张辉等

[摘要] 医患关系指以医生为主体的人群与以患者为主体的人群在医疗过程中发生的一种特殊的社会关系。我国正处于社会转型期，在医疗卫生领域的矛盾和冲突尤为突出。本文从精神分析的视角出发，抛开医患冲突的表象，对患者症状的由来及其潜意识中的心理防御机制进行分析，揭示出患者的移情源于对疾病、死亡的焦虑与恐惧，患者角色引发的无能感与弱小感，对安全、爱和尊重的需要，自我保护心理和性格特征等心理活动；而医生对患者的反移情对于医患关系而言是一把双刃剑。通过对医患互动的深度解读，为构建和谐医患关系提供建议。

[关键词] 医患关系；精神分析；移情；反移情；心理防御机制

[中图分类号] R197.32 [文献标识码] A [文章编号] 1673-7210（2015）05（b）-0158-03

Perspective of psychoanalysis in relationship between doctors and patients

ZHANG Hui FANG Shengyu YANG Fengchi

School of Health Management and Education， Capital Medical University， Beijing 100069， China

[Abstract] The doctor-patient relationship is a special social relationship which existes between the doctor-main crowd and the patient-main crowd in the medical process. China is in the period of social transition， the contradictions and conflicts in the field of health is particularly prominent. Despite the appearance of the doctor-patient conflict， this article analyzes the origin of patients' symptoms and the psychological defense mechanism in patients' subconscious. This article reveals the source of patients' transference is including the anxiety and fear to disease and death， patient role sense of incompetence and weak， the needs of safety， love and esteem， mental process of self protection and personality characteristics. While the doctor's counter transference is a double-edged sword to the doctor-patient relationship. The aim is to provide constructing advices for a harmonious relationship between doctors and patients by depth interpretation of doctor-patient interaction.

[Key words] Doctor-patient Relationshi； Psychoanalysis； Transference； Counter transference； Psychological defense mechanism

从精神分析的理论出发，所有的人际关系都是移情的产物，医患关系也不例外。精神分析认为疾病是其成长经历中的冲突从潜意识中被重新激活，而症状是妥协的产物。在医疗情境中，患者对医生发生移情。医生对患者移情产生某种特定反应，即反移情。本文从精神分析的视角，通过对移情和反移情的分析，对医患互动进行深度解读。

1 精神分析视角对患者的理解

1.1 症状的由来

现代医学认为，精神因素可以引发心理应激。所谓心理应激是指个体在生活适应过程中，关于环境要求与自身应对能力不平衡的认识所引起的一种心身紧张状态，这种紧张状态倾向于通过非特异的心理和生理反应表现出来[1]。……