翻訳教えて下さい。
Working with the suicidal patient, as much as any other clinical experience, can help the beginning therapist gradually replace a grandiose professional ego-ideal with one that is more realistic. How exactly does this transformation take place?
The beginning psychotherapist undertakes the treatment of the suicidal patient with the optimistic belief that a combination of caring, encouragement, hopefulness, good intentions, empathy, and intuition will produce a positive outcome. A “contract for safety,” wherein the patient agrees not to act on suicidal impulses and, instead, will call the therapist or seek other help, provides additional assurance. Newly prescribed medication promises to relieve suicidal despair. Hospitalization, if required, will provide needed safety.
Over time though, the suicidal patient does not improve. The despair does not abate. The hopelessness intensifies. The patient can identify no reason to live. Relentless gloom pervades the therapy. Imperceptibly but forcefully, an important realization takes hold of the therapist at a visceral as well as at a cognitive and emotional level: it is impossible for one person to keep another person alive over time. While this insight serves to moderate the pursuit of omnipotence, the realization that even clinical competence does not guarantee that one`s patient will not commit suicide is unsettling.
Comforting thoughts begin to give way. Contracts for safety now feel illusory as therapists realize that patients who are in sufficient anguish to want to end their lives will not be compelled to live simply because they have promised (a therapist) they will not kill themselves. Therapists begin to have second thoughts about the unrealistic healing powers they previously attributed to psychotropic medication, although they do appreciate the ability of there medications to sometimes diminish unbearable anguish to the point where patients can address their conflicts and problems. They hear stories of patients who have killed themselves in a hospital.
（中略）
Slowly an obvious fact emerges: If suicidal patients were completely intent on dying, they would have already killed themselves. Some part of the patient wishes to live, and it is with this part that the therapist attempts to connect, no matter how suicidal the patient may be. What emerges from this connection is the therapeutic alliance, the agreement between the therapist and the healthy part of the patient about what to work on in the therapy.
The beginning therapist learns that aligning with the healthy part of the patient is not to be confused with cheerleading for living. Although allied with this healthy part, the therapist maintains neutral curiosity about the parts of the patient that with to die. The therapist learns to overcome the fear that exploring the patient’s with to die puts such ideas in the patient’s mind. Feelings of omnipotence diminish. The therapist comes to see that exploring the patient’s inner world with dispassionate, nonjudgemental interest conveys several therapeutic meta-communications what you are feeling is not unspeakably bad, it is human; I’m interested in whatever you are thinking and feeling; I appreciate the distinction between self-destructive thoughts, feelings, fantasies, and action; your anguish is not as devastating to me as it is to you; my strength will be here for you to borrow if you need to; your therapy is a place where your destructive urges can be understood rather than judged; I will try not to leave you alone with your anguish. A determination to enter the patient’s inner world and stay with the associated feelings and thoughts gradually replaces the therapist’s quest to be all-knowing.
