Schafer R
Int J Psychoanal. 1994 Dec;75 ( Pt 5-6):1023-30.
There has never been a fact that has not already been conceptualised. To enter into discourse as a fact, whatever the case may be in the world that is of immediate concern must always already be symbolically mediated, that is, already a specialised version of that aspect of the world. To become a 'clinical' fact, however, 're'conceptualisation is required; before then the clinician has only details. Details become clinically significant when, implicitly or explicitly, they are situated and redefined in a context of interrelated clinical narratives. These narratives are based partly on dialogue and partly on the general theories or metanarratives provided by one or another school of psychoanalytic thought. During psychoanalysis, new clinical facts continue to be conceptualised, and these often alter their own formative contexts, for they include the consequences of previous conceptualisations. Consequently, facticity is always in flux as, over time, understanding alters meaning and emphasis. Even the apparently brute fact of corporeality changes with changes of age, culture, historical epoch, gender of patient, and phase of analysis. In analysis, a central role is played by insight into the functions served by the analysand's uses of 'fact' in the course of devising, unconsciously, transferenceAcountertransference enactments. Illustrated case material is provided.
从来没有一个事实是没有经过概念化的。要作为一个事实进入话语，无论当下所关注的世界情形如何，都必定已经经过了符号中介，也就是说，已经是那个世界方面的一个特定版本。然而，要成为一个“临床”事实，则需要“重新”概念化；在此之前，临床医生只有细节。当细节在相互关联的临床叙述语境中被隐含或明确地定位和重新界定时，它们就变得具有临床意义。这些叙述部分基于对话，部分基于一种或另一种精神分析思想流派提供的一般理论或元叙述。在精神分析过程中，新的临床事实不断被概念化，而这些事实往往会改变它们自身的形成语境，因为它们包括先前概念化的结果。因此，随着时间的推移，理解改变了意义和重点，事实性总是处于变动之中。甚至身体性这一表面上确凿的事实也会随着年龄、文化、历史时期、患者性别以及分析阶段的变化而变化。在分析中，洞察被分析者在无意识地设计移情 - 反移情表现过程中对“事实”的运用所发挥的功能起着核心作用。文中提供了说明性的案例材料。
