作者: Marian Tolpin, M.D. / 4530次阅读 时间: 2017年6月30日
来源: 译者:玄渊

Doing Psychoanalysis of Normal Development: Forward Edge Transferences
Marian Tolpin, M.D.

This paper develops the idea of a “leading edge” transference, which was mentioned by Heinz Kohut in his supervision of Jule Miller (see Miller, 1985). In the early stages of developing his theory of selfobject transferences in his lectures to candidates (see Tolpin and Tolpin, 1996), Kohut also occasionally referred to patients' overlooked “forward moves,” which remobilized still healthy strivings and needs of the child and adolescent self. For the time being, at least, I use the term forward edge childhood strivings and transferences—”leading edge” having been rendered less useful by its frequent use in advertising. I have also considered describing the transference remobilization of the “growth edge” or “growing edge” of development, loosely analogous to the normal functioning of the epiphyses (growth centers of the long bones) before their closure ends further growth. There may be other felicitous terms for what I have in mind. It is my impression that the theory of forward edge or growth transferences that I am proposing has validity for all psychoanalytic theories, not only for the theory of the self that informs this work. For example, Racker (1968, p. 150-154) described a “total transference,” including a “prospective” element that has been overlooked.

这篇论文发展了“前沿”的转移的观点,这在科胡特对朱尔·米勒的督导中被提及。(see Miller, 1985) 在对申请者的演讲中(see Tolpin and Tolpin, 1996),科胡特发展了他的自体客体转移的理论,此外,他还偶尔提及了病人被忽视的“向前的运动”(“forward moves”),“向前的运动”重新活化了孩子和青少年自体的健康努力和需要。我暂时使用这个术语:前行端的童年期努力和转移,“前沿”这个词因为在广告中的频繁使用,而变得不再那么有用。我也认为,将“成长边缘”或者“成长边缘”的发展的转移再活化的描述,有点类似在骨头间的闭合处停止进一步生长之前,骨骺所行使(长骨的成长中心)的正常功能。在我的头脑中,可能还有其他更确切的词语。我的印象是,对于所有的精神分析理论来说,我所提议的向前成长或发展的转移理论都是有效的,它不仅仅适用于这篇文章所提及的自体的理论。例如,雷克(Racker,1968, p. 150-154)描述的“全转移”(total transference),就包含了一直被忽视的预期因素。

Forward and Trailing Edge Transferences: An Enlarged Interpretive Framework

The title of this paper usually comes as a surprise to psychoanalysts. One friendly colleague put it this way: “You can't do psychoanalysis of normal development—psychoanalysis is about abnormal development and psychopathology!” My reply to such objections is, Yes, that is precisely the problem: theories of psychoanalytic treatment and practice (regardless of their many critical differences and the recent influence of developmental findings) place the strongest emphasis on abnormal development and psychopathology. Specifically, the problem for theory and practice I am referring to is created by our view of transference proper as a “pathogenic complex” (Freud, 1912, p. 104), “new [artificial] illness” (Freud, 1914, p. 154). (For an instructive paper on changing views of what constitutes the core childhood pathology that is repeated in transferences, see Cooper, 1987.)

这篇论文的题目通常让精神分析家们诧异。一个和善的同事这样说:“你无法对常态发展来做精神分析——精神分析是关于变态发展和精神病理学的。”我对这个反对意见的回应是:对,这恰恰就是问题:精神分析治疗和实践的理论(不考虑它们的重要差异和最近调查结果的影响)将最大的重心放在变态发展和精神病理学上了。具体来说,我指的理论和实践的问题,由适合当作“致病情节”(pathogenic complex,Freud, 1912, p. 104)和“新(假)病” (new [artificial] illness ,Freud, 1914, p. 154)的转移的观点所创。(这是在一篇有启发性的论文中,与转移中重复的,构成童年期病理学核心变化的观点有关。见库珀(Cooper),1987)

In fact, the problem is twofold. First, the “new illness” view of transference is a source of theory induced clinical blindspots, which prevent us from recognizing and analyzing “forward edge” transferences—transferences of still remaining healthy childhood development in the unconscious depths, albeit in the form of fragile “tendrils” that are thwarted, stunted, or crushed. Second, it places unintended iatrogenic limits on therapeutic action because we do not support struggling “tendrils” of health and facilitate their emergence and growth. Instead, we actually obscure them by assigning what remains of healthy development to the concept of “therapeutic alliance” or positive relationship with a “new object.” As a consequence, tendrils of health are not fully reactivated in depth and are not accessible to a vitally important working-through process. It is this bit-by-bit and over again process that is the basis for expansion, integration, transformation, and stabilization of healthy aspects of the self into an altered psychic reality.


To repeat my main point: At one and the same time, theory-induced blindspots restrict our clinical vision of the patient's (and our own) psychic reality because first, they lead us to expect transference repetitions of nuclear childhood pathology and its later derivatives, and second, they obscure the subtle hints of bona fide transferences that derive their force and momentum from still-viable tendrils of healthy childhood motivations, strivings, expectations, and hopes of getting what is needed now from the forward edge transference to the analyst. (For a discussion about the early effort to include hope in the etiological equation, see French, 1958.)

再次重复我的主要观点:与此同时,理论引入的盲点限制了我们对病人(和我们)的精神现实的临床视野,因为,首先,这些盲点让我们对儿童核心病理学及它的衍生物的转移重演抱有期望,其次,这些盲点隐藏了真正转移(bona fide transferences)的微妙暗示,这些真正转移源自儿童期健康的动机、努力、期望和希望搞明白从分析家“前行端转移”中知晓需要什么的力量和动力。(对此的讨论,涉及在病因学影响因素中,包含希望的早期努力。)

Here it is crucial to stress that fragile tendrils of remaining healthy needs and expectations are not readily apparent on the surface. My clinical examples will show that we have to be primed to look for them in order to see them and tease them out from the trailing edge pathology in which they are usually entwined. For instance, tendrils of forward edge strivings have to be disentangled from manifestly pathological mergers, idealizations, grandiosity, “narcissistic entitlement” (Murray, 1964), rage, envy, depreciation, and, further, from intermediate defenses and compromise formations that protect the self the patient has built up and, at the same time, inhibit, restrict, and further compromise normal development.

在这里,强调“保持健康的需要和期望的脆弱“卷须”,在表面看来并不是显而易见的”这个观点非常重要。我的临床例子显示,我们不得不要做好寻找“卷须”的准备,以求能发现他们,能从通常缠住我们的滞后端病理学(trailing edge pathology)中挑拣出他们。例如,前行端努力的“卷须”必须从病理性融合、理想化、夸大、自恋性津贴(narcissistic entitlement,穆雷(Murray),1964)暴怒、嫉妒、贬低以及更进一步的中介防御(intermediate defenses)、保护病人已建立起来的自体的妥协形成、抑制、限制及更进一步的妥协正常发展中清理出来。

When the joint analytic work required to see, interpret, and foster the healthy tendencies is done by both patient and analyst, we are likely to actualize these tendencies and revive the “urge to complete development” and to regain “developmental momentum,” as noted by Bibring (1937) and Anna Freud (1965). In other words, the vague “curative factors” these authors adduced can now be grounded in the clinical theory of analyzable forward edge transferences that restart and reinvigorate an expectable developmental process.

正如毕布林(Bibring,1937)和安娜·弗洛伊德(Anna Freud,1965)所注意到的,当需要看到、解释和培育健康倾向的联合分析经由分析家和病人共同完成时,我们很可能实现了这些倾向,使“全面发展的驱动力” (“urge to complete development”)复活,重拾“发展势头”(developmental momentum)。换言之,这些作者举出的模糊的“治愈因素”(“curative factors”),如今可被分析式的以 “重新开启和复兴预期中发展过程的前行端转移”的临床理论为基础。

Before turning to the clinical examples of healthy tendrils that are overlooked in their transference potential, I want to briefly mention two interconnected historical trends that delayed the discovery of analyzable transferences of health, indelibly shaped the theory and technique of psychoanalytic practice and its accent on repetitions of pathology, and continue to interfere with our doing psychoanalysis that reactivates and strengthens normal self-development.


Delay of the Discovery of Analyzable Transferences of Health: Demarcation of Positive Alliance and New Object Relationship From Transference As New Illness

Psychoanalysis originated in studies of illness—Freud initially discovered the childhood depth of transference while, as a physician, he was investigating and trying to cure his patients' pathology. The initial trend to base analytic understanding of transference proper on a disease model of childhood development continued when Freud (1937) and other pioneers treated patients whose disorders posed challenges to successful analytic treatment. Their lack of success was attributed to their patients' “narcissistic resistances”; to “bedrock” factors such as psychic “inertia” and “adhesiveness of the libido”; to unconscious superego resistances and “negative therapeutic reaction”; to constitutional factors that led to ego deficits and distortions; and to primitive early object relations, archaic defenses, and splits.

精神分析源自对疾病的研究——弗洛伊德最早发现了在童年期的深层转移,于此同时,作为一名医生,他正研究和尝试治疗病人的病症。恰好在童年期儿童发展的疾病模型上,在对转移的分析性理解的基础上,最初的潮流还在持续着,在当时,弗洛伊德和其他的精神分析先驱们所治疗的病人病症,对成功的分析性治疗提出了挑战。他们将缺乏成功归因于他们病人的“自恋性阻抗”;诸如精神“惰性”(“inertia”)和“力比多的粘附性”(“adhesiveness of the libido”)这样的“基石”(“bedrock”)因素;无意识超我的阻抗和“治疗性负面反应”(“negative therapeutic reaction”);导致自我赤字和扭曲的构成因素;早期原始的客体关系、古老的防御和分裂。

This phase of “pathomorphic” theory led to the second major historical trend which still dominates many sectors of the field—namely, the demarcation of transference proper (a new edition of childhood illness) from unobjectionable positive transference (Freud, 1915), the therapeutic split in the ego (Sterba, 1934), and the positive identification/positive relationship with the idealized analyst described by Zetzel (1956), Stone (1961, 1981), Greenson (1965), Greenson and Wexler (1969), Gutheil and Havens (1979), Renik (1995, 1996, 1998, 1999), Meissner (1996), Shane, Shane and Gales (1997), Hausner (2000), and Novick and Novick (2000). In this connection also see Bacal (1985, 1990) on optimal responsiveness. And for early active therapy see Ferenczi (1920). Friedman (1969) wrote a penetrating review of the concept of therapeutic alliance.

“病理形态”(“pathomorphic”)理论的阶段导致第二个历史潮流,这个潮流今天仍在许多领域中占据主导位置,换句话说,从无异议的正转移(positive transference)而来的恰当的转移的分类(童年期疾病的新版本)(Freud, 1915),

自我的治疗性分裂(Sterba, 1934),积极认同/与理想化的分析家的积极关系【(Zetzel,1956)Stone (1961, 1981), Greenson (1965), Greenson and Wexler (1969), Gutheil and Havens (1979), Renik (1995, 1996, 1998, 1999), Meissner (1996), Shane, Shane and Gales (1997), Hausner (2000), and Novick and Novick (2000).】在这点上,我们也能看到巴克沃(Bacal)的“恰到好处的回应”(optimal responsiveness),早期活跃的治疗,我们可以看到费伦齐(Ferenczi,1920)和弗里德曼(Friedman,1969)则敏锐地提出了治疗联盟(therapeutic alliance)的概念。

In spite of their many differences, these authors conceptualize a “real relationship” with the analyst variously as a “real person,” an “ally,” a “therapeutic partner,” or a “working partner”—that is, a “new (nontransference) object” with whom a development-fostering, development-correcting experience takes place. In my view, the historical trend of conceptualizing alliance, real relationship, and new object was a constructive transitional effort to fill the analytic “vacuum” caused by too-exclusive emphasis on transference as childhood pathology. Stone (1961) was particularly eloquent in describing the “psychological vacuum” in the psychoanalytic situation, which was often a “severe impediment [for] initiation and productive continuation of a psychoanalytic process” (p. 116). My point is that filling the vacuum by encouraging alliance, real relationship, and real love (Novick and Novick, 2000) also interferes with the full therapeutic process, which depends on transferences of reanimated health.

尽管有诸多不同,这些作者将与分析家的“真实关系”(“real relationship”)进行了不同的概念化,如“真实的人”,“同盟”,“治疗伙伴”,或者是“工作伙伴”——也就是说,“新的(非转移的)客体”,与这个新客体一起,一个发展-养育,发展-纠正的经验才得以发生。在我看来,对“联盟”,“真实关系”和“新的客体”的概念化的历史潮流,是在过渡期的有建设性的努力,它填补了过度强调转移为“童年期病理”所填补的分析性空白。斯通(Stone,1961)在分析情境下描述这个“心理空白”的说法,很有说服力,分析的情境通常是“开始的时候严重的阻碍,随后分析过程债务延续很多产。” (p. 116)我的观点是,通过对“联盟”,“真实关系”和“真爱的鼓励”来填补空白,这同样干扰了整个治疗过程,要知道治疗的过程依赖于对健康鼓励的转移上。

The major theoretical trends outlined above converge in clinical practice. They are mutually reinforcing, continuing a one-sided emphasis on repetition of trailing edge developmental pathology while at the same time short-circuiting the in-depth reanimation of transferences of health. This topic requires a great deal more discussion, including the attitude of suspiciousness toward health as a resistance. (For example, see Brenner, 1979, and Stein's 1981 “serious concern,” [p. 871] with the analytic trend to see what appear to be a patient's positive or healthy attitudes instead of recognizing them as hiding resistance.) The last point about the theory and technique of doing psychoanalysis that I want to emphasize before leaving these historical trends is: as far as a more thorough-going and enlarged therapeutic process is concerned, analysis of the forward edge of transference is as important, at the very least, as analyzing revived trailing edge pathology.

上面的主要理论倾向汇聚在临床实践上。他们彼此加强,一方面不断强调病理学发展的滞后端重复,同时绕过健康的转移的深层鼓舞。这个论题需要大量的讨论,包括作为阻抗的对健康的怀疑态度。(举个例子,见布伦纳(Brenner,1979)和施泰因(Stein,1981)[p. 871]的“严肃关切”(serious concern)的概念,分析的趋势是发现病人的主动或健康的态度,而不是将它们看作是隐藏的阻抗)在离开这些历史潮流之前,我想要强调的做分析的理论和技术的最后一点是:直到同更彻底、更扩展的分析过程相关,转移的前行端分析与滞后端的病理学的复活相比,起码是同等重要的。

Clinical Examples of Unseen Forward Edge Tendrils

I want to turn now to three clinical examples published in the psychoanalytic literature of overlooked healthy strivings that can be reanimated in fully developed transferences, provided that the strivings or tendrils are recognized for what they are. Brief vignettes from the treatment of two adult patients show that tendrils of health are easily mistaken for either oedipal or preoedipal pathology and that the pathological emphasis discourages growth of the tendrils and the development of a stable forward edge transference.


In the analysis of a child, a more detailed look at the therapeutic process demonstrates a resurgence of his still-valid developmental needs (barely recognizable as such) for expectable self–selfobject experiences. After many frustrating months of trying to uncover the unconscious roots of the child's pathological narcissism, the analyst's understanding of the child's lack of expectable control over himself and his world and his spontaneous (unrecognized) selfobject functions (mirroring, idealized, and twinship) began to fit together with the child's valid needs. With the ever-increasing mutuality and reciprocity of patient and analyst, an unseen selfojbect transference took root and silently played a critical role in the cure. That is to say, although it was not recognized, interpreted, or reconstructed, a forward edge transference infused the therapeutic process. The transference experience at one and the same time loosened the vise of the child's trailing edge transference pathology on his self-organization and reanimated his thwarted and stunted forward edge development. These interdigitating processes went on together to set derailed development back on a forward track.


An Unnoticed Forward Edge Transference: Seeing Pathology Where There Is Health

In an invaluable account of his consultations with Heinz Kohut, Jule Miller (1985) described learning how Kohut worked and actually analyzed selfobject transferences. Miller described a patient of Kohut's who suffered from contentless depression, restlessness and anxiety, feelings of great uncertainty about himself, and troubling homosexual fantasies and feelings. Kohut pointed out that the patient seemed to feel stronger and had some sense of mastery when he was connected to the analyst he admired and looked up to. When the analyst went away or failed to understand him, the strengthening connection was disrupted. The patient then felt ravenous, like he could eat the analyst's couch or the pictures off the wall; he was exhausted and unsure of himself, or he felt like an untethered spaceman adrift forever in outer space. At such times, the patient went to pornography shops in search of an improved sense of being anchored and alive that he experienced when the transference was in place. In other words, at times of disruption of an unnoticed idealizing transference, the trailing edge transference (depression, anxiety, self-doubt) and “intermediate” (defensive) sequences (for example, devouring food and pornography to overcome his lassitude) came to the psychological fore.


An analytic hour illustrates the basis for Kohut's identification of leading edge tendrils of a quiet idealizing transference that the analyst could not see because of the implicit, prevailing pathologyoriented analytic milieu. The hour provides a microscopic glimpse of the self–selfobject experience: the analyst misunderstands the patient's enthusiasm and inadvertently precipitates his deflation (the trailing edge of his development); at the same time, the misunderstanding temporarily (in this instance) interferes with the patient's use of the analyst as the “idealized parent imago” with whom he is trying to accomplish his developmental goals—to recover from his deflation/depression, maintain his revived enthusiasm, and take in (internalize) the increased sense of his own importance and effectualness that he feels in the strengthening idealizing bond and make it his own.

分析时刻说明了科胡特对主要的理想化转移的滞后端“卷须”的主要认同基础,由于含蓄的、居于主导地位的病理起源的原因,分析家无法看到这理想化转移的滞后端。时间提供了对自体-自体客体经验微观一瞥:分析家误解了病人的热情,无意间将他的打击沉淀下来(发展的滞后端);与此同时,误解(在这种情况下)干扰了把分析家看作是“理想化父亲形象”的使用,病人通过“理想化的双亲形象”( “idealized parent imago”)来努力实现他的发展目标——从他的气馁和抑郁去恢复,保持他复活的热情,吸收(内化)不断增加的自身重要性和有效性的感觉,这种感觉让他感觉到不断加强的理想化连接,并让它成为自己的一部分。

The patient arrived at an hour eager to tell Miller something he had just heard about a performer he knew Miller liked. Miller did not see or respond to the patient's excitement and enthusiasm. The eagerness and enthusiasm were, to Kohut, the signs of the patient's more alive self-experience, of his expectation and hope that the analyst would appreciate the message and the messenger, that he would share in an experience the admired analyst enjoyed. Instead, his eagerness was interpreted as a manifestation of unconscious competitive, rivalrous impulses with the analyst-father (trained in ego psychology, Miller thought the patient was trying to one-up him, as it were, as though he were saying, “I know something you don't know”).


At first, the “good” patient allied himself with the all-knowing analyst (Stone, 1961, began the discussion of bondage to the omniscient analyst) and complied with the interpretation. However, in agreeing with the analyst, he sounded stilted and formalistic, saying that, yes, the idea that he was competing with the analyst had some “cogency.” For Kohut, the patient's stilted agreement was an affective signal, a signal that just when he was most enthusiastic (instead of depressed and anxious) he was most vulnerable to being deflated by the inexact interpretation. His stilted agreement is also an example (in my view) of the patient's wish/need to cooperate and maintain the needed relationship with the analyst—although he is injured, he joins forces with the analyst (therapeutic alliance), the injury goes unnoticed and unrepaired, he looks at himself through the analyst's eyes (observing ego and working alliance), and he continues to feel deficient.


Fortunately, however, a grain of the patient's forward edge of development remained—a tendril of healthy self-assertion and the expectation that his injury would be attended to by the analyst. Following his compliant, “Yes, competition has cogency,” the patient said spontaneously. “What you said sure punctured my balloon.” In other words, there was a remaining tendril of still-healthy independent initiative and self-assertion entwined with the pathological identification with the “aggressor” who deflated him. Like a healthy child who protests deflation just at the moment when he expects and hopes to feel enhanced, the patient turned toward the analyst and used a powerful metaphor (his punctured balloon) to express his deflation. And like a healthy child who expects that his injury will be understood and thereby ameliorated, the patient was still able to trust the analyst enough to expose his injury and to continue to expect and hope that his injury would be understood as valid and (thereby) healed. The example demonstrates that a failure to understand is still a route to recognition of the real possibility that an analyzable, self-esteem facilitating, forward edge transference can be established—a transference, when seen and interpreted, that gradually assists the chronically deflated, uncertain adult to join in the experience that supports regained developmental momentum.


It is important to note that Kohut did not dismiss the idea that competitiveness could have cogency for the patient. However, in this “bit” of the analytic process, pathogenic competitive wishes were secondary, not part of the leading edge of this patient's development. Rather, in a tendril of an idealizing transference, the patient, Kohut said, was like a proud, excited boy, running to tell his admired father a special tidbit, a boy who expected to be enjoyed and admired—the experience (repeated over and over) that eventually heightens selfesteem, self-certainty, and self-firmness. The interpretation was a “downer,” like a pathogenic repetition or rebuff of his valid needs to join in with his father and to be enjoyed, that contributed to the persisting childhood anxiety about his own worth. In this instance, the analytic accent on the trailing edge (pathological rivalry and competition) obscured the forward edge transference—the patient's healthy expectations for the kind of uplifting experience and mirroring approval that could ultimately strengthen his own capacity to maintain and restore , even in the face of inevitable injuries and deflation.


A Voyeuristic Symptom and A Thwarted Attempt At a Constructive Forward Move

Guntrip (1961) described a failed attempt at analysis: the patient initially sought treatment and then fled. In a retrospective reassessment of the flight, Guntrip realized that his guiding theory of infantile wishes directed to (internal) archaic objects “missed the real point” (p. 53). The real point, in his language, was the patient's attempt to make a “constructive forward move” to remain attached. The “real point” in forward edge transference terms is the importance of recognizing crushed tendrils of a mobilizable selfobject transference in a manifestly pathological adult symptom—a symptom that signifies the effort to forestall further fragmentation of the cohesive self, rather than a regression to a normal libidinal stage of security. Guntrip's example follows.

冈特里普 (1961)描述了分析中一类失败的尝试:病人先是来寻求治疗,然后离开。对这个过程的回溯性的再评估,冈特里普意识到,婴儿愿望的指导理论,针对的是“错失真正的点”(内在)的古老客体。在他的语境中,真正的点,就是父母试图让“建设性的向前运动”仍保持“卷须”的状态。在前行端转移的术语中,“真正的点”是在成人明显的病理症状中,识别出可动员的自体客体转移的被压碎的“卷须”——一个表示努力预先阻止聚合自体进一步崩解的症状,而不是在正常力比多安全下的退行症状。冈特里普的例子也是这样的。

A shy, schizoid professional man in his forties sought analysis because of an embarrassing symptom—”he was intensely preoccupied with breasts and felt compelled to look at every woman he passed.” There were other “childish feelings [not specified] he intensely disliked admitting” (p. 34). The patient told Guntrip he believed that his preoccupation with breasts was somehow connected with his cold and unresponsive wife who was like his mother. He always thought of his mother as “buttoned up tight to the neck.” Guntrip attributed the patient's symptom and his distress and embarrassment to a regressive process that revived infantile oral wishes for security at the breast (pp. 49, 50). With interpretations to this effect (not specified), the patient's breast preoccupation subsided. Guntrip took the disappearance of the compulsive looking at women's breasts as a sign of analytic progress. Soon, looking was replaced by a “spate of fantasies,” so compulsive and all-absorbing that they interfered with the patient's work.

一个害羞的、精神分裂的白领,四十多岁,来做分析的目的是因为一个令人尴尬的症状,——“他强烈的关注乳房,以致于他感觉自己被迫注视每一个从他身边走过的女人。”同时还有另外他不愿意承认的“婴孩式情感”(未指明) (p. 34)。病人告诉冈特里普,他对于乳房的关注,可能与他冷漠的和不回应的妻子有关,他妻子与他的母亲非常像。他经常把他母亲想作是“颈部严密的封了口”(“buttoned up tight to the neck.”)冈特里普将病人的症状、苦恼和尴尬归于一个退行的过程,在这个过程中它复活了口腔的愿望,为了在乳房那里获得的安全感(pp. 49, 50)。在解释这个效果中(未指明),病人对乳房的关注并平息了下来。冈特里普把病人强迫性观看女人的乳房的症状消失看作是分析过程的一个迹象。不久,“看”被“幻想的洪水”(spate of fantasies)所取代,它是如此的强迫性和令人神魂颠倒的,以致于他们干扰了病人的工作。

The fantasies that replaced the voyeurism were variations on the same theme. In these fantasies, the patient retired to an isolated sea coast, built himself a strong house, and walled it off from the life going on outside. The series of fantasies came to a climax Guntrip did not understand at the time: the patient built himself an impregnable castle on top of what Guntrip (under the influence of his theory) described as a breast-shaped mountain and walled it around with impassable defenses. “The authorities camped round about and tried to storm the citadel but were quite unable to break in” (p. 50). Sometimes he emerged in disguise to inspect the outside world, but no one could get in contact with him. “Finally [Guntrip wrote] he saw me coming up the mountain side, hurled great boulders at me and drove me off. One or two weeks later the patient suddenly broke off the analysis, using a passing illness of his wife's as an excuse” (p. 50). At this point of final rupture Guntrip thought the patient's regressive wishes were going even farther—from wanting to be at the breast, he now wanted to be safe inside the womb. Then he reconsidered his views.

取代窥阴癖的幻想是在同一个主题下的变奏。在那些幻想中,病人去到一个与世隔绝的海滨,自己搭建了牢固的房屋,将自己与外部的世界隔离了起来。这一连串的幻想来到一个冈特里普当时并不理解的高潮中:病人自己建造了一个固若金汤的城堡,在城堡的顶端(在他的理论影响下),被描述为一个乳房形状的山头,围绕在它周围建了无法逾越的防御的墙。“有关当局围绕着它建营,试图对城堡发动猛攻,但却始终无法攻破城堡”。(p. 50),有时他出现在监查外部世界的伪装中,但是没有人联系到他。“最终(冈特里普写到),他看见我出现在山边上,向我投掷了巨石,将我击败。一两个星期之后,病人突然中断了分析,用他妻子的疾病作为借口。(p. 50)”在最终破裂的这点上,冈特里普认为,病人的退行的愿望走得更远了——从想要“成为吃奶的”,到现在想要“在子宫中的安全”。接着冈特里普重新思考了他的观点。

Guntrip's belated understanding was profound: he saw the incompleteness of the theory of wishes to return to earlier oral, anal, or incestuous modes of “erotic happiness.” The “orality” involved in looking at breasts was not a wish; it expressed the patient's attempt to “stay born,” to actively struggle to “stay in object-relationships” as a separate ego (p. 50) and go on living (p. 53). In short, Guntrip realized the symptom reflected the “real point” of the patient's disorder and his turning to the analyst: he was attempting, with part of his personality, to make a “constructive … forward move” (p. 5; italics added) to protect himself (his remaining self) from the danger of nonexistence. In self psychological terms, Guntrip critiqued himself and realized he failed to see that the patient was urgently searching for a self–selfobject bond— the self that remained was trying to stay attached, to save himself from an overwhelming fragmentation that threatened an already enfeebled self.

冈特里普迟来的理解很深刻:他把愿望的不完全理论看作是回到更早的口腔期、回到肛门期、或者回到“色情性愉悦”(erotic happiness)的乱伦模式。涉及观看乳房的“口欲形态”(orality)并不是一个愿望;它表达的是病人想要“保持在出生状态”(stay born)的努力,是主动与“分离的自我停留在客体关系”(“stay in object-relationships”)的抗争(p. 50),从而得以继续生活下去。简言之,冈特里普意识到,症状反映的是病人心理障碍的“现实点”(real point)和他对分析家的转向:他试图,同他的部分人格,“做一个有建设性的先前运动”(p. 5),从而使自己(他剩下的自体)免于受到不存在感(nonexistence)的威胁。冈特里普用自体心理学的方式批评了自己,并意识到自己没能看到病人在迫切地寻找着自体-自体客体的连接,病人剩下的自体仍试图要保持联结,试图从威胁虚弱自体的压倒性分裂中将自身拯救出来。www.psychspace.com心理学空间网

«我的关系性的自体心理学 自体心理学