形成对于诊断理解的两个阶段

我自己对于咨询师如何理解不同个案，或者所谓诊断的理解，比如南希的书或PDM的形成过程，我的理解如下。首先，你会理解某一类的来访者，这些来访者可能与你自己相似，你能够产生认同感，因为你肯定属于某一种人格类型。这个理解就像是在游戏里的迷雾地图之中的一个明亮的点。

此外，除了你自己之外，你可能也会熟悉某些亲密关系或家人，这些都是你的散点，也是你的样本。然后，在这个阶段，你开始与个案工作，可能会连续地督导某一种人格类型的案例，比如自恋人格。这是一个逐渐形成理解的过程。

当你接触越来越多的来访者并积累了更多经验后，你就能够将这些散点连接成线或者形成一个更全面的理解。这是第一阶段的工作。如果你有机会在精神科实习，那将是非常有益的。尽管我后来没有听从我的督导建议，但现在我有了更多的个案量，我意识到已经没有机会回去实习了。

在个人职业中，你可能只会遇到数百个来访者，这已经是非常不错的了。然而，在个人职业中，你能够深入地与这些来访者合作，这可以在一定程度上弥补一些精神科实习的不足。但是如果在早期职业中还没有饱和的情况下，精神科实习将是非常有益的。

第二个阶段是在你有了分类之后，你要理解同一人格类型下不同来访者之间的差异，每个人都有独特之处。例如，对于自恋人格，每个来访者都可能有自恋伤害，但不同的自恋人格来访者展现出的特质是不同的。这是第二阶段的学习任务，你要更深入地了解每个来访者的特质。

这也有点像婴儿的发展过程。早期的婴儿可能会发展出一些分裂机制，因为在混乱的环境下，分裂是一种高级的防御机制。然而，随着时间的推移，到了抑郁位，你可能需要更精细的判断。

My understanding of how therapists comprehend different cases or the formation of diagnoses, as discussed in books like Nancy’s or the PDM, is as follows. Initially, you understand a certain type of patient, perhaps those who are similar to yourself, where you can easily identify because you belong to a certain personality type. This understanding is like a bright spot on a foggy map.

Additionally, besides understanding yourself, you may also be familiar with certain intimate relationships or family members, serving as your samples. Then, in this phase, you start working with patients, perhaps continuously being supervised cases of a particular personality type, like narcissistic personality. This is a gradual process of forming understanding.

As you encounter more patients and accumulate more experiences, you can connect these scattered points into lines or form a more comprehensive understanding. This is the work of the first stage. If you have the opportunity to intern in psychiatry, it can be very beneficial. Though I didn’t follow my supervisor’s advice later on, with more cases now, I realize that I won’t have the chance to go back to an internship.

In a private practice, you might only meet a few hundred clients, which is already quite good. However, in a private practice, you can work more deeply with these patients, which can compensate to some extent. But if you’re in the early stages of your career and haven’t saturated your experience, a psychiatry internship is very beneficial.

The second stage involves understanding the differences between patients of the same personality type. Each person has unique traits. For instance, with narcissistic personality, each patient may have narcissistic injuries, but the flavor of these injuries differs among different patients. This is the learning task of the second stage, where you need to understand the nuances of each client more deeply.

This process is somewhat like the development of an infant. Early on, infants might develop some splitting mechanisms because in a highly chaotic environment, splitting is a sophisticated defense mechanism. However, as you move into the preparatory stage, in a depressive state, you may need more nuanced judgment.