www.nmgpsy.com内蒙古心理网DEBATE BETWEEN KOHUT (HK) AND KERNBERG (OK)
内蒙古心理网 B TJQ"o$|q*^内蒙古心理网@;Op"D wY1i%wXgI'd enjoy getting any of your ideas about how to improve on or further elaborate
this dialogue.
内蒙古心理网(I/w@[3gz)q*yPp8[^#y+` iQ_0内蒙古心理网j-^8cv/~V Ca"A ?OK:Heinz, are you not indulging the patient's grandiose fantasy that he is the
superior one, patronizing the therapist?
内蒙古心理网6c5qepp z(q"p内蒙古心理网?"I|9|!F:ZU KTHK:Of course. The patient must be indulged in this fantasy if he is to
experience this developmental stage. His grandiosity must be permitted. This is
difficult because for the patient to act out such fantasies alienates the
therapist. It is a test of the therapist's capacity for .
%g,]5nP-X$T6DF"S U v0 c7w} k E1P%K0OK:No, that is not the countertransference problem. The countertransference
problem is therapist's fear of the patient's anger. The therapist hesitates to
confront the patient's fantasy for fear of provoking his rage. It is a test of
whether the therapist can withstand the patient's rage. Indulging the patient's
grandiosity only supports a defense against this rage. The rage is generated by
the feelings of inferiority that the patient's grandiosity also defends against.
内蒙古心理网n KF6_]'N]c[ G@QX0HK:Yes, well certainly that is a persuasive concept, and many eminent
clinicians find it so. I formerly accepted it myself. However, I have since come
to the conclusion that the patient's rage is reactive. He is angry because in
interpreting his grandiosity you have, in reality, attacked his narcissism.
8? e8y h G+mK0内蒙古心理网#J!a k8I H~ A(Q/EOK:Oh, but he can't enjoy his narcissism since he really feels inferior to the
therapist.
内蒙古心理网Pw T9w$l W8x z%oX y{2B4`0HK:No, I think that is a later capacity. He really does not have the psychic
structures necessary to support competitive feelings. To interpret as if he
does, only becomes a demand from the therapist to be included in the patient's
consciousness.
@W&Q)_9g#m6t6T0内蒙古心理网#P}3n^5zbHj^OK:There is no need for interpretations to be experienced as a demand by the
therapist as long as the therapist is neutral.
P%H#{O wCg r)a0!s:F9ea)snA0HK:The word is empathic, not neutral. I don't think there is any way to be
neutral from your position. Aren't you at risk for feeling like you have failed
if you allow the patient to exclude you? Even if feeling excluded did not
provoke you, is it not still up to you, for the patient's sake, to prevent him
from ignoring and depreciating you?
内蒙古心理网8fnD k0]*M(b7P
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e)I1E0X0If I may say so, my model gives the therapist a way to accept what the
patient is doing and so provides him with a way to cope with the
countertransference.
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O-~0OK:Wait a minute. What you say about empathy, after all, goes without saying. I
have to say that what you are really doing here is advocating complicity with
the patient's withdrawal into grandiosity that you are obviously not all that
happy with yourself.
ed~/NeRfp-f#k0内蒙古心理网4F/Ati;l)YHK:[Falls silent at this point, permitting Kernberg's grandiosity.]
内蒙古心理网:|~;DWAz+|9K(O)N0OK:[continuing] I cannot see that your complicity--call it what you will--your
endless patience, is any more than a manipulation, a corrective experience. And
one that is not likely to be very corrective since we are talking about severely
regressed patients who will interpret your behavior in magical, omnipotent ways.
内蒙古心理网R Rl M y{Bi内蒙古心理网5J O nRx3? B eEHK:Otto, Otto. You really cannot take empathy for granted. To sustain it is a
demanding task that can never be completely successful. It does not simply mean
being a good diagnostician. You seem to be overlooking the fact that these
patients are constantly testing the therapist over a long period, both with
their grandiosity and with their tantrums.
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