Sorensen Barbara, Abbass Allan, Boag Simon
Macquarie University, NSW, Australia.
Professor, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
Psychodyn Psychiatry. 2019 Fall;47(3):291-316. doi: 10.1521/pdps.2019.47.3.291.
In this article, we review Davanloo's metapsychology of the unconscious and how it can contribute to the current psychodynamic understanding and treatment of psychosis. In this framework, current attachment and emotions become connected with unconscious conflict-laden feelings about early attachment trauma at the core of the unconscious conflict. These conflict-laden feelings mobilize unconscious anxiety and defenses, which are alongside or, in and of themselves, constitute the entire picture of psychosis. Those patients with low emotional capacities are provided specific therapeutic techniques to bolster anxiety tolerance while those more defended patients are offered means to begin to accept and experience the feelings they have about present and past adverse experiences including those caused by psychosis itself. Case and case series research have shown this model to be clinically effective and cost effective as an adjunct to care. Case vignettes will describe the assessment of capacities and treatment frame for patients with a history of psychosis. Davanloo's metapsychology of the unconscious offers an important contribution to the current psychodynamic understanding of psychosis by considering the role of attachment, emotions and unconscious conflict and addressing these through specific psychodynamic interventions.
在本文中，我们回顾了达万卢的无意识元心理学，以及它如何有助于当前对精神病的心理动力学理解和治疗。在这个框架中，当前的依恋和情感与无意识中关于早期依恋创伤的充满冲突的情感相联系，而这些情感处于无意识冲突的核心。这些充满冲突的情感会引发无意识焦虑和防御机制，它们要么与精神病的整体情况并存，要么本身就构成了精神病的全貌。对于那些情绪能力较低的患者，会提供特定的治疗技术来增强焦虑耐受性，而对于那些防御性更强的患者，则会提供方法，让他们开始接受并体验自己对当前和过去不良经历（包括由精神病本身引起的经历）的感受。病例和病例系列研究表明，作为护理的辅助手段，该模型在临床上有效且具有成本效益。病例 vignettes 将描述对有精神病病史患者的能力评估和治疗框架。达万卢的无意识元心理学通过考虑依恋、情感和无意识冲突的作用，并通过特定的心理动力学干预来解决这些问题，为当前对精神病的心理动力学理解做出了重要贡献。
