潛意識幻想與移情詮釋－－精神分析導向心理治療評估

Unconscious Phantasy and Transference Interpretation-- Psychoanalytic Psychotherapy Assessment

本文描繪一位被醫院診斷為發展遲緩與飮食問題的四歲小男孩，其精神分析治療評估歷程，以及筆者如何由治療評估瞭解男孩的內在衝突並訂定治療計畫。筆者藉由分析遊戲和治療情境中的移情與反移情，瞭解小男孩如何被他內在的摧毀力所驚嚇與困惑。這現象與他個人的幻想和早期不穩定的居住環境息息相關。男孩在遊戲中顯示在他的心智中，缺乏一位有效能的成人幫助他處理內在難以面對的摧毀衝動，以致他害怕自身的攻擊慾力會摧毀一切，因而採用了較無助益的防衛機制。筆者藉由精神分析治療評估推測小男孩內在過多而未被處理的焦慮，與他的飮食問題有關，此外，也因過度焦慮，而影響他的象徵能力，進而導致發展上的遲緩。

This paper describes the psychoanalytic assessment process of a four-year-old boy who has eating difficulties and developmental delay. The author shows how the assessment facilitates the understanding of the boy's internal conflict and the set up of psychotherapy plan. Through analysis of transference and counter-transference that manifested in the play and analytical situation, the boy showed the therapist that he was frightened and confused about the destructiveness inside him linked to the very unhelpful condition in the family. In his mind he fears that his destructive feelings will be unmanageable and that his aggression will destroy everything and nothing could be repaired. The excessive, unprocessed anxiety might have affected his ability for symbolization and thus contribute to his eating problem and developmental delay.