Here and Now:My Perspective
此时此地：我的视角
Betty Joseph贝蒂·约瑟芬
杨立华 翻译
If I look back over my analytic career I realize that my work has increasingly focused on, or perhaps rather started from,what is going on in the room between patient and analyst. Today I want to think briefly why this is so. What is clear is that this focus allows the patient and analyst to feel more anchored.
如果我回过头来看我的分析生涯，我会意识到我的工作与其说逐渐聚焦在，还不如说开始于，咨询室里病人和分析师之间发生的事情。今天，我想要想一想为什么是这样。很清楚的一点是，这让病人和分析师可以觉得更加心里有底。
By working in the here and now I mean this in a broad, global way but also in a minute way, and it is related to my understanding of psychic reality in the patient and the analyst.I like primarily to make interpretations that grow out of what the patient is saying or doing in the session, with his background and our previous work somewherein the back of my mindand thus to eschew避免general explanations.The patient may tell me that her mother was so fragile that even when she was very young she felt that she had to be very protective towards her mother.It may seem from previous experience that this refers to myself, but I suspect this is not of real use to her, nor convincing to me, unless it is being manifested in some way in the session.But it would alert me to examine, for example, whether I was talking a bit carefully, was my tone a bit delicate柔和的, etc. and if soas a consequence因此，结果she might have experienced me, whether consciously or not, as pussyfooting round her rather than interpreting straight. This can then give me a more global viewpoint - I may come to realize that over a series of sessions the patient and I have been talking to each other 'carefully' as if each was more comfortable that way, so that the patient was feeling that interpretations were only 'interpretations' and not to be taken too seriously and I was colluding with this.【精确性】
工作于此时此地，我所表达的意思既是广义的，也是狭义的，而这与我对病人和分析师心里的心理现实的理解相关。从根本上说，我喜欢给出从病人在面谈中说的或者做的事情中产生的解释，同时将他的背景和我们之前的工作放在我脑海中的某个地方，从而避免给出宽泛的解释。病人也许会告诉我，她的母亲是如此的脆弱，以致于当她还非常小的时候，她就觉得她必须关切保护她的母亲。从之前的经验来看，它似乎指的是我本人，但是我怀疑这对她有真正的用处，也无法让我觉得确信，除非它在面谈中以某种方式表现出来。但是，它会让我留心观察，比如，我是否讲话的时候有一点小心，我的语气是不是有点柔和，等等，如果说这样，结果就是，不管是否有意识，她也许将我体验为，在她身边缩手缩脚的而不是直接给予解释。这可以给我一个更加广阔的视角——我也许会开始意识到，在一系列的面谈之后，病人和我就“小心翼翼地”和对方交谈，好像这样让双方更加舒服，因此病人会觉得解释只是“解释”，不会太当一回事，而我配合了这一切。
But the statement thatthe mother was so fragilemay of course be stated for some quite other reason, for example, to express understanding she had gained from previous work, to control the analyst and prevent her from being straight and clear. The possibilities are legion众多的，大量的 and our attempt to understand what is going on in the here and now means trying to understand not only what is actually being said, butwhy it is being said now and said in this way, what impact it may be designed to have and what impact does it have.【多样性与精确性】
但是，“母亲是如此的脆弱”这一陈述，当然可以是基于一些其他的原因说出来的，例如，表达她从之前的工作中获得的理解，控制分析师、防止她说话直截了当。有大量的可能性，因此我们努力去理解此时此地发生的事情就意味着不仅理解实际上说了什么，而且要理解为什么现在说，为什么以这种方式说，它原本要形成的影响是什么，它实际形成了什么影响。
When we are using the expression here and now, 'here' refers primarily to what is going on between the two participants in the room, but in addition it conveys the immediate, often concrete, reality of the individual's experience, which may, for example, be focused on his body, the analyst's room/body. This aspect is particularly vivid in patients with strong psychotic anxieties. To give an example, a child patient at a certain point in his analysis, was almost unable to enter the playroom where the shadowy remains of another child's scribbling乱涂，乱写，乱画 remained indelibly crayoned on the wall. To him the shape of the scribbling became volcanoes, 'here', my room became an object of terror, and when he managed to come in he was extremely anxious and would stand flat against the opposite wall as far away as possible.【此地】
当我们使用此时此地这个词的时候，“此地”主要指的是在咨询室里的两个参与者之间发生的事情，此外，它也表达即时、常常是具体的，个人的现实体验，而这也许，比如，聚焦于他的身体，分析师的房间/身体。这一方面在有强烈精神病性焦虑的病人身上尤其鲜活。举个例子，在他的分析的某个点上，一个儿童病人，几乎无法进入游戏室，因为在那里的墙上，有另外一个孩子用蜡笔乱涂留下的没法擦掉的朦胧痕迹。对他来说，乱涂的东西的形状变成了火山群，就在“此地”，我的房间变成了一个令人恐惧的对象，当他努力让自己进到房间里来的时候，他极其焦虑，因此离得远远的，紧靠着墙站着。
The notion of 'here' also implies that there is a world outside, and I like to keep this connection somewhere in the back of my mind so that links will occur, or will need to be made, between what is being understood in the consulting room and its implicationsin the patient's everyday life. Some patients will resist this linking firmly and try, probably unconsciously, to hold the analyst's mind fixing it into a kind of emotional pas de deux. This in itself will need understanding and interpreting.【日常生活】
“此地”这个概念也意味着有一个外面的世界，我喜欢将这个联系放在我脑海中的某个地方，以便在咨询室里面理解的东西和它在病人日常生活中的含意发生联结，或者分析师需要在这两者之间做出联结。有些病人会坚决地抵抗这个联结，并且尝试——可能是无意识地——约束分析师的思维，将它固定在一种情感的芭蕾双人舞之中。这本身需要理解和解释。
The now, when we speak of here and now, implies a sense of time, not just past and future, but an awareness of the patient's situation at the moment, one that is dynamic, never static, and that changes from moment to moment. The analyst is in a position to witness the movement and thus to gauge the forces operating in the patient, forces however that will find responses in the analyst, which should help in his understanding. Seen from this angle the analyst's interest will lie in trying to understand the dynamics of change, without using the notions of progress or regression - rather observing thatthis is the way that this patient operates at this time- a kind of respect for his defences and his need for them.【变化的动力】
此时，当我们谈及此时此地的时候，意味着一种时间观念，不仅仅是过去和未来，而且是对病人在此刻的情境的觉察，而此刻是动态的，永远不会是静止的，并且每时每刻都会变化。分析师处在一个见证这个变化的位置，从而去推测病人内部运作着的力量，这些力量不管用什么样的方式，将会在分析师身上得到反应，而这一反应应该有助于他的理解。从这个角度来说，分析师的兴趣将会在于试图去理解变化的动力，而不需要用到进展或者退行的概念——而是观察到，这就是这个病人此时运作的方式——一种对他的防御和他对防御的需要的尊重。
I am very much concerned to try to follow the movement in the session, in the patient's associations and in his response to interpretations, recognizing the brevity短促，短暂 of 'now'. As the analyst interprets the situation changes, the patient responds, or does not respond, anxiety increases and new defences are quickly mobilized, or there is a moment of relief, tension lessens and one can sense that the patient feels warmth towards the analyst. The nature of the response can help us to seesomething ofthe anxiety, for example, that lies behind it. The kind of movement going on in the session means constant change, change in the nature of defences or need for them, change in the perception of the object and change in the feelings towards the object. In this way we have a chance to see in a mini form the stuff that may lead to real stable psychic change. A further advantage of trying to follow in detail and in the present the movement of the patient and his material in the session is that it enables us tocontact and begin to understand small quantities of anxiety or excitement as it arises and shifts rather than its accumulating or being evaded逃避and the patient then being confronted with more massive anxiety or panic states later on.
【及时解释的必要性】
我非常用心地努力跟上面谈中、病人的自由联想中以及他对解释的反应中的变化，察觉到“此时”的一纵即逝。随着分析师给出解释，情境也随之改变，病人给出回应，或者不予回应，焦虑增加，新的防御迅速动员了起来，或者有一刻的轻松，紧张缓解了，可以感觉到病人对分析师抱有温情。反应的本质可以帮助我们看到它背后的东西，比如几分焦虑。面谈中的进展引起持续的变化，防御性质或者对防御的需求的变化，对客体的感知的变化以及对客体的感觉的变化。以这种方式，我们就有一个机会以微小的形式，看到会带来真正稳定的心理改变的东西。努力在细节上以及在当下，跟上病人和他的材料在面谈中的发展，还有一个进一步的好处，那就是在少量的焦虑和兴奋出现和移动的时候，它让我们可以接触并且理解它，而不是让它累积起来或者被回避掉，病人之后会面临更加大量的焦虑或者惊恐状态。
I am stressing here the importance to me of trying to follow the moment to moment shifts in the session; there is of course always the risk of this leading to the patient feeling too closely followed or even harassed and trapped. Certainly the analyst needs to try to be aware of the possibility of this and be sensitive to the patient's state of mind and his need for space to elaborate and stretch mentally.【又不能逼得太紧】
我这里强调的是，对我来说努力跟上面谈中一刻接一刻的转变的重要性；当然，这经常会有导致病人觉得跟得太紧，甚至觉得厌烦和被控制。当然，分析师需要试着觉察到这种可能性，并且对病人的思维状态，以及他对心理上发展和扩张的空间的需要保持敏感。
Working in the here and now, I have indicated, of course involves an awareness not only what is going on immediately in the patient but is necessarily dependent on the analyst's sensitivity,so far as is possible, to what is being evoked in himself. I gave an example of this where the analyst came to recognize that she was pussyfooting round the patient. To me this means that whatever our technical and theoretical knowledge our basic tool isour ability to try to recognize what we actually feel, experience or suspect is going on in ourselves - our psychic reality. In the absence of this capacity something quite fundamental will be lacking, I believe, in relation to our patients and our understanding of them.
工作于此时此地，我已经指出了，当然不仅涉及病人身上即时发生的事情，而且必然依赖于分析师的尽可能地对他自己身上激起的东西保持敏感性。 我举了这样一个例子，就是分析师觉察到她对病人缩手缩脚的。对我来说这意味着，不管我们的技术和理论知识是什么，我们的基本工具是我们识别我们实际上感受、体验或者怀疑我们自己身上发生着什么——我们的心理现实。我相信，缺乏这一能力，有些相当基本的东西将会缺失， 这些东西与我们的病人以及我们对他们的理解相关。
Freud saw transference as being aspects of the patient's early history being repeated, transferred in his relationship with the analyst. Melanie Klein took this further showing how aspects of the very early relationship of the child with his parents were internalized and built up his inner world of objects, and that aspects of these inner objects were projected into the relationship with the analyst forming the transference. I am suggesting that as we follow the moment to moment shifts in the session we can begin to get an idea of how his past was built up because we can see elements of it being reconstructed in the session. To give a very over-simplified kind of example - the analyst gives what seems to her a straightforward interpretation, the patient responds with anxiety and anger suggesting that he felt that the analyst was rebuking and mocking him, but his angry response evokes in the analyst a sense not only of being grossly misunderstood but of wanting to pressurize or bully the patient into understanding. If this type of situation seems in varying ways to be repeated as the analysis goes on and the analyst is aware of the pull towards this kind of enactment it can give us some idea of the kind of pressures the patient very possibly experienced in his past with, say,a father who actually did or was felt to bully or pressurize the child. And we see how the child probably responded with fear and anger or hostility. This would make the father more upset and hostile and the two would get caught upin a vicious cycle. A cycle that is repeated in the transference but there we may begin to be able to unwind it. (This I shall discuss further in a moment.) Thus fragments of history come alive under our eyes.
弗洛伊德将移情看成是病人早年过去中某些方面的重复，转移到了他和分析师的关系中。梅兰妮·克莱因推进了这一点，表明儿童与他的父母关系中非常早期的方面是如何内化，并且构建了他的内部客体世界，而这些内部客体的某些方面被投射到了与分析师的关系之中，形成了移情。我想要表明的是，随着我们跟随着面谈中一刻接一刻的移动，我们可以开始产生关于他的过去是如何构建起来的想法，因为我们可以看到它的很多元素在面谈中重构了。给一个非常简化的例子——分析师给出一个她觉得直截了当的解释，病人回应以焦虑和愤怒，表明他觉得分析师是在指责和嘲笑他，但是他的愤怒反应在分析师身上激起一种感觉，不仅仅是被严重误解了，而且想要强迫或者威胁病人接受这种理解。如果这种类型的情境随着分析的进行，以各种方式得到了重复，分析师觉察到朝向这种见诸行动的吸引力，它可以给我们一些想法，就是病人过去和某个人，比如说，一位实际上确实或者被觉得是威胁或者强迫这个孩子的父亲，在一起的时候可能体验到的压力。而我们可以看到这个孩子可能如何做出恐惧和愤怒或者敌意的反应。这将会让父亲更加心烦和敌对，然后这两个人就这样陷入了一个恶性循环之中。这个循环在移情中重复了，但是我们也许可以开始解开它。（我一会会更一步讨论它。）这样，过去的片段在我们眼皮底下活跃起来。
I like therefore to try to understand what is being lived out by the patient and the role that I am being asked to play. If what I have learnt about his pastcomes into my mindand seems relevant at that moment then I like to connect it in my interpretations. It means that the patient's history so far as it is known, or assumed to be known, is at the back of my mind rather than leading my expectations.Premature linking with history can easily be a defensive move both for patient and analyst.But in the long term I do feel that an understanding of what has gone on in the past, its meaning to the patient and his involvement in it, is not only of great interest to me as his analyst. It is also important to the patient that he can feel that his analyst has a sense of continuity and has his history in his mind. I believe this gives the patient a sense that there can be some flexibility in the understanding and interpretation of his history, and a greater sense of integration of himself.
因此，我先要理解病人活现的东西，还有我被要求扮演的角色。如果我对他过去的了解进到我的脑海里，并且似乎与那个时刻相关，那么我喜欢将它在我的解释中关联起来。它意味着，就已经知道的，或者假定知道的病人的过去来说， 是在我思维的背景之下而不是引导着我的期待。与过去过早的联结，很容易成为病人和分析师的一个防御举动。但是，从长远来看，我确实觉得，对过去发生了什么的理解，它对病人的意义，以及他在其中的参与，不仅对我作为分析师来说是兴趣所在。它对病人来说也是很重要的，因为他可以感到他的分析师有一种连续感，并将他的过去放在心里。我相信，这给了病人一种感觉，那就是，在过去和解释他的过去方面，可以有一些灵活性，并且让他对自己有更多的整合感。
This I think has an important bearing影响, as I indicated earlier, on the whole issue of psychic change. To my mind real psychic change does not come about through the patient's recognition of the way he repeats old patterns of behaviour and relating, important as this awareness may be.Psychic change I think must depend on the patient's ability to feel how and why he experienced or was caught up in certain manoeuvres, anxieties, defences, and this will only come about as he not only repeats his past, but moment by moment reconstructs it in the transference.The process of reconstructing will have an impact on the analyst as he is drawn into the various roles he is required to enact - or rather, since he is the analyst, he needs to become aware of this, to verbalize what is going on rather than enact. I attempted to illustrate this with the example of the child with the bullying father. As the patient experiences an object, the analyst, who does not get drawn into bullying he may begin to feel less angry, more trusting, and thus the analyst will be experienced as more benign and internalized as a more benign object evoking less anxiety and rage in the patient.In this way the vicious cycle can begin to loosen.I believe that this is an import aspect of achieving psychic change - by minute but ascertainable changes that take place within the transference and hence in the patient's internal world.
我认为，就像我之前指出的，这对心理改变的整个问题有重要的影响。在我看来，心理改变并不是通过让病人意识到他重复的旧有行为模式以及与人打交道的方式，虽然这个意识也许很重要。我认为，心理改变必须依靠病人感受到他体验或者陷入某种策略、焦虑、防御之中的方式和原因，这只会在他不仅重复他的过去，并且一刻接一刻地在移情中重建它的时候发生。这个重建的过程将会在分析师身上形成影响，因为他被卷入各种需要他去扮演的角色之中——更确切地说，因为他是分析师，他需要对此有所察觉，并且将发生的事情用语言表达出来而不是行动化。我之前试着用强势的父亲和孩子的例子来说明这一点。随着病人体验到一个客体，也就是分析师，没有受到诱惑去威胁他，他也许开始感到更少的愤怒，更多的信任，因此分析师将会被体验为更加和蔼的，并且被内化为一个更加亲切的客体，在病人身上激起更少的焦虑和愤怒。这样，恶性循环可以开始松开。我认为，这是获得心理改变的一个重要方面——通过移情中发生的微小但明确的改变，这些改变由此可以在病人的内在世界中发生。
I want to return to the issue of analytic explanations. They, like the patient's told history, have a place at the back of my mind. I do not like to try to explain to a patient in general, for example, why he is using a particular defence unless I can see what is happening in the transference, how, for example, he has gone silent or become withdrawn and what seems to have resulted from this, what has been achieved by it. My aim is to help both of us to observe and understand the movement rather than my giving my patient what is essentially a more theoretical explanation, however correct this may be. If we give our patients general explanations or show them simply the way they are repeating their past, I suspect we become, in their minds,someone who wants them to change, a needy or a superego figure, rather than an analyst who will really try to enter into their state of mind at that moment. I do not, as I said previously, think that our interpretations are only concerned about what is going on in the room; I like to start from there and be able then, or maybe much later, to understand and to help the patient to understand its relevance to what is going on in his outside life and to his general difficulties and hopes.
我想要回到精神分析解释的问题上来。它们，就像病人陈述的过去，在我的脑海中有一席之地。我不喜欢试着给出一般性的解释，比如，他为什么在用一种防御，除非我可以明白在移情中发生了什么，比如，他是怎么变得沉默或者变得退缩，以及这看起来导致了什么结果，它达成了什么目的。我的目标是帮助我们两个人去观察和理解变化，而不是我给我的病人一个本质上来说更加理论化的解释，不管它多么正确。如果我们给我们的病人一般性的解释或者简单地向他们表明他们重复过去的方式，我怀疑在他们的心里，我们会变成某个想要他们改变的人，一个提要求的或者超我的形象，而不是一个真正想要试着进入他们在那个时刻的内心状态的分析师。就像我之前说过的，我并不认为我们的解释应该只关心在咨询室里进行的事情；我喜欢从那里开始，然后接着，又或许是很久以后，能够理解和帮助病人理解它与他外在的生活还有他总体的困难和希望之间的相关性。
In this brief contribution I have been stressing the importance of movement; here I am adding the importance of the analyst's mind being able to move from what is going on in the room to the outside world and the past, but understanding, I am suggesting, needs to start from what is going on here and now.
在这篇简短的文稿中，我已经强调了变化的重要性；这里，我要加上分析师的思维可以从在咨询室里发生的事情移动到外在世界和过去中去的重要性，但是我要指出的是，理解，必须从此时此地发生的事情作为开始。
（翻译：杨立华，20170601）
References
Aguayo J (2011).The role of the patient's remembered history and unconscious past in the evolution of Betty Joseph's "here and now" clinical technique(1959-1989). Int J Psychoanal, 92:1117-1136.
M Blass RB (2011).On the immediacy of unconscious truth: Understanding Betty Joseph's "here and now" through comparison with alternative views of it outside of and within Kleinian thinking. Int J Psychoanal, 92: 1137-1157.
Busch F (2011).The workable here and now and the why of there and then. Int J Psychoanal, 92: 1159-1181.
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