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奥格登《投射认同与心理治疗技术》 第5章

王静华2016-4-25 17:39
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王静华按:这是李孟潮老师在2016年2月份开始的《心之母体》微课上提供的1982年版的奥格登的《投射认同与心理治疗技术》,不同的同学翻译了不同的章节,其中第二章“投射认同概念”请访问羽毛之:http://www.psychspace.com/home/space-15701-do-blog-id-4855.html。我翻译了第4章“不同精神分析技术的对比”和第5章“母性过度投射认同带来的发展性影响”。投射认同是一个非常常见的心灵间、主体间交流过程,作为咨询师或者是分析师,仔细理解并体会、体验着在会谈期间发生的心灵互动,并纳入到咨询框架内,才会心怀慈悲地构建分析空间,形成个人意义,并帮助来访者内化,从而拥有了自己的心灵空间和心理辩证过程,也促进生活空间、人际空间、关系空间的打开,达到更好地生活的目标。


THE DEVELOPMENTAL IMPACT OF EXCESSIVE MATERNAL PROJECTIVE =IDENTIFICATION=
母性过度投射认同带来的发展性影响

The concept of identification(认同) has historically served as a vehicle for conceptualizing the interface between object relations and individual psychological organization. This has involved thera¬pists and analysts in the task of coming to terms with their views about the ways in which the psychological attributes of one person are "taken in by” or ”made a part of" another person (Fairbairn, 1952; Fraiberg et al.,1975; Freud, 1905,1915b; Guntrip, 1961; Hartmann, 1939; Kernberg, 1966,1976; Knight, 1940; Loewald, 1962; Schafer, 1968).
认同、一直以来被用于概念化客体关系和个体心理结构之间的相互影响。这就要求治疗师和分析师考虑某个人的心理特点上是“将另一个人吸收进来”还是“成为另一个人的一部分”。(Fairbairn, 1952; Fraiberg et al.,1975; Freud, 1905,1915b; Guntrip, 1961; Hartmann, 1939; Kernberg, 1966,1976; Knight, 1940; Loewald, 1962; Schafer, 1968).
In this tradition the present chapter examines a form of identification demonstrated by a specific group of patients. This form of internalization(内化) will be explored to further refine the concept of identification and contribute to our thinking about the interplay of maternal pressures and the psychological processes of the infant. 
本章会仔细分析一组特定的病人所使用的一种认同。探索这种形式的内化是为了更细致地说明认同这个概念以及有助于我们思考母性压力和婴儿心理过程之间的相互影响。
The clinical focus will be on one of this group of patients who demonstrate a form of identification with their mother and in particular with the conflicted aspects of the mother. These patients seem to take the mother’s pathology(病理学), and especially the mother's view of the patient as colored by her pathology, as a model for identification which is reflected in their self-represen¬tations(自体表象), in their object relations(客体关系), and in many of the characteris¬tics of their ego(自我) organization. The early history of these patients is dominated by a picture of a mother deeply involved in her own problems—problems from which she failed to shield the infant.  Among the group of patients studied, examples of such maternal preoccupations include: one mother who was consumed by wish¬es for the child to be an embodiment of an aspect of herself which was both intensely hated and highly idealized; another mother who was filled with the need for the baby to restore her relation¬ship with her mother, who had died when she was 10 years old; and finally,a mother consumed by wishes and fears concerning the sex of the child because of her own wishes, fears, and disappointments about her own sex. 
聚焦在其中一个临床案例,其呈现与母亲、尤其是与母亲有冲突的一面形成的某种形式的认同。这些病人看起来具有母亲病理性的部分,尤其是母亲认为病人是有病理性,做为一种认同模型,就会在病人的自体表象、客体关系和自我组织的许多方面中反应出来。这些病人的早期,最突出的场景就是母亲被深深地卷入进她自己的问题中——这些问题使其无法保护婴儿。在这些病人中,这类母性“先占”问题包括:母亲渴望孩子成为她自己的某个部分,这个部分既被强烈憎恨也被高度理想化;母亲需要利用孩子还原她自己和母亲的关系,而她的母亲在其10岁的时候死了;母亲对孩子的性别带有某种期望和恐惧,因为她对她自己的性别具有这些期望、恐惧和失望。
Such circumstances become pathogenic when the mothers attempts to deal with her problems interfere with her ability to respond empathically to her child. Such interference may occur under conditions where the mother, in her attempts to deal with consciously unacceptable feelings, develops excessive reliance on such psychological processes and modes of behavior as splitting(分裂), denial(否认), projective identification(投射性认同), and impulsive activity(冲动行为). 
这样的情况是致病性的,母亲竭力应对自身的问题,会阻碍她共情地回应孩子的能力。这种阻碍发生的条件是,母亲竭力应对持续不断的、难以接受的感受时,过度依赖分裂、否认、投射性认同和冲动行为这样的心理过程和行为模式。
A clinical discussion of the process of internalization of the conflicted psychological state of the mother will be used as a vehicle to formulate a developmental hypothesis regarding this identification, and to offer some thoughts about this specific use of early identification as a defensive response to excessive mater¬nal projective identification.
对内化母亲冲突的心理状态的临床讨论,将形成关于这种认同的发展性假设,并提供使用这种早期认同作为对母性过度的投射性认同的防御性反应的一些想法和观点。

CASE HISTORY
案例
Miss R.,a 34-year-old single woman born in Wales, was working as a secretary in a large American city when she decided to seek psychotherapy. Life had become "unbeara¬ble" as a result of her desperate longing for a boyfriend who had just broken off their relationship. Unable to live without him, she felt on the verge of suicide. The patient thought constantly about this man who had let her down. Miss R. ruminated about the things she might have done to prevent the breakup and the ways she could possibly get him to take her back. 
R小姐,34岁,单身,秘书,出生于威尔士,寻求心理治疗时,在美国大型城市工作。生活 “难以承受”,她绝望地想念前男友,其刚刚和R小姐中断恋情。病人不断地想着这个男人让她很失望。她翻来覆去地思考着她可以做些什么来避免关系中断,以及她可以让前男友回心转意的方式。
This was the fourth time in 12 years that the patient had been involved in a very intense, dependent relationship that had ended this way. She had been treated for a year in psychotherapy after the third of these relationships. That therapy was terminated when the therapist left the area. Eighteen months later, the patient sought therapy for a second time. 
这是病人12年来第4次卷入到这种非常强烈的、依赖性的关系中,并以此种方式终止关系。在第三段恋情结束后,她接受了持续一年的心理治疗。直到治疗师离开这个城市。18个月以后,病人第二次求助于心理治疗。
Miss R. appeared considerably older than 34 and gave the appearance of being a rather old-fashioned, slightly untidy woman who had somehow refused to accept the fact that times had changed. She looked drained and tired; her eyes were red, presumably from crying and lack of sleep.
 R小姐看起来比34岁老多了,穿着相当过时,有些不太整洁,看起来她有些拒绝接受时代已经改变了这个事实。她看起来就像被抽干了、很疲倦,眼睛红红的,
Since Miss R. was 18 years old she had been filled with the conscious wish to find a man who loved her and could alleviate her intense feelings of longing and incompleteness. The involvements chat dominated the patient’s adult life were all so similar that a description of one can serve for all four.
 R小姐从18岁起就一直期望能找到一个爱她的男人,缓解强烈渴求和不完整的感觉。这种混乱状况支配了病人的成年生活,这4段恋情都如此相像,描述其中给一个就可以代表所有。
Soon after the end of the previous therapy, the patient became involved with a lawyer who had had a long series of short, unsuccessful relationships with women. The patient knew this about the man but blinded herself to the fact that he did not express any affection for her. Miss R. became more and more clinging and demanding of his affection, until he told her after 14 months that she was "too much for him” and ended the relationship. The patient appeared at his office begging him to take her back and telephoned him several times a day. She cried at work, took frequent sick days,and finally was dismissed. 
在上一次治疗结束后不就,病人就投入到和一个律师的关系中,这个律师有着一系列和女性的短暂的、不成功的关系。病人了解这个律师,但是自欺欺人地忽视律师并没有向她表达任何爱慕之情。R小姐变得越来越依附律师,并且渴求他的感情,直到14月后律师表示她“对他索求太多”并结束了关系。病人到律师的办公室乞求他回心转意并一天之内给他打好几个电话。她在工作时不断哭泣,经常性地生病,最终被解雇了。
On the basis of talks with her mother (the circum¬stances of which are described below), as well as through discussions with her father and maternal grandfather, the patient gradually constructed the following history, which she presented over the course of the beginning stages of therapy. Miss R. was the eldest of three children born to a lower-middle-class family in urban Wales. The patient’s mother, Mrs. R., was a strikingly attractive woman who had had a series of successes in amateur singing competitions in London before she married. She was considered very tal¬ented and had fantasies of becoming a famous opera singer. However, at 23 she felt old and thought that she had already lost her chance for a successful operatic career. 
通过和病人的母亲交谈(生活背景在后面描述),也包括病人的父亲,外婆,病人逐渐建构如下的历史,其在治疗的开始阶段就呈现出来。 R小姐出生于威尔士城市的中下阶层,是三个孩子中最年幼的一个。病人的母亲R女士是个相当吸引人的女性,结婚前在伦敦的一系列业余歌唱比赛中取得了一系列的成功。R女士被认为极富天赋并且幻想着能成为一名著名的歌剧歌唱家。可是,在她23岁时,她觉得年纪大了并认为自己已经失去了成就歌剧事业的机会。
Mrs. R. had been raised by two alcoholic parents who could barely provide the essentials of life for their two children. From the age of 9, Mrs. R. worked to buy relatively expensive cloches for herself and her brother in order to create the impression that she came from a middle-class family. She daydreamed of having immense wealth and of marrying a diplomat or a man of royal lineage.
 R女士的父母都是酗酒者,几乎没有办法为他们的两个孩子提供生活必需品。从9岁起,R女士就开始工作赚钱为她自己和她的弟弟买相对昂贵的帽子,这样就会让别人以为她是来自中产阶级。她幻想着拥有巨大的财富并且嫁给一个外交官,或者是一位皇室贵族。
While in London the patient’s mother met and, after 6 months, married a man who had recently inherited a family business in Wales. Upon returning to Wales, they dis-covered that the business had faltered and was nearly bank¬rupt. Two months after the marriage, the patient was conceived. Breast-feeding was continued for 16 months. In these early months the patient's mother seemed to enjoy the closeness of the breast-feeding situation, during which she would sing to the infant. The patient believed that this relationship changed drastically once she was weaned. From then on the mother was described as having been a very powerful, angry woman who could be ruthless in her attacks on the patient. The patient had vivid memories, dating back to a time before she was 4, of being treated with disdain and disgust and of having been told over and over that she was incorrigibly stupid, unlikable,and exceedingly ugly. In the mother’s mind the distastefulness of these traits was compounded by their apparent close resemblance to the traits of the patient’s father. The mother treated her husband with contempt and ceaselessly criticized him for his ineptitude and lack of manliness. The father remained very much to himself, hardly involving himself with his children. 
在伦敦,R女士遇到了一个刚刚继承威尔士家族企业的男人,6个月后就嫁给了他。一返回到威尔士,他们就发现这个家族企业已经摇摇欲坠、几近破产。婚后两个月、怀上了R小姐。The infant was seen as a quiet, ' easy'* baby. 婴儿被认为安静、易带。母乳喂养持续了16个月。母亲看起来很享受母乳喂养带来的亲密感,哺乳时会对婴儿唱歌。病人认为当断奶时,这种亲密的关系就发生了巨大的改变。从那时起,母亲被描述成一个非常强势、愤怒,会无情地攻击病人。病人清楚地记得当她4岁的时候,被母亲充满蔑视厌恶地对待,母亲一而再、再而三地告诉她是多么地蠢笨、招人厌和无比的丑陋。在母亲看来,这些令人厌恶的性格品质和病人的父亲几乎一模一样。母亲瞧不起自己的丈夫,无休止地批评他的蠢笨、缺乏男子汉气概。父亲沉浸在自己的世界中,很难和自己的孩子沟通。
The patient developed a quiet resemblance and was often stubborn, but never defiant. Miss R. remembered her childhood as a continual barrage of verbal attacks from a mother whose venom seemed to increase instead of subside with each assault. 
病人变得安静如一副肖像,也常常是执拗的,但从来不目中无人。 R小姐记得当她是个孩子时,会遭到母亲持续不断的言辞攻击,并且会越来越强烈,而不是在每次攻击后平息下来。
Mrs. R. would periodically withdraw into severe de¬pression, sometimes lasting for months at a time. During these periods, she would cease to care for her own ap-pearance (which she highly prized at other times) and would neglect the cleaning of the house and the preparation of meals. Instead, she spent most of her time in bed talking to herself and to the patient about how worthless, old, and unattractive she felt. 
R女士会周期性地陷入严重的抑郁中,每次会持续好几个月。在这时,R女士不再关心她的外貌(其它时候她非常爱惜自己的外貌),不再清洁房屋和准备三餐。取而代之的是,她大部分时间是躺在床上并自言自语,也会告诉病人她感到自己是多么的无价值、衰老和没有吸引力。
From early school age, Miss R. was interested in music and dance and was recognized at school as having talent. When the patient performed in school programs, Mrs. R. consistently refused to attend. The patient's fantasies of becoming a famous ballerina elicited rage from the mother who would accuse her of living in a dream world. 
读书早期,R小姐就对音乐和舞蹈感兴趣,被认为有天赋。当病人在学校表演时,她的母亲坚定地拒绝参加。病人梦想成为一名著名的芭蕾舞者,引发了母亲的狂怒并谴责病人活在一个幻想世界中。
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The patient’s mother repeatedly threatened to send her to live with an aunt in London. At the age of 6,and again at the age of 9,Miss R. was sent to London for a period of a month when the mother could "bear it no longer.” Then, when the patient was 11, without warning, the mother moved away with a man 10 years her junior. She returned after 6 months, disappointed and defeated. Shortly thereaf¬ter, the patient and her family emigrated to America. The verbal attacks on Miss R. continued until the patient left home at age 18. Having done well in secondary school, the patient was accepted at a university. However, her parents refused to pay the tuition, even though they could have afforded it, and in the end the patient moved to another city, where she began working as a secretary. A few years later, she became involved in the first of the four relationships that dominated the succeeding years of her life. 
病人的母亲一再重复要威胁送她去伦敦和姑妈生活在一起。6岁和9岁时,病人被她的母亲送到伦敦一个月,因为母亲“受不了了”。当病人11岁时,没有任何征兆的,母亲跟一个比她小10岁的男人搬走了。6个月以后,母亲回来了,失望而且挫败的。这之后很快,病人和她的家庭就搬到了美国。对病人的言辞攻击一直持续到病人离开家庭,那时病人18岁。中学学业不错,病人进入了大学。可是,她的父母拒绝支付学费,即使他们能够承担,最后,父母搬到另一座城市,在那里,病人开始从事秘书工作。几年以后,病人开始第1段恋爱关系,这种关系方式主宰了她之后的生活。
Miss R. insisted that she had found her previous therapy extremely helpful and would "do anything" to be treated again. In the twice-weekly therapy to be presented here, the patient very soon established a pattern of filling the hours with detailed descriptions of the latest insults, embarrassments, and humiliations that she had suffered at the hands of her most recent boyfriend. These monologues were intertwined with repetitive accounts of her intense longing for this same man and the feeling that she could not go on without him. The descriptions were delivered in a monotonous, persistent tone that did not reflect any ability to distance herself from the material or understand it. In addition, the patient managed to communicate the fierce tenacity with which she would hold onto this mode of relating. 
病人坚定地认为她之前的治疗非常的有帮助并且“做任何事情”以便能再次被治疗。现在是一周两次的治疗,病人很快就呈现出一种模式,治疗时间里充满在最后的前男友的恋爱关系中承受的侮辱、难堪和耻辱的详细描述。同时她又不断地声明她是多么强烈地渴求这个男人、没有这个男人她活不下去,这些独白错综复杂地交织在一起。她以单调、固执的语气说着这些,并没有能力让自己和这些材料保持一定的距离、理解它们。另外,病人努力传达出她在这种紧抓不放的关系模式中的强烈的黏附性。
As the therapist began to feel he understood some aspect of the transference or some other part of the patient's communication, he would venture a clarification or occa¬sionally an interpretation(解释). Such interventions were consis¬tently met with indifference, and the patient would go on with her descriptions in precisely the same way as she had before the intervention. For example, in the third month of treatment, the patient spent large portions of a number of sessions mechanically and repetitively describing a bout of shingles that she had had a year before beginning therapy. In the course of this narrative, Miss R. talked about how callously several doctors had treated her. She said that she had had this kind of experience with doctors all through her life. *Tve always hated their patronizing, their use of their knowledge and position to belittle others and to boost their own egos. I could never relax with any of them and always felt humiliated by them.” As this theme was repeated in several sessions, the patient at one point made a slip and substituted the therapist's name for that of one of the earlier doctors. Later in the session the therapist said, ”1 wonder if you sometimes feel that I can be a patronizing, belittling, humiliating doctor?" The patient, without pause or hesita¬tion, responded that the therapist was a psychiatrist and that she was referring to internists. In the same breath, the patient began a lengthy description of an incident in her adolescence when a dermatologist had paraded her in front of a group of medical students so they could examine her severe case of facial acne. 当治疗师开始觉得他对这种移情的某些方面或者是病人沟通内容某些部分有了一些理解,他会尝试做一个澄清或者偶尔是一个解释。这些干预被不置可否,病人将继续她的描述而且正好是从干预前的那个点开始。例如,治疗的第三个月,病人花了大部分的会谈时间机械、重复地描述她在治疗前一年得的带状疱疹。在这段叙述中,R小姐说医生们是多么冷淡无情地对待她。她说她这一生遇到的一声都是这么的冷淡无情。痛恨他们自视高人一等,利用他们的知识和地位贬低他人,自我膨胀。我从没觉得他们中的某个人让我感到放松,总是被他们羞辱。因为这个主题在几次会谈中一再重复,病人在这里翻了一个小错误,早期医生中的一位被换成了治疗师。在这次会谈中,治疗师问到:“我想知道,你是否偶尔也会觉得我是一个自视清高、贬低侮辱他人的医生。”病人没有意思停顿和犹豫地回应到治疗师是精神分析师、她在说的是内科医生。同时,病人开始冗长地描述她青春期遭遇到一次意外,一位皮肤科医生在一群医学院学生前展示她严重的青春期面部痤疮
Gradually, after several more weeks of this form of interaction,the therapist began to stop the patient when she attempted to ignore what had been said and would ask her to consider the way that she had of not giving any evidence of having "held” or "taken in” what had been said even for a moment. This intervention in turn would be ignored or paid momentary lip service, and the patient would return to another monologue as if nothing had been said. In the same way, the patient responded with bewilderment when her repeated lateness to her sessions was treated as worthy of exploration for possible meaning. 
这种方式的干预之后持续了几周,逐渐地,治疗师可以在病人企图忽视他所说的时打断她,并请她思考她的这个行为:似乎没有“持有”或者“接受”他所说的、即使只是一小会儿。这个干预也接着被忽视或者口头上应付一下,接着病人继续另一段独白,似乎刚才什么也没有说过。同样地,当她的不断迟到被认为值得探索其内在意义时,她也是含混不清地回应。
This form of interaction continued for 6 months, dur¬ing which the therapist struggled to understand the mean¬ing underlying this transference-countertransference pattern. The therapist would often feel tormented by the patient’s relentless, monotonous, lifeless descriptions, fre¬quently feeling trapped in seemingly endless therapy hours. Sometimes, he felt as if he were utterly helpless in the hands of a robot, without any hope of appealing to a responsive human core. At other times, he imagined himself taking the patient by the throat and sadistically jolting her from her lifeless discourses. It was when these sadistic fantasies were at their peak that the therapist felt the greatest impulse to flee from the room. At the same time as the therapist was becoming aware of these countertransference feelings, he also noted a recurrent theme in the patient's monologues. The patient began to talk almost exclusively about her mother's threats to abandon her and the three different occasions when she actually did so. 
这种形式的干预持续了6个月,治疗师挣扎着去了解潜伏在移情-反移情模式之下的意义。治疗师被病人不间断的、单调的、毫无生命的叙述中痛苦不堪,经常觉得自己被困在这看起来没完没了的治疗时间里。偶尔,他感到自己被困在一个机器人的手里,没有任何希望唤得一个人性的回应。其它时候,治疗师想象自己掐住病人的喉咙,虐待性地晃动她,终止她死气沉沉、喋喋不休的叙述。当这种虐待性的幻想达到了顶峰时,治疗师觉得逃离房间的冲动也达到了顶峰。同时,当治疗师对这些反移情变得越来越有觉察时,他也注意到病人的独白中一个重复的主题。病人几乎无一例外地会开始谈论她的母亲总是威胁要抛弃她并且事实上确实发生过三次。
The awareness of the transference-countertransference themes described and their link to the theme of abandon¬ment led the therapist to say to the patient::"I get the feeling that the repetitive descriptions you bring to each session are in ways an attack on me, an effort to goad me into attacking you in precisely the way your mother used to do. Maybe there would be some comfort in that for you. After all, at lease you knew your mother was there when she was attacking you.” 
觉察到移情-反移情的主题并将之与抛弃的主题联系在一起,治疗师对病人说到:“我有一种感觉,每次会谈中的重复描述就像是对我的攻击,这是为了努力让我知道你母亲过去恰恰就是以这种方式攻击你的。也许对你而言这也会带来某种程度的舒适感。毕竟,当你母亲攻击你的时候,你知道你的母亲在那里。”
A subtle shift occurred at this point. 在这个点上发生了微妙的转化。The patient seemed not to be moved by this interpretation, any more than she had been by earlier interventions, but for the first time something different happened in the therapy. In the succeeding sessions, Miss R. continued with her monoto¬nous descriptions with one important change: she no longer looked at the therapist. The patient's impact on the thera¬pist was no longer simply one of torment; there was a glimpse of some other element in it. In retrospect, it seemed that this element had been present in the earlier phase of work but had been more thoroughly masked by the intensity of feeling involved in the tormentor-tormented aspect of the interaction. Even though the form of the repetitive descrip¬tions remained the same, there were subtle, almost sublimi¬nal shifts in the nature of the interpersonal interaction(人际互动). The patient no longer nodded at the therapist as she walked to her chair at the beginning of the session; she made no reference to the content of previous meetings; her dreams were very vague and contained only one person, herself. The therapist found himself struggling to maintain the sense of himself as the tormented object in preference to the increasingly chilling and disorienting feeling that was being fostered in him—the feeling of his not being there at all. 
病人看起来并没有被这个干预所触动,就像之前的那些干预后的结果一样,但是第一次,一些不同的事情在治疗中发生了。接下来的会谈,R小姐继续她单调乏味的叙述,但是有一个重要的变化:她不再看着治疗师。这带给治疗师的影响是治疗师不仅仅只是感到一种痛苦,那里似乎有一丝不同的元素在里面。回顾以往的会谈,这个元素在工作的早期就呈现过,却被会谈中浓厚的折磨-被折磨的氛围彻底掩盖了。 即使重复性叙述依然没有改变,在人际互动的性质却又了一丝微妙的、几乎是潜意识层面的转变。会谈开始走向椅子时,病人不再向治疗师点头;她不再参考前次会谈的内容;她的梦非常模糊并且只有一个人:她自己。治疗师感到他正在挣扎着维持他做为被折磨的客体的自我感,之后内心中升腾出持续攀升的寒冷和失整合感——感觉他不再在那里了。
Even though this awareness of the struggle was helping the therapist to clarify for himself the nature of the therapeutic interaction, the therapist did not immediately offer this to the patient in the form of an interpretation. It was felt that the resistance to such an idea was still very powerful, and that the therapeutic alliance was fragmentary. 
即使觉察到这种挣扎正在帮助治疗师澄清现在的治疗性互动的性质,治疗师也没有立刻对病人给出解释。对话语解释的阻抗仍然强有力,而且治疗联盟是碎片状的。
The therapist was able, however, to make use of this understanding in his handling of the material that the patient was offering. Over the next several months, as Miss R. talked about the tormented feelings she had had in her relationships with her boyfriends and her mother, the thera¬pist was attuned both to the way the mother was felt to be more securely present in a tormented-tormenting relation¬ship and to the way the patient herself felt more recognized, more present, more real for her mother at those times. 
可是,治疗师有能力利用病人提供给他的这些材料。在接下来的几个月,R小姐谈及在与前男友们和母亲的关系中的被折磨感,治疗师将两者相较,在被折磨-折磨的关系中母亲被感到是更加安全的,病人自己感到对母亲更加认可、更有存在感、更加真实。
Very slowly the patient's descriptions of the mother s torment began to reflect a distance on the material. Miss R. for the first time was able to tell the therapist about the infrequent but highly significant periods of calm in the storm of maternal torment: it had been very important to Mrs. R. that the patient and no one else look at her photograph album with her. At these times, the patient’s mother took on a softness and youthfulness that she dis¬played at no other occasion. They would spend hours admir¬ing photographs and newspaper clippings from the era of the mother’s amateur singing competitions and the patient s early infancy. Mrs. R. would sing in a way that the patient genuinely admired and felt soothed by. She said she felt "aglow” at these special times. In fact, she took on a gentleness in the therapy hours as she quietly talked about the way she had felt special to her mother at chose times, as if there were something about herself that the mother could not do without. But these times with her mother had had abrupt endings leaving the patient feeling as if she (Miss R.) had disappeared afterward. 
非常缓慢的,病人开始能对母亲施虐性的叙述保持一定的距离。R小姐第一次能够告诉治疗师关于在母性折磨风暴中罕见却极为重要的平静的时刻:这对母亲很重要,除了病人,没有人和母亲一起看过她的相册。在那些时光里,病人的母亲看起来柔和而且年轻,这在其他场合中是看不到。她们一起花费数个小时赞叹这些照片和关于母亲业余歌唱比赛的新闻简报以及病人的婴儿早期。母亲会唱起来,病人真诚地感到钦佩并被抚慰。病人说在这些特殊的时光中,她感到自己好像在发光。事实上,当她安静地谈论在那些时光里她对母亲而言是特别的,她在治疗时间里也显得很温柔,似乎有一些什么是关于她自己的,母亲不能做也没有做的。但是这些时光里母亲会突然生硬的结束并让病人感到好像之后她自己就消失了。
It was at this point in the therapy, just when a therapeu¬tic alliance seemed to be developing, that the patient became increasingly anxious, developed migraine headaches and nausea, and began to cancel sessions. It took a long time before Miss R. was able to say that she had become very frightened of talking openly to the therapist because she had "known” from the beginning that there was a secretary in another division of the clinic whom she knew socially, who had access to her records and had been reading them. She knew this because the secretary had made reference to Miss R. being over 30,and there was no other way she could have known that other than from the records. Since in the therapist's view the patient appeared to be well over 30,this suggested that Miss R.'s suspicions may not have been founded in reality. The therapist explored with the patient the basis of her belief that the secretary had seen her records. In the following session, the therapist said that he had found on looking into the record-keeping practices of the clinic that it was highly unlikely that the secretary could have had access to the patient's records, but that it would be naive to say that any records are totally immune to vandalism. The patient sullenly said that she had half-expected to be publicly humiliated when she came to any clinic, and that she guessed she would just have to live with that danger. 
治疗中的这个时刻,正好是治疗性联盟看起来正发展起来,病人的焦虑持续增加,出现偏头疼和恶心,并开始取消会谈。过了很久,病人才能说出她被对治疗师的开放交谈吓坏了,因为她从一开始就知道在另外一家诊所有一个她认识的秘书,这位秘书看到了她的诊疗记录并且已经在阅读。她知道这个是因为这位秘书知道病人超过30岁,除了翻阅治疗记录,没有其它方式可以知道这个信息。 其实治疗师认为病人目测就明显超过30岁,这说明R小姐的怀疑是没有事实根据的。治疗师和病人探索这种想法的依据。在接下来的会谈,治疗师说他已经调查了诊所的档案保管工作,秘书是绝对不可能翻阅病人的记录,但是也不能保证档案保管能挡住所有刻意而为的人。病人突然说当她进入任何一家诊所,她是有一半期望被公开羞辱,这样她猜她将不得不和那种危险共存。
Over che next few weeks of therapy, the patient was able to address the transference level of her anxieties. She noted that although she had had fears about doctors and breaches of confidentiality prior to the beginning of the therapy, not until she began talking about and reexpcrienc- ing in the therapy the moments of feeling aglow did she begin to be overwhelmed by her fears of exposure. She said that she felt that the core of her worries was a fear of being found out, of being exposed as different from what she appeared to be. She talked about fantasies and dreams that she had had since childhood of being exposed as utterly and basically fraudulent. It was not so much that there was a horrible crime that she was keeping hidden; rather, it was the act of deception itself that was the crime. 
接下来几周的治疗,病人能够谈论她的焦虑的移情。她注意到虽然在开始治疗前,她对医生和违背保密性感到害怕,但是当她开始在治疗时再次经历这些发光的时刻时,她开始被暴露的恐惧所淹没。她说她这些担心的核心是害怕被揭发,害怕被发现与她看起来的完全不同。她谈论她从儿童时期就有的被揭露是个彻头彻尾的骗子的幻想和梦。并没有说她持续隐藏是多么可怕的罪行,而是说,欺骗本身就是犯罪。
As this was being discussed, Miss R/s anxiety and somatization subsided. The patient went on to relate the feeling of being exposed to earlier feelings that she had had with her mother. She could understand the feeling being present at the "special” times with her mother because to be that special was such a fragile and tenuous situation in the midst of all that had happened before and all that was sure to happen afterward. How long could it be before the mother would see the patient for what she was? What was surpris¬ing to the patient was the awareness of the same fear of exposure during the mothers torment. The patient began to be aware that there too she felt the danger of exposure. For how long could she really be the living embodiment of worthlessness and ugliness for the mother to rave at? 
当这些被讨论以后,R小姐的焦虑和躯体化平息了下来。病人继续将这些感受与早期和母亲在一起时的感受。她能够理解到与母亲在一起的“特别”时光的感觉依然存在,因为成为特别是如此的脆弱和纤薄,以前发生过、之后也必定会发生。多长时间以后母亲才能如其所是地看到病人?让病人感到吃惊的是意识到在母亲折磨期间,她也同样害怕暴露。病人开始意识到她感到过多的关于暴露的恐惧。她成为那个无价值的、丑陋不堪的、让母亲咆哮的活生生的化身多久?
At this point the therapist could make use of his experience in the countertransference to say: "You must have struggled desperately to be a child your mother could despise and torment, because you must have been afraid that if you weren't, you would have ceased to exist for her at all."
在这个时刻,治疗师就可以利用他的反移情体验说到:“你过去一定是拼命地努力地要去做一个你母亲可以轻视和折磨的孩子,因为你一直都害怕如果你不是这样的话,你对她而言根本就是不存在的。”
Over the next year of the therapy—which lasted two years in all—the patient's fear of becoming nonexistent appeared and reappeared in the transference, in the pa¬tient's outside relationships, and in the patient's increasing understanding of her early relationship with her mother. During a series of sessions in the middle of the second year of the therapy the patient recxpcrienced an eerie feeling that she had not thought much about since she was a child, although the feeling had not been an uncommon one for her. It was only through her description of a group of memory images that she could convey to the therapist any sense of the feeling that she was experiencing. 
治疗接下来的一年——总共持续了两年——病人在移情中、在治疗室外的关系中和病人对与母亲的早期关系的不断理解,害怕变得不存在一再出现。治疗的第二年中旬的一系列谈话,病人再次经历一个从她是个孩子时就不太会有的一种怪异感觉。她只需描述一组记忆图像,她就能够传达给治疗师任何她正体验的感受。
In each of these memories, the patient pictured herself in a dimly lit room watching her mother doing something, while her mother was unaware that the patient was in the room. The mother was pictured as being lost in her thoughts as she sat listening to the radio, or cleaning the silverware, or smoking a cigarette. The patient became extremely anxious in the therapy hours as she remembered these scenes. Miss R. said that she hated the eerie feeling associated with these memories, and that she could hear a thin, high-pitched, "empty" sound that went along with the feeling. The patient said that the sound ought to be used in a science fiction movie about outer space. The sound somehow reminded her of a large, clean, empty stainless steel container that did not "even have any fingerprints on it." The feelings of outer- space-like aloneness and sterile emptiness that Miss R. had often felt when she was with her mother were powerfully felt in the therapy hours over a period of several months. At times the patient said she felt nauseated by these feelings and was afraid that she would leave the hour and only be able to remember the therapist as a man in a semidarkened room, lost in thought and unaware that she had been sitting with him during the sessions. 
所有这些记忆,病人描述她自己是在一个昏暗的房间里看着母亲做事情,而她的母亲并没有察觉到病人在房间里。母亲被描述失去了她自己的思维,当她坐在那里挺收音机,或者当她在擦拭银器,或者是在抽烟。当病人在治疗期间回忆起这些记忆时,病人变得极度焦虑。 R小姐说她憎恨那个伴随着这些记忆的怪异感觉,而且伴随着感觉她能听见一个细细的、尖声的、“空空”的声音。病人说这种声音本应该出现的关于外太空的科幻电影中。这个声音不知为何让她想到一个大大的、干净的、空空的不锈钢容器,“甚至没有一个手指印”。她过去和母亲在一起时经常感受到的外太空般的孤独感和贫瘠的空虚感,在过去几个月中的治疗时间里被强烈地感受到。有时病人说,她对这些感觉感到恶心并且害怕将离开而她仅仅能够记得治疗师不过是一个坐在半明半暗的房间的男人,陷入沉思,不知道病人和他坐在一起。
Many of the issues dominating this phase of the work were brought into clearer focus in a session that followed the patient's viewing The Wizard of Oz on television. In that hour Miss R. described how terrified she had been of the movie when she was a child. She said that during the previous evening while watching the film she had been very moved at the end when Dorothy finds that the Wizard is a little, bald-headed man and in a rage of disappointment shouts at him, ”You’re a very wicked man/* The Wizard says, "No,Dorothy, Ym not a very good wizard, but I'm not a bad man." The patient sobbed bitterly and said, ”I’m like the Wizard. I wasn't as special as she needed me to be or as ugly as she needed me to be. If I wasn't a wizard, I was nothing to her." 
这个阶段的工作的很多主题在接下来病人观看《绿野仙踪》后就开始变得更加清晰的聚焦。当R小姐是个孩子时,她对这部电影感到非常恐惧。她在治疗会谈的前一个晚上看了《绿野仙踪》,看完以后非常感动。最令她感动的情结发生在电影的结尾,即桃乐丝发现魔法师根本一点都不神奇。桃乐丝看到他是一个相貌平平且秃头的小个子男人。桃乐丝感到一阵愤怒和失望,她大声喊到:“你是一个非常邪恶的男人。”,魔法师回答到:“不,桃乐丝,我虽然不是一个很好的魔法师,但我也不是一个坏人。”。说到这里,病人哭了起来、说到:“我喜欢魔法师。我不是那个她需要我是的那样特别、也不是那个她需要我是的那样丑陋不堪。如果我不是魔法师,那么我对她来说就什么也不是了。”
In che months of therapy that followed,various aspects of this early relationship were expressed in the transference. At one point, the patient began to feel she had some very special importance for the therapist, perhaps as a star patient. In the midst of this the patient became very anxious and in one session asked the therapist to authorize in writing that her lateness to work on a given morning had been due to her therapy session. Upon analyzing this request the patient became aware that her reason for the request was the feeling chat she was so unreal to the therapist chat he would not be able to remember her name without consulting his records. At other times, there was intense despondency between sessions, stemming from the feeling that she did not exist for the therapist when she was not with him. 
接下来几个月的治疗,早期关系中的多个方面在移情中表现出来。在这个时刻,病人开始觉得她对治疗师在某些方面变得非常重要,也许是一个“明星”病人。这个阶段的中期,病人变得非常焦虑,在一次会谈中病人要求治疗师可以写下她某个特定的早晨她的迟到。通过分析这个请求,病人意识到这是因为她感到她对治疗师来说是不真实的,不询问他的记录的话他就不能够记得她的名字。其它一些时候,会谈之间出现强烈的依赖,这是源于病人感到当她没有和治疗师在一起的时候,她对治疗师是不存在的。
This material was discussed in terms of the patient's feeling that she did not exist for her mother other than as the ugly, stubborn, villainous child the mother needed to torment and despise, or the child who could reflect the glow of the mother、feelings about herself in the photograph album.
这些材料被讨论,病人觉得如果不是那个丑陋、固执、罪恶、母亲可以折磨和鄙视的孩子,或者是那个可以衬托出母亲的光辉、感到自己就是在相册的那个孩子,她对母亲而言就不存在。
As the profound sadness of these ideas was discussed, the patient grew increasingly free with her anger, an emo¬tion that had been almost totally absent before. Formerly, anger had to be disavowed, as in her attribution of her lateness to events outside her control. The patient had also tended to somatize (migraine headaches and nausea) or feel suicidal at times when one would have expected her to have felt angry. Very gradually, the patient became more and more able to express her resentment toward her mother for having used her "to be her wicked and wonderful wizard.” Miss R. could also say that she did not intend co be a special patient for the therapist any more, and chat he would have to find someone else to do that for him. This change could be discussed as a reflection of the fact that the patient was no longer afraid to acknowledge the separateness of herself and her mother-therapist. Formerly, feelings different from those appropriate to the "wizard" had been experienced as threatening to expose her as being other than simply a reflection of her mother's or of her therapist's needs and fantasies. 
随着这些想法带来的厚重的悲伤被触及,病人逐渐从她的愤怒中解脱,更有自由感,而这种感觉在以前几乎是没有的。以前,愤怒是被否认的,因为她无法了解这些超出她控制的事情。当他人觉得她已经感到愤怒时,病人就会躯体化(周期性偏头疼和恶心),或者有时想自杀。逐渐地,病人变得越来越能够表达对母亲的愤怒,怨恨母亲一直把她当做“她丑陋而且很棒的魔法师”。R小姐也说到她不再打算成为治疗师的特殊病人,治疗师应该已经找到其他人作为自己的特殊病人。这个变化表明病人不再害怕承认她自己与她的母亲治疗师的分离。以前,与“魔法师”对应的,这个感觉会被体验为一种威胁到暴露自己只不过是母亲或者治疗师需要及幻想的投射。
There was also the feeling of freshly discovering people and things around her. She complimented and criticized the therapist for the selection of pictures in his office and noticed new clothes chat he wore. She also seemed to discover herself as a physical being and began to dress and wear her hair much more age-appropriately and stylishly. Again, this was understood in terms of the patients ability to acknowledge and even enjoy a sense of her own separate¬ness without feeling in danger of becoming nonexistent for the internalized mother or for the therapist as a result of being separate from each. 
她对她周围的人们和事物也有新的发现并饶有兴致。她对治疗师挂在办公室的画既恭维也有批评,并留意到治疗师的新衬衫。。她也看起来发现她自己是一个活生生的人,开始注意打扮、讲究穿戴、打理头发,与她的年龄更相称、时尚起来。再者,病人有能力承认并享受她与内化的母亲或者治疗师的分离感,她并没有感到自己不存在的感觉。

PROJECTIVE IDENTIFICATION AND IMPINGEMENT 
投射性认同和侵犯
Projective identification constituted an important dimen¬sion of the therapeutic interaction between Miss R. and her therapist, and the latter's awareness of this was central to his understanding of his countertransference responses to the pa¬tient. For example, Miss R. relied heavily on projective identifica¬tion in her efforts to master the internalized tormenting- tormented relationship with her mother. For a long period of time, the patient projected the internalized, tormented child into the therapist, while she herself adopted a strong identification with her tormenting mother. In so doing, Miss R. felt she had rid herself of an unwanted part of herself and succeeded in turning the therapist into the tormented child. 
投射性认同构建起R小姐和治疗师治疗性互动的重要维度,后者觉察到这是他理解自己对病人的反移情的核心。例如,R小姐强烈依赖投射性认同来控制与内化的与母亲的折磨-被折磨的关系。很长一段时间,病人将内化受折磨的孩子投射进治疗师里,而她自己对内化的折磨的母亲进行强烈认同。如此,R小姐感到她可以摆脱她不想要的部分并成功地将治疗师转变成被折磨的孩子。
This was not simply a fantasy, since the patient's mode of relating elicited a very strong countertransference response in the therapist, in which he felt powerless to be anything other than the object of torment for the patient. The therapist fantasied that the only alternative to being the tormented object was to become nonexistent for the patient. At other times the therapist felt that fleeing from the room (thus ending the relationship) would be the only way to oppose the immense pressure to be the tormented object for the patient. 
这不仅仅是一个幻想,病人建立关系的模式引出治疗师强烈的反移情,治疗师感到除了成为那个病人的被折磨的客体外,他无力成为其他样子。治疗师幻想成为一个被折磨的客体的唯一办法就是变得对病人而言不存在。在其他时候,治疗师觉得,从这个房间逃出去(也因此结束了关系)将是对抗成为被病人折磨的客体的巨大压力的唯一途径。
Later the therapist came to understand the patient's projec¬tive identification as a defense against reexperiencing in the transference the painful awareness of separateness from the mother-therapist. Only through his awareness of his feelings as responses to the patient's projective identifications was the therapist able to make use of this material to understand the patient and avoid acting on or closing off his feelings. In part, it was the therapist's analysis of these countertransference re¬sponses that allowed the patient to reinternalize the projected aspect of herself in a modified form—a form she could accept as a part of herself and analyze and integrate in the second year of therapy. 
后来,治疗师理解到病人的投射性认同是对再次体验到她与母亲-治疗师是分离的痛苦体验的防御。只有通过觉察自己对病人投射性认同的感觉,治疗师才有能力利用这些材料来理解病人并避免付诸行动,或者关闭自己的感受。在某种程度上,治疗师对这些反移情反应的分析使得病人以改进过的形式再次内化自己投射出来的部分——这种形式她可以接受为是她自己的一部分,在治疗师的第二年进行分析和整合。
The history, recovered memories, and transference-coun- tertransference patterns offered important data regarding the unique qualities of the failure of maternal responsiveness that were internalized by the patient.  The history is replete with examples of the mother’s difficulty in responding to those aspects of the patient’s needs, wishes, and interests that were not simply extensions of what the mother needed the patient to be. 
个人历史、恢复的记忆、移情-反移情模式提供了关于母性共情回应失败的特征的重要信息。个人历史充满了母亲回应病人需要、愿望和兴趣的困难,而不仅仅是母亲需要病人成为自己的部分。
The patient poignantly portrayed in the transference as¬pects of her early experience with maternal impingement. The patient had been noticeably relaxed in the sessions for several weeks in the beginning of the second year of therapy and seemed to be getting considerable pleasure and satisfaction from the meetings. In the session that marked the end of this period, the patient came in, sat down, and immediately began to cry. The therapist asked her what was wrong. She explained that she had just been yelled at by her boss at work. She then told the therapist to go on with what he had in mind for chat day’s session, adding that she did not want to interfere with what he had planned for that meeting. 
病人令人心酸地描绘出早期母亲侵入体验到的移情特征。第二年治疗的开始几周,病人在会谈中感到极大的放松,看起来开始从会谈中得到极大的快乐和满足感。这个阶段的结束的标志是病人进来、坐下并立刻开始哭泣。治疗师询问她怎么了。她解释说她刚才在工作中向她的老板大喊大叫。接着她就告诉治疗师继续他对这次会谈的计划,并补充到她不想打乱他对这次会谈的原本的计划。
The therapist was stunned by this and said, "You’re saying that you feel I have a plan for each session that I need to get through at any cost, and that my plans have nothing at all to do with anything you happen to be feeling?" The patient said that was right and was curious why the therapist had called it a feeling of hers, when she felt that it was a fact. 
治疗师听到这些感到很震惊并说:“你刚才说你觉得我对每次会谈有一个计划,我不惜一切代价来完成这个计划。我根本就没有什么计划,那是你现在的感觉。”病人说是这样的,并好奇当她认为事实上就是这样的时候,为什么治疗师说这是她的感觉。
This theme recurred over and over again in different forms. Since the therapist was reasonably certain that he was not being unresponsive to the patient, the material could be understood as a set of feelings portraying early experiences of maternal impinge-ment. The patient was gradually able co view such interactions with the therapist as a re-creation of her own relationship with her mother, wherein gratification of specific maternal needs was substituted for an empathic responsiveness to the child’s internal state. 
这个主题以不同形式一而再、再而三地出现。既然治疗师相当确定他不是对病人没有反应,这一串的感觉就可以作为描绘病人早期母性侵犯体验的素材。病人逐渐能够观察和治疗师之间的互动,作为她自己和母亲关系的再创造,其中,特定的母性需要的喜悦代替了对孩子内在状态的共情性回应。
The history that Miss R. presents and the therapeutic relationship she established offer ample evidence of the presence of an intense, circumscribed mother-daughter interdependence. This interdependence can be understood as having been based on the projection of maternal pathology in such a way that highly circumscribed aspects of the relationship with the child took on critical importance, leaving the mother virtually oblivious to and unresponsive to qualities and aspects of the child that lay outside the ”beam” of the projected maternal pathology (Greenacre, 1959). As described above, Miss R/s mother oscillated between intense feelings of glowing grandiosity and equally intense feel¬ings of worthlessness and self-hatred. Both of these secs of feelings became the basis for a powerful projective identification, with the patient as recipient. While the patient was acting in congruence with these projective identifications, aspects of the patient were terribly important to her mother, but the scope of these projective identifications was limited. The patient felt that, at those times when she was unable to be the embodiment of the projected aspect of the mother, she ceased to exist for her mother.
 R小姐的病史以及她建立的治疗性关系,充分证明了存在一个强烈的、受限的母亲-女儿的内在依赖。非常重要的是要理解到这个内在依赖建立在母性病理性投射上而这使得与孩子的关系高度受限,使得母亲事实上对孩子的个性和特性完全忽视、无反应,这些都被丢在母性病理性投射性认同的外面。正如前所描述的,R小姐的母亲在发光耀眼的感受和同样强烈的感到无价值和自我憎恨之间强烈摆动。这两个感受构成了强烈的投射性认同的基础,而病人是接收者。当病人能够表现的和这些投射性认同一致,病人的这些特征对她的母亲就变得非常重要,但是这些投射性认同的范围是非常有限的。病人觉得,当她没有办法成为母亲投射的载体时,她对母亲而言是不存在的。
To summarize, Miss R. presented a picture of her mother as a powerful woman who needed her child to be a reflection of a specific aspect of her own pathology—the wicked or the wonder¬ful wizard. More specifically, the mother’s pathology seemed to be characterized by a splitting of self- and object-representations(客体表象) into idealized and denigrated parts. This splitting was main¬tained by means of projective identification and was reflected in her to-and-fro movement from idealization of self and object to feelings of worthlessness and despair. The analysis of the trans¬ference and the countertransference suggested that the patient had felt real for the mother only when she was in a tormented- tormenting relationship, and that she had clung to this form of relatedness in preference to the sense of not existing for the mother. A basic anxiety for the patient with her mother, with her boyfriends, and in the therapy was a fear of being exposed as different from what she was in the mother’s projective fantasies. If this were to happen, Miss R. feared, she would be outside the realm of what was meaningful to the mother and that outside this "beam” she would be unmothered and dangerously unprotected. Any acknowledgment of separateness from the mother's fantasy of the patient was experienced as a threat to the relative safety of the equilibrium wherein the patient was for her mother what her mother needed her to be. 
最后, R小姐呈现的母亲是一个强有力的女人,就需要她的孩子成为她自身病理性部分的投射——邪恶的或者是奇妙的魔法师。更具体地说,母亲病理性的部分看起来是将自体表象和客体表象分裂成理想化和诋毁的部分。这个分裂是通过投射性认同得以维持下来的,体现在她在自体客体的理想化和无价值绝望之间来回摇摆。对移情和反移情的分析,表明病人只有当她处于被折磨-折磨的关系,她对母亲而言才是真实存在的,相较于对母亲而言自己不复存在、她宁愿坚持这种形式的关系。病人与母亲关系、与男朋友们的关系以及在治疗中的基本焦虑是对暴露出她不在母亲的投射性幻想中,她对此感到恐惧。如果发生了,她就在母亲的意义王国之外,在这个“光束”之外,她就将不受母亲抚育并且毫无保护的危险中。任何意识到自己不是母亲幻想的一部分都会被病人体验为对安全感的威胁,这个安全感来自于为了母亲而成为母亲需要自己成为的那个样子。

THE DEVELOPMENT OF A DEFENSIVE IDENTIFICATION 防御性认同的发展
In viewing internalization of maternal pathology from a developmental perspective, the discussion must immediately center around the changing pattern of the ways in which the mother and child perceive one another. At the beginning, the good-enough mother and her infant feel to one another as if they are a single unit (Mahler, 1968; Spitz, 1965; Winnicott, 1956). There is no inside or outside, self or other. The mother’s role is to be responsive to the infants emotional and physiological needs and in so doing create the illusion that the infant and mother are one. The wished-for breast is there when it is wanted and in precisely the way that it is wanted because that is the nature of things. 
从发展性观点来考虑母性病理性的内化,讨论必须立刻集中于母亲和孩子感知彼此的变换模式。刚开始,足够好的妈妈和她的婴儿会感到她们彼此是一体的。不分内/外、自体/客体。母亲的角色就是去回应婴儿情感和生理上的需要,这就造成一种幻觉:婴儿和母亲是一个人。当乳房被渴望时,乳房就在那儿,并且是以它被渴望的方式出现,因为事物的本性就是这样的。
Miss R. gives us some indication that her mother was a good-enough mother at this early stage and could take genuine pleasure in caring for her infant and in responsively meeting the infant's needs. In addition, there is evidence for an early period of good-enough mothering in the therapeutic relationship. Miss R. was extremely adept at creating a holding environment for the therapist for a brief time while he was ill: in a tender and humorous way, the patient expressed her concern for the thera¬pist in a card in which she parodied Welsh home medical remedies. 
R小姐的母亲在最早期的时候是一个足够好的妈妈,并能从照顾婴儿和回应满足婴儿的需要中得到真实的快乐。另外,在治疗性关系中,也有得到早期足够好的妈妈的照料的印迹。 R小姐在治疗师病假时,为治疗师创造了一个极富抱持性的环境:以一种温柔幽默的方式,病人通过一张卡片表达了对治疗师的关心,在这种卡片上她诙谐了模仿威尔士家庭处方。
On the road to developing the capacity to differentiate self and object, the mother helps the infant create transitional objects and phenomena (Winnicott, 1951). The transitional object is at once an object created and magically controlled by the infant and an object separate from him. The question of which it is,is never asked because it is both, in such a way as to make the question never arise. As soon as there is an awareness of the question, the child is on his way to recognizing the object as separate. Mrs. R/s ability to help the patient create a transitional realm of experi¬ence was hampered by the intrusion of her own pathology into her efforts at empathy. The patient gives us evidence that her mother ceased to be a responsively flexible medium (a mirror) and instead reflected the very definite features of her own conflicted and poorly integrated internal state. The subjective object(主观性客体) was prematurely given definite shape that denied the infant the illusion that she herself had created it. This resulted in a premature awareness of the separateness of the infant and mother which the infant could not tolerate. 
在发展出分化自体和客体的过程中,母亲帮助婴儿创造过渡客体和过度空间(Winnicott, 1951)。过渡客体是一个可以立刻被婴儿创造,被其魔法般地控制并且与之分离。这是哪一个?这个问题从来不会被问起,因为过渡客体就是两者(过渡客体和婴儿),这样,关于“这是哪一个?”这种问题就从来不会被提出。一旦意识到有这个问题,孩子就开始发现客体是与之分离的。 R母亲的病理性部分侵入共情能力,这阻碍她帮助病人创建一个过渡客体经验的能力。病人向我们展示她的母亲停止成为一个反应性灵活的载体(镜映),相反地,将绝对属于她自己的冲突的、未能整合协调好的内在状态反射给病人。主观性客体过早地被赋予了确切的形状,这否认了婴儿自主创造的幻想。导致婴儿过早地意识到与母亲是分离的,而这是婴儿无法承受的。
Miss R.'s internalization of maternal pathology may be understood in terms of a specific mode of defense employed by the infant in her attempt to protect herself against the premature recognition of separateness imposed on her by excessive mater-nal projective identification. The infant struggled to maintain the illusion that it was she herself,and not an outside object with motives and wishes different from her own, that she was sensing in the maternal impingements. The child attempted to create the illusion that her spontaneous gesture was characterized specifi¬cally by those qualities of the mother's pathology that were communicated through the nature of the projective identifica¬tions. She struggled to maintain the crumbling illusion that it was she who created the conflicted moods and feelings that she was perceiving, even though this was at variance with the sense that she was coming upon something that had nothing to do with her.
 病人内化母性的病理性是婴儿使用的特定的防御方式,婴儿在竭力保护她自己以对抗被强加、被过度的母性投射性认同带来的分离感。婴儿竭力维护一种幻想:那就是她自己,并不是来自与她有不同动机和愿望的外部客体,她正在体验母性侵入。孩子经历创造出一种幻想,她自然特质就是具有母性病理性的那样的特征,这是通过投射性认同完成的。她竭力维护一种破碎的幻想,她觉得就是她创造了这种冲突的情绪和感觉,即使感觉明显不同,她觉得是来自于与她无关的某物。
This defensive illusion is not at all equivalent to the creation of the normal transitional object, which is characterized by the irrelevance of the question, "Is it me or not-me?” In her desperate attempts to deny her perception of separateness, she cook the mother’s pathology (communicated by means of projective iden¬tification) as the basic mark of herself and modeled her self- and object-representations according to it. The anxiety underlying the fiercely stubborn allegiance to the character structures that evolved in this way is the terror of reexperiencing the feeling of being prematurely separate from the mother and subject to feelings of intense helpessness and a sense of being dangerously exposed and unprotected. 
这种防御性幻想并不能等同于创造了一个正常的过渡性客体,其特定是带来了一个非相关性的问题:“这是我的还是非我的?”。婴儿不顾一切地否认她感知到的分离感,她把母亲的病理性(通过投射性认同)“烹”成她自己的基本特性,把她的自体表象和客体表象以此为模型。焦虑背后是强烈而固执地忠实于以这种方式逐渐发展的性格结构,是害怕再次体验到过早地感到与母亲的感觉,屈服于强烈的无助感和外露却缺乏保护的感觉。
On the basis of this developmental formulation, I feel that we can conceptualize the internalization under study as a distinc¬tive form of identification. As with other forms of identification, it involves a process in which the infant modifies his self¬representations and patterns of behavior in an effort to make himself like the perceived object (Schafer, 1968). This particular form of identification is distinguished by the following charac-teristics: (1) the identification originates as a specific defensive response to maternal projective identification in an effort to deny the separateness of self and object; (2) the qualities of the projective identification that are internalized are taken as the basic mark of the self and used as a model for the development of object relations, self-representations, and other internal struc¬tures. 
基于这种发展性构想,我认为我们可以尝试概念化这种内化是一种与众不同的认同形式。和其它形式的认同一样,认同过程涉及到婴儿修改了自体表象和行为方式努力让自己与被认为样子一样(Schafer, 1968).这种特殊形式的认同具有以下特征:(1)这种认同起源于对于母亲投射性认同的特定的防御反应,努力否认自体和客体是分离的;(2)被内化的投射性认同的特性被吸收为自体的基本特征,并作为发展客体关系、自体表象和其它内在结构的模型。
From this perspective the observations of Ritvo and Solnit,based on a Yale Child Study Center longitudinal study, become particularly relevant. They reported that identifications seem to develop in the service of defense rather than in the service of adaptation when an infant's inborn characteristics collide "forcefully with the deepiest conflicts in the mother" (p. 81). " The child imitated the mother in toto and in this way perfected a controllable, kinesthetic image of the mother to replace the threatening representation of the mother” (p. 82). What was imitated was not simply the mother, but the mother in a state of distress in which her pathology was most graphically expressed. It is significant that their findings relate the observa¬tion of conflict-laden maternal handling of the infant to the appearance in the child of a form of identification that was felt to function in the service of defense and that took the form of a total imitation of the mother in a state of conflict.
 从这个视角来看,Ritvo and Solnit基于耶鲁儿童研究纵向研究的观察,就变得尤其有意义。他们报告说,当婴儿天生的特性与母亲内在最深的冲突有着非常激烈的矛盾时,认同看起来是因为防御的目的发展起来的,而不是为了适应。儿童完全模仿母亲,并且以这种方式扮演一个可控的、肌肉性的母亲形象来代替威胁性的母亲表象。所模仿的不仅仅是母亲这个人,而是悲痛中的母亲,这时母亲的病理性被最为生动形象地表达出来。这个发现意义重大,他们将观察到的母亲充满冲突的对待婴儿与儿童的一种认同的表象联系起来,认为这是一种防御并且完全模仿母亲的冲突状态。
The particular defensive identification under discussion can be understood as arising out of a failure of the mother to adequately shield the infant from her pathology, thereby expos¬ing the infant to a premature awareness of the object as separate. The infusion of the internalized representation of the maternal conflict into so many aspects of the developing psychological structures and organizations of the infant reflects both the massive effort to deny the separateness and the very malleable and incomplete nature of the infant’s psyche at the stage in question. The aim is not to model the self after an external object in order to emulate it; rather, it is an effort to modify the internal structures in order to deny the perception that the object is different from the self. For this reason the aspects of self and ego modeled in this way are not sources of pride, strength, or well-being; instead, they are felt to be fragile and sensitive areas that can tolerate no inspection lest the disguise cease to function, leaving the patient exposed to the knowledge of the separateness of the mother. 
这种特别的防御性认同可以被理解为是由于母亲没有保护婴儿远离她的病理性,因而让婴儿过早地意识到与客体的分离感。内化的母亲冲突的表象侵入进婴儿的发展性心理结构和组织的许多方面,既反应了付出巨大的努力否认这种分离感也反应了婴儿在出问题的这个阶段婴儿心理有非常大的可塑性和不完整性。修改内在结构的目的并不是自体是为了模仿而模仿一个外部客体,而是为了否认感知到客体是与自体不同的。因为这个原因,自体和自我以这种方式构建的模型并不是自豪、力量或幸福的来源,他们感到脆弱、敏感、不能容忍任何核实,以免这种伪装会失去它本有的功能,让病人暴露在意识到与母亲的分离感。


SUMMARY 总结
A defensive form of internalization stemming from the impact on the infant of excessive maternal projective identifica¬tion has been discussed. This internalization took the form of an identification with the conflicted aspect of the mother and influenced the development of the patient's self-representations(自体表象), qualities of ego(自我) and superego(超我) functioning, and object relations(客体关系). A developmental hypothesis was proposed in which the infant was seen as having experienced premature awareness of the mother as a separate person as a result of the mothers excessive reliance on projective identification as a mode of relatedness and form of psychological defense. In the child's attempt to defend herself against such disturbing awareness of separateness, she struggled to maintain the illusion that it was herself and not the mother that she was perceiving in the projected maternal pathology. The result was a strong defensive identification with the projected aspects of the mother. The motivation for this identification was powerfully enhanced by the fact that the child felt real for the mother only when in the "beam” of her pathology, that is, only when behaving in a way that was congruent with the mother、 projective identifications. The development of this type of defen¬sive identification is understood as representing one of a variety of possible pathological adaptations to excessive maternal projec¬tive identification. 
已经讨论了内化的防御性形式,这是源于母亲过度的投射性认同于婴儿带来的影响。这种内化认同了母亲有冲突性的特性,影响了病人的自体表象、自我品质、超我功能和客体关系。这就提出一个发展性假设,当母亲过度依赖于投射性认同作为关系模式,会让婴儿过早地体验到母亲是一个分离的人并形成心理防御。孩子努力保护她自己对抗这种令人嫉妒不安的分离感,她努力去维持一种幻想,也就是她感受到的母亲的投射性病理性部分是她自己的、不是母亲的。这是一个很强有力地、与母亲投射的部分的防御性认同的结果。这种认同的动机被这样一个事实极力增强:孩子感到只有在母亲的病理性“光束”之下、她才是真实存在的,也就是,只有当以与母亲投射性认同一致的方式行为时。这种类型的防御性认同可以被理解为代表了适应母亲过度的投射性认同的各种可能的病理的一种。



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奥格登《投射认同与心理治疗技术》 第5章
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