Ogden Thomas H
306 Laurel Street, San Francisco, CA 94118, USA.
Int J Psychoanal. 2007 Jun;88(Pt 3):575-89. doi: 10.1516/pu23-5627-04k0-7502.
Many patients are unable to engage in waking-dreaming in the analytic setting in the form of free association or in any other form. The author has found that "talking-as-dreaming" has served as a form of waking-dreaming in which such patients have been able to begin to dream formerly undreamable experience. Such talking is a loosely structured form of conversation between patient and analyst that is often marked by primary process thinking and apparent non sequiturs. Talking-as-dreaming superficially appears to be "unanalytic" in that it may seem to consist "merely" of talking about such topics as books, films, etymology, baseball, the taste of chocolate, the structure of light, and so on. When an analysis is "a going concern," talking-as-dreaming moves unobtrusively into and out of talking about dreaming. The author provides two detailed clinical examples of analytic work with patients who had very little capacity to dream in the analytic setting. In the first clinical example, talking-as-dreaming served as a form of thinking and relating in which the patient was able for the first time to dream her own (and, in a sense, her father's) formerly unthinkable, undreamable experience. The second clinical example involves the use of talking-as-dreaming as an emotional experience in which the formerly "invisible" patient was able to begin to dream himself into existence. The analyst, while engaging with a patient in talking-as-dreaming, must remain keenly aware that it is critical that the difference in roles of patient and analyst be a continuously felt presence; that the therapeutic goals of analysis be firmly held in mind; and that the patient be given the opportunity to dream himself into existence (as opposed to being dreamt up by the analyst).
许多患者无法在分析情境中以自由联想或任何其他形式进行白日梦。作者发现，“像做梦一样交谈”已成为一种白日梦形式，在这种形式中，此类患者能够开始梦到以前无法梦到的经历。这种交谈是患者与分析师之间一种结构松散的对话形式，其特点通常是原发性思维和明显的逻辑跳跃。从表面上看，像做梦一样交谈似乎是“非分析性的”，因为它可能“仅仅”是谈论诸如书籍、电影、词源学、棒球、巧克力的味道、光的结构等等话题。当分析“进展顺利”时，像做梦一样交谈会不知不觉地融入和脱离对梦的谈论。作者提供了两个详细的临床案例，展示了与在分析情境中几乎没有做梦能力的患者进行分析工作的情况。在第一个临床案例中，像做梦一样交谈作为一种思考和联系的形式，患者首次能够梦到她自己（从某种意义上说，还有她父亲）以前无法想象、无法梦到的经历。第二个临床案例涉及将像做梦一样交谈用作一种情感体验，在这种体验中，以前“隐形”的患者能够开始梦到自己的存在。分析师在与患者进行像做梦一样交谈时，必须敏锐地意识到，至关重要的是要持续感受到患者和分析师角色的差异；要牢记分析的治疗目标；并且要给患者机会梦到自己的存在（而不是由分析师凭空想象出来）。
