Pfäfflin F
Universitätsklinikum Ulm, Abteilung Psychotherapie.
Psyche (Stuttg). 1994 Sep-Oct;48(9-10):904-31.
The prevalent approach to the treatment of patients displaying transsexual symptoms is one that favours somatic intervention of either a hormonal or surgical nature. Normally these patients refuse to avail themselves of the possibility of psychotherapy and are indeed regarded by many therapists as largely inaccessible to therapy of this kind. Pfäfflin looks into the factors involved in the disinclination displayed by both patients and therapists to embark upon such a process. He discusses the unconscious defence mechanisms operative in this disinclination with particular reference to the incipient stages of a course of treatment extending over a number of years and involving a patient initially determined to undergo a surgical "sex change". The patient's insistence on being acknowledged as a woman is regarded here as a creative defence against a major diffusion of identity from a genetically earlier phase, connected with incomplete separation and individuation. In the author's opinion the patient's ability to relinquish this defence will depend largely on the therapist's ability to acknowledge its creativity.
对于表现出易性症症状的患者，普遍的治疗方法倾向于采用激素或手术等躯体干预手段。通常情况下，这些患者拒绝接受心理治疗，而且许多治疗师确实认为这类治疗对他们基本无效。普法夫林研究了患者和治疗师都不愿开展此类治疗过程的相关因素。他特别针对一个为期数年、涉及一名最初决心接受手术“变性”的患者的治疗初期阶段，讨论了这种不情愿背后起作用的无意识防御机制。患者坚持被认可为女性，在这里被视为一种创造性防御，以抵御来自基因早期阶段的身份认同的重大扩散，这与不完全的分离和个体化有关。在作者看来，患者放弃这种防御的能力在很大程度上取决于治疗师认可其创造性的能力。
