追蹤
思想起心理治療中心 (松德院區) ------ Taipei Psychotherapy Center
關於部落格
SpaceToThink-WayToTalk-FutureToHope
中心位於北市聯合醫院松德院區(原:北市療)第五院區。以"精神分析取向心理治療師"的培訓與個案治療為目的。培訓課程則擁有相當豐富的精神病理學理論,精神分析理論閱讀課程,以及多種臨床案例的工作坊。思想起心理治療中心並與臺灣精神分析學會密切合作。。
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(思想起論壇第六想)Winnicott 的觀察

The Observation of Infants in a Set Situation *Winnicott, D.W. (1941) *International Journal of Psycho-Analysis, 22:229-249 *Based on a paper read before the British Psycho-Analytical Society, April 23, 1941. *Paddington Green Children's Hospital, London ****************** THE SET SITUATION *閃亮的直角壓舌器 (spatula)放在桌上 *請母親儘量少貢獻 *請訪客不要主動示好 *嬰兒必然被壓舌器吸引 ******************** THE INFANT‘S BEHAVIOUR 第一階段 *嬰兒將手放在壓舌器上,但未預期地發現要想一下這情境。他陷於困境中。手放在壓舌器上且身體靜止,張大眼睛望著我和他的母親,觀望和等待,或是他完全放棄興趣,臉埋入母親的上衣中。經常不需要主動再保證,就可以處理這情境,觀看兒童對壓舌器的興趣逐漸且自發的回復,是很有趣的。 ********************* STAGE I *The baby puts his hand to the spatula, but at this moment discovers unexpectedly that the situation must be given thought. He is in a fix. Either with his hand resting on the spatula and his body quite still he looks at me and his mother with big eyes, and watches and waits, or, in certain cases, he withdraws interest completely and buries his face in the front of his mother's blouse. It is usually possible to manage the situation so that active reassurance is not given, and it is very interesting to watch the gradual and spontaneous return of the child's interest in the spatula. ************************** THE INFANT‘S BEHAVIOUR 第二階段 *在「猶豫期」時,嬰兒身體靜止,但不僵直。逐漸地他變得夠勇敢而讓感情發展,然後樣子就很快地改變。從第一階段變成第二階段的時刻是明顯的,孩童接受對壓舌器的欲望之真實性的預告是,嘴巴內中的改變,舌頭變厚和軟,流大量口水。不久他將壓舌器放入口中,用牙齦咀嚼,或是模仿父親吸雪笳。嬰兒行為的改變是醒目的。不再是期待和靜止,而是發展出自信,和自由的身體動作,有一般的動作、和操弄壓舌器的特定動作。 ************************** *嬰兒似乎覺得壓舌器為他所擁有,可用於自我表現。他用它敲擊桌子、或附近的鐵碗,儘可能地吵雜;或是拿它到我的嘴巴和他母親的嘴巴,如果我們假裝被餵食,他將會很高興。顯然地他希望我們來玩被餵食的遊戲,如果我們太笨地將它吃進嘴巴而糟蹋了這遊戲,他會不高興。 *我從來沒看過,因為壓舌器既不是食物、也不是裝食物的容器,而讓嬰兒不滿意。 ******************** STAGE II *All the time, in 'the period of hesitation' (as I call it), the baby holds his body still (but not rigid). Gradually he becomes brave enough to let his feelings develop, and then the picture changes quite quickly. The moment at which this first phase changes into the second is evident, for the child's acceptance of the reality of desire for the spatula is heralded by a change in the inside of the mouth, which becomes flabby, while the tongue looks thick and soft, and saliva flows copiously. Before long he puts the spatula into his mouth and is chewing it with his gums, or seems to be copying father smoking a pipe. The change in the baby's behaviour is a striking feature. Instead of expectancy and stillness there now develops self-confidence, and there is free bodily movement, both general movement and specific, the latter related to manipulation of the spatula. *************************** *The baby now seems to feel that the spatula is in his possession, perhaps in his power, certainly available for the purposes of self-expression. He bangs with it on the table or on a metal bowl which is nearby on the table, making as much noise as he can; or else he holds it to my mouth and to his mother's mouth, very pleased if we pretend to be fed by it. He definitely wishes us to play at being fed, and is upset if we should be so stupid as to take the thing into our mouths and spoil the game as a game. *At this point, I might mention that I have never seen any evidence of a baby being disappointed that the spatula is, in fact, neither food nor a container of food. **************************** THE INFANT‘S BEHAVIOUR 第三階段 *嬰兒不小心掉落壓舌器。如果它被撿回,他會高興,重新玩它,然後又掉落,但不是不小心。當它又被撿回,他故意將它掉落,享受將它狠狠地丟棄,當它碰到地上發出響聲時,他特別高興。 *第三階段的結束是,當嬰兒拿著壓舌器下來地板,他開始嚐它、玩他,或是他感到無聊而伸手去拿其他的東西。 ******************************* *這常模的描述,對五至十三個月的年齡而言,是可靠的。 *十三個月大以後,嬰孩的焦慮還是可以反映在此情境,是嬰孩的正向興趣變得太廣泛了。 ****************************** STAGE III *In the third stage the baby first of all drops the spatula as if by mistake. If it is restored he is pleased, plays with it again, and drops it once more, but this time less by mistake. On its being restored again, he drops it on purpose, and thoroughly enjoys aggressively getting rid of it, and is especially pleased when it makes a ringing sound on contact with the floor. **************************** *The end of this third phase is when the baby either wishes to get down on the floor with the spatula, where he starts mouthing it and playing with it again, or else when he is bored with it and reaches out to any other objects that lie at hand. **************************** DEVIATIONS FROM THE NORMAL *在此情境中,不同於行為常模的任何變異,都是顯著的。 *主要且最有興趣的變異是在猶豫期,可能是誇大的或是缺乏的。有的嬰兒完全沒興趣,過了長時間才察覺興趣或鼓起勇氣去展現。有的嬰兒馬上抓住它和放進口中。這兩者都是偏離常模。如果抑制很強,多少都會有苦惱,苦惱可能很急性的。 *另一種變異是嬰孩抓住壓舌器後,馬上將它丟在地上。觀察者將它放回後,嬰孩重複地丟。 **************************** *I have said that any variation from that which I have come to regard as the norm of behaviour in the set situation is significant. **************************** *The chief and most interesting variation is in the initial hesitation, which may either be exaggerated or absent. One baby will apparently take no interest in the spatula, and will take a long time before becoming aware of his interest or before summoning courage to display it. On the other hand, another will grab it and put it to his mouth in one second. In either case there is a departure from the normal. If inhibition is marked there will be more or less distress, and distress can be very acute indeed. ******************************** *In another variation from the norm an infant grabs the spatula and immediately throws it on the floor, and repeats this as often as it is replaced by the observer. ****************************** DISCUSSION OF THEORY *The hesitation in the first place is clearly a sign of anxiety, although it appears normally. *As Freud (1926) said, 'anxiety is about something'. There are two things, therefore, to discuss: the things that happen in the body and mind in a state of anxiety, and the something that there is anxiety about. ****************************** *If we ask ourselves why it is that the infant hesitates after the first impulsive gesture, we must agree, I think, that this is a super-ego manifestation. *I suggest that the hesitation means that the infant expects to produce an angry and perhaps revengeful mother by his indulgence. ****************************** *The 'something' which the anxiety is about is in the infant's mind, an idea of potential evil or strictness, and into the novel situation anything that is in the infant's mind may be projected. When there has been no experience of prohibition the hesitation implies conflict, or the existence in the baby's mind of a phantasy corresponding to the other baby's memory of his really strict mother. ********************************** *What we see is the result of the infant's impulse to reach out and take being subjected to control even to the extent of temporary denial of the impulse. *the danger exists in the infant's mind and can only be explained on the supposition that he has phantasies or something corresponding to them. ******************************* what does the spatula stand for? *The answer to this is complex because the spatula stands for different things. *That the spatula can stand for a breast is certain. It is easy to say that the spatula stands for a penis, but this is a very different thing from saying it stands for a breast, because the baby who is always familiar with either a breast or a bottle has very seldom indeed any real knowledge based on experience of an adult penis. ******************************** the spatula also stands for people *He may only see in the spatula a thing that he takes or leaves, and which he does not connect with a human being. *he may show that he sees me or mother behind the spatula, and behave as if this were part of me (or of mother). *he may see mother and me and think of the spatula as something to do with the relation between mother and myself. ****************************** *some infants obviously prefer to think of the spatula as related to the bowl, and they repeatedly take it out of the bowl and replace it with evident interest and pleasure and perhaps excitement . They seem to find an interest in two objects simultaneously more natural than an interest in the spatula as a thing that can be taken from me, fed to mother, or banged on to the table. ******************************* 完整經驗 *對嬰兒直覺的經營上,母親自然地允許各式經驗的完整歷程,直到嬰兒長得夠大而能了解她的觀點。她痛恨去中斷這些經驗,例如餵食、睡眠、或排泄。在我的觀察中,人為地給予嬰兒權利去完成一個經驗,這對他而言,是很重要的客體-課程。 ******************************* Whole Experiences *What there is of therapeutics in this work lies, I think, in the fact that the full course of an experience is allowed. From this one can draw some conclusions about one of the things that go to make a good environment for the infant. ******************************* *In the intuitive management of an infant a mother naturally allows the full course of the various experiences, keeping this up until the infant is old enough to understand her point of view. ********************************** *She hates to break into such experiences as feeding or sleeping or defæcating. In my observations I artificially give the baby the right to complete an experience which is of particular value to him as an object-lesson. ******************************* *In psycho-analysis proper there is something similar to this. The analyst lets the patient set the pace and he does the next best thing to letting the patient decide when to come and go, in that he fixes the time and the length of the session, and sticks to the time that he has fixed. ****************************** *Psycho-analysis differs from this work with infants in that the analyst is always groping, seeking his way among the mass of material offered and trying to find out what, at the moment, is the shape and form of the thing which he has to offer to the patient, that which he calls the interpretation. ******************************* *Sometimes the analyst will find it of value to look behind all the multitude of details and to see how far the analysis which he is conducting could be thought of in the same terms as those in which one can think of the relatively simple set situation which I have described. Each interpretation is a glittering object which excites the patient's greed. ******************************* NOTE ON THE THIRD STAGE *whereas the infant who is dismissed in the second stage is upset at the loss of the spatula, once the third stage has been reached the infant can be taken away and can leave the spatula behind him without being made to cry. ****************************** *This inside mother to a large extent reflects his own feelings, and may be loving or terrifying, or changing rapidly from one attitude to the other. When he finds he can master his relation to his inside mother, including his aggressive riddance of her (Freud brings this out clearly), he can allow the disappearance of his external mother, and not too greatly fear her return. *************************** *he also externalizes an internal mother whose loss is feared, so as to demonstrate to himself that this internal mother, now represented through the toy on the floor, has not vanished from his inner world, has not been destroyed by the act of incorporation, is still friendly and willing to be played with. And by all this the child revises his relations with things and people both inside and outside himself.
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