Psychoanalytic Treatment of an adult Woman Experiencing Childhood Sexual abuse: A Case Report

幼年時期受性虐待東方成年女性之精神分析治療：一例報告

李豪剛(Howard Kant Lee)

《童綜合醫學雜誌》 2卷2期 (2008/12) Pp. 82-87

https://doi.org/10.29838/TMJ.200812.0005

摘要

目的：某些描述性研究顯示幼年時期受性虐待導致日後長期之後遺症，其臨床表徵有個別之差異性，影響因素包括受虐待時的年齡、加害人與受虐者之關係、受虐者幼年早期之心性發展以及其與主要客體關係之品質等等。對精神分析治療中之困境加以深入剖析，有助於了解其臨床表徵之各個面向；國內外極少有受性虐待東方成年女性之精神分析治療報告，其治療過程及效果值得探討。個案報告：X女士，40歲，已婚育有兩子。主訴有間歇憂鬱發作甚至癱瘓在床長達三個月；在六歲至十歲之間她曾被一位陌生老榮民性侵及騷擾多次，一直到精神分析治療中才吐露出來。在治療早期她重複提及對治療者之害怕及矛盾，常常夢到治療者幫助她及放棄她，嗣後雖經解析仍無進展之後她鄭重考慮退出治療。在治療六個月之後，就信任及安全之主題予以同理解析之後，獲得重要進展，在與施暴丈夫之互動中情緒更加沉穩及自我肯定。雖然婚姻暴力仍然持續，在接受精神分析治療兩年期間未服用任何精神科藥物情形之下其憂鬱發作未再出現。結論：幼年時期創傷伴隨人格之原始面貌會在精神分析治療中發動再現，其強度似乎與受虐之持續性與否、父母配偶是否為加害人有關；在東方文化的背景下，經由精神分析治療，個案中止發展之人格可以甦醒、復活，臨床症狀獲得舒解。

關鍵字

精神分析治療 ； 幼年時期受性虐待

並列摘要

Background: Very few literatures have reported clinical vignette of psychoanalytic treatment of a female adult with childhood sexual abuse in a context of an oriental culture. Some descriptive studies have reported the long term sequelae of childhood sexual abuse. There are variations in the clinical manifestation of these patients. Influencing factors include the age at which abuse occurs, the relationship of the perpetrator with the victim, early childhood development and mainly the quality of the relationship with his or her primary objects, etc. In-depth exploration of the clinical dilemmas that are present in the psychoanalysis of the patient may shed light on the psychopathology of these clinical manifestations.Case reports: Mrs. X, a forty-year-old married mother of two, sought treatment because of episodic depression that incapacitated her to the extent of being bedridden for as long as 3 months with each episode during the past 15 yrs. From the age 6 to 10, a veteran who was a stranger to her sexually assaulted her. She kept the abusive relationship secret to all until the psychoanalytic treatment sessions. In the early phase of the treatment, she repeatedly mentioned her feeling of fear and conflict with the therapist. Frequently dreaming of the therapist helping or abandoning her. Trials of interpretation were fruitless and she seriously considered withdrawing from the therapy after a seductive behavior being confronted by the therapist. However, important progress occurred 6 months after treatment had begun which was heralded by empathic interpretation of the trust and safety issues. She was reported to be more assertive and stable emotion in dealing with the abusive husband. Without any psychotropic medication, she remained symptom free throughout the two years when she was in therapy albeit abuse by her spouse was ongoing.Conclusion: Reenactment of childhood trauma along with the primitive aspects of personality was mobilized in the treatment, which seemed to be overwhelming if the abuse had been persistent or parental and spouse abuse present. Taken together, we suggest that the developmental arrest resulted from early childhood trauma can be reawakened and revived with symptom relief through psychoanalytic psychotherapy in the context of an oriental culture.

並列關鍵字

Psychoanalytic treatment ； Childhood sexual abuse