科胡特1期35讲8第八课

1、第八课学观点Reviewing the Economic Poof View: Freud placed great emphasis on the relativety orensity of experien. Compare, for exle, the difference bett in actual neurosis,nactual neurosis and psychoneurosis. Freudtulatedundischarged libido from coituserruptus laterrudeso Consciousness asanxiety, the latt

2、er representing a transformation of the dammed-up libido. Later Freudaddedt actual neuroses could result from the damming up of aggressive as well assexual tens.经济学观点回顾：强度的相对性。经症actual neurosis和精神神经症psychoneurosis（精神的力比多侵入意识导致焦虑，精神神经症代表被拦蓄的力比官能症）的区别：多的转移现象。后来经症是未补充说经症也可以来自被压抑的。Freud appd the concept

3、 of “libidinal imbalance not only to anxiety neurosis butalso to neurasthenia. Here again hetulatedt undischargedties of. As anexciexion produymptoms directly, not by structural-topographicle he suggested the neurasthenia of adolescence, in which prolonged masturbatorystimulation with only partial d

4、ischarge and satisfaction leads to an accumulation ofundischarged libido, whisuch as nuchal headaches.ay then produce “toxic changesfor exle, symptoms经症包括焦虑神经症和神经症。未的兴奋直接产生症状，而不是来自结构-地形学的。累，产生“的神经症，延长刺激以及只能部分和满足导致未的力比多的积”例如颈背的头痛。Sleep disturbanmay represent psychoneurotic disorders, on the one hand,

5、 or actualneuroses, on the other.he former, the insomnia may result from sleep being equatedwith forbidden fantasies, which can lead to neurotic inhibition of sleep.he caseof actual neurotic insomnia, undischarged tens disturb sleep directly. The lattercondition is closer to psychotic pathology: com

6、pare, for exle, the schizophrenicsdifficulty in going to sleep and the psychotic depressives early-morning awakening.睡眠可以是精神神经症，也可能是经症。前者，失眠也许来自睡眠等同于被的幻想，导致对睡眠的神经症性压抑。在经症的失眠中，未的张力直接干扰睡眠。后者更接近于精神疾病：比较精神症的难以入睡和性抑郁的早醒。Certain concepts of psychosomatic medicine also derive from the theory of actualneuro

7、sis. In his pr on psychogenic visual disturban, for exle, Freud (1910)distinguished betn hysterical blindness as a psychoneurotic symptom and otherconditions of the eye caused by hypererotization or libidinization of the eye, whichmay actually damage the physiological functioning oftan. Alexanders (

8、1950)ive neuroses employed thelater distinction betsame distinction.n converreactions and vege某些身心医学的概念也来自于经症理论。（1910）年的关于精神性视觉的文章的中，他区分了癔症性失眠和其他由高情欲化或力比多化导致的失明，后者可能实际危及眼睛生理。Alexander后来区分转换反应和植物性神经官能症也应用了相同的标准。Q u e s t i o n : What is the relation of the following observation to the concept of actu

9、alneurotic insomnia? Following certaypes of sports, athletes have difficultyslengfor exle, afting-pong, tennis, and squash. After other sports, such asfootball, athletes sleep well. Could the difference be due to hostile tens notbeing as compley dischargedhe former sports and thus producing insomnia

10、 of theactual neurotic type?提问：下面的观察与经症失眠的关系？在某些运动过后，运动员会难以入睡比如乒乓球、网球和壁球等。而在其他运动后，例如足球，运动员睡的很好。这些不同是由于前者中张力没有因此导致经症类型的失眠吗？A n s w e r :t could be the answer. Fenichel (1945) referred to the “damming up oflibido; but damming up of other tens also occursfor exle, damming up ofaggressive tens. The spec

11、ific characteristic of these conditions ist they donot depend on structural, but only on a dammed-up se. Freud delimited theterm psychoneurosis from neurosis on the basis oft distinction: Actual neurosis isbased on “psychoeconomic imbalance produced by undischarged ten; psychoneurosisresults from st

12、ructural：可能。Fenichel在.“力比多的拦蓄”；但也会出现其他张力的拦蓄比如张力。这些情况的特征是不依赖于结构，而只是由于拦蓄状态。区分精神神经症与神经症：于结构化的经症是基于没有得到。的张力而产生的“精神经济学的不平衡”；精神神经症来自How does free assotion fito these various pos of view and approaches? Waelder(1960) suggestedt in free assotion, the ego iped to regress in one area(and therefore underwork),

13、 but overwork in anotherspecifically, in observing itself.It is a common misconceptiont free assotion is a purely passive or negativepros, a giving up of something (controls, self-criticism). Free assotion is muchmoren just letting omental contents to investigated.lf go. It also involveively allowin

14、g even unpleasanteconscious sot they can be experienced, perceived, and联想与各种观点是怎样的关系呢？Waelder认为在联想中，自我被要求退行到一个领域（并因此降低工作），但在另一方面提高工作尤其是它对自己的观察。一种通常的误解是联想是一种单纯的或消极的过程，是放弃些什么（控制、自我批评）。联想并不仅仅是放手。它也包括积极地允许不愉悦的心理内容进入意识，来被体验、感知和探究。Free assotion, therefore, is workworkt produa gradual extenof thet what wee

15、go. It would be an inaccurate caricature ofthis concept to say, however,strive for inysis isrsonalityt is all preconscious in place ofunconscious. Freud (1937a) poed out in “ysis Terminable anderminabletthe goal ofysis is different fromt. Any walled-off contentt is not active,and for which represis

16、working satisfactorily, is left alone. Even reality testingcane pathological!联想因此是一种工作产生一种逐步地扩展自工作。但也不能说在分析中追求的是一种完全被前意识取代。在1937年的“有终止和无终止的分析”中这不是分析的目标。任何被阻隔的内容如果没有被激活，也就是压抑安全地即使现实检验是有问题的。！着，那就可以放一边。etic Pof View: In some ways this viewpomost accuray characterizespsychoysis. Freud approached tetic q

17、uestion originally from his studies ofpsychoneurotic symptoms, dreams, and so forth. But what is the difference betndynamic formulations and reconstructions from tetic poof view? The latterdeal with those traumatic situations in which an old (nonpathological) dynamicequilibrium is replaced by a new,

18、 permanent (pathological) one. Tetic poofview goesthe recognition of certain dynamic patternst repeat themselves inthe patients life and therutic pros. A dynamic reconstruction is not complete intetic sense, even when traced back to childhood. Similarly, when free assotionis used and the same patter

19、n occurs“dynamic, not “genetic.he transference to theyst,t is学观点：在某个角度来说，这个观点是最精确代表精神分析的。最初通过对精神神经症症状、梦等的研究得出这个观点的。动力学建构和学重构的区别：学处理那些情景，在其中一个旧的（非病理性的）动力均衡被一个新的、持久的（病理性的）动力平衡所取代。学观点了对某些动力学模式（在患者的生活和治疗过程中重复它们自己）的识别。仅仅是动力学重构从学的角度上来说是不完整的，即使回溯到童年时期。相似的，当联想过程中出现相同的模式的移情，这是动力学，不是学。A formulationes genetic

20、when the reliving involves not only the repetitivepattern but also the specific inner mental and external environmental eventstoccurred at the time of the childhood trauma (Hartmann and Kris, 1945). The repetitivepattern iually a symptomt defends against repetition of the trauma itself. Thehe transf

21、erence. It is rarely remembered directlygenetic repetition can occur onlyas the original event, but it is relivedhe transference where it is“reconstructed and then sometimes may be remembered.只有在再次的不仅仅包括重复模式而且还包括在童年时的特定内在心理和外在环境事件的情况下，构想才能称之为学（Hartmann and Kris, 1945)。重复模式实际是一个症状来防御重复。学重复只能出现在移情中。很少

22、是直接想起最初的事件，而是在移情中被再次，这事件被“重建“然后有时候会被想起。Clinical ele: A man described a recent job situation in which his work, whichpreviously had been good, deteriorated after the appearance of a younger coworker inthe same department.he course of theytic work, it was foundt the worksetback resulted from jealousy

23、and anxiety produced by competition with the new coworker. The same dynamic could be established in relation to previous job situations. His childhood history suggested the same problem in relation to schoolmates and particularly toward his younger brothers. Thus the dynamic formulation of this patt

24、ernwas guilt about sibling rivalry leading to work inhibition. The pattern was repeated inhisassoysis. Athe did goodytic work, wisteady flow of freetions; then came a setback and.ysis of therevealedt the patienformulation andd “noticed a “new patient oftheysts. The same dynamicreion were made as bef

25、ore. Work flowed again. On a laterocca, severeset in. Slow progressheysis of therevealed fantasiest the othatient was very ill,t he looked weak and paleyounger sibling then emerged.which was not actually the case. Memories of illness in aFinally, after many such phases of severe, dream material made

26、sible thereconstruction, and later memory,t a younger brother had died in early infancy,duringriod ofense hostile jealousy on the part of the patient.临床例子：一位描述最近的一个工作情况，以前他工作的很顺利，但在一位较年轻的同事出现后就了。在分析过程中，发现工作挫折来自于与新同事竞争而产生的嫉妒和焦虑。相同的动力可以在之前的工作中发现。他的童年历史也有相同：与同学和弟弟。因此对这个模式的动力构想是同辈竞争的内疚导致工作压抑。模式也在分析中重复。首先他的分析工作顺利，能源源不断地联想；然后出现了退步和阻抗。对此阻抗的分析显示患者注意到分析师的一位新的患者。分析师给出相同的动力构想和解释后，分析流畅起来。但在下一次分析时，出现严重的阻抗。对这个阻抗的分析的缓慢进展了一个幻想：其他患者病得非常严重，看起来虚弱和面色苍白