それでは治療者は来談者を心地よくさせればいいのか？
これが最後の疑問である。治療が継続する大きな要因が、患者さんの居心地の良さであるとしたら、治療者はそれを提供することを第一に考えるべきであろうか？ 私はそれを否定しないが、治療者が向かうべき問題はより大きなものである。それは来談者の人生の質（QOL)の向上に最善を尽くすことである。それがその時の来談者に安心感を提供したり、孤独を救うことを意味するのなら、それでいいのである。しかしその時に来談者が洞察を得ることが将来的なQOLの向上に役立つのであれば、それも大切なことである。(←提供モデルの基本理念である。) すると治療者がどのようなスキルや力を備えていることが、来談者のQOLの向上につながるのだろうか? おそらくそれは来談者の体験を的確に知る認知能力と共感能力、そして倫理観、愛他性ということになるだろうか。治療構造、精神分析の(相対的な意味での)基本原則はそれを最大限にするために用いるものである。
Fairbairn
It has not been
well recognized that Fairbairn’s theory of schizoid mechanism is practically
that of splitting and dissociation. Fairbairn says, ”… it may be added
that my own investigations of patients with hysterical symptoms leave me in no
doubt whatever that the dissociation phenomena of ‘hysteria’ involve a
split of the ego fundamentally identical with that which confers upon the term
‘schizoid’ its etymological significance”. （p. 92）(”Psychoanalytic Studies of the Personality”
Routledge, 1952 ) “So far as the manifestations of dual and multiple personality are
concerned, their essentially schizoid nature may be inferred from a
discreet study of the numerous cases described by Janet, William James,
and Morton Prince. … The personality of the hysteric invariably
contains a schizoid factor in greater or lesser
degree, however deeply this may be buried.(ibid, P5.)”
Although Fairbairn did not follow suit in
neglecting the notion of dissociation as many of his contemporary analysts, his
definition of schizoid phenomenon that he associated with dissociation is
unfortunately too ambiguous. He states that there are three features of
schizoid state, including omnipotence, isolation and detachment, and concern
for inner reality, which did not include any nuance of mental functions being
separated or “split” apart, as the original idea of dissociation and hypnoid
state connoted. Fairbairn might have observed this schizoid phenomenon in
various kinds of psychopathology, especially against the background of
Bleuler’s proposal of “schizophrenia”, which also appeared to have not only
psychotic features but also dissociative aspects. Although schizoid problem
became one of the main focuses of the British object relations theory, it grew
apart of the concept of dissociation. It was Guntrip who summarized the
“schizoid problem” in the chapter 6 of his book (Guntrip, 1971).
“As Winicott stated, if the care of
“good enough mother” was unavailable, a child splits off true, vulnerable self
underneath false self. “ “ If an external defense of cold and emotionless
intellectual person hides a vulnerable, greedy and fearful infantile self, it
would eventually appear in the world of dreams and fantasy".
Harry Guntrip (1971)
Psychoanalytic theory, therapy, and the self, Basic Books.
