Hamburg P, Herzog D
Harvard Medical School, Eating Disorders Unit, Massachusetts General Hospital, Boston 02114.
Am J Psychother. 1990 Jul;44(3):369-80. doi: 10.1176/appi.psychotherapy.1990.44.3.369.
Supervising residents, fellows, and interns conducting psychoanalytic psychotherapy with eating-disorder patients presents special problems and opportunities. The authors explore specific countertransference issues in the long-term therapy of patients with anorexia and bulimia, and describe how these issues in the therapy are often mirrored in the supervisory process. Countertransference phenomena include being secretive, intrusive, shaming, overcontrolling, overindulgent, or overidentified. Experiences associated with countertransference impasses include power struggles, despair, helplessness, and boredom. The wide range of transference and countertransference manifestations represents the difficult domain of long-term therapy with anorexic and bulimic patients, whose relationship with their eating symptom is so complex and ambivalent. Therapists in training benefit from a supervisory attitude of respect and empathy, with specific attention to countertransference difficulties as they arise. While unaddressed countertransference poses the risk of disrupting the supervision and/or the therapy, appropriate recognition and exploration of its meaning in the supervision is an especially valuable training tool in the teaching of psychodynamic psychotherapy, and a source of learning for the therapist in training, the supervisor, and ultimately the patient.
指导住院医师、研究员和实习生对饮食失调患者进行精神分析心理治疗会带来特殊的问题和机遇。作者探讨了在厌食症和贪食症患者的长期治疗中特定的反移情问题，并描述了这些治疗中的问题如何常常在督导过程中得到反映。反移情现象包括隐秘、侵扰、羞辱、过度控制、过度纵容或过度认同。与反移情僵局相关的体验包括权力斗争、绝望、无助和厌烦。广泛的移情和反移情表现代表了对厌食症和贪食症患者进行长期治疗的困难领域，他们与饮食症状的关系是如此复杂和矛盾。接受培训的治疗师受益于尊重和共情的督导态度，尤其要关注反移情困难的出现。虽然未解决的反移情存在干扰督导和/或治疗的风险，但在督导中对其意义进行适当的识别和探索是精神动力心理治疗教学中特别有价值的培训工具，并为接受培训的治疗师、督导以及最终为患者提供了学习来源。
