Parson E R
J Am Acad Psychoanal. 1986 Jul;14(3):349-75. doi: 10.1521/jaap.1.1986.14.3.349.
In this paper I have discussed two types of transference manifestations to an institution; namely, the "VA Medical Center transference syndrome" (VATS) and the "VA medical center split transference syndrome" (VAST). Transference to an institution was identified as an important issue deserving the attention of psychotherapists and psychoanalysts. Two case studies illustrated the dynamics of these two transference phenomena. Moreover, as a consequence of exposure to traumatic war experiences in Vietnam, these two illustrative cases portrayed a strong tendency to splitting dynamics and fragmenting ego operations inherent in what has been referred to here as "post-traumatic borderline personality disorder" (p-TBPD). In the VATS case, the patient struggled with intense feelings of dissociated and repressed guilt over the five men killed and two severely wounded in Vietnam for which he believed himself to be responsible. Initially, the patient had denied he felt responsible and guilty over this tragic event; however, later as trust developed and intense paranoid defenses were attenuated, these painful memories were expressed in vivid detail. His affective attachment or transference to the VA Medical Center was an "instrumental transference" in that it served the purpose of giving him the sense of protection from his guilt-ridden ego and harsh, punitive superego. The task of the treatment was to first establish trust through emphasizing the "real" relationship and fostering the idealizing transference. Through the idealizing transference, the patient began to decathect from the VAMC as his sole protective object. With this patient the "real" relationship was essential in assisting him to relinquish his transference hold on the VAMC and embark on "the road to recovery" (Brende and Parson, 1985). The VAST case portrayed the situation in which the veteran "bifurcates" his transference responses--one to therapist, the other to the VAMC. As in the VATS case, it was essential to emphasize the real relationship, maintaining an active intervening stance, while fostering the idealizing transference.(ABSTRACT TRUNCATED AT 400 WORDS)
在本文中，我讨论了两种向机构的移情表现形式，即“退伍军人事务部医疗中心移情综合征”（VATS）和“退伍军人事务部医疗中心分裂移情综合征”（VAST）。向机构的移情被认定为一个重要问题，值得心理治疗师和精神分析学家关注。两个案例研究阐释了这两种移情现象的动态过程。此外，由于在越南经历了创伤性战争体验，这两个案例展现出一种强烈的倾向，即存在于此处所谓“创伤后边缘型人格障碍”（p-TBPD）中的分裂动态和自我运作碎片化。在VATS案例中，患者因在越南导致五人死亡、两人重伤而挣扎于强烈的解离和压抑的内疚感中，他认为自己对此负有责任。起初，患者否认自己对此悲剧事件负有责任和内疚感；然而，后来随着信任的建立以及强烈的偏执防御减弱，这些痛苦的记忆被详细生动地表达出来。他对退伍军人事务部医疗中心的情感依恋或移情是一种“工具性移情”，因为它起到了保护他免受充满内疚的自我和严苛、惩罚性超我的影响的作用。治疗的任务首先是通过强调“真实”关系并培养理想化移情来建立信任。通过理想化移情，患者开始减少对退伍军人事务部医疗中心作为其唯一保护对象的情感投入。对于这个患者，“真实”关系对于帮助他放弃对退伍军人事务部医疗中心的移情依赖并踏上“康复之路”（布伦德和帕森，1985）至关重要。VAST案例描绘了退伍军人将其移情反应“一分为二”的情形——一种指向治疗师，另一种指向退伍军人事务部医疗中心。与VATS案例一样，强调真实关系、保持积极的干预立场并培养理想化移情至关重要。（摘要截选至400字）
