Kernberg O F
New York Hospital-Cornell Medical Center, Westchester Division, White Plains 10605.
Am J Psychother. 1993 Spring;47(2):245-54. doi: 10.1176/appi.psychotherapy.1993.47.2.245.
This paper summarizes the experiences with suicidal and parasuicidal behavior of the psychotherapy research project on borderline patients in progress at the Westchester Division of the New York Hospital-Cornell Medical Center. In the diagnostic evaluation of these patients, it is important to differentiate acute and chronic suicidal behavior with the presence or absence of depression. The dominant psychodynamic features of chronic characterological suicidal behavior are reviewed, with a particular emphasis on the psychopathology of self-directed and projected primitive hatred, and the defenses against its conscious awareness on the part of the patient. A general psychotherapeutic strategy to deal with suicidal and self-destructive behavior is mapped out, centered upon the transformation of self-destructiveness into specific transference constellations that must be diagnosed, interpreted, and gradually worked through in the transference in the course of the treatment. The treatment of chronic, characterologically anchored suicidal behavior without depression requires the setting up of specific structuring of the psychotherapy from the very beginning of treatment, embodied in the establishment of a treatment contract that contributes to the organizing frame for the entire psychotherapy. The precondition for this psychotherapeutic work and limiting factors affecting its effectiveness are spelled out.
本文总结了纽约医院-康奈尔医学中心韦斯特切斯特分部正在进行的关于边缘性患者心理治疗研究项目中自杀及准自杀行为的相关经验。在对这些患者进行诊断评估时，区分伴有或不伴有抑郁的急性和慢性自杀行为非常重要。本文回顾了慢性特质性自杀行为的主要心理动力学特征，特别强调了自我导向和投射性原始仇恨的心理病理学，以及患者对其有意识觉察的防御机制。文中勾勒出了一种应对自杀和自我毁灭行为的总体心理治疗策略，其核心在于将自我毁灭转化为特定的移情模式，在治疗过程中必须对这些模式进行诊断、解读，并在移情中逐步加以处理。对于无抑郁的慢性、特质性自杀行为的治疗，需要从治疗一开始就对心理治疗进行特定的结构化设置，具体体现为制定一份治疗合同，该合同有助于为整个心理治疗构建组织框架。文中阐述了这种心理治疗工作的前提条件以及影响其有效性的限制因素。
