Kantrowitz Judy L
Boston Psychoanalytic Institute, Harvard Medical School, 334 Kent St, Brookline, MA 02446, USA.
Int J Psychoanal. 2008 Apr;89(2):355-68. doi: 10.1111/j.1745-8315.2008.00039.x.
In this paper, I wish to illustrate how working with a patient who had a certain kind of narcissistic difficulty led me to develop particular clinical strategies to facilitate the development of a sturdier sense of self, greater affect tolerance and modulation, the diminution of harshness of her superego, and the ownership of projected parts of herself, and to decrease paranoid ideation. I call upon concepts from various theoretical schools of psychoanalysis to make sense of the dynamic intricacies of the patient's psychological organization as they revealed themselves in the analytic process. These conceptualizations of the patient's difficulties and of clinical interventions to address them result in a hybrid theory of both theory and technique. What transpired in the clinical work also led me to propose an additional way to understand this kind of patient's difficulties with accepting interpretations or any view that differed from the patient's subjectivity. I am proposing that 'otherness' itself, rather than only specific conflictual aspects of the self, is disowned. It is the analyst's empathic stance toward all that is repudiated--the specific disowned aspects of the self and 'otherness' itself--along with empathy for the patient's conscious state that will enable reinternalization and ultimately healing.
在本文中，我希望说明与一位存在某种自恋困难的患者一起工作是如何引导我制定特定的临床策略，以促进更稳固的自我意识的发展、更强的情感耐受和调节能力、超我严苛性的减轻、她自身投射部分的归位，并减少偏执观念。我借鉴了精神分析各理论流派的概念，以便理解患者心理组织的动态复杂性，这些复杂性在分析过程中得以展现。对患者困难及应对这些困难的临床干预的这些概念化，形成了一种理论与技术相结合的混合理论。临床工作中发生的事情还促使我提出另一种方式，来理解这类患者在接受与患者主观性不同的解释或任何观点时所遇到的困难。我提出，被否认的是“他者性”本身，而不仅仅是自我的特定冲突方面。正是分析师对所有被拒绝之物——自我的特定被否认方面和“他者性”本身——的共情立场，以及对患者意识状态的共情，将促成重新内化并最终实现治愈。
