The scientific standing of psychoanalysis

精神分析的科學(xué)立場(chǎng)

作者：Mark Solms

翻譯：妃子笑

2018年2月

This paper summarises the core scientific claims of psychoanalysis and rebuts the prejudice that it is not ‘evidence-based’. I address the following questions. (A) How does the emotional mind work, in health and disease? (B) Therefore, what does psychoanalytic treatment aim to achieve? (C) How effective is it?

本文總結(jié)了精神分析的一些核心科學(xué)主張，駁斥了所謂的精神分析并非“循證”的偏見(jiàn)，作者主要闡述了如下的問(wèn)題：A情感心智在健康和疾病領(lǐng)域是如何工作的？B精神分析的治療目標(biāo)是如何達(dá)成的呢？C精神分析有多么有效？

A. As regards the workings of the emotional mind, our three core claims are the following.

一、關(guān)于情感心智是如何工作的，主要有以下3個(gè)方面來(lái)論述：

(1) The human infant is not a blank slate;

1.1 人類嬰兒并不是一塊白板。

like all other species, we are born with innate needs. These needs (‘demands upon the mind to perform work’, as Freud called them, his ‘id’) are felt and expressed as emotions. The basic emotions trigger instinctual behaviours, which are innate action plans that we perform in order to meet our needs (e.g. cry, search, freeze, flee, attack). Universal agreement about the number of innate needs in the human brain has not been achieved, but mainstream taxonomies (e.g. Panksepp, 1998) include the following.【1】

【1】Here I am focusing on emotional needs – which are felt as separation distress, rage, etc. – not bodily drives – which are felt as hunger, thirst, etc. – or sensory affects – which are felt as pain, disgust, etc. (See Panksepp, 1998.) The way in which I use the term ‘a(chǎn)ction plans’ in this article is synonymous with the use of the term ‘predictions’ in contemporary computational neuroscience.

這里主要聚焦在情感需求—比如分離痛苦、憤怒等等，而不是身體的需求—比如饑餓、口渴等，也不是感官的影響—比如疼痛、惡心等（見(jiàn)Panksepp，1998）我使用“行動(dòng)方案”這個(gè)術(shù)語(yǔ)的方式和當(dāng)代的計(jì)算機(jī)神經(jīng)科學(xué)使用“預(yù)期”這個(gè)術(shù)語(yǔ)的方式是如出一轍的。

就像其他物種一樣，我們生來(lái)是攜帶一些內(nèi)在需求的。這些需求由情感來(lái)感知的，也是靠情感來(lái)表達(dá)的，（依靠頭腦工作來(lái)滿足需求，弗洛伊德叫做本我的部分）。這些基本的情感激發(fā)了本能的一些行為，這些行為就是內(nèi)在行動(dòng)方案，我們依靠這些內(nèi)在行為方案來(lái)滿足我們的需要（比如說(shuō)哭泣、尋找、僵直、逃跑、攻擊）。現(xiàn)在關(guān)于人類大腦到底有多少內(nèi)在需要并沒(méi)有達(dá)成廣泛的一致，但是主流的分類方法還是有的，（比如 Panksepp，1999），具體如下 1：

• We need to engage with the world – since all our biological appetites (including bodily needs) can only be met there. This is a foraging or seeking or ‘wanting’ instinct. It is felt as interest, curiosity and the like. (It coincides roughly but not completely with Freud’s concept of ‘libido’.)
  我們需要和這個(gè)世界打交道的，因?yàn)槲覀兯�有的那些生物性渴望（包括軀體的需要）都要在這個(gè)世界上得到滿足。這種就叫做覓食、尋求或者想要的那種本能。這種需求在情感上就是感興趣、好奇和喜歡。（這方面和弗洛伊德的力比多的概念有所重合，但并不是完全一樣）。

• We need to find sexual partners. This is felt as lust. This instinct is sexually dimorphic (on average) but male and female inclinations exist in both genders.
  我們需要找到我們的性伴侶。這種本能的情感就是性欲。這種本能是二元性別的（在統(tǒng)計(jì)意義上的二元性別），但是任何性別中都存在男性或者女性的潛在可能。

• We need to escape dangerous situations. This is fear.
  我們需要逃離危險(xiǎn)的環(huán)境，這種情感叫做害怕。
  

• We need to destroy frustrating objects (things that get between us and satisfaction of our needs). This is rage.
  我們需要摧毀那些讓我們挫敗的東西（就是阻止我們滿足我們需要的事物）。這種情感叫做憤怒。
  

• We need to attach to caregivers (those who look after us). Separation from attachment figures is felt not as fear but as panic, and loss of them is felt as despair. (The whole of ‘a(chǎn)ttachment theory’ relates to vicissitudes of this need.)
  我們需要依附依戀于我們的照料者（就是那些照顧我們的人）。和依戀對(duì)象分離的話，我們就不僅會(huì)害怕還有更深的恐慌，如果喪失了依戀對(duì)象我們就會(huì)絕望。（整個(gè)依戀理論跟我們依附需求的變遷是有關(guān)系的）
  

• We need to care for and nurture others, especially our offspring. This is the so-called ‘maternal instinct’, but it exists (to varying degrees) in both genders.
  我們需要照顧和養(yǎng)育其他個(gè)體，特別是養(yǎng)育我們的后代。這就是所謂的“母性本能”，這種本能在兩種性別中都存在，只不過(guò)程度不同。
  

• We need to play. This is not as frivolous as it appears; play is the medium through which social hierarchies are formed (‘pecking order’) and in-group and out-group boundaries maintained.
  我們需要玩耍。玩耍這個(gè)需求可不像看上去那樣無(wú)聊。玩�？梢宰鳛橐粋�(gè)媒介，通過(guò)這個(gè)媒介社會(huì)階層形成了，（也就是團(tuán)體中的位序形成了），而且團(tuán)體內(nèi)部和外部的這些界限得以維持。

• The (upper brain-stem and limbic) anatomy and chemistry of the basic emotions is well understood (see Panksepp, 1998 for a review).
  

關(guān)于上腦干和邊緣系統(tǒng)的解剖學(xué)和主要情感化學(xué)物質(zhì)的這些科學(xué)研究都已經(jīng)很好的被解釋了。（詳見(jiàn)panksepp，1998年的研究）

The main task of mental development is to learn how to meet our needs in the world.

1.2 精神心智發(fā)展的主要任務(wù)就是學(xué)會(huì)如何在這個(gè)世界上滿足我們的需求。

We do not learn for its own sake; we do so in order to establish optimal action plans to meet our needs in a given environment. (This is what Freud called ‘ego’ development.) This is necessary because innate action programmes have to be reconciled with actual experiences. Evolution predicts how we should behave in, say, dangerous situations, but it cannot predict all possible dangers (e.g. electrical sockets); each individual has to learn what to fear. This typically happens during critical periods in early childhood, when we are not best equipped to deal with the fact that innate action plans often conflict with one another (e.g. attachment v. rage, curiosity v. fear). We therefore need to learn compromises, and we must find indirect ways of meeting our needs. This often involves substituteformation (e.g. kicking the cat). Humans also have a large (cortico-thalamic) capacity for satisfying their needs in imaginary and symbolic ways. It is crucial to recognise that successful action programmes entail successful emotion regulation, and vice versa. This is because our needs are felt as emotions; thus, successful avoidance of attack reduces fear, successful reunion after separation reduces panic, etc., whereas unsuccessful attempts result in persistence of fear and panic, etc.

我們不僅僅為自身需要的原因去學(xué)習(xí)，我們這么做就可以建立起來(lái)最優(yōu)化的行為方案來(lái)滿足我們?cè)诮o定環(huán)境中的需要（這就是弗洛伊德說(shuō)的“自我”的發(fā)展）。這種發(fā)展是很有必要的，因?yàn)閮?nèi)在的行為模式一定要和實(shí)際經(jīng)驗(yàn)相協(xié)調(diào)。進(jìn)化能夠預(yù)期我們應(yīng)該如何行為，比如在危險(xiǎn)的環(huán)境中如何行為，但是進(jìn)化不能預(yù)料所有可能的危險(xiǎn)（比如說(shuō)電插座的危險(xiǎn)），每一個(gè)個(gè)體必須學(xué)會(huì)害怕哪些東西。這種情況經(jīng)常發(fā)生在童年早期的關(guān)鍵時(shí)期，在早期關(guān)鍵期我們還沒(méi)有配備足夠的能力來(lái)處理一個(gè)事實(shí)，就是有些內(nèi)在的行動(dòng)方案是和其他方案相矛盾沖突的，（比如說(shuō)依戀和憤怒，好奇和害怕）。因此我們需要學(xué)會(huì)妥協(xié)，我們必須找到能夠滿足需要的那種間接的方式，這就經(jīng)常涉及到替代形成（比如說(shuō)踢貓理論）。人類也擁有一個(gè)巨大的能力（皮質(zhì)丘腦的能力）用想象的和象征的方式來(lái)滿足自己的需要。這種能力對(duì)于認(rèn)識(shí)到成功的行為模式需要成功的情感調(diào)節(jié)至關(guān)重要，反之亦然。這是因?yàn)槲覀兊男枰�都是以情感的方式�?lái)被感知的；因此成功避免被襲擊的話就可以減少害怕，和依戀對(duì)象分離后重新團(tuán)聚就可以減少恐慌等等。反之如果這些行為企圖沒(méi)能成功的話，就會(huì)導(dǎo)致害怕和恐懼持續(xù)下去。

Most of our action plans (i.e. ways of meeting our needs) are executed unconsciously.

1.3 我們大多數(shù)的行為方案（也就是滿足我們需要的那些方式）都是無(wú)意識(shí)的執(zhí)行的。

Consciousness (‘working memory’) is an extremely limited resource, so there is enormous pressure to consolidate and automatise learned solutions to life’s problems (for a review see Bargh & Chartrand, 1999, who conclude that only 5% of our goal-directed actions are conscious). Innate action programmes are effected automatically from the outset, as are the programmes acquired in the first years of life, before the cortical (‘declarative’) memory systems mature. Multiple unconscious (‘non-declarative’) memory systems exist, such as ‘procedural’ and ‘emotional’ memory (which are mainly encoded at the level of the basal ganglia). These operate according to different rules. Not only successful action plans are automatised. With this simple observation, we can do away with the unfortunate distinction between the ‘cognitive’ and ‘dynamic’ unconscious. Sometimes a child has to make the best of a bad job in order to focus on the problems which it can solve. Such illegitimately or prematurely automatised action programmes are called ‘the repressed’. In order for automatised programmes to be revised and updated, they need to be ‘reconsolidated’ (Tronson & Taylor, 2007); that is, they need to enter consciousness again, in order for the long-term traces to become labile once more. This is difficult to achieve, not least because most procedural memories are ‘hard to learn and hard to forget’ and some emotional memories – which can be acquired through just a single exposure – appear to be indelible, but also because the essential mechanism of repression entails resistance to reconsolidation of automatised solutions to our insoluble problems. The theory of reconsolidation is very important for understanding the mechanism of psychoanalysis.

意識(shí)（“叫工作記憶”）是一個(gè)非常有限的資源，要鞏固和自動(dòng)化學(xué)習(xí)應(yīng)對(duì)生活問(wèn)題的方案是面臨巨大壓力的。（Bargh和Chartand兩位科學(xué)家1999年得出一個(gè)結(jié)論，我們?nèi)祟愐阅繕?biāo)為導(dǎo)向的行為只有5%是意識(shí)層面的）。內(nèi)在行為模式從一開(kāi)始就是自動(dòng)有效的，這是在生命的早年就獲得的那些模式，在皮質(zhì)記憶（“陳述性記憶”）系統(tǒng)成熟之前就有了。多種的無(wú)意識(shí)記憶（“非陳述性記憶”）系統(tǒng)是存在的，比如說(shuō)“程序的”和“情感的”記憶（這些記憶主要是在基底神經(jīng)的水平上來(lái)編碼的）。這些記憶的運(yùn)作取決于不同的規(guī)則。不僅僅是成功的行為方案是自動(dòng)化的。我們簡(jiǎn)單觀察一下，就可以弄清楚， “認(rèn)知的”無(wú)意識(shí)和“動(dòng)力學(xué)的”無(wú)意識(shí)之間是不同的。有時(shí)，一個(gè)孩子需要從不好的工作任務(wù)中獲取最佳利益，就要聚焦在那些能被解決的問(wèn)題上面，這種不合邏輯的或者說(shuō)早熟的自動(dòng)化的行為模式稱為“壓抑”。為了讓自動(dòng)化模式重新修訂和更新，就需要一個(gè)重新整合的過(guò)程（Tronson和taylor，2007年），也就是說(shuō)這些行為模式需要再一次進(jìn)入意識(shí)層面，為了讓那些長(zhǎng)期記憶的痕跡變得更加松動(dòng)。這一目標(biāo)并不容易達(dá)到，不僅僅因?yàn)槌绦蛴洃洝昂茈y記住也很難忘記”，一些情緒記憶只需要簡(jiǎn)單的暴露體驗(yàn)就可以呈現(xiàn)出來(lái)，看上去非常持久，而且也因?yàn)閴阂值母�本機(jī)制導(dǎo)致了阻抗，這些阻抗不利于重新整合和自動(dòng)化那些難題的行動(dòng)模式。重新整合對(duì)于理解精神分析的機(jī)制非常重要。

The clinical methods that psychoanalysts use flow from the above claims

二、精神分析師使用的臨床辦法起因于如下幾個(gè)方面：

Psychological patients suffer mainly from feelings. The essential difference between psychoanalytic and psychopharmacological methods of treatment is that we believe feelings mean something. Specifically, feelings represent unsatisfied needs. (Thus, a patient suffering from panic is afraid of losing something, a patient suffering from rage is frustrated by something, etc.) This truism applies regardless of aetiological factors; even if one person is constitutionally more fearful, say, than the next, their fear is still meaningful. To be clear: emotional disorders entail unsuccessful attempts to satisfy needs.

2.1 心理病人主要是因?yàn)榍楦猩显馐芡纯唷＞�神分析療法和精神藥理學(xué)療法之間的主要區(qū)別就是我們相信情感、感受意味著一些事情。特別是，情感代表著未能滿足的需要。（因而，一個(gè)恐慌的病人是害怕失去某種東西，一個(gè)憤怒的病人被什么挫敗了，等等）。不管病因?qū)W如何解釋，這個(gè)常理是顯而易見(jiàn)的，即使一個(gè)人本質(zhì)上更加害怕了，那么也要說(shuō)這種害怕是仍然是有意義的。澄清一下：情感障礙使得我們滿足需要的那些企圖沒(méi)能成功。

The main purpose of psychological treatment, then, is to help patients learn better (more effective) ways of meeting their needs. This, in turn, leads to better emotion regulation. The psychopharmacological approach, by contrast, suppresses unwanted feelings. We do not believe that drugs which suppress feelings can cure emotional disorders. Drugs are symptomatic treatments. To cure an emotional disorder, the patient’s failure to meet their underlying need(s) must be addressed, since this is what is causing their symptoms. However, symptom relief is sometimes necessary before patients become amenable to psychological treatment, since most forms of psychotherapy require collaborative work between patient and therapist. It is also true that some types of psychopathology never become accessible to collaborative psychotherapy.

2.2精神分析治療的主要目標(biāo)是幫助病人們學(xué)習(xí)滿足需要的更好的（更有效的）方式。從而，這就導(dǎo)致了更好的情緒調(diào)節(jié)。精神病理學(xué)的方法正好相反，是要壓抑那些不想要的感受。我們不認(rèn)為壓抑感受的那些藥物能夠治愈情感障礙。藥物是針對(duì)癥狀的一種治療方式。要治愈一種情感障礙，病人潛在的需要沒(méi)有被滿足這種情況是必須要言說(shuō)的，因?yàn)檫@樣才導(dǎo)致了他們的癥狀。當(dāng)然有的時(shí)候在病人能夠配合心理治療之前，癥狀的緩解是很有必要的，因?yàn)榇蠖鄶?shù)心理治療的形式都需要病人和治療師合作進(jìn)行。也有可能某些類型精神機(jī)能障礙永遠(yuǎn)也不能進(jìn)行合作的心理治療。

Psychoanalytical therapy differs from other forms of psychotherapy in that it aims to change deeply automatised action plans. This is necessary for the reasons outlined above. Psychoanalytic technique therefore focuses on the following.

2.3 精神分析療法和其他心理治療的方法有所不同。精神分析療法的目標(biāo)是致力于深入的改變自動(dòng)化的行為方案，上文已經(jīng)大體闡述了必須這么做的主要原因。因此，精神分析技術(shù)主要聚焦在以下幾個(gè)方面：

• Psychoanalytical therapy differs from other forms of psychotherapy in that it aims to change deeply automatised action plans. This is necessary for the reasons outlined above. Psychoanalytic technique therefore focuses on the following.
  識(shí)別出占主要地位的那些情感（意識(shí)層面已經(jīng)感覺(jué)到了但是個(gè)體自己不一定能意識(shí)到是屬于他自己的，等等）

• These emotions reveal the meaning of the symptom. That is, they lead the way to the (ineffective) automatised programmes that gave rise to the feelings.

  這些情感揭示出癥狀的意義。那就是這些情感導(dǎo)致了（無(wú)效的）自動(dòng)化行為模式，這種行為模式又引起了一些感受。

  
  
• The pathogenic action programmes cannot be remembered directly for the very reason that they are automatised (i.e. unconscious). Therefore, the analyst identifies them indirectly, by bringing to awareness the repetitive patterns of behaviour derived from them.

引起疾病的這些行為模式不能被直接回憶起來(lái)，因?yàn)檫@些模式都是自動(dòng)化的（比如說(shuō)無(wú)意識(shí)層面的）。因此精神分析師們通過(guò)把重復(fù)性行為模式帶入到意識(shí)層面的方法來(lái)間接的識(shí)別出這些模式。

• Reconsolidation is thus achieved through reactivation of mainly subcortical longterm traces via their derivatives in the present situation (this is called ‘transference’ interpretation). Only cortical memories can be ‘declared’.

重新整合的過(guò)程是通過(guò)主要是皮質(zhì)下長(zhǎng)期記憶的痕跡的重新激活來(lái)實(shí)現(xiàn)的，這種重新激活是在當(dāng)下情景中通過(guò)皮下衍生物產(chǎn)生的（這就是對(duì)所謂的“移情”的解釋）。只有皮層的記憶可以“呈現(xiàn)”。（妃子笑個(gè)人理解皮質(zhì)下的記憶直接呈現(xiàn)不了，要通過(guò)當(dāng)下情景刺激下的衍生物來(lái)激化。）

• Such reconsolidation is nevertheless difficult to achieve, mainly owing to the ways in which non-declarative memory systems work, but also because repression entails resistance to the reactivation of insoluble problems. For these reasons, psychoanalytic treatment takes time – i. e. numerous and frequent sessions – to facilitate ‘working through’.

然而，重新整合的過(guò)程是很難實(shí)現(xiàn)的，主要是因?yàn)榉顷愂鲂杂洃浵到y(tǒng)的工作方式，也因?yàn)閴阂謾C(jī)制產(chǎn)生了對(duì)重新激活那些難解問(wèn)題的阻抗，正因?yàn)槿绱耍�精神分析治療需要的時(shí)間比較長(zhǎng)，比如說(shuō)長(zhǎng)時(shí)間多頻次的咨詢次數(shù)，來(lái)促進(jìn)“修通”。

• Mental healthcare funders need to learn how learning works. For a more detailed account of the mechanism of psychoanalytic therapy, see Solms (2017).

精神健康中心的資助者們需要了解這種學(xué)習(xí)機(jī)制是怎么運(yùn)作的。想了解精神分析療法更加細(xì)致的機(jī)制是怎樣的話，詳見(jiàn)solms（2017）的研究成果。

Psychoanalytic therapy achieves good outcomes – at least as good as, and in some respects better than, other evidence-based treatments in psychiatry today.

三、精神分析療法的效果至少和其他循證心理療法一樣有效，而且在有些方面更加有效。

Psychotherapy in general is a highly effective form of treatment.

3.1 一般來(lái)說(shuō)心理治療都是一種非常有效的治療形式。

Meta-analyses of psychotherapy outcome studies typically reveal effect sizes of between 0.73 and 0.85. An effect size of 0.8 is considered large in psychiatric research, 0.5 is considered moderate, and 0.2 is considered small. To put the efficacy of psychotherapy into perspective, recent antidepressant medications achieve effect sizes of between 0.24 and 0.31 (Kirsch et al, 2008; Turner et al, 2008). The changes brought about by psychotherapy, no less than drug therapy, are of course visualisable with brain imaging.

對(duì)于心理治療方法療效的元分析研究顯示：效應(yīng)量在0.73到0.85之間（妃子笑個(gè)人補(bǔ)充效應(yīng)量是指由于因素引起的差別，是衡量處理效應(yīng)大小的指標(biāo)。與顯著性檢驗(yàn)不同，這些指標(biāo)不受樣本容量影響。它表示不同處理下的總體均值之間差異的大小，可以在不同研究之間進(jìn)行比較。一般用于針對(duì)某一研究領(lǐng)域內(nèi)的元分析中，經(jīng)常見(jiàn)于心理，教育，行為研究等。其主要統(tǒng)計(jì)思路是指主要變量引起的響應(yīng)差別除以相應(yīng)的標(biāo)準(zhǔn)誤差，這一相對(duì)量對(duì)估算處理效應(yīng)很重要。效應(yīng)量太小，意味著處理即使達(dá)到了顯著水平，也缺乏實(shí)用價(jià)值。）在精神病學(xué)的研究中效應(yīng)量達(dá)到0.8就相當(dāng)大了，中度的效應(yīng)量為0.5，小的效應(yīng)量為0.2。為了深入透徹地總結(jié)心理治療方法的有效性，近期關(guān)于抗抑郁藥物治療的有效性研究中，效應(yīng)量也才是0.24到0.31之間（Kirsch 及其他人 2008年；Turner 及其他人2008）。這樣看由心理治療帶來(lái)的變化根本不低于藥物治療，當(dāng)然這種變化也可以在腦顯像中可視化的呈現(xiàn)出來(lái)。

Psychoanalytic psychotherapy is equally effective as other forms of evidence-based psychotherapy (e.g. cognitive–behavioural therapy (CBT)).

3.2 精神分析療法和其他循證的心理療法是一樣有效的。（比如說(shuō)認(rèn)知行為療法CBT）。

This is now unequivocally established (Steinert et al, 2017). Moreover, there is evidence to suggest that the effects of psychoanalytic therapy last longer – and even increase – after the end of the treatment. Shedler’s (2010) authoritative review of all randomised controlled trials to date reported effect sizes of between 0.78 and 1.46, even for diluted and truncated forms of psychoanalytic therapy. An especially methodologically rigorous meta-analysis (Abbass et al, 2006) yielded an overall effect of 0.97 for general symptom improvement with psychoanalytic therapy. The effect increased to 1.51 when the patients were assessed at follow-up. A more recent meta-analysis by Abbass et al (2014) yielded an overall effect size of 0.71, and the finding of maintained and increased effects at follow-up was reconfirmed. This was for short-term psychoanalytic treatment. According to the meta-analysis of de Maat et al (2009), which was less methodologically rigorous than the Abbass studies, longerterm psychoanalytic psychotherapy yields an effect size of 0.78 at termination and 0.94 at follow-up, and psychoanalysis proper achieves a mean effect of 0.87, and 1.18 at follow-up. This is the overall finding; the effect size for symptom improvement (as opposed to personality change) was 1.03 for long-term psychoanalytic therapy, and for psychoanalysis it was 1.38. Leuzinger- Bohleber et al (2018) will shortly report even greater effect sizes for psychoanalysis in depression. The consistent trend toward larger effect sizes at follow-up suggests that psychoanalytic therapy sets in motion processes of change that continue after therapy has ended (whereas the effects of other forms of psychotherapy, such as CBT, tend to decay).

這一點(diǎn)現(xiàn)在是眾所公認(rèn)、毋庸置疑的。（Steinert等人2017年）而且，有證據(jù)顯示精神分析療法的效果持續(xù)的時(shí)間更持久，甚至在治療結(jié)束后還會(huì)持續(xù)增加有效性，2010年Shedler的權(quán)威評(píng)論報(bào)告了迄今為止所有的隨機(jī)對(duì)照實(shí)驗(yàn)的效應(yīng)量在0.78到1.46之間，甚至包含了那些簡(jiǎn)化、縮短的精神分析治療。一項(xiàng)特別嚴(yán)格的方法學(xué)意義上的元分析研究（Abbass 等人，2006年）表明，精神分析治療對(duì)大多數(shù)癥狀改善的總體效應(yīng)量為0.97。當(dāng)對(duì)病人進(jìn)行追蹤評(píng)估時(shí)效應(yīng)量可以增加到1.51。一項(xiàng)更新的元分析由Abbass等人（2014）年做出，該研究表明，總體的效應(yīng)量為0.71，并且再次確認(rèn)了這個(gè)結(jié)論：追蹤隨訪效應(yīng)量發(fā)現(xiàn)效果持續(xù)鞏固并且還會(huì)繼續(xù)增加。這是短程精神分析治療效果的研究。根據(jù)Maat等人（2009年）的元分析研究，Maat這個(gè)研究不如Abbass的研究那樣嚴(yán)格和方法論，這個(gè)研究顯示長(zhǎng)程精神分析療法的效應(yīng)量在治療結(jié)束后為0.78，追蹤隨訪效應(yīng)量話是0.94，并且正當(dāng)?shù)木�神分析療法的平均效�?yīng)量為0.87、追蹤隨訪效應(yīng)量為1.18。主要的結(jié)論如下：長(zhǎng)程精神分析療法的癥狀改善（而不是指人格變化）的效應(yīng)量為1.03，而精神分析的效應(yīng)量為1.38。Leuzinger Bohleber等人（2018年）不久就會(huì)發(fā)布一個(gè)精神分析治療抑郁癥的更高的效應(yīng)量。追蹤隨訪的效應(yīng)量這種不斷持續(xù)增長(zhǎng)的趨勢(shì)，意味著精神分析療法的動(dòng)力過(guò)程在治療結(jié)束后還在持續(xù)發(fā)揮改變的作用。（對(duì)比其他心理治療方法，比如說(shuō)CBT的效應(yīng)量是趨向減少的）

The therapeutic techniques that predict the best treatment outcomes, regardless of the form of psychotherapy, make good sense in relation to the psychodynamic mechanisms outlined above. These techniques include (Blagys & Hilsenroth, 2000):

3.3 忽略心理治療的各種形式，預(yù)期會(huì)產(chǎn)生最好治療效果的療效型技術(shù)都與上文概括的心理動(dòng)力學(xué)機(jī)制有很大關(guān)系，這些技術(shù)包括如下內(nèi)容（Blagys和Hilsenroth ，2000年）：

unstructured, open-ended dialogue between patient and therapist

治療師和病人之間非結(jié)構(gòu)化的、無(wú)限制的對(duì)話

identifying recurring themes in the patient’s experience

識(shí)別和確認(rèn)病人體驗(yàn)經(jīng)歷中的復(fù)發(fā)性的主題

identifying recurring themes in the patient’s experience

把病人的情感和認(rèn)知與過(guò)去的經(jīng)歷聯(lián)系在一起

drawing attention to feelings regarded by the patient as unacceptable

要注意到病人無(wú)法接受的情感

drawing attention to feelings regarded by the patient as unacceptable

指出病人避免某些情感的方式

focusing on the here-and-now therapy relationship

聚焦于此時(shí)此地的治療關(guān)系

drawing connections between the therapy relationship and other relationships.

把治療關(guān)系和其他人際關(guān)系相關(guān)聯(lián)

It is highly instructive to note that these techniques lead to the best treatment outcomes regardless of the type of psychotherapy the clinician espouses. In other words, these same techniques (or at least a subset of them; see Hayes et al, 1996) predict optimal treatment outcomes in CBT too, even if the therapist believes they are doing something else.

非常有指導(dǎo)意義的是注意到這些技術(shù)可以產(chǎn)生最好的治療效果，不管臨床醫(yī)生擁護(hù)哪種心理治療流派，換句話說(shuō)，同樣的技術(shù)（或者至少是上述技術(shù)的子集，Hayes等人，1996年）也能夠在CBT治療中產(chǎn)生最優(yōu)的療效，即使治療師以為他們?cè)谧鰟e的事呢。

It is therefore perhaps not surprising that psychotherapists, irrespective of their stated orientation, tend to choose psychoanalytic psychotherapy for themselves! (Norcross, 2005)

3.4 因此，我們毫不驚訝的發(fā)現(xiàn)，也許心理治療師，不管他們自己聲稱何種治療方向，他們都傾向于為他們自己選擇精神分析的心理治療（Norcross，2005年）。

I am aware that the claims I have summarised here do not do justice to the full complexity and variety of views in psychoanalysis, both as a theory and a therapy. I am saying only that these are our core claims, which underpin all the details, including those upon which we are yet to reach agreement. These claims are eminently defensible in the light of current scientific evidence, and they make simple good sense.

本文總結(jié)的所有觀點(diǎn)，沒(méi)能公正全面的考慮到精神分析理論或者精神分析療法涉及的所有復(fù)雜性和各種各樣不同的觀點(diǎn)，本文這些觀點(diǎn)只是我們的核心觀點(diǎn)，這些觀點(diǎn)是所有細(xì)節(jié)的基礎(chǔ)，包括那些尚未達(dá)成一致的細(xì)節(jié)。根據(jù)當(dāng)今的科學(xué)證據(jù)來(lái)看這些核心觀點(diǎn)是非常有說(shuō)服力的，簡(jiǎn)潔而明了。

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