克莱因派分析师处理投射性认同

——技术之意义的转换

Providing new meaning to the patient's PI phantasies is a goal for some Kleinians. Through analysis and verbalization of the patient's unconscious phantasy, a new meaning is constructed for the patient to internalize. Malin and Grotstein (1966) point out the importance of PI receptivity in the analyst. The ability to receive the projections and then modify them for the patient is crucial for a successful working-through process. The patient hopes that the analyst can handle their ejected psychic material without being destroyed. Sometimes this hope collapses into dread and the patient feels alone with an overwhelmed object. The principal manner in which the patient feels the analyst has survived the ego's deposit of material is through the nature of the analyst's interpretation. Therefore, Malin and Grotstein emphasize the therapeutic value and the necessity for direct interpretation of PI. They write:

向病人的投射性认同幻想提供新的意义是一些克莱因派分析师的目标。通过把病人的无意识幻想进行分析并用语言表达出来，从而一种新的意义得以建构并被病人内化。马林与格罗斯坦指出了分析师接受投射性认同的重要性。接收投射然后并向病人予以转化是成功修通的关键。病人希望分析师能够处理他们拒绝的、排出的心里材料而不被毁坏掉。有时候这种希望会崩溃而陷入恐惧，此时病人感觉独自承受要压垮他的客体。病人感受到分析师从自我材料处理过程中成功存活下来的最重要的方式就是通过分析师的解释。因此，马林和格罗斯坦强调治疗的价值和对投射性认同直接解释的必要性。他们写道：

correct interpretations can be seen as an important way in which the patient can observe how his projections have been received and acknowledged by the analyst. If this does not take place the patient is left with futility, despair, and doubt…

(Malin and Grostein 1966:29)

正确的解释可以被看作一种重要的方式，使用这种方式病人可以观察到，他的投射性认同是如何被分析师接收和确认的。如果病人没有观察到这些，他可能会感觉到没有效果，绝望和怀疑…

These authors state the importance of understanding what can appear to be a negative therapeutic reaction, especially with more disturbed patients. They describe the patient's need to preserve the analyst as a good object by maintaining distance from him. By not being close to the analyst, the patient prevents the projection of bad objects into the analyst and thus the risk of destroying him and their only hope for survival. However, the same patient may keep their distance if they feel they have already contaminated the analyst by projecting bad objects into him.

这些作者陈述了理解什么看起来是负性治疗反应的重要性，尤其是与严重患者工作时。他们认为病人需要通过与分析师保持一定距离而使分析师保持为一个好客体。通过不靠近分析师，病人阻止了把坏客体投射给分析师，也阻止了破坏分析师和他们存活下去的唯一希望的风险。但是，如果病人觉得他们已经通过把坏的客体投射给分析师玷污了他，这些病人也许会保持他们的距离。

Malin and Grotstein provide a case study in which the patient felt the analyst was rigid, hard to please, and snotty. This was a projection of a father identification. At other times, the patient felt the analyst was insincere and martyr-like. This was a projection of a mother identification. Malin and Grotstein write:

马林和格罗斯坦提供一个个案研究，这位个案觉得分析师是死板的，难于取悦的和下贱的。这是一种对父亲认同的投射。在其他时候，这位病人觉得分析师是二心的和殉道者。这是一种母亲认同的投射。马林与格罗斯坦写道：

the projections were accepted by the analyst for their psychic validity, and then interpreted as his need to put bad parts of himself…into the analyst in order to rid his ego of these bad contents… Not only was he repeating with the analyst what he had experienced with his father and mother, but he was also taking possession, in fantasy, of the analyst from within to guarantee total possession of the object… Without this guarantee, as it were, there existed no relationship for him.

(Malin and Grotstein 1966:30)

这些投射由于一些心理上的效果被分析师接受然后被解释为是他（患者）需要把部分坏的自己投射到分析师身上，如此的话，他就可以消除掉自己身上这些坏的内容…他和分析师不仅仅在重复他与他的父亲和母亲在一起时的经历，而且他也在幻想层面上拥有分析师以保证他整个拥有客体…如果没有这种保证，正如上面所说，这里就和他没有关系。

The authors go on to describe how the patient needed to not only own the analyst to prevent the loss of the relationship but that he felt his love was bad and would be rejected as well. Therefore, he related to the object with his "bad" self in order to protect the object from the bad loving aspects of himself. Also, he was excited if he felt he hurt the object in this way. If the analyst was hurt, the patient felt he had an effect on another person, thus confirming his existence. This also gratified his intense envy of the analyst's strength.

作者们继续描述病人需要的不仅仅是分析免受关系丧失而且他觉得他的爱是坏的也是被拒绝的。因此，他与客体和他坏的自体联系从而保护客体免受他自体坏的方面的影响。如果他觉得他用这种方式伤害客体，他也会兴奋的。如果分析师受到了伤害，病人感觉他对另一个人产生了影响，从而证明了自己的存在。这也能满足他对分析师力量的强烈的妒忌感。

Grotstein explain their technical approach and its results: 格罗斯坦对他们的技术方法及其结果进行了解释：

consistent interpretations of all of these mechanisms wherever they occurred considerably lessened the negative transference, and the patient was subsequently able to recognize that he was warding off his deep feelings of dependency on the analyst. Changes occurred by virtue of analyzing the projections rather than by the analyst's unconsciously or consciously responding as if they were objectively valid. In other words, it was a new experience for the patient which allowed him to integrate the previously projected parts, now reintegrated into the ego, so that a higher level of functioning could occur.

(Malin and Grostein 1966:30)

所有这些机制的连续性解释，无论他们在哪发现的，都相当地弱化了负性移情，并且，病人接着就能够认识到，他退行到了对分析师的深深地依赖之中。改变的发生是经由分析这些投射，而不是分析师无意识或有意识地回复，就像他们是客观有效的。换句话说，对病人来说这是一种新的体验：允许他去整合以前投射出去的部分，现在重新整合进自我，如此，更好的功能水平就产生了。

One aspect of this approach is to show the patient a new take on an old belief. This is done by the analyst not acting out the PI phantasy with the patient and instead interpreting the patient's self-object conflicts. In this way, there is a new experience of self and object.

这种方法的一个方面是想病人展示一个老的观点有了新的见解。这不是分析师通过对投射性认同幻想见诸行动而是通过向病人解释自体-客体冲突而完成的。这种方式是一种自体-客体新经验。

I think this is accurate and a vital part of analytic technique. At the same time, I think all analysts need to not idealize this transformative function and realize that it is very common to, at first, act out the PI, then understand it, and then interpret it for the patient. In that sense, we often become part of a living, here-and-now transformation of self and object within the intrapsychic and interpersonal world of the transference-countertransference.

我认为这是分析技术中精确和重要的部分。同时，我认为，所有的分析师不必理想化这种转换功能和意识到见诸行动投射性认同然后理解它是非常普遍的，然后向病人解释它。在这种意义上来说，我们经常成为移情反移情的个体内在和人际间里自体与客体鲜活的此时此地转换的一个部分。

In a rather extreme case example, David Rosenfeld (1992) shows his technical style with PI. He writes of a patient who burst into a staff meeting at the hospital. The patient told Rosenfeld that he hated him and was going to kill him because he resembled the patient's father. He said he would then kill everyone else in the room. Rosenfeld states:

在非常极端的案例中，大卫罗森费尔德展示他处理投射性认同的技术。他写道一个病人突然闯入医院的员工会议。这个病人告诉罗森费尔德他恨他和他要杀了他因为他与他（患者）的父亲很像。他说他然后杀了屋中其他人。罗森费尔德写道：

I told him he wanted to kill a crazy part inside his head and a crazy father inside him, that he projected this and wanted to see it in me, instead of seeing it inside his head. He replied that he was going to kill all the social workers and psychologists. Then I told him that he scattered onto everyone what was going on in his head and that he wanted to get rid of that crazy Samuel by seeing him in me and then in the people there, but that what he wanted to see outside and kill was what was crazy in him… I insisted that he wanted to kill his own crazy part and we wanted to help him be cured by means of words, that there was no need to kill.

(Rosenfeld 1992:20)

我告诉他说他想杀了他头脑中一个疯狂的部分和他内在的父亲，他把这投射我身上并想从身上看到它，而不是在他的头脑里看到它。他重复说他要杀了所有这些社会工作者和心理学家。然后我告诉他他把自己分散到大家身上他头脑中正在进行的事情和他想通过在我身上和其他人身上看到疯狂的塞缪尔除掉他，但是在外面他想看到和想要啥是在他内在里那个疯狂的部分…我坚持说他想杀掉他自己那个疯狂部分和我们想通过语言的方式帮助他疗愈他，这种方式不需要杀戮。

Rosenfeld was direct with the patient about what he felt was being projected and the motivations behind those actions. In doing so, he transformed the intrapsychic meaning of this patient's angry and scary phantasies.

罗森费尔德与病人直接谈论他感受到的部分在投射和那些行为背后的动机。通过这样做，他转换了这个病人愤怒和受惊幻想的心理意义。

Part of this direct interpretation and transformation was the converting of a dangerous projection back into an internalization of bad objects. With a patient as disturbed as this and wanting so desperately to get rid of the toxic internal objects, that sort of interpretation would need to be repeated many times over, from many different avenues. Such a patient would undoubtedly resist and reject the interpretation much of the time, with the analyst needing to follow up with more understanding and discussion.

直接解释和转换部分正是把危险的投射物转化回为坏客体的内化。与如此严重困扰和如此绝望地想除掉这中毒的内在客体的病人工作，那类解释需要不断地重复多次，从不同的角度。这样病人大多数时候毫无疑问会阻抗和拒绝这种解释，这需要伴随分析师更彻底理解和讨论。

In 1983, Herbert Rosenfeld mentions the importance of being careful in interpreting to overly anxious patients as they may take the interpretation in as yet another persecutory object. While he suggests using a minimum of verbal interventions in these types of situations, he still feels that direct interpretation of PI is essential to successful technique. He describes how in one form of PI, the patient believes he has forced himself omnipotently into the analyst, creating anxieties about loss of self. The patient then fears the analyst will control his mind and drive him mad. This pushes the patient to attack back and fight for his life. Rosenfeld writes:

在1983年，赫尔伯特罗森费尔德当那些过度焦虑的病人也许会把解释当作另一个迫害客体时指出向他们解释时谨慎的重要性。尽管在这些情境下他建议使用最小的语言干扰，他还是觉得对投射性认同进行直接解释是取得成功所必要的。他描述了在一种投射性认同形式中，病人是如何相信他成功地强迫自己进入分析师，产生了很多丧失自体的焦虑。病人然后担心分析师会控制他的思想并驱使他疯狂。这促使病人把攻击收回并为他的生命而战。罗森费尔德这样写道：

it is then, of course, essential to establish with the patient that he is afraid he has forced the mad parts of his self into the therapist and that he is now terrified that the analyst will retaliate and force the madness back into him and, as a punishment, entirely deprive him of his sanity.

(Rosenfeld 1983:263)

当然，有必要与病人确立的是，他很害怕他已经被迫把他自己疯狂的部分投射到治疗师身上和他现在很恐惧的是分析师会报复他把这个疯狂的部分再投射回给他，以此作为惩罚，彻底让他远离正常。

I find it fascinating that looking back on David Rosenfeld's case of the patient wanting to kill the staff, one would see the patient potentially taking Rosenfeld's interpretation in this persecutory manner.

在回顾大卫罗森费尔德的想杀死员工的个案时，会发现，这个病人有可能把罗森费尔德的解释以这种迫害者的方式吸收进来，这一点我觉得很迷人。

Later in the paper, Herbert Rosenfeld discusses a patient who brought in a dream of a starving baby and a starving mother. After telling the dream, she realized she never knew whether she was devouring others or being devoured by others. She then felt intense pressure on her head and felt like bursting. Rosenfeld writes: "I interpreted that she felt that she wanted to project the starving, demanding mother into me to get some relief" (1983:265). This illustrates his goal of putting the patient's phantasy into words and then describes to the patient the motivation and subsequent results of his phantasies. The desires, the anxieties, and the outcome of the PI phantasy are articulated to the patient. The analyst then waits to hear the next association. By showing the patient the details of their core unconscious beliefs, it provides room for them to generate new meaning, within the context of the transference. Transformation of the old PI process allows room for new, more integrated object relations.

在这篇文章后面，罗森费尔德谈论了这样一个案例：个案带进来一个有关一个饥饿的婴儿和一个饥饿的母亲的梦。说了这个梦之后，她（患者）意识到她从不知道她是否在吞噬他人或被他人吞噬。然后她的头感觉到强烈的压力并感觉像爆炸。罗森费尔德写道：“我解释说她觉得她想把饥饿的要求的妈妈投射到我身上来获得一些缓解”。这阐释了他的目标，即把病人的幻想转化成语言然后描述给病人其背后的动机和他幻想的结果。分析师把投射性认同幻想涉及的欲望、焦虑和的结果都很清楚地传达给患者，然后等着听下面的联想。通过向患者展示他们无意识信念的细节，在移情的脉络里，它为他们产生新的意义提供了空间。转换老的投射性认同过程为新的、更加和谐的客体关系提供空间。

摘自《临床中的投射性认同》（ "projective identification inthe clinical setting" by Robert Waska)