Selzer M A, Carsky M
Department of Psychiatry, New York Hospital Cornell Medical Center, White Plains 10605.
Am J Psychother. 1990 Oct;44(4):506-15. doi: 10.1176/appi.psychotherapy.1990.44.4.506.
When something in common can be found to establish relatedness; when therapists can trust that the patients will eventually be able to contain their destructiveness and that on some level they struggle with their pathology, then patients begin to identify with their therapists and with those aspects within themselves. This activity requires that first a climate of safety, based on a frame, be established. Once it is established, the search for the common "thing"--the organizing object--and the ability to work with it can go on with far less distraction. Along the way, therapists insist that words can be used to convey meaning, creating the climate for eventual interpretation. In the case described, the therapist made it clear that he disagreed with the patient's delusional viewpoint, but at the same time was interested in hearing the material as a source of ideas about how the patient experienced her world, and how to discover what remained of her capacity for self observation and nonpsychotic thought. The therapist's acceptance of the need for such a preliminary phase may make it possible for severely resistant patients to become engaged with those treating them.
当能够找到一些共同之处来确立关联性时；当治疗师能够相信患者最终能够控制自己的破坏性，并且在某种程度上他们与自己的病理状态作斗争时，患者就开始认同他们的治疗师以及自身的那些方面。这项活动首先需要建立一种基于框架的安全氛围。一旦建立起来，寻找共同的“东西”——组织性客体——以及与之合作的能力就可以在干扰少得多的情况下继续进行。在此过程中，治疗师坚持认为言语可以用来传达意义，为最终的解释创造氛围。在所描述的案例中，治疗师明确表示他不同意患者的妄想观点，但同时有兴趣将这些素材作为了解患者如何体验她的世界以及如何发现她自我观察和非精神病性思维能力残余的想法来源。治疗师接受这样一个初步阶段的必要性，可能会使严重抗拒的患者能够与治疗他们的人建立联系。
