Feldman M D, Feldman J M
University of Alabama at Birmingham 35294-0018, USA.
Int J Psychiatry Med. 1995;25(4):389-99. doi: 10.2190/LK90-A41X-WYVC-C3JA.
Patients who simulate or actually self-induce illnesses to assume the "sick role" present a number of imposing psychotherapeutic challenges. The purpose of this article is to discuss the countertransferential reactions that are mobilized in therapy with these patients.
Literature searches of the MEDLINE and HEALTH databases were performed using the term "factitious disorder." The resulting citations were examined for descriptions of the potential and actual countertransference responses in therapy with such patients. The few citations with relevant material were supplemented with other clinical literature on countertransference as well as observations from cases in which the authors have served as therapists or consultants.
Once the medical dissimulation has been exposed, the most conspicuous difficulty is in persuading the patient to agree to therapy. When therapy does take place, both the patient's overt behaviors, such as actual bodily damage, and his or her underlying emotional issues can mobilize particularly intense reactions in the therapist.
Recognition and management of the countertransference reactions likely to emerge in therapy with factitious disorder patients are particularly important if the therapy is to be maximally effective.
那些伪装或实际自我诱发疾病以扮演“患者角色”的患者带来了诸多严峻的心理治疗挑战。本文旨在探讨在对这些患者进行治疗时所引发的反移情反应。
使用“做作性障碍”这一术语对MEDLINE和HEALTH数据库进行文献检索。对检索所得的文献进行审查，以查找关于对此类患者进行治疗时潜在和实际反移情反应的描述。对少数包含相关材料的文献，补充了其他关于反移情的临床文献以及作者作为治疗师或顾问时的病例观察结果。
一旦医疗伪装被识破，最突出的困难在于说服患者同意接受治疗。当治疗实际进行时，患者的公开行为，如实际的身体损伤，以及其潜在的情感问题，都可能在治疗师身上引发特别强烈的反应。
如果要使治疗达到最大效果，认识并处理在对做作性障碍患者进行治疗时可能出现的反移情反应尤为重要。
