Zerbe Kathryn J
J Am Psychoanal Assoc. 2019 Feb;67(1):185-214. doi: 10.1177/0003065119826624.
The impact and complex nature of keeping secrets deserves greater scrutiny within psychoanalysis. While the capacity to keep a secret is a developmental achievement that furthers conscious choice and healthy boundary setting between self and others, an individual's need for privacy must be distinguished from untoward costs of collusion and concealment. Clinical case material shows that not all secrets are unconscious or multilayered, as assumed in most of the psychoanalytic literature. Nonetheless, in these cases deleterious effects to psyche and soma took root. These patients assumed that their secret was irreparably destructive to an essential object relationship; shame, guilt, narcissistic vulnerability, unconscious identification with an injured party, and developmental deficit were other factors found to undergird this mode of pathogenic dissembling. Two clinical examples also demonstrate that embodied countertransference reactions may herald the revelation of a secret in treatment that had been hidden, but in plain view. Secrets appear to exert their profound psychological and physical effects on patient and analyst by biological mechanisms that are as yet poorly understood but are readily observed in clinical practice. Psychoanalysts who keep in conscious awareness both the adaptive value and the potential costs of maintaining the confidences of others over the course of a career are better positioned to assist their patients and themselves in rendering essential self-care.
在精神分析领域，保守秘密的影响及复杂本质值得更深入的审视。尽管保守秘密的能力是一项发展成就，它有助于促进有意识的选择以及自我与他人之间健康的边界设定，但个人对隐私的需求必须与勾结和隐瞒所带来的不良代价区分开来。临床案例材料表明，并非所有秘密都如大多数精神分析文献所假设的那样是无意识的或多层次的。然而，在这些案例中，对心理和身体的有害影响却已生根发芽。这些患者认为他们的秘密会对一段重要的客体关系造成无法挽回的破坏；羞耻、内疚、自恋的脆弱性、对受伤一方的无意识认同以及发展缺陷是被发现支撑这种致病性伪装模式的其他因素。两个临床例子还表明，身体层面的反移情反应可能预示着治疗中一个隐藏但又显而易见的秘密即将被揭示。秘密似乎通过一些生物学机制对患者和分析师产生深刻的心理和生理影响，这些机制目前还知之甚少，但在临床实践中却很容易观察到。在职业生涯中始终有意识地意识到保守他人秘密的适应性价值和潜在代价的精神分析师，更有能力帮助他们的患者和自己进行必要的自我关怀。
