Chefetz Richard A
a Institute of Contemporary Psychotherapy & Psychoanalysis , Washington , D.C. , USA.
J Trauma Dissociation. 2017 May-Jun;18(3):465-475. doi: 10.1080/15299732.2017.1295428. Epub 2017 Feb 16.
The identified "problem self-state" in a dissociative disorder consultation is like the identified patient in a family therapy; the one who is identified may have an assigned role to be blamed which serves the function of deflecting the activities of painful self-states in other family members. In consultation, the "family" includes the therapist in addition to the patient. When the state identified as a problem self-state is an abuser/protector self-state, complications often involve the profound nature of transference-countertransference enactments between patient and therapist, the delusion of separateness, chronic and acute threats of suicide, negative therapeutic reactions, and the evocation of intense negativity. They also involve affect phobia in both patient and therapist, and the emergence of intense shame in the clinical dyad amongst additional potential burdens in these complicated treatments. The task of the consultant is to protect both patient and therapist from an untoward outcome while relieving the painful burdens entailed by the treatment. The typical core dynamic of the abuser/protector state is as a repository for shame/humiliation welded to anger/rage. This dynamic, and others, must be understood in order to resolve these impasses and create useful movement toward growth in both patient and therapist.
在分离性障碍咨询中识别出的“问题自我状态”类似于家庭治疗中被认定的患者；被认定的一方可能被赋予了受指责的角色，这起到了转移其他家庭成员痛苦自我状态活动的作用。在咨询中，“家庭”除了患者还包括治疗师。当被认定为问题自我状态的是施虐者/保护者自我状态时，并发症通常涉及患者与治疗师之间移情 - 反移情表现的深刻性质、分离妄想、慢性和急性自杀威胁、消极治疗反应以及强烈消极情绪的唤起。它们还涉及患者和治疗师双方的情感恐惧症，以及在这些复杂治疗的其他潜在负担中，临床二元组中强烈羞耻感的出现。咨询者的任务是保护患者和治疗师免受不良后果，同时减轻治疗带来的痛苦负担。施虐者/保护者状态的典型核心动力是作为与愤怒/狂怒相联系的羞耻/羞辱的储存库。为了解决这些僵局并在患者和治疗师双方都朝着成长方向产生有益进展，必须理解这种动力以及其他动力。
