Pam A
Department of Psychiatry (Psychology), Albert Einstein College of Medicine, Bronx, NY.
Am J Psychother. 1994 Summer;48(3):432-40. doi: 10.1176/appi.psychotherapy.1994.48.3.432.
Limit setting is a necessary aspect of clinical treatment but the professional literature on this subject is relatively sparse and does not address many core issues, including some countertransferential and ethical problems raised by the approach. Many clinicians struggle with the "authoritarian" nature of limit setting, especially when they have great power over patients as in a hospital setting. This paper traces the theory of limit setting back to Freud's conception of "acting-out in the transference" and the corresponding need by clinicians to manage nihilistic behavior which threatens the treatment process, whether inpatient or outpatient. When done properly, setting limits makes working with acting-out patients viable, enabling them both to master devastating early experiences and to replace restraint by others with self-control. Techniques are addressed which lead to the responsible and effective use of power, but at the same time observing the social and practical limits inherent in the approach.
设定界限是临床治疗的一个必要方面，但关于这一主题的专业文献相对较少，且未涉及许多核心问题，包括该方法引发的一些反移情和伦理问题。许多临床医生对设定界限的“专制”性质感到纠结，尤其是在医院环境中他们对患者有很大权力的时候。本文将设定界限的理论追溯到弗洛伊德的“移情中的付诸行动”概念，以及临床医生应对威胁治疗过程的虚无主义行为的相应需求，无论患者是住院还是门诊。如果操作得当，设定界限能使治疗付诸行动的患者可行，使他们既能掌握早期的毁灭性经历，又能用自我控制取代他人的约束。文中还探讨了一些技巧，这些技巧能导致权力的负责任和有效使用，但同时也要遵守该方法固有的社会和实际界限。
