今早說了一個半小時說了些甚麼不復記憶趁沒有忘光前紀錄於此
起因是Clara Mucci十二月六日剛出那本書「Borderline Bodies」
我囫圇吞棗感受到一種「匯通的快樂」
這個快樂是一個疑問 (problematic)
Mucci 曾就學於 Otto Kernberg, Peter Fonagy, Allan Schore
加上可愛的 Sandor Ferenczi 這四個人默默站在這本書後面
既然提到 Kernberg 那 Mucci 跟克萊茵學派的關係如何初步看來她對克萊茵學派強調的死亡毀滅驅力不盡同意
我還看不出 Fonagy 教了她甚麼因為 mentalization 的前提是依附關係健康而她筆下那些被 screwed up badly 的不幸的人恐怕一時半會 mentalize 不了甚麼名堂
Allan Schore 應該是這本書的直接啟發者
...
at the beginning of the current century I suggested that a deeper understanding
of borderline bodies was one of the next frontiers of interpersonal
neurobiology, psychotherapy, and psychiatry.
Clara
Mucci begins this book with my assertion that “Intersubjectivity is thus more
than a match or communication of explicit cognitions. The intersubjective field
co-constructed by two individuals includes not only two minds but two bodies”
(Schore, 2012, p. 40).
Following
this, on the very first page she states her central thesis, that the body is
the essential go-between in the relationship between self and other, and that a
major clinical expression of personality disorders is not only through
relational impairments but also through their stressful dysregulation of the
body. Indeed, for Mucci, the body is the depository of intergenerational
transmissions that are responsible for a kind of traumatic graft into the body
derived from early relational trauma and subsequent affect dysregulation.
To
my mind this book on Borderline Bodies represents a passing of the torch, but
more than an expansion and elaboration of my theoretical models, the author
succeeds in creating a new fine-grained clinical vista for working more
effectively with these “difficult” patients.
(Mucci,
Clara. Borderline Bodies: Affect Regulation Therapy for Personality Disorders
(p. x). W. W. Norton & Company. 2018-11-6, Kindle edition.)
上午我說老師的未竟之夢變成學生的論文題目這是多麼自然可喜的事
剛剛說「匯通的快樂」是甚麼意思
意思是說雖然Mucci和Schore沒有明說但他們似乎都回到Ferenczi一九三零年代初期的嘗試而關係學派正是從那裡出發的
當關係的創傷(relational trauma)尤其是Mucci所謂first-level那種兩歲以前的創傷已經發生了這個人的brain-mind-body都被狠狠搞亂這就是最困難嚴重的個案
而Mucci所謂second-level那種孩子長大一點才發生的創傷也不可小覷
因為我們的童年太長而前額葉的成熟甚至要到二十幾歲才完成
邊緣系統 (limbic
system) 和前額葉的整合仍會出大問題
「匯通的快樂」是指Mucci和Schore對治療的理解可以接上關係學派和互為主體性
因為上述這些嚴重的病人語言無效
他們必須先擁有經驗
很久以後才能說點甚麼
而治療者就是那個經驗的一起經驗者
Furthermore
she points out Ferenczi’s central principle that more than a “bad object” the
therapist must be experienced as a “new object.” (ibid, p. xv)
上午我說所謂新的客體就是沒有被毀滅的倖存的客體Winnicott說過類似的話關於倖存
Gunderson 說邊緣性人格違常的治療初期宜採 Kohut 路數中期才改為 Kernberg路數意思是說先養後教
而Jeremy Safran 講治療聯盟的高-低-高 (high-low-high) 的過程和 Kohut 講的disruption-restoration cycle 是同一件事
low 或 disruption 的時候就是語言終於被喚進場的時候
如果之前好的關係的底子夠厚也許你不會被你的病人放鴿子因為他捨不得雖然他很氣你所以這個 moment 也是他進入 depressive position 的猶豫兩難 (ambivalence) 的時候
「匯通的快樂」也是指關係學派一直強調的 mutual re-enactment
這是 Ferenczi 的 legacy 是他留給我們的最重要的難題
而 Mucci 和 Schore 從神經科學跨領域回到治療室是同意這點的
這個 re-enactment 就是上述所謂優先於語言的經驗
不過每個治療者對re-enactment的理解各有不同
我可沒有打算養而不教
雖然我是那個有名的放牛吃草信仰者
所以問題是我教了牛甚麼
或更重要的是
牛教了我們甚麼
