Eshel Ofra
Israel Psychoanalytic Society and Institute, Israel.
Psychoanal Rev. 2012 Apr;99(2):149-78. doi: 10.1521/prev.2012.99.2.149.
The paper puts forward the dimension created by analytic presence and the ensuing patient-analyst interconnectedness in the process of psychoanalytic treatment and change, particularly with more disturbed patients. Working within this dimension, at a fundamental level of contact and impact, opens up new possibilities of extending the reach of psychoanalytic treatment. The analyst's "presencing" and interconnectedness with the patient forge a living therapeutic entity that is not a one-person or two-person psychology, but an emergent two-in-one new entity that goes beyond the confines of the separate subjectivities of patient and analyst and the simple summation of the two. The paper describes the kind of knowledge, experience, and powerful therapeutic potential that comes into being through analytic "presencing" and patient-analyst interconnectedness, and particularly focuses on the chimeric element, or quality, of this interconnectedness. The term "chimera/chimerism"-chosen here for its wealth of mythological, genetic, biological, biomedicinal (chimeric proteins), and psychoanalytical associations-is used in this paper to highlight the complex quality of patient-analyst interconnectedness, especially in difficult, psychotic, psychically foreclosed, dissociative and perverse states. The author offers an extensive clinical account of psychoanalytic treatment of a patient convicted of sex offenses in order to illustrate "presencing," interconnectedness, and the extent and intricate emotional meaning of the extreme chimerism that this kind of (difficult) treatment entailed.
本文提出了在精神分析治疗与改变过程中，由分析性在场以及随之而来的患者与分析师之间的相互联系所创造的维度，尤其是针对病情更严重的患者。在这个维度内，在接触与影响的基本层面上开展工作，为扩展精神分析治疗的范围开辟了新的可能性。分析师的“在场”以及与患者的相互联系形成了一个鲜活的治疗实体，它既不是一人心理学也不是两人心理学，而是一个新出现的二合一的实体，超越了患者和分析师各自主观性的局限以及两者的简单相加。本文描述了通过分析性“在场”和患者与分析师的相互联系所产生的那种知识、体验和强大的治疗潜力，并特别关注这种相互联系的嵌合元素或特质。本文选用“嵌合体/嵌合现象”这个术语，是因其丰富多样的神话、基因、生物学、生物医学（嵌合蛋白）以及精神分析方面的关联，用以突出患者与分析师相互联系的复杂特质，尤其是在困难、精神病性、心理封闭、解离性和变态状态下。作者提供了对一名性犯罪定罪患者进行精神分析治疗的详尽临床案例，以阐释“在场”、相互联系，以及这种（困难的）治疗所涉及的极端嵌合现象的程度和错综复杂的情感意义。
