自体心理学中的阻抗

The

concept

of

resistance

in

selfpsychologyRowe.

Crayton

American

Journal

of

Psychotherapy

50.1

(Winter

1996):

66-74.Das

ichegoFreud（1856-1939）egoselfSelf

psychology(自体心理学)Ego

psychology(自我心理学)Erik

EriksonI

wasone

of

thefirst

writers

to

usethe

term

“self-esteem

”。(1890)Heinz

HartmannWilliam

JamesDevelopment

of

theoryEgo-psychology自我心理学Self

psychology

自体心理学Object——relation

theory客体关系理论(1)Resistance

阻抗(2)Transference

移情(3)Selfobject

transference自体客体移情Traditional

psychoanalysis传统精神分析选题依据及写作目的

resistance（阻抗）是患者在心理治疗过程中的必然反应。传统精神分析观点将阻抗视为对治疗行为的抗拒。这种观点直接影响了分析师对到阻抗的策略。甚至是治疗的效果。柯胡特曾经因为无法应对痛患者沟通的僵局而中止治疗，这迫使他对传统精神分析中的做多理论进行反思。

“阻抗”的再定义对自体心理学的发展有重要意义。也在客观上推动的临床心理治疗技术革新和发展。

本文旨在通过论述阻抗概念不同时期的发展，结合具体临床案例探讨心理问题治疗新模式。UNICAT

摘要TRADITIONAL

VIEW

OF

RESISTANCE--DEFENSE

AGAINST

AWARENESS

ANDRESOLUTION

OF

CONFLICTSELF

PSYCHOLOGY"S

VIEW

OFRESISTANCE--PROTECTING

THESELFKOHUT"S

CONTRIBUTIONS

OFSELFOBJECT

AND

SELFOBJECTTRANSFERENCESEXAMPLES

OF

RESISTANCESSUMMARYTRADITIONAL

VIEW

OF

RESISTANCE--DEFENSE

AGAINST

AWARENESS

ANDRESOLUTION

OF

CONFLICTTraditional

view

of

resistances

as

treatmentinterferences

that

must

be

overcome

as

they

defendagainst

awareness

of

impulses

and

allow

forunconscious

instinctual

gratification.传统观点中的阻抗——对理性意识和冲突解决反防御在传统观点中阻抗表现为反抗冲动意识的防御和无意识自我满足式放任，因为阻抗被看成是对治疗的一种干扰行为，理所当然的被认为应该克服。Clinical

concept

of

resistanceIn

the

course

of

this

difficult

work

Ibegan

to

attach

a

deeper

significance

tothe

resistance

offered

by

the

patient

inthe

reproduction

of

her

memories

and

tomake

a

careful

collection

of

the

occasionson

which

it

was

particularly

marked

..在困难的工作过程中我试图去找寻阻抗的更深层意义，这涉及到病人如何重建她的记忆，如何收集那些被特意标记过场景信息。佛洛依德对于阻抗的理解促使他对防御进行概念化定义，与此同时对自由联想进行谨慎的启发也是他在技术层面的一次改变。Handling

resistance

of

traditional

vieIn

a

general

sense,

the

handling

ofresistances

(both

tactical

and

strategic)involves

the

establishment

and

maintenance

of

a

therapeutic

situation

in

which

thepatient

increasingly

accepts

and

uses

theanalyst"s

vantage

point

in

regard

to

changeand

psychic

maturation,

and

increasinglyrecognizes

his

own

resistances

as

internalpsychic

operations

activated

in

opposition

tothe

avowed

purpose

of

the

analysis在一般意义上，处理阻抗（无论是战略性还是战术性阻抗）涉及到治疗情境的建立和维持，在该情境中病人逐渐接受和运用分析者的客观位置来实现改变和寻求心理成熟，并且慢慢了解到他自己的阻抗是自己内部被激活的心理作用，这种作用对分析师所倡导的治疗目的有反作用。SELF

PSYCHOLOGY"S

VIEW

OF

RESISTANCE--PROTECTING

THE

SELFIn

contrast

to

the

traditional

view

of

resistancesas

interferences

and

obstacles

that

must

beremoved

or

modified,

self

psychologyrecognizes

that

resistances

are

important

inpreserving

the

self.自体心理学中的阻抗——一种自我保护行为与传统观念中将阻抗视为必须被清除或修正的干扰和阻碍不同，自体心理学认为阻抗在自我保护方面有重要的作用。柯胡特简洁的表明了他的观点：“所有那些所谓的阻抗都是为自我基本目的服务的，完全没有被克服的必要。”EXAMPLES

OF

RESISTANCESCase

of

Mr.

V.Mr.

V.,

a

thirty-two-year-old

intelligent,

highlyanxiousand

somber

man,

was

adopted

atbirth.

At

three

years

of

age

his

adoptedparents

died,

and

he

was

sent

to

aseriesoffoster

homes

where

he

was

sexually

abusedand

suffered

innumerable

traumaticseparations.

At

seventeen

years

of

age

heleft

the

last

home

and

fended

for

himself.

Hewould

frequently

solicit

both

female

andmale

prostitutes

who

would

agree

to

abuseand

humiliate

him.

Mr.

V.

had

been

asuccessful

computer

salesman

but

had

lostthe

job.冲突型案例Case

of

Ms.OMs.

O.,

an

intelligent,attractive

twenty-six-year-old

Hispanic

woman,

was

the

youngestof

six

siblings.

She

lived

in

a

crowdedapartment,

with

only

two

rooms,

one

ofwhich

served

both

as

a

bedroom

andkitchen

for

the

entire

family.

For

the

firsttwo

years

of

her

life,

she

had

the

attentionof

her

parents,

but

then

suffered

abrupt

andsevere

emotional

estrangement

from

themas

they

became

overwhelmed

by

theircircumstances

and

had

little

time

for

her.Ms.

O.

was

sexually

molested

by

her

olderbrother

when

she

was

five

years

of

age

andwas

subjected

to

the

nightly

sounds

of

hermother

and

father

having

intercourse

in

anadjoining

bed.缺陷性案例SummarySeveral

examples

serve

to

show

howseverely

traumatized

patients

can

becomefixated

on

primitive,

highly

organizedselfobject

configurations.

As

patients

feelunderstood,

they

internalize

anxiety-relieving

functions.

They

feel

lessvulnerable

and

more

capable

of

movingforward

in

the

treatment.诸多案例告诉我们被严重伤害过的病人会变得固着于高度组织化的自体客体结构上。可只要病人感受到理解，他们就可以内化消退焦虑的功能。他们不再脆弱不堪并会随着治疗进程变得愈发好转。展望和不足本文比较明确论述了自体心理学中阻抗这一概念相较 传统观点个改变。正是基于这种改变影响到了分析师 在进行治疗时使用的策略。丰富了临床治疗的方法。联系两个案例刚好对应边缘型人格的冲突型和逃避型，指导意义很强。作者作为一名医生却没有很好根据理论深入剖析案例，分析论述多流于表面，内容显单薄。就自体心理学框架下如何应对阻抗没有提出具体的指导意见。不无遗憾。我的思考阻抗移情理解干预反思康复边缘性人格观察，解释谢谢观看！Thanks

for

your

seeing!Object——relation

theory客体关系理论（object-relationstheory）是心理动力取向的人格发展理论，主张人类行为的动力源自寻求客体。客体关系理论是在精神分析的理论框架中探讨人际关系，更强调环境的影响。认为真正影响一个人精神发展过程的是在出生早期婴儿与父母的关系。客体(object)一词为弗洛伊德（Freud）

所使用，对婴儿而言，客体指满足需求的事物，对儿童而言，客体一词可与『他人』互换，客体关系即指人际关系。而此等人际关系乃塑造了个体目前与人们之间的互动情形，不论是真实的或幻想的。backTransference移情移情是对目前的一个人的感觉、驱力、态度、幻想和防御的体验，这种体验是不现实的，是源自童年早期对于重要人物的反应的重现和替代。移情指向某人的特殊关系，它是一种特殊类型的客体关系，它的主要特征是对一位不适宜人物的感觉体验，而实际上是指向另一个人的。分析心理学的移情，则是指所有的感情，即不仅指爱情，也指仇恨与憎恶等阴性情绪的转移。建立在弗洛伊德精神分析理论基础上的心理治疗，无论是运用经典的精神分析不觉是改良的短程心理治疗，甚至是与精神分析学唱反调的行为疗法，心理医生们都无法回避或忽视移情现象的存在。一个有经验的心理治疗家，可以运用患者的移情来达到治疗的目的。这比没有移情的效果要明确而持久得多。在欧美，心理医生在为患者进行心理治疗时，常以患者是否有移情现象来预测其成功率。有人说，没有治疗进程中的移情，就没有治疗的效果，这说明移情的重要性不亚于疏导和劝慰。Self

psychology

sees

transferences

as

mobilizationsof

unrequited

self

object

needs

for

idealizing;

forrecognition

of

exhibitionistic

expressions

of

ideas,talents,

and

abilities;

and

for

experiencing

alikenesswith

others.

These

needs

emerge

as

strivings

towardestablishing

self-cohesion

and

continue

to

unfoldand

develop

in

the

treatment

as

mature

forms

ofself

object

transferences.

Kohut

emphasized

thatthrough

the

development

of

the

self

objecttransferences,

the

patient"s

arrested

developmentcan

be

set

in

motion

and

come

to

completion.自体心理学将移情视为满足理想化自体客体需求的调动行为，可以对观点，天赋，能力方面表现癖的表现进行再认，同时也可以用来和他人分享共同的共同点。伴随着努力实现自我凝聚力的建立这些需求渐渐出现，同时也展开和发展了自体客体移情形式的成熟治疗模式。柯胡特强调通过自体客体发展移情的发展，病人获得的改善可以被嵌入行为并被继续完成。•back自体心理学1970年代初，海因茨．科胡特发表其现已闻名于世的专题论文，《自体的分析》(1971)，首次提出“自体心理学”理论。弗洛伊德最先于20世纪早期向科学界引入精神分析，自体心理学自出现后，迅速成长为最重要的精神分析理论。科胡特接受的训练属于美国自我心理学理论，他赢得

了坚定保守的弗洛伊德精神分析师之声誉，于1964

年成为美国精神分析协会的主席.但最终促使他质疑精神分析理论（他曾以此做为科学依据）并借以获得声

誉的，并非他的治疗策略，而是他的正直、以及他对

许多患者的治疗僵局及过早终止治疗的深切关注。当

一位同事问他为什么会改变自己的想法时，他坦然承

认，他“越来越感到我[向患者]做出的解释很勉强，而患者的、有关我不理解他们之抱怨是有理由的”在

揭示他的自体理论时，科胡特撇开自己的经典理论，

转而从患者身上寻找线索。自体（self）在精神分析过程