Paranoid Anxieties 偏执焦虑 Her paranoid symptoms remained a persistent feature of her treatment. They became less of a problem as therapy progressed, and particularly after Gloria got out of the hospital. They never completely disappeared, and from time to time they would become more intense and paralyzing to her. It became clear in time that these symptoms were related to and in part in the service of her regressive infantile wishes. Her narcisssism generated expectations that were continually disappointed, and her rage and disappointment were dealt with by paranoid mechanisms. 她的偏执症状一直是她治疗的一个特点。随着治疗的进展，这些问题变得不那么严重了，尤其是在格洛丽亚出院后。它们从来没有完全消失过，对她来说，它们有时会变得更强烈，更令人麻痹。随着时间的推移，人们逐渐清楚，这些症状与她退化的婴儿愿望有关，并在一定程度上是为之服务的。她的自恋产生了期待，而这些期待不断地变成失望，她的愤怒和失望被偏执机制处理了。 At the beginning of her treatment, her paranoid ideas were quite severe and paralyzing. In her acute decompensation, she felt that the members of her family were trying to kill her and somewhat later she felt that the staff at the hospital was trying to kill her. She complained bitterly that she was being tortured by them and that as soon as she got out of the hospital she was going to sue them all and the hospital as well. These intense feelings and the distortions accompanying them dissipated somewhat, although Gloria never relinquished her feeling that the staff had mistreated her. This remained a problem for her because she knew that I was in agreement with the staff's accusations and she could not reconcile this with her growing trust in me as a kind, sympathetic, and helpful person. I made no attempt to help her resolve this dilemma, but simply tried to explore her feelings. Any attempt on my part to move her in one direction or the other would have been disastrous. 在她开始治疗的时候，她的偏执想法是非常严重和使人麻痹的[使人啥都干不了的意思]。在她的急性失代偿期，她觉得她的家人想要杀她，后来她觉得医院的工作人员想要杀她。她痛苦地抱怨说，她正在遭受他们的折磨，她一离开医院，就要起诉他们所有人，还要起诉医院。这些强烈的感觉和伴随而来的扭曲在某种程度上消失了，尽管格洛丽亚从未放弃她的感觉，工作人员虐待了她。这对她来说仍然是个问题，因为她知道我同意工作人员对她的指控，而她不能把这与她对我的信任调和起来，因为她越来越相信我是一个善良、富有同情心和乐于助人的人。我并没有试图帮助她解决这个困境，只是试图探索她的感受。一切把她往一个方向或另一个方向移动的尝试，都将是灾难性的[又恢复了非黑即白的偏执状态]。 Little by little these more general fears diminished, although they have remained a part of her clinical picture, ready to be revived and intensified at any moment. But gradually they seemed to lessen in intensity and Gloria seemed more and more able to deal with them on more realistic terms. She gradually became aware that these paranoid ideas and anxieties reflected her own inner feelings and were not based on any reality. She became increasingly aware that they were the product of her own projection. Little by little we were able to explore her fear and relate them to her own anger. She remained quite isolated and withdrawn however. She would complain that she was afraid of meeting people. She felt terribly embarrassed in being with other people and trying to carry on a conversation. She didn't know how to act or what to say. She was afraid of looking stupid or foolish. She was afraid that if she tried to relate to people, they would reject her. What gradually emerged, behind these fears and embarrassments that so paralyzed and plagued her, were Gloria's expectations that people should be nice to her, be interested in her, and even admire her. Her chronic and anticipated disappointments made her feel hostile and rejecting toward everyone she met. That her own hostility was in question rather than anyone else's she could recognize, but she could not appreciate that her own behavior brought about the reaction in others that she so resented and feared. It was a form of self-fulfilling prophecy. 这些更普遍的恐惧一点一点地减少了，尽管它们仍然是她临床表现的一部分，随时准备恢复和加剧。但渐渐地，它们的紧张感似乎减弱了，格洛丽亚似乎越来越能以更现实的方式与他们打交道。她逐渐意识到这些偏执想法和焦虑反映了她自己的内心感受，并不是基于任何现实。她越来越意识到它们是她自己投射的产物。渐渐地，我们能够探究她的恐惧，并将其与她自己的愤怒联系起来。然而，她仍然十分孤立和孤僻。她会抱怨说她害怕见人。和别人在一起，尝试和别人交谈时，她感到非常尴尬。她不知道该怎么做，也不知道该说些什么。她担心自己看起来很愚蠢。她担心，如果她试图与人交往，他们会拒绝她。在这些使她麻痹，使她痛苦的恐惧和尴尬的背后，逐渐显露出来的是格洛丽亚的期望，即人们应该对她友好，对她感兴趣，甚至钦佩她。长期预期的失望让她对遇到的每一个人都充满敌意和排斥[还没跟人打交道呢，就预料这人会辜负自己，然后就对别人很生气]。有问题的是她自己的敌意，而不是她识别出的其他人的敌意，但她无法理解自己的行为引起了别人的反应，而她对别人的反应如此憎恨和恐惧。这是一种自我实现的预言。 Many of her fears were related to her concern that people would hate, reject, and revile her if they could see what she was really like. She felt that she was hateful and evil. She gradually came to recognize that she had so much anger and hatred stored up in her that if it ever came out people would want to reject her and get rid of her. She was a monster that would have to be destroyed. It turned out—by and large—that the "private thoughts" that Gloria was so reluctant to share with me were thoughts and feelings about how evil and hateful she was. Her fear was that if I knew about how bad she was I would want to get rid of her and would reject her. 她的许多恐惧都与她的担忧有关，她担心如果人们能看到她的真实面目，就会憎恨、拒绝和辱骂她。她觉得自己既可恨又邪恶。她逐渐意识到自己内心积存了太多的愤怒和仇恨，一旦爆发出来，人们就会想要拒绝她，摆脱她。她是一个必须被消灭的怪物。事实证明，总的来说，格洛丽亚不愿与我分享的“私人想法”是关于她是多么邪恶和可恶的想法和感受。她害怕的是，如果我知道她有多坏，我就会想摆脱她，拒绝她。 Gloria is still in therapy. She is making slow and very unsteady progress. Much has changed in her relationship with her parents over the years. She has a much more realistic appraisal of their shortcomings and weaknesses. But the road ahead will be long and fraught with difficulty. Gloria has not yet made the choice between regression and progression. Her paranoid need to place the blame and the responsibility for her condition elsewhere is still strong and persistent. She still avoids and resists the commitment to the hard work of therapy, clinging to her wish for a magical solution. But the indices are more positive now than they were two or three years ago. How much further we can go remains a moot question. If the paranoid process in this young woman is or seems to be losing its sting, we cannot assure ourselves that it will not win out in the end. Time alone can tell. 歌洛莉亚还在接受治疗。她的进步很慢，很不稳定。这些年来，她和父母的关系发生了很大变化。她对他们的缺点和弱点有一个更加现实的评价。但前方的道路将是漫长而充满困难的。格洛丽亚还没有在退步和进步之间做出选择。她将导致自己状态的过失和责任归咎于他人的偏执需要仍然是强大而执着的。她仍然逃避和抗拒对治疗的努力工作的承诺，坚持她寻求一个神奇的解决方案的愿望。但与两三年前相比，现在的指标更加积极。我们能走多远仍是一个悬而未决的问题。如果这个年轻女人的偏执过程正在或似乎正在失去它的刺，我们不能保证它最终不会赢。只有时间能说明一切。