在移情的建立和发展中,固然情感的发起来自患者,但医生面对患者的移情所采取的对应态度是十分重要的。没有经验的医生有可能回避,甚至不知所措,而有经验的医生却可因势利导,借以促进患者的心理康复。不过,必须指出,顺应患者的移情,有可能使医生自己陷入移情中去。比如患者喜欢医生,医生也有意无意地喜欢患者,结果出现了“反移情”现象。这种反移情现象在现今的心理治疗中是屡见不鲜的。严格说来这是个医德问题、技术问题,但也应想到心理医生也是人,一个有感情的人,何况医生本身不见得就没有潜在的心理问题,甚至是很严重的情节,遇到了相应的患者,反移情的现象便可以产生。
这就是为什么经典精神分析学派一再强调,精神分析医生自己必须先接受精神分析,如果内在的情节太多,压抑太重,他们便不可能做心理医生。再者,在中外的心理医生群体中,都掺杂有这类分子,他们借心理治疗之机,行使个人的私欲,利用患者的移情,有意识地诱导患者以达到不可告人的目的,致使患者受到侮辱甚至伤害。尽管许多情况是处于患者的自愿,但医生的责任是无法推卸的。
如今的青少年中,患这样那样的心理疾病者占体总的 5%-8% 左右,他们都需要进行心理调治。心理卫生、心理咨询和心理治疗是怎么一回事?有些人还不十分清楚,纵然有些了解,但像移情这类复杂现象,对他们来说绝对是个谜。为此,在推广和普及心理卫生工作中,有必要把治疗中的移情问题提出来加以介绍和解释。具有这种知识后,既能使他们积极地配合医生的治疗,也能起到一定的警觉作用。以防止误入移情的 “情网”,不能自拔。当然,作为医生,要学会利用移情促进有效的治疗,也能在关键时刻运用心理技术把患者投来的感情转移出去,比如“心理升华”、“关系合理化”和“情感移位”等。升华作用是指把感情化为进取的动力,使患者在学业、事业上获得成功;合理化作用是指把医患关系正常化为师生、亲子或友谊;移位作用则指把移给医生的感情,经医生之手再转位到更利于患者感情发展的人身上去等等。
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研究结果发现:1.反移情感觉包括喜欢、欣赏、痛苦、遗憾、害怕、失望、丢脸、责备及生气;反移情行为包括顺应个案需求、情绪过度涉入、形成非治疗关系及忽略个案。2.反移情影响包括:过早结束治疗关系、阻碍治疗的有效进行、阻碍问题判断的客观性、无法准时结束、紧张的治疗关系、藉以了解个案的动力。3. 反移情的触发包括:个案的行为模式与特质、个案的过去经验、会谈中特殊事件与议题、对治疗进展的评估、对个案的知觉、个案的移情。4.反移情的来源包括:治疗者的性格因素、自恋自尊受损、价值观、个人经验、对治疗效果的期待及特殊议题。5.反移情处理包括:设定清楚的治疗结构、不断的自我觉察与了解、运用专业能力、自我接纳、克制与暂时搁置、接受督导
A Study of Psychotherapists’ Countertransference
Shu-Chun Lin (Section of Counseling and Guidance, Tamkang University)
Ping-Haw Chen Department of Education Psychology & Counseling, National Taiwan Normal University)
Abstract
The purpose of this study was to explore psychotherapists’ countertransference (CT) experiences. Four psychotherapists using the psychodynamic approach were interviewed by the individual depth interview method. Each therapist took 5-7.5 hours on average to complete the interview. Five research questions were raised: 1.How to define CT? 2.What were the CT experiences? 3.How to manage CT? 4.What were the impacts of CT on the therapeutic effectiveness and experience of being a therapist? 5.What were the difficulties in managing CT?
The findings were: 1.CT feelings included liking, admiration, pain, regret, fear, inability, guilty, blame, and anger. CT behaviors included complying with the client’s request, emotional involvement, forming a non-therapeutic relationship, and neglecting the client. 2.CT effects on terminating prematurely, blocking effective therapeutic progress, losing objectivity while judging problems, not being able to end the session on time, building tense therapeutic relationship, and blocking the understanding of the client. 3. CT was triggered by clients’ behavior patterns and traits, clients’ past experiences, special events, special issues, the evaluation of the therapeutic progress, therapists’ perception of clients and clients’ transference. 4.CT was originated from therapists’ personality traits, therapists’ narcissistic injury, therapists’ values, therapists’ personal experiences, therapists’ expectation of therapeutic effects and specific issues. 5.CT management contained setting clear therapeutic structures, enhancing self-awareness and self-understanding, self-acceptance, and professional ability, abstinence and receiving supervision.
Key Words
countertransference, psychotherapy, psychodynamic approach.