Dorfman Lerner B
Acta Psiquiatr Psicol Am Lat. 1981 May;27(2):107-15.
In this paper I intend to present the different aspects of cotherapy as a teaching function beginning by the definition of the concept and its two meanings: the large one (the totality of means implemented in the treatment of a patient, (P.) and the narrow one (therapy session with two therapists who are present simultaneously). Then I carry on to the need of a basic agreement in therapeutic ideology and of permeability in the therapeutic team (T.T.) for mutual suggestions. I point to the advantages of the inclusion of the inexperienced therapist in the sessions, taping and observation through the Gesell chamber for the formation of therapists. Next there is a division of the treatment period in three stages; pre-session (the stage previous to the initiation of cotherapy for the first time and from then on previous to each one of the following sessions), the session (in which a therapeutic, a teaching and an intrapersonal period are differentiated and the post-session (in which the above mentioned periods are made explicit, are thought over and the therapeutic project is constantly adjusted. The advantages of the cotherapy for the P. are also mentioned. They are: a) betterment of the contention of the P. when his anxiety expresses itself in inadequate acting outs or is manifested in a very noisy manner; b) useful strengthening of the therapeutic action and of the making of limits: the fact that two therapists coincide in their view gives to their words more credibility and authority; c) the fact that there are two therapists instead of one makes the duplication superior to the sum of the same two therapists taken separately respect ot the offer of more information, models, views; d) a greater possibility of dramatizing roles due to the different personalities of therapists (roles that can be maintained by each therapist beyond the session period with the P.), facilitating in that way a better understanding by the P. of therapeutic interventions: e) unlike what happens with individual therapy, cotherapy allows the passage of a situation in which the third person is only included in fantasy to another in which the third one is included in the actual reality facilitating then a larger interplay between projections-introjections and its further comprehension by the P. Amongst its disadvantages there could be named: a) lack of intimacy as experienced by therapists and/or P.; b) risks of ill doing due to a T.T. wrongly combined; c) possibility of development of a "co-transference neurosis" that should require supervision by a third therapist; d) high cost to the institution. The advantages are, nevertheless, superior to the disadvantages so cotherapy is recommendable in any institution in which therapists are trained.
在本文中，我打算从联合治疗作为一种教学功能的概念定义及其两种含义入手，阐述联合治疗的不同方面：广义的（在治疗患者时所采用的全部手段）和狭义的（由两名治疗师同时在场进行的治疗环节）。接着，我论述了治疗理念达成基本共识以及治疗团队具备相互建议的渗透性的必要性。我指出让缺乏经验的治疗师参与治疗环节、通过盖塞尔观察室进行录音和观察对培养治疗师的益处。接下来，治疗期分为三个阶段：治疗前阶段（首次开展联合治疗之前的阶段，以及此后每次后续治疗之前的阶段）、治疗阶段（在此阶段区分出治疗期、教学期和人际期）以及治疗后阶段（在此阶段明确上述各个时期，进行反思并不断调整治疗方案）。文中还提到了联合治疗对患者的益处。它们是：a）当患者的焦虑以不适当的行为表现出来或以非常吵闹的方式显现时，其自控能力得到改善；b）有效增强治疗效果并设定界限：两名治疗师观点一致使他们的话更具可信度和权威性；c）有两名治疗师而非一名治疗师，在提供更多信息、模式和观点方面，两人配合的效果优于各自单独工作的总和；d）由于治疗师个性不同，更有可能使角色戏剧化（这些角色可由每位治疗师在与患者的治疗期之外保持），从而有助于患者更好地理解治疗干预措施；e）与个体治疗不同，联合治疗能使第三人仅存在于幻想中的情形转变为第三人实际参与其中的情形，进而促进投射 - 内摄之间更大的相互作用以及患者对其的进一步理解。联合治疗的缺点包括：a）治疗师和/或患者可能会感到缺乏亲密感；b）由于治疗团队组合不当存在治疗失误的风险；c）可能发展出“共同移情神经症”，这需要第三位治疗师进行监督；d）对机构而言成本较高。然而，联合治疗的优点大于缺点，所以在任何培养治疗师的机构中，联合治疗都是值得推荐的。
