Williams Paul
Bengers Cottage, Bengers Lane, Mottisfont, Hampshire SO51 0LR.m, UK.
Int J Psychoanal. 2014 Jun;95(3):423-40. doi: 10.1111/1745-8315.12141. Epub 2014 Mar 12.
The author reviews some clinical experiences of the treatment of personality disordered patients suffering from internal domination of ego functioning by a defensive pathological organization. In particular, the function and purpose of perverse, sadistic attacks by the organization on the ego are considered and questions pertaining to technique are raised. It is suggested that different forms of sadistic, subjugating activity by pathological organizations may denote differences in intent borne of the type and severity of the psychopathology of the individual. Patients with severe narcissistic psychopathology for whom object contact has become associated with the arousal of intense psychotic anxieties seem more likely to be subjected to an invasive, annihilatory imperative by the pathological organization, the purpose of which appears to be to obliterate the experience of contact with any differentiated object, to avoid emotion and to use coercion to enforce a primitive identification by the ego with the psychotic organization in the mind. Certain patients with less severe narcissistic psychopathology, yet for whom object contact can also be associated with the arousal of psychotic anxieties due to intense or persistent conflict with the object, sometimes expressed as organized sadomasochistic clinging to a punishing and punished object (for example, in certain borderline or depressed patients) exhibit sadistic attacks that serve less to annihilate object contact and more to intrusively control and punish the object. Observations of these phenomena have been made by a number of psychoanalysts in recent decades and these contributions are discussed. This paper is addressed primarily to the implications for technique with such patients, particularly a need for triangulation of their experiences of oppression in order to loosen the controls over the ego by the pathological organization.
作者回顾了一些治疗人格障碍患者的临床经验，这些患者的自我功能受到防御性病理组织的内在支配。特别探讨了该组织对自我进行变态、施虐攻击的功能和目的，并提出了与治疗技术相关的问题。研究表明，病理组织的不同形式的施虐、征服行为可能表明个体心理病理学类型和严重程度所导致的意图差异。对于患有严重自恋心理病理学的患者，客体接触已与强烈的精神病性焦虑的唤起相关联，这类患者似乎更有可能受到病理组织的侵入性、毁灭性指令的影响，其目的似乎是消除与任何分化客体接触的体验，避免情感，并使用强制手段迫使自我在心理上与精神病性组织进行原始认同。某些自恋心理病理学不太严重的患者，然而由于与客体的强烈或持续冲突，客体接触也可能与精神病性焦虑的唤起相关联，有时表现为对惩罚与被惩罚客体的有组织的施虐受虐式依恋（例如，在某些边缘型或抑郁患者中），他们表现出的施虐攻击较少用于消除客体接触，而更多用于侵入性地控制和惩罚客体。近几十年来，许多精神分析学家对这些现象进行了观察，并对这些贡献进行了讨论。本文主要探讨这些现象对治疗这类患者技术的影响，特别是需要对他们的压迫经历进行三角测量，以放松病理组织对自我的控制。
