Gill H S
Tavistock Clinic, London, UK.
Br J Med Psychol. 1989 Mar;62(1):1-11. doi: 10.1111/j.2044-8341.1989.tb02805.x.
In psychoanalytic treatment insight does not necessarily lead to change, because psychoanalysis has not yet integrated into its theory and technique the full significance of two determinants: (1) the resistances arising from the patient's environment, and (2) the role played by the patient's will in his/her analysis. This paper is focused on the second determinant. Freud's elucidation of repression and other defences challenged the assumption that the will operated in an uncomplicated, straightforward manner. When, however, neurotic fears, secondary gain, or guilt underlying the inhibited or misdirected will are thoroughly analysed, patients are enabled to strive for their long-range aims, as clarified during the course of their analysis. Psychoanalytic theory has not recognized the will for two reasons. (1) Its theory is committed to determinism, which does not characterize its practice. Psychoanalysis does not predict outcome as required by philosophical determinism, but traces it backwards to find that it is meaningful, and not arbitrary or purposeless. (2) It attributes 'willing' to the ego, along with other multifarious functions, which confounds the development and operation of distinct functions, and distracts attention from the phenomenological investigation of each separate function.
在精神分析治疗中，领悟并不一定能带来改变，因为精神分析尚未将两个决定因素的全部意义融入其理论和技术之中：（1）患者所处环境产生的阻抗；（2）患者的意志在其分析过程中所起的作用。本文聚焦于第二个决定因素。弗洛伊德对压抑及其他防御机制的阐释，对意志以简单、直接的方式起作用这一假设提出了挑战。然而，当对抑制或误导意志背后的神经症性恐惧、继发性获益或内疚进行彻底分析时，患者就能朝着他们在分析过程中明确的长远目标努力。精神分析理论未认识到意志有两个原因。（1）其理论秉持决定论，但这并非其实践的特点。精神分析不像哲学决定论所要求的那样预测结果，而是追溯结果以发现其具有意义，并非随意或无目的的。（2）它将“意愿”与自我的其他多种功能归为一类，这混淆了不同功能的发展和运作，分散了对每个单独功能的现象学研究的注意力。
