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社会危机时期的精神分析心理治疗:对治疗关系的影响。

Psychoanalytic psychotherapy in times of social crisis: The impact on therapeutic relationship.

作者信息

Soumaki Eu, Anagnostopoulos D C

机构信息

The "Spyros Doxiadis" Diagnostic & Therapeutic Unit for Children.

Department of Child Psychiatry, Medical School, National and Kapodistrian University of Athens, Children's Hospital of Athens "Agia Sofia", Athens, Greece.

出版信息

Psychiatriki. 2018 Jul-Sep;29(3):257-263. doi: 10.22365/jpsych.2018.293.257.

Abstract

Discussion on defining therapy factors develops along two lines: one focusing on the interpretation and another focusing on the relationship. Changes in the socio-economic circumstances, cultural particularities, dismissal of institutions, constant negation, lack of boundaries, confusion of roles, various family secrets revealed due to "collapses," major conflicts, violence and aggression filling the individual as part of both the internal and the external reality - all are known risk factors causing the individual to experience trauma either due the nature of the received stimuli/threats or due to the loss of the enabling/supportive environment. Also, this situation affects the analyst's psychic structure as well. The analyst will have to strike a balance between their own internal objects, which under the circumstances activate the analyst's own suppressed conflicts, and the multiple intense projections of the analysand. First of all, the internal struggles taking place in the analyst's psychism regarding their own griefs, frustrations, and conflicts concerning their adjustment to the current reality, as well as individual griefs relating to their narcissistic doubts and the projections of omnipotence they receive. The question is whether the analyst will go through a destabilization process, being overwhelmed by psychic stimuli in multiple levels, or react with "manic defences" resulting, perhaps, in the prevalence of anti-psychoanalytic dynamics on the transference - countertransference axis. A second line of thought involves the internal struggles taking place in the psychic structure of the analysand, and often the "meeting" of the latter with the analyst through the "parallel process." Finally, we think about the multiple - due to psychic tensions - instances of enacting (or acting out) and the setting being put to the test in terms of frequency, fees, difficulty of symbolic processing, and aggressiveness towards the interpretations and demands of the analyst as object introjected to the superego and requiring "compliance" to certain standards, the setting principles. We refer to the internal processes resulting from conflicts in the therapists' psychic structure as regards their own internal objects, life experiences, frustrations in relation to the parent/authority, adolescent conflicts with the system, political views, life philosophy, and sense of fairness. Issues are more complex in the therapy of children and adolescents. Their mental condition is affected by that of their parents. When it is hard for the therapist to become an object of identification and idealization, since all institutions around them have been undermined, confirming the adolescent's guilt-ridden fantasy aggression? How, then, will the therapeutic process move forward when models crumble; when parents are being proved weak and unable to receive the aggressiveness of the independence-gaining process; and when reverie fantasies cease to exist? Today, more and more often we see adolescents who cannot develop because they are involved in their own parents' unprocessed situations. Despite the aforementioned difficulties, the therapy space as a setting with boundaries and empathetic functions could function as a "womb" that will give birth to new mental life. And this life will bloom as long as therapists preserve intact within them their values and principles - and their ability for reverie!

摘要

关于治疗因素定义的讨论沿着两条线索展开

一条侧重于阐释,另一条侧重于关系。社会经济环境的变化、文化特性、机构的解散、持续的否定、缺乏界限、角色的混淆、由于“崩溃”而暴露的各种家庭秘密、重大冲突、充斥着个体内心与外部现实的暴力和攻击——所有这些都是已知的风险因素,会使个体因所接收的刺激/威胁的性质或因失去支持性环境而经历创伤。此外,这种情况也会影响分析师的心理结构。分析师必须在自身内部客体(在这种情况下会激活分析师自身被压抑的冲突)和分析对象的多重强烈投射之间取得平衡。首先,分析师内心发生的内部斗争涉及他们自身的悲伤、挫折以及与适应当前现实相关的冲突,还有与他们的自恋疑虑以及所接收到的全能投射相关的个人悲伤。问题在于分析师是否会经历一个失稳过程,被多层次的心理刺激压垮,或者以“躁狂防御”做出反应,这可能导致在移情 - 反移情轴上反精神分析动力占主导。第二条思路涉及分析对象心理结构中发生的内部斗争,而且通常是后者通过“平行过程”与分析师的“相遇”。最后,我们思考由于心理紧张而出现的多重付诸行动(或 acting out)的情况,以及在频率、费用、象征处理的难度以及对作为内摄到超我中的对象且要求“遵守”某些标准(即设置原则)的分析师的解释和要求的攻击性方面对设置进行的检验。我们将治疗师心理结构中因自身内部客体、生活经历、与父母/权威相关的挫折、与系统的青少年冲突、政治观点、生活哲学和公平感等冲突而产生的内部过程称为问题。在儿童和青少年治疗中,问题更为复杂。他们的心理状况受其父母的影响。当治疗师难以成为认同和理想化的对象时,因为他们周围的所有机构都已被破坏,这是否证实了青少年充满内疚的幻想性攻击?那么,当模式崩溃、父母被证明软弱且无法承受争取独立过程中的攻击性、幻想不再存在时,治疗过程将如何推进?如今,我们越来越多地看到青少年因卷入父母未处理的情况而无法成长。尽管存在上述困难,作为具有界限和共情功能的设置的治疗空间可以起到“子宫”的作用,孕育新的心理生活。只要治疗师在内心保持其价值观和原则以及幻想能力,这种生活就会绽放!

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