Kim Eugene H, Gray Sheila Hafter
Tripler Army Medical Center, Honolulu, HI, USA.
J Am Acad Psychoanal Dyn Psychiatry. 2009 Fall;37(3):421-37. doi: 10.1521/jaap.2009.37.3.421.
Complicating the management of the transference-countertransference set for the military psychiatrist is the dilemma of dual agency. This can be a hidden force in the work of most psychiatrists but it is continuous in the field of military health care. The military clinician must candidly engage with this dilemma as it is intrinsic to the mission, "to conserve the fighting strength." In the conduct of a dynamic psychotherapy, the military psychiatrist must craft ways simultaneously to attain both the needs and interests of the individual patient and those of the organization of which he or she is a member. Presented in this article is a case in which the dual agency dilemma manifested itself between the patient and military therapist within the transference-countertransference set. The discussion will center around (a) how this ubiquitous dilemma may present and affect the progress of a psychotherapy, and (b) interventions that will help resolve the conflict. Time honored psychoanalytic principles guiding these interventions include maintenance of therapeutic neutrality, recognition of the therapist's bright and blind spots, and awareness of patterns in the patient's current and past relationships.
军事精神科医生在处理移情 - 反移情关系时面临的一个复杂问题是双重代理困境。这在大多数精神科医生的工作中可能是一种隐性力量，但在军事医疗领域却持续存在。军事临床医生必须坦诚地面对这一困境，因为它是“保持战斗力”这一使命所固有的。在进行动态心理治疗时，军事精神科医生必须设法同时满足个体患者的需求和利益以及他或她所属组织的需求和利益。本文介绍了一个案例，其中双重代理困境在移情 - 反移情关系中患者与军事治疗师之间显现出来。讨论将围绕以下两点展开：（a）这种普遍存在的困境可能如何呈现并影响心理治疗的进程，以及（b）有助于解决冲突的干预措施。指导这些干预措施的长期以来的精神分析原则包括保持治疗中立性、认识治疗师的优点和盲点，以及了解患者当前和过去关系中的模式。
