Akhtar S
Jefferson Medical College, Dept. of Psychiatry, Philadelphia, PA 19107-4192.
Int J Psychoanal. 1994 Jun;75 ( Pt 3):441-55.
In this paper, the author has summarised Mahler's views on the initial acquisition of object constancy in early childhood. He then attempts to delineate its vicissitudes during oedipal phase, latency, adolescence, and various phases of adult development. Following this, the author describes, with the help of brief clinical vignettes, six psychopathological syndromes of adult life associated with disturbed object constancy: (i) impaired optimal distance; (ii) persistent splitting of self- and object-representations, with the concomitant intensification of affects; (iii) paranoia; (iv) inordinate optimism and the 'someday' fantasy; (v) malignant erotic transference; and (vi) impaired capacity to mourn, intense nostalgia and the 'if-only' fantasy. Finally, the author outlines the technical implications of these concepts and attempts to show that six tasks seem especially important for analytic work with such patients: (i) safeguarding the analyst's 'holding' function; (ii) interpreting splitting mechanisms, especially as these pertain to negative transference; (iii) maintaining optimal distance; (iv) discerning nonverbal communications, especially through countertransference; (v) encouraging developmental initiatives; and (vi) facilitating mourning, not only of past losses but also of those inherent in the analytic situation. Through all this, the author attempts to highlight, elucidate and extend modestly the work of Margaret Mahler.
在本文中,作者总结了玛勒关于儿童早期客体恒常性初步获得的观点。接着,作者试图描绘其在俄狄浦斯期、潜伏期、青春期以及成人发展各阶段的变迁。在此之后,作者借助简短的临床案例,描述了与客体恒常性紊乱相关的六种成人生活中的精神病理综合征:(i)最佳距离受损;(ii)自我和客体表象的持续分裂,同时情感强化;(iii)偏执;(iv)过度乐观与“总有一天”的幻想;(v)恶性色情移情;(vi)哀悼能力受损、强烈的怀旧情绪与“要是……就好了”的幻想。最后,作者概述了这些概念的技术含义,并试图表明,对于这类患者的分析工作,六项任务似乎尤为重要:(i)维护分析师的“抱持”功能;(ii)解读分裂机制,尤其是与负性移情相关的机制;(iii)保持最佳距离;(iv)辨别非言语交流,特别是通过反移情来辨别;(v)鼓励发展性举措;(vi)促进哀悼,不仅要哀悼过去的丧失,也要哀悼分析情境中固有的丧失。通过这一切,作者试图突出、阐明并适度拓展玛格丽特·玛勒的工作。