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Theory and Practice of Psychological Counseling
ISSN Print:2664-1828
ISSN Online:2664-1836
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关系中创伤，关系中疗愈：小A的动力学咨询实录
Wounded in Relationships, Healed in Relationships: A Psychodynamic Counseling Case Report of Client A
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Information:
湖南师范大学，长沙
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Keywords:
Complex trauma; Psychodynamic therapy; Narcissistic personality organization; Defense mechanisms; Unconscious interpretation复杂性创伤; 动力学咨询; 自恋型人格组织; 防御机制; 潜意识诠释
- Abstract: This case study focuses on a 27-year-old female whose core difficulties stem from unconscious conflicts and the overuse of pathological defenses rooted in complex childhood trauma: (1) A “highfunctioning false self ” masking unconscious feelings of worthlessness; (2) The use of “idealization/ devaluation” splitting defenses to cope with anxiety in object relations; (3) The repression of traumatic sexual shame leading to sexual inhibition and the instrumentalization of relationships. The case is conceptualized as a narcissistic personality structure with high social adaptability, with its personality organization functioning at a high borderline level. The therapy adopted a psychodynamic approach, following the pathway of “establishing a therapeutic alliance — exploring unconscious defenses/ interpreting transference and early object relations — working through traumatic conflicts”. Supportive techniques were used to stabilize the sense of self, while exploratory techniques facilitated deeper transference work, gradually loosening the pathological defenses. Following the intervention, the client’s beliefs of “I am worthless/unloved” were partially worked through, her defense mechanisms became more adaptive, genuine emotional connections in relational patterns increased, and sexual shame was somewhat alleviated. 本案例聚焦一名27岁女性，核心困扰源于复杂性童年创伤引发的潜意识冲突与病理性防御过度使用：（1）以“具有高度社会适应性的假性自体”掩盖潜意识中的“无价值感”；（2）借助“理想化/贬低”分裂防御应对客体关系焦虑；（3）创伤性性羞耻的压抑，引发性功能抑制与关系工具化倾向。案例概念化为人格组织处于高边缘性水平，临床呈现为具有高度社会适应性的自恋型人格结构。咨询以动力学为核心，通过建立“治疗联盟—探索潜意识防御/诠释移情与早期客体关系—修通创伤冲突”的路径，运用支持技术稳定自体感，探索技术深入移情，逐步松动病理性防御。干预后，来访者“我是无价值的/不被爱的”等想法得到部分修通，防御机制更具适应性，关系模式中真实情感联结增多，性羞耻感有所缓解。
- DOI: 10.35534/tppc.0808042 (registering DOI)
- Cite: 田晓雪. (2026). 关系中创伤，关系中疗愈：小A的动力学咨询实录. 心理咨询理论与实践, 8(8), 363-373.
