Fancher E
Psychoanal Rev. 1990 Spring;77(1):41-57.
For historical reasons, psychoanalytic psychotherapy has been regarded as a second-class treatment in comparison with psychoanalysis, and standards for training in it have lagged behind those for psychoanalysis. However, psychoanalytic psychotherapy is the treatment of choice for many healthier (or higher-level) patients who cannot receive analysis for any reason, and also for a large population of more-disturbed patients who are not appropriate for psychoanalysis. Mastering techniques of psychoanalytic psychotherapy may be as difficult as mastering those of psychoanalysis, and should require comparable theoretical training, supervision, and personal treatment. This "development lag" in the training of psychoanalytic psychotherapists has taken place for several reasons: (1) Psychoanalytic ideas first emerged in America in the context of a new movement toward an electric, but dynamic psychiatry from which psychoanalysis had to establish its separate identity. (2) Psychotherapy was associated with techniques of suggestion and manipulation from which psychoanalysis wished to separate. (3) Because psychotherapy was seen as an inferior form of therapy which required little training, institutes were slow in being established, and reluctant to require a "training analysis." It is suggested that with the full training of psychoanalytic psychotherapists, this discipline may be regarded as a profession comparable to psychoanalysis. It is further suggested that the optimal treatment for the full training of the psychoanalytic psychotherapist is psychoanalysis, and that a "training psychotherapy" is not an adequate substitute, but may provide a transitional step to resolve initial resistances and to prepare the therapist for a training analysis.
由于历史原因,与精神分析相比,精神分析心理治疗一直被视为二流治疗方法,其培训标准也落后于精神分析的培训标准。然而,精神分析心理治疗是许多因任何原因无法接受精神分析的较健康(或较高层次)患者的首选治疗方法,也是大量不适合精神分析的病情较重患者的首选治疗方法。掌握精神分析心理治疗技术可能与掌握精神分析技术一样困难,并且应该需要相当的理论培训、督导和个人治疗。精神分析心理治疗师培训方面的这种“发展滞后”有几个原因:(1)精神分析思想最初在美国出现,当时正朝着一种电子但动态的精神病学新运动发展,精神分析必须从中确立其独立身份。(2)心理治疗与暗示和操纵技术相关联,而精神分析希望与之分离。(3)由于心理治疗被视为一种低等治疗形式,所需培训很少,培训机构的建立很缓慢,并且不愿意要求进行“培训分析”。有人认为,随着精神分析心理治疗师的全面培训,这一学科可能会被视为与精神分析相当的一门专业。还有人进一步认为,对精神分析心理治疗师进行全面培训的最佳治疗方法是精神分析,“培训性心理治疗”不是一个充分的替代方法,但可能提供一个过渡步骤,以解决最初的阻抗,并让治疗师为培训分析做好准备。