一境界例患者の個人精神療法

A Psychotherapy of a Borderline Patient

　抄録　著者は本稿において初診時15歳の境界性人格障害患者の初めの6年間の支持的精神療法の経過をその個人療法を中心に提示した。そしてこの患者の治療経過は，寡黙で一見素直だが周囲との関わりを拒み自殺企図を繰り返す「自閉」の時期，次いで治療者の個人的背景を知りたがり，さらに治療者と両親に激しい怒りや被害念慮を示すようになる「共生」の時期，そして個体としての統合性を増し衝動行為などへの内省力を高める「個体化進展」期として3期に分けて捉えられることを示した。ここでは患者の対人関係の特徴（自閉と共生），および他から区別される個体としてのあり方，つまり個体性の障害が，患者の病理およびその治療による変化を捉える上で有用な視点であると考えられた。さらにこの視点から境界例患者のそれぞれの治療段階での治療者の働きや役割についての考察が行われた。

　A case report of the first 6 year-psychotherapy of a borderline patient (15 years old at the first interview, male, unmarried), illustrates three phases of the therapy relationship; autism, symbiotic relation, and individuation. In the autistic phase which characterized the first year of therapy, the patient didn't recognize “not-me”; external objects and even his feelings and actions. He was quite passive and silent, and seemed to refuse to relate with the therapist in the interviews. The therapist accepted his silence only explaining the aim of the therapy and the role of the therapist. He then started relating with the therapist by asking his personal background, and gradually developed a symbiotic relationship with the therapist. In the symbiotic phase he showed intense intimacy, salvation desires, and at the same time extreme agression including homicidal ideas towards the therapist. The therapist was involved in the turbulent affects as a person, and suffered from the ambiguity of individuality and self boundary, a pathology shared with the patient, In this impasse of the psychotherapy it was the effort of the therapist to deliniate the boundary between the two participants and to reestablish his own individuality while keeping the therapeutic attitude, that enabled the patient to grasp his own feelings, actions, and intentions as inseparable parts of himself. In other words, it was this mutual involvement of the therapist and the patient that advanced the individuation process of the patient.