性和身体虐待(otto Kernberg)
lechi01 作者: lechi01 / 2695次阅读 时间: 2016年8月13日
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Incest as trauma has received much recent attention, and psychoanalytic study of its victims indeed illustrates the basic dynamic of internalization of an object relation dominated by hatred. In exploring these psychodynamics we have to keep in mind that the sadomasochistic component of sexual excitement permits the recruitment of aggression in the service of love. But this is a response that, when a sexual response is overwhelmed by rage and hatred, may be transformed into sexual sadomasochism in which love is recruited in the service of aggression. That is, sexual intercourse may become a symbolic gratification of sadomasochistic tendencies, replicating in the sexual area the interactions I have described in relationships dominated by hatred.

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乱伦作为创伤近期获得了很多关注,精神分析对其受害者的研究阐明了一个内化的、被恨控制的客体关系的基本动力。在探索这些心理动力中我们必须记住:性兴奋时的施虐受虐部分让爱在性中补偿了恨。但当一个性反应被愤怒和恨淹没时,这会转化为性施虐受虐,在其中爱被用于服务攻击。性交会成为一种施虐受虐倾向的象征性满足,在性领域中复制我之前描述的在被恨所控制的关系中的互动。

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Not all sexual abuse is experienced as aggressive; unconscious infantile sexuality, the excitement, gratification, and triumph resulting from breaking oedipal barriers, and the guilt such triumph produces, complicate the psychological effects of sexual abuse. Nevertheless, the distortion of superego structures brought about when cross-generational (in particular, parent-child) incest occurs destroys the potential for integrating sadistic parental images into the superego. The conflict between sexual excitement and guilt is thus transformed into one between frail idealization and overwhelming aggression, creating a truly traumatic situation in which libidinal and aggressive strivings can no longer be differentiated. The unconscious identification with the victimizer and the victim may become confused. The repetition compulsion of incest victims who transform their later sexual life into a chain of traumatophilic experiences often makes it difficult to determine whether the patient was the victim or the victimizer.心理学空间)I)g&THwU dW)s"H

不是所有的性虐待都被体验为攻击;由突破俄狄浦斯屏障所导致的潜意识婴儿化性欲、性兴奋、满足和胜利等,和这样的胜利导致的内疚,复杂化了性虐待中的心理影响。然而当代际间(尤其是父母与儿童间)的乱伦出现时,引发的超我扭曲会破坏施虐父母影像整合进超我。性兴奋和内疚的冲突因此转变成脆弱的理想化和淹没性攻击相结合的超我,创造了一个真实的创伤情景,在其中力比多和攻击性不再被区分。潜意识中对施害者和受害者的认同会变得混淆。强迫性重复地将他们后来的性生活转变成一连串创伤癖体验的乱伦受害者,经常难以区分他们究竟是受害者还是施害者。

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In the clinical situation, such incest victims reactivate the identification wit the victim-victimizer dyad and unconsciously attempt to reproduce the traumati situation in order to undo it and to recover the ideal object behind th persecutor. In addition, the repetition compulsion expresses the desire for revenge the rationalization of hatred of the seducer, and the potential sexualizatio of the hatred in the form of efforts to seduce the seducer. The psychoanalytic treatment of incest victims who have had sexual experiences with forme therapists sometimes repeats these experiences with uncanny clarity. Unconsciou envy of the current therapist, not involved in the chaotic mixture of hatred and sexuality in which the patient experiences himself as hopelessly mired, is another source of negative therapeutic reactions.

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在临床情景中,这样的乱伦受害者再次激活了对受害-施害配对的认同,潜意识地试图再次创造创伤情景来消除它,恢复迫害者背后的理想化客体。另外,强迫性重复表达了想要报复,合理化对诱惑者的恨,以诱惑引诱者的形式潜在地将恨性欲化。对有与之前的治疗师有性经历的乱伦受害者的动力学治疗中有时候异常清晰地重复了这些体验。潜意识嫉妒当下的治疗师(不包括卷入混乱的恨和性欲混合,在其中患者体验自己为无助地陷入泥潭)是另一种负性治疗反应的来源。

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Recent research by Paris (1994b) confirms the importance of a history of sexual abuse in patients with borderline personality disorder as well as their tendency toward dissociative reactions. Paris also points out that a predisposition to dissociative reactions does not seem to be secondary to sexual trauma. In clinical practice, both types of problems are seen together with some frequency. Some borderline patients present dissociative reactions in the form of amnesias, depersonalization states, and even multiple personalities, of which the patients are cognitively aware but which are affectively split.心理学空间b4yM{'pT'~

Paris(1994b)最近的研究确认了性虐待历史在边缘人格障碍以及他们倾向于解离反应的重要性。Paris也指出,解离反应倾向并不就是性创伤的次发反应。在临床实践中,两种问题类型经常会一起看到。一些边缘患者呈现健忘、人格解体状态、甚至多重人格等形式的解离反应,患者能在认知上对此有觉察,但情感上是分裂的。

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What is often striking in such dissociative states is the patient’s remarkable indifference to what seems to be a dramatic psychopathological phenomenon: Indeed, some patients present an almost defiant affirmation of the “autonomy” of their split-off personalities while refusing to consider any personal responsibility for these phenomena. Often, the mutual dissociation of alternate personality states raises the question of why some apparently not incongruous personality states appear to be split from each other.

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在这些解离反应中经常令人惊讶的是患者对一些看起来戏剧性的心理现象明显地漠不关心:实际上,一些患者表现出一种几乎藐视性的断言,认为他们的人格分裂是自动性的,拒绝认为需要为这现象负任何个人责任。经常,交替人格的解离会引起疑问:为什么一些看上去不协调的人格状态会相互之间处在分离状态。

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In my experience, when the clinician asks how the patient’s central personality, her sense of awareness, concern, and responsibility, relates to these split-off personality states, this immediately triggers a new development in the transference. Many patients develop a paranoid reaction to such inquiry; this evolves into a specific transference disposition in which the therapist appears as a persecutory figure in contrast to other persons in the patient’s life, including other therapists, who are idealized as helpful, tolerant, nonquestioning, admiring, and supportive. The patient’s alternate personality states take on more specific meanings in relation to such split object representations, permitting a clarification of the function of such split states in the transference. In short, approaching the patient from the position of an assumed observing, central, “categorical” self illuminates hidden splits in the transference and permits exploration of the unconscious dynamics involved in the split personality state that are obscured by the usual, apparently untroubled enactment of such states.心理学空间x^3Nqit

在我的经验中,当治疗师询问患者的中心人格、她的意识、担心和责任等与这些分离的人格状态是怎样的关系时,这会立即触发一个新的移情发展。很多患者对此提问会发展出一个偏执反应;这发展成一种特殊的移情倾向,在其中治疗师表现为一个迫害者角色,相反于来访者生活中的其他人,包括其他治疗师,他们被理想化为有帮助的、宽容的、不会质疑的、赞赏的和支持的。患者交替的人格状态呈现更多这些分裂的客体表象的特殊意义,可以在移情中澄清这分裂状态的功能。简而言之,从一个假设的观察、中心、“绝对”的自体来面对患者,会阐明在移情中隐藏的分裂,可以探索分裂人格状态中的潜意识动力,而这动力之前被通常的表面上没缘由的激活所掩盖。心理学空间N` oL Qe[ |Kf

The patient now may be tempted to angrily accuse the therapist of not believing in the existence of his multiple personalities. The therapist’s concerned and neutral stand—being interested in the patient’s experience, not questioning its authenticity, but at the same time evaluating the implications for the patient’s central self-experience—gradually permits the patient to increase his self-observing function in contrast to the previous defensive denial of concern and what might be called blind enactment of dissociative states.心理学空间 X*l mmgE

患者现在会被引诱谴责治疗师不相信他的多重人格的存在。治疗师关心和中立的态度逐步让来访者增加他的自我觉察功能,对患者的体验感兴趣,不质疑其真实性,但而不是之前的防御性否认担心和被称为盲目地解离状态的行动化。

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In severe personality disorders, the approach I have just outlined transforms what appears to be a dreamlike, often apparently affectless dramatization into a concrete object relation in which intense rage and hatred emerge, split off from other idealized object relations. Once the emergence of mutually split-off peak affect states in the context of split-off primitive object relations becomes evident in the transference, the intepretive integration of these developments may proceed.心理学空间6DdS'O,kB#Z

在严重人格障碍身上,这个我呈现的方法将模糊的、经常表面上无情感的剧情转变成具体的客体关系,在其中强烈的愤怒和攻击会出现,并与其他理想化的客体关系保持分裂。一旦在移情中明显出现在分裂的原始客体关系背景下相互分裂的峰值情绪状态,对这些发展的解释性整合就能开始。心理学空间s`9K"ba!YSi

This approach contrasts with a tendency on the part of some therapists to explore each dissociated personality state while respecting its split-off condition, bypassing the defensive denial of concern about this condition. I believe that such an approach tends to prolong the dissociative condition itself unnecessarily and may aggravate it.心理学空间)E;Eeuo v

这个方法不同于某些治疗师:倾向于探索每部分解离的人格状态同时尊重它的分裂条件,绕过对这条件防御性的否认。我相信这样的方法会导致不必要的延长解离条件,并会加重它。心理学空间!ubGqb.~G4JTK

When such dissociative reactions occur in the context of real or fantasied past incest or sexual abuse, a similar defensive denial of concern for the nature of the dissociative process may often be observed. Such a development contrasts markedly with cases in which, under psychoanalytic exploration, repressed memories of past sexual abuse, including incest, are uncovered, leading to a traumatic emotional reaction that colors the psychotherapeutic relationship for perhaps several months and is gradually worked through. In this latter case, characteristics of a post-traumatic stress syndrome may emerge in the psychotherapeutic relationship; the patient shows great concern for himself, intense ambivalence in relation to the abuser, and ambivalence regarding his own past and present sexuality. The elaboration of such a traumatic recovery of memory contrasts sharply with the long-term repetitive evocation of past traumatic sexual experiences in the context of a present-day expression of hatred, disgust, and revulsion linked to the patient’s sexual life in general or to all persons of the gender of the traumatizing agent.心理学空间F_e`MvG

当这样的解离反应出现在现实或想象的过去的乱伦或性虐待的背景中时,一个相似的、防御地否认对解离过程的本质有担心,会经常被观察到。这样一种发展明显反差于另外些情况,在其中那些在精神分析探索下被压抑的过去性虐待经历,包括乱伦,被揭露出来,导致一种创伤情绪反应,会可能影响几个月的治疗关系,然后逐步修通。在这后面的情况中,一种创伤后应激综合征会在治疗关系中浮现;患者表现出对自己巨大的担心,对于虐待者关系的强烈的矛盾感,对自己过去和现在的性方面存在矛盾心理。详细描述这样一种创伤记忆恢复明显不同于长期在现在的对自己的一般的性生活或所有代表同性别的性创伤代理人的关系中表达恨、厌恶和反感的背景中重复唤起过去创伤性性体验。心理学空间%z&D;k_:fo`.j

In such cases, particularly when traumatic sexual memories appear repeatedly in the context of dissociative ego states, a characteristic lack of concern, denial, or dramatic indifference toward the dissociative process may also be present. The patient may insist on engaging the therapist as a “witness” or support figure in the struggle against a hated and feared sexual object. In the transference, the therapist may be identified with either the abusing object or a conspiratorial helper (for example, the “innocent bystander” mother, who, in subtle or not-so-subtle ways, protected an incestuous father).

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在这样的情况中,尤其当创伤的性记忆反复表现在解离的自我状态中时,也会有一种特征性的对解离过程缺乏担心、否认或戏剧性地漠不关心。患者会在与一个恨和害怕的性对象的挣扎中坚持将治疗师看做“目击者”或支持者。在移情中,治疗师会被认同为施虐客体或一个阴谋的帮助者(例如,“无辜受殃”的母亲,她以微妙或不微妙的方式保护一个乱伦的父亲)。心理学空间/iXZ9}q.lM

Here again, the world seems to be split between those who side with the traumatizing object and those who support the patient’s wishes for a vengeful campaign against that object. Because of the current cultural concerns about sexual abuse, the patient’s split world of object relations may be rationalized in a conventional ideology that confirms and maintains his condition as a victim.

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再次,世界看起来被分裂为站在迫害客体一边的和支持患者想那客体复仇的。由于当下文化关注性虐待,患者的分裂的客体关系的世界会被合理化为一个符合习惯的意识形态,认可和保持自己的作为受害者的身份。心理学空间*gpo9f/C k`$AB

I have found it very helpful to ask the patient what keeps the hatred alive in his life and what its functions are in his current conflicts. When the fact of past sexual abuse is unclear, even in the patient’s mind, the patient may insistently demand the therapist’s confirmation of his suspicions. The therapist’s stance— that the patient’s experiences are real in their present quality and that the patient himself will eventually be able to clarify and gain understanding of and control over the internal past—often raises the same intensity of suspicion and rage in the transference as do attempts to clarify the relation between the patient’s central self-experience and a dissociative state. In other words, the patient may not be able to tolerate the therapist’s concerned but neutral position, which runs counter to the overriding need to divide the world into allies and enemies. The therapist’s consistent interpretation of the patient’s need to maintain such split relations will eventually, under optimal conditions, permit more specific focus on the enactment of the relationship between victimizer and victim, with frequent role reversals, in the transference. This permits analysis of the patient’s unconscious identification with the victimizer as well as with the victim role as the major dynamic that maintains the characterologically anchored hatred.

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我发现问患者问以下问题是有帮助的:是什么让恨继续留在他的生活中以及在他当下的冲突中它的功能是什么?。当过去性虐待的事实不清晰时,甚至在患者的记忆中也不清晰时,患者依然会坚持要求治疗师确认他的怀疑。治疗师的态度——患者当下的经验才更真实,患者自己会最终能够澄清和获得对内在过去的理解和控制——经常导致在移情中同样强烈的怀疑和愤怒,就如在试图澄清患者的中心自我体验和一种解离状态的关系时。也就是说,患者会不能够忍受治疗师的关心但中立的位置,这个和高于一切地需要将世界分成联盟和敌人是不一致的。治疗师持续解释患者对保持这样的分裂关系的需要,在最理想的情况下会最终对在移情中施害者和受害者关系的活化(并频繁地角色反转)有更多的关注。由此可以分析作为患者的潜意识认同施害者,就如同对受害者的认同,共同组成了主要动力,保持了特征性的、铆定的恨。心理学空间4~#ejL6\

A positive consequence of such a therapeutic approach is the gradual liberation of the patient’s sexual life from its infiltration by unrecognized, unmetabolized hatred. The revulsion against sexuality in victims of early sexual abuse has many roots: The invasion of their psychic and physical boundaries is experienced as a violent attack; the transformation of a person in a parental function into a sexual abuser is experienced as sadistic treason, in addition to disorganizing the early buildup of an integrated if primitive superego. The reprojection of early persecutory superego precursors in the form of paranoid tendencies intensifies yet more the aggressive implications of a sexual attack and weakens the capacity for any trusting relationship.

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这样一种治疗方法的一个积极结果是逐步把患者的性生活从它的被未认识的、没有代谢的恨所渗透的关系中解放出来。在早年遭受性虐待的受害者对性欲的反感有很多根源:他们身体和心理边界的入侵被体验为一种暴力攻击;一个人从处在父母功能中到成一个性虐待者的转变被体验为一种施虐背叛,还有瓦解了早期建立的整合的原始超我。在偏执倾向中早期迫害超我的再次投射强化了一个性攻击的攻击性意义,削弱了建立任何信任关系的能力。

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Unconscious guilt arising from the activation of the patient’s own sexual impulses in the context of sexual seduction and abuse increases this revulsion against all sexuality and the temptation to reproject such guilt feelings, thus reinforcing the patient’s paranoid approach to sexual objects and repression of sexual wishes, fantasies, and experiences. If traumatized victims of concentration camps or torture have to reencounter awareness of their own sadistic tendencies as they discover their unconscious identification with both victim and victimizer, the victims of sexual abuse have to reencounter an awareness of their own sexuality in unconscious identification with both the self and the object of the traumatic experience. The treatment cannot be completed if such a reencounter has not been achieved. Stoller’s (1985) understanding of the nature of erotic excitement as an early fusion of sensuous experience and unconscious identification with an aggressive object—in other words, the erotic roots of polymorphous perverse sadomasochism—is relevant in this connection. At some point, a toned-down, tolerable sadomasochistic tendency should become available for retranslation into a language of erotic fantasies, opening up the polymorphous perverse component of adult genital sexuality.心理学空间u*[ ?(|v ]'O$E

由于患者自己的性冲动在性诱惑和虐待的激活而产生的潜意识的内疚,会增加这种对所有性欲的反感,被诱惑再次投射这内疚感,因此再次强化了患者的偏执地对待性客体和压抑性愿望、幻想和体验。如果酷刑创伤受害者必须再次觉察他们自己的施虐倾向,让他们发现自己的潜意识认同受害者和施害者,性虐待受害者也必须再次觉察他们的潜意识认同创伤经验中的自体和客体双方中的自己的性欲。如果这样的再次相遇没有完成治疗就无法完成。Stoller(1985)将色情性兴奋的本质理解为一种早期感觉体验的和潜意识地认同一个攻击性客体的融合——也就是说,色情的多形态的倒错的施虐受虐的根源——是与这连接相关的。在某个时候,一个缓和的、可忍受的施虐受虐倾向可能重新翻译成一个色情幻想的语言,打通成人生殖器性欲的多形态倒错部分。

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——(摘自KERNBERGHatred as a Core Affect of Aggression》 朱一峰译)心理学空间gHo k5m+\*G;f:M(G

 

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