Kinzie J D, Boehnlein J K
Department of Psychiatry, Oregon Health Sciences University, Portland.
Am J Psychother. 1993 Winter;47(1):90-102. doi: 10.1176/appi.psychotherapy.1993.47.1.90.
Psychotherapy with severely traumatized patients is a long, draining process that often produces strong countertransference reactions. It is difficult to therapeutically and ethically handle these personal responses. We feel that at different stages in therapy different ethical principles should guide the therapy. At the early stages, fidelity and nonmaleficence should be the guiding principles. As trust and confidence develop, therapists may have more personal freedom to act; beneficence, i.e., providing specific confident care then becomes the primary ethical principle. In later stages of therapy, promoting the principles of autonomy and justice come into play. As therapy further progresses, therapists' own needs, the principle of self-interest, may be utilized in the therapeutic relationship. Throughout therapeutic contacts with traumatized patients, therapists need to monitor their own needs, and find appropriate ways outside of therapy to cope with these often intense feelings. Continuing to feel therapeutically competent and ethically grounded, yet maintaining the personal strength and balance to treat traumatized patients, pose major challenges for therapists.
对严重受创伤患者进行心理治疗是一个漫长且耗费精力的过程，常常会产生强烈的反移情反应。从治疗和伦理角度处理这些个人反应都很困难。我们认为在治疗的不同阶段，不同的伦理原则应指导治疗。在早期阶段，忠诚和不伤害应作为指导原则。随着信任的发展，治疗师可能会有更多的个人行动自由；此时，善行，即提供特定的保密护理，成为主要的伦理原则。在治疗的后期阶段，促进自主和公正原则开始发挥作用。随着治疗的进一步推进，治疗师自身的需求，即自利原则，可能会在治疗关系中被利用。在与受创伤患者的整个治疗接触过程中，治疗师需要监控自己的需求，并在治疗之外找到适当的方式来应对这些常常很强烈的感受。持续保持治疗能力和伦理基础，同时保持治疗受创伤患者所需的个人力量和平衡，对治疗师构成了重大挑战。
