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Am J Psychoanal. 2022 Sep;82(3):456-479. doi: 10.1057/s11231-022-09371-w.
The use of the empathic mode for engaging and communicating with patients has become widely accepted by many psychoanalytic psychotherapists since Kohut's early formulations (Kohut, 1971; Atwood & Stolorow, 2014). However, diagnostic understanding based on ongoing empathic immersion with our patients is often complicated because it is continually being modified as we know them more deeply and as transference and countertransference factors influence our perceptions. To illustrate the complexity of diagnosis when it is grounded in ongoing empathic engagement with our patients, I describe in detail my treatment of an elderly woman who initially presented with severe and acute symptoms of psychological, cognitive, and physical impairment. As the treatment has progressed, my diagnostic understanding has been continually modified to include a combination of psychodynamic and organic factors including PTSD, intense unresolved grief, and extreme feelings of guilt and need for punishment. Adding further to this conundrum, I have been frequently challenged by my own responses to the fluctuations in her progress, especially to periods of hopefulness followed by periods of despair and regression.
自科胡特早期的论述（Kohut, 1971; Atwood & Stolorow, 2014）以来，许多精神分析心理治疗师广泛接受了共情模式在与患者接触和沟通中的运用。然而，基于与患者持续共情沉浸的诊断理解往往很复杂，因为随着我们对他们的了解加深，以及移情和反移情因素影响我们的认知，这种理解会不断改变。为了说明当诊断基于与患者持续共情参与时的复杂性，我详细描述了我对一位老年女性的治疗，她最初表现出严重和急性的心理、认知和身体损伤症状。随着治疗的进展，我的诊断理解不断被修改，包括包括创伤后应激障碍、强烈未解决的悲伤、极度内疚感和需要惩罚的心理动力和身体因素的组合。更复杂的是，我经常受到自己对她病情波动的反应的挑战，尤其是在充满希望的时期之后，接着是绝望和倒退的时期。
