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[精神分析治疗中的“阐释”原则与“回应”原则。针对不同患者群体的两种治疗取向的理论基础评论]

[The "interpretation" principle and the "response" principle in psychoanalytic therapy. Comments on the theoretical foundation of two therapeutic orientations, directed at different patient groups].

作者信息

Heigl-Evers A, Nitzschke B

出版信息

Z Psychosom Med Psychoanal. 1991;37(2):115-27.

PMID:1853645
Abstract

The theoretical justification for two psychoanalytic, therapeutic offers, one of them oriented toward the principle of "interpretation" the other toward that of the "answer", is based on the differences in the psychopathology of two groups of disturbances: In the case of classical (transfer) neuroses, conflict pathology is dominant, in the case of preoedipal or ego structure disturbances, development pathology is dominant. The differences in these forms of illness are related above all to the degree of structuring of the patient. Neuroses exhibit a higher degree of structure than ego structure disturbances, if we understand 'structure' as the differentiation of the psychic apparatus in a certain number of systems with certain programs, i.e. fixed forms of organized behavior. Classical neuroses are more highly structured forms of disturbance with an oedipal superego, intra-psychic conflicts, and an ego which, as an organization process, reveals a potential for integration and a greater tolerance for frustration; they stand in contrast to less highly structured preoedipal forms of disturbance with precursors of a superego in the form of an externalization of guilt, the ego as a kind of battlefield between the id and the superego, with a low tolerance for frustration, i.e., an intolerance of failure. Therapy in these two cases must differ according to the differences in the level of organization: In the case of classical neuroses, application of the therapeutic principle of "interpretation" is indicated, in the case of ego structure disturbances, the principle of "answer" should be applied.

摘要

两种精神分析治疗方法的理论依据,其中一种以“解释”原则为导向,另一种以“回应”原则为导向,是基于两组心理障碍在精神病理学上的差异:在经典(移情)神经症的情况下,冲突病理学占主导地位;在俄狄浦斯前期或自我结构障碍的情况下,发展病理学占主导地位。这些疾病形式的差异首先与患者的结构化程度有关。如果我们将“结构”理解为心理器官在一定数量具有特定程序的系统中的分化,即有组织行为的固定形式,那么神经症比自我结构障碍表现出更高程度的结构。经典神经症是具有俄狄浦斯超我、内心冲突以及作为一种组织过程表现出整合潜力和对挫折有更大耐受性的自我的更高结构化的障碍形式;它们与结构较松散的俄狄浦斯前期障碍形式形成对比,后者具有以罪恶感外化形式存在的超我前身,自我是本我和超我之间的一种战场,对挫折耐受性低,即对失败不耐受。在这两种情况下,治疗必须根据组织水平的差异而有所不同:在经典神经症的情况下,应采用“解释”的治疗原则;在自我结构障碍的情况下,应采用“回应”原则。

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