Submission in Therapy 治疗中的顺从 The same attitude was generated in the transference. Gloria approached me with considerable wariness and fear. She saw me as someone with great power and knowledge. Her attitude was at first one of suspicion and distrust, but little by little that gave way to an attitude that said that I was the all-knowing and all-seeing doctor who understood the mysteries of why people behaved as they did and why people became mentally disturbed. She regarded her therapy as a process in which she came to my office and spent the allotted time with me, answered my questions, and then waited until I saw fit to tell her what the problem was and what she should do about it. She tried persistently and continually to shape the therapy in such a way that I would be put in the position of telling her what to do, so that she would be able to submit to my directives or wishes. Her wish to submit to my authority was overwhelming, but it also became increasingly clear that she knew no other way of carrying on a relationship with another human being. Again and again I pointed this out to her and frequently commented on the fact that she related to her father in just the same way. She at first denied any such parallel, but gradually came to accept its accuracy. When I tried to point out to her that she set up the relationship in the same way, she resisted the idea vigorously. She persisted in denying and rejecting any suggestion that she contributed in any way in making the relationship one of submission. 在移情过程中也产生了同样的态度。格洛丽亚带着相当的警惕和恐惧走近我。她认为我是一个有很大能力和很多知识的人。起初，她的态度是怀疑和不信任，但渐渐地，这种态度让位于这样一种态度:我是一个无所不知、无所不晓的医生，我理解人们为什么会这样做，为什么会精神失常。她把她的治疗视为一个过程，在这个过程中，她来到我的办公室，花指定的时间和我在一起，回答我的问题，然后等到我觉得合适的时候，告诉她问题是什么，她应该怎么做。她坚持不懈地、不断地努力把治疗塑造成这么一种样子，使我能够告诉她该做什么，使她能够听从我的指示或愿望。她想服从我的权威的愿望是压倒一切的，但也越来越明显的是，她不知道与另一个人保持关系的其他方式。我一次又一次地向她指出这一点，并经常评论说，她和她父亲的关系也是如此。起初她否认有任何类似的说法，但渐渐地接受了这种说法的正确性。当我试图向她指出，她也是用同样的方式建立起这段关系的时候，她坚决反对这个想法。她坚决否认和拒绝任何暗示，说她在使这段关系成为一种屈服的过程中作出了任何贡献。 This conviction of hers and her persistent attitude were related to another crucial aspect of her treatment. A persistent issue in the treatment was whether and to what extent she was going to allow herself to become a patient. She had resisted hospitalization, blaming her parents for it and feeling that she had been unjustly and without reason railroaded into the hospital. She blamed me for permitting this to happen and for having participated in it. She had persistently resisted and rejected all aspects of her hospital program. The issue over and over again was whether she would accept the need and the reality of being a patient. She gradually came to terms with this partially during her hospital course, but only gradually and partially. She was able to accept some responsibilities in the hospital and to participate in some of the modalities of treatment offered. At each point, the same issue was rejoined and reworked. She always raised the issue in terms of whether she was going to be forced to submit to this or that treatment or regulation. She deeply resented the submitting because it was being forced on her, consistently refusing to accept it because she might need it or might be able to use it to her own benefit. 她的这种信念和坚持不懈的态度与她治疗的另一个关键方面有关。在治疗过程中，一个长期存在的问题是，她是否，以及在多大程度上允许自己成为一名患者。她一直拒绝住院，把这件事归咎于父母，觉得自己被不公平地、毫无理由地强行送进了医院。她责怪我允许这种事情发生，并参与其中。她一直坚持抵制和拒绝医院项目的所有方面。一次又一次的问题是她是否会接受做一个病人的需要，以及作为一个病人的现实。在她住院的过程中，她逐渐地、部分地接受了这种情况，但只是逐渐地、部分地接受了。她能够承担医院的一些责任，并参与提供的一些治疗方式。在每一点上，相同的问题都被重新组合并重新处理。她总是提出她是否将被迫顺从这种或那种治疗或规矩的问题。她对顺从深恶痛绝，因为它是强加给她的，她不断地拒绝(因为她可能需要它，或者可以利用它为自己谋利)接受它。 As time went on we continued to work our way up the treatment scale. The issue was rejoined over medications. Was she going to submit to my wish for her to take certain medications or not? She would not accept my judgment that the medicines were necessary or useful for her. She continually questioned what the medicines were, why was she taking them, did she really need them, weren't there other medicines that would be better, etc. I made only moderate attempts to answer such questions. My answers would very likely not have satisfied her, and I felt that they were a cover for her real concerns, I related them directly to the question of whether she was going to be my patient and whether she was going to be able to trust me sufficiently to rely on my judgment about such things. She would never admit that she was gradually coming to accept me and trust me but continued to question and object, while at the same time she came around to taking the medication and in the long run very faithfully too. I felt quite sure that if I had not related the issue of taking medications to her concerns over having to submit and trusting me she would have sabotaged that as she had successfully sabotaged so many other things in her life. 随着时间的推移，我们继续提高治疗水平。这个问题在药物治疗上再次出现。她会顺从我的意愿让她服用某些药物吗?她不会接受我的判断，认为这些药对她是必要的或有用的。她不断地问这些药是什么，她为什么要服用它们，她真的需要它们吗，难道没有其他更好的药吗，等等。我的答案很可能没有满足她,我感觉它们是对她真正关切的一个掩盖,我将回答与这些问题关联：她是否打算做我的病人,她是否打算充分信任我，在这些事情上依靠我的判断。她从不承认她正在逐渐接受我和信任我，但继续质疑和反对，而与此同时，她开始服药，从长期来看，也非常忠诚[即按时服药]。我非常肯定，如果我没有把吃药的这事和她对不得不屈服和信任我的担忧联系起来[用了点威胁的手段，不吃药就是不相信医生。利用了患者的顺从特点]，她就会像成功地破坏了她生活中的许多其他事情一样，破坏了这件事。 The issue was also joined at another level within psychotherapy itself. From time to time, Gloria would make it quite clear that she had something on her mind that was causing her severe distress but she would not communicate to me. When I observed that I could not help her with her problems unless she shared them with me, she would reply that these were her own private thoughts and none of my business. She did not want to let me in on everything and had no intentions of telling me these private things. She had to keep something for herself. Such a stance by a paranoid patient puts the therapist in a difficult position. I was hopeful that she would share these "private" thoughts with me but I did not want to violate her emerging sense of autonomy. I chose a middle course. I indicated that I thought it was important for her to discuss such things and I was willing to help her with them, but that it was up to her to decide whether she wanted to talk about them or not. At times she would go on to talk about what was bothering her, but at other times, she would choose to keep the matter to herself. 这个问题在心理治疗本身的另一个层面上也存在。格洛丽亚会时不时地明确表示，她心里有什么事让她非常痛苦，但她不愿和我沟通。当我发现除非她把问题告诉我，否则我无法帮助她解决问题时，她会回答说，这些都是她自己的想法，与我无关。她不想把一切都告诉我，也不想把这些私事告诉我。她得给自己留点东西。偏执患者的这种态度会让治疗师陷入困境。我希望她能和我分享这些“私人”想法，但我不想破坏她逐渐形成的自主性。我选择了中间路线。我表示，我认为对她来说，讨论这些事情很重要，我愿意帮助她，但这取决于她是否愿意谈论这些事情。有时，她会继续谈论困扰她的事情，但有时，她会选择不把这件事告诉别人。 Frequently the issue of whether she was going to be a patient was joined over her participation in the therapy process itself. Her attitude persistently was that her part of the bargain was to bring herself to my office at a given hour—no more. Time and again I pointed out that therapy was more than just bringing a warm body to my office. Her reluctance, however, persisted. In reply to my inquiries she would block, her memory would fail, she would present me with a blank mind without thoughts or feelings. The question here too was whether she was going to put herself to work in therapy, rather than making herself the passive and helpless victim of the process to which she had to submit herself. Her need to see herself as passive, powerless, helpless, and unable to take any action on her own behalf—even in therapy—was overwhelming. 她是否会成为一名病人的问题常常与她参与治疗过程本身有关。她一贯的态度是，她的职责是在指定的时间到我的办公室来——仅此而已。我一次又一次地指出，治疗不仅仅是把一个温暖的身体带到我的办公室。然而，她仍然不情愿。在回答我的问题时，她会阻塞，她的记忆会衰退，她会给我一个没有思想和感觉的空白的头脑。这里的问题也在于，她是否要把自己投入到治疗中去，而不是让自己成为这个过程被动和无助的受害者，在这个过程中，她不得不屈服。她把自己看成是被动的、无能为力的、无助的、不能为自己采取任何行动的人——即使是在治疗中——的需要是压倒性的。