Trust and Autonomy 信任和自主权 We have observed that the issues of basic trust and autonomy are primary in the psychopathology of paranoid states. It can be seen quite readily that these issues were central in the present case. Gloria's early mothering experience was defective on a number of counts. Her mother's depression diminished her availability and responsiveness to Gloria's needs. Moreover, her mothering activities were overburdened with her feelings of anxiety, insecurity, and inadequacy. Her mothering was consequently inconstant and conflicted. There was no opportunity and no sign of a secure and reassuring interaction between mother and child. The mutually rewarding and responsive relationship that offers the opportunity for the development of basic trust was lacking. The failure to achieve a sense of trust in the significant caretakers is unavoidably accompanied by a failure to achieve a sense of trust in oneself, in one's own trustworthiness. These deficits in self-esteem in turn impair severely the capacity for meaningful relations, as was evident in Gloria's therapeutic experience. Her relationship to me was shrouded in distrust and suspicion. It took literally years before even the glimmer of a capacity to trust appeared. Even then, the issue of trust remained a central one for the continuing course of therapy. It was the issue that was embedded in her chronic resistance to participating in and committing herself to the process of therapy and to the therapeutic relationship. 我们已经观察到，在偏执状态的精神病理学中，基本信任和自主性是首要问题。可以很容易地看出，这些问题在本案例中是中心问题。格洛丽亚早期的育儿经历在很多方面都有缺陷。她母亲的抑郁削弱了她对格洛丽亚需求的可用性和反应能力。此外，她的育儿活动因为感觉焦虑，不安全和不胜任而负担过重。因此，她的育儿活动是反复无常和矛盾的。不可能，也没有迹象表明母亲和孩子之间有安全可靠的互动。缺乏为发展基本信任提供机会的相互奖励和相互反应的关系。对重要照顾者缺乏信任感，就不可避免地伴随着对自己、对自己的可信度缺乏信任感。这些自尊的缺失反过来严重损害了建立有意义的关系的能力，这在格洛丽亚的治疗经验中时很明显的。她和我的关系笼罩在不信任和怀疑之中。实际上，过了好几年，信任的微光才出现。即使在那时，信任的问题仍然是继续治疗的核心问题。这问题嵌在她对参与并投入治疗过程和治疗关系的长期抗拒之中。 The impairment of trust developmentally undercuts the basis on which the child's emerging sense of autonomy can be erected. The child requires a trusting relationship particularly with the mother, which can allow him to undertake initiatives without fear of the loss of love and support. We have seen that this basis was not available to Gloria. Her whole relationship to her mother was overshadowed by the continuing threat of loss and abandonment. Any initiatives toward independent behavior on Gloria's part were taken at great risk. The difficulty in negotiating this developmental step toward diminishing dependence and emerging autonomy was magnified by Gloria's mother's incapacity to deal with Gloria's emerging self-will. As far as we know Mrs.G.'s own insecurities made it necessary for her to exercise more or less rigid and inflexible control over Gloria's behavior. Gloria's childish initiatives toward independent action were a threat to her. We know that the mother's demands on her daughter extended to feeding and to toilet training. Mother kept to a rather rigid feeding schedule, and tried to make Gloria feed even when she did not want it. Toilet training was done on schedule, and became an issue of control. We do not have a great deal of evidence to suggest that either of these typical interaction situations were productive of severe conflict, but it seems clear from the mother's attitude toward them and her manner of going about them that they turned out to be situations in which the infant Gloria was overcontrolled. 信任的缺失在发展过程中削弱了孩子逐渐形成的自主感得以树立的基础。孩子需要一种信任的关系，特别是与母亲之间的信任关系，这可以让他采取主动，而不用担心失去爱和支持。我们发现格洛丽亚没有这个基础。她与母亲的整个关系都笼罩在失去和被遗弃的持续威胁之下。格洛丽亚任何采取独立行动的主动性都面临着极大的风险。格洛丽亚的母亲无力处理格洛丽亚逐渐显现的自我意愿，这加大了协商这一发展步骤，使其朝着越来越少的依赖性和越来越多的自主性发展的难度。据我们所知G.夫人自己的不安全感使她有必要对格洛里亚的行为或多或少地加以严格和不灵活的控制。格洛丽亚幼稚地主动采取独立行动，对她是一种威胁。我们知道，母亲对女儿的要求延伸到喂养和上厕所的训练。母亲遵循一个相当严格的喂养时间表，并试图在格洛丽亚不想吃的时候吃。厕所训练按时完成，成为一个控制问题。我们没有大量的证据表明,这两种典型的互动导致了大量严重冲突,但作为婴儿的格洛丽亚被过度控制这点似乎是清晰的，这点从母亲对它们的态度以及处理它们的方式就可看出。 Gloria was never severely punished. She did not need to be. The usual tactic for keeping Gloria in line, and for mother to allay her own anxiety, was for Gloria to be threatened with abandonment. This controlling tactic was so frequently resorted to because it seemed to be so successful. But we can see that it was so precisely because it struck Gloria at the level of her greatest vulnerability. Unwittingly and unconsciously, Gloria's parents reinforced and intensified her most severe infantile trauma. It is worth noting that what was in question here was not merely a form of disciplinary practice, but that this practice and the means of maintaining parental control and authority were motivated by powerful anxieties in both parents. There was a real sense in which the impulses to independent and autonomous action on Gloria's part were a severe threat to both parents. Her autonomy had to be crushed in order to preserve the psychic integrity of the parents. 格洛丽亚从未受到严厉惩罚。她不需要这么做。为了让格洛丽亚守规矩，也为了让母亲减轻自己的焦虑，通常的策略是让格洛丽亚受到被遗弃的威胁。这种控制策略之所以经常被采用，是因为它似乎非常成功。但我们可以看出，正是因为它击中了歌洛莉亚最脆弱的地方。不知不觉中，格洛丽亚的父母强化并加重了她最严重的婴儿创伤。值得注意的是，这里所讨论的不仅仅是一种纪律实践的形式，而且这种实践以及维持父母控制和权威的手段都是由父母双方强烈的焦虑所激发的。从某种意义上说，格洛丽亚想要采取独立自主行动的冲动对父母双方都是一个严重的威胁。为了保持父母精神上的完整，她的自主性不得不被碾碎。 The picture is not all that simple, however. Gloria played a significant role in the interaction with her parents. She was an unconscious collaborator in the continuing frustration and impairment of her ownautonomy. The many ways in which she drew those around her to violate her autonomy and exercise control over her, were quite apparent in the interaction with the staff of the hospital, in the repeated patterns of interaction between Gloria and her parents, and, particularly striking to me, in her interaction with me in therapy. After the therapeutic relationship had matured and after she had gained some moderate degree of trust, Gloria subjected me to a continual and unrelenting seduction to exercise control and direct her in one or another direction. It was an attempt to re-create within the transference the pattern of relationship that she had developed with her parents. We have glimpsed some of its origins and motivations. But suffice it to say that it provides a difficult therapeutic dilemma for the therapist and was one of the most difficult aspects of Gloria's therapy to deal with. 然而，情况并非那么简单。格洛丽亚在与父母的互动中发挥了重要的作用。在持续的挫败感和对自己自主性的损害中，她是一个无意识的合作者。她通过很多方式，吸引她身边的人侵犯她的自主性并对她施加控制，这在她与医院工作人员的互动中，在格洛丽亚与父母不断重复的互动模式中，特别令我震惊的是，在与我在治疗的互动中，太明显了。在治疗关系成熟之后，她获得一定程度的信任之后，格洛丽亚不断地、毫不留情地诱惑我，要我控制她，并把她引向一个或另一个方向。这是一种尝试，试图在移情中重建她与父母之间发展起来的关系模式。我们已经瞥见了它的一些起源和动机。但我只想说，这给治疗师提供了一个艰难的治疗困境，也是格洛丽亚治疗中最难处理的问题之一。 But Gloria was really no different than the other patients we have been considering. The issue of autonomy is central in every case. This is particularly difficult when movement in the therapy is so slow and inapparent, as it was with Gloria and with several other cases, especially Bob B. The therapist finds himself wanting to tell the patient what to do, wanting to get the therapy moving, wanting to become more active and directive, out of a sense of frustration and impotence. But the therapeutic task, it seems to me, is not to take away or violate the patient's autonomy as others around thepatient have done for so long, but to allow the patient's autonomy to grow, to give it room to flourish, to enable the patient to find and realize it. It is precisely this course of therapeutic intent that the patient resists, and that is perhaps the best index of its therapeutic significance. It is also the striking point that makes the therapy of the paranoid process so difficult. 但是格洛丽亚和我们考虑过的其他病人并没有什么不同。自主性问题在每个案例中都是核心问题。当治疗进展是如此缓慢和不明显时,正如格洛丽亚和其他几个案例，尤其是鲍勃·B. 那个[此处估计写错了，可能作者想说的是ROBERT B.那个案例]，这是特别困难的。治疗师发现自己想要告诉病人要做什么,想要得到治疗有进展,想要变得更加活跃和有指导性,想要摆脱挫败感和无能为力的感觉。但在我看来，治疗的任务不是剥夺或侵犯病人的自主性，就像病人周围的人长期以来所做的那样，而是让病人的自主性成长，给它蓬勃发展的空间，让病人发现并实现它。病人抗拒的正是这一治疗意图的进程，这也许是其治疗意义的最佳指标。这也是让偏执过程的治疗变得如此困难的一个显著原因。