This paper develops the idea of a “leading edge” transference, which was mentioned by Heinz Kohut in his supervision of Jule Miller (see Miller, 1985). In the early stages of developing his theory of selfobject transferences in his lectures to candidates (see Tolpin and Tolpin, 1996), Kohut also occasionally referred to patients' overlooked “forward moves,” which remobilized still healthy strivings and needs of the child and adolescent self. For the time being, at least, I use the term forward edge childhood strivings and transferences—”leading edge” having been rendered less useful by its frequent use in advertising. I have also considered describing the transference remobilization of the “growth edge” or “growing edge” of development, loosely analogous to the normal functioning of the epiphyses (growth centers of the long bones) before their closure ends further growth. There may be other felicitous terms for what I have in mind. It is my impression that the theory of forward edge or growth transferences that I am proposing has validity for all psychoanalytic theories, not only for the theory of the self that informs this work. For example, Racker (1968, p. 150-154) described a “total transference,” including a “prospective” element that has been overlooked.
这篇论文发展了“前沿”的转移的观点,这在科胡特对朱尔·米勒的督导中被提及。(see Miller, 1985) 在对申请者的演讲中(see Tolpin and Tolpin, 1996),科胡特发展了他的自体客体转移的理论,此外,他还偶尔提及了病人被忽视的“向前的运动”(“forward moves”),“向前的运动”重新活化了孩子和自体的健康努力和需要。我暂时使用这个术语:前行端的童年期努力和转移,“前沿”这个词因为在广告中的频繁使用,而变得不再那么有用。我也认为,将“成长边缘”或者“成长边缘”的发展的转移再活化的描述,有点类似在骨头间的闭合处停止进一步生长之前,骨骺所行使(长骨的成长中心)的正常功能。在我的头脑中,可能还有其他更确切的词语。我的印象是,对于所有的精神分析理论来说,我所提议的向前成长或发展的转移理论都是有效的,它不仅仅适用于这篇文章所提及的自体的理论。例如,雷克(Racker,1968, p. 150-154)描述的“全转移”(total transference),就包含了一直被忽视的预期因素。
The title of this paper usually comes as a surprise to psychoanalysts. One friendly colleague put it this way: “You can't do psychoanalysis of normal development—psychoanalysis is about abnormal development and psychopathology!” My reply to such objections is, Yes, that is precisely the problem: theories of psychoanalytic treatment and practice (regardless of their many critical differences and the recent influence of developmental findings) place the strongest emphasis on abnormal development and psychopathology. Specifically, the problem for theory and practice I am referring to is created by our view of transference proper as a “pathogenic complex” (, 1912, p. 104), “new [artificial] illness” (Freud, 1914, p. 154). (For an instructive paper on changing views of what constitutes the core childhood pathology that is repeated in transferences, see Cooper, 1987.)
这篇论文的题目通常让精神分析家们诧异。一个和善的同事这样说:“你无法对常态发展来做精神分析——精神分析是关于变态发展和理学的。”我对这个反对意见的回应是:对,这恰恰就是问题:精神分析治疗和实践的理论(不考虑它们的重要差异和最近调查结果的影响)将最大的重心放在变态发展和精神病理学上了。具体来说,我指的理论和实践的问题,由适合当作“致病情节”(pathogenic complex,Freud, 1912, p. 104)和“新(假)病” (new [artificial] illness ,Freud, 1914, p. 154)的转移的观点所创。(这是在一篇有启发性的论文中,与转移中重复的,构成童年期病理学核心变化的观点有关。见库珀(Cooper),1987)
In fact, the problem is twofold. First, the “new illness” view of transference is a source of theory induced clinical blindspots, which prevent us from recognizing and analyzing “forward edge” transferences—transferences of still remaining healthy childhood development in the unconscious depths, albeit in the form of fragile “tendrils” that are thwarted, stunted, or crushed. Second, it places unintended iatrogenic limits on therapeutic action because we do not support struggling “tendrils” of health and facilitate their emergence and growth. Instead, we actually obscure them by assigning what remains of healthy development to the concept of “therapeutic alliance” or positive relationship with a “new object.” As a consequence, tendrils of health are not fully reactivated in depth and are not accessible to a vitally important working-through process. It is this bit-by-bit and over again process that is the basis for expansion, integration, transformation, and stabilization of healthy aspects of the self into an altered psychic reality.
实际上这个问题有两面性。首先,“新病”的转移观点,是引入临床盲点的理论来源,这个临床上的盲点阻止了我们分析和识别“前行端”转移——在深处,转移仍在童年期健康地发展,尽管它仍然采用一种脆弱的“卷须”(tendrils)的形式,这个“卷须”是“挫败的”、“成长受到障碍的”、“被压碎的”。其次,它无意间对治疗行动设置了医源性的限制,因为我们不支持奋斗的、健康“卷须”,从而促进它的出现和成长。相反,事实上我们通过指定什么是“治疗同盟”的健康发展,通过指定什么是与“新客体”的积极关系,来掩盖“卷须”。结果,健康的“卷须”并没有深度地充分活化,也就无法接近至关重要的修通过程。这是个逐步的、一次又一次的过程,这个过程是自体的健康方面扩张、统合、转变、稳定从而进入精神现实的基础。
To repeat my main point: At one and the same time, theory-induced blindspots restrict our clinical vision of the patient's (and our own) psychic reality because first, they lead us to expect transference repetitions of nuclear childhood pathology and its later derivatives, and second, they obscure the subtle hints of bona fide transferences that derive their force and momentum from still-viable tendrils of healthy childhood motivations, strivings, expectations, and hopes of getting what is needed now from the forward edge transference to the analyst. (For a discussion about the early effort to include hope in the etiological equation, see French, 1958.)
再次重复我的主要观点:与此同时,理论引入的盲点限制了我们对病人(和我们)的精神现实的临床视野,因为,首先,这些盲点让我们对核心病理学及它的衍生物的转移重演抱有期望,其次,这些盲点隐藏了真正转移(bona fide transferences)的微妙暗示,这些真正转移源自儿童期健康的动机、努力、期望和希望搞明白从分析家“前行端转移”中知晓需要什么的力量和动力。(对此的讨论,涉及在病因学影响因素中,包含希望的早期努力。)
Here it is crucial to stress that fragile tendrils of remaining healthy needs and expectations are not readily apparent on the surface. My clinical examples will show that we have to be primed to look for them in order to see them and tease them out from the trailing edge pathology in which they are usually entwined. For instance, tendrils of forward edge strivings have to be disentangled from manifestly pathological mergers, idealizations, grandiosity, “narcissistic entitlement” (Murray, 1964), rage, envy, depreciation, and, further, from intermediate defenses and compromise formations that protect the self the patient has built up and, at the same time, inhibit, restrict, and further compromise normal development.
在这里,强调“保持健康的需要和期望的脆弱“卷须”,在表面看来并不是显而易见的”这个观点非常重要。我的临床例子显示,我们不得不要做好寻找“卷须”的准备,以求能发现他们,能从通常缠住我们的滞后端病理学(trailing edge pathology)中挑拣出他们。例如,前行端努力的“卷须”必须从病理性融合、理想化、夸大、性津贴(narcissistic entitlement,穆雷(Murray),1964)暴怒、嫉妒、贬低以及更进一步的中介防御(intermediate defenses)、保护病人已建立起来的自体的妥协形成、抑制、限制及更进一步的妥协正常发展中清理出来。
When the joint analytic work required to see, interpret, and foster the healthy tendencies is done by both patient and analyst, we are likely to actualize these tendencies and revive the “urge to complete development” and to regain “developmental momentum,” as noted by Bibring (1937) and Anna Freud (1965). In other words, the vague “curative factors” these authors adduced can now be grounded in the clinical theory of analyzable forward edge transferences that restart and reinvigorate an expectable developmental process.
正如毕布林(Bibring,1937)和安娜·(Anna Freud,1965)所注意到的,当需要看到、解释和培育健康倾向的联合分析经由分析家和病人共同完成时,我们很可能实现了这些倾向,使“全面发展的驱动力” (“urge to complete development”)复活,重拾“发展势头”(developmental momentum)。换言之,这些作者举出的模糊的“治愈因素”(“curative factors”),如今可被分析式的以 “重新开启和复兴预期中发展过程的前行端转移”的临床理论为基础。
Before turning to the clinical examples of healthy tendrils that are overlooked in their transference potential, I want to briefly mention two interconnected historical trends that delayed the discovery of analyzable transferences of health, indelibly shaped the theory and technique of psychoanalytic practice and its accent on repetitions of pathology, and continue to interfere with our doing psychoanalysis that reactivates and strengthens normal self-development.
在转向那些“健康的卷须在他们潜在转移中被忽略”的临床例子之前,我想要简明地提起相互有影响的历史潮流,在这历史潮流中,推迟发现“可分析的健康性转移”,无法磨灭地构造了精神分析实践和对病理性重复强调的理论和技术,不断地干预了我们正在从事的“恢复和加强正常自体发展”的精神分析。
Psychoanalysis originated in studies of illness—Freud initially discovered the childhood depth of transference while, as a physician, he was investigating and trying to cure his patients' pathology. The initial trend to base analytic understanding of transference proper on a disease model of childhood development continued when Freud (1937) and other pioneers treated patients whose disorders posed challenges to successful analytic treatment. Their lack of success was attributed to their patients' “narcissistic resistances”; to “bedrock” factors such as psychic “inertia” and “adhesiveness of the libido”; to unconscious superego resistances and “negative therapeutic reaction”; to constitutional factors that led to ego deficits and distortions; and to primitive early object relations, archaic defenses, and splits.
精神分析源自对疾病的研究——弗洛伊德最早发现了在童年期的深层转移,于此同时,作为一名医生,他正研究和尝试治疗病人的病症。恰好在童年期儿童发展的疾病模型上,在对转移的分析性理解的基础上,最初的潮流还在持续着,在当时,弗洛伊德和其他的精神分析先驱们所治疗的病人病症,对成功的分析性治疗提出了挑战。他们将缺乏成功归因于他们病人的“自恋性阻抗”;诸如精神“惰性”(“inertia”)和“力比多的粘附性”(“adhesiveness of the libido”)这样的“基石”(“bedrock”)因素;无意识超我的阻抗和“治疗性负面反应”(“negative therapeutic reaction”);导致赤字和扭曲的构成因素;早期原始的客体关系、古老的防御和分裂。
This phase of “pathomorphic” theory led to the second major historical trend which still dominates many sectors of the field—namely, the demarcation of transference proper (a new edition of childhood illness) from unobjectionable positive transference (Freud, 1915), the therapeutic split in the ego (Sterba, 1934), and the positive identification/positive relationship with the idealized analyst described by Zetzel (1956), Stone (1961, 1981), Greenson (1965), Greenson and Wexler (1969), Gutheil and Havens (1979), Renik (1995, 1996, 1998, 1999), Meissner (1996), Shane, Shane and Gales (1997), Hausner (2000), and Novick and Novick (2000). In this connection also see Bacal (1985, 1990) on optimal responsiveness. And for early active therapy see Ferenczi (1920). Friedman (1969) wrote a penetrating review of the concept of therapeutic alliance.