作者：Robert Waska

书籍：The Modern Kleinian Approach to Psychoanalytic Technique_ Clinical Illustrations 现代克莱因精神分析技术——临床案例

粗译：胡尚伟  松原梦空间心理咨询室

案例

Sally 和Rick做了四次夫妻治疗后，Rick宣布他再也不回来了。他很抑郁，生气，充满敌意，拒绝参与到任何一次的会谈中。我是被他“解雇”的第三个治疗师。我建议Sally继续治疗。

我们第一次一对一的会面，Sally就揭露说，Rick是个酒鬼，成年每天都喝醉。为此也引发了他和青春的女儿打架，整个家都不安生。这些以前从来没说过。另外，Sally还揭露说Rick有多抑郁，曾经很可能还自杀过，她对他们的婚姻有多无助。与此同时，Sally觉得如果她要忍受这种状况，并努力帮助Rick，他也许会回来，成为一个好一点儿的丈夫，生活的也快了一点儿。我指出，这种（忽略并等着瞧）策略在过去的十年里都没有其效果。Sally同意这一点，然而说道：“除了离开他我没有看到任何其他的方式，而我又怎能够这样对待我的家庭呢？”

所以接下来的几个月里，我们探索了Sally控制她的丈夫和她的内部客体的各种方式，目的是努力赢得他们的爱，避免他们会崩溃或避免他们报复以及证明她是多么的忠诚她是多么的好，在整个过程中否认任何不好的感觉。我解释了她这种模式，聚焦并控制她的客体从而回避了她自己的需要，她自己的欲望，在她的幻想中，如果她有自己的需要和欲望，这会伤害或激怒她的客体。因此，Sally从不要求，也从不曾被失望，也从不面对分离或丧失所带来的痛苦。控制是她与客体的链接方式，这种链接让她不用面对丧失、拒绝和内疚。

我一来来到工作室，准备与Sally的咨询，就感觉靠她很近。我们距离会谈开始还有五分钟或十分钟。我从车里走出来，她从窗户处对我说：“你还需要几分钟吗？不着急，慢慢来”我的反移情是，我感觉到被控制，我想告诉她停止监控我想要什么，管好你自己的事，在会谈开始前保持安静。反观我这种感觉，我能够为她需要控制我并确信我很好我不是她的负担等做出解释。Sally告诉她把我看做是“繁忙、需要打电话、需要整理自己、看报纸，一般需要几分钟打理自己。”我解释说，你把看的很虚弱，如此才需要你的照顾。她同意并说道：她“从没认真想过这点，但现在她是认真的，她觉得这是她看大多数人的方式。”我进一步评论说，如果她的周围都是一些虚弱的人，她将会感到焦虑，内疚，她要控制并照顾我们所有人。她说，她认为她“为别人花费了大量的时间，特别是她自己的家人。”

在近期的一个小节中，我注意到她走进工作室，然后非常焦虑地汇报她的最近“进展”，告诉我她非常不安，当她想到要给她的老公下最后通牒时。听后我带有歉意的解释说，她想象我在要求她跟她的老公做出抉择，要么他赶快修复他们的婚姻，要么就和他离婚。我说她一定很焦虑地觉得她必须这么做才能够取悦我，而此时她并不想这么做。Sally说，“我确实感觉到你想要我这么做而我很害怕这么做，我觉得如果真的做了什么的话，我就会伤害了某个人。而我并不想这么做。”我解释说，“所以，你感觉被困在了两者中间，要么让我失望，不做那些你想象中我要求你做的家庭作业，要么伤害所有那些对你很重要的人。”她同意这种说法，并说道她认为我真的想要她 “采取行动”，没想到会有其他的选择。我解释说，“当你努力控制他人或想象中我正在控制你时，我们漏掉了一点。你正在把自己排除在所有事情之外。当你控制我们时，你的需要、你的感受以及你的想法都隐藏在了要取悦我的后面。我觉得你正在努力规避你需要我或者你需要我的帮助的风险。通过努力帮助我们和拯救我们，你回避掉了你也希望我能帮助你或拯救你。”Sally看起来很惊讶。她说，“我从没有想过我是这幅画里的一部分，从来没有。”

下一个小节时，我做好准备Sally会把她老公淘汰出局除非他努力修复他们的婚姻。十年了，一点用都没有，所以要么现在，要么永远别做，我这么合理化自己。我可以经由我这不是我开始的风格以及非常强烈的感觉来反观我的反移情幻想。我认识到这是源于上次咨询的投射性认同过程的一部分，在这里我已经部分受到了影响，她自己渴望控制还有她对她老公长期酗酒和抑郁的抱怨和不耐烦。

所以，利用这洞察我来解释，她吸引我关注她把自己的需要和欲望看作是自私、强加和卑鄙的信号。换句话说，对于Sally来说，关注她自己和她的感受意味着是贪婪和索求。所以，为了保护客体，她忽略她自己的需要。作为回应，Sally松了口气说道，“我真的觉得你很严格的要求说，你现在应该采取行动了。我不想那么做，我不想伤害他，特别是当他如此落魄的时候。”我用解释回应说：“你很惊讶我考虑到你和你的需要，因为你从来没有这么做过。但是，我认为你担心聚焦于你的需要意味着释放这种索求卑鄙的小人。”Sally开始哭并说道：“我不知道如何成为我自己，我担心我所要的太多。”

随着我们继续讨论她渴望待在她老公身边并努力寻找“使他再次变得完整”和“把他从所迷失的糟糕之处拯救出来”的方式，我解释说她想要获得一个爱和照顾的保证而不是离开这个糟糕的地方，也是，如果她放手并自己照顾自己的话，她会迷失的地方。我说她非常害怕失去和孤独，所以不管怎么样，她都坚定守在闸门口不让它们（失去和孤独）进来。Sally回应道，“我害怕让Rick失望，在他不安和无助的时候留下他自己。我不想让他失望。”我解释说：“你觉得，另外，我也认为你同样也担心让我失望，所以你不得不让自己困在中间，”暗指她所处的俄狄浦斯期位置，处在两种问题或两个课题中间，同时不惜任何代价要找到一条路来。

Sally告诉我，“我就是这么觉得的，我总是感觉到我处在混乱的中间，努力整理它使之有序。”我解释道：“你说你做那些事为了另一个人好，取悦我们。但是，我觉得更大的原因是你害怕我们不爱你，如果你停止控制我们的话。换句话说，看起来像是你努力强迫他人喜欢你、爱你，其实你非常害怕如果你放手了，我们依然不在乎你，那么你将陷入完全的孤独中。”Sally开始哭起来了，并在点头。

在最近的一个小节中，Sally告诉我她为自己感到骄傲，想跟我分享“一些他最终捍卫自己立场的例子”。她告诉我她如何告诉她老公，她是“真的被你周末晚餐时的粗鲁和自私行为搞的没有胃口了。”她还告诉他当他出去酗酒的时候她很讨厌干那些灵活，而且她再也不回去干洗店了或把所有这些需要洗的东西就留在洗衣机里。对于Sally来说，这确实是非常不同的做法。

与此同时，在反移情中，我觉得她在努力给我留下深刻的印象。所以我问她，你跟我分享你的这种胜利是为了自己还是为了我好呢？她说，“我是为了我自己好，但是我也注意到我希望我照顾自己的越多，也许Rick也会开始想着照顾他自己。”我说，“对于你来说，不去照顾另外的人，不去再确保我们很好，真是不容易。没有了对我们快乐与否的关照，你将会开始担心你自己了？”在这，我向Sally传达了这样的看法，她控制我们是为了她自己，而只是为了我们好。

Sally说：“我不知道我是否是为了我自己。我需要他，他也需要我。我知道这听起来像是有病，但是我觉得如果我需要帮助的话，我需要一些备份计划。我觉得我还不能照顾好自己。” 在我温柔的探测下，Sally解释说她不仅把她老公看做是“处在边缘且需要恒定照顾和注意（的人）”而且也把她自己看做处在孤独和被遗弃的边缘的人。事实上，我并不知道她是否用她照顾他的角色来防御她自己更加原始和无助的感觉，因为没有人能够有恒定的依恋关系。

所以，我说道，“看起来好像你是他的照顾者和护士，同时他也是你的护士和照顾者。看起来你在担心的是，如果你不在他身边，你会怀念。”Sally考虑了几分钟后说，“我觉得我很可能会变得脆弱、混乱许多年。我认为我没有能力在经济上照顾自己。我也不想放弃我已经拥有的这些安慰，我也不想面对噩梦一般的将来。至少在我还不能够照顾好自己的时候，我愿意有个人照顾我引导我到正确的方向。我不知道我将会在什么时候需要他但我确信我现在想清楚了。”我说，“好像你已经准备好让自己悬在这条线上，如果没有这条线你会怀念它。要是没有你的照顾者，那将是致命的。”Sally回复说，“命运是一个很好的词。就是这个词，那将是致命的。”

 

CASE MATERIAL

 

After seeing Sally and Rick for four sessions of couple’s therapy, Rick announced he would not return. He was depressed, angry, extremely adversarial, withholding, and unwilling to engage in any sort of dialogue. I was the third therapist he “fired.” I suggested Sally continue on her own.

 

The first time I met with her one-on-one, Sally revealed that Rick was an alcoholic and had been getting drunk almost every day for years. This often caused fights with their teenage daughter and left the family on pins and needles. None of this had come out previously. Also, Sally disclosed how depressed Rick had been, perhaps even suicidal at times, and how hopeless she felt about the marriage. At the same time, Sally felt that if she simply tolerated the situation and tried to be supportive to Rick, he might come around and be a better husband and become happier with his life. I pointed out that this “ignore it and see what happens” strategy hadn’t worked yet in the last ten years. Sally agreed but said, “I don’t see any other way except to leave him,and how could I do that to the family?”

 

So, over the next few months, we explored Sally’s way of trying to control and manage her husband and her internal objects in an effort to win their love, prevent their collapse and/or enraged revenge, and to prove how  loyal and nice she was, denying any ill feelings along the way. I interpreted a pattern of focusing on and controlling the object as a way to avoid being

needy or ever having her own desires, which she imagined would hurt and/or enrage the object. In this need-free zone, Sally never had to ask, never had to be disappointed, and never had to face the pain of separation or loss. Control was her link to the object and a way to never face loss, rejection, or guilt.

 

As I arrived at my office for a session with Sally, I pulled in next to her. We had about five or ten minutes before our appointment. As I got out of my car, she said from her rolled-down window, “Do you need a few minutes? Take your time!” In the countertransference, I felt controlled and wanted to tell her to stop monitoring what I want, mind your own business, and be quiet since

we still have five minutes before our session. Reflecting on this feeling, I was then able to make interpretations about her need to control me and make sure I was OK, happy, and not burdened by her. Sally told me she thinks of me as “busy, needing to make phone calls, having to collect myself, deal with paperwork, and generally needing a few minutes to gather myself.” I interpreted

that she saw me in a weakened state that required her attention, healing, and management. She agreed and said she “had never really thought about it, but now that she is, she thinks she sees most people that way.” I commented that if she is surrounded by weakened, burdened people, she is going to feel anxious, guilty, and will want to control and heal us all. She said, she thinks she

“spends a lot of time doing that to people, especially my family.”

 

In a recent session, I noticed that she came in and essentially began anxiously reporting her recent “progress” and telling me how she was very uncomfortable with the idea of having to give her husband an ultimatum. After listening to this defensive apology for a bit, I interpreted that she imagined I was demanding that she stage an intervention with her alcoholic husband and either put him into rehab or divorce him. I said it must make her very anxious to feel she would have to do this to please me or get me off her back, when it wasn’t what she wanted to do. Sally said, “I do feel you want me to do that and it is scary. I feel if I take any of that kind of action, I will end up hurting somebody. And, I don’t want to do that.” I interpreted, “So, you feel caught in the middle of either disappointing me and not doing the homework you imagine I am demanding or hurting all these other people who are important to you.” She agreed and said she thought I really wanted her to “take action” and was surprised to hear otherwise. I interpreted, “When you try and control others or imagine I am trying to control you, one thing is missing from the picture. You are excluding yourself from everything. When you control us, what you need, what you feel, and how you think are hidden behind trying to please me. I think you are trying to prevent the risk of

needing me or wanting my help. By trying to help us all and save us all, you avoid wishing I could help you or save you.” Sally looked very surprised. She said, “I never have considered myself to be part of the picture. Never.”

 

In the next session, I found myself ready to demand that Sally kick her husband out of the house if he didn’t go to rehab. It’s been ten years and nothing has worked, so it’s either now or never, I reasoned with myself. I was able to reflect on this countertransference phantasy by nature of it not being my style to begin with and by the sheer intensity of the feeling. I realized it was probably

part of a projective identification process from the last session in which I had been partly affected by Sally’s own desire to control and fix mixed with her chronic resentment and impatience over her husband’s long-standing alcoholism and depression.

So, I used this insight to now interpret that she may be taking my attention to her own needs and desires as a signal to be selfish, forceful, and mean. In other words, to Sally, paying attention to herself and her feelings meant being greedy and demanding. So, to protect her objects, she ignored her own needs. In response, Sally breathed a sigh of relief and said, “I really thought you were

going to come down hard on me and say I should take action now. I don’t want to do that, I don’t want to hurt him, especially when he is so down.” I repeated my interpretation, saying, “You are surprised I am thinking of you and your needs, since you never do. But, I think you worry that focusing on your needs means unleashing this demanding, mean person.” Sally started to cry and said, “I don’t know how to be me, I worry I could be asking for too much.”

 

As we proceeded to talk about her wish to fix her husband and find some way to “make him whole again” and “save him from this terrible place he seems so lost in,” I interpreted that she wanted a guarantee of love and attention instead of the terrible place she would feel lost in if she let go and

took care of herself. I said she was very much afraid of loss and loneliness, so she kept that away by keeping her finger in the dike no matter what. Sally responded, “I am afraid of letting Rick down, leaving him on his own when he is so unstable and helpless. I don’t want to let him down.” I interpreted, “You feel that, plus I think you are worried about letting me down, so you must feel

trapped in the middle,” alluding to her frequent oedipal position of feeling in the middle of two issues or objects and having to find a way to be in charge and control of the outcome at any cost.

Sally told me, “I do feel that way. I always end up feeling like I am in the middle of a mess, trying to sort it out and keep things going.” I interpreted, “You say you do that to be good to the other person and please us all. But, I think the bigger reason is you are afraid we won’t love you if you stop controlling

 

us. In other words, it looks like you are trying to force others to like you and love you and that you are very afraid that if you let go, we won’t care, and you will be all alone.” Sally started to cry and nodded yes.

 

In a recent session, Sally told me she was proud of herself and wanted to share “some examples of finally standing up for myself.” She told me of how she had told her husband that she was “really turned off by his rude and selfish behavior at a family dinner over the weekend.” And, she had told him that she was sick of having to cover for his chores when he disappeared for a drink

and never comes back to do the laundry or leaves everything in the washing machine. This was indeed a different way for Sally to be relating, actually thinking of how she felt and how he was impacting her.

 

At the same time, in the countertransference, I felt she was trying to impress me a bit. So, I asked her if she was sharing this victory for her own sake or to make me feel good too. She said, “Well, I felt good for myself, but I also noticed that I was hoping the more I took care of myself, maybe Rick would start to want to take care of himself.” I said, “It is very hard for you to not keep an eye on the other person, to make sure we are going to be OK. Without us being happy or well, you are worried where you are?” Here, I introduced the idea that Sally controlled us for her own benefit, not just for the benefit of the object.

 

Sally said, “I don’t know if I could make it own my own. I need him, and he needs me. I know that sounds sick, but I feel like I need to have some kind of backup plan if I need help. I don’t think I could take care of myself.” With my gentle probing, Sally explained that she not only saw her husband as “on the edge and needing constant care and attention” but herself as constantly on

the edge of loneliness and desolation. In fact, I wondered if she used her role of caretaker for him to defend against a much more primitive and hopeless sense of herself, as someone unable to function without the constant attachment of someone, anyone.

 

So, first I said, “It looks like you are the caretaker and nurse for him and he is nurse and caretaker for you. And, it looks like you are worried that if you don’t have him around, you will perish.” Sally thought about it for a few minutes and said, “I feel I will probably become frail and demented in so many years. I don’t think I will be able to take care of my finances alone. I

don’t want to give up the comforts I have now and I don’t want to face what seems like a nightmare out there in the future. At least I would have someone to watch over me and guide me in the right direction if I wasn’t able to take care of myself. I don’t know when I will need him that way but I want to be sure I have it figured out now.” I said, “It looks like you are already feeling

that you hang on by a thin thread and without him you will perish. Without your caretaker, it will be fatal.” Sally replied, “Fatal is a good word. That is exactly how it feels. It will be fatal.”

 

摘自著作：Robert Waska  《The Modern Kleinian Approach to Psychoanalytic Technique_ Clinical Illustrations》pp.51-55

 

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