Sixth phase: Re-introjection of the modified projection

第六个阶段：修正后的投射的再摄

If all goes well, the analyst’s interpretations will be absorbed by the patient, that is, the analysand will be able to re-introject parts of his projections in an altered form. In doing that, it is not only the interpretations which will be introjected, but also the transformations which have taken part within the analyst (Bion’s a-function). The elements thus taken up and changed into symbols are now available to the analysand as building blocks for further thought, i.e. he can relate it to other meaningful material (associations, memories, and perceptions within the transference situation). In this case, the reception of the interpretation corresponds with a withdrawal of the projection. Through this regaining of the lost parts of the self the patient gains access to an experience which not only conveys containment, but an experience of genuine separation. In this moment, which the patient will experience like a loss, he will be confronted with the conflicts of the depressive position. An internal space unfurls which he can experience as separate from the internal space of the analyst and from the transference situation. The working through described by Freud (1914) refers largely to the working through of this experience of loss. Its aim is the construction of a psychic space in the patient which will form the prerequisite for further biographical reconstructions. (Weiss, 2003a, 2005).

如果进展顺利，分析师的解释将会被病人吸收进去，也就是受分析者将能够再摄他投射的、不同形式的部分。这样做时，不仅是解释将被再摄，而且分析师内在参与的转化功能（阿尔法功能，比昂）也会被再摄。这些被接受和被转化为象征符号，受分析者就可以将它们作为进一步思考的结构性组件，例如，他可以将其关联到其他有意义的材料（移情性场景中的关联，记忆，认知）。在这种情况下，接受解释也就对应着撤回投射。通过再获失去的自体，病人就体验到包容，而且体验到真正的分离。在这种病人将体验为丧失的时刻，他将面对抑郁位的冲突。病人的内在空间展开，能够体验到与分析师内在空间的分离以及与移情场景的分离。弗洛伊德（1914）认为修通主要就是对丧失的修通。目标是构建病人的心灵空间，这将形成更进一步的个人传记式重构的先决条件。

 

Pathology

病理学

At times, the re-introjections might be blocked even though the analyst’s interpretations were based on ‘digested’ projections. The analysand might then put up a barrier against the uptake of the interpretations and might possibly attempt to project parts of it again. This tendency will be all the more pronounced the more the patient’s psychic equilibrium depends on splitting and projection. In this case, the analyst’s attempt at interpretation “to locate and give back to the patient missing parts of the self” will quickly be “felt to threaten the whole balance and lead to more disturbance” (Joseph, 1987, p. 67). The patient clinically experiences this situation as the analyst trying to plant something in him, which has nothing to do with him or rather concerns the analyst.

有时，即使分析师的解释是基于“消化”过的投射，再摄会可能被阻塞。受分析者可能构建起壁垒对抗对解释的摄取，很有可能再次尝试投射这部分。这种趋势越是断然坚决，病人心灵平衡越是依赖分裂与投射。在这种情况下，分析师尝试通过解释“去找到并归还病人失去的部分自体”，将很快“被感受为威胁到整体平衡并导致更加的烦乱不安。”（约瑟夫，1987，p.67）。在这种情景下，病人体验到分析师正竭力将与他无关或者与分析师有关的东西植入他内部。

At a certain time during treatment, a female patient reacted particularly touchily to my interpretations, which she experienced as an attempt to provoke her and to demonstrate my superiority. One day she arrived agitated to her session, and complained bitterly about a driver who had thrown a banana skin out of the car window at a crossroads ahead of her. She pulled up next to him and at eye level gesticulated angrily through the window. The driver then followed her to ask for the reason of her behaviour. She asked him indignantly whether he thought it all right to throw banana skins in front of her car. He replied quite calmly: “And this is why you are so agitated?” During this time, she actually experienced my interpretations as banana skins I had thrown to make her slip so that I could then look down on her from my superior position and could comment supremely serenely on her indignant reaction. She sought to avoid such situations by coming up to eye level with me to giving me discreet warnings. In this way, she made me give my interpretations in a guarded way at times, as if I wanted to avoid confrontation and did not want to become the condescending object by whom she felt humiliated.

治疗的某个时刻，女性病人对我的解释尤为敏感易怒，她将之体验为试图激怒她并显示我的优越感。一天，她激动地进入会谈，怨愤地抱怨在十字路口，一个司机把香蕉皮扔出车窗、扔到她前面。她在他旁边停了下来，双眼平视地向车窗内做了一个愤怒的手势。于是司机跟上她询问她的行为的理由。她愤怒地质问他是否想过把香蕉皮扔到她车前是合适的行为。他平静第回答到：“那么这就是你为什么如此愤怒的原因？”。在这个期间，她对我的解释的体验就像是我扔给她的香蕉皮、让她摔倒，这样我就可以站在优越性的位置上蔑视她并心安理得地高尚地评论她愤怒的反应。她通过与我目光平视，以给出谨慎的警告来设法避免这样的状况。以这种方法，她使我有时以谨慎的方式给出我的解释，好像我想要避免对质并且不想成为居高临下的客体让她感到屈辱。

 

Borderline patients in particular tend to perceive the analyst’s interventions as provocative, manipulative, reproachful, appeasing or seductive. In this way, patient-centred interpretations will be experienced as projections emanating from the analyst and may lead to further projections (Money- Kyrle, 1960). The analyst now finds himself in a dilemma as the patient is not just projecting individual unbearable feelings and perceptions, but the whole process of projective identification as such will be put into him, leading to the conclusion that it is the analyst who projects into the patient (a situation which is not easily distinguished from situations where the analyst is actually projecting defensively). Here one could talk about a first degree dilemma.

边缘性病人尤其容易倾向于把分析师的干预体验为挑衅的、操控的、责备的、安抚性的或者是诱惑性的。因此，病人-中心的解释将会被体验为是来自于分析师的投射并可能导致更进一步的投射（蒙利·凯里，1960）。现在，分析师发现自己处于一个困境中，病人并不仅仅是投射他个人难以承受的情感和认知，而且整个投射认同过程像这样进入病人，就会得出分析师投射进病人里的结论（这种状况和分析师实际的投射性防御不容易区分开）。这里谈论的就是第一类困境。

 

Rosenfeld (1949) described this sequence with the example of an analysand who dreamed that a surgeon lost balance during an operation and fell straight into the patient. He got so entangled that “he could scarcely manage to free himself. He nearly choked and only by administering an oxygen apparatus could he manage to revive himself” (p. 44). This patient was not just very frightened to be persecuted by an intrusive analyst. The basis for his feelings of being menaced was his own anxiety about falling into the analyst and getting mixed up with him to such a degree that he would not find his way out. That is, he had projected his own excessive projective identification into the analyst (see Sodre, 2004, p. 58) and thus feared the analyst projecting into him.

罗森菲尔德（1949）用接受精神分析的人幻想外科医生在手术期间失去平衡而直接跌进病人这个例子来描述发生过程。他被缠绕很紧以至于没办法让自己挣脱出来。他几乎要窒息了、只能通过吸氧设备才能让自己恢复呼吸“（p.44）.这个病人并不仅仅是非常害怕被侵入性的分析师迫害。他感到被威胁是源于他自己有跌进分析师、与他搅和在一起、没有办法找到出来的路的焦虑。也就是，他投射了他自己的过度的投射性认同进入分析师（Sodre，2004，p.58），因而害怕是分析师投射进他。

 

In such situations, analyst-centred interpretations may be helpful. They describe the patient’s feeling of being threatened and thus create a space for his anxiety that the analyst might rob him of the one defence mechanism available and to turn it against him. According to Money-Kyrle, what has to be interpreted before all in such a situation is “the patient’s fear of becoming the victim of the projective identification emanating from the analyst [. . .] and so of being overwhelmed with confusion, illness, collapse and death” (Money Kyrle, 1960, p. 351). It is only when this anxiety is exposed that an attempt can be made as a second step to interpret this process as a result of projective identification.

在这种情景下，分析师-中心的解释可能会有帮助。描述病人有被威胁的感觉，这就为病人的焦虑创造了一个空间，分析师就可能剥去病人使用的防御机制并将其还给病人。蒙利·凯里说在进入令人筋疲力尽的状况之前就必须先行解释，“病人害怕成为分析师投射认同的牺牲品[…]，因而在困惑、疾病、坍塌和死亡焦虑中不堪重负”（蒙利·凯里，1960，p.351）。只有当这种焦虑暴露出来，接下来就可以尝试去解释这个投射认同过程。

 

At times, even analyst-centred interpretations will not be heard in the sense of containment, but will be experienced by the patient as confirmation of his projection. A complex situation may result where the patient experiences patient-centred interpretations as projections emanating from the analyst and analyst-centred interpretations as affirmation of his projections. This situation could be described as a second degree dilemma and poses particular challenges for the technique of the analyst. He will be caught in a doublebind situation which allows him little room for manoeuvre. This in turn may exactly correspond to the kind of situation the patient unconsciously fears most. Clinically the analyst feels in a dead end. If he interprets the patient’s projection he will be accused of projecting something into the patient. If he interprets how the patient is experiencing him and what motives might underlie his behaviour, the patient will not experience this as an interpretation of his feelings, but as a confession of the analyst’s actual feelings.

有时，即使是分析师-中心的解释也不会被认为是包容性的，反而被病人体验为对投射的确认。复杂的状况就是导致病人体验病人-中心的解释是源于分析师的投射，而分析师-中心的解释是对他的投射的确认。这种状况就是第二类困境并对分析师的技术提出了特别的挑战。他将处于一个进退两难的境地、几乎没有挪动的余地。这反过来恰恰就是病人无意识中最害怕的情景。临床上，分析师感到处于僵局。如果他解释病人的投射，会被指责投射进病人；如果解释为病人是如何体验他的和病人行为之下的动机，病人将不会把这些体验为是对他的感觉的解释，而是分析师坦白了他的实际感受。

 

Singing a song of the Holy Ghost “who knows every darkness of the soul” in a low and romanticized voice was how a patient began one of her first sessions with me. When I put it to her that she longed for complete understanding but at the same time feared me as a god-like, all-knowing figure, she responded that she had to believe everything I said in order not to go under. I interpreted that she saw me as someone who demanded total belief from her in order to be saved. She replied to this that everything I said had the aim of convincing her of the truth of my thoughts and to rob her of the space for her own thinking.

以低沉而浪漫的声音唱着圣灵之歌“谁了解灵魂的每一个黑暗角落”，一个病人就是以这种方式开始和我的第一次会谈。当我提出这是她渴望获得完全的理解但同时又害怕我是一个上帝一般、全知全能的人物，她回应说为了不沉没下去、她不得不相信我说的每一件事。我解释说为了被拯救、她视我是某个要求她全然信任的人。对此，她回答说我说的每一件事都是为了说服她相信我的想法是正确的、并为了剥夺她自己的思考空间。

 

Such situations are extraordinarily difficult to work with clinically. Occasionally it is possible to describe the general atmosphere of the session without prematurely referring to either of the participants. At other times it might be more helpful to name the underlying psychotic elements (such as in the example given above where the patient was convinced that the analyst thought himself “the Holy Ghost” who knew the truth) or just to outline the dilemma the analysand is in (if she believes me she has to relinquish her own thinking, if she does not she will go under). If the analyst is capable of grasping the nature of the dilemma rather than desperately seeking an ‘escape’, he will be able to absorb some of the patient’s despair, which may be experienced as a capacity to take in a third position from whom the patient has felt excluded.

这种状况临床上工作起来会非常的困难。有时，可能可以描述这样的会谈场景没有指涉双方中的任何一个。有时，命名潜藏下方的精神病性元素可能更有用（就如上面的例子，病人确认分析师认为他自己就是知道真理的“圣灵”）或者仅仅是勾勒出受分析者所处的困境（如果她相信我就不得不放弃她自己的思想，否则，她就将沉没下去）。如果分析师能够捕捉到困境的本质，而不是绝望地寻求“逃离”，他将能够吸收病人的某些绝望，这就可能被体验为有能力使用病人不具备的、一个第三方的位置。

 

Summary and conclusion

总结和结论

 The model presented here describes the analytic process of understanding as ideally a transformation of a projection. In order to schematize this, different part-processes were differentiated, which in the actual clinical situation happen more or less contemporaneously and repeat themselves in different sequences and cycles. Even though this distinction appears artificial it might be useful in trying to improve the ease of localizing regressions and blockages in the process of understanding. This presupposes that the analyst is capable of facing the exposure to powerful, intense experience (see Brenman Pick, 1985, p. 164), while continuing to think.

这里呈现的模型描述了理想情况下投射转化的分析过程。为了更有系统性，不同的过程做了区分，实际临床情景其实或多或少地同时发生并以不同顺序和循环往复的方式重复它们自身。即使这样的区分显得有些做作，但对尽力摆脱退行和减少理解的过程中的阻碍是有用的。这是假设分析师有能力直面强有力、强烈的体验（布兰曼·皮克，1985，p.164），同时还能继续思考。

 

In her unpublished records, Melanie Klein distinguished between two phases of projective identification. The first one is an attribution while the second one is an intrusion/penetration into the object. Although it is doubtful that there are purely attributive i.e. non-intrusive projections, it seems clinically expedient to distinguish different degrees of intrusion which affect the analyst’s psyche in different ways. Following Klein, Bion (1962b) turned his attention to the function of the receiving object and Money-Kyrle (1956) described the countertransference as a process of transformation. He talked about ‘slow-motion’ movements and of phases of delayed introjection. Such ‘slow motion phases’ – or, put spatially, dead-end situations – might be more easily differentiated using the model presented here.

在她未出版的记录，梅兰妮·克莱因区分了投射认同的两个阶段。第一个是归因阶段，而第二个是侵入/渗入进客体的阶段。虽然不能确定是否有单纯的归因也就是非-侵入性投射，临床上的权宜之计是区分不同程度的侵入，它们以不同的方式影响着分析师的心灵。在克莱因之后，比昂（1956b）将注意力转向接受性客体的功能，蒙利·凯里(1956)认为反移情是转化的过程。他谈及“慢动作”推进和延迟内摄的不同阶段。这样的“慢动作阶段”——或者，给僵局带来空间感——使用此文呈现的模型可能就更容易区分出来。

 

Clinically, it does make a difference whether the analyst has a problem in receiving a projective identification or in detaching the projection from his internal objects. In the former case, the patient will experience an analyst who cannot receive his anxieties; in the latter the analyst will be identified with a concrete internal object. Similarly, it is clinically relevant whether the patient is unable to take up an interpretation or whether the analyst uses the interpretation to defensively re-project something that is unbearable to him. In the one case the analyst will be able to examine the difficulties of reception; in the other he will become a persecutory figure confirming and reinforcing the patient’s anxiety.

临床上确实需要区分分析师是否有接受投射性认同的困难和与内在客体分离的困难。前者，病人体验到分析师无法接受他的焦虑；后者分析师将与其内核内部客体产生认同。类似地，临床相关的，到底是病人不能接受解释还是分析师使用的解释是防御性地将病人无法承受的部分再次投射回病人。前者，分析师将能够检查接受的困难因素；后者，分析师将成为迫害性的而确认、强化病人的焦虑。

 

Occasionally, a patient might experience containment but feel that taking back the projections is too taxing as he feels unable to deal with the pain of understanding associated with separation (see Steiner, 1993, 1996). In this instance, interpreting the fear of loss is of primary importance to allow access to the feelings of mourning and guilt which go hand in hand with the experience of loss.

通常，病人可能体验到涵容，但感觉收回投射太沉重了，他感到无法应对伴随理解而来的分离感的痛苦（斯坦纳，1993,1996）。在这种情况下，解释害怕失去是非常重要的，允许接触到哀悼和内疚的感觉，并同时体验失去。

 

One patient described the situation as needing to feel confident that I would be able to “bear” his feelings. However, as soon as I attempted to make sense of the distinctly noticeable feelings of mourning and pain in the countertransference, he reacted with anxiety and conveyed the feeling to me that I was doing something unbearable to him. The transition from ‘enduring’ to active understanding actually produced strong anxieties about loss in him during this phase, and were at times related to a feeling that he would not be able to survive the end of the analysis. If these anxieties became unbearable to him he brought about a deadlock in which I was only allowed ‘to endure’ and thus created a joint suffering as a protection against

mourning and pain of being understood.

一个病人描述这个情景下需要对我能“承受”他的感受有信心。可是，一旦我试图理解显而易见的强大的反移情中的悲伤和痛苦时，他反应很焦虑并传达给我一种感觉我正在做着让他无法承受的事情。在这个阶段，从“忍受”到积极地理解的转变实际产生了很强的关于失去的焦虑，而且有时会有一种感觉，他在分析结束时将无法存活下来。如果这样的焦虑对他是无法承受的，就会导致僵局，这时我仅仅被允许“去承受”并因此创造了联合保护对抗被理解的悲伤和痛苦。

 

This conflict concerns the balance between containment and understanding. There is actually no real understanding without prior containment and the experience of being understood. On the other hand, there is no real containment without the second step towards active understanding which will ultimately lead to the acknowledgement of separation and loss. Both movements have to be linked in the analytic work to form interpretations in a way in which the patient will be able to take them in (see Steiner, 1993). While containment conveys the experience of being understood and is mainly concerned with part-object relations that have not been symbolized (LaFarge, 2000), patient-centred interpretations facilitate active understanding. This understanding is linked to the acknowledgement of loss and brings into play the conflicts of the depressive position. This can give rise to further projections and defensive splitting if the emerging feelings appear unbearable. Clinically, these might manifest as regressions as soon as there is a significant development in the patient.

这个冲突涉及到涵容和理解之间的平衡。没有之前的涵容和被理解的体验，就不会有真正的理解。另一方面，没有第二步“积极理解”带来最终承认分离和失去，就不会有真正的涵容。在分析工作中，这两种活动必须被联系起来、病人能够将它们内化（斯坦纳，1993）。但涵容传达了被理解的体验，主要关注的是尚未被符号化的部分客体关系（拉法基，2000），病人-中心的解释可以促成这种积极的理解。这种理解与承认失去有关，带入抑郁位的冲突。如果浮现出来的感受是无法忍受的，就促成了进一步的投射和防御性分裂。临床上，一旦病人有很大的发展，就可能呈现为退行。

 

There may be manifold reasons for this. Often feelings of shame and embarrassment play an important part, which the patient feels exposed to at a time when he is about to relinquish the protection of his pathological organization (Steiner, 2006a). This situation calls for special strategies of interpretation and must be distinguished from other forms of negative therapeutic reactions (Spillius, 1992).

这种情况可能涉及多种原因。通常，羞愧感和尴尬起着重要的作用，这时病人打算放弃他的病理性结构的保护时，他感到被暴露了。（斯坦纳，2006a）。这种状况要求特殊的解释策略，必须和其它形式的负性治疗反应加以区分（斯皮利厄斯，1992）。

 

Acknowledgements

I thank Claudia Frank and Esther Horn (Stuttgart) for their inspiring comments and discussions on reading the different versions of the manuscript.