Presenting Complaints 主诉 In the beginning Jim did not present an unusual picture. He decided to seek treatment while he was still in his graduate studies. The precipitating event had been the disruption of a relationship with his girl friend, which proved to be somewhat traumatic for him. But this was superimposed on more chronic difficulties. His relationships with his family had been difficult and quite tense since he had come to graduate school. Moreover he suffered from long-standing difficulties in day-to-day living. He felt himself to be rather shy and insecure; he had difficulties in relating to people and to his friends, both male and female. He constantly felt tense and worried. His world was discolored by almost constant anxiety, and at times this was nearly incapacitating. This was particularly the case when he felt called on to perform—when he was called on in class, or when he wanted to ask a question, or when he had to make some form of presentation to his class or other group, or when he had to talk with any of his professors or his adviser. At such times he would literally shake with anxiety; he would sweat profusely and feel that he would surely bungle what he was doing or make a fool of himself. He would begin to stammer, could not organize his thoughts, forgot important things that he knew he otherwise had firmly in mind—and generally deteriorated in his level of functioning. 起初，吉姆的表现并无异常。他决定在攻读研究生期间寻求治疗。导火索是他与女友的关系破裂，这对他来说有些创伤性。但这只是他长期困扰的叠加。自从他开始读研究生以来，他与家人的关系就一直很紧张。此外，他在日常生活中也长期遇到困难。他觉得自己相当害羞且缺乏安全感；他与他人，无论是男性朋友还是女性朋友，相处都有困难。他总是感到紧张和担忧。他的世界因几乎持续的焦虑而失去了色彩，有时这种焦虑几乎让他无法正常工作。尤其是在他觉得自己需要表现的时候——比如在课堂上被点名，或者当他想要提问，或者他必须向班级或其他群体做某种形式的展示，或者他必须与任何一位教授或导师交谈时。在这些时候，他会因焦虑而浑身颤抖；他会大量出汗，感觉自己肯定会把事情搞砸或出丑。他会开始口吃，无法组织思绪，忘记一些他本来清楚记得的重要事情——总体上，他的功能水平会大幅下降。 This was also very much the case in his relations to women. He felt awkward and embarrassed in asking girls for dates, feeling sure that they would turn him down, or that they thought him funny or ugly or repulsive. He could overcome his doubts and anxieties to a point, but when the relationship became somewhat closer, his difficulties increased. When he came to a point in the relationship at which sexual activity seemed possible, his anxiety markedly increased. He became obsessed with the idea that he could not perform sexually, and felt that he only wanted to plunge in and get it over. His major complaint was premature ejaculation; this was a fear that pervaded all of his thinking about sex and was proof to him of his sexual inferiority and inadequacy. 他在与女性的交往中也是如此。他觉得约女孩出去很尴尬，确信她们会拒绝他，或者觉得他很滑稽、丑陋或令人厌恶。他能在一定程度上克服自己的疑虑和焦虑，但当关系变得有些亲密时，他的困扰就加剧了。当关系发展到可能发生性行为的阶段时，他的焦虑显著增加。他变得对无法进行性行为的想法产生了强迫性思维，感觉自己只想匆匆了事。他主要的抱怨是早泄；这种恐惧弥漫在他对性的所有思考中，对他而言，这是自己性方面低劣和不足的证据。 In the face of these anxieties and the incapacitation related to it, Jim decided to seek help. He was treated in psychotherapy for a brief period of a few months in a local clinic. He gradually came to realize that his problems were deep and long-standing. When the psychiatrist suggested that he seek more extensive treatment—psychoanalysis—he responded positively, if hesitantly, and was referred to me. 面对这些焦虑以及由此导致的无能为力，吉姆决定寻求帮助。他在当地诊所接受了几个月短期的心理治疗。他逐渐意识到自己的问题根深蒂固且由来已久。当精神科医生建议他接受更广泛的治疗——即精神分析疗法时，他虽有些犹豫，但还是积极响应，并被介绍给了我。 I saw him in several evaluative interviews vis-a-vis. He was in his early twenties, short in stature but stocky and well-built. His manner was at first noticeably tense and his speech produced with some pressure and was punctuated with nervous laughter. His level of anxiety was obviously high. During the course of the first interview he seemed to relax somewhat and his nervous movements seemed to disappear. He was able to relate with apparent warmth and spontaneity, expressed himself fluently and with some insight—and despite his anxiety left a rather good impression. There was no evidence of thought disorder or severe depression. Despite the incapacitation of his anxiety, he had managed to maintain a rather high level of achievement and performance in his academic pursuits. In the last interview he was able to show some humor and warmth, and generally seemed well able to accept and utilize my questions and a few trial interpretations. He seemed sincerely troubled and well motivated, and I felt that he would be a rather suitable candidate for analysis. My diagnostic impression was that he presented a symptomatic picture consistent with anxiety hysteria and that his personality was structured along the lines of male hysteria with an admixture of obsessive-compulsive features. I felt he would be an interesting patient. 我在几次面对面评估访谈中见到了他。他二十出头，个子不高，但身材魁梧，体格健壮。一开始，他的表现明显很紧张，说话也有些吃力，还不时地紧张地笑出声来。他的焦虑程度显然很高。在第一次访谈过程中，他似乎放松了一些，紧张的举动似乎也消失了。他表现得热情而自然，表达流畅且颇有见地——尽管有些焦虑，但还是给人留下了相当不错的印象。他没有思维混乱或严重抑郁的迹象。尽管焦虑使他感到无能为力，但他还是设法在学业上保持了相当高的成就和表现。在最后一次访谈中，他展现出了一些幽默和热情，并且总体上似乎能够很好地接受和利用我的问题以及一些试探性的解读。他看起来真心感到困扰，并且动机明确，我觉得他是一个相当适合进行分析的对象。我的诊断印象是，他的症状表现符合焦虑性癔症，他的人格结构属于男性癔症类型[即表演型]，并夹杂着一些强迫性特征。我觉得他会是一个很有意思的病人。