自戀狀態與負向移情：夢的分析個案研究

本文以克萊恩學派觀點，描述一位自戀狀態之青少年，接受筆者一週三次，為時三年的治療過程後，夢境主題及移情內涵之轉變。根據當代精神分析理論，自戀病患處在一種缺乏客體的狀況下，拒絕承認自己對客體的需求，若客體擁有自己所需要的東西，即表現出強烈嫉羨與憤恨，並以貶抑、嘲笑、淡化客體存在之方式，使自己留在自給自足、自大全能的狀態中。弗洛伊德認為處在自戀狀態中的病人，缺乏移情現象，無法被治療。克萊恩學派則認為藉由詮釋負向移情，可導出病人對治療師的移情，使治療得以進行。本報告以夢的分析為主軸，描述案主在接受治療的過程中，夢境主題及在診療室中的移情內涵，由拒絕客體，到嘗試接受客體的曲折心路歷程。漫長三年的治療使案主能夠在嫉羨、懷恨她所需要的客體時，亦能將客體的美善留駐心中。

關鍵字

精神分析；心理治療；自戀狀態；負向移情；移情詮釋；夢的分析

並列摘要

Based on Melanie Klein's psychoanalytical theory, this paper delineates the change of the psychotherapy process of an adolescent girl who is in a narcissistic state. The therapy, which focuses on the analysis of dream and transference, lasts for 3 years. According to contemporary psychoanalytic understanding, narcissistic persons refuse to acknowledge their need for an object. They believe that they have given life to themselves, and are able to feed and look after themselves without external help. They are extremely envious when they realize that other people possess something that they want and desire. They enjoy attacking the object, the therapist, or the analytic progress by devaluing, belittling, teasing and criticizing in order to assert their superiority and hold onto their omnipotent, self-sufficient, narcissistic state. They feel humiliated and defeated by the revelation that it is the external object, which in reality contains the valuable qualities that they had attributed to their own creative powers. Freud believes that narcissistic patients cannot be treated since they have no capacity for transference. Kleinian from their clinical experiences, on the other hand, believe that through the interpretation of negative transference, narcissistic patients can be treated. This paper demonstrates the progress of a narcissistic adolescent girl, after receiving 3 years of psychoanalytic psychotherapy. Based on the analysis of dream and transference, the therapist observes that the themes of the transference in the girl's dreams have passed through different stages: from a very narcissistic state to a state where the girl was ambivalent about the object/psychotherapist. At the end of the un-finished treatment, the girl, while admiring and attacking the object/therapist, is able to keep the good object inside through splitting.