被遮蔽的個案：後結構主義觀點下的精神動力學派心理治療

**傳統上心理治療被視為是會談者與個案兩人的互動，牽涉的是兩個談話主體之間的心理活動及外顯行為。然而，倘若去除談話主體而梳理其結構，心理治療會談是否能以另一種方式為吾人所理解？ **本研究從Michel Foucault及Roland Barthes的思路出發，以精神動力學派心理治療為研究對象，分別從精神動力學派理論和會談實作兩部分討論。Foucault認為現代的人類科學僅是表象符號的自主運作，知識本源的「人」其實位在域外；Barthes則將文字、圖像都視為符號，而認為文本有多種層次的符號系統，最要緊的是解讀出眾符號背後的內涵意義以及神話層次裡的布爾喬亞意識型態。因此，研究者首先從精神分析以及客體關係理論出發，耙梳精神動力學派隱含的結構：精神動力學派觀點下的個案是有限界的時空折疊構形，內卅外空間是等價的，個案的生命流動則在動力學派往復、回歸的時間觀之下成為封閉的生命之流。其次，研究者討論會談實作如何構築出精神動力學派理論下的個案形象。會談者與個案的問答內容、決策與行動，都是受結構決定的；心理治療會談是結構的自主運動。運動的目的在建構個案形象，使之合於精神動力學派理論，並使個案的問題成為一以貫之的敘事而容易被他人所理解，並且在同樣的框架內尋求解決之道；整合論述正是這自主運動的體現。末尾，研究者認為因為精神動力學派渴望視自身為科學，不僅治療者在實作當中不斷以分析互動過程來確保自己的客觀立場，在處理「理性卅情緒」或「意識卅無意識」等二元對立的詞組時，情緒與無意識是需要被拉到理性和意識裡頭檢視的事物，從而再次肯定了理性的優勢地位。在問題形式不斷變換當中，心理治療成為一串相互指涉的符號鍊，而無法指向某個固定的核心。研究者的結論認為只要個案依舊受理論指引而被理性地折疊成一貫的、有限界的、以無意識活動為中心的時空構形，便值得進一步探討精神動力學派是否有能力抵達個案的本質。

關鍵字

後結構主義；詞與物；符號學；精神動力學派

並列摘要

**A traditional view of psychotherapy is that psychotherapy is the interactions, both verbal and behavioral, between two subjects. The intention of my thesis is to question the traditional view via post-structuralist approaches. Following the concepts of The Order of Things by Michel Foucault and Mythologies by Roland Barthes, I reveal both the tempo-spatial structure and structured tempo-spatiality of psychoanalysis and object-relation theories. Patients under the psychodynamic gaze are subtracted to be a folded configuration of topologically covalent space with bounds, and of recurrent and return life flow. Therefore, the practices of psychodynamic psychotherapy as a whole is an autonomous system, whose aims are to fold patients into specific tempo-spatial configurations by a sort of patterns and rules. This folding makes patient’s life into a coherent and cohesive narrative, and thus precludes the existence of a shattered and de-centered self without being psychopathologized. **Besides, psychodynamic psychotherapy shows the dominant power of rationality when therapists deal with the binary opposite words such as “rational/emotional” and “conscious/unconscious”. In order to explore patient’s inner world and to treat the distorted intra-psychic organ, his/her unconscious emotional conflicts need to be objectified and objective, especially when they are destructive. The Objectification and objectivation reflect the desire of psychodynamic theory to see itself as science. In addition, patient’s problems will be transformed into psychodynamic problems by metonymic and synecdochic manipulations which delicately make psychodynamic psychotherapy into a cross-reference symbolic chains which could extend to anywhere as long as therapists wish. Anywhere means nowhere; thus no stable, non-reducible signified could be referred, nor an intra-psychic genesis could be traced back. It is questionable whether psychodynamic psychotherapy could reach the essence of patients.

並列關鍵字

Post-structualism ； The Order of Things ； Semiology ； Psychodynamic Psychotherapy

參考文獻

蕭文，2004，〈個案為什麼沒有按照劇本演出－後現代思考與諮商典範的轉移〉，《輔導季刊》40(3): 1-5。

Berger, Peter L. and Thomas Luckmann著、鄒理民譯，1991，《知識社會學：社會實體的建構》。臺北市：巨流圖書有限公司。（Berger, Peter L. and Thomas Luckmann, 1966, The Social Construction of Reality: A Treatise in the Sociology of Knowledge.）

Foucault, Michel著、孫淑強、金筑雲譯，2004，《癲狂與文明－－理性時代的精神病史》。臺北市：淑馨出版社。（Foucault, Michel, 1973, Madness and Civilization: A History of Insanity in the Age of Reason.）

Gabbard, Glen O.著、陳登義譯，2006，《長期精神動力取向心理治療－－基本入門》。臺北市：心靈工坊文化事業股份有限公司。（Gabbard, Glen O., 2004, Long-Term Psychodynamic Psychotherapy: A Basic Text.）

Andrews, Linda B., 2008, “The Psychiatric Interview and Mental Status Examination.” in Textbook of Psychiatry, ed. by M. H. Ebert. New York: McGraw-Hill Medical.

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被遮蔽的個案：後結構主義觀點下的精神動力學派心理治療

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