Self psychology’s primary goal is to strengthen the self through specific qualities of relationship that enable the patient to have a new experience in the treatment and also get in touch with and include more and more of his or her past and current experience in the patient’s sense of who he or she is or can be. The more of our experience we can include in our sense of self, the richer we feel and the more confidence we have that we will be able to face life’s inevitable challenges and setbacks. But what anyone can include in a sense of self is closely related to what is positively responded to by the individual’s human environment from birth onward. Additionally, effective parents both “dose” and name their children's experience in accordance with the child’s momentary state and current level of development (Emde, 1990). At times, analysts may need to do the same with their patients.
自体心理学的主要目标是通过特定的关系量来强化自体，这种关系使患者能够在治疗过程中获得新的体验，并与患者的认同感中（他或她是谁或者可以是谁）越来越多的过去和现在的经验联系起来。我们容纳在自体感的经验越多，我们感觉就越丰富，我们能够面对生活中不可避免的挑战和挫折的信心也就越大。但是，任何人都可以在自体感中容纳的是与个人的人类环境从生而来的密切联系的积极响应的东西。另外，起作用的父母也按照孩子的瞬间状态和当前的发展水平“量身定制”并命名了孩子的体验（Emde，1990）。有时，分析师也许需要对患者做同样的事情。
The analyst’s mirroring or responsiveness does more than reflect what the patient presents. When successful it adds something, however subtle, or enhances the patient’s understanding of his or her own experience. For instance, for a patient who was the second of seven closely spaced children—with a depressive and understandably exhausted mother— an abiding theme of treatment was her inability to feel she had a right to anything even to her own psychoanalysis. She worried about burdening me with her talk. One day she began her session as follows: “I feel like saying ‘this happened and this happened and this happened’, but what stops me is that I think of my mother” I responded, “You’re afraid I’ll react the way your mother did.” And then I continued, in a mock-exasperated voice, “I can barely survive just seeing that you seven kids get clean and clothed and fed. So don’t ask me to just sit here and listen to you!” The patient’s eyes filled with tears and she responded, “Yes， that’s exactly how she talked.” She later spoke of how comforting it had been to feel so known and understood by me in relation to her painful formative experiences. Ultimately she felt more confident that not everyone in her life would feel as put-upon by her everyday needs as had her fatigued and harassed mother (Teicholz, 199’s).
分析师的镜映或回应不仅仅是反应患者的表现。当它成功地增加了一些东西时，无论如何微妙，会提高患者对自身体验的理解。例如，一个患者，她是七个出生年龄间隔很短的兄弟姐妹中的第二个孩子——有一位抑郁且可想而知的疲惫的母亲——她治疗的永恒主题是，她无法感觉自己对一切东西的权利甚至是自己的精神分析。她担心与我的谈话会加重我的负担。有一天，她开始了会谈，如下：“我想说‘它发生了，发生了，发生了’，但是阻止我的是，我想到我的母亲”我回应说，“你害怕我会以你母亲的方式做出反应。”然后，我以一种模仿的声音继续说道：”只是看到你们七个孩子弄干净，穿上衣服和吃饱，就够我受的了。所以不要要我坐在这里听你的话！“病人的眼睛充满了泪水，她回答说：”是的，那就是她说的话。“她后来谈到我对于她痛苦的形成体验的了解，是多么令她安慰。最终，她更感确信，她的生活中的不是每个人都会受到日常需要的影响，像她的疲惫而厌烦的母亲（Teicholz，199年代）一样。
Just as we are strengthened by having a more inclusive sense of self, we are weakened to the extent that, for any reason, the experience we are able to include in our sense of self is highly selective. The less our experience has been contained, made sense of, and named by our early caregivers, the ''thinner” or more shallow is our sense of who we are and the more fragile and vulnerable we are likely to feel. Without the fullness of our own experience in our sense of who we are,we go through life “operating on one cylinder” or “without a full deck of cards.”
正如我们通过拥有更加包容的自体感而得到加强，那么我们减弱的程度，就是因为，我们包含在自体感中的经验是精挑细选的。我们容纳早期照料者理解和命名的经验越少，我们是谁和我们可能感到的脆弱性的感觉就更“单薄”或更肤浅。如果我们对自己是谁的感觉缺乏丰富经验，我们就会经历“无从下手”或是“没有底牌”的生活。
Traumatic experience, large or small，is the biggest contributor to the gaps in our sense of self, generating ''black holes” of the mind that admit no light or leading to psychic ''compart- mentalization” in which the traumatic experience and associated self-states are walled-off and lose their (associative) links to the rest of the personality. Although trauma is defined as any experience that the mind cannot assimilate，there are nevertheless degrees of trauma ranging from the more catastrophic—as, for example, repeated childhood experiences of severe pain and terror intentionally inflicted by those who are supposed to be protecting and nurturing the child—to the more subtle disruptions of a sense of “going on being” （Winnicott，1960b）， such as might come from the daily experience of being raised by a parent who fails to respond or responds negatively or by a parent who chronically responds in ways that are slightly off, to the spontaneous gestures and initiatives of the child. Many children are regularly beat up or sexually abused by older siblings or have parents who repeatedly tell them they are stupid, ugly, or will never amount to anything. It is not only the gross trauma of such outright attacks on the self that derail development but also the everyday erosions that accumulate over time; these latter experiences, although less dramatic, can also lead to a somewhat compromised, distorted, or impoverished sense of self.
创伤经验，无论是大还是小，最大的贡献是造成了自体感的缺口，产生心灵的“黑洞”，它不允许光明或导致心理上的“精神分化”，隔离了创伤经验和相关联的自体状态，并失去与其他人格（相关）的联系。虽然创伤被定义为心灵无法吸收的经验，但是创伤的程度是不一样的，从更大灾难——例如，由那些应该保护和照顾孩子的人造成的严重的痛苦和恐惧童年期重复经验——到更加微妙的“持续存在”感的破坏（温尼科特，1960b），比如可能来自父母提出的无法回应或消极回应，或长期以来的父母以偏离的方式对孩子自发的姿态和主动性做出日常的回应。许多孩子经常被哥哥和姐姐殴打或性虐待，或有父母反复说他们是多愚蠢多丑陋，或者说他们会一事无成。不仅是这类阻碍自体发展事件的完全爆发，而且日积月累的日常侵蚀，都会造成严重的创伤，后一种经历虽然不那么戏剧化，但也可能导致一些有些妥协、扭曲或消耗了自体感。
I believe that the process of articulating one’s life experience, both current and historical (the process of bringing all the parts of oneself together in one place), in the presence of an affirming and active listener or resonant witness is growth promoting in itself, exactly because over time it does seem to accrue to a sense of continuity, cohesion, and value about who one is. This experience in psychoanalysis is especially powerful because most patients feel the recognition to be coming from an idealized other—no matter how complex, qualified, or “ironic” the adult patient’s experience of the analyst’s authority might be (Hoffman, 1996).
我相信，在一个肯定和积极的倾听者或共同见证者面前，将当前和历史（将自己的所有部分结合在一起的过程）表达出来的过程本身就是促进性成长，正是因为随着时间的推移，它似乎会产生一种连续感，内聚力和价值观。精神分析的这种体验特别强大，因为大多数患者感觉到来自理想化他人的认可——无论成人患者对分析师权威的体验可能是多复杂、有限或“讽刺”（Hoffman，1996）。
Thus far, I have described the analyst’s participation as if the analyst is easily able to achieve the goals of listening, accepting, and understanding what the patient presents. This is not, of course, what happens at every moment of every treatment. Beyond the analyst's extensive training and experience—and beyond the patient’s commitment to the process—the match or fit between patient and analyst can be an important factor in its success; not every patient can work with every analyst and vice versa. New research also suggests that, from the moment of birth, bidirectional influence begins between parent and child. We now recognize that the analyst's influence on the patient also goes beyond the intended impact and that the analyst is affected in unrecognized ways by each patient as well. These factors complicate the goals with which analyst and patient begin any treatment.
到目前为止，我所描述分析师的参与，就好像分析师很容易实现倾听、接受和理解患者所呈现的目的。当然这并不是每次治疗的每一时刻都会发生的事情。除了分析师的丰富的训练和经验外——在患者对该过程的承诺之外——患者和分析师之间的匹配度或适合度可以成为分析成功的重要因素; 不是每个患者都可以和每个分析师一起工作，反之亦然。新的研究也表明，从出生的时刻起，父母和孩子间的双向影响就开始了。我们现在认识到，分析师对患者的影响也超出了预期的影响，分析师也受到每个病人的未被承认的影响。这些因素使分析师和患者开始治疗的目标复杂化。
Self psychologists tend to use this new knowledge of bidirectionality as a spur toward more vigilant self-monitoring and more constant exploration of the ways that the intersection of subjective experience between patient and analyst might in some way unwittingly hurt the patient or stymie the analytic progress. In spite of recognizing bidirectionality of influence, in other words, the self psychologist's emphasis remains on facilitating an elucidation of how the patient is being affected by the analyst in unintended or hurtful ways.
自体心理学家倾向于利用这种双向性的新知识来激励更加警惕的自我监测，并且更多地不断探索患者和分析师之间的主观感受可能以某种方式不经意地伤害患者或阻碍分析的进展。尽管认识到双向性的影响，换句话说，自体心理学家的重点仍然在于促成一个说明：即分析师是如何以无意或有伤害的方式影响到患者的。
Patients often come for help because of the unintended ways that their parent’s personalities, behaviors, or relationships have negatively affected their development. The analyst’s efforts toward identifying the subtle ways in which his or her own errors, blind spots, or foibles are also having an impact on the patient can become a model for identifying what has been hurtful in the patient’s early formative experience as well, enabling the patient to attain more emotional distance from what has caused the harm—regardless of how unwitting this harm was in the minds and hearts of the early caregivers and no matter how unintended it is now on the part of the analyst.
患者常常来寻求帮助是因为父母的个性、行为或对他们发展产生不利影响的关系的这种无意的方式。分析师努力识别自己的错误、盲点或弱点也同样对病人产生影响的微妙方式可以成为识别病人早期形成过程中受到伤害的模型，它使患者能够从造成伤害的情绪上获得更多的情感距离——无论这种伤害在早期护理人员心中多么毫不知情，也无论现在分析师方面是多么无意。
This process of identifying what has historically been influential and even hurtful (via an ongoing illumination of the unintentionally hurtful experiences in the treatment relationship) is not undertaken for the purpose of blaming either the parents or the analyst but rather for the purpose of understanding the conditions under which the patient developed and the conditions to which the patient had no choice but to adapt. These conditions and related experiences centrally and enduringly contributed to the patient’s experience of self and the world as well as to the characteristic ways of organizing his or her experience. The patient's adaptation to conditions that were less than ideal should be applauded to the extent that these adaptations enabled the patient to survive in those less than optimal conditions and to go forward in life. But now, these earlier adaptations may have to be deconstructed, and this should be done in the gentlest possible manner (Teicholz, 1996).
识别患者早年受影响甚至伤害的过程（在治疗关系中通过持续阐述无意的受伤体验），不是为了指责父母或分析师而是为了理解患者成长的条件和患者别无他法只能适应的条件。这些条件和相关经验集中而持久地为患者的自体和世界的经验以及组织他或她的经验的特征的方式做出了贡献。患者对这些适应条件不那么理想化应受到赞赏，因为这些适应性使得患者能够在不那么良好的条件下生存并在生活中进步。但现在，这些早期的改编可能必须被解构，这应该是以最温和的方式进行的（Teicholz，1996）。
In self psychology the effort toward gentleness prevails because protecting the patient from experiencing too much of his or her own vulnerability is a paramount concern— especially during the initial phase of treatment; empathy plays a prominent role in this effort. By the late 1980s and early 1990s, however, some analysts began to feel that empathy was necessary but not sufficient to psychic growth. They began to think more about other kinds of relational interactions that might lead to the enhancement of the sense of self or the expansion of subjectivity. They wanted to move beyond the self-psychological emphasis on getting and staying inside the patient’s experience and began to place greater emphasis on the analyst’s unique self-expression as an “outside other” in relation to the patient—greater emphasis on expression of the analyst’s unique, authentic, and even disjunctive subjectivity, sometimes including negotiation of difference. With these ideas, the relational movement in psychoanalysis was born and began to grow.
在自体心理学中，温和的努力普遍存在，因为防止患者体验太多自己的脆弱是至关重要的——特别是在治疗的初始阶段;共情在这一努力中起着突出的作用。然而，到20世纪80年代末和90年代初，一些分析家开始觉得共情是必要的，但不足以促进心理发展。他们开始更多地思考可能导致自体感增强或主体性扩展的其他种类的关系互动。他们希望超越自体心理所强调的获得并保持内部的父母经验中，并开始更加强调分析师作为与患者相关的“外部他人”独特的自我表达，——更加强调分析师对于独特、真实，甚至分离的主体性的表达，有时包括对差异的协商。有了这些想法，精神分析中的关系运动才诞生并开始发展。
Over the past two decades, dialogue between relational analysts and self psychologists has moved proponents of both theories toward an expanding middle ground. Still，whereas in self psychology the analyst tries to capitalize more on the resonances between patient and analyst, enabling the analyst to see the patient from within the patient’s own vantage point, in relational treatment the analyst is more likely to give the patient feedback on how she is seen by an “outside other” and it is more likely for the two to confront differences directly. The relational analyst believes that the patient’s growth is facilitated by a more direct exposure to the differentiated and even disjunctive subjectivity of another individual, including the analyst (Aron；, 1996; Hoffman, 1996; Mitchell, 1997; Benjamin, 1988; Bromberg, 1996). Debates continue concerning whether the patient is better served by the analyst’s empathy and attunement or by the analyst’s authentic self- expression, disjunctive subjectivity, and difference (Teicholz, 2000); but many such discussions take place as much within the minds of individual analysts in a given moment as in disagreements between analysts practicing according to different theoretical paradigms.
在过去二十年间，关系派分析师和自体心理学家之间的对话已将两种理论的支持者转移到不断扩大的中间地带。尽管如此，在自体心理学中，分析师试图更多地利用患者和分析师之间的共鸣，使分析师能够从患者自己的优势中看到患者，在关系治疗中，分析师更有可能给患者反馈以显示她如何被“外在他人”所看到，这使两人更有可能直接面对分歧。关系派分析师认为，促进病人成长的方式是更直接地暴露出与另一个人包括分析师的差异甚至是分离的主体性（Aron，1996; Hoffman，1996; Mitchell，1997; Benjamin，1988; Bromberg，1996 ）。是分析师的共情和协调更好，还是分析师的真实自我表达，分离的主体性和差异性（Teicholz，2000）更好，争论还在继续;但是在特定的时刻，如由于不同的理论模式产生不一致的分析实践时，许多这样的讨论发生在个别分析师的思想中。
My own leaning is to defer as much as I can to the patient’s psychic state, particular needs，and level of psychic functioning at any moment, allowing my best empathic grasp of these to guide but not limit me in how I respond. By this I mean that I feel free to draw on any part of my multifaceted authentic experience or to enter into a full relational engagement to the extent that I feel a given patient is interested and can possibly benefit from it at any moment.
我自己的倾向是尽可能地遵从患者的心理状态、特别需要和任何时候的心理功能水平，让我以最好的共情性理解做出引导，而又不限制我如何回应。这意味着我可以自由地利用我多方面的真实经验的任何部分，或者进入一个充分的关系的参与，只要我对这位病人有兴趣，并且可以在任何时候受益。
My thinking is that the initial laying down, in childhood, of a subjective sense of self and inter- subjective relatedness are huge psychic achievements that involve complex neurological and psychological developments in intimate interaction with the human environment. These developmental achievements can be either greatly facilitated or traumatically interfered with by the quality of parental care, sibling constellation, and other events and conditions of a child’s life. For this reason I expect that my patients will arrive for treatment with a wide range and infinite variety of capacities for self-delineation, self-assertion, and differentiated relatedness (Teicholz, 2001). Furthermore, after any of these psychic achievements have initially been attained in life, even the healthiest and most mature individuals still fluctuate along a continuum from fragility to robustness in the sense of self and they therefore fluctuate, as well, in their capacity for and interest in differentiated relatedness. At the more fragile end of this continuum, patients may need more of a sustained empathic stance on the part of the analyst, whereas at the more robust end of the continuum, they may be more interested in and benefit from a fuller elucidation of the analyst’s differentiated subjectivity as well as their own. But in all cases, the analyst keeps in mind the purpose of the analytic relationship, which is to help the patient know, accept, and integrate more of the patient’s own experience, in the interests of living a fuller and more satisfying life, a life that includes sustaining relationships outside of psychoanalysis. Even with this focus—given the unending variety of human experience and creative adaptations—the range of psychoanalytic interactions is vast.
我认为，在童年期，最初建立的主体的自体感和主体间相互关系是巨大的精神成就，它涉及复杂的神经和心理发展与人类环境的亲密互动。父母照料的品质、手足间关系的位置以及儿童生活的其他事件和条件，要么大大促进要么创伤性地干扰了这些发展成就。因此，我希望我的患者在治疗中自体描述、自体肯定和关系的分化中具有广泛和无限多种能力（Teicholz，2001）。此外，在最初的生活中获得任何一点成就之后，即使是最健康和最成熟的个体，在自体感中仍然从脆弱到稳健的做连续波动，因此它们也有能力和兴趣在分化的关系中波动。在这个连续性的更脆弱的一端，患者可能需要更多的分析师方面持续的共情态度，而在连续性的更坚固的一端，他们可能更有兴趣并受益于分析师对区别主体性以及自己的主体性更全面的说明。但在所有情况中，分析师都牢记分析关系的目的，就是为了帮助患者了解、接受和整合患者自己的更多经验，为了生活在更美好更令人满意的生活中，一种含有精神分析之外的持续关系的生活。即使有了这个焦点——鉴于人类经验和创造性适应性的不断变化——精神分析相互作用的范围仍是巨大的。
Recently there have been empirical studies in the overlapping fields of developmental psychology, infant-caregiver research, attachment theory, and neuroscience that have an important bearing on our current psychoanalytic understanding of psychic growth and change. On the basis of these studies, the self-psychological emphasis on the need for a coherent sense of self, on the need for attunement, and on the curative power of cycles of relational disruption and repair have all been affirmed (Sander, 2002; Schore, 2003a, 2003b; Kandel, 2005). As mentioned earlier, contemporary research also supports the understanding of all dyadic relationships as being characterized by bidirectional influence between partners, even to the extent that in micro-analyses of video-taped interactions between mother and infant, the researchers are very soon able to predict the rhythm of vocalizations or the sequence of facial expressions within a given dyad because each partner in the dyad soon comes to influence the other in predictable ways in response to specific dyadic cues (Beebe, 2005). At the same time however, no two dyads are alike, and the same individuals, if paired with different partners, will create different dyadic patterns (Tronick, 2003).
最近对发展心理学，婴儿看护者研究，依附理论和神经科学的重叠领域进行了实证研究，这些研究对我们目前对心理发育和变化的精神分析理解有重要影响。基于这些研究，自体心理学强调需要凝聚的自体感、需要协调，以及关系破坏和修复周期的治愈力都得到了肯定（Sander，2002; Schore ，2003a，2003b; Kandel，2005）。如前所述，当代研究同样支持以同伴间的双向影响为特征的二元关系，即使在母婴互动的视频的微量分析中，研究人员很快能够预测指定的母婴二元组发音的节奏或面部表情的顺序，因为二元组中的成员均以可预测的方式用特殊的二元组的信号很快影响到另一个人（Beebe，2005）。
This mutual and bidirectional influence-while making possible the co-creation of unique but ultimately predictable patterns of interaction within a given dyads also makes possible the co-creation of new ways of relating that can affect the individual experiences of the two partners and ultimately influence their internal structures of experience. In this scenario, the analyst becomes a new dyadic partner for the patient, co-creating with the patient new patterns of interaction and experience that the patient ultimately can take into other relationships (Lyons-Ruth, 1999).
这种共同和双向的影响——虽然使得在给定的二元组中共同创造出独特但最终可预测的互动模式变得可能，也使得共同创造出可能影响两个同伴的个人经验的新的相关方式并最终影响 他们的内部结构经验成为可能。在这种情况下，分析师成为患者的新的二元组同伴，与患者共同创造患者最终可以参与其他关系的新型互动和经验（Lyons-Ruth，1999）。
The recognition of unintended influence in the analytic situation has also turned analytic attention to the analyst’s unique subjectivity, which we now realize cannot really be kept out of the treatment relationship (as Freudian theory once suggested it could). Increasingly analysts from all theoretical paradigms are accepting the analyst’s unique presence and personality as a given and are working to find ways not only to rein it in when appropriate but also at other times to use it more freely and effectively on the patient’s behalf.
对于分析情境中无意识的影响的认识也使分析的注意力转向分析师独特的主体性，我们现在认识到它不能真正摆脱治疗关系（如弗洛伊德理论曾经提出的那样）。 所有理论模式的分析师越来越多地接受分析师的独特的在场和既定的人格，并且都在努力寻找方法，不仅在适当的时候控制它，而且在其他时候，以更自由和有效的方式代表患者使用它。
For instance, when the analyst has an association, sensation, or feeling that the analyst believes might be germane to what the patient is currently discussing, the analyst might share this experience with the patient, with the idea that the two can search together for its meaning in relation to current concerns of the patient and the analytic relationship. With acceptance of constant bidirectional influence, we additionally have no choice but to let go of preconceived ideas of how an individual treatment will progress. On the one hand, the analyst is totally focused on helping the patient elucidate experiences and attain mastery over them to improve the patient’s overall quality of life. On the other hand, the entire process must be seen as an improvisation, with each person making a move and waiting to see how the other responds before planning the next step in our now very open-ended repertoire of analytic interventions. In this new psychoanalytic world, no verbal exchange is (a priori) off-limits that might creatively contribute to the alleviation of the patient’s suffering or contribute to the patient’s psychic growth.
例如，当分析师产生联想、感觉或者觉得可能与患者正在讨论的内容有关联的东西时，分析师可能会与患者分享这种经验，认为两个人可以一起在病人和分析关系中当前所关心的内容中寻找出它的意义来。如果我们能够接受持续的双向影响，我们就只能放弃个体治疗如何进步的成见。一方面，分析师完全专注于帮助患者阐明经验并掌握它们，以提高患者的整体生活质量。另一方面，整个过程必须被视为一个即兴发挥，每个人都在采取行动，等待其他人的回应，然后再规划我们现在非常开放的分析干预剧目的下一步。在这个精神分析的新世界中，没有言语交流（先天）的禁区，可能创造性地有助于缓解患者的痛苦或有助于患者的心理成长。
The recognition of unpredictable bidirectional influence additionally undermines the earlier view of fixed developmental stages and places more emphasis on nonlinearity in human development. In many treatments I have been totally surprised by the trajectory the patient’s life ends up taking. Although I might start with some rough ideas about the direction in, which an iudividual’s psychic development and life might move with successful treatment, I am often moved by the unexpected ways in which my patients solve the unique problems in their lives—often surprised by the interests and talents that seem to emerge from nowhere, not previously recognized but all along waiting for the right moment to be developed.
承认不可预测的双向影响另外削弱了固定发展阶段的早期观点，并更加强调人类发展中的非线性。在许多治疗中，我完全惊讶于患者生命终结的轨迹。虽然我可能对这个方向开始有了一些粗略的想法，即个人的精神发展和生活可能会因为成功的治疗而取得进步，我经常被病人解决他们生活中的独特问题所采取的意想不到的方式而打动—— 经常被这些趣味和才能感到惊奇，它们不知从何处产生，以前也没有得到承认，但一直在等待发展的合适时机。
In this new psychoanalytic world, where the multiplicity and unpredictability of experience is constantly highlighted, Kohut has been criticized for his emphasis on continuity and coherence. But Kohut chose these emphases exactly because he recognized the enormous multiplicity of human experience and the lifelong vulnerability to fragmentation, which—without enough of a sense of continuity and coherence—can leave the individual unable to develop talents, set goals, or pursue meaningful activities and relationships. Bringing these “modern” and “postmodern” views together, the healthy “self” today is seen as experientially and functionally cohesive but also prone to periodic destabilization as part of creative cycles of growth.
在这个精神分析的新世界，经验的多样性和不可预测性不断被突出，科胡特因强调连续性和凝聚性而被批评。但是，科胡特选择的这些重点，正是因为他认识到人类经验的巨大多样性和持续终身的对分裂的脆弱性——没有足够的连续感和凝聚感——可以让个人无法发展出才能、设定的目标或追求有意义的活动和关系。将这些“现代”和“后现代”的观点结合在一起，今天健康的“自体”被看作是凝聚了经验和功能，但作为创造性增长循环的一部分，也容易发生周期性的不稳定。
In closing, I shall again briefly outline how I think psychoanalysis works, using everyday language’s and then offer a brief clinical vignette. The patient comes for help with how she feels or with how she is living her life. She may experience her problems primarily in the quality of her feelings—too omnipresent and intense or too absent and not intense enough; she may want help primarily with her relationships or help to identify and achieve life goals. Sometimes people come for psychoanalysis because they are burdened by ongoing realities in their lives that are just too painful and that no one should have to bear alone. Regardless of the presenting problems, the analyst invites the patient to tell the analyst everything about the patient—about the patient’s past and current life, about the people, feelings, ideas, and activities that have historically and currently populated that life. With the patient’s help, the analyst tries to engender a dialogue in which the two can make sense of the patient's current feelings and behavior—especially those areas of' living that are most problematic but never looking at problems in isolation from the whole person and his or her successes in life.
最后，我将使用日常语言再次简要地介绍下我认为的精神分析的工作原理，然后提供一个简短的临床小插曲。患者为了她的感觉或她如何生活来寻求帮助。她可能把她的主要问题体验为情感量——太多和过于强烈或是太少和不够强烈；她也许主要是为了帮助她的关系或是确定和完成生活目标。有时人们来寻求精神分析是因为他们负担的现实生活太过于痛苦，没有人可以独立承受。无论呈现的问题如何，分析师请患者告诉他有关病人的一切——关于病人过去和现在的生活，关于从前和现在居于生活中的人们、感受、想法和活动。在患者的帮助下，分析师试图形成一个对话，让双方理解患者目前的感受和行为——特别是那些最有问题的生活领域，但从来没有从整个人和他或她生活成果中的分离出的问题。
Once in treatment the patient will have an opportunity for new experiences along two inter-related tracks. One track will be the direct experience of the treatment relationship itself in which the analyst listens attentively, accepts, and tries to understand ail that the patient has to say but filters it through the analysts own different sensibility and subjectivity—thus reflecting back to the patient what has been presented, but also in every interaction reflecting back something slightly different as well, because it comes from the unique and therefore different subjectivity of the analyst. The other experiential track is the opportunity for the patient to create a new and different narrative of his or her life thus far, in which all the elements are reevaluated, seen anew, and reorganized into a different whole. This reordering and new gestalt may provide a second chance for the patient to change how he or she experiences self, in part through the gradual “detoxification” of earlier destructive experiences but also through a simultaneous gathering in of positive experiences that were somehow not previously included in the self-concept or sense of possibilities.
一旦进行治疗，患者将有机会在两个相互关联的轨道上获得新的体验。一个轨道将是治疗关系本身的直接经验，分析师在治疗关系中仔细聆听，接受并尝试理解所有患者必须说出但为分析师自己不同的识别力和主观性过滤的内容，从而把患者提出的内容反映给他，而且在每一次互动中也反映出一些稍微不同的东西，因为它来自分析师的独特而不同的主体性。另一个经验轨道是病人有机会对其迄今为止的生活创造出一个新的和不同的叙述，其中所有的元素被重新评估、重新看到和重新组织成一个不同的整体。这种重新排序和新的完形可能提供了第二次机会，以便通过对早期破坏性经历的逐渐“解毒”，并且通过同时收集以前不包括在自体概念或可能性上的积极经验，改变其所体验到的自体。
As an example, I once worked with a patient who, in spite of considerable brilliance，was totally stuck in his career and was also unhappy because he repeatedly got involved with women he experienced as domineering and in relation to whom he felt “second tier.” He started treatment as a twice-divorced man in his 40s， with both parents deceased. The patient’s mother had seemed to him to be by far the more powerful and dominant of his two parents. She had been an intelligent, lively, and engaged presence who had nevertheless also actively devalued her husband in front of her children. By contrast the patient spoke of an abiding sense of absence, silence, and depression in relation to his father; which had left him feeling that he had a “gaping hole where my father should be.”
举一个例子，我曾经工作的一位病人，他的职业生涯尽管相当的辉煌，却完全陷入了僵局，也不快乐，因为他总是被自己体验为霸道的女性缠住，和她相比，他认为自己是“低人一等”。他40岁的时候因为两次离婚和父母双亡而开始治疗。对患者来说，他的母亲显然是更强大的在双亲中占主导地位。她一直是聪明、活泼也显得很忙，然而她也在孩子面前积极地贬低了丈夫。相比之下，病人谈到的父亲总是缺席感、沉默感和沉默感，这使他感觉自己有一个“我父亲应该有的空洞”。
Toward the end of his treatment this patient for the first time began to remember good times that he had actually spent with his father; previously forgotten outings and conversations with his father, the reporting of which in treatment began to build a new and different view of his father and their relationship. As part of this process the patient suddenly remembered that after his father finally retiring from a lifetime of stultifying labor, he had started a small business—working from home—that had been very pleasurable and successful for him. The emergence of these new memories seemed to coincide with a transformation of the patient’s own sense of self and of what might be possible for him in his life. He suddenly moved ahead in his career and got involved with the first woman he had ever dated who treated him with respect.
在他治疗结束时，这个病人第一次开始记住他实际上与父亲一起度过的美好时光; 对以前被遗忘的与他父亲的外出和对话的报告在治疗中，开始对他的父亲和他们的关系建立出一个新的和不同的看法。作为这个过程的一部分，病人突然想起，在父亲终于从一个终身都很乏味的工作中退休出来，他在家上班开始了一个小本生意，这对他来说非常愉快和成功。这些新记忆的出现似乎与患者自身自体感以及他生活中可能的转变相吻合。他突然在职业生涯中有了进展，并第一次得到和他约会的女人的尊重。
One way of thinking about this patient’s changes in treatment is that through the repeated elaboration of his relationship with his mother in the analytic relationship—along with the simultaneous experience of a new relationship with a female analyst who left ample space for his own thoughts and feelings—the patient felt empowered to reevaluate and experience his earlier relationships with both parents in new ways. No longer intimidated by his mother's view of things, he could finally reclaim his father and create a different relationship with him (in his mind and heart). He was able to do this through the spontaneous welling-up in treatment of new memories of his father that were more independent of his mother’s denigrating viewpoint. As the patient claimed these more substantive and positive memories with his father, he was filling the “gaping hole” he had previously felt in his psyche. He was also able to appreciate his mother as less overpowering—the reevaluations of both parents working together to help him experience himself more positively and become more successful in his own creative pursuits and relationships.
思考这个患者治疗变化的一种方式是，通过在分析关系中重复阐述他与母亲的关系，以及与一位女分析师的新关系的同步体验，她为患者的想法和感觉留下了充足的空间——患者感到有能力以新的方式重新评估和体验他与父母早期的关系。他不再因母亲对事物的看法而感到恐慌，终于可以重新承认父亲，并与他建立了不同的关系（在他心中）。他能够通过治疗自发涌现出对父亲的新记忆来做到这些，而不再依赖于母亲诋毁的观点。随着病人对父亲的承认更为实质和积极回忆，他正在填补他以前在心理上感受到的“空洞”。他也能够体谅他的母亲不是那么强硬——父母双方共同努力的重新评估，帮助他更积极地体验自己，并在自己的创造性追求和关系中变得更加成功
I have, of course, left out vast quantities of material and many events in the progression of this patient’s analytic work with me, which proceeded over 3 years with sessions four times a week. We devoted many sessions to dream analysis and others to the patient’s current relationships and problems at work. We additionally observed our own interactions with the hopes of learning still more about the patient and his characteristic ways of experiencing himself and relating to others. All of these strands of experience tended to be woven together in almost every psychoanalytic session.
当然，我在这个病人的分析进展中省略了大量的材料和许多事件，这个分析过程持续了3年，每周四次。我们的许多次会谈致力于梦境分析，以及患者当前的关系和工作中的问题。我们此外还观察到自己希望更多地了解病人，以及他体验自己和与他人相关的特征之间的相互作用。所有这些经验线索在几乎每一个精神分析会谈中常常都是编织在一起的。
Overall, this treatment supported an approach that made room for the fullest elaboration of the patient’s experience in all realms of life, historical and current, including his relationship with the analyst. But many treatments run into more frequent hitches than this one and demand more of the analyst's ability to think on his or her feet in a crisis. With this in mind I think of myself as taking an empathic approach until I come up against a brick wall and have no choice but to analyze myself, my patient, and our relationship in order to work myself back to an empathic position. I scan everything in my experience’s past or present, and I am willing to draw on or to share with my patient anything I can find in myself that might help me get back with my patient on a collaborative, playful, and growth-promoting trail toward psychic growth in relationship. All the while I envision the fabric of the patient’s psyche getting stronger and more able to draw on the deep and broad reservoirs of his or her own experience so that the patient is better able to forge the life that is wanted, to resolve the conflicts that arise in this life, and to face down the inescapable challenges of the human condition.
总的来说，这种治疗支持了一种方法，充分阐述了患者在所有生活领域，过去的和现在的经验，包括他与分析师的关系留出了空间。但是，许多治疗方法相比于此会陷入到更常见的问题中，需要分析师在危机中更多的思考能力。带着这样的想法，我以为自己是采取共情的方法，直到我撞上一堵墙，别无选择，只能分析自己、患者和我们的关系，以便自己回到一个共情的位置。我审视了自己过去或现在的经历的一切，我渴望去借鉴或分享我自己能够找到的病人一切东西，这可能有助于我与患者的关系中的心灵成长回到一个合作的、好玩的和促进成长的路径上。我一直设想了病人的心灵建构会变得越来越强大，越来越能够利用其经验的深度和广度，使患者更好地锻造所需要的生活，解决生活中产生的冲突，挫败人类不可逾越的挑战。
Conflicts of Interest
利益冲突
The author declares no conflicts of interest.
作者声明没有利益冲突。www.psychspace.com心理学空间网
