On Aggression: Its Forms and Functions

攻击的形式与功能

JAMES L. FOSSHAGE, Ph.D.

翻译：王静华

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译者注：福斯吉博士是纽约精神分析主体间性研究机构的创始成员，同时现任纽约大学精神治疗和精神分析博士后项目的临床心理学教授。在此文（1998）中，福斯吉博士以动机系统理论为基础阐释攻击的来源、形式、功能，扩展了攻击谱系，从温和的厌恶反应到暴怒，既有果断自信中的攻击，也包括自体状态被剥夺的析出物，并简要论及在临床情境当中，分析师该如何进行处理愤怒和攻击，并指出毫无疑问地是进入患者的精神内在世界，从其内部视角理解他的体验是首当其冲的任务。面对患者的愤怒和攻击，自体心理学和经典精神分析有完全不同的立场，后者认为是对原始驱力的防御、需要被穿透而易在分析场景中形成对立，后者认为自体感受到威胁而进行的自我保护，需要分析师进行倾听和理解。正如弗洛伊德所说：肉体伴随现象有着最完整的精神序列，意识的断裂处就是潜意识的浮现。愤怒与攻击也正是断裂之处，看到语言背后的主体，危机也是对深度相遇时刻的渴望。

“Where there is ruin, there is hope for a treasure.——Rumi”——何处有毁灭，何处就有希望看到珍宝。

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Discussions of aggression require consideration of motivation and affect theory. Regardless of our motivational model, aggression is motivated and involves dysphoric affects of anger, fear, shame, and disgust. Even when we view aggression, not as a drive, but as a reaction to frustration, we view the aggressive response to be activated by frustration and related signal affects, and to be motivated, that is to have an inner thrust and an aim.

对攻击的讨论需要考虑动机和情感理论。不管我们的动机模型是怎样的，攻击是受到激发后的反应，并且涉及愤怒、恐惧、羞耻和厌恶各种焦虑不安的情感。而且我们不认为攻击是内驱力（drive），而看成是对挫折的反应，我们认为攻击性反应是由挫折和相关重要情感所激发，也就是说具有内在推力（inner thrust）和目标。

Although within psychoanalytic parlance aggression has been used to refer both to hostility, hate, and acts of destructiveness and to acts of assertion. I differentiate between assertiveness and aggression. I view them not as points on the same continuum, but as two different types of experiences and, therefore, as belonging to two different motivational systems.

尽管在精神分析用语中，攻击不仅是指敌意的、憎恨的和摧毁性行为，也包括果断自信的行为。但我在果断自信（assertiveness）和攻击之间加以区分。我不认为它们是连续体上不同的点，而是看作两种不同类型的体验，因此属于两个不同的动机系统。

Lichtenberg (1989), in a motivational systems model that I have found quite compelling, has designated and described assertion and aggression, respectively, as the exploratory-assertive and aversive motivational systems, two of five posited systems. (The other three are psychological regulation of physiological requirements, attachment affiliation, and sensual-sexual.) Each motivation is anchored in a basic need (for example, the need to explore or the need to protect oneself) and begins with innate response patterns that are then shaped by learning. Each system can be activated primarily from the inside or the outside. Within this framework, our motivations shift in priority as well as typically involve several at the same time that may or may hot be readily distinguishable. For example, in a competitive sport, or in an intellectual discussion, aggression often augments assertion, and the two may not be easily distinguishable until the anger and attacking within the aggressive response intensifies. Both motivational systems are likely to be activated and oscillating in a background and foreground configuration. The primary aim of these motivational systems is not to discharge energy, but to serve the basic needs of the individual in dealing adaptively with the environment. They function overall to develop, consolidate, and maintain a positive cohesive sense of self, the overriding motivational principle.

引起我注意的是，利希腾伯格（1989）在动机系统中把自信果断和攻击归入两个不同的动机系统，也就是探索-自信动机系统和厌恶动机系统，这两个系统属于五个动机系统（另外三个分别是同生理需要相关的心理调节系统、依恋和归属需要系统、感官满足和性满足系统）。每个系统锚定于一个基本需要之上（例如，探索的需要或保护自己的需要），是天生的反应模式，之后通过学习不断被塑造。每个系统在根本上可以从内部被激活，也可以从外部被激活。在这个框架之内，典型情况是我们的动机同时涉及多个动机系统并且它们的优先级也在转变，这些可能易于区分，也可能不容易。例如，在竞争性运动或者智性讨论中，攻击常常提升果断自信，这两者很难区分，除非攻击性回应中愤怒和攻击变得尖锐起来。这两个动机系统很有可能都被激活，并且在前台和后台结构之间摆荡。这些动机系统的首要目标不是为了释放能量，而是服务于个体适应性地应对环境的基本需要。总的来说，它们的功能是发展、巩固和维持积极的自体统整感，这是最重要的动机原则。

The conceptualization of exploratory-assertive motivation is partially based on infant research. Infants actively or assertively respond to problem solving experimental situations. On the basis of these experiments Broucek (1979) concluded that the infant's source of pleasure does not derive from problem-solving alone (the exploration), but from the infant's pleasure in noting that he had produced the result (the assertion). The pleasure derived from the exploratory-assertive behavior has been termed efficacy, or competence pleasure, and contributes substantially to self-feeling. Although the exploration-assertiveness is at times primary, it can also be seen as a variable admixture to all other motivational systems.

对探索-自信动机系统的概念化是基于婴儿研究结果。在问题解决实验性情境中，婴儿的反应是积极的或自信的。Broucek（1979）根据这些实验结果，得出这样的一个结论：婴儿的快乐源头不仅仅只是解决问题（探索），而且婴儿高兴地注意到他制作了结果（果断自信）。探索-自信行为带来的快乐被称之为效能感或胜任的快乐，并且从本质上促进了自体感受（self-feeling）。尽管探索-自信动机系统有时居于第一位，但是它也能够视为其它所有动机系统的可变混合物（variable admixture）。

In turning to aversive motivation, Lichtenberg (1989) has proposed that aversion, not aggression, more optimally designates the system, because not one, but two innate response patterns comprise the system—antagonism (or aggression) and withdrawal. This duality, as ethologists have pointed out, enhances adaptive flexibility in fight or flight reactions. The term aggression addresses only one of the response patterns, namely, antagonism. Recognition of these two innate response patterns positions us as analysts to better appreciate withdrawal and avoidance as aversive reactions in their own right rather than solely as defenses against anger and aggression. At times, it is more adaptive to flee than to fight. To use the term aversion, rather than aggression, to designate this system more easily encompasses the full range of reactions from mild to intense. To aggress etymologically means "to move toward" or "to attack" and psychoanalytically is often used to connote an aim of destructiveness, which applies only at one end of the spectrum of aversion. For example, when the infant turns his head away from the mother or when the patient turns away from the analyst, withdrawal is a mild form of aversiveness. On the other end of the spectrum rage over a perceived insult can trigger dangerously destructive aggressive responses. We importantly use aversiveness to regulate our attachments and self experience. For example, when we feel too vulnerable in a relationship, we may avert the other through antagonism or withdrawal, and/or we may fortify ourselves through aggressively augmenting our assertiveness.

论及自信动机系统，利希腾伯格（1989）提出，自信是更适切的命名而不是攻击，是因为这个系统包含两个与生俱来的反应模式——对抗（或攻击）和撤回。正如动物行为学家指出，对抗/回避的双重性提升了适应性地灵活使用战斗/逃跑反应。攻击，这个术语仅强调了双反应模式之一，也就是对抗。认知到这两个与生俱来的反应模式，使作为分析师的我们能够更好地理解到撤回和回避本身就是厌恶反应，而不仅仅是对愤怒和攻击的防御。有时，逃跑比战斗是更具适应性。用厌恶而不是攻击，命名这个系统，更易涵括从轻微反应到强烈反应的全部范围。从词源学上来讲，攻击意味着“向前推进（to move forward）”或者“进攻（to attack）”；从精神分析视角，攻击常常隐含着摧毁性的目的，仅适用于厌恶光谱的一端。例如，婴儿把头转离母亲或者是病人转过脸去、不看分析师，撤回是厌恶反应的一种温和形式。厌恶光谱的另一端，感知到被羞辱引发的暴怒能够触发危险的摧毁性攻击反应。重要地是，我们使用厌恶反应来调节我们的依恋关系和自体体验。例如，当我们在关系中感到太脆弱，我们也许通过对抗或撤回来回避他人，并且（或者）通过攻击性地增强我们的自信而防护我们自身。

Affects are reactions to and amplifiers of our experience and activate motivational systems and responses. Lichtenberg (1989) notes: "Each of the other systems begins with an inherently triggered affect response of a pleasurable nature . . . [which] provide[s] a target motivating a search for recreating the experience" (pp. 186-187). The dystonic affects of anger and fear (shame and disgust) activate and partially define the aversive motivation. These affects are not pleasurable, but successful aversive action can produce a pleasurable relief from them. This pleasurable relief, in turn, can become the goal for future aversive actions and, thereby, can serve as one basis for sadism and masochism.

情感由我们的体验引发，同时也放大我们的体验并激活动机系统和反应。利希腾伯格（1989）写到，“其它每个系统开始于从内在触发快乐本性的情感反应…[这]提供了一个动机目标，也就是寻求重新创造这个体验”（pp. 186-187）。愤怒和恐惧（羞耻和憎恶）是异常不协调的情感（dystonic affects），它们激活并部分地界定了厌恶动机。这些情感不会让人感到快乐，但是成功的厌恶反应能够消除这些情感而令人快乐。反之，这个令人快乐的消除结果，在将来可能成为厌恶反应的目标，从而构成施虐狂和受虐狂的基础。

As the individual interacts with the world, the activation and experience of each motivational thrust shapes self-feeling and self-organization. To be able to become angry and to avert a perceived threat or hurt can both protect the individual and self-cohesion as well as enhance feelings of power. In augmenting exploration and assertiveness in overcoming obstacles, aggression can increase our sense of efficacy. This includes, for example, the aggressively tinged effort to be "heard" by the other. Aggression as one pole of aversiveness can serve multiple functions. In regulating our interactions and attachments with others, aggression serves vitally necessary self-protective, self-delineating, and self-restorative functions.

随着个体与世界的持续互动，每个动机推力的激活和体验塑造了自我感受和自体-组织。能够愤怒和能够避开感知到的威胁或伤害，既能提升个体的力量感，也能够保护个体及其自体统整感。在增强探索性和克服障碍的自信方面，攻击性能够增加我们的效能感。例如，这包括略有攻击性地努力让他人“倾听”。果断自信端的攻击性具有多重功能。在调节我们和他人的互动和依恋方面，攻击性的关键作用是提供了不可或缺的自体保护、自体界定和自体复原功能。

The capacity to experience anger, fear, and shame and to respond aversively is crucially important for all, regardless of gender. The availability and prominence of aversiveness is, of course, shaped by experience within the family, peer group, and the society at large. Parental responses to the child's expressions of anger and fear and to the child's aversive responses shape the individual's responses to these affects and aversiveness and their future availability for self protection and augmenting self-assertion. For example, parental attempts to squelch the child's anger can intensify the child's frustration, anger, and aggressive response; can lead to shame and a devaluation of anger and aggression; can result in suppression and repression of these feelings; and, finally, lead to a sense of helplessness and depletion. If this parent-child scenario becomes thematic, the child's anger and aggression will not be as available to deal with future self-injuries. In contrast, parental reception, understanding, and attuned responsiveness to the child's frustration, anger, and aggression will facilitate the development of modulating capacities and the availability and constructive usefulness of aversiveness in dealing with the world. Gender-related cultural expectations clearly shape the boy's and girl's attitudes toward anger, fear, and aversiveness and then availability.

       体验到愤怒、恐惧和羞耻的能力和厌恶反应的能力，对所有人而言都是至关重要的，这与性别无关。当然，厌恶反应的有效性和突显性在很大程度上受到家庭、同辈和社会中的体验所影响。双亲对孩子表达愤怒和恐惧的反应、双亲对孩子厌恶反应的反应，共同影响个体对这些情感和厌恶的反应方式，并决定这些反应将来的有效性。例如，双亲压制孩子愤怒，可能强化孩子的受挫感、愤怒和攻击性反应；导致羞耻并贬低愤怒和攻击的价值；导致对这些感受的抑制和压抑；并最终导致无助感和剥夺感。如果这个父母-孩子场景成为一种主题性背景，孩子就无法在将来利用愤怒和攻击应对自体-伤害。相反，双亲的接纳、理解并同调回应孩子的受挫感、愤怒和攻击性，将促进调节能力的发展以及有效且具建构性的方式使用攻击性。显而易见的是，与性别相关的文化期望，形成了男孩和女孩朝向愤怒、恐惧和厌恶反应的不同态度以及随后的有效性。

An individual can become predominantly aversive in reaction to environmental surrounds that require prolonged periods of antagonism and/or withdrawal. These aversive states can become sought after both for the expected needed protection and for their familiar and, therefore, self-cohesive properties. Moreover, in these environments aversiveness can dominate attachment experiences and become a primary avenue of connecting. Relating through hostilely tinged, chiding remarks is a common example. In these situations the schemas of self, of others, and of self-with-others are gradually shaped during the formative years, which involve and require an aversiveness.

个体对周围环境的厌恶反应很强烈，对抗和（或）撤回的时期就会持续很久。这些厌恶状态能够变成寻求期望的所需保护，也能够变成寻求它们熟悉的特质和自体统整性。再者，在这些环境中，厌恶反应能够控制依恋体验并成为联结的首要方式。以略带敌意的指责性评论的方式来建立关系，就是一个常见的例子。在这些情境中，关于自体的图式、他人的图式以及自体-和-他人的图式，都是逐渐地形塑于性格形成阶段，这个阶段就涉及并要求有厌恶反应。

In addition to this relational shaping of "characterological" aversiveness, research, particularly in laboratory experiements with mammals (Ginsburg, 1982), strongly suggests that genetic predispositions also can contribute to aggressive tendencies. The individual's genetically based temperament, as-demonstrated in the Thomas and Chess (1977) studies, contributes substantially to the interaction with the environment and presumably to experiences of frustration and perceived danger that necessitate aversiveness. For example, such temperamental dimensions as the threshold of responsiveness (that is, the intensity of stimulation required to evoke a response that varies for each of us), the intensity of reaction, and quality of mood would especially affect an individual's experience of the world and the activation of aversiveness.

除了这个关系造成“性格”厌恶的观点之外，有关研究、特别是关于哺乳类动物的实验室研究结果（Ginsburg，1982），有力地指出遗传倾向也会导致攻击倾向。正如Thomas和Chess（1977）的研究结果所表明，个体天生气质极大地影响了与环境的互动作用，并推测体验到挫折和感知到危险，这就是厌恶成为必然的反应。例如，影响个体对世界的体验和厌恶反应的激活的气质维度，主要涉及反应能力的阈值（也就是，唤起反应所需达到的刺激强度，阈值因人而异）、反应的强度和情绪特质。

From a self psychological perspective, a primary clinical focus is on the development, consolidation, and maintenance of the self. Self-development occurs within what Kohut (1984) called a self-selfobject matrix. The self-object can be conceptualized as a dimension of our relationships that serves to vitalize self experience (Stolorow, Brandchaft, and Atwood, 1987; Lichtenberg, Lachmann, and Fosshage, 1992, 1996). A perceived threat to the self, whether triggered by an external situation or an internal process, will activate specific affects and fight or flight reactions. All perceived threats are experienced as ultimately jeopardizing the sense of self. Anger is a reaction to a perceived threat or injury to the self. The intensity of the anger and aggression varies widely from a momentary aggressive remark to a perseverative intent and action to kill. Chronic hostility, in my view, is a deeply embedded pattern of experiencing one's self in relationship to threatening or injuring others in which anger and aversiveness become dominant self-protective reactions to others. These deeply embedded aggressive patterns provide self-cohesive properties and offer, as well, primary avenues of attaching, both of which contribute

to their enduring quality.

自体心理学的首要临床焦点是自体的发展、巩固和维持。自体-发展（self-development）是在科胡特（1984）称之为的自体-自体客体基质内浮现出来的。自体-客体可以被认为是一种关系维度，这个维度具有活化自体体验的作用（Stolorow, Brandchaft, and Atwood, 1987; Lichtenberg, Lachmann, and Fosshage, 1992, 1996）。当感知到对自体的威胁，无论是由外部情境触发还是内在过程触发，将激活特定的情绪以及逃跑/战斗反应。所有感知到的威胁最终都会被体验为危及自体感。愤怒是一种反应，是因为感知到自体受到威胁或伤害。愤怒和暴怒的强度变化幅度很大，从短暂的攻击性评论到固着在谋杀的意图和行为。在我看来，慢性敌意状态是一个人处于深度嵌入模式：自体持续地体验到关系他人具有威胁性或伤害性，其中的愤怒和厌恶反应成为首要自体-保护反应。这些深度嵌入的攻击性模式既成为依恋的重要途径，也提供自体统整性，这两方面的原因使得这些模式一直持续下去。

The term narcissistic rage, to my mind, is problematic. First, the term has been used with very different theories of narcissism—that is, Freud's theories of primary and secondary narcissim, which from a developmental perspective ultimately require renunciation of primitive and defensive states, and Kohut's theory of a narcissistic developmental line, which involves the development, consolidation, and maintenance of the self, a life-long task. The use of the term within self psychology is also problematic. The term narcissistic rage implies that there is rage that does not directly involve the self. Indeed, Kohut did differentiate between aggression directed toward objects and narcissistic rage. I view this distinction as a residual of Kohut's initial postulation of separate object relational and narcissistic developmental lines, a position that he never fully resolved despite his subsequent conceptualization of an overarching theory of the self. Within this overarching theory, anger and aggression, from my perspective, are always variably intense reactions to protect, delineate, or restore the self from perceived threats and injury within a relational field. For these reasons, I use the term narcissistic rage, not to distinguish a different kind of rage, but to refer to those most-intense-angry reactions involving perceived threats or injury to the self.

自恋性暴怒，这个术语在我看来是有问题的。首先，不同的自恋理论都在使用这个术语——也就是，弗洛伊德关于原发自恋和次发自恋的理论，它是从发展的角度来看，它们是最终需要放弃的原始和防御的状态；科胡特关于自恋的发展途径的理论，它涉及自体的发展、巩固和维持并且是持续一生的任务。在自体心理学体系中使用这个术语也是有问题的。自恋性暴怒，这个术语暗示存在暴怒，但没有直接关联到自体。科胡特确实曾经在指向客体的攻击和自恋性暴怒之间做出了区分。我认为这个区分是科胡特早期观点的残留物，因为科胡特最初假设客体关系发展和自恋发展是两条独立的发展路径。从我的角度来看，在这个重要的理论架构内，当在一个关系场域具有感知到威胁和伤害时，出于保护自体、界定自体或恢复自体的目的而引发愤怒和暴怒，其强烈程度常常是变化不定的。由于这些原因，我使用自恋性暴怒这个术语，不是为了区分不同类型的暴怒，而是指那些因感知到威胁或伤害自体而引发的最强烈的愤怒反应。

Envy, a very complicated affective experience, in my view, is not primary developmentally or pathogenically. Best conceptualized as a continuum in intensity and reactions, envy refers to discontent over another's possession of what one would like for oneself. Envy's fertile field is negative and devitalized self-feeling. As the experience of envy intensifies, determined by the self state and the particular meaning of the other's possession, anger and aversiveness will intensify. Analysis most profitably focuses on the meaning of the other's possession for the patient and its reflection of the patient's sense of self.

嫉妒，一种非常复杂的情感体验，在我看来，它在发展上或病理性上都不是原发的。最恰当的是概念化为一个在强度和反应方面的连续体，嫉妒是指不满于另一个人拥有自身想要的。消极的和失去活力的自体感觉会滋生嫉妒。随着嫉妒体验的增强——取决于自体状态以及他人拥有物的特定意义，愤怒和厌恶反应也将增强。分析最好集中在他人拥有物对于病人的意义和它反映出病人的自体感。

The magnitude of experienced threat or injury to the self is codetermined by the occurrence, its meaning, and the self state. These experienced threats or injuries can lead to variably intense aversive reactions, to depletion and/or fragmentation, and/or to a variety of self-protective or defensive reactions. The availability of anger and aversiveness is crucially important in protecting and maintaining a vitalized sense of self. When a person is in a state of depletion, anger and aversiveness are most likely not available, not as a product of defense, but as a result of the self state. Some experience of self-cohesion is necessary to activate self-protective and self-restorative measures. Based on drive theory, the unavailability of anger and aggression traditionally has been viewed as the result of defenses. To suggest to an individual in a depleted state, however, that he is defending against his anger and aggression will typically intensify feelings of inadequacy, unworthiness, and depletion. Instead, empathic understanding and explanation of the precipitants of the depleted self state is required to facilitate self-restoration.

自体体验到威胁或伤害的程度，是由浮现的意义和自体状态共同决定，并且能够导致不同程度的厌恶反应、剥夺和（或）碎裂、和（或）各种自体保护性或防御性反应。愤怒和厌恶的可用性在保护和维持自体感活力方面至关重要。当一个人处于剥夺状态，最可能的情况是无法使用愤怒和厌恶，这不是防御而是自体状态的结果。自体统整性的体验，有必要在一定程度上激活自体保护性的和自体恢复性的应对措施。经典的驱力理论认为，无法使用愤怒和攻击是防御的结果。但是，对于处于剥夺状态的个体，防御自身的愤怒和攻击性通常会强化缺陷感、无价值感和剥夺感。相反，表达对被剥夺的自体状态的析出物的共情理解并给予解释，可以促进自体恢复。

A notion that emanates from Freud's energy model is that anger accumulates. A more parsimonious explanation is that accumulative injuries without aversive action increase self-instability that, in turn, requires an intensified aggressive reaction for purposes of self-protection and self-restoration.

       愤怒累积（anger accumulates）是来自弗洛伊德能量模型的一个概念。一个更加保守的解释是缺乏厌恶反应导致伤害不断累积，使得自体不稳定性增加，转而诉诸一个强烈的攻击性反应以获得自体保护和自体恢复。

Self states and aversive reactions are all intricately shaped in relational experience and the resultant affect-laden organizing principles or schemas of self, other and self-with-other. An individual who is prone to experience others as noxious may be constantly in an angry and aggressive state. To conceive of the anger and aggression as self-protective and augmenting self-assertion in reaction to a thematic lived-experience with noxious others positions us advantageously not to attempt to control the anger or undo the aversiveness, but to understand its usefulness, the current precipitants, the underlying activated schemas, and their genesis. Gradually through the transformation and/or deactivation of these problematic schemas and the establishment of new organizations, the chronic state of aversiveness will wane. When a patient is consistently abusive and hostile, understanding and explaining the underlying schemas that generate the hostile attitudes over time will ameliorate abusive-hostile states. To focus on "management" of the aggression, depending on the transferential meaning, can more easily replicate within the analytic relationship the traumatogenic scenario of control and domination, exacerbate the anger and aggression, and lead to intense transference-countertransference impasses.

自体状态和厌恶反应在关系体验中被错综复杂地塑造，形成有关自体、他人和自体-和-他人的情感充盈的组织原则或图式。倾向于将他人体验为有害的个体，可能持续处于愤怒和攻击状态。愤怒和攻击是由有害他人的主题生活体验所引发，因而具有自体-保护性并且增加自体-肯定，这样的观点有利于我们不试图控制愤怒或撤销厌恶反应，而是去理解它的有用性、当前的析出物、潜藏的被激活的图式和它们的起源。通过逐渐地对这些问题图式的转化和（或）去活性、建立起新的组织结构，慢性厌恶状态将随时间慢慢消退。当一个病人总是恶语相向和充满敌意，理解并解释潜藏的引发敌意态度的图式将慢慢地改善谩骂-敌意状态。注意对愤怒的“管理”，根据转移的意义，分析关系中更容易重复创伤性控制和支配情境，加剧愤怒和攻击性反应并导致强烈的移情-反移情僵局。

The analyst's empathic stance "to hear" sufficiently the affective reactions and then gradually to inquire and understand the precipitants of the reactions is the foremost task. This process facilitates the understanding and management of the precipitants, which enables restoration of self-equilibrium. A patient's aggressively expressed dissatisfaction with the analyst may require both understanding and some alteration in the analyst's behavior as part of a mutual regulation of the analytic relationship.

充分“倾听”情感反应的共情姿态，并逐渐探索和理解反应的析出物是分析师首当其冲的任务。这个过程促进对析出物的理解和管理，这促使自体平衡状态的重建。病人攻击性地表达对分析师的不满，可能既要求理解也需要部分改变分析师的行为，因为分析师行为是分析关系的相互调节系统的一部分。

To hear the affective reactions and to inquire to deepen the understanding of them are finely tuned processes. To inquire prematurely can convey to the analysand disquietude with their reactions. For example, I am reminded of a man in his early forties who was in analysis with me. He was highly expressive and reactive and prone to rages. At one point in the analysis he became intensely suicidal. Because he was a former alcoholic, I knew that he would react negatively to my suggestion of exploring the possible use of medication. Nevertheless, it was my intense worry about him that led me to raise, ever so carefully, the issue of medication. He flew into a rage, claiming that I must not really understand him, for if I did I would know that prescribing medication to an alcoholic is like prescribing cianide. I listened to him and understood how my suggestion had come across. As he continued to rage at me, I found myself internally becoming defensive—after all, I had prefaced my suggestion with a statement that I felt it would upset him; I had some understanding of him. I made a few utterances in my defense, attempting to retrieve our disrupted connection and to stabilize myself. My patient understandably heard me as defensive. My utterances just added fuel to the fire, because they conveyed that I was averting, rather than receiving and understanding, his rage. It rapidly became clear to me that I best listen. Approximately 20 minutes later, the patient, having expressed his rage and apparently having felt listened to, refocused on other topics of his concern. Once he felt heard and that he had averted any further consideration of medication, he, in a more self-consolidated state, could return to his agenda. He ended the session with his (and our) usual warm handshake—the rupture had been repaired.

       倾听并探索情感反应，以便能够深化对这些情感反应的理解，这是一个精密调谐的过程。不成熟的探索可能让受分析者对他们的反应感到焦虑不安。例如，我想起一位40岁出头的男性，他曾经接受我的分析。他非常具有表现力和反应性并且容易暴怒。到了分析的某个节点，他变得极具自我毁灭性。因为他有过酒精成瘾史，我知道我探索药物治疗可能性的建议将会引发他的消极反应。然而，我强烈的担忧促使我非常小心地提起药物治疗议题。他暴怒，宣称我根本就没有真正理解他，因为如果我确实知道对酒精成瘾者开药就如同开氰化物。我倾听并理解我的建议是如何被理解的。随着他持续表达对我的暴怒，我发现我自己内在变得防御——毕竟给出建议前，我说我感到可能会让他烦乱；我对他有一定程度的理解。处于防御，我说出一些话语，试图恢复破裂的联结并稳定我自己。可以理解，我的病人听出我正在防御。我的话语仅仅是火上加油，因为它们传达的是我正在躲避，而不是接受和理解他的暴怒。显然，我最好迅速进入倾听。病人一直在表达他的暴怒并且明显感到自己在被倾听，大约20分钟以后，他就重新聚焦在他关心的其它主题上。一旦他感到被倾听，并且他已经避开进一步考虑药物治疗，他就处于更加自体巩固的状态并能够返回他的日程。会谈结束时，他和往常一样热情地和我握手——破裂得以修复。

Why had his reaction been so intense? I believe that the intensity was related, not only to the meaning of the medication, but also to the triggering of another thematic experience in the analytic relationship, namely, that the other person could not hear or understand him, even his most fundamental aspects. This configuration was related to his experience with a very powerful, aggressive, and seductive mother who was typically self-involved with her agenda and rode roughshod over his agenda. His rage, in my view, was not a breakdown product of a momentarily fragmented self, but was an intense effort to stave off, impact, and change the noxious analyst. The intensity was needed in light of how noxious the analyst was experienced on this occasion.

为什么他的反应如此强烈？我相信，强烈程度不仅与药物治疗具有的意义相关，而且也与触发了在治疗关系中的另一个主题体验有关，也就是，另一个人没有倾听或理解他，这是他最根本的层面。这个结构与他对母亲的体验有关，他的母亲非常强有力、具有侵略性和诱惑性，常常自我专注于她自己的议题中却对他的议题冷漠地置之不理。在我看来，他的暴怒并不是自体暂时碎裂的产物，而是极力推开、影响和改变有害的分析师。强烈程度取决于在这种情境下，体验到的分析师的有害程度。

How do we approach, at times survive, those patients who are pervasively hostile, contemptuous, abusive, and/or sadistic both in and out of treatment? A consistently abusive and hostile patient can easily jeopardize our self-equilibrium and stretch our empathic capacities. The analytic task, as I see it, remains the same, namely, to enter the patient's subjective world through sustained empathic inquiry in order to understand and explain their experience from within their perspective.

面对那些在治疗内外处于弥漫性敌意、轻蔑、谩骂和（或）施虐的病人，我们该如何处理、有时是如何存活下来？一个持续谩骂和敌意的病人，很容易危及我们的自体平衡感和消耗我们的共情能力。照我看来，分析任务维持不变，也就是通过持续的共情探索进入病人的主观世界，以便在他们的视角内部理解和解释他们的体验。

As we illuminate the patient's experience and its current and past genesis, then we are able to understand and explain the hostile and contemptuous attitudes. To include the interpersonal consequences of these attitudes (as gathered from what I call the other-centered listening perspective [Fosshage, 1995, 1997] in our interpretive construction conveys a more comprehensive understanding of the here and now. For example, a patient's persistent expectation that the analyst does not care, triggering a consistently hostile, aversive reaction, is illuminated more fully by including the interpersonal consequences of the aversive reactions, namely, the likely occurrence of pushing the other person away (that is, triggering the other person's aversiveness) and reconfirming the schema of the uncaring other.

由于我们阐明了病人的体验、体验的当下及过去的起源，那么我们就能够理解和解释这些敌意、轻蔑的态度。表达对此时此地更加全面的理解，需要在我们的诠释建构中包含这些态度导致的人际结果（从我称之为的他人中心倾听视角获知[Fosshage, 1995, 1997]）。例如，病人持续的敌意和厌恶反应的触发原因是分析师没有关注病人长久的期望，对此进行更加充分地阐释，就要包括厌恶反应带来的人际结果，也就是，很有可能将他人推得很远（也就是，触发了他人的厌恶反应）并再次证实不关心他人的图式。

Every analyst can feel threatened and react aversively to contempt and hostility. Indeed, our affective experience of the patient centrally guides our analytic activity. However, our personal subjectivities, including the psychoanalytic models we espouse, and our momentary self states deeply affect what we hear as hostile and contemptuous and our reactions to those expressions. Because the analysand may or may not experience hostility when the analyst feels it, we always need to assess the relative contributions of patient and analyst to the analyst's as well as the patient's experience. The analyst's countertransference, which I define as the analyst's experience of the patient, provides valuable data about the patient and the analyst. Accordingly, the notion that specific countertransferential reactions are "inevitable" responses to specific transferences is a myth, because it understates the analyst's contribution to his/her way of experiencing and organizing the transferential pull.

对于轻蔑和敌意，每个分析师都能够感到受威胁和厌恶。确实，我们对病人的情感体验对我们的分析活动会产生很大影响。但是，我们个人的主体性，包括我们支持的精神分析模型和我们暂时的自体状态，会强烈地影响我们对那些敌意和轻蔑表达的倾听和反应。因为当分析师感受到敌意的时候，受分析者可能体验到敌意、也可能没有体验到，我总是需要评估病人病人和分析师两者对于病人体验和分析师体验的相对贡献值。我把分析师的反移情定义为分析师对病人的体验，提供关于病人和分析师的宝贵资料。相应地，这个想法——对于特定的移情，特定的反移情反应是“不可避免的”反应——有点儿天方夜谭，因为它低估了分析师影响了体验和组织转移拉力的方式。

Analytic approaches differ as to the use of countertransferential data. Because we must carefully assess the origins of our experience of the patient, it is usually best, in my view, to use our experience initially to inform empathic inquiry into the patient's experience. Subsequently, the carefully timed sharing of the analyst's experience directly with the patient and the use of both the similarities and discrepancies between the two subjective experiences can deepen the analytic process and illuminate the intersubjective encounter. In contrast, the direct sharing of the analyst's experience initially with the patient before inquiry into the patient's experience can too easily shift the patient's focus from his experience to the analyst's. If, during the empathic inquiry, the patient acknowledges hostility, then our task is to illuminate its current and past origins. The analyst's disclosure of his/her subjective reactions subsequently can offer a needed confirmation and further illumination of the intersubjective field. If the patient does not report experiencing hostility, then the analyst needs to address and explain internally his/her experience.

不同的分析方法，使用反移情资料的方式不同。因为我们必须小心评估我们对病人体验的起源，在我看来，利用我们的体验最好首先是以共情探询的方式进入病人的体验。随后，分析师小心地、切合时机地与病人直接分享体验，并且利用两个主观体验之间的相似性和差异性能够加深分析进程并阐明主体间性的相遇。相反，还未探询病人体验，首先直接分享分析师的体验，可能很容易把病人的关注点从自身体验转变成分析师的体验。如果在共情探询期间，病人承认有敌意，那么我们的任务就是阐释它当下和过去的起源。分析师在这之后再暴露他（她）自己的主观反应，能够提供一种所需的确认并进一步阐明主体间性场域。如果病人报告没有体验到敌意，那么分析师需要在其内在处理并解释他（她）的体验。

Each analytic pair creates a unique analytic experience for patient and analyst. Each analyst at some point will inevitably feel threatened by a persistently hostile, abusive, and/or extremely rageful patient. At those moments the analyst's assertiveness may need to be augmented with mild forms of aversiveness to protect and maintain the analyst's self-cohesion. These moments, depending on the intensity and type of aversiveness and the meaning for the patient, can convey importantly to the patient that the patient can threaten the analyst, with all of its ramifications, and that the analyst can be vulnerable, aversive, and yet, not destructive or destroyed. The analyst's survival of the patient's aggression (Winnicott, 1947) and vice versa mitigates the feeling of destructiveness while enabling the patient to retain the important self-sustaining connection. These experiences for both patient and analyst, however subtlely communicated, are necessary for the analysis to continue and serve as new relational experiences that will deepen understanding facilitate the acceptance, modulation, and availability of assertive and aversive motivations, important ingredients of self experience.

每一组分析配对，都为病人和分析师创造出独一无二的分析体验。无可避免的是，每个分析师将在某个时刻感到被持久的敌意、辱骂和（或）极度狂怒的病人所威胁。在那些时刻，分析师温和的厌恶反应也许能够增强自身的果断自信，以便保护并维持分析师的自体统整。重要的是，根据厌恶的强烈程度和形式以及对于病人的意义，这些时刻可以向病人表明病人是能够威胁到分析师的，带来各种后果，并且分析师可以是脆弱的、表达厌恶的，但是分析师不具有毁灭性或不可被摧毁。分析师从病人的攻击中存活下来（Winnicott, 1947）并且反之亦然，这使得毁灭感得以减轻而让病人能够保留重要的自体-维持性联结。无论以何种微妙的方式进行沟通，这些体验对于病人和分析师双方都是必不可少的，以便让分析继续并带来新的关系体验，这些新的关系体验将深化理解并促进对自信和厌恶动机的接纳、调节和可用性，这些都是自体体验的重要成分。

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