南希·麦克威廉姆斯谈心理健康、移情与解离

关于这个，还有其他评论、想法或进一步的反思吗？

Any more comments on that or any thoughts or further reflection?

我们所有人都非常需要被倾听。

We we all really need to be listened to.

如今我看到太多人，他们的父母虽然出于好意，却不了解倾听孩子的重要性。

I'm seeing so many people these days who were brought up by well intentioned parents who didn't understand the importance of listening to their child.

他们对孩子有自己的期望。

They had an agenda for the child.

你必须竞争。

You have to compete.

你必须做到最好。

You have to be the best.

你必须当医生或律师。

You have to be a doctor or a lawyer.

你必须去上学，取得好成绩，而不是问你现在的感受如何？

You have to go to school and get a's, as opposed to how are you experiencing?

这个世界。

The world.

是的。

Yeah.

帮助他们命名自己的情绪，好奇这个孩子是谁，他的性格如何，有什么天赋，他想做什么？

Helping them name their feelings, being curious about who this child is, what kind of temperament does your kid have, what kind of talents, What do they want to do?

什么能带给他快乐？

What gives them joy?

嗯。

Mhmm.

我们现在是一个如此焦虑的文化。

We're we're such an anxious culture now.

变化太快了。

Things change so fast.

人们必须适应他们成长过程中未曾经历过的文化。

People have to adapt to cultures that they didn't grow up in.

我们生活在一个大众文化中。

We live in a mass culture.

人们很难再有被他人认真好奇地了解的经历。

It's much harder for people to have the experience that someone took the time to be curious about them.

嗯。

Mhmm.

我觉得，有人愿意倾听你、理解你的故事，帮助你理清发生过的事情以及你的反应，这种感觉具有深远的疗愈作用。

I think it's just profoundly healing to feel like somebody listens to you and hears your story and, helps you make sense of things that have happened to you and how you reacted to them.

是的。

Yeah.

对。

Yeah.

我觉得，甚至就像我们刚开始录制时，你让我讲讲我是怎么进入播客行业的，

I think even, like, how you when we when we first got on and we were recording it, and you're like, tell me about how you got into podcasting.

那时候我能跟你讲这些，感觉被理解真好。

And I was able to tell you that felt it feels good to feel known.

是的。

Yeah.

当别人对你的情绪产生共鸣时，那种感觉很好。

It feels good to to have someone who's excited when you're excited or, you know, resonate.

做真实的自己。

To be authentic.

如果你试图用这种方式操控别人，人们迟早会看出来。

If you if you if you try to do it manipulatively, people figure it out sooner or later.

我的意思是，

I mean,

很多人都是带着操控的目的这么做。

a lot of people do it manipulatively.

我们都听腻了那些话。

Like, we've all we're all pretty sick of of hearing.

您的来电对我们非常重要，是的。

Your call is very important to us Yeah.

当你被挂机一小时的时候。

When you put on hold for an hour.

对吧？

Right?

我实际上认为，下一代青少年——我看到的那些人，大概在十几岁到二十出头之间——对任何虚假的东西都极其怀疑。

I I actually think that this next generation, you know, adolescents that I'm seeing to maybe, like, early twenties are so skeptical of anything that's false.

他们真的受够了。

Like, they're just done.

而且是的。

And Yeah.

人们经常批评TikTok，但我实际上认为TikTok是人们对真实声音渴望的体现。

You know, like, people are critical of TikTok, and I actually see TikTok as an expression of people's yearning for authentic voices.

我同意。

I agree.

新闻也在变化，因为现在有这样一些人，他们真心相信某件事，就会分享，比如俄亥俄州有列火车着火了，但主流媒体似乎并没有报道这件事有多可怕。

And the news is, like, changing because it's like you have these people who really believe in a certain thing sharing, like, oh, there was a train that, you know, lit on fire in Ohio, and the news seems to not be reporting how scary this is.

这就是我觉得可怕的原因。

And here's why I think it's scary.

这些人的出发点非常真实。

And it's like these people are coming from a very authentic place.

是的。

Yes.

我认为这一代年轻人对任何不真实的东西都完全无法容忍。

And I think I think this next generation has just a complete intolerance of anything that's not truly authentic.

甚至像真人秀，如果你回想十五年前真人秀的制作方式，那些根本算不上真正的真人秀。

And even, like, reality show, like, the way like, if you think, like, fifteen years ago, like, the way reality shows were done, those weren't really reality shows.

现在人们看这些节目，就会说，是的。

And people watch it now, and they're like, yeah.

这不真实。

That's not real.

就像，是的。

Like Yeah.

你知道吗，他们是在唤起某些情境或构建故事情节。

You know, we're they're they're evoking certain scenarios or they're creating story lines.

你知道吗？

You know?

是的。

And, yeah.

所以，我同意你的观点，必须是真实的，因此你必须自己去做功课，因为如果你不做自己的功课，任何共情或恰当的言辞都会被当作是伪装。

It's so I'm I'm with you on like, it has to be real, and therefore, you have to do your own work because if you don't do your own work, it's like any empathy or the right words are just gonna be felt as, you know, facade.

被利用。

As being, being used.

对。

Yeah.

被利用，被操控。

Being used, being played.

是的。

Yes.

我的意思是，这是年轻成年人正常的关注点。

I I mean, that's an that's a normal young adult preoccupation.

在我那个年代，六十年代，我们反抗虚伪。

In my own era, we in the sixties, we railed against hypocrisy.

我们对《麦田里的守望者》中的霍尔顿·考尔菲德产生共鸣，他把一切称为虚伪，但我们那个时代并没有像今天年轻人所面对的那样，存在如此大规模的虚伪和操纵文化。

We we resonated to Holden Caulfield in, Catcher in the Rye calling things phony, but we didn't have nearly as much of a culture of, phony, manipulativeness on a grand scale as young people today are dealing with.

是的。

Yep.

对。

Yeah.

这很好。

That's good.

你知道，我认为是的。

You know, I think that the yeah.

人们渴望被听见。

The it's they're the people are yearning to be heard.

他们渴望被理解。

They're yearning to be understood.

他们渴望被反映。

They're yearning for mirroring.

我认为，在这一代人中，随着社交媒体的兴起，这也影响了他们的父母。

I think that there's also, in this next generation, you know, with the rise of social media, there's and the rise of social media that's influenced their parents as well.

是的。

Yes.

我认为，这正在创造一些独特的动态，让人们感到依然需要面对面的交流。

I think I think it's it's creating, some unique dynamics where people feel that still face.

我不知道你是否还记得。

I don't know if you remember.

电子化的依然面对面。

Edtronic still face.

是的。

Yes.

当然。

Absolutely.

没错。

It's like Right.

我觉得很多孩子正在

I think a lot of kids are getting

一种

a form

静止面容的表现。

of still face.

观察。

Observation.

我们这一整代人都习惯了静止面容。

We've got a whole generation that is used to the still face.

你对贝翠丝·比布及其关于早期婴儿的研究怎么看？她揭示了在头四个月内相互协调与依恋风格之间的联系。

What do you think about Beatrice Beebe and her work on early infants and showing the link between, like, attunement within the first four months to attachment styles?

这对你分析思维有影响吗？

Was that influential in your analytic thinking at all?

是的。

Yeah.

我非常喜欢她的研究。

I love her work.

我认为她是目前我们所拥有的最具创造力和最投入的研究者之一。

I think she's she's one of the most creative and devoted researchers we have out there.

我欣赏她的发现之一是，你不需要百分之百地投入才能有效。

And one of the things I love about her findings is you don't have to be devoted a 100% of the time to be effective.

你明白吗？

You

你知道吗？

know?

如果你是，我想我记不清她的数据了，但大概是说，最优秀的婴儿母亲大约有百分之四十的时间能与孩子同步。

If you are I think I can't remember her data exactly, but something like if the best mothers of infants were tuned in about forty percent of the time.

这实际上真的很了不起。

And that's and that's amazing, actually.

对吧？

Right?

是的。

Yes.

确实是。

It is.

确实是。

It is.

即使是百分之四十。

Even forty percent.

并不容易。

Aren't easy.

是的。

Yeah.

是的。

Yeah.

我认为她的研究对我理解这种混乱型依恋产生了深远影响。

I I, I think that her work was really influential for me understanding, like, this disorganized attachment

哦，是的。

Oh, yes.

对。

Yes.

这让我意识到，这种依恋模式会导致青少年时期及之后的解离问题。

And putting that on my radar as, like, something that leads to later life dissociation, in adolescence and and different issues.

是的。

Yeah.

我特别喜欢你提到的观点，即解离其实很常见，比人们意识到的要普遍得多。

I'm I really like how you talk about how dissociation is common in with more more people dissociate than they realize.

对吧？

Right?

你能稍微谈一谈这个吗？

Can you talk a little bit about that?

我们每个人都在某种程度上处于不同的自我状态，所有人都具备一定程度的解离能力。

Well, we're all in somewhat different self states, and we can we all have the capacity to dissociate to some extent.

如果你曾经在高速公路上开车，心里想着别的事情，你可能开了二十英里却完全不记得驾驶的过程，因为你的思绪飘到了别处。

If you've ever driven down the highway and you're thinking about something, you can be you can go 20 miles and not remember that experience of driving because you're in your head somewhere else.

对于创伤幸存者来说，这是人类心智具备的一种非凡能力。

If you are a trauma victim, it's an extraordinary capacity that the human mind has.

比如，如果你是一个被性侵的小女孩，人类的心智会告诉自己：我不是那个小女孩。

If you're a little girl being raped, for example, the human mind can say, I'm not that little girl.

我飘在天花板上，看着那个小女孩正在经历这一切。

I'm up on the ceiling watching that happen to that little girl.

如果你经历了足够多的童年创伤，就会发展出一种应对机制——切换自我状态，甚至可能对自己是谁失去记忆。

And if if you are subject to enough childhood trauma, you develop as a coping mechanism, shifting self states in which you may have amnesia for who you are.

在最极端的情况下，你会患上解离性身份障碍，比如你打开衣橱，发现一堆你根本不记得买过的鞋子。

In the in the most extreme case, you have dissociative identity disorder where you look in your closet and you find a whole bunch of shoes that you don't remember buying.

嗯。

Mhmm.

但确实存在一个交替人格做过这件事。

But there's, you know, there's an alter personality who has done that.

我认为，人们常常误解患有解离性身份障碍的患者。

And people, I I think, very often misunderstand patients with dissociative identity disorder.

他们过于关注其奇特性，而没有意识到这仅仅是

They get so they occupied with the exoticness of it that they don't see that this is only an extreme version

嗯。

Mhmm.

我们所有人所做之事的极端版本。

Of what all of us do.

我的意思是，我们大多数人回想起来，都会有一些时候走神，进入一种现实解体或人格解体的状态，感觉生活就像在看电影一样。

I mean, most of us can can think of times when we kinda zoned out, when the when we, went into a state of derealization or depersonalization, and life felt kind of like we were watching a movie.

当代关系心理分析学派，尤其是受菲利普·布罗姆伯格工作启发的文献，大量探讨了我们所有人如何拥有不同的自我状态，而心理健康的一部分，就是能够站在这些状态之间的间隙中——比如，当我扮演不同角色时，我感觉自己完全是另一个人，就像现在，我是那个在授课的南希。

There's a lot of contemporary literature in the relational psychoanalytic movement, mostly, inspired by the work of Philip Bromberg about how we all have different self states, and part of mental health is is being able to stand in the spaces between those states so that if I feel like I'm a completely different person when I'm in a different role, like, now I'm being the Nancy who teaches.

现在我是那个和孙子孙女在一起的南希，我无法在所有这些角色中都觉得自己是同一个南希，否则我就有点解离了。

Now I'm being the Nancy with grandchildren, and I can't I can't feel like I'm Nancy in all those roles, then I'm slightly dissociated.

有时候，人们会以这种状态来适应环境。

Sometimes people use this adaptively.

我有一个病人，她有一个替代人格，因为无法忍受牙医而由这个人格去看了牙医。

I I had a patient who, who had a kind of alter personality who went to the dentist because she couldn't bear the dentist.

她曾经被牙医创伤过。

She'd been traumatized by a dentist.

所以，那个她感觉毫无关联的解离部分替她去看了牙医。

So this dissociated part of herself that she felt no attachment to went to the dentist.

这些情况有时是有适应性的，但大多数时候，人们来找治疗师是因为它们已经变得适应不良。

So these things can be adaptive, but mostly when people come to therapists for them, it's because it's maladaptive.

当你正和心爱的伴侣亲密时，突然间你却飘到了内心某个地方，不在现场，也无法回来。

You're making love to your beloved partner, and suddenly you're out in inner space somewhere, and you're not there, and you can't come back.

你的伴侣感受到了，而你却不知道该怎么办。

And your partner feels it, and you don't know what to do about it.

嗯。

Mhmm.

是的。

Yeah.

我可以在那里探讨几个方向，但其中一件你 elsewhere 提到的、让我觉得特别有帮助的事情是，你谈到了那种源于创伤的移情，其中可能包含解离。

A couple of directions I could go there, but one of the things that I heard you say elsewhere that was really helpful is you talked about, you know, some of the transference that comes from that trauma where there could be the dissociation.

我们通常认为移情是他们把治疗师当成拯救者或迫害者。

You know, we often think of transference as, like, they make the therapist the rescuer, the persecutor.

嗯。

Mhmm.

但你提到过一种非回应性的、旁观者式的移情。

But one thing you talk about is that nonresponsive, bystander transference.

对。

Yes.

对。

Yes.

你提到，这往往是患者最愤怒的地方。

And you talk about how that's actually where the patient is often most angry.

当你这么说的时候，我立刻想到，这正是我所见到的情况。

And when you said that, I was like, that's exactly what I've seen.

就像当他们经历的时候，比如他们的父亲或继父在虐待他们，而母亲却只是装作看不见，被动地回避。

It's like it's like when they went to their it's like, you know, maybe their father or their stepfather was abusing them, And then there's that the mother who's just turning a blind eye passively

是的。

Yes.

她选择站在施虐者一边，可能自己也选择了 dissociation（解离）。

Siding with just going dissociating herself probably Probably.

不。

No.

她没有看到真正发生的事情，没有看到那些虐待和悲剧。

To seeing what's really going on, and the and and the abuse and and the tragedy.

所以，这对我理解这一点很有帮助。

So that was that was helpful to kind

去

of get

度过那段经历。

through that.

我

I

我有一个病人，她的母亲是施虐者，而父亲则是冷漠的旁观者。

I've I have a patient whose, mother was the abusive one, and her father was the uninvolved bystander.

她对父亲更生气，嗯。

And she's more angry at her father Mhmm.

而不是对母亲。

Than her mother.

但你所描述的这种情形在临床上更常见：孩子被男性亲属、父母或祖父母虐待，他们向母亲求助时，母亲要么责怪他们，要么恍惚发呆，或者完全无动于衷，孩子对这种冷漠的愤怒往往超过对虐待本身的愤怒。

But but the the scenario you're depicting is a little more clinically common where a a child was abused by a male relative, parent, grandparent, and they tell their mother, and the mother either blames them or zones out or she's she's just nonresponsive, they have more rage toward the non responsiveness than toward the abuse.

至少，施虐者还在把他们当作一个重要的人来对待。

The abuser at least is treating them like an important object.

你知道吗？

You know?

施虐者和他们之间是有关系的。

The the abuser has a relationship with them.

当有人拒绝与你建立关系时，这比受到伤害更糟糕。

When somebody refuses to have a relationship with you, it's worse than being hurt.

被忽视，被某人置之度外，不关心你。

Being ignored, being endangered by somebody, not caring.

我认为这源于我们原始的依恋需求和生存需求，因为我们生来都无法独自生存。

And I think it goes back to our primitive need for attachment, for survival, because we all we're all born unable to survive by ourselves.

如果有人不关注你，这比有人以糟糕的方式关注你更危险。

And if somebody isn't paying attention to us, it's more dangerous than if somebody is paying attention in a bad way.

是的。

Yeah.

是的。

Yeah.

我觉得这一点上，他们从‘是’那里获得了一种冷漠的神情。

I think there's something about that, like, still face that they're getting from the Yes.

来自非施虐伴侣的那种‘好’，其实是一种不同的虐待形式。

From from the nonabuse nonabusive partner who's well, it's it's a different form of abuse.

对吧？

Right?

这是

It's

是的。

Yes.

这是一种忽视。

It's neglect.

这这这

It's it's it's

一种忽视型的虐待，或者说是共谋。

a neglectful abuse or, you know, being complicit.

是的，我认为创伤研究者，像我们这样的人，比如范德科尔克和理查德·查菲，发现忽视比明显的虐待更具致病性

Yeah, I think the trauma researchers, people like us, well, Vander Kolk and Richard Chaffetz, are finding that neglect is more profoundly pathogenic

哦，我有一篇

Oh, I have

比明确的虐待更具有致病性。

than explicit abuse.

我有一篇文章，看过之后谈到创伤的长期影响和持久效应。

I have this one article that I've looked at that talks about the long term effects of, the enduring effects of trauma.

文章里有一张大脑的图片，它的大小只有正常大脑的一半。

And there's this picture of a brain, and it's just half the size of a normal brain.

是的。

Yeah.

因为大脑需要人际关系，是的。

And it's because the brain requires relationship Yes.

才能成长。

For growth.

是的。

Yes.

而且，是的，忽视会带来一些可怕的长期后果。

And, yeah, so neglect is some awful long term consequences of neglect.

是的。

Yeah.

是的。

Yeah.

我认为这要追溯到，嗯，孩子最主要的需求是什么？

And I think it goes back to kind of like, well, what is the primary drive of the of the kid?

你知道，是依恋，是连接。

You know, it's for attachment, for connection.

是的。

Yes.

我不确定，如果你倾向于这种观点，还是更偏向驱力理论，你的想法是什么？

And I don't know, like, if you kind of side with that or more of drive theory and and and your thoughts.

我喜欢雅克·潘克塞普的研究。

Well, I like Yacch Panksepp's work.

我认为驱动力这个概念有其存在的空间，但我并不认为我们所响应的驱动力是弗洛伊德所提出的力比多与死亡驱力的二元对立。

I I think there is a place for the idea of drive, but I don't think that the drives that we respond to are the Freudian dichotomy of, libido and the death drive.

嗯。

Mhmm.

弗洛伊德喜欢简化和过度概括问题，但潘克塞普提出大脑中存在七种动机系统。

Freud liked to oversimplify things and overgeneralize things, but Panksepp talks about there being seven motivational systems in the brain.

寻求系统，主要由多巴胺介导，这类似于早期心理学文献中所称的‘寻求’，即热情与好奇心。

The seeking system, that's kind of dopamine, mediated mostly, and that's, like, what we've called the sectants, in some of the early psychological literature for, you know, enthusiasm, curiosity.

我有需求。

I have a need.

我会走进世界去寻找它。

I'm going into the world to find it.

大脑中有两个焦虑系统。

There are there are two anxiety systems in the brain.

一个是雅普·汉克斯哈所称的恐惧系统，即对捕食者的恐惧。

One is, what what Jaap Hanksha has called the fear system, which is the terror of predation.

我会被捕食者毁灭。

I'm gonna be destroyed by a predator.

这由一组神经化学物质介导。

And that's, that's mediated by one set of neurochemicals.

然后是依恋系统，即由其他化学物质（包括血清素）介导的恐慌与悲伤系统。

And then there's the attachment system, which is the panic grief system that is mediated by other chemicals, including serotonin.

这就是为什么对于更偏执的患者，SSRIs通常无法减轻他们的焦虑，因为他们反应的是恐惧系统。

That's why, for more paranoid patients, the SSRIs don't tend to reduce their anxiety because they're reacting to the fear system.

我会被毁灭。

I'm gonna be destroyed.

所以这是不同的大脑系统。

So that's a different brain system.

因此，这三个系统就是这样。

So there are those three systems.

还有一个愤怒系统。

There's the anger system.

你激怒任何动物，大脑中某个特定区域就会被激活，产生愤怒反应。

You irritate any animal, a certain part of the brain lights up and handles that with anger.

还有关怀系统、亲职系统、欲望系统和玩耍系统。

There's the care system, the parental system, there's the lust system, and there's the play system.

所有哺乳动物都需要玩耍。

All mammals need to play.

如果你在成长过程中缺乏打闹式玩耍，无论性别如何，日后都会更难集中注意力和保持专注。

And if you don't have rough and tumble play, whatever your gender growing up, you'll have more troubles with concentration and focus later.

PANCED提出，我们之所以看到越来越多的注意力缺陷多动障碍（ADD/ADHD），可能是因为孩子们缺乏足够的自然自发的打闹式玩耍。

PANCED has suggested that maybe one of the reasons we're seeing more ADD and ADHD is that our kids aren't getting enough organic spontaneous rough and tumble play.

相反，他们被安排坐在电脑前，或者参加有监控的玩耍约会，或是被送去参加各种课程。

Instead, they're being stationed in front of computers or, or giving monitored play dates or sending, sending off to lessons of various kinds.

是的。

Yeah.

这些系统都是驱动力系统，并且都涉及情感。

So those systems are, are drive systems and, and they all involve feelings.

它们都有各自的情感成分。

They all have their affective component.

你很难将情感与驱动力完全分开。

You can't quite separate out affect and drive.

但这些初级系统之一是依恋系统。

But one of those primary systems is the attachment system.

那就是恐慌与悲伤系统。

That's the panic grief system.

是的，我认为这绝对是基本的，因为如果没有它，我们就无法生存。

And yeah, I think that's absolutely primary because if we don't have that, we don't survive.

你知道，你不能把孩子单独留在山坡上指望它活下来。

You know, you can't leave a kid on a hillside and have it survive.

是的。

Yeah.

我真的很喜欢你对恐慌悲伤系统的理解，你也喜欢它。

I I really like how you, yeah, enjoy enjoy pancep as well.

这个名字对我来说总是很难记。

It's the name's always hard for me.

我觉得运动，我之前读过一项关于武术对多动症益处的研究，效果非常显著。

And I think play, there's something about I've assumed thinking about, like, this study I read about the benefit of martial arts for ADHD, and the effect size was phenomenal.

真的吗？

Really?

这很有趣。

That's interesting.

我经常看到这些多动症孩子，我就想，这个孩子需要更多的运动。

And and I'm like, I I often see these ADHDers, and I'm like, this kid needs more sports.

不管怎样，我会告诉家长，是的。

Whatever you do, I tell the parents Yeah.

不要通过剥夺他们的运动来惩罚他们。

Do not discipline them by taking away their sports.

是的。

Yes.

因为我也有同样的观察。

Because that I've seen that as well.

比如，他们作业没做完，所以不许他们去运动。

It's like, well, they they aren't doing their homework, so they're not allowed to play their, you know, sport.

不是这样的。

It's like, no.

别这么做。

Don't do that.

你不能不让他们运动。

You don't play.

让他们去运动。

Let them play.

他们需要身体接触。

That's They need the body contact.

他们需要一种无精打采的表情。

They need the, an anergic expression.

我会带我儿子出去，让他早上做冲刺训练。

I get my son out, and we'll have him do sprints in the morning.

我们让这变得好玩又有趣，就像爸爸的种族歧视。

We make it play and fun, so daddy racism.

你知道，这能让他为上学做好准备，让他的大脑进入状态。

You know, and it's that gets him ready for school and gets his brain kind of like, okay.

这样我们就能集中注意力。

So we can focus.

这是一种历史悠久的方法，早在现在这些流行的药物出现之前，就被用来应对多动症了。

That's a time honored method of dealing with ADHD long before we had the the medications that are so popular now.

是的。

Yeah.

是的。

Yeah.

所以，好吧。

So okay.

所以，解离，我们来看看。

So dissociation, let's see.

我们之前讨论过一些这种移情，以及它如何可能被投射到你这位治疗师身上。

We talked about we talked about some of that sort of transference and kind of how that can be placed on you as the therapist.

你可能会变成那个无动于衷的旁观者。

Potentially, you can become that nonresponsive bystander.

当这种情况发生在你身上时，或者当你意识到时，你会怎么对客户说？比如当他们把你想象成那个无动于衷的旁观者时？

When that happens to you or when you you know, what do you say to the the client, like, when they imagine you to be that nonresponsive bystander?

有趣的是，这种移情在治疗中并不像其他移情那样明显，比如他们害怕你是施虐者，或者期待你是救世主。

Well, interestingly, that doesn't come into the treatment nearly as obviously as other transferences like their fear that you're the abuser or, or or their expectation that you're the savior.

或者，

Or,

但你会通过几种方式注意到它。

but you do notice it in a couple of ways.

一种方式是思考你的病人所提到的内容，比如他们的父亲在哪里？

One is, just thinking about the your patient's material on how where was their father?

或者他们的母亲在哪里？

Or where was their mother?

你知道的？

You know?

所以你会从他们谈论的内容中注意到这种缺失。

So you notice it in what they're talking about as an absence.

你也可以通过反移情来察觉，比如当你开始感到异常无聊、分心、隐约烦躁、不在状态、心不在焉或走神时，这很可能意味着你被置于小时候那个心不在焉的人的位置。

You can also notice it through the counter transference, which is if you start feeling oddly bored, distracted, you know, vaguely irritated, not fully there, tuned out, zoned out, that probably means you're being placed in the position of the person who was zoned out when they were little.

有意思。

Interesting.

或者你的体验可能是他们那种走神部分的体现，而你们俩都处于一种恍惚状态。

Or maybe your experience is part of them that zones out, and you're both sort of in a trance.

但当这种情况发生在治疗师身上时，我认为正确的应对方式是说：我感觉在你和我之间正发生某种奇怪的、短暂的现象。

But when that happens to the therapist, I think the proper way to deal with it is to say, I feel like there's this odd, transient thing going on between you and me.

你觉得自己完全在场吗？

Are you feeling fully there?

我意识到自己很难保持共鸣，我在想你我之间正在重现什么。

I realize I'm struggling to stay attuned, and I wonder what's being recreated between you and me.

所以你需要像处理其他阻碍真实连接的因素一样来应对它。

So that you you have to address it like anything else that gets in the way of continued authentic connection.

或者，你也可以就此提问。

Or, you can ask about it too.

你感觉我完全在这里吗？

Are you experiencing me as as fully here?

不管你是还是不是，如果你察觉到他们在跟你说话时，仿佛你是一堵墙纸，你也可以问他们。

You know, whether you are or not, you can ask the patient if you pick up that they, they are talking to you as if you're wallpaper.

有时候，这种做法会带来一些进展。

And, and sometimes that goes somewhere.

有时候，有些患者会对这种问题感到恼火，你会慢慢学会这一点。

Sometimes, there's some kinds of patients that are irritated by that kind of question, and you learn that.

有些病人会说，这跟你没关系。

And there's some patients that say, this is not about you.

这跟我有关。

This is about me.

我只是不想，你知道的，让你保持你的角色。

I just won't you know, stay in your role.

但是，

But,

也许这是他们摆脱自身解离的一个步骤。

Maybe that's one step of them getting out of their own dissociation.

你知道，如果他们

You know, if they're

可能是这样。

It could be.

他们对你生气，某种程度上能让他们从解离状态中走出来，进入一种情绪，虽然可能不是

Their their, getting angry at you kinda moves them out of that dissociation and just an into a emotion, not probably the

这是一种在心理治疗中非常有用的情绪。

emotion that's supposed to be very useful emotion in psychotherapy.

我们必须确保患者明白，我们邀请他们对我们完全愤怒，并不意味着他们应该在其他任何人身上也这样做。

We we have to make sure patients know that the fact that we invite them to be fully angry at us doesn't mean that they should go around, you know, doing that with everybody.

但这种治疗应该是一个安全的空间，让愤怒以全部的强度出现，因为没有愤怒就没有成长。

But this therapy should be a safe place where anger comes in in all of its intensity, because there's no growth without anger.

如果你不给孩子设定界限，比如不让他们跑上马路，孩子是不会生气的。

You don't give a child a limit, like don't run into the street without the kid getting angry.

这是正常发展的一部分。

It's a part of normal development.

你不会对青少年说：我不希望你晚上超过午夜外出。

You don't say to an adolescent, I don't want you to go out later than midnight.

哦，我的朋友们都出去得更晚。

Oh, my friends are going out later.

对于任何限制中的痛苦方面，人们都需要经历愤怒，这是一种正常的适应，否则他们只是以一种不完全的方式顺从。

There's a normal adaptation to any, painful aspect of, of limitation that where people have to go through anger or else they're just being compliant in a way that doesn't fully

是的

Yeah.

要整合起来。

Get integrated.

所以治疗师必须成为愤怒的对象，这种愤怒总比人们只是敷衍了事要好。

So therapists have to be objects of anger, and the anger is better than than people just going through the motions.

对。

Right.

是的

Yeah.

因此，这通常是走向真实的第一步。

So that's often the first step to authenticity.

如果你的患者从未对你发过脾气，那就很重要了，要开始问一问，比如：你从不抱怨。

And if you don't if a patient's never been angry at you, it's important to start asking, you know, you never complain.

你正常的感受在哪里？比如你希望治疗能快一点，或者你觉得我没理解什么？

Where's your normal feeling that you wish this therapy would go faster or you think I didn't understand something?

你知道，这花了不少钱。

You know, this is costing you a lot of money.

我本来以为你会对那些正常的事情感到不满，但你从来不会提。

What are the all the normal things that I would expect you to be irritated by, you never bring up.

这是为什么呢？

What's that about?

然后你去处理他们面对情感时的各种防御机制，那些都是正常的情感。

And then you work through whatever defenses they have against feeling, what are normal feelings.

你知道的，不一定是你想付诸行动的情感，而是正常的情感。

You know, not necessarily feelings that you wanna act out, but normal feelings.

是的。

Yeah.

你认为治疗师普遍更难体验到愤怒吗？

Do you think do you think therapists in general have a harder time experiencing anger?

比如，这是你观察到的普遍现象吗？

Like, is that is that a common thread that you see?

我的朋友，澳大利亚的朱迪·海德，写了一篇关于治疗师人格类型的博士论文，最常见的类型是抑郁型人格，这很合理。

Well, my friend, Judy Hyde, in Australia did a doctoral dissertation on personality types among therapists, and the most common personality type was depressive personality, which makes sense.

你知道，那些容易感受痛苦的人，我不是说他们有临床抑郁症。

You know, people who feel pain and I don't mean that they had clinical depressions.

我是说，他们往往对自己很苛刻。

I mean, that they they tend to be self critical.

当他们受到批评时，会立刻觉得一定是自己的错。

When they're criticized, they immediately feel it must be their fault.

如果你是治疗师，当你的病人情况好转时，你会把功劳归于病人的能力。

And when they're pay if you're a therapist, if your patient does well, you credit the patient's capacity.

如果病人没有起色，那就是你的错。

If your patient's not doing well, it's your fault.

你倾向于主动接近他人来解决问题。

You like to move toward people to solve problems.

因此，很多治疗师都有一种略带抑郁的心理倾向。

So a lot of therapists have a somewhat depressive psychology.

他们对自己要求很严。

They're hard on themselves.

如果从精神分析的角度来看，他们使用内射而不是投射。

They use introjection, if you wanna get psychoanalytic about it, rather than projection.

而且他们总是担心自己做错了事，因此很难轻易感受到愤怒。

And, and they they're always worried that they did the wrong thing, so they tend not to find their anger very easily.

他们很难——我的意思是，治疗师通常不应该向患者表达愤怒，但治疗师确实应该对治疗框架有明确的规则。

And, they have trouble, I mean, it's not usually a proper thing for a therapist to express one's anger at a patient, but it is a proper thing for a therapist to have really clear rules about the frame.

你知道吗？

You know?

这是我的收费标准。

This is my fee.

这是你可以给我打电话的时间。

This is when you can call me.

如果你感到不安而我又无法联系时，你应该这样做。

This is what you should do if you're upset and I won't be available.

这将是我疫情期间的假期。

This is going to be my vacation, during the pandemic.

如果你不相信口罩的作用，我表示抱歉，但当你来我的办公室时，我坚持要求你戴口罩。

I'm sorry if you don't believe in masks, but when you come to my office, I want to insist that you wear a mask.

你知道，无论你的劳动条件如何，这些对治疗师来说都很难坚持。

You know, whatever are your conditions of labor, those are really hard for therapists to stand by.

他们必须学会这些。

They have to learn those.

你必须学会如何说我的收费标准是这样，或者我已经五年都按同样的费用接待你了。

You have to learn how to say my fee is such and such, or I've seen you at the same fee for five years now.

有点偏离了正常范围。

It's got a little a little out of line.

我必须提高费用。

I have to raise it.

对不起。

I'm sorry.

我理解你不喜欢，但这就是我的收费标准。

I understand you don't like it, but this is gonna be my fee.

我认为，这类评论对新手治疗师来说，比天然的共情更难掌握。

Those kinds of comments, I think are much harder for early therapists than natural empathy.

共情不需要刻意训练他们。

Empathy, you don't have to drill into them.

他们天生就是富有共情心的人。

They're naturally empathic people.

但要维护他们帮助他人所需的前提条件，这涉及一定程度的自我主张，

But standing for the conditions under which they can help people, which involves a certain degree of their own aggression

是的。

Yeah.

对他们来说真的非常困难。

Is really, really hard for them.

所以我不确定这是否正是你问题的本意，但这是我多年教导人们如何成为治疗师的过程中所观察到的。

So I don't know if that's where you were thinking with your question, but that's what I've observed over years of teaching people how to be therapists.

不。

No.

我认为，界限是一种我经常看到的现象，当人们试图设立界限时，会流露出细微的愤怒表情。

I think that's I mean, boundaries are a form of I I see often when, you know, a microexpression of anger when people go to form, like, a boundary.

对吧？

Right?

所以我认为，界限是一种愤怒，或者说是展现自我的方式。

So I think boundaries are, a form of anger, or, you know, exerting yourself.

这就是我所坚持的。

Here's what I here's what I stand for.

这就是我的立场。

Here's what my frame is.

是的。

Yeah.

所以，没错，我同意。

So, yeah, I I agree.

我觉得这两者非常相关，所以你能讨论你所讨论的内容也就不足为奇了。

I think that those those two are very related, so it makes sense why you why you discussed what you discussed.

你知道我在想什么吗？

You know what I was thinking?

我在想我们正在谈论解离的问题。

I was thinking about how we're talking about dissociation.

我们在讨论有些人如何活在一种伪装之中。

We're talking about how some people, like, live in a facade.

对吧？

Right?

因为他们可能不得不表演，或者必须，你知道，也许他们身边有一个充满各种‘应该’的父母。

Because they maybe they have to perform or they have to, like, you know, maybe they have a lot of that that parent with a lot of shoulds.

他们应该成为这样。

They should be this.

他们应该成为那样。

They should be that.

他们应该成为这样。

They should be this.

然后他们就活在这些‘应该’之中。

And then they kind of, like, live to those shoulds.

我在想，你对卡伦·霍妮、神经症与人的成长，以及她对神经症结构的理解有什么看法？

And I was thinking, what do you think about Karen Horney, neurosis and human growth, and that kind of, like, her version of seeing the neurotic structure.

你欣赏她哪一点，或者你觉得她和别人有什么不同？

And what do you what do you appreciate about that, or what do you kind of differentiate about that?

我很久没读过卡伦·霍妮的著作了，不过在六七十年代，我非常欣赏她的作品。

It's been a long time since I read Karen Horney, whose work I did like a lot back in the sixties and seventies.

我记得她谈过‘应该’的暴政。

I remember her talking about the tyranny of the shoulds.

在那个年代，人们普遍把神经症问题归因于所谓的严苛超我，人们总在说：我应该这样做。

And back in those days, it was very common to locate, neurotic problems as in the domain of the so called harsh superego that people were always saying, I should do this.

我应该那样做。

I should do that.

你知道吗，我会遇到那些深受‘应该’暴政之苦的病人，但我也见过一些病人，他们觉得自己有权利不去拥有道德准则。

You know, I I would I would say that I see those patients who are suffering from the tyranny of the shoulds, but I also see patients who feel a kind of entitlement not to feel a moral compass.

你知道，这更像是‘你应该适应我’。

You know, that I it's more like you should adapt to me.

你应该为我的痛苦补偿我。

You should compensate me for my suffering.

我有权利，我被伤害了，所以我有权利让世界来照顾我。

I'm entitled to, I've been victimized, so I'm entitled to the world taking care of me.

而这恰恰是相反的。

And that's kind of the opposite.

与其说是内心充满批判的声音，不如说是一种空洞的心理状态，总在问‘谁来解决这个问题？’

A kind of instead of being too full of a critical voice inside, it's kind of an empty psychology of who who's gonna just fix this?

这更接近于，嗯，不是完全符合DSM的自恋型人格障碍，而是在自恋谱系上的一种表现吗？

Is is that more of, like, the not not full DSM, narcissistic personality disorder, but kind of a, you know, on on the spectrum of narcissism.

你看到的是这种情形吗？

Is that what you're seeing?

一种自恋的成分。

A narcissistic element.

我认为任何一种特权感都源于，你知道，是什么让我有资格拥有……

I think Any any kind of sense of entitlement does because, you know, what entitles me to to,

拥有

to

我本应拥有的生活？

the life I think I should have?

我总是从这样一个立场出发：我非常幸运。

It it you know, I I always come from the position of, I'm very lucky.

我本可能是一个被埋在地震废墟下的叙利亚或土耳其人，在严寒中无助地挣扎。

I could be a Syrian or Turkish person buried under mounds of earthquake debris in the bitter cold.

是什么让一些人无法意识到：我确实有很多可以抱怨的事，但我也有许多可以积极建设的东西。

And what is it that some people can't sort of contextualize, alright, I have many things to complain about, but I also have things I can build on positively.

我认为我们生活在一个助长自恋的文化中。

I think we live in a culture that feeds our narcissism.

我一直注意到，广告一直在这么做。

I've been interested that, commercials have been doing this.

早期的广告在营销文化中，常常试图激发我们的性吸引力。

Commercials early on in in ad culture, tried to appeal to our sexuality a lot.

现在它们则是在迎合我们的特权感。

Now they're appealing to our entitlement.

你值得拥有这个。

You deserve this.

给自己放个假吧。

Give yourself a break.

你有这个权利。

You're entitled.

这其实是在迎合我们所有人内心一种原始的渴望——希望世界能按照我们想象的样子重塑。

It's it's it's appealing to this primitive wish we all have to be able to make the world over into whatever we think it should be for us.

是的。

Yeah.

我喜欢你提到的历史背景，还有时间维度，比如我们已经忘记了过去这里有多么舒适、危险有多么少，而这些现在已经不复存在了。

I I like how you say the historic historical, and also the time context of, like, how we forget how comfortable and how little dangers that used to be here don't exist anymore.

你知道，我们对一万年前人类生活的残酷经历似乎完全失忆了。

You know, it's like we have amnesia to the human experience of, you know, ten thousand years ago was brutal.

我觉得平克说过，当时男性的凶杀率高达百分之五十，你知道吗？他们发现的一些古代骨骼上都有明显的砍痕。

Like, I think, Pinker talked about the homicide rate for men was like fifty percent, you know, like fifty percent of some of the ancient bones that they found have, like, gashes in them.

而你知道，现在的情况是，是的。

And, you know, it's like Yeah.

现在我们谈论的是每十万人口中只有六起凶杀案，你知道吗？在发达国家就是这样。

Now it's like, we're talking about six per hundred thousand, you know, is like the homicide rate or, you know, in developed countries.

所以我们只是，是的。

And so we're just we yeah.

我确实能感受到这一点，那种从感恩中诞生的生命体验。

It's like I definitely resonate with that, like, coming from a coming to life from a place of gratitude.

但问题是，我们该如何让其他人也进入这种状态呢？

But then the question is, like, how do we get other people into that space?

你知道的。

You know?

是的。

Yeah.

你不能只是靠说服他们就能达到那个状态。

You can't get there just by trying to talk them into it.

我认为，这需要一个缓慢的过程。

There there's a slow process, I think, you have to go through.

有些病人把治疗当成一种任务，认为只要不停地抱怨，直到你终于明白，就会有某种神奇的事情发生，仿佛他们心中仍抱着一个全知全能的父母形象——只要让他们被理解，一切就会被解决。

There are some patients who approach therapy as if their job is to complain until you finally get it, And then something magic is gonna happen as if they still have some image of an all powerful parent who, if they can only make them understood, will fix things.

我记得曾有一位病人，因为她觉得我花了太长时间才理解她有多混乱，于是对我大发雷霆。

And I remember saying with a patient once who who threw a fit at me because she felt like it had taken me forever to understand how disorganized she was.

我说，那我们来做个思想实验吧。

I said, well, let's do a thought experiment.

假如我能说些什么，让你觉得我真的、真的懂了呢？

What if what if I could say something that made you feel I really, really get it?

我明白你的感受。

I get what it's like to be you.

然后呢？

Then what?

现场陷入了一片沉默，随后她说：我还是得自己解决我的问题，对吧？

And there was this pregnant silence, and then she said, I'd still have to solve my own problems, wouldn't I?

从那时起，她开始逐渐感受到自己对生活的掌控感，不再那么被动地觉得自己是命运的受害者。

And that was the beginning of her beginning to feel some sense of agency in her life and feeling less passively like the victim of circumstances.

在那次治疗结束时，情况非常有趣。

At the end of that therapy, it was very interesting.

很有趣。

Interesting.

我像往常一样对即将结束治疗的患者说：回顾一下，你觉得我们的工作怎么样？

I did what I always do with patients who are terminating, saying, well, how do you how do you evaluate our work looking back?

你知道吗？哪些部分对你有帮助？

You know, what was helpful?

什么不是呢？

What wasn't?

你觉得整体上对你有帮助吗？

Do you feel it was overall good for you?

她说：哦，是的。

And she said, oh, yeah.

这对我特别有帮助。

It was it was great for me.

我根本没什么不满。

I don't have many complaints at all.

我说：那你觉得最有帮助的是什么？

I said, well, what do you think was most helpful?

她说：你就是把问题解决了。

She said, well, you just fix things.

我说：你什么意思？

I said, what do you mean?

因为我一直觉得整个治疗的重点在于我不去解决它，而让她学会自己解决问题。

Because I was thinking the whole therapy was about my not fixing it and her learning how to fix things herself.

她说，当灯泡坏了的时候，你就直接换了一个。

She said, well, when the light bulb went out, you just changed it.

当空调对我来说太冷的时候，你就直接关掉了。

When the air conditioner was too cold for me, you just turned it off.

而我的家人可能会坐上好几个小时，讨论现在灯泡的质量有多差，或者

And my family would have we would have sat around for hours talking about the bad quality of light bulbs these days or how

空调都不好用了。

air conditioners don't work anymore.

她说，你示范了你可以采取行动。

And she said, you modeled that you can do something.

所以你永远不知道患者从你的存在中汲取了什么。

So you never know what patients are taking from your presence.

但她从中领悟到的是：哦，这件事你其实可以做点什么？

But what she took was, oh, you can do something about that?

也许我也可以对此做点什么。

Maybe I can do something about that.

所以，这是她治疗中一个有趣的方面。

So that that was an interesting feature of her therapy.

我觉得我有点偏离了你之前提出的话题。

I think I'm a little bit off the topic that you you posed there.

不。

No.

我觉得，当我听到患者不断谈论他们所经历的困难时，显然，这往往是他们来接受治疗的原因，我常常在他们讲述这些时想，他们是否在真实地体验着这些情绪？

I I think I think you're well, do you I when sometimes when I hear, like, patients continually wanting to talk about the the hardships that they're in, obviously, that's why they're they're coming to therapy a lot of the time, I think to myself, as they're talking about this, are they experiencing that emotion congruently?

对吧？

Right?

所以，他们是

So it's like, are they

是的。

Yes.

他们真的像故事里描述的那样悲伤吗？

Are they as sad as their stories tell?

有时候我觉得，有些患者可能认为治疗就该是这样，也许他们基于以往的治疗经验，觉得这才是建立连接的方式。

Or sometimes I feel like sometimes patients will think that that's how therapy is supposed to go and that's how we connect maybe based on previous therapies.

或者当我真正与他们产生共鸣时，通常他们会感到愉悦或某种形式的连接。

Or sometimes when I do attune to them, usually, they feel pleasure or some sorts of some sort of connection.

在最好的情况下，甚至是一种感激之情。

And so it's like or gratitude, in the best cases.

在他们谈论这些内容时感受到这种情绪，真的让人感觉很好，所以我们就会探讨这种体验是如何发生的。

And it's like feeling that in the midst of what they're talking about feels really good, so we talk about how that's being experienced.

但我不确定，也许你指的是，我确实有一些客户非常停滞不前，你知道的，只是……

But I don't know, maybe you're talking about, I I do have some clients that are really stuck, you know, and just

是的。

Yeah.

我指的是那些仅靠共情共鸣还不够的人。

I'm talking about the people for whom empathic resonance is is not quite enough.

好的。

Okay.

当然，每个人都需要这样。

That certainly, everybody needs that.

每个正在受苦的人都需要感受到你在努力理解他们的痛苦。

Everybody who's suffering needs to feel as if you're trying to understand their suffering.

但他们也需要帮助，去想象从受害或无助的痛苦状态，转变为能够对生活有一定掌控权的可能性，是的。

But they also need help imagining that it's possible to move from a position of victimization or, helpless suffering to a position of, having some say in your life Yep.

并且解决一些问题。

And solving some problems.

对于某些患者来说，过于一致地表现出同情会强化他们一生中唯一拥有的那种依恋模式。

And there are patients for whom it's problematic to be too consistently sympathetic because it reinforces the only kind of attachment they have had in their life.

那位对我会换灯泡如此感动的女士就是如此。

That was true of the woman who got so impressed with my changing the light bulb.

她与母亲之间唯一温暖的依恋，就是两人一起哀叹世界多么不公平、男人多么糟糕、家庭多么不公。

The only warm attachment she'd had to her mother was when the two of them condole together about how unfair the world was or how bad men were, how unfair the family was.

那就是她对依恋的原型。

And that was her prototype for attachment.

所以，你不应该只是强化一种病态的依恋模式。

So, you don't wanna you don't wanna just reinforce a a pathological attachment configuration.

你希望人们学会，他们可以对你生气。

You want people to learn they can be angry at you.

他们常常需要经历一段愤怒的时期。

They can they can often, again, you have to go through a period of some anger.

我认为，人们在真正理解那些伤害之前，是无法原谅他人所犯下的罪行的。

I think people can't forgive people for crimes against them until they really get what the crimes were.

心理治疗不是为了责怪父母，而是为了理解那些出错的事情以及他人的局限性。

And psychotherapy is not about blaming parents, but it is about understanding things that went wrong and limitations of other people.

一旦你处理完对这些事的感受，自然的进展就会让你意识到：我想我的父母在他们的条件下已经尽力了，他们做得还不错。

And once you get through your feelings about that, the natural progress moves toward, you know, I think my parents did the best they could and given their histories, they did pretty well.

我原谅了他们的不足，并感激他们给予我的一切。

And, I forgive them for their failings, and I'm grateful for what I did get from them.

所以，感激之情是在这个过程的最后才出现的。

So the the gratitude comes at the end of a process like that.

它并不是来自那些告诉你‘你应该感恩，因为你没有像其他人那样受苦’的陈词滥调。

It doesn't come from homilies about how you should be grateful because you're not suffering as much as some other people.

是的。

Yeah.

当然。

Absolutely.

那样根本毫无帮助。

That's that's not gonna help at all.

恰恰相反，这只会让他们更生气。

It's like, if anything, it'll make them more angry.

你知道的。

You know?

这很明显，你根本不懂我。

Like, that this is just obvious that you don't understand me.

如果你一开始就从一些说教开始，是的。

If if if you were to start with some homily yeah.

那里有很多内容需要梳理。

It's there's a lot there's a lot to unpack there.

我认为人们建立的联系或连接模式，比如像你所说的，通过共同抱怨某事来建立联系，如果他们在世界上找到类似的东西，这些联系几乎会被强化，对吧？

I think that the connections that people make or the patterns of connection, you know, whether it's connecting, like you said, over talking negatively about something, they almost become reinforced if that's what they they they they'll they'll find something similar in the world, right, often.

但如果这种联系不一致、不真实，回到现在人们那种对真实性的‘盖革计数器’般的感知，它就不会让人觉得真实。

But then it doesn't it doesn't really if it's not congruent, if it's not authentic, coming back to kind of, like, that Geiger meter of authenticity that people have nowadays, it it it doesn't feel true.

对吧？

Right?

因此，我常常把患者的创作作品视为找到真实与一致性的途径，无论是诗歌、梦境、艺术还是音乐。

And so I often will think about the creative work of my patients as a way of getting to what is congruent and true, whether it's, like, poetry or, dreams or art or music.

是的。

Yes.

我很好奇，你如何利用这些真实一致的空间去触及真实的人，然后与真实的人建立连接？

And I'm curious maybe, like, how do you use those congruent spaces to get to the real person and then connect with the real person?

这个问题很难一概而论，因为我觉得每个人活力的来源都大不相同。

It's hard to answer that in general because I think, people differ so much in where their vitality exists.

有些病人很难向治疗师敞开心扉，并不是因为他们不想，而是因为这对他们来说太痛苦了。

There are some patients that have a terrible time opening up to a therapist, not because they don't want to, but because it's just so painful for them.

但他们可能在某个根本点上能够谈论真实的情感。

But they may be able to talk about authentic feelings at one root.

他们可能通过文学、音乐或电子游戏来表达这些感受，你知道的，不一定是高雅艺术。

They may be able to talk about it in literature where they may be able to find it in music or video games, you know, not necessarily high art.

当他们谈论这类事情时，他们的活力就会显现出来。

They their vitality may come out when they're talking about that kind of thing.

还有一些病人非常被动，你会觉得他们的寻求系统出了问题。

And there are some patients that are very passive and you feel like something went wrong with their seeking system.

他们完全找不到任何热情。

They, they, they don't find any enthusiasm.

他们并不完全是抑郁，但他们就是没有活力。

They're not exactly depressed, but they, they, they don't have vitality.

温尼科特说过，一个人可以看似正常，却并不真正活着。

Winnicott said a person can be normal without being alive.

而我们的工作就是帮助人们找到他们真正活着的时刻。

And, it's our job to help people find where they're alive.

但我确实遇到过一些患者，他们通过艺术作品表达得更好。

But I I've had patients that have communicated better via artwork.

是的。

Mhmm.

我曾有一位极度分裂的患者，她和我交流非常困难，每次治疗的前二十分钟都会坐着摇晃、搓手，并喃喃自语：‘我知道我做不到这个。’

Or, I had one extremely schizoid patient who had such trouble talking to me that she would sit and rock and wring her hands and mutter to herself for the first twenty minutes of every session saying, I knew I couldn't do this.

我知道我做不到，我真的没法谈论这些。

I know I can't I just can't talk about this.

我做不到，我真不该试着这么做。

I can't I was crazy to try to do this.

你知道，这是一个有着高度适应性虚假自我的人，她能很好地适应工作，却与任何人都无法建立亲密关系。

You know, this was a person who had a a a very adaptive false self, adaptation to her work, but she was intimate with nobody.