梦出患者(dreaming the patient)

类型: concept
创建时间: 2026-08-29
最后更新: 2026-08-29
主来源: ogden-ontological-psychoanalysiseshel-withnessgovrin-interpretation

摘要

梦出患者(“dreaming” the patient)指分析师为其病人尚未能被梦的经验执行做梦这一心理工作。其理论谱系是:比昂把分析的重心从梦(dream)移到了做梦着(dreaming)——做梦被他等同于「做无意识心理工作」,是使经验变得可被精神消化的机制本身;奥格登据此提出,分析师以遐想(reverie,清醒的做梦)接收病人无法自行梦出的经验,并把转化后的(被梦过的)版本返还给病人;埃谢尔则把这一操作推到极限——她在自己的心灵臂弯里抱住病人死去的身体,「思考着、感受着、并梦出那死亡」。

这一概念的关键技术规定有二:(一)分析师是从遐想出发说话(speak from reverie),而不是关于遐想说话(speak about it);**(二)**遐想的材料恰恰是分析师最平庸、最日常的念头,因此会谈中的走神、记忆、身体感受都可能(而非必然)是这一过程的素材。

必须首先交代一项文本事实:在本批资料中,「dreaming the patient」这一短语仅以关键词形式出现于埃谢尔《Withness》一文的关键词行;奥格登 2019 年《本体论精神分析》全文使用「undreamt」「dreamt」「dreaming」,但未使用该短语。该短语的经典出处是奥格登 2004 年〈This art of psychoanalysis: dreaming undreamt dreams and interrupted cries〉,该文见于埃谢尔的参考文献,但其正文不在本批资料内。详见第一节。

一、术语与来源:本批资料的覆盖范围(如实标注)

检索记录:对本批六份 raw 文件检索 dreaming the patientdream the patientdreamt byundreamtdreaming,结果如下:

文献dreaming the patientundreamtdreaming说明
Ogden, Ontological(2019)016 + 3核心机制表述集中在第三节;undreamt 出现于遐想定义句(第三节)
Eshel, Withness(2013)1(仅关键词行)03正文中的实际用法为 "dreaming" the death;参考文献著录 Ogden (2004)
Govrin, Interpretation0011 + 2绝大多数为「dream-work / dream-work-α」的比喻性用法;第七章第四节一处直接表述本机制
Eshel, Interconnectedness000

关键词行原文(本批资料中该短语的唯一出处):

Keywords: Analyst’s “presencing,” patient–analyst interconnectedness or “withness,” passion, compassion, fetishistic-masochistic perversion, early breakdown, suffering versus feeling pain, transformation O → K, “dreaming” the patient.

— Eshel, Withness,Keywords

该短语的经典出处不在本批资料内。埃谢尔《Withness》的参考文献中著录为:Ogden, T. H. (2004), “This art of psychoanalysis: dreaming undreamt dreams and interrupted cries”, Int. J. Psychoanal., 85:857–877(— Eshel, Withness,REFERENCES)。该文正文未收录于本批资料,本页不引用其内容。

【推断】 本页以下各节所呈现的机制内容,全部来自本批资料中实际存在的文本(奥格登 2019 对遐想与 undreamt 的表述、埃谢尔对「梦出那死亡」的自述、Govrin 第七章第四节的转述),未从奥格登 2004 年原文外推任何内容。凡属跨文献的机制性重述,均标【综合】。

二、从「梦」到「做梦着」:名词与动名词之分

奥格登在论文摘要中把这一转换写成了纲领:

Winnicott shifts the focus of psychoanalysis from the symbolic meaning of play to the experience of playing, and Bion shifts the focus from the symbolic meaning of dreams to the experience of dreaming in all of its forms.

— Ogden, Ontological,摘要

并在第三节给出了比昂版的等价命题:

Just as Winnicott shifted the focus of analysis from play to playing, Bion shifted the analytic focus from (the understanding of) dreams to (the experience of) dreaming (which, for Bion, is synonymous with doing unconscious psychological work [cf. Ogden 2007a]).

— Ogden, Ontological,第三节「III. BION’S CONTRIBUTIONS TO」

「名词与动名词之分」的原始出处是温尼科特谈游戏,奥格登把它当作整篇论文的判据使用:

I suggest that in her writings Klein (1932), in so far as she was concerned with play, was concerned almost entirely with the use of play [as a form of symbolization of the child’s inner world] … It is simply a comment on the possibility that … the psychoanalyst has been too busy using play content to look at the playing child, and to write about playing as a thing in itself. It is obvious that I am making a significant distinction between the meanings of the noun ‘play’ and the verbal noun ‘playing.’ [pp. 39-40]

— Ogden, Ontological,第一节(引 Winnicott, 1971a, pp. 39–40)

奥格登随即把这一区分翻译成认识论/本体论之分:

Winnicott is making a distinction here between the symbolic meaning of “play” and the state of being involved in “playing.” Arriving at understandings of the symbolic meaning of play is the domain of epistemological psychoanalysis; working in and with the state of being involved in playing is the domain of ontological psychoanalysis.

— Ogden, Ontological,第一节

【综合】应用到梦上,这一区分给出本页的判据表

名词形式动名词形式
游戏play(可被解释的符号内容)playing(一种存在状态)
dream(可被解释的文本)dreaming(做无意识心理工作的过程
领域认识论精神分析本体论精神分析
分析师的动作解释意义参与/代为执行这一过程

因此「梦出患者」不是一个关于梦的内容的概念,而是关于做梦这一功能由谁来执行的概念。

三、机制:分析师为尚未能被梦的经验做梦

奥格登在第三段给出了本批资料中对该机制的定义性表述

Bion’s (1962a, 1962b) conception of “reverie” also reflects his ontological bent. Reverie (waking-dreaming) is a state of being that entails making oneself unconsciously receptive to experiencing what is so disturbing to the patient (or infant) that he is unable to “dream” (to do unconscious psychological work with) the experience.

— Ogden, Ontological,第三节

梦出患者的材料来自分析师的遐想,而遐想的内容是最平庸的

The analyst’s (or mother’s) reveries, waking dreaming—which often take the form of his most mundane, quotidian thoughts (Ogden 1997a, 1997b)—constitutes a way in which the analyst (or mother) unconsciously experiences something like the patient’s (or infant’s) unthinkable, undreamable experience.

— Ogden, Ontological,第三节

返还的技术规定——从遐想出发说话,而非关于遐想说话

In the analytic setting, the analyst makes available to the patient the transformed (dreamt) version of the patient’s “undreamt” or partially dreamt experience by speaking (or relating in other forms) from, not about, reverie experience (Ogden 1994).

— Ogden, Ontological,第三节

Govrin 在第七章第四节用几乎相同的语言复述了这一机制:

Bion’s conception of reverie—a state of unconscious receptivity to the patient’s undreamable experience—exemplifies ontological thinking. The analyst doesn’t interpret the patient’s projective identifications but becomes temporarily transformed by them, offering back a “dreamt” version of what was previously unthinkable. This represents a fundamentally different way of being with patients’ psychotic anxieties.

— Govrin, Interpretation,第七章第四节「Part IV: From Knowing to Being—The Ontological Turn」

【推断】 关于「走神、困倦」:「困倦(drowsiness/sleepiness)」在本批资料中没有任何文本依据,本页不将其列为遐想的材料。被文本明确证实的只有两项:遐想被定义为 waking-dreaming(清醒的做梦),以及其内容「往往采取最平庸、最日常的念头(his most mundane, quotidian thoughts)」的形式。奥格登文中实际给出的遐想实例是一段青春期记忆与一个词的重复,而非困倦(见第七节)。

四、与 α功能、涵容的关系

梦出患者不是与涵容并列的另一套机制,而是同一机制在本体论读法下的表述。三者的关系如下:

(一)α功能是「转化」的隐喻,其产物是做梦的零件。 奥格登明确把 α功能读作隐喻,并把 α元素与温尼科特的持续存在对接:

I view Bion’s (1962a) theory of alpha-function as a metaphor for the transformation of beta-elements (raw sense impressions that are bodily responses to experience, but which do not yet constitute meaning, much less being oneself) into alpha-elements, which comprise components of subjectless being, much like Winnicott’s “going on being.”

— Ogden, Ontological,第三节

(二)α元素 → 梦思 → 做梦;而做梦即主体之诞生

Alpha elements are linked with one another in the process of producing “dream-thoughts,” which in turn are used in the process of dreaming. Dreaming is the psychic event in which the individual becomes a subject experiencing his own being.

— Ogden, Ontological,第三节

(三)α功能停摆的双重代价,正是「梦出患者」要处理的

When, in severe forms of psychopathology …, alpha-function ceases to process sense impressions, not only does the individual lose the capacity to create meaning, he also loses the capacity to experience himself as alive and real.

— Ogden, Ontological,第三节

(四)涵容侧的对应表述——母性遐想是 α能力的前提:

Toward the end of Chapter 12 of Learning from Experience, Bion asks: “When a mother loves the infant, what does she do it with?” He replies: “Leaving aside the physical channels of communication my impression is that her love is expressed by reverie” (Bion, 1962).

— Govrin, Interpretation,第三章「Reverie and Alpha-Function」(引 Bion, 1962)

The development of the infant’s alpha capacity depends fundamentally on the mother’s capacity for reverie, which enables her to receive any psychic object from the infant and submit it to the process of transformation through her own alpha-function.

— Govrin, Interpretation,第三章

【综合】因此可归纳出一张同一机制的三种描述语言

语言描述强调本批资料中的出处
涵容语言母亲/分析师接收投射,转化后返还代谢、承受、不被排泄Govrin 第三章;Eshel(containing 与 holding 并列)
α功能语言β元素经 α功能转化为 α元素装置、加工、可储存性Ogden 第三节;Govrin 第三章
梦出语言分析师为病人未梦出的经验做梦存在状态、主体之诞生、不可解释性Ogden 第三节;Eshel 关键词与结语

三种语言描述同一件事,但梦出语言多出一层:它把终点规定为「个体成为经验其自身存在的主体」,而不只是「意义得以生成」。这也是奥格登坚持用动名词的理由——做梦不是产生某物,而是成为某人的事件

五、温尼科特的合流:「幻想化」干扰做梦

奥格登引用温尼科特晚期论文〈做梦、幻想化与生活〉,为「梦出患者」提供了另一半论证——它说明了为什么不能用解释去替代做梦

Winnicott (1971b), in one of his late papers, “Dreaming, Fantasying, and Living,” reaches a conclusion that lies at the heart of his opus and differentiates his approach from Klein’s, in particular, and epistemological psychoanalysis in general. For Winnicott, unconscious fantasy is a vicious cycle that entraps one in one’s inner world. In describing a portion of an analysis, he writes:

For me the work of this session had produced an important result. It had taught me that fantasying interferes with action and with life in the real or external world, but much more so it interferes with dream[ing] and with the personal or inner psychic reality, the living core of the individual personality. [1971b, p. 31]

— Ogden, Ontological,第一节(引 Winnicott, 1971b, p. 31)

【综合】这一命题的激进性在于:幻想化(fantasying)不只是干扰行动与外部生活,它更严重地干扰做梦本身——即干扰「个体人格的活的核心」。因此分析师若以诠释喂养病人的幻想化,就是在破坏做梦。奥格登由此给出整篇论文的治疗目标句:

From the perspective of ontological psychoanalysis, it is not the knowledge arrived at by patient and analyst that is the central point; rather, it is the patient’s experience of “arriv[ing] at understanding creatively and with immense joy,” an experience in which the patient is engaged not predominantly in searching for self-understanding, but in experiencing the process of becoming more fully himself.

— Ogden, Ontological,第一节

Ontological psychoanalysis suggests that our patients come to us not primarily seeking understanding but hoping to become more fully themselves.

— Govrin, Interpretation,第七章第四节

六、埃谢尔如何使用:梦出那死亡

埃谢尔的用法把「梦出患者」推到了极限对象上——不是梦出一段被压抑的经验,而是梦出死亡本身

背景:病人 P.(严重恋物—受虐倒错)在分析的第五年,倒错崩解后暴露出的核心状态是死寂。埃谢尔描述这些无法被容纳、无法被受苦的经验轰炸着两个人心灵的边界

Therefore, in the fifth year, all these menacing, unbearable, uncontained, and unsuffered feelings were overwhelmingly relived in the treatment, bombarding the boundaries of his psyche and mine over the entire fifth year, in a desperate plea to be taken in, suffered, and transformed.

— Eshel, Withness,CONCLUDING THOUGHTS

她先做了一切「分析师会做的事」,但仍不够——这是本段最精细的临床自述:

I was there with these feelings, speaking about them and speaking them, thinking and understanding them, struggling to ensure survival—more and more in the grip of these feelings, but not yet there in the patient’s inmost devastation, not “unless the bottom of the trough [had]… been reached, unless the thing feared [had]… been experienced” (Winnicott 1974, p. 105, italics in original).

— Eshel, Withness,CONCLUDING THOUGHTS(引 Winnicott, 1974, p. 105)

然后是「梦出」发生的那一刻

I was experiencing the terror of breakdown, suicide, and death, but not yet death itself, until the time that I starkly took them into myself and was with the dying child-man, holding the dead body in the arms of my psyche—thinking, feeling, and “dreaming” the death (Bion 1992, p. 216; Eigen 2001; Grotstein 2007, 2009; Ogden 2004).

— Eshel, Withness,CONCLUDING THOUGHTS

其结果——转化发生在分析师之内,然后才可能发生在病人之内

Thereby, this desperate, attacking plea turned into suffering and profound, immense sorrow within me. It became a wordless, deep, psyche-to-psyche interconnectedness and com-passion; and the death that was taken in and became experienced and suffered for the first time by me-with-him was transformed, and could then become, within him, a different, new possibility of being and experiencing.

— Eshel, Withness,CONCLUDING THOUGHTS

其方法论前提被埃谢尔单独标出

I emphasize that in order for the patient to be there and experience these agonizing feelings, the analyst must be there, with-in. Only then, can the deadly breakdown that has already happened be experienced and lived out t(w)ogether in the treatment.

— Eshel, Withness,CONCLUDING THOUGHTS(引 Winnicott, 1974, p. 106 之后)

【综合】埃谢尔的用法与奥格登的用法有明确差别,可视为对同一概念的激进化

奥格登埃谢尔
分析师的位置接收、转化、从遐想出发说话与之合一(becoming at-one with it)、在其内
转化发生于分析师的无意识接收 + 言语返还分析师之内先发生,再「could then become, within him」
术语框架reverie / undreamt / alpha-functionpresencing / withness / transformation O → K
关键词「speaking from, not about, reverie」「wordless, deep, psyche-to-psyche interconnectedness」
是否为言语操作是(或以其他关系形式)明确无言的(wordless)

埃谢尔把这一操作归入她划分的第三种分析功能——处理最未分化心理功能区的转化:

  1. Transformation in O, when dealing with the most non-thought, unknown, undifferentiated zone of psychic functioning (Winnicott, Milner, late Bion, late Lacan). Rather than epistemological exploration (knowing), the focus here is on the unknown and unknowable, ultimate, emotional reality-O, the primacy of being at-one with the patient’s emotional reality, and a lived, new experience.

— Eshel, Withness,WHAT KIND OF ANALYTIC PRESENCE AND “WITHNESS” WOULD THAT BE?

七、奥格登的临床:不解释,而描述

案例一(Jim): adolescent 住院病房的长期病人,沉默、面无表情。奥格登描述自己的反应该被如何使用。

About five months into the analysis, Jim was brought to his session walking in a listless way. His face was utterly expressionless; his eyes were like the eyes of a dead bird. He said to no one in particular, “Jim is lost and gone forever.”

— Ogden, Ontological,第五节「V. CLINICAL ILLUSTRATIONS」

分析师自己的存在状态被用作工具

In the first of the sessions I have described, I was for quite a long time completely immersed in a state of losing my sense of being someone. Jim and I were “lost and gone forever,” and initially we were each absolutely alone in that state—we did not exist for one another, any more than we existed for ourselves.

— Ogden, Ontological,第五节

I simply experienced a terrifying sense of losing myself, which was essential if I was to ever be of any use to him. In not being anyone, I was experiencing something akin to what he was feeling in the session, and probably for the entirety of his life.

— Ogden, Ontological,第五节

这就是「遐想的材料是最平庸的念头」的实例——一段青春期记忆,一个词的重复:

As the session continued, I was reminded of a frightening experience I had had as an adolescent when, alone in the kitchen after dinner, I repeated the word napkin out loud over and over again until it became a mere sound, no longer having any tie to the thing it once named.

— Ogden, Ontological,第五节

My reverie about my own experience as an adolescent helped me, at least for a moment, to be both in the situation with the patient and to bring to it some of my own sense of living at the very edge, but not over the edge, of losing myself.

— Ogden, Ontological,第五节

分析师说的话——描述状态,而非解释内容

I said to him, “Sitting here feels like being nowhere and being no one.”

— Ogden, Ontological,第五节

以及最关键的自我约束——拒绝符号化

I was not the least bit inclined to take up possible symbolic meanings of watching TV, for to do so, would have decimated the living experience that was occurring, an event having everything to do with being, and little to do with understanding.

— Ogden, Ontological,第五节

其回应是隐喻,而不是解释

But the more important part of my response to his question took the form of my describing (not explaining) by means of a metaphor, something of the state of being I felt was occurring: the sensory experience of the striking of a match and illuminating for a moment what had been invisible (the two of us as separate people), followed by a feeling that the darkness was not quite as absolute as it had been.

— Ogden, Ontological,第五节

案例二(Mr. C.):脑瘫病人报告了一个「没什么发生」的梦——他洗着车、听着音乐,并且第一次完整接受了自己有脑瘫这件事:

I had not the slightest inclination to talk with Mr. C. about my understanding of the dream. I said to him, “What a wonderful dream that was”

— Ogden, Ontological,第五节

比昂的等价技术(奥格登引 Clinical Seminars)——不问梦的内容,问梦者的所在:

So why does the patient come to see a psycho-analyst and say he had a dream? I can imagine myself saying to a patient, “Where were you last night? What did you see?” If the patient told me he didn’t see anything—he just went to bed—I would say, “Well, I still want to know where you went and what you saw.” [p. 142]

— Ogden, Ontological,第三节(引 Bion, 1987, p. 142)

Here, Bion is imagining talking with a patient in a way that focuses not on the content of what the patient is calling a dream, but on the state of being of the patient—“Where did you go?” “Where were you?” “Who were you?” “Who did you become when you got into bed?”

— Ogden, Ontological,第三节

⚠️ 矛盾标注
议题:梦出患者是分析师侧的操作(分析师代病人做梦,再把被梦过的版本返还),还是两人共同生成的存在事件(分析师在病人经验之内与之合一)?
A 方立场:奥格登——机制是分两步的:分析师先以遐想无意识地经验到「类似病人不可思考、不可梦的经验」,然后将其转化版提供给病人——「In the analytic setting, the analyst makes available to the patient the transformed (dreamt) version of the patient’s ‘undreamt’ or partially dreamt experience by speaking (or relating in other forms) from, not about, reverie experience」(Ogden, Ontological,第三节)。主体与功能仍然是分离的:分析师做梦,病人接收。
B 方立场:埃谢尔——转化先在分析师之内发生,然后在病人之内成为可能,且这一过程明确是无言的、心灵对心灵的相互贯通——「It became a wordless, deep, psyche-to-psyche interconnectedness and com-passion; and the death that was taken in and became experienced and suffered for the first time by me-with-him was transformed, and could then become, within him, a different, new possibility of being and experiencing」(Eshel, Withness,CONCLUDING THOUGHTS)。她明言这超出两人心理学,是「patient and analyst become an emergent two-in-one new entity」。
备注:这属于范式差异。奥格登保留了两人的分离性与分析师的特定功能(他明确说自己不把温尼科特与比昂视为客体关系理论家,但也不主张合一);埃谢尔的「同在(withness)」则要求在病人经验之内在那里。两者对「分析师该说什么」的技术结论却高度一致:奥格登「I had not the slightest inclination to talk with Mr. C. about my understanding of the dream」,埃谢尔则把转化描述为 wordless。差异在于转化的场所:在分析师之内(奥格登的遐想)还是在两者之间生成的第三实体(埃谢尔的相互贯通)。参见 concept-withnesscomparison-withness-vs-analytic-third
补充:Govrin 的转述站在 A 方一侧——「The analyst doesn’t interpret the patient’s projective identifications but becomes temporarily transformed by them, offering back a ‘dreamt’ version of what was previously unthinkable」(Govrin, Interpretation,第七章第四节)。

关键引文

  1. Reverie (waking-dreaming) is a state of being that entails making oneself unconsciously receptive to experiencing what is so disturbing to the patient (or infant) that he is unable to “dream” (to do unconscious psychological work with) the experience.
    — Ogden, Ontological,第三节

  2. The analyst’s (or mother’s) reveries, waking dreaming—which often take the form of his most mundane, quotidian thoughts (Ogden 1997a, 1997b)—constitutes a way in which the analyst (or mother) unconsciously experiences something like the patient’s (or infant’s) unthinkable, undreamable experience.
    — Ogden, Ontological,第三节

  3. In the analytic setting, the analyst makes available to the patient the transformed (dreamt) version of the patient’s “undreamt” or partially dreamt experience by speaking (or relating in other forms) from, not about, reverie experience (Ogden 1994).
    — Ogden, Ontological,第三节

  4. Bion shifted the analytic focus from (the understanding of) dreams to (the experience of) dreaming (which, for Bion, is synonymous with doing unconscious psychological work).
    — Ogden, Ontological,第三节

  5. Dreaming is the psychic event in which the individual becomes a subject experiencing his own being.
    — Ogden, Ontological,第三节

  6. I was experiencing the terror of breakdown, suicide, and death, but not yet death itself, until the time that I starkly took them into myself and was with the dying child-man, holding the dead body in the arms of my psyche—thinking, feeling, and “dreaming” the death (Bion 1992, p. 216; Eigen 2001; Grotstein 2007, 2009; Ogden 2004).
    — Eshel, Withness,CONCLUDING THOUGHTS

  7. I was not the least bit inclined to take up possible symbolic meanings of watching TV, for to do so, would have decimated the living experience that was occurring, an event having everything to do with being, and little to do with understanding.
    — Ogden, Ontological,第五节

关联

引用来源

  • ogden-ontological-psychoanalysis — 第三节为遐想、undreamt、α功能与做梦的全部定义性引文来源;第一节提供名词/动名词之分与温尼科特「幻想化干扰做梦」;第五节提供 Jim、Mr. C. 等临床例证
  • eshel-withness — Keywords 提供 “dreaming” the patient 这一短语在本批资料中的唯一出处;CONCLUDING THOUGHTS 提供「梦出那死亡」的完整段落与其前后文;WHAT KIND OF ANALYTIC PRESENCE 一节提供第三种分析功能的划分;REFERENCES 著录 Ogden (2004) 为该短语的经典出处
  • govrin-interpretation — 第七章第四节提供对本机制的复述;第三章提供母性遐想与 α功能的涵容侧表述

覆盖度说明(如实标注):(一)dreaming the patient 这一短语在本批资料中仅出现 1 次,且位于关键词行,正文中无一处对该短语本身作定义或展开;正文中的实际用法为 "dreaming" the death。(二)该短语的经典文献 Ogden (2004) This art of psychoanalysis: dreaming undreamt dreams and interrupted cries正文不在本批资料内,仅有埃谢尔参考文献中的一行著录;本页未从该文外推任何内容。(三)「困倦」作为遐想材料在本批资料中无任何文本依据(见第三节【推断】标注)。

引文处理说明:原始 PDF 转 Markdown 时产生的三类排版伪影在引文中已按原刊印刷形式还原——断字连字符(intercon- nectedinterconnected)、跨行断字被误插的斜体标记(*com-* *passion**com-passion*)、以及缺失空格(child’sinnerworldchild’s inner world)。Govrin 原文中标引年份的下划线标记 <u>…</u> 已去除;Eshel 原文中的 markdown 斜体标记(*com-passion*)予以保留。

变更记录

  • 2026-08-29: 初始创建,来源 ogden-ontological-psychoanalysiseshel-withnessgovrin-interpretation。第一节以检索表形式如实标注本短语在本批资料中的实际覆盖范围;第三节标注「困倦」无文本依据;第四节以三语言对照表处理与涵容/α功能的关系;第七节以矛盾标注处理奥格登与埃谢尔对转化场所的分歧。