分析师在慢性危机时期对精神分析治疗的作用

摘要(中文译文)

分析师在长期危机时期在精神分析治疗中的作用，通过两个案例研究的材料加以说明。第一个临床片段展示了一位分析师能够与创伤性外部现实在患者身上唤起的恐惧共处，即便分析师同时试图与患者一起探索以独特方式处理这一现实的内心世界。第二个案例研究聚焦于分析师在这一长期危机时期的反移情——她与患者共同经历着这一危机——如何使她难以涵容患者的恐惧与焦虑，因为她自身的生存以及作为分析师的认同都受到了威胁。在第二个案例中，分析师出于对外部情境的否认，盲目地聚焦于患者的内部现实，以对抗自己在面对死亡与毁灭时的被动感和无助感。她固守“经典”分析，试图分析患者的防御、对其进行修通等，从而做出所谓的分析性诠释，而不是与患者的恐惧以及她自己的恐惧共处，并更直接地帮助患者。一个转折点随着分析师孙女的出生而到来；对新生命安全的担忧使分析师敏锐地意识到，不可能忽视外部现实，必须在日常生活和分析中为其留有一席之地。这种觉察使分析师能够涵容患者的恐惧，这帮助患者感到更多支持并促进了改变。

Abstract

The role of the analyst in psychoanalytic treatment during periods of chronic crises is illustrated with material from two case studies. The first clinical vignette shows an analyst able to stay with fears evoked in the patient by the traumatic external reality, even as the analyst tried to explore with the patient an inner universe that handled this reality in unique ways. The second case study focuses on how the analyst's countertransference during this period of chronic crises, which she was experiencing along with the patient, made it difficult for her to contain the patient's fears and anxieties, because of the threat to her own existence, as well as to her identity as an analyst. In this second case the analyst, out of denial of the external situation, focused blindly on the patient's internal reality in order to counteract her own sense of passivity and helplessness in the confrontation with death and destruction. She clung to "classical" analysis by trying to analyze the patient's defenses, work them through, etc., thus making so-called analytic interpretations rather than staying with the patient's fear, as well as her own, and helping the patient more directly. A turning point came with the birth of the analyst's granddaughter; fear for the new arrival's safety made the analyst sharply aware that it is impossible to ignore external reality, that it must be given a place both in everyday life and in analysis. This awareness enabled the analyst to contain the patients' fears, which helped him feel more supported and facilitated change.

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