Willenberg H
Clinic of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University Hospital, Mainz, Germany.
Psychother Psychosom. 1994;62(1-2):129-34. doi: 10.1159/000288913.
In the treatment of patients with factitious disorder it is important to realize that at various levels of their experience these patients are more intimate with death than with life. This requires a particular awareness of resistance mechanisms to countertransference as well as of the importance of clinical procedures, in particular with regard to superego analysis. A requirement for establishing a psychotherapeutic alliance with patients suffering from factitious disorder is a high degree of 'therapeutic eros', hope and trust in one's own capabilities. The emphasis on a 'biophile attitude' does, however, involve the danger that the destructive potential, fantasies of death or killing, but above all feelings of guilt and shame are euphemistically interpreted and played down. A supportive superego analysis is viewed by the patient as playing down her or his 'terror of conscience' and a sense of being left alone. The therapist can be of greater help to the patient by focusing on his or her need and by escorting him or her. This requires that the therapist accept the feelings of relentlessness and hopelessness experienced by the patients in her- or himself. By relinquishing the denial of death-directed tendencies, the therapist is able to establish normality, reality and structure, and is thus in a position to exert a stabilizing effect, initially on her- or himself, but frequently also on the patient, for whom new horizons open.
在治疗做作性障碍患者时，重要的是要认识到，在他们经历的各个层面上，这些患者与死亡的关系比与生命的关系更为密切。这需要特别意识到对抗反移情的抵抗机制以及临床程序的重要性，特别是在超我分析方面。与做作性障碍患者建立心理治疗联盟的一个要求是高度的“治疗热情”、对自身能力的希望和信任。然而，强调“亲生物态度”确实存在这样的危险，即对破坏潜力、死亡或杀戮幻想，尤其是内疚和羞耻感进行委婉解释并淡化处理。支持性的超我分析被患者视为淡化了他们的“良心恐惧”和孤独感。治疗师通过关注患者的需求并陪伴患者，能为患者提供更大的帮助。这要求治疗师在自身接纳患者所体验到的无情和绝望感。通过放弃对死亡指向倾向的否认，治疗师能够建立正常、现实和结构，从而能够产生稳定作用，最初作用于自身，但也常常作用于患者，为患者打开新的视野。
