Chessick R D
Am J Psychother. 1981 Oct;35(4):489-501. doi: 10.1176/appi.psychotherapy.1981.35.4.489.
The fundamental practical premises underlying the practice of intensive psychotherapy are investigated in this article. Based on ego-psychology orientation, mental illness is classified in terms of premature ego development, ego distortions, ego deviations, ego regression, and ego defects. General healing factors are reviewed, first as presented, for example, in Frank's "demoralization hypothesis." The forms of psychotherapy may be classified in terms of how they approach the problem of demoralization and failure of ego adaptation, into counseling, supportive, reeducative, and psychoanalytic. Intensive psychotherapy is conceived of as a derivative discipline of psychoanalysis. It is different in that the goals are more limited, and active interventions ("parameters" or "departures") are often unavoidably called for, making it less "neat and orderly," more taxing on the therapist, and more of an art. It is similar in that an emphasis on the patients' spontaneous associations and an attempt to retain analytic neutrality as much as possible leads to the formation of transferences and resistances which may be dealt with by interpretation. However, full-blown transference neuroses usually do not form as in classical psychoanalysis, limiting the depth and extensiveness of the procedure. Intensive psychotherapy is the treatment of choice for selected cases of schizophrenia, severe personality disorders, and psychosomatic conditions.
本文探讨了强化心理治疗实践背后的基本实际前提。基于自我心理学取向,精神疾病根据自我发展早熟、自我扭曲、自我偏差、自我退行和自我缺陷进行分类。回顾了一般的治愈因素,首先如弗兰克的“士气低落假说”中所呈现的那样。心理治疗的形式可以根据它们处理士气低落和自我适应失败问题的方式进行分类,分为咨询、支持性、再教育性和精神分析性。强化心理治疗被视为精神分析的一个衍生学科。它的不同之处在于目标更为有限,并且常常不可避免地需要积极干预(“参数”或“偏离”),这使得它不那么“整齐有序”,对治疗师的要求更高,更像是一门艺术。它的相似之处在于,强调患者的自发联想并尽可能保持分析中立会导致移情和阻抗的形成,这些可以通过解释来处理。然而,通常不会像经典精神分析那样形成全面的移情神经症,这限制了该过程的深度和广度。强化心理治疗是某些精神分裂症、严重人格障碍和身心疾病病例的首选治疗方法。