的危险之中;而如果他跟随他的爱好,那么,他将必定会歪曲他可能感知到的东西。必须不能忘记,我们所听见东西多半是只有后来才能识别它们的含意的东西。

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z] dc%\6U/Y+\0It will be seen that the rule of giving equal notice to everything is the necessary counterpart to the demand made on the patient that he should communicate everything that occurs to him without criticism or selection. If the doctor behaves otherwise, he is throwing away most of the advantage which results from the patient’s obeying the ‘fundamental rule of psycho- analysis’. The rule for the doctor may be expressed: ‘He should withhold all conscious influences from his capacity to attend, and give himself over completely to his "unconscious memory".’ Or, to put it purely in terms of technique: ‘He should simply listen, and not bother about whether he is keeping anything in mind.’ What is achieved in this manner will be sufficient for all requirements during the treatment.

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将会看到,对一切事物给予相等的注意力这条规则必须对应于对病人做的要求,即他应该没有批评没有挑选地传达一切他想到事物。如果医生表现得不是这样,那么,他就是在扔掉大部分的优势,这个优势缘于病人遵守“精神分析的基本规则”。对医生的规则可以表达为:“他应该抑制来所有的来自他的注意能力的意识的影响,而使自己完全屈服于“他的无意识记忆”,或者,单纯以技巧的措辞来说:“他应该仅仅是倾听,并且不要烦恼于他是否在记什么东西。”用这个方式所达到的东西将足以满足治疗中的所有要求。

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!@*Y3j0uzo9Y!R%rR0Those elements of the material which already form a connected context will be at the doctor’s conscious disposal; the rest, as yet unconnected and in chaotic disorder, seems at first to be submerged, but rises readily into recollection as soon as the patient brings up something new to which it can be related and by which it can be continued. The undeserved compliment of having ‘a remarkably good memory’ which the patient pays one when one reproduces some detail after a year and a day can then be accepted with a smile, whereas a conscious determination to recollect the point would probably have resulted in failure.心理学空间`F$qg5\eY

/EN@,[:J3UX[Sq0U0已经形成了一个连贯的脉络的材料的那些部分将会任凭医生的意识处理;那些剩下的部分,当时还是不连贯的、秩序混乱的部分,似乎开始时是潜在水下的(潜在意识之下的),但是,一旦病人谈到某个与之相关的东西,那些混乱的部分就容易浮现在(医生的)回忆中,并且,通过谈到的那个东西,那些混乱的东西就能够继续(浮现)。当整整一年过后我们复述一些细节时,那时病人给予我们的拥有一个“非常好的记忆”这个不应得的称赞,会被(我们)用一个微笑来接受,然而,对于回忆这个要点,一个有意识的决定,将很可能导致(回忆)失败。心理学空间F%{vi-L p"N3J-Xp

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Mistakes in this process of remembering occur only at times and places at which one is disturbed by some personal consideration (see below) - that is, when one has fallen seriously below the standard of an ideal analyst. Confusion with material brought up by other patients occurs very rarely. Where there is a dispute with the patient as to whether or how he has said some particular thing, the doctor is usually in the right.心理学空间jxqj$on#j

7Y&kT0x M8Q^Z01 A patient will often assert that he has already told the doctor something on a previous occasion, while the doctor can assure him with a quiet feeling of superiority that it has come up now for the first time. It then turns out that the patient had previously had the intention of saying it, but had been prevented from performing his intention by a resistance which was still present. His recollection of his intention is indistinguishable to him from a recollection of its performance.心理学空间Xk(en#u:I-K

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这种回忆过程中的失误只是有时会出现,并且只出现在我们被一些个人的顾虑打扰地方(看下面)--也就是说,当我们降到一个一个完美的分析家的标准以下时。混淆由其他病人提供的材料是很少发生的。与病人之间存在关于“他是否或怎样说过某个特殊的东西”的一个争论时,医生经常都是对的。

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1一个病人会经常宣称,他在以前的一个场合已经告诉了医生某个事情,然而医生可以以一种优越的和缓的感情向病人担保,它现在是第一次出现。然后,结果证明,病人以前曾打算说这个事情,但是一个仍然存在的阻抗阻止了他实施他的意图。对他来说,他对他的意图的回忆与对这个意图的实施的回忆是不能辨别的。心理学空间v9Fy^._1Hu

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(b) I cannot advise the taking of full notes, the keeping of a shorthand record, etc., during analytic sessions. Apart from the unfavourable impression which this makes on some patients, the same considerations as have been advanced with regard to attention apply here too. A detrimental selection from the material will necessarily be made as one writes the notes or shorthand, and part of one’s own mental activity is tied up in this way, which would be better employed in interpreting what one has heard. No objection can be raised to making exceptions to this rule in the case of dates, the text of dreams, or particular noteworthy events which can easily be detached from their context and are suitable for independent use as instances. But I am not in the habit of doing this either. As regards instances, I write them down from memory in the evening after work is over; as regards texts of dreams to which I attach importance, I get the patient to repeat them to me after he has related them so that I can fix them in my mind.心理学空间#M+tyDc

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我不能建议在分析的会面中写下完整的记录,保留一个速写记录等。除了给一些病人留下不适宜的印象,关于注意力在这里的运用,同样的顾虑也被提出了。我们写下笔记或速写记录将必然成为对材料的一个有损害的挑选,并且用这个方法时我们自己部分的精神活动被占用了,而这部分的精神活动可以更好地用于解释我们所听到的东西。在日期、梦的原貌的情况中,或者在特别显著的事件的情况中,这些事件在它们的脉络中很容易被分离出并适合作为例子独立使用,没有一个异议能够被举出来排除这个规则。但是我也不习惯于这么做。至于一些例子、一些我认为有重要价值的梦的原貌,我在晚上工作结束后把它们从记忆中写下来,并且在病人提到它们后,我让他向我重复它们,以便我能够在心中牢记它们。

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(c) Taking notes during the session with the patient might be justified by an intention of publishing a scientific study of the case. On general grounds this can scarcely be denied. Nevertheless it must be borne in mind that exact reports of analytic case histories are of less value than might be expected. Strictly speaking, they only possess the ostensible exactness of which ‘modern’ psychiatry affords us some striking examples. They are, as a rule, fatiguing to the reader and yet do not succeed in being a substitute for his actual presence at an analysis. Experience invariably shows that if readers are willing to believe an analyst they will have confidence in any slight revision to which he has submitted his material; if, on the other hand, they are unwilling to take analysis and the analyst seriously, they will pay no attention to accurate verbatim records of the treatment either. This is not the way, it seems, to remedy the lack of convincing evidence to be found in psycho-analytic reports.

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H,@&V2q,{@T0根据出版这个案例的科学研究的目的,在与病人的会面中做记录可能是正当的。以一般的根据,这很少被拒绝。必须牢记,对分析案例的历史的精确报告所拥有的价值比可能预期的要少。严格地说,这些案例只拥有表面的精确性,是“现代的”精神病学提供给我们的表面上精确的典型例子。通常,对于读者来说,这些案例让人劳累的,并且还没有成功地成为分析中他真实的存在的替代品。经验总是表明,如果读者愿意相信一个分析师,那么,他将会信任任何对他所递交的材料的轻微修改;另一方面,如果读者不重视分析和分析师,他们也不会去注意精确的、一字不差的心理治疗记录。似乎,这不是补救在分析报告中发现的缺乏令人信服的证据的方法。

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&l hE%e}6jp0a)m;E6u0(d)One of the claims of psycho-analysis to distinction is, no doubt, that in its execution research and treatment coincide; nevertheless, after a certain point, the technique required for the one opposes that required for the other. It is not a good thing to work on a case scientifically while treatment is still proceeding - to piece together its structure, to try to foretell its further progress, and to get a picture from time to time of the current state of affairs, as scientific interest would demand. Cases which are devoted from the first to scientific purposes and are treated accordingly suffer in their outcome; while the most successful cases are those in which one proceeds, as it were, without any purpose in view, allows oneself to be taken by surprise by any new turn in them, and always meets them with an open mind, free from any presuppositions.

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V1a@L$WP&n0毫无疑问,精神分析特有的其中一个主张是,在它的践行中研究和治疗是一致的。

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当治疗仍旧在进行时,在学术上致力于这个案例不是一件好的事情—如同科学兴趣所要求的,把案例的结构拼合起来、试图预言它进一步的发展和不时地获取当前的状况的一个图景。从一开始就被奉献给科学的目的并被相应地治疗的个案,在它们的结果中受到损害;而最成功的案例是那些,在其中,我们似乎没带任何在考虑的目的而进行治疗,我们允许自己惊讶于任何新的变化,并总是以开放的思想面对他们,免除任何预想。 

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2]({:o \I#I0The correct behaviour for an analyst lies in swinging over according to need from the one mental attitude to the other, in avoiding speculation or brooding over cases while they are in analysis, and in submitting the material obtained to a synthetic process of thought only after the analysis is concluded. The distinction between the two attitudes would be meaningless if we already possessed all the knowledge (or at least the essential knowledge) about the psychology of the unconscious and about the structure of the neuroses that we can obtain from psycho-analytic work. At present we are still far from that goal and we ought not to cut ourselves off from the possibility of testing what we have already learnt and of extending our knowledge further.

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对于一个分析师,正确的行为,在于根据需要从一种心理态度转到另一种态度(研究与治疗),在于,当他们处在分析之中时,避免推测或者对个案冥思苦想(研究的态度),并且在于,只在分析结束之后,才把获得的材料递交到一个人为的思考过程。如果我们对无意识的心理、对我们从分析工作中可以获得的神经症的结构有全部的认识(或者至少是必要的认识),那么,这两种态度之间的区别将没有意义。心理学空间0q Br1k rG

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目前,我们仍远离那个目标,并且,不应该使我们自己,从检验我们已学到的东西的可能性、从进一步扩展我们的知识的可能性中隔离开来。心理学空间e.Cd"qw

;b {{'kx}~i|`0(e) I cannot advise my colleagues too urgently to model themselves during psycho-analytic treatment on the surgeon, who puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the simple aim of performing the operation as skilfully as possible. Under present-day conditions the feeling that is most dangerous to a psycho-analyst is the therapeutic ambition to achieve by this novel and much disputed method something that will produce a convincing effect upon other people. This will not only put him into a state of mind which is unfavourable for his work, but will make him helpless against certain resistances of the patient, whose recovery, as we know, primarily depends on the interplay of forces in him. The justification for requiring this emotional coldness in the analyst is that it creates the most advantageous conditions for both parties: for the doctor a desirable protection for his own emotional life and for the patient the largest amount of help that we can give him to-day. A surgeon of earlier times took as his motto the words: ‘Je le pansai, Dieu le guérit.’1 The心理学空间C'\tTN MX X7b

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analyst should be content with something similar.

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我也不能强烈地建议我的同行在分析治疗中模仿外科医生,一个外科医生会把他所有的感觉,甚至他的人类的同情,搁置在一边,并把他的精神力量集中在尽可能熟练地实施手术这个简单的目标上。在现今的情况中,对一个精神分析师最危险的感觉是这个治疗的野心:通过这个新奇的、备受争议的方法来得到某个会对其他人产生一种令其信服的影响的东西。这不仅会使分析家进入一种不利于他的工作的思想状态,而且会使他在与病人的某些阻抗对抗时感到无能,这个病人,正如我们知道的,他健康的恢复主要取决于他体内的力量的相互作用。在分析师的中需要这种情感冷淡的理由是,它为两个当事人创造了最有利的条件:对于医生的一种对他情感生活的有利的保护、对于病人的我们今天能够给予他的最大量的帮助。一个早期的外科医生把这句话作为他的座右铭:“Je le pansai, Dieu le guérit。”1分析师应该满足于某个相似的东西。

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(f) It is easy to see upon what aim the different rules I have brought forward converge. They are all intended to create for the doctor a counterpart to the ‘fundamental rule of psycho-analysis’ which is laid down for the patient. Just as the patient must relate everything that his self-observation can detect, and keep back all the logical and affective objections that seek to induce him to make a selection from among them, so the doctor must put himself in a position to make use of everything he is told for the purposes of interpretation and of recognizing the concealed unconscious material without substituting a censorship of his own for the selection that the patient has forgone. To put it in a formula: he must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient. He must adjust himself to the patient as a telephone receiver is adjusted to the transmitting microphone. Just as the receiver converts back into sound waves the electric oscillations in the telephone line which were set up by sound waves, so the doctor’s unconscious is able, from the derivatives of the unconscious which are communicated to him, to reconstruct that unconscious, which has determined the patient’s free associations.

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5L4z'zps;n+u:H01 [‘I dressed his wounds, God cured him.’]

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很容易明白,我所提出的这些不同的规则集中于什么目标。它们都是打算为医生创造一个 与“精神分析基本规则”匹配之物,而这个基本规则是为病人准备的。正如病人必须讲述一切他的自我观察能够察觉的东西,并且阻止所有逻辑上的、情感上的反对,那些设法诱使他从自我观察中作出挑选反对,所以,为了解释的目的,并为了在医生没有用自己的稽查取代病人已抛弃的挑选之情况下识别隐藏的无意识材料,医生必须把自己放置在一个位置上以利用他所被告知的一切。以常规的话来说:医生必须使他自己的无意识像一个善于接纳的器官一样转向传递病人的无意识。如同一个电话接收器被调整以适应这个传递(声音)的话筒一样,他必须调整自己以适应病人。如同电话接受器在为声波设立的电话线中把声波转换成电信号一样,因此,医生的无意识能够,从向他传递的无意识的派生物中,重建支配病人的自由联想的那种无意识。心理学空间 _&O w?4Lh%q Yl2u

~(u Vc9oz3R3d9g01【我包扎他的伤口,上帝来治愈他】。

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q1BR#b,Cw0But if the doctor is to be in a position to use his unconscious in this way as an instrument in the心理学空间Y E.t#V.A%{7DoM`

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analysis, he must himself fulfil one psychological condition to a high degree. He may not tolerate any resistances in himself which hold back from his consciousness what has been perceived by his unconscious; otherwise he would introduce into the analysis a new species of selection and distortion which would be far more detrimental than that resulting from concentration of conscious attention. It is not enough for this that he himself should be an approximately normal person. It may be insisted, rather, that he should have undergone a psycho-analytic purification and have become aware of those complexes of his own which would be apt to interfere with his grasp of what the patient tells him. There can be no reasonable doubt about the disqualifying effect of such defects in the doctor; every unresolved repression in him constitutes what has been aptly described by Stekel as a ‘blind spot’ in his analytic perception.

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但是,如果医生在分析中要处在一个位置以用这种方法把无意识当做一个工具使用,他自己必须高程度地达到一种心理学的标准。他不能宽恕在他身上的任何阻抗,这些阻抗从意识中抑制他的无意识所察觉到的东西;否则,他将会把分析引导入一种新的挑选和扭曲,这种挑选和扭曲远比有意识的集中注意力所导致的(挑选)更有害。为此,(医生)他自己是一个接近正常的人,这还不足够。更确切地说,应该强调,他本应该经历一个精神的分析的净化,并意识到他自己的那些情结,那些情结会倾向于干扰他对病人所告诉他的东西的理解。关于在医生身上的这些缺点给他带来不合格的影响,这不存在任何合理的疑问;在他身上每一个未解决的压抑在他的分析的感觉中构成了被Stekel恰当描述为“盲点”的东西。心理学空间;C;^&_!mtt

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Some years ago I gave as an answer to the question of how one can become an analyst: ‘By心理学空间%Rv5s4C C_4iu3f

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analysing one’s own dreams.’ This preparation is no doubt enough for many people, but not for

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!x:}oXVE%y.x0everyone who wishes to learn analysis. Nor can everyone succeed in interpreting his own dreams without outside help. I count it as one of the many merits of the Zurich school of analysis that they have laid increased emphasis on this requirement, and have embodied it in the demand that everyone who wishes to carry out analyses on other people shall first himself undergo an analysis by someone with expert knowledge.

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@ vkb8Mv}0几年前,我曾就一个人怎样能够成为一个分析师这个问题给出过一个答案:“通过分析一个人自己的梦。”这个准备毫无疑问对很多人是足够的,但是不是对每一个想要学习精神分析的人。也不可能每个人在没有外部的帮助下都可以成功地解释他自己的梦。精神分析的苏黎世学派已经更加地强调这个必要条件,并且在这个要求中,即每个想在其他人身上实施分析的人他自己应该首先在某个有内行知识的人那里经历一个分析,具体体现了。我把这视为的他们许多优点中的一个。

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4m)c+Gx \0Anyone who takes up the work seriously should choose this course, which offers more than one advantage; the sacrifice involved in laying oneself open to another person without being driven to it by illness is amply rewarded. Not only is one’s aim of learning to know what is hidden in one’s own mind far more rapidly attained and with less expense of affect, but impressions and convictions will be gained in relation to oneself which will be sought in vain from studying books and attending lectures. And lastly, we must not under-estimate the advantage to be derived from the lasting mental contact that is as a rule established between the student and his guide.心理学空间I&eF!}8~PM

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任何认真从事这项工作的人都应该选择这个过程,这提供了不止一点优势;这个涉及到使我们自己处于对另一个人开放的状态而不受疾病的驱使的牺牲是充分值得的。不仅是我们学习认识隐藏在我们自己心灵中东西的这一目标会以更快的速度、更少的情感代价达到,而且将会得到关于我们自己的印象和信念,而从学习书本和参加课堂中寻求这些都是徒劳的。最后,我们一定不要低估这个将从持久的精神接触中得到的优势,通常这种学生和他的引导者之间的接触已成惯例了。

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eWqn o&];tvF0An analysis such as this of someone who is practically healthy will, as may be imagined, remain incomplete. Anyone who can appreciate the high value of the self-knowledge and increase in selfcontrol thus acquired will, when it is over, continue the analytic examination of his personality in the form of a self-analysis, and be content to realize that, within himself as well as in the external world, he must always expect to find something new. But anyone who has scorned to take the precaution of being analysed himself will not merely be punished by being incapable of learning more than a certain amount from his patients, he will risk a more serious danger and one which may become a danger to others. He will easily fall into the temptation of projecting outwards some of the peculiarities of his own personality, which he has dimly perceived, into the field of science, as a theory having universal validity; he will bring the psycho-analytic method into discredit, and lead the inexperienced astray.心理学空间V@6v1q(E3^A

}(B4O"Oj ]~ f0一个分析,比如实际上是健康的某人的分析,如同可以想象的,依然是不完整的。任何一个能够欣赏自我认识和后天获得的自我控制的增强之价值的人,在分析结束时,将会以自我分析的形式继续对他的人格进行分析性检查,并心甘情愿去体会:在他的内部,也在外部世界中,他总是期望去发现某个新的东西。但是任何一个轻蔑地去提防自己被分析的人,将不只是受惩罚于不能从他的病人那里学习许多东西,而且他会冒一个更严重的危险,一个威胁到他人的危险。按照在科学领域有普遍的正确性的一个理论,他很容易掉进向外投射他自己人格的一些特性的诱惑中,这些特性是他已经朦胧地感觉到的;他会败坏精神分析方法的名声,并使没有经验的人误入歧途。

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,g6Ei6q'T @(e o0(g) I shall now add a few other rules, that will serve as a transition from the attitude of the doctor to the treatment of the patient.心理学空间H2LG I,D9G6P8l

3J2tC5wm2wy1_-S|0现在,我应该添加一些其他的规则,这些规则会充当一个从医生的态度到病人的治疗的过渡。

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wsq E)Xj~.W-I0Young and eager psycho-analysts will no doubt be tempted to bring their own individuality freely into the discussion, in order to carry the patient along with them and lift him over the barriers of his own narrow personality. It might be expected that it would be quite allowable and indeed useful, with a view to overcoming the patient’s existing resistances, for the doctor to afford him a glimpse of his own mental defects and conflicts and, by giving him intimate information about his own life, enable him to put himself on an equal footing. One confidence deserves another, and anyone who demands intimacy from someone else must be prepared to give it in return.

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1zTR%t9ptAu0为了鼓舞支持病人并使病人跨越他自己刻板的个性的障碍,年轻又热心的精神分析师毫无疑问会受诱惑而把他自己的个性直率地带入讨论中。以一种克服病人存在的阻抗之观点来看,对于医生提供给病人对他自己的心理缺点和冲突的一瞥,并且,对于医生通过给予病人关于他自己的生活的私人信息而使病人能够处在一种平等的地位之上,可能会(我们)会预料,这是相当正当的、确实有用的。一个信任应该得到另一个信任,并且任何要求从其他人那里得到隐私的人就必须给予隐私作为交换。心理学空间3o7Gm Tpls

Hw$LMF1}Z~0But in psycho-analytic relations things often happen differently from what the psychology of心理学空间!BX2Ao4yaSQ

4XG/wG]-] H.c0consciousness might lead us to expect. Experience does not speak in favour of an affective technique of this kind. Nor is it hard to see that it involves a departure from psycho-analytic principles and verges upon treatment by suggestion. It may induce the patient to bring forward sooner and with less difficulty things he already knows but would otherwise have kept back for a time through conventional resistances. But this technique achieves nothing towards the uncovering of what is unconscious to the patient. It makes him even more incapable of overcoming his deeper resistances, and in severer cases it invariably fails by encouraging the patient to be insatiable: he would like to reverse the situation, and finds the analysis of the doctor more interesting than his own.

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7K @N zI0但是,在精神分析的关系中,事物的发生经常不同于意识的心理学可能引导我们预想的东西。经验没有表明支持这种类型的情感的技术。这也不难看到,这种技术包含了对精神分析原则的一种偏离,并且用暗示来接近治疗。这可能使得病人提前时机,并以较小的困难获得他已经的知道的但在其他方面由于常见的阻抗被抑制了一段时间的事物。但是这个技术没有得到任何朝向揭开对病人来说是无意识的东西的帮助。它甚至使得病人更加不能克服他的更深层的阻抗,并且在更严重情况中,它因为鼓励病人变得不知足而失败:病人想要扭转情境,相比自己的分析他更感兴趣于寻找对医生的分析。

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OQ.f)_8Y0The resolution of the transference, too - one of the main tasks of the treatment - is made more difficult by an intimate attitude on the doctor’s part, so that any gain there may be at the beginning is more than outweighed at the end. I have no hesitation, therefore, in condemning this kind of technique as incorrect. The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him. In practice, it is true, there is nothing to be said against a psychotherapist combining a certain amount of analysis with some suggestive influence in order to achieve a perceptible result in a shorter time - as is necessary, for instance, in institutions. But one has a right to insist that he himself should be in no doubt about what he is doing and should know that his method is not that of true psycho-analysis.心理学空间4J V'l)gDk l

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移情的解决—其中一个主要的治疗任务—也因为在医生的角色中一种亲密的态度而变得更加困难,因此,一开始在那里的任何收获到最后却是十分沉重的负担。因此,在谴责这种技术不适当时,我毫不犹豫。医生对他的病人应该是不透明的,并且应该像一面镜子,除了展示病人向他展示的东西外,不展示任何的东西。实际上,确实,对于一个精神治疗师,为了在一个更短的时间内获得一些得到一种可察觉的结果而使一定量的分析结合一些暗示性的影响,这没有什么非议—例如,在(治疗)体系中这是必要的。但是,我们有权利坚持,他对他自己正在做的事情应该完全明白,并且应该知道,他的方法不是真正的精神分析的方法。心理学空间&n_\ wp2l

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(h) Another temptation arises out of the educative activity which, in psycho-analytic treatment,

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devolves on the doctor without any deliberate intention on his part. When the developmental

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inhibitions are resolved, it happens of itself that the doctor finds himself in a position to indicate new aims for the trends that have been liberated. It is then no more than a natural ambition if he endeavours to make something specially excellent of a person whom he has been at such pains to free from his neurosis and if he prescribes high aims for his wishes. But here again the doctor should hold himself in check, and take the patient’s capacities rather than his own desires as guide. Not every neurotic has a high talent for sublimation; one can assume of many of them that they would not have fallen ill at all if they had possessed the art of sublimating their instincts.

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另一个诱惑出现于教育上的活动,这种活动在精神分析治疗中,在医生的角色中没有任何深思熟虑的打算,便被移交给了医生。当发展的抑制被解除,那可能会出现,医生发现他自己,因为那些摆脱束缚的趋势而处在一个暗示新的目标的位置上。如果,医生竭力在已经一个如此痛苦的人中做某个特别极端的事物以摆脱他的神经症,如果,医生以为他的愿望而设置了高的目标,那么,这就不只是一个自然的野心。但是,在这里医生应该再次约束他自己并把病人的能力而不是他自己的欲望作为指导。并不是每一个神经症患者都有一个高的升华才能;我们可以设想,他们中很多人,如果拥有升华他们的本能的艺术,将根本不会罹患(这种)疾病。

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If we press them unduly towards sublimation and cut them off from the most accessible and convenient instinctual satisfactions, we shall usually make life even harder for them than they feel it in any case. As a doctor, one must above all be tolerant to the weakness of a patient, and must be content if one has won back some degree of capacity for work and enjoyment for a person even of only moderate worth. Educative ambition is of as little use as therapeutic ambition. It must further be borne in mind that many people fall ill precisely from an attempt to sublimate their instincts beyond the degree permitted by their organization and that in those who have a capacity for sublimation the process usually takes place of itself as soon as their inhibitions have been overcome by analysis. In my opinion, therefore, efforts invariably to make use of the analytic treatment to bring about sublimation of instinct are, though no doubt always laudable, far from being in every case advisable.心理学空间"_.T%AJ*C l

~.zU?i7g/p0如果我们不当地推挤他们朝向升华,并且把他们与最易接近的、最方便的本能满足隔绝,我们通常会使得生活比他们在任何情况下感觉到更困难。作为一个医生,首先,我们必须容忍一个病人的弱点,并且,如果我们因为一个只有普通价值的人而为工作和乐趣重获某种程度的能力,我们应当满足。教育的野心和治疗的野心一样是没什么用的。必须更加牢记,很多人罹患疾病(神经症)恰恰是因为超过他们的组织所允许的程度而试图升华他们的本能,还有,在那些有能力去升华的人中,一旦他们的抑制被分析克服,这个过程会自然发生。因此,在我看来,利用分析治疗来引起本能升华的努力,虽然毫无疑问是值得赞赏,但并不是在任何情况都是适当的。心理学空间!L/oeDx5m K {C

YkGRw Qm0(i) To what extent should the patient’s intellectual co-operation be sought for in the treatment? It is difficult to say anything of general applicability on this point: the patient’s personality is the determining factor. But in any case caution and self-restraint must be observed in this connection. It is wrong to set a patient tasks, such as collecting his memories or thinking over some particular period of his life. On the contrary, he has to learn above all - what never comes easily to anyone - that mental activities such as thinking something over or concentrating the attention solve none of the riddles of a neurosis; that can only be done by patiently obeying the psycho-analytic rule, which enjoins the exclusion of all criticism of the unconscious or of its derivatives.心理学空间 ZRoL2@ I,_

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在治疗中,应该在多大程度上寻求病人的理智的合作?在这一点,说任何普遍适用的东西都是困难的:病人的个性是决定因素。但是,无论如何,在这种关系中,谨慎和自我克制都是必须遵守的。给病人设置任务,比如,收集他的记忆或者仔细考虑他的生命的某个特殊时期,这是错误的。相反,他首先必须认识到—从未轻易用于给任何人的东西—精神活动,比如仔细考虑某个东西或者集中注意力,都没有解决任何一个神经症的谜团;能做的只有耐心地遵守精神分析的规则,这些规则能够阻止无意识以及它的派生物的批评。心理学空间5Ya0Cey1R

R#q|,? X4P0One must be especially unyielding about obedience to that rule with patients who practise the art of sheering off into intellectual discussion during their treatment, who speculate a great deal and often very wisely about their condition and in that way avoid doing anything to overcome it. For this reason I dislike making use of analytic writings as an assistance to my patients; I require them to learn by personal experience, and I assure them that they will acquire wider and more valuable knowledge than the whole literature of psycho-analysis could

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#V"{ }~ZN0teach them. I recognize, however, that under institutional conditions it may be of great advantage to employ reading as a preparation for patients in analysis and as a means of creating an atmosphere of influence.心理学空间Q1@)k{{ _$b

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面对在治疗中理智的在讨论时习惯了避开之艺术的病人、对他们的情况进行大量的而又经常很精明的推测并用那种方式避免做任何事情来克服它的病人,我们必须坚强不屈地遵守那条规则。因为这个原因,我不喜欢用精神分析著作来作为对我的病人的一个帮助;我要求他们通过个人的经验来学习,并且我向他们担保,他们获得的知识将比全部精神分析著作所能够教给他们的更宽广、更有价值。然而,我承认,在遵守规则的条件下,在分析中使用阅读作为病人的一个准备、作为创造影响的氛围的一种方法,是具有很大的优势的。

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:`s;z7gpv0I must give a most earnest warning against any attempt to gain the confidence or support of parents or relatives by giving them psycho-analytic books to read, whether of an introductory or an advanced kind. This well-meant step usually has the effect of bringing on prematurely the natural opposition of the relatives to the treatment - an opposition which is bound to appear sooner or later - so that the treatment is never ever begun.心理学空间#D7E)l$X2|0]$`3xx1|

$}0af9d|w`"P!I0我必须给出一个最认真的警告,反对通过给予父母或亲戚精神分析著作阅读来增加他们的信任或支持的企图,无论这是一个引导的还是是先进的方法。这个出于好心的做法会具有有过早地引起亲属对治疗的自然的反对的作用—这是迟早必然出现的—以至于治疗根本不会开始。

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Let me express a hope that the increasing experience of psycho-analysts will soon lead to agreement on questions of technique and on the most effective method of treating neurotic patients. As regards the treatment of their relatives I must confess myself utterly at a loss, and I have in general little faith in any individual treatment of them.

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让我表达一种希望,精神分析的越来越多的经验,将很快在技术的问题上、最有效的治疗神经症病人的方法上达成一致。至于对他们的亲属的治疗,我必须完全困惑地自我坦白,并且在对他们的个人治疗上我通常很少有信心。心理学空间W#v)f7G-W^

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