Self-restoration of People Living with HIV/AIDS in China [1 ed.] 9789811574122, 9789811574139

Table of contents :
Foreword
Contents
1 Introduction
1.1 Rationale for Research on AIDS
1.2 Research Participants
1.3 Research Methods
1.3.1 Participant Selection
1.3.2 Data Collection and Analysis
1.4 Research Ethics
1.4.1 Informed Consent
1.4.2 No Harm but with Benefits
1.4.3 Rigorous Survey
1.5 Theoretical Perspective
2 Governance of AIDS and Actions Taken
2.1 Outbreak of AIDS
2.2 AIDS Governance in China
2.2.1 Status Quo of AIDS Population
2.2.2 Prevention and Treatment of AIDS
2.3 Policy Guarantees Related to AIDS
2.3.1 The Successive Introduction of AIDS Prevention and Treatment Measures
2.3.2 Institutional Guarantee of AIDS Medical Service System
2.3.3 Funding Inputs for the Implementation of the AIDS Policy
2.3.4 Project Configuration for AIDS Prevention, Involvement and Intervention
2.4 Development of AIDS NGOS in China
2.4.1 The Development of AIDS NGOS in China
2.4.2 Actions Taken by AIDS NGOs
2.4.3 Criticism and Reflection on AIDS Governance and In-Place Action
Reference
3 The Relational Psychoanalysis: The Way of Relationship Construction and Deepening Treatment
3.1 The Classical Spiritual Analysis Represented by the Drive-Conflict Model
3.2 A Paradigm Shift Characterized by the Development-Inhibition Model
3.3 Integration Model with Relational Theory as the Core
3.4 Special Insights of Self-psychology in Psychological Therapy
References
4 Mutual Influence of the Infected
4.1 The Course of “Dying to Live”
4.2 The Psychological Dynamic Analysis from Disintegrating to Restoring
4.2.1 Fracture of Self Development
4.2.2 Pursuit of the Self-Object Demands
4.2.3 Restoration of Self Structure
4.3 Way to Involve and Intervene in the Journey
References
5 Crossing the River with a Stone: The Exploration of Infecting Love with Love
5.1 Support and Cure by Empathy
5.1.1 Understanding the Dynamics of Therapy
5.2 The Interpretation of the Healing of the Occurrence of Reconstruction
5.3 Effects of Moderate Response
References
6 Self-restoration in Relationship Co-construction
6.1 Subjective Feeling of Helping Themselves and Others
6.2 Self-restoration Under the Co-construction of the Relationship
6.2.1 The “Cocktail Intervention Therapy” Under the Relationship Co-construction
6.2.2 New Experience of Helping Others Help Themselves
Reference
7 Re-Exploration of Self-restoration and Intervention Mechanism
7.1 The Mechanism Exploration of Self-restoration
7.1.1 The Stage of Self Ignorance: The Fracture of the Self-object Bond
7.1.2 The Stage of Spontaneous Action: The Repair of Self-object Bond
7.1.3 The Stage of Self Disintegrating: The Disintegrating of Self Structure
7.1.4 The Stage of Active Repair: The Pursuit of the Self-object Needs
7.1.5 The Stage of the Self Stability: The Reconstruction of Self Structure
7.2 The Intervention Mechanism of “Dying to Live”
7.2.1 Mature Self: The Appropriate Intervention Object and the Final Intervention Target
7.2.2 Self Disintegration: Poor Adaptation and Internal and External Conflicts
7.2.3 Self Repair: The Organic Combination of Empathy and Moderate Response
7.2.4 Self Restoration: Focus on the Satisfaction of the Self-object Needs and the Formation of Compensation Structure
Afterwords
References

Citation preview

Rongting Hou

Self-restoration of People Living with HIV/AIDS in China

Self-restoration of People Living with HIV/AIDS in China

Rongting Hou

Self-restoration of People Living with HIV/AIDS in China

123

Rongting Hou Inner Mongolia University of Science and Technology Baotou, China Translated by Hulin Zhao Henan University of Chinese Medicine Zhengzhou, China

ISBN 978-981-15-7412-2 ISBN 978-981-15-7413-9 https://doi.org/10.1007/978-981-15-7413-9

(eBook)

Jointly published with Huazhong University of Science and Technology Press The print edition is not for sale in China (Mainland). Customers from China (Mainland) please order the print book from: Huazhong University of Science and Technology Press. © Huazhong University of Science and Technology Press 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Foreword

The book is based on the Ph.D. thesis of Hou Rongting. This English version is translated by Zhao Hulin from Henan University of Chinese Medicine. In guiding graduate students to write theses, I hold a basic belief that students must have something to say before they can write, and that writing must be supported by theoretical thinking before they can finish the writing. I want to explain two important concepts in this belief: having something to say (i.e., having substance) and having theoretical framework (i.e., how to say). Students who claim to follow the school system but have nothing other than their courses and lessons are usually not chosen by our institute. In other words, the chosen graduate students must have some life experiences worth discussing, for instance, their own experiences, or their relationships with others. This is called having something to say (i.e., having substance). What theories (how to say) to use when he or she is going to start writing thesis next? I am a believer in the saying “to believe everything in books is worse than to have no books at all”. If my students believe everything in books and can’t discuss with me, it will be a nightmare for me. “Can discuss” and “can debate” are the essence of “can say”. But at the beginning of discussion and debate, we will suddenly fall into the historical flood of thought, and we will enter the vast world of literature. In the spring of 2013, I received a message that a Ph.D. candidate from Renmin University of China was coming to the Department of Psychology at Fu Jen Catholic University to study for a “double training doctoral degree”. I got a general idea of his work before Remin University of China and his sociology studies after he was enrolled. After a few letters between us and my careful evaluation, I decided to let him have a try. Our Ph.D. students usually take 5 or 6 years to complete their courses, and with the time to write their thesis, it is common for our Ph.D. candidates to study for seven or eight years. After the summer vacation, I met the student mentioned above, Hou Rongting at the beginning of the 2013 school year. He can only use two academic years to finish his study here. In addition to taking courses, he also took all three courses I had opened in each semester, including an elective course for undergraduates, as well as a master’s and doctoral courses in my institute. In short, he took all the time to learn. The assigned v

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Foreword

readings I’ve given to each course do contain some very advanced theories, like “relational psychoanalysis”, as well as some very classic (but never-obsolete) subjects, like “spiritual life”. My students are required to read the profound works of many scholars who emerged in the United States after the 1990s, without Chinese translations, and works of philosophers in the Song Dynasty, without modern Chinese versions. Many students’ learning attitude, compared with Rongting, I must admit, is inadequate. So, I found out very quickly that he is a student who has something to say and is willing to have theories. We took the time to draw up a plan for the writing of the thesis. The book includes social work, psychological intervention and the researcher’s introspection. “Interdiscipline” is the general term for this kind of research, and the researcher needs to break through any intellectual barriers between knowledge rather than breaking down barriers between disciplines. The topic is how HIV-infected people can firmly believe that they live because of certain interventions or assistances, which is a “spiritual” issue. However, psychology may not be able to deal with such issues face to face. The “psychoanalysis” we discuss must be cross-examined by western scholarship from its origin and by the ancient and present knowledge transmitted by Chinese. In the year I began to supervise Rongting, my own research project (not to follow someone else’s “project”) was to write a paper on philosophy and psychology, “The Moment of Healing: A Multicultural Cross-Discussion of Mindology and Healing”. There are no “discipline boundaries” in my question, both in thinking and writing. I won’t ask students to imitate my research, but to a certain extent, this academic attitude will manifest itself in the supervision relationship. Young scholars who can’t use this as their ambition to learn will certainly work very hard. On the other hand, the fully immersed study will soon generate motivation for learning, so that thesis writing becomes a work of “can discuss” and “can debate”. After discussing with me, Rongting chose the essentials of Kohut’s self-psychology (self-psychology, also known as autologous psychology) and turned it into a method of psychological intervention, and practiced it in the objects he wanted to assist, that is, some HIV-infected people. At the most fundamental level, I explain the goal of this thesis writing: to enable infected people to gain a new life through “psychological motivation” caused by “psychotherapy”. This fundamental proposition forms a very directional discourse in the understanding of Rongting, called “being-to-death” and “dying to live”. Whether or not the language used in this proposition constitutes a “neologism”, this is a challenging proposition for researchers themselves, for intervention, and for the objects of intervention. Nevertheless, he finished his thesis writing with something to say and with theoretical framework, but with no waste of a moment and efficiency in the course of studying while discussing. Students in Taiwan will neither do it nor can do it with this “time-consuming” way. I don’t have to write a summary of the book. As long as I explain how the unprecedented “double training doctoral degree” like this is done, the rest is for the reader to read. If you’re a graduate student, how do you get started with topics like

Foreword

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this? How do you write it down? How to combine the practice with theoretical thinking? In the course of writing this book, there is an ice-breaking discussion, which later appears in the first chapter of the book. Rongting shows his understanding in the tone of my explanation like this (not exactly the words in the book). A brief explanation for “helping profession”: it’s a system of knowledge and practice that encompasses a wide range of disciplines. In human civilization, it is linked to the saying “God helps those who help themselves”. But in modern society, the concept of “God help” has gradually been replaced by “social support”, and “self-help” is “the ultimate purpose of all these social supports”. We can use the word “self-help” to express the purpose of “social worker” for social support. It is the same with a proverb, “to give a man a fish is inferior to teach him how to fish”. However, in the academic “helping profession” needs to develop a system of discourse like Kohu’s self-psychology. The key word Kohut needs to explain is his own creation of “self-object”, which, with the joint effort of the helper and the object in need, is nothing more than to form a “self-help relationship”. If this process is further developed through sophisticated theoretical development, it may form a complex set of knowledge/practice discourses that require hundreds of thousands of words to be clarified. When I saw an understanding like this in Rongting’s writing plan, I realized that the power of knowledge had been generated in his thinking, and I knew that this relationship between teachers and students would develop comfortably for a limited time. I really just want to explain how to start. Also just want to say, like me, a good scholar can let knowledge be produced “without external demands”. In the guiding relationship of a doctoral thesis, the supervisor’s actual job is simply to “inject impetus”, rather than pushing people into the thesis writing as if the ducks were pressed on the shelf. I’m glad that in my coaching career, I met students like Rongting in the fall of 2013 and completed this compact and unprecedented work before the summer of 2015. December 2017

Wei-Li Soong Fu Jen Catholic University

Contents

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2 Governance of AIDS and Actions Taken . . . . . . . . . . . . . . . . 2.1 Outbreak of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2 AIDS Governance in China . . . . . . . . . . . . . . . . . . . . . . . . 2.2.1 Status Quo of AIDS Population . . . . . . . . . . . . . . . 2.2.2 Prevention and Treatment of AIDS . . . . . . . . . . . . . 2.3 Policy Guarantees Related to AIDS . . . . . . . . . . . . . . . . . . 2.3.1 The Successive Introduction of AIDS Prevention and Treatment Measures . . . . . . . . . . . . . . . . . . . . 2.3.2 Institutional Guarantee of AIDS Medical Service System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.3 Funding Inputs for the Implementation of the AIDS Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3.4 Project Configuration for AIDS Prevention, Involvement and Intervention . . . . . . . . . . . . . . . . .

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1 Introduction . . . . . . . . . . . . . . . . . . . . . 1.1 Rationale for Research on AIDS . . . 1.2 Research Participants . . . . . . . . . . . 1.3 Research Methods . . . . . . . . . . . . . 1.3.1 Participant Selection . . . . . . 1.3.2 Data Collection and Analysis 1.4 Research Ethics . . . . . . . . . . . . . . . 1.4.1 Informed Consent . . . . . . . . 1.4.2 No Harm but with Benefits . 1.4.3 Rigorous Survey . . . . . . . . . 1.5 Theoretical Perspective . . . . . . . . . .

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2.4 Development of AIDS NGOS in China . . . . . . . . . . . 2.4.1 The Development of AIDS NGOS in China . . 2.4.2 Actions Taken by AIDS NGOs . . . . . . . . . . . 2.4.3 Criticism and Reflection on AIDS Governance and In-Place Action . . . . . . . . . . . . . . . . . . . . Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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3 The Relational Psychoanalysis: The Way of Relationship Construction and Deepening Treatment . . . . . . . . . . . . . . . . . . . . 3.1 The Classical Spiritual Analysis Represented by the Drive-Conflict Model . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 A Paradigm Shift Characterized by the Development-Inhibition Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Integration Model with Relational Theory as the Core . . . . . . . 3.4 Special Insights of Self-psychology in Psychological Therapy . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Mutual Influence of the Infected . . . . . . . . . . . . . . . . . . . . . . 4.1 The Course of “Dying to Live” . . . . . . . . . . . . . . . . . . . . 4.2 The Psychological Dynamic Analysis from Disintegrating to Restoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2.1 Fracture of Self Development . . . . . . . . . . . . . . . . 4.2.2 Pursuit of the Self-Object Demands . . . . . . . . . . . 4.2.3 Restoration of Self Structure . . . . . . . . . . . . . . . . . 4.3 Way to Involve and Intervene in the Journey . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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5 Crossing the River with a Stone: The Exploration of Infecting Love with Love . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1 Support and Cure by Empathy . . . . . . . . . . . . . . . . . . . . . . 5.1.1 Understanding the Dynamics of Therapy . . . . . . . . . . 5.2 The Interpretation of the Healing of the Occurrence of Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.3 Effects of Moderate Response . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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6 Self-restoration in Relationship Co-construction . . . . . . . . . . . . . 6.1 Subjective Feeling of Helping Themselves and Others . . . . . . 6.2 Self-restoration Under the Co-construction of the Relationship 6.2.1 The “Cocktail Intervention Therapy” Under the Relationship Co-construction . . . . . . . . . . . . . . . . 6.2.2 New Experience of Helping Others Help Themselves . Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Contents

7 Re-Exploration of Self-restoration and Intervention Mechanism . 7.1 The Mechanism Exploration of Self-restoration . . . . . . . . . . . . 7.1.1 The Stage of Self Ignorance: The Fracture of the Self-object Bond . . . . . . . . . . . . . . . . . . . . . . . . 7.1.2 The Stage of Spontaneous Action: The Repair of Self-object Bond . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1.3 The Stage of Self Disintegrating: The Disintegrating of Self Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1.4 The Stage of Active Repair: The Pursuit of the Self-object Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1.5 The Stage of the Self Stability: The Reconstruction of Self Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.2 The Intervention Mechanism of “Dying to Live” . . . . . . . . . . . 7.2.1 Mature Self: The Appropriate Intervention Object and the Final Intervention Target . . . . . . . . . . . . . . . . . 7.2.2 Self Disintegration: Poor Adaptation and Internal and External Conflicts . . . . . . . . . . . . . . . . . . . . . . . . . 7.2.3 Self Repair: The Organic Combination of Empathy and Moderate Response . . . . . . . . . . . . . . . . . . . . . . . . 7.2.4 Self Restoration: Focus on the Satisfaction of the Self-object Needs and the Formation of Compensation Structure . . . . . . . . . . . . . . . . . . . . . .

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Afterwords . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169

Chapter 1

Introduction

1.1 Rationale for Research on AIDS When it came to the topic of AIDS, two deep impressions were left upon the author. First, AIDS was a formidable, infectious and fatal disease; second, I only knew one of the facts that AIDS was transmitted by blood. It was not until the second year of my college life that AIDS caught my attention when a public event occurred. In 2003, the epidemiological investigation by anti-epidemic workers in Hohhot City of the Inner Mongolia Autonomous Region in China revealed that 13 people were infected with HIV (Human Immunodeficiency Virus) due to blood transfusion. The blood was illegally drawn by one county hospital of Hohhot City during October, 1998 and September, 2000. This had been the first domestic major medical accident of HIV infection ever since the implementation of Blood Donation Act of the People’s Republic of China in 1st, October, 1998. In China, the initial transmission of AIDS was not through sexual behaviors, different from that in other countries of the world. The earliest outbreak of AIDS was caused by intravenous drug users in China’s southwest border areas. Later, major adjustments were made on the AIDS policy, such as the publicity of the prevention of AIDS and the implementation of the “Four Frees and One Care” policy. Specifically, the “Four Frees and One Care” policy refers to the implementation of free antiviral treatment for AIDS-infected peasants and people with financial difficulties in towns and cities, the implementation of free and anonymous blood tests in key areas of the AIDS epidemic and free access to schooling of AIDS orphans, the implementation of free AIDS counseling, screening and antiviral treatment for pregnant women in the demonstration area of comprehensive AIDS prevention and control in hope of reducing mother-to-child transmission. The policy also includes people living with AIDS who are in financial difficulty into government assistance to give necessary life relief and actively support them to participate in production activities. The author’s bond with AIDS research dated back to 2007. In that year, the author participated in qualitative and quantitative survey of the AIDS prevention project sponsored by research institutes under International Labor Organization and © Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9_1

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1 Introduction

Ministry of Human Resources and Social Security of the People’s Republic of China, and met with so-called high-risk groups, such as female sex workers and male objects (mainly miners in the southwest of China and truck drivers). Because at that time the mainstream idea of AIDS prevention and treatment was individual practice showed a significantly positive correlation with individual knowledge, attitude, and belief, the author’s understanding of AIDS prevention remained at the level of improving condom use and clearly distinguishing the infection pathways of AIDS. In 2009, when the author participated in a survey of the survival status of infected persons initiated by an organization for the infected, it was the first time that the author had met with infected persons, including those infected through blood transfusion when having an operation, children transmitted by their mothers, men or women infected through sex. It was the first time that the author had known the presence of homosexuals and the possible transmission through sex between them. At that time, there was a general debate in society about the “nocence” and “innocence” of infected people. Those who were infected with HIV through blood transfusion and mother were often considered innocent; while those through improper sexual behaviors, drugs injection or homosexuality were nocent, especially those through homosexuality more discriminated against. The living conditions of infected people were much worse in the past than they are now. There are still many difficulties in testing, diagnosing, dispensing, treatment of opportunistic infections and other complicating diseases, and medical insurance. Therefore, under the impetus of the international community, domestic and foreign funds, and social forces, a large number of social organizations has been set up dedicated to the involvement and intervention in the treatment of infected people. The reason why the author’s research can be started lies in strong assistance of these non-governmental organizations. It is like key mediators, making the author successfully find the infected and gain their trust in convenience of completing the survey. At that time, the domestic academic circles showed enthusiasm about the research on AIDS, but the focus was the prevention and treatment of AIDS. The psychological problems of the infected have always been a phenomenon of almost any discipline, including clinical medicine, public health, epidemiology, psychology, sociology, social work and other disciplines, nevertheless it has never been a research question, but a common sense. Compared with the severe AIDS epidemic, anxiety, fear and worry for AIDS is ignored. In 2013, when China’s economy continued to develop at a high speed, it was also the last year of financial support to China by the international community and international non-governmental AIDS organizations. The final round of capital investment in China by The Global Fund to Fight Aids, Tuberculosis and Malaria and China-Gates AIDS Project marked the end of the financial support. Worse, China’s private organizations for the infected were facing many new problems. As one of the evaluations of the China-Gates AIDS Project, we undertook a research project on the support and care of infected people, and explored how relevant organizations, including non-governmental organizations, can work together to care and help them. It was based on this survey, jokingly called “eating, living and laboring together”, that the author had a deeper understanding of infected people. Before getting along

1.1 Rationale for research on AIDS

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with them, the author assumed that infected people in organization A should be worried about the disease, be pessimistic, disappointed, and unwilling to contact with others, and perhaps some of them would resent society. However, it could be found in the process that they are far more optimistic than imagined, and full of confidence in life. The author can always hear their exhortation: “Keep healthy. Now many young people overwork to death, because they don’t care staying up. Instead, we are now more concerned about our health than ever before.” Once the organization has any activities, the infected people actively provide mutual assistance and perform their respective roles to keep activities orderly. The apartment provided by organization A for them looks like a warm home. Organization A has a long history in city B and has been involved in the support and care of infected people since its inception, but it belongs to non-governmental organizations, also known as grassroots organization. What makes the author most curious is how such an organization, formed spontaneously by infected persons, survives for so many years and obtains an excellent reputation. Most importantly, Special Hospital for Infectious Diseases and Centers for Disease Prevention and Control at all levels (hereinafter referred to as CDPC) are also very dependent on and trust the organization. It improves not only the use of condoms among local AIDS population, but also the initial screening rate, flow rate, detection rate and other epidemiological testing data. It is because of its presence that the infected individual is no longer dispersed. Many infected no longer need to solely bear the panic and helplessness caused by infection. In their words, “we found a sense of belonging in the organization, which can really bring us hope and change.” Their comment contains a high degree of recognition of organization A by the infected. A quantitative survey of the project demonstrates that the recognition of organizations for the infected is stronger than that of medical staff CDPC workers. First of all, because of the existence of organizations for the infected, everything has changed from helping and supporting the infected, guiding them to see the doctor to how to survive and live better. Members of these organizations, in addition to several formal full-time staff, are mostly volunteers. They are far less professional than medical workers in terms of the medical level; they are also inferior to professional social workers in terms of helping others. However, they play an important role. China’s current social work is in the development period, so medical and mental social workers, especially those involved in the AIDS population, are few. Further, it is often difficult for professional social workers to have a comprehensive understanding of the infected person when they are engaged in matters related to the infected person. Just as an infected person once pointed out: “In fact, you do not understand my fear!” Such an assessment is a challenge to a professional social worker in terms of its professionalism. Nevertheless, these infected people, with the assistance of organizations, not only can face the fact of their own infection, but also provide support and care for other newly diagnosed infected people to improve their living and life status quo. The author can’t help but ask, can a few talks, some medical information, a few words of comfort, and empathy like “everyone is so”, “I understand your feelings” work?

4

1 Introduction

In the AIDS prevention and control system, it has long been in the era of medical hegemony, especially for AIDS people. They sincerely hope that the development of medical technology can completely cure AIDS. However, this is bound to be a long and arduous task. Because of this, we step into a de-medical way for AIDS prevention and care from the perspective of social science. Although it has only just started, much relevant research has emerged, such as supplying care for the infected from aspects of social capital, social support, and social policy. Necessarily, there is no shortage of attention to the psychology of infected people. But there is little deeper understanding of it, just regarding it as anxiety, stress, fear and so on. It is the result of disease and social factors, but there is often a lack of the voice of psychology, especially psychoanalysis. Even in case of psychoanalysis, previous research often emphasizes an outdated libido theory, which is indeed a century-old misunderstanding of Freud and psychoanalysis. Just as Mao Zedong thought was not the thought of Mao Zedong alone, psychoanalysis was not created by Freud alone. As the chief architect of psychoanalysis, Freud planned the blueprint for psychoanalysis. Since his creation, he had experienced schools such as self-psychology, the psychology of object relations, the psychoanalysis of self-psychology and relational psychoanalysis, and continued to develop. In particular, the emergence of the relational psychoanalysis broadened our vision of relation research. Although sociology and social work have never given up on the study of relation, they have focused more on the macro aspects. Looking glass self or generalized others are good cases in point. Under the influence of the relational psychoanalysis, some questions are always flashing in the author’s mind: whether the success of organization A is simply because it provides some support and services, and a place to get together to communicate with each other, Or is it due to the personal charisma of X (the head of organization A)? These facilities and social support are easy to be provided, why in B City, with the help of infected people, other organizations, including hospitals and CDC, can not obtain such trust of infected people? More importantly, what allows infected people to be so open to and optimistic about the severe AIDS? It turned out to be “psychological motivation” and “psychotherapy” that allowed infected people to gain a new life. Generally, HIV infection often means being on the brink of death, and death goes hand in hand, a situation that coexists with death. As many infected people believe, HIV infection is like being sentenced to death, and perhaps the next stop is death. However, the intervention of organization A has changed the passive situation of infected people in response to HIV, and infected people have thus gained survival support and life care, gained psychological motivation to combat HIV. Consequently, negative emotions such as fear of HIV have been soothed to achieve a self transition from disintegrating to restoration. In the process, the intervention of organization A has played an important role in helping self-help function, putting infected people on a healing path of “dying to live”. This happens to be the basic connotation of the concept “helping profession”. It is a system of knowledge and practice that contains a wide range of disciplines. In human civilization, it is roughly similar to the proverb “God helps those who help themselves”; while in modern society, it has gradually been replaced by social

1.1 Rationale for research on AIDS

5

support. “Self-help” is the ultimate goal of all these social support. We can use it to express social workers’ understanding of the purpose of support. However, the helping profession can even develop a system of discourse that requires the use of hundreds of thousands of words to be clarified, such as the self psychology theory of Kohut discussed in this book. In a word, “self-object” by Kohut, under the joint treatment of helping professionals and objects, will not only form the synonym of the concept of “self-help relationship”, but it will inevitably form a set of complicated knowledge and practice.

1.2 Research Participants Since the birth of mankind, disease has been like a shadow following a form. Health and disease are a set of corresponding concepts that have not yet been fully and clearly defined. In the authoritative teaching materials familiar to medical students in China, disease refers to a regular process of injury and anti-injury caused by the interaction between etiology and body under certain conditions. In cases of falling ill, a series of changes of function, metabolism and morphological structure occur in the body, and the coordination between the body and internal and external environment goes wrong. Finally, different symptoms appear in the clinical performance, so that the body’s mechanism to labor and adapt to environment reduces or loses. In short, disease is an abnormal process of life activity in which the body is affected by etiological damage under certain conditions and is disturbed by homeostasis. This concept attempts to generalize the nature of the disease, and it changes with the increasing level of human awareness of the disease and the development of the disease itself. Diseases can be divided into infectious and non-infectious diseases, sudden seizures of acute conditions that can be cured and chronic conditions that require long-term medication, curable and incurable diseases, and so on. AIDS, for example, is one of the more terrible conditions in human history. It is both an infectious and currently incurable disease that requires lifelong medication due to autoimmune dysfunction that can occur at any time with opportunistic infections. Those infected do not die of AIDS per se, but from other diseases or complications caused by opportunistic infections. We cannot equate its treatment with conventional diseases in general from the outset. For people living with AIDS, we have no intention to explore their pathology, because in any case, they are physically patients. People turn pale at the mere mention of the incurable AIDS. In this situation, it is whimsical to make the infected psychologically healthy and sound. In the participation of the interview and the author’s observation, many people lose sleep, have nightmares, find food tasteless and feel like dying when they get the result of positive HIV test. They experience what all other diseases share, but they also have an experience that other diseases have never had. However, they can survive in such an environment, live well, and even take AIDS as a gift of life. Many of them are gay, and there is such a strange presence in them. It is not discrimination against them, but praise for them, who can combine so many stigma and illness,

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1 Introduction

and live bravely and engage in all kinds of work. So, the author thinks that it is of more significance to analyze their spirit and life. They are ordinary people, but so strong to live, and live better. The most important part is to find mechanisms for their active survival and life, especially from the psychological dynamics, to serve so many people who are plagued by HIV. After all, there are too few people who can face it frankly. The current AIDS prevention and control policy in China has provided a certain guarantee for the medical treatment of AIDS people. Besides, various groups of infected people all over the country are exploring the intervention. Nevertheless, there are few theoretical studies on intervention and treatment to help them achieve their self-restoration from the perspective of psychological dynamics, especially the application of psychoanalysis. The folk intervention and the intervention practice is a kind of personal experience, and often need theory guidance and experience enhancement. Therefore, it is helpful exploring the psychological and self-restoration mechanism of infected people to expand the application of theoretical research, enhance the ability of intervention and support of civil organizations, enrich the practical guidance for infected people, improve their life quality and survival status. Unlike traditional professional psychoanalysis, this study does not focus on the entire life experience of infected people, much less on the identity of their homosexuals, but on the changes brought about by HIV, as is the case with psychoanalysis clinical work. Therefore, this study should be a psychoanalytically-informed research. There is no doubt that the course of their lives has changed as a result of HIV infection. So, what makes them face this “gift of God”? What kind of psychological motivation supports them and guides them? How do they go on to find, deconstruct, and reconstruct themselves in this situation? These are the questions that need to be solved in this study. They acknowledge the medical “authenticity” of the disease, and also believe that it has a richer spiritual meaning. For infected people, HIV is a powerful owner, living in them, but also a loyal slave, which is a dialectical existence. The disease destroys their immune system, thus making it impossible to resist the invasion of other viruses and causing disease, which is medically referred to as opportunistic infections. In particular, ordinary people rarely become ill due to diseases such as Kaposi’s sarcoma, but it has a chilling manifestation of their complications. The defects of the autoimmune system make the infected people often become ill, and the effect of their treatment is not obvious. Therefore, they first have to face the fact of HIV infection. Second, the infection of the disease is an infection through a “relationship”. In other words, the real impact of HIV is on the individual’s significant other, who are most likely to be their loved ones or sexual partners and children. Furthermore, after the infection, the first group to suffer from the disease is those having the most intimate relationship with the infected person. Later, the most intimate relationship gradually breaks out, accompanied by the discrimination and fear of the common, and they gradually lose their various connections. They have to bear the fear, worry and sadness caused by the virus alone. Therefore, every infected person has the unconscious use of the disease. Its central purpose is to solve the conflicting internal relations caused by AIDS, and to achieve their own aspirations in an alternative form. Whenever and wherever they are, they

1.2 Research Participants

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must face this truth and be encouraged to bear what they have done and all the consequences. This book focuses on the restoration of the AIDS population from the perspective of relational theory. The reason why it is called self-restoration is somewhat hollow for us to talk about life and death. This is not the case for people living with AIDS, and since the diagnosis of the infection, death has followed them like a shadow. “You may never know, the next stop is Death” (infected X). In the days near death, however, many of them were reborn. The reason why it is called a relational perspective is that every disease and every growth of an infected person means dealing with conflicts with self and others (including HIV, doctors and case managers, etc.), especially with the therapist in the interactive treatment, to obtain a perception of life and the self. All must be based on a true understanding of AIDS. In the coexistence with HIV, they experience the physical and mental development brought about by changes in relations, and this will ultimately be beneficial. This book attempts to analyze their “dying to live” intervention mechanisms, to explore what kind of deconstruction and construction their hearts have really experienced after they have been informed of the diagnosis, what is supporting them to go down, to come out, and to go further; to try to discover and explain the healing, to expect them to be able to reduce psychological stress. The book is more an attempt to boost their lives and promote their positive optimism to “live to the successful development of antiviral drugs” (infected X).

1.3 Research Methods This study uses the in-depth interview method and the participation observation method in the qualitative research so that the researcher can understand things from a specific position, and can explore the so-called reality presented by the interaction and construction between the individual and society. This study explores the “dying to live” process of the AIDS population. It is the journey of the heart in the face of HIV infection, it is also the existence and presentation of self and disease, relationship between self and surrounding. It is the comprehensive performance of emotion, cognition and behavior by a person in the very subjective situation. It is a subjective experience and phenomenon that the individual and members of the organization for the infected interact with and construct under the social context. It emphasizes the communication between each other, and as a creative discovery of inter-subjectivity, emphasizes subjective construction of the two parties. Qualitative research has included ground theory, ethnography, narrative, phenomenology, hermeneutics, action research and so on. Among them, phenomenology is the basis of qualitative research, is also an important cornerstone of the psychoanalysis of relational theory. It attaches importance to the existence of human subjectivity and inter-subjectivity, and pay attention to the structure and nature of the real experience of individuals. Therefore, the author, as a subjective participant, understand the subjective intention of the survey participants in the joint

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1 Introduction

construction with the researcher and constant self-reflection, and with a participatory, equal interaction. The author’s research content is the “dying to live” self-restoration mechanism of AIDS population, so it will inevitably involve the infected person and the related staff. Because of the discrimination brought about by AIDS, the infected people have a certain degree of concealment and particularity. If there is no important insider’s leadership and reference, it will be extremely difficult to find them. At the same time, they distrust and reject “outsiders”, including doctors. The author must first gain their trust if they are asked to cooperate. The author with the help of the founder of A organization, X, contacts the organization of infected people. The author’s help with the corresponding paperwork of A and some other help for A and infected individuals make him obtain the trust of infected people. This is precisely in line with the requirements of qualitative research and guarantees obtaining real and detailed information.

1.3.1 Participant Selection First, choose a successful organization. Since 2002, a large number of grassroots organizations has been set up in China to combat AIDS, but their development and their way of intervention are different. That organization A is chosen is because it is the largest grassroots organization in City B, with a long time of establishment. It has experienced two transformations, its ability to intervene infected people is stronger, and the head of the organization is keen on relevant research. In addition, the author has many good cooperation experiences with the organization, so it is easy to make acquaintance and carry out work. Secondly, the author adopts a simple and easy way to avoid causing unnecessary trouble to organization A and infected individuals. Meanwhile, the author chooses the interviewee in line with the principle of no harm but with benefits. Based on this, the first chosen participant is X, the head of organization A. He had been combating HIV for more than 10 years, during which he had been evicted from his home by his parents for HIV infection. He had experienced three months of death next to the morgue in YD hospital; and had experienced the physical and mental suffering as a result of opportunistic infections; and had formed drug dependence caused by worry and fear of trembling hands. With the support and care of health workers, a trainer Y and many infected people, he eventually went from disintegrating to restoring. He is still as healthy as ever, more frankly saying “to live to the successful development of antiviral drugs”. X, from his own experience, puts forward the life concept of “dying to live”, Together with Y, he establishes A organization, and puts forward the intervention model of life support and survival care for the infected people. In the struggle against AIDS, he not only changed his own destiny, but also influenced the lives of others.

1.3 Research Methods

9

The second chosen participant is trainer, Y, who has many years of work experience in organization A. He is not the infected himself, but joins the care and intervention of infected people from the very start. His first care object is X. Perhaps it is on the basis of such an experience, more based on the identity of a non-infected person, he has more time and energy to provide services to infected people. It also breaks the cycle that non-infected people can’t really understand or support infected people, and truly realize the way of support and care for infected people. Y has more than 40 infected people to supply support and care. Different infected people have different experiences, but Y has a considerable amount of work experience. They have jointly explored a set of intervention model and personal perception accepted by infected people. The last interviewee selected was an infected Z. Z showed a positive reaction in the initial sieve of organization A in March 2012, after which it was once out of contact with X and A because of fear of AIDS. It was also because unbearable physical and mental torture brought by AIDS, he chooses to suicide. After rescued, he recognized the fact of his own HIV infection, but was pushbacked and refused to have surgery. Eventually, under the guidance of X, the operation was successfully carried out at YD Hospital. A professional relationship was established with X, and the support and care of X was re-accepted. His current value of CD4, an important immune cell in the body’s immune system, is maintained at around 540. He has become a volunteer for organization A, supporting the care of five infected persons. Additionally, the author observes as participants the daily work of organization A, listening to their words and feeling their inner world in the participation.

1.3.2 Data Collection and Analysis This study mainly uses two methods of interview and participant observation, because they are more suitable for the interview object of this study (infected person/organization leader). As mentioned earlier, because of the particularity of the interviewees, only when trust and bond is established between the author and them, can they reduce their defensive mind and open their hearts to talk about their real situation and ideas. Interviews are semi-structured, and the outline of interviews lists only the main aspects and scope of the survey. Interview is a process of discussion, with the narration of interviewees as the center, accompanied by the author’s inquiry. Because of the privacy involved in the interviewees, the author explains his identity and the purpose of the investigation in detail to the interviewees, obtains their orally informed consent and recording permission, and conducts interviews in a separate enclosed room. After the interview, in order to express the gratitude to the interviewees and compensation for the time taken, the author gave the gift as a reward. The participant observation refers to a method that the researcher direct observe the subjects in the natural state and the organizational environment in which they are located. It produces the most direct, specific and vivid perceptual cognition. In this

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1 Introduction

study, the author conducted internship in A organization for one and half months, and participates in their daily work, including many meetings, daily work assistance, draft of relevant files, business in the street office and related departments and so on. The observation and experience make me obtain detailed records of their living conditions, organizational environment and their interaction, access to perceptual information. And through listening, chatting and other ways, the author left a favorable impression on the interviewees in the organization. After returning to the place of residence, the author quickly recorded the observed phenomena and personal feelings, and collated the recordings. Data are collected in a variety of ways, ranging from information obtained on site through observation, records obtained through interviews, as well as some essay thoughts and diaries, and other relevant information obtained on site. This requires the classification, induction, comparison, collation, especially the individual collation of their original words, and the establishment of archives for qualitative analysis. After that, it is necessary to split many cases into different parts according to the needs of research design, form concepts, make codes, and then find their internal relations, sum up the corresponding common problems. This study adopts QSR NVivo 8.0 to carry on the data analysis of the interview data. NVivo is a qualitative analysis software developed by QSR and is currently a generic version of 8.0. The full name of the software is NUDIST Vivo, of which NUDIST is an abbreviation for Non-numerical Unstructured Data by Techniques of Indexing Searching and Theorizing, meaning that it can be used as a non-numerical, non-structural data indexing search system and auxiliary tools to assist shaping theory. It is the international mainstream qualitative analysis software. The application of auxiliary software can greatly shorten the research cycle of qualitative research that needs to deal with a large number of raw materials, and help researchers rapidly screen information and have effective thinking in the vast text. This study uses in-depth interview and participant observation as research methods, record a large number of interview content and feeling and thinking of the field survey. Besides, the NVivo software can be used to organize the original data, encode, decode and annotate the interview data and field notes on the basis of the careful study of the interview data. Because the software combines the computer’s powerful index search and assists in shaping theory, the author can at any time extract and reorganize the data on demand, assist in the analysis of the hidden theoretical model and the relationship between the data. Furthermore, NVivo combines many of today’s emerging functions like hyper text, can integrate data such as Excel, Word, and Adobe’s PDF into the system, making the data more diverse in how it behaves. In addition, NVivo is also used in the literature review of this book. The coding of different literature content can bring a unified extraction of similarities and differences between these documents, and can effectively improve the ability and efficiency of induction and summary.

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1.4 Research Ethics Internationally, the focus on research ethics in social surveys began in the midtwentieth century, with the “Tuskegee Syphilis Study” as a key event. Since 1932, funded by the U.S. government, the Study has been tested, but not treated in black people for more than 40 years of research. The experiment has made the US government notorious and become a negative example in the history of medical ethics. Since then, international attention has been paid to the study of ethical issues, in which respect, benefit and fairness have been defined as three basic principles of research ethics. This is especially true of AIDS research. Regardless of the public’s fear of AIDS, infected people often hide their true identity because of the stigma and infectivity of AIDS. Many of them are at the bottom or margin of society. Their marginal status and moral discrimination put them in a vulnerable position not only in society, but also in the research. Therefore, in order to “protect themselves”, they show obvious resistance to and perfunctory attitude towards any “survey”. This situation prompts the author to keep an eye on and reflect on the research methods and the related problems of research ethics when doing research. This study focuses on the illness and emotional representation of the subjects after infection, often involving many personal information of them. Although the name of the infected person and other characteristics can be hidden in the writing of the book, the infected people in the inner circle may often infer and speculate based on their illness and personal performance, This can cause the infected person to worry about the real statement. This also prompted the author to always think about how to let infected people open their mouths in the process of interviewing, how to obtain more real information, how to let infected people reduce the psychological burden, how to implement confidentiality guidelines, and how to try to defuse the “privacy barrier” in sociological survey. These special factors also prompted the author to rely on his own strength, and maintain interpersonal relationship through equal interaction and exchange with the infected people. The introduction of key people helps the author enter the organization for the infected, and the process of eating, living, and working together wins their trust. On the basis of equal exchange, the author relies on empathy to feel, to understand the living conditions and emotional fluctuation of infected people, and finally completes the collection of interview data, collation and analysis.

1.4.1 Informed Consent Informed consent refers to the need for researchers to obtain the consent of the subject or participant in any field of scientific research with human beings as subjects. Specifically, when a potential subject or participant obtains all the necessary information about the study and fully understands it, he or she voluntarily makes a decision

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1 Introduction

on whether to participate in scientific research or whether to withdraw in the course of scientific research without coercion, undue pressure and inducement. In this study, at the beginning of the survey, the author explains in detail to the subjects the main purpose and research methods of this study, so that they clearly know the presentation of interview data in the book, as well as the right to request changes in the way of research and withdrawal from research. In addition, the author also presents to the infected person the research he has carried out and the ethics education he has received and the observance of the research ethics, in order to obtain the trust and attention of the infected person, so as to ensure the authenticity of the data and the possible return visit. Because of the personal privacy involved in infected persons, the study did not sign formal informed consent with them, but took the form of orally informed consent, and stressed that infected persons could interrupt interviews at any time.

1.4.2 No Harm but with Benefits Because this study involves the personal experience and emotional changes of infected people, it will not only occupy much time and energy of them, but also may cause the infected people’s fear of exposure to identity. Therefore, the first and fundamental “no harm” in this study is to keep confidential, that is, not to disclose the information of the interviewees, including text description and recording materials. In terms of text description, the author will not ask the name of the infected person or illustrate the interviewee’s personal information, only in the form of DCYJ** on behalf of the sequence of their interview. Because the interview needs to be recorded, the author makes a recording with the permission of the infected person, and promises that the recording material will only be used by the researcher and destroyed in time after use (has now been destroyed). In addition, the interview involves the personal life and emotional expression of the infected person, and occupies a certain amount of time, therefore, this study also embodies the principle of allowing the infected person to benefit from the survey. In the course of interview, the author uses empathy to understand the emotional experience of infected people, so that they feel the support and care of the author. Apart from that, the author tries to exchange information and emotion with the infected people, not only talking about “their world”, but also talking about “my world”. It is the most basic interpersonal interaction guidelines instead of purely asking infected people to cooperate. And after the interview, the author gives the infected person a gift as a token of gratitude. The above principle of no harm but with benefits can make infected people really feel the author’s concern for their lives and respect for the value of life, and can also bring them a certain degree of return.

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1.4.3 Rigorous Survey The study of social sciences should be accountable not only to the research participants surveyed, but also to other social science researchers. This study attaches great importance to this principle in the course of interview, and strives to verify the accuracy of the data through various channels in case of discrepancy of information. The data survey and analysis strictly abides by relevant norms. The personal information of the infected person is blurred in the book, in order to prevent others’ guess and speculation. The necessary technical treatment has been done for some of the interview content and materials that have to be cited, and efforts have been made to present the most complete and accurate information to the peers in the presentation of the content of the study. In the author’s view, the accurate and true presentation of survey data is not only the embodiment of the professional level of researchers, but also the observance of academic norms and research ethics, moreover the expression of the most sincere thanks to the infected people.

1.5 Theoretical Perspective The above mentioned “communication between each other is also a kind of creative discovery of inter-subjectivity, emphasizing the construction of the subject and his counterpart”, is also called psychotherapy. It refers to psychological and physical treatment methods with professional assistance. It usually requires the therapist to interact with the client in a cooperative manner rather than in a general doctor-patient relationship. This psychotherapy is intended for people with mental illness, mental dysfunction and all those who feel psychologically painful and troubled. It is also the connotation of psychotherapy in this book. The establishment of a unique interpersonal relationship assists therapists to deal with psychological problems, reduce subjective painful experience, cure mental illness and thus promote the individual’s mental health and its growth and development. Psychotherapy generally means the establishment of a treatment system based on psychotherapy theory and related clinical research (mainly psychological counseling, clinical psychology and psychiatry). It aims to establish relationship, dialogue, communication, deep self-exploration, behavioural change and other skills to achieve treatment goals, such as improving the mental health of recipients or reducing symptoms of mental illness. So far, psychotherapy has many different schools in continuous development. Generally speaking, the mainstream hundreds of psychotherapy methods have psychoanalysis (including Jung’s analytical psychology, Adler psychoanalysis, dynamic orientation psychotherapy, psychoanalysis of object relationship, psychoanalysis of self-psychological orientation, etc.), behavioral therapy, cognitive behavior therapy, client-center treatment, group psychotherapy, Gestalt therapy, psychological drama, language therapy, family therapy, sexual therapy and art therapy. There is ambiguity about the division of methods between different

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1 Introduction

schools, and even experienced therapists are unable to understand the treatment of all schools. There is also no consistent classification in the famous psychiatric classics of the United States (Synopsis of Psychiatry) and the psychiatric textbooks of Oxford Press in the UK. Therefore, this book also needs to make specific choices about the psychotherapy that must be involved in the research action. As mentioned above, psychotherapy used in this book is Kohut’s self-psychology and its subsequent development, and it can be summarized as relational psychoanalytic therapy. In this book, the psychological treatment of infected persons by organization A is included in the intervention. It is one of the main actions of organization A. The head of his organization, X, after contracting HIV, was once unable to work and live properly because of stress and fear, and suffered severe anxiety, inability to fall asleep, hands trembling and other symptoms, but also received medication from a psychiatrist, thus formed a drug dependence. X later found that other infected people are also faced with similar psychological conditions. In this case, the psychological state of infected people should not be underestimated. Therefore, at the beginning of its establishment, the organization has made it one of the main goals to improve the psychological state of infected persons. X’s psychotherapy is a kind of trial and test based on his own experience. Though lack of certain theoretical guidance, it has achieved a certain therapeutic effect. In the intervention of organization A, most infected people often have the same or similar experience, and are more spontaneous in the use of empathy and emotional experience for treatment. By sharing their experiences of seeking medical advice, they support each other and are treated with each other. There is an interactive relationship between a trainer and an infected person that is closely linked by infection. This approach is different from the common abuse and misuse of empathy, is also indeed different from the traditional authoritative treatment and the doctor-patient relationship. The psychotherapy method in this study originated from Kohut, a famous American psychoanalyst, and followed the classical psychoanalysis. It was a unique psychoanalysis study developed in the 1950s and the 1960s. Kohut was long been engaged in the clinical treatment and research of narcissistic personality disorder, and has systematically constructed his self psychology system on the basis of traditional psychoanalysis theory before his death. After his death, scholars has developed contemporary psychoanalysis schools on the basis of the original single theory, internally including a variety of orientations. Over the past more than 30 years, selfpsychology has gone far beyond the single theoretical framework of Khut’s selfpsychology in theory, forming the main theoretical characteristics of pluralism, relationship and postmodernism. Therefore, it has converged with other similar schools, forming relational psychoanalytic therapy. In theory, the book still focuses on the new exploration of psychoanalysis methodology by self-psychology, puts forward a new interpretation of self and his or her own experience, and introduces a moderately new point of view in the research practice. In practice, the treatment will be more directed to mental illness and mental health, hoping to expand the treatment scope and treatment content of self-psychology. This treatment practice is mainly embodied in: Based on the inter-subjectivity of analyst

1.5 Theoretical Perspective

15

and patient, the analyst carries out the treatment with analytical interpretation. In the treatment of sexual psychological problems, this book discusses the key concepts of Kohut’s theory, that is, the relationship between the failure of self-object and gender identity, the problem of libido, gender trauma and self-pathology, and the influence of analyst’s gender on treatment through psychoanalysis. In the case of gay therapy, this book probes into the gender identity of homosexuality, the significance of gender to homosexuality, the problem of lesbian homosexuality, and the twinship transference of homosexuality. In the treatment of addiction problem, the author puts forward the unique treatment concept and method by using the theory of inter-subjectivity. In the treatment of suicide, this book puts forward a new concept of narcissistic suicide, probes into the relationship between suicide and traumatic idealization, the relationship between efficacy and suicide treatment. In the aspect of grief treatment, the author puts forward a brand-new theoretical model of clinical grief treatment. In psychiatric treatment, the book probes into the relationship between psychosis and the failure of individual cognitive development, and puts forward the basic framework of mutual psychiatric treatment, and so on. So far, however, few theories of self-psychology have been applied to the practical guidance of infected people, so this book attempts to expand its application areas in order to better guide practice. Whether the academic community or the public first consider the cure of the AIDS population medicine, then comes its way of infection. Academia may pay attention to the social relations of infected people, such as discrimination, social support and social capital. Besides, the public’s understanding of the psychology of infected people is based on common sense, only knowing that they will have concerns about disease, fear of death, anxiety about treatment and so on. The existing psychology related research is more focused on the living conditions of AIDS people. Due to psychological problems, AIDS people’s quality of life is significantly lower than ordinary people. They are often worried about the onset of disease, fear of exposure, medical rejection, afraid to seek employment, no money to see a doctor, family do not accept, dare not inform their partner, do not know when to start taking medication, because side effects are too big and self-stop, There is no place to live, be ostracized by neighborhood friends and relatives, look down on themselves, selfisolation, do not know where the future, want to commit suicide can not find a way, want to live and can not find a reason, want to cooperate with the treatment but can not swallow pills and other predicament. For their concerns and psychological problems caused by HIV infection, the corresponding intervention measures are nothing more than providing some psychological support and psychological counseling. In serious cases, they will take some drugs for treatment prescribed by psychiatrists. Few research focuses on the process from knowing being infected to facing the fact and the changing course of their own experience from the perspective of psychoanalysis. Among many current theories of psychotherapy and psychological counseling, this book, from the perspective of relational theory, guided by self-psychology and its development, attempts to analyze the process of infected people facing HIV from their own disintegration to their own reconstruction, and gain the confidence and courage to stand up again. “Although

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1 Introduction

the HIV virus can not be killed by drugs at this time, I can obtain a new life in the symbiosis with HIV, and wait for the good news of medical cure in the process of helping others and self-help” (infected X), to achieve the self-restoration of the AIDS population. However, the existing research at home and abroad does not specifically include the psychological problems of infected people in the treatment scope of selfpsychology. Analyzing the infected person himself or herself from the angle of self-psychology is still in a relatively blank state at present. It is proved that selfpsychology broke through the so-called “non-analytical” possibility at the beginning. The initial treatment of narcissistic patients is extended to the current various fields. In particular, George Hagman’s theoretical model on grief divides the grief process into five stages of the shock stage, the search stage, the psychological disintegration, the psychological reorganization and the new identity. It provides guidance for the self-restoration of the AIDS population. AIDS is currently incurable and infectious. After diagnosis, the infected person is faced with a confrontation with the disease (virus) and the loss of the relationship caused by its infection, including, of course, psychological relations. Since 2007, the author has been in contact with infected people. Whenever mentioning the first time to know HIV infection, they are often in a state of shock, suspicion and numbness. The first thing that an infected person thinks about is that AIDS is incurable, that he will soon die, and that he will die in pain. Even by taking antiviral drugs, their life can only be extended for a period of time, unable to achieve the effect of a complete cure. They will be burdened with all kinds of stress. At this stage, these thoughts flashed quickly through my mind: “I was like thunderbolt, my mind is blank about how I can be infected, how I can be contracted, who passed it to me, I am about to die, and will die badly?” (infected X). They experience a sense of helplessness that is dominated by anxiety, worry, and fear. AIDS patients often show doubts about the test results and “Why me” questions, can not calmly face and accept the reality, but have a little fluke, such as whether it is the hospital testing went wrong. “I’ve looked at the test sheet several times, including the name and the positive reaction, and you know, it’s not a joke,” he thought. Later, I went to the provincial CDC (then called Epidemic Prevention Station) to re-examine” (infected X). In general, many infected people have not yet become ill at this time, only the carriers of HIV. They often have an illusion to rely on their own efforts to deal with HIV. They understand that AIDS is an disease resulting from immune dysfunction, and look forward to combating HIV by their own efforts, such as strengthening exercise, taking health care drugs to improve immunity, go on dieting. Of course, because the HIV virus also has self incubation period, plus the efforts of infected people, they have received a certain level. However, when the number of CD4 in an infected person drops to a certain extent, opportunistic infections are often concurrent. At this time, infected people not only bear the inner fear, but also experience the impact of failure of their own efforts and unsatisfaction of self-object needs. Coupled with the pain of opportunistic infection, it often leads to the instability of their own experience and eventually fragmentation.

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Self fragmentation refers to the feeling of “I’m going to fall apart” that everyone experiences at some point in their lives. In his writings and published articles (1959, 1966, 1971, 1977, 1984), Kohut clarified the anxiety, shock, and immobile fragmentation that can occur to individuals in any situation based on the clinical experience. Although Kohut’s self and self-object are mainly used for people with psychological defects, Kohut has also suggested that they accompany the individual a whole life. Here, the author does not think that all people living with AIDS have psychological pathology, admittedly, many of them have some anxiety about HIV infection. As Kohut points out, the specific experience of personality is falling on a spectrum, and anxiety and worry, a point in the spectrum, will change with a variety of stress situations. Self and self-object will also change in this process, thus affecting the development of the individual. Therefore, this book tries to use self-psychology and the development of its successors as the theoretical focus, the orientation of relational theory as the therapeutic framework, self and self-object as the explanatory items of psychological motivation, in the relationship between analyst and analysand, paying attention to how infected people with the help of infected organizations face difficulties together, solve problems, get rid of troubles, complete their own process from fragmentation to restoration, and realize the cure of “relational theory” and “self-psychology”, after facing their own fragmentation.

Chapter 2

Governance of AIDS and Actions Taken

2.1 Outbreak of AIDS AIDS, known as the most serious public health problem in the twentieth century, is also named the “Black Death of the twentieth century”, because of its infectious and high fatality rate. The epidemic has been extended to the twenty-first century, and there is no trend of slowing down. AIDS, short for Acquired Immune Deficiency Syndrome, is caused by retrovirus infection of human immunodeficiency virus (HIV). It infects human immune system cells, destroying or damaging its function. There are no symptoms in the early stages of infection. But, as infections develop, the immune system begins to weaken, and infected people are more likely to suffer from socalled opportunistic infections. It shows a comprehensive condition that contributes to a variety of clinical symptoms, rather than a mere disease. Because the HIV virus itself is very small, the existing testing methods do not determine the presence of HIV. Only after the human body is infected with HIV for a period of time, the blood will produce the corresponding HIV antibody. At this time the test will show what we call a positive reaction. However, the time at which individuals produce antibodies varies from person to person and is generally considered to be 6–12 weeks after infection, with the longest clinical report being 12 months. This period is often referred to as the window period. But as the test approach progresses, the window period has now been shortened to 1–2 weeks. Unlike other viruses, HIV infection does not immediately lead to a clinically symptomatic response. On the contrary, it has an incubation period in the human body, as fast as half a year and as slow as more than 10 years. When an individual is still in its incubation period, it is traditionally referred to as an infected person or a carrier living with HIV. In the event of an opportunistic infection, or according to medical diagnostic criteria, such as the CD4 (an important immune cell in the body’s immune system) of an infected person less than 350, it is recommended to take antiviral drugs. The vitality of HIV virus is relatively fragile, so it will die when exposed to air for a few minutes. Its transmission pathway is mainly through direct contact with © Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9_2

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mucosal tissue of the mouth, genitals, anus, etc. or with the virus of blood, semen, vaginal secretion, breast milk. Therefore, all kinds of sexual behavior, blood transfusion, shared needles, drug intravenous injection are known routes of transmission. In addition, there is a risk of cross-infection of the virus, if the medical device is not thoroughly disinfected in all traumatic medical examinations, such as colonoscopy and gastroscopy, tooth washing and fillings. The world’s first report on AIDS appeared in the United States. In June 1981, the U.S. Center for Disease Control and Prevention reported the world’s first case of HIV infection. Because the infected person is a gay man, AIDS has been regarded as a disease of homosexuals, especially gay men, in the many years that followed. Homosexuality is even equated with AIDS. Since the discovery of AIDS, human beings have begun to fight against AIDS. However, early medicine is often helpless to AIDS, so that many infected people suffer from pain and death. AIDS has been overshadowed by a layer of terror. It was not until 1996, when Dr. David Ho, a Chinese American scientist, pioneered cocktail therapy to effectively control the replication of HIV in the body, delaying the onset of most infected people and beginning to significantly reduce their mortality rate. But today, scientists around the world are still conducting much research and many clinical experiments, hoping to find a cure as soon as possible. However, since its diagnosis, AIDS has not only been a disease problem. In the past more than 30 years, it has killed tens of millions of people. According to a 2016 report by the United Nations Programme on HIV/AIDS, UNAIDS, the number of people living with HIV worldwide was 36.7 million (30.8–42.90 million), of which 34.5 million (28.8–40.2 million) adults and 2.1 million (1.7–2.6 million) children (younger than 15 years of age). Only in 2016, 1.8 million (1.6–2.1 million) of new infections were added. Today, AIDS has become a worldwide problem, not only bringing pain, fear and even death for the infected themselves, but also seriously affecting the stability of the country and economic and social development. What is more, nearly half of the infected people do not know they are ill or refuse to check because of their own window period, incubation period and social stigmatization. All exacerbates the risk of HIV transmission. In addition, HIV is spreading to the general population through sexual transmission by people with high-risk behaviours (gay men, co-needles, sex workers and clients), and the rate of sexually transmitted infections between the same gender is increasing at a significant rate. Unlike ordinary diseases, AIDS cannot be cured only through research in the field of medicine or biology. Because of the spread of HIV through blood, sex and other means and the stigma associated with it since its birth, AIDS has been more manifested as a serious social problem. Today, the spread of AIDS in China has been spread from high-risk groups to the general population. People become jittery at the mere mention of AIDS in society. This is not because AIDS is incurable, and it alone is not fatal, and effective control of HIV can be achieved through the continuous use of antiviral drugs. In terms of its infectivity alone, HIV will die in the air for a few seconds to a few minutes, and its transmission pathway is limited to few transmission methods, such as blood and body fluids, which are simply less contagious than SARS virus, hepatitis virus, tuberculosis virus and many other viruses. However, AIDS has

2.1 Outbreak of AIDS

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become the most frightening disease in today’s society. It gradually evolved from the initial purely medical problems into a major public and social problems affecting social security and stability. First of all, the transmission of AIDS includes the most obscure human transmission through sex (hepatitis virus will also be transmitted through sex, but there is no stigma such as AIDS), which makes the AIDS population with an unclean stereotype, even more filthy than syphilis. Coupled with the link between aids and drugs, homosexuality, sex workers and multi-partner sex, AIDS has become a target of stigma, and infected people have been shamed. Second, because the disease destroys the body’s immune system, it causes individuals to suffer from other diseases due to defects in the immune system. For infected people themselves, the disease destroys their immune system, preventing individuals from invading other viruses and causing disease, which is medically referred to as opportunistic infections. The disease, known as opportunistic infections, rarely occurs in the general population, such as Kaposi sarcoma, Pneumocystis and pneumonia caused by cytomegalovirus infection. Its symptoms (especially reports of skinny and festering infections) are often chilling. Third, because of the problem of their own immune system, the condition of infected people is very easy to relapse, and the effect of treatment is not obvious, known as “like cancer invasion”. As a result, many concerns and fears, like HIV, often coexisted with infected people, so that they can not bear the weight of life and emotion. Finally, the spread of AIDS has turned to the general public, forming an infection through relationship and an emotional isolation. In other words, two people who pass by usually do not have any relationship or emotion, and will not be infected. AIDS hit the most central circle of mankind, especially for the Chinese people. If you use Fei Xiaotong’s differential order pattern to describe their interpersonal relationship, the fact of being infected, just like the stone thrown into the lake, not only aroused thousands of waves in the life of infected people, more importantly, its spread mainly from the most inside out. The most susceptible to infection is their own lover or sexual partner and other most intimate people. The first to cause fear and stigmatization of infection is the infected person and his partner and family. Furthermore, after the infection, the first to suffer from the disease is what the Chinese consider to be the closest relationship group or important person. Afterwards, from the most intimate relationship to the outward rupture, along with the social stigma and fear, infected people gradually face the fracture and miss of their own surrounding relations, and then bring emotional ups and downs. To sum up, the infection has since become an unspeakable secret for infected people. They not only combat the physical torture caused by HIV, but also silently bear the fear, anger and sadness caused by the infection (being) negative feelings (negative affect), More likely to present (expression) a combination of negative emotions, including shame, guilt, and alienation. The whole society needs to face the negative emotion of the infected person and the concentrated outbreak and presentation of its cocktail form, which affects the harmony and stability of the society.

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2.2 AIDS Governance in China 2.2.1 Status Quo of AIDS Population AIDS ravages in the world, with no exception in China of the world’s largest population. In the past more than 30 years, China’s AIDS epidemic has experienced the introduction period (1985–1988), diffusion period (1989–1993), rapid growth period (1994 to date) based on the division of the epidemic trend of AIDS. 1 of thousands of infected people from Argentina died of complications at Peking Union Medical Colledge Hospital in June 1985. Subsequently, in the AIDS monitoring work in Zhejiang and Guangdong, 4 hemophilia patients and 1 Congolese international students who had used imported blood products were found to be infected with HIV. In February 1987, another case of AIDS was detected in Fujian province. This series of individual cases has become the first wave of AIDS landing in China’s territory. In 1989, the first large-scale aids outbreak occurred in Yunnan province on the border between China and Myanmar in the group of intravenous drug users (Liu 2005). With intravenous drug infection gradually spread from rural areas along the border to the urban area, China’s HIV transmission rate began to accelerate significantly. Especially since 1994, the AIDS epidemic in China has shown a rapid upward trend. At present, the AIDS epidemic in China has spread to 34 provinces, municipalities and autonomous regions (including Hong Kong, Macao and Taiwan). Under the powerful impact of AIDS, all the provincial regions of China have not been spared. China has become one of the fastest-growing countries in Asia to spread AIDS. As of May 31, 2017, China has reported a total of 708,158 cases of HIV infection and AIDS patients, a cumulative report of 219,050 deaths of people living with HIV. There were 413,369 cases of HIV infection alive and 294,789 cases of AIDS patients. Because of the incubation period of AIDS itself and the concealment of infected people, the actual number of infected people is much larger than the cumulative number of reported people. Besides, HIV is sexually transmitted by people with high-risk sexual behavior to the general population, and the rising rate of same-sex transmission is obvious. Although modern medicine has confirmed that the way HIV is transmitted is limited to three finite forms of mother-to-child transmission, blood transmission and sexual transmission, and policies such as “Four-Free and One-Care” also provide drug security for infected people, drugs do not solve all the problems of infected people. As the perspective of today’s popular trinity of physiology, psychology and society shows, drugs can only solve the viral problems of the AIDS population themselves, and cannot eliminate the side effects caused by drugs, such as the psychological problems of death caused by HIV. And under the influence of the national mainstream values, there has always been a tendency to “demonize” AIDS. This is actually inseparable from the ideas and ethics of people in China for more than thousands of years. The spread of AIDS in China is often contrary to the

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Confucian tradition and social mainstream values, so the AIDS population is also considered to be social fringe or vulnerable groups contrary to the mainstream value. Therefore, the problem of AIDS has also evolved from the initially pure medical to major public issues affecting public safety in society. The academic research covers various fields such as medicine, epidemiology, public health, biology, psychology, sociology and so on.

2.2.2 Prevention and Treatment of AIDS (I) Prevention of AIDS Modern Chinese Dictionary interprets prevention as a response measure to tackle that may deviate from the subjective expected track or objective universal law in the course of the development of things in advance. It is what we often say a precaution. In the field of medicine, the prevention of diseases has to go through three stages: the prevention of pathogenic factors, pre-clinical prevention (or pre-symptom prevention) and treatment as a means of clinical prevention. At present, China’s AIDS has entered a period of rapid growth, and the epidemic and spread of AIDS has become more serious. Internationally, it took more than 5 years to control AIDS falling, 14 years for the United States, where the outbreak has been severe, and 12 years for Thailand, which has undergone twists and turns. As far as the field of medicine is concerned, due to the earlier detection of AIDS abroad, relatively perfect scientific and technological facilities, research in prevention has basically entered a mature stage, currently mainly focused on AIDS treatment and prevention and control of vaccine research and development. From the point of view of social science and humanities, the burden of AIDS social prevention is even heavier. Each country or region forms self social prevention model in its response to the AIDS challenge. From a global perspective, the more successful cases of AIDS social prevention are: changing the unsafe behaviour of gay or bisexual men in the United States; developing needle exchange and marketing in Australia; promoting condom use in Thailand; methadone substitution and withdrawal therapy in Hong Kong, China, etc. In the area of AIDS prevention, Taiwan, China, introduced the “AIDS Case Manager Program” in 2005, which has achieved good results in the prevention of AIDS and the behavioural change of infected people. In 2003, the Chinese government formulated a series of new decisions and major measures, including “Four-Free and One-Care policy” and “AIDS Comprehensive Prevention and Control Area”. Effective strategies are seen by the international community to reduce the harm of AIDS, such as condom promotion, needle exchange and methadone substitution therapy, are also beginning to receive state support. In general, the prevention of AIDS in China is mainly reflected in the following two aspects.

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1 preventive measures for people at high risk Although the route of AIDS transmission has been transformed from high-risk groups to the general population, the prevention of AIDS in high-risk groups can not be underestimated. High-risk groups mainly include sex workers and male objects, homosexuals. There are very few infected lesbians, but gay men have become a new growth point in the number of AIDS infections in China. Among them, sex workers include women and men who engage in sexual activity in places such as entertainment, communities and the streets. At present, sexual transmission has gradually become the main way of AIDS transmission in China. In particular, sex workers in entertainment venues have many high-risk behaviors of infection and sexually transmitted diseases like AIDS. Multiple sexual partners, frequent replacement of sex partners, low condom use, menstrual sexual behavior and group sex, all increase their own risk of infection and transmission to others. Therefore, sex workers are not only the high-risk population of AIDS prevention, but also the important middle population of the transmission of AIDS through the general population. Thus, it plays an important role to carry out AIDS prevention and to improve the use of condoms in an all-round way, in the control of the AIDS epidemic and other aspects. The problem of HIV transmission and infection among homosexuals has also attracted more and more attention, as a result of the sexual behavior of gay men. Severe friction causes skin breakage, so that HIV virus is very easy to invade the body. On the other hand, the survey shows that the phenomenon of multiple sexual partners and low condom use among gay men is more common. Consequently, gay men are subject to a high risk of HIV infection in many countries. For them, there are standardized health education models, participatory training models, peer education models and so on based on individual cognitive psychological models. For example, with the support of the Global Fund, many regions of China give full play to the advantages of non-governmental organizations and to facilitate communication with homosexuals, recruit peer educators and carry out peer health education models. In the course of practical operation, some scholars have summed up the following experiences: establishing an objective and scientific attitude towards homosexuality, and helping them to communicate with their families to seek understanding and reduce their possibility of marrying the opposite sex because of social pressure; creating a relaxing social environment, and changing the situation of multiple sexual partners among them; helping them to establish a correct attitude towards AIDS, and have regular HIV testing; enhancing their awareness of condom use, and designing and producing condoms suitable for their use; strengthening the training of medical personnel, and paying attention to gay population in outpatient STD patients, having HIV test for them and providing effective physical and mental treatment in a timely manner. China’s earliest AIDS outbreak occurred in Yunnan province among drug injecting populations. The sharing of needles caused their infection. It is also accompanied by

2.2 AIDS Governance in China

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the concurrency of drug addicts and AIDS infection, which sets off many social problems and personal physical and mental disorders. Many areas carry out service platform management and referral work for intravenous drug patients. The content of the work mainly includes three major parts: First, help people living with HIV to establish confidence, adapt to the living environment, and provide consultation for intravenous drug population testing before and after HIV testing. Publicize AIDS prevention and control knowledge and national policies and regulations, and provide psychological support for consultants, including emotional support, in order to eliminate doubts and psychological pressure. Second, carry out outreach services like health education and publicity activities related to AIDS knowledge and HIV voluntary counselling in communities, drug rehabilitation centres, detention centers, prisons, places where high-risk groups are more concentrated. Third, do a good job of cleaning needle exchange work by providing needle exchange services through peer education staff exhibition for intravenous drug users, and do a good job of needles, condom distribution and needle recovery and treatment. 2. prevention measures for the whole population At present, the AIDS epidemic in China has entered a period of rapid growth, and the outbreak began to spread from high-risk groups to the general population. Among them, although blood transmission is only one of the ways to spread AIDS, it can not be ignored that the blood is the most likely way to infection. The institutional system to ensure the safety of blood products is one of the ways to reduce social susceptibility. The way HIV is transmitted through the blood is also the most threatening way to make AIDS a “national tragedy” in China at present. Relevant prevention measures are adopted to ensure blood safety, including the sound establishment of a system of policies and regulations for the unpaid blood donations, the examination of HIV antibodies before blood collection, and the severe crackdown on illegal blood collection and supply. According to the theory of “sexual social network”, Pan Suiming put forward that “bridge crowd” is the main risk group to spread AIDS, among which they are no longer the so-called commercial sex workers, but the male in the sexual relationship network. with the expansion of AIDS from high-risk groups to the general population, it is more important to carry out health education and behavior changes aimed at the general population, especially the bridge population. In terms of specific operations, it is important to carry out AIDS-related education mainly for the general public, to enhance their knowledge of HIV epidemic, reduce the susceptibility to sexual behavior, improve condom use, and so on. At the same time, in order to reduce the susceptibility of adolescents, the national strategy should focus on strengthening family communication, creating safe space and occasions for peer communication; reducing the probability of infection among underage girls; strengthening the human rights protection of people living with AIDS; developing relevant curricula in educational institutions; and establishing health and welfare services that benefit young people; reducing the vulnerability of children and young people; and reducing the susceptibility of unemployed youth.

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In addition, with the economic development in recent years, the number and mobility of floating population is increasing, so China has increased the education of AIDS knowledge, and issued China Action Plan to Curb and Combat AIDS (2001– 2005), China Medium and Long-term Plan for the Prevention and Control of AIDS (1998–2010), Publicity on Prevention and Treatment of AIDS and Sexually Transmitted Diseases, AIDS Control and Regulations and other regulations and policies. All these have greatly promoted the prevention and control of AIDS in social policy. (2) Treatment of AIDS The term “treatment” usually refers to the process of intervening or altering a particular state of health and the activities carried out to eliminate the pain. With the progress of science and technology and the deepening of the understanding of the essence of life and disease, the medical treatment methods have made great progress since the nineteenth century. In addition to traditional internal and surgical treatment, there are new treatments such as physical therapy, radiotherapy, nuclear medicine, psychotherapy, physical therapy, biological feedback, organ transplantation, and medical engineering. New therapies are emerging like mushromms, but for the purposes of their clinical selection of therapies, the following three are necessary. 1 Elimination of Etiology It is also known as special-effect therapy and considered to be more ideal therapy, that is, the purpose of treatment is to eliminate the cause, and to achieve radical treatment, such as the use of chloramphenicol in the treatment of typhoid patients and surgical correction of deformities. As far as the particularity of AIDS is concerned, there are no relevant medical methods or drugs that can achieve the effect of eradicating the etiology. However, since the discovery of HIV virus, domestic and foreign scholars conduct research from the perspective of etiology, epidemiology and other aspects, and are devoted to exploring its pathogenesis and vaccine research and development, and put forward a series of treatment methods to regulate the immune system. The literature published in professional journals and included in the PubMed has been as many as millions, but the progress of its research has not kept pace with the AIDS epidemic. 2 Symptomatic Therapy It is also called palliative therapy. The purpose of symptomatic therapy is not to eliminate the cause, but to relieve certain symptoms. When the cause of many diseases is not recognized, the treatment measures taken fall within the scope of symptomatic treatment. In modern medicine, symptomatic treatment is a necessary and correct choice, when sometimes the cause is unknown or known, but it cannot be eliminated, for example, tumor resection or when the symptoms themselves pose a threat to life, such as shock correction, organ transplantation and so on. With regard to the treatment of AIDS, no drug or therapy has been effective in reducing mortality since the first case of AIDS was detected in the United States

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in 1981. The number of people dying of AIDS in the world increases year by year, and once contracted, they will be ostracized and isolated, waiting for death to occur, suffering from discrimination and illness. Until 1995, there was a breakthrough. The cocktail therapy, invented by Chinese-American scientist Dr. He Dayi, is not a cure, but it significantly reduces mortality, delays the onset of the disease indefinitely, and reduces the number of viruses in the AIDS population to a standard of almost zero medical testing, thus significantly improving the survival of the AIDS population. However, cocktail therapy does not completely eliminate HIV, it also has strong side effects for some infected people. The medical community believes that AIDS can not be called a curable disease. It is worth mentioning that traditional Chinese therapies such as traditional Chinese medicine, traditional Chinese medicine therapy and integrated traditional Chinese and western medicine therapy account for a significant proportion of symptomatic treatment. So far, the vaccine that can be applied has not been produced, but TCM has some drugs that can be used to assist in the treatment of AIDS patients, and this treatment is complementary to antiviral therapy. 3 Supporting Therapy The purpose of supporting treatment is neither to eliminate the cause nor to treat certain symptoms, but to improve the general situation of the patient, such as mental state, medical protection, etc. Strictly speaking, all treatments must be based on supportive treatment, but this is easily overlooked by medical staff, especially the mental support for patients and the improvement of the medical environment. If psychology can only be sidelined in the field of AIDS prevention, then in terms of support for treatment, it happens to be the field in which psychology plays a role. Although the drug can enable infected people to maintain a “healthy” state for a long time, the blood virus load can also reach the almost zero medical test, it can not completely eliminate the HIV virus in the AIDS population. Therefore, too much emphasis on drug treatment has not been able to meet the objective needs. Many scholars have suggested that, in addition to drug treatment, the role of emotional therapy can not be ignored. It is necessary and humane to provide them with psychological care and emotional support and also a necessary way to induce them to fulfil their obligations and protect others from infection. Studies have shown that psychological problems of AIDS people mainly include fear, stress, negativity, revenge and numbness. It needs a long process of psychological transformation from the initial stress state to the acceptance of reality, and with a positive attitude towards the treatment. As a result, their mind tends to behave differently at different stages. Before diagnosing HIV infection, there is the possibility of psychological symptoms associated with infection, such as anxiety and depression caused by excessive panic, especially those with high-risk behaviors that are even accompanied by obsessive–compulsive disorder or “false AIDS syndrome”, which is also known as “phobia”. After the diagnosis of HIV infection, infected people may first show a strong psychological response, such as shock, denial, ashamed, anger, fear, despair. Some people will retaliate against others at this stage or use suicide to escape reality. Depression and anxiety is the most common emotional expression of

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AIDS people. A domestic survey in China found that 25% of infected people suffered severe depression, 60.7% moderate and above. In addition to primary anxiety in the AIDS population, quite a lot result from poor physical and medical conditions such as endocrine disorders, drug side effects and other anxiety. The second is sleep disorders, especially insomnia very common in the AIDS population. Although sleep disorders are not a serious mental illness, it greatly affects the quality of life of patients and their own immunity. Again, it is rare to have a state of paranoia associated with an infected person. The incidence of dementia in patients with advanced AIDS is as high as 20%. In addition, those infected during this period often endure the double pain of untreated physical pain or untreated depression, which is prone to suicidal thoughts and actions. There are also infected people who do not want to endure this pleading way of life and choose to die with dignity. It has been documented that the suicide rate among people living with AIDS is 7.4 times that of non-AIDS people. Domestic surveys have also found that the proportion of suicidal willingness among people infected with drug-sharing syringes is 31.11%, well above the 8.57% of sexually transmitted infections and the 3.23% of people infected with blood transmission. Limited by the sample of the survey, the results of these surveys do not clearly represent the psychological attitude of all infected people, but they also reflects from one side the necessity of psychological support for the AIDS population and the worrying situation of the psychological status of infected people. Most of the existing research in academic circles is quantitative research, which tends to make regression analysis of the psychological obstacles that occur to infected people. Results demonstrate that, because of the infectious, incurable and high fatal rates of HIV, AIDS is often perceived as linked to bad behaviors, such as homosexuality, drug use and sexual disorder. Once diagnosed with HIV, infected people are alienated, evaded and discriminated against by society, medical personnel and even family members, so that they suffer social exclusion and isolation. In addition, the infected people are mainly young adults. Difficult to face the threat of loss of family, work and life, it is easy for them to have a variety of negative psychological performances. The second is the treatment from drugs. Many drugs related to AIDS treatment are likely to cause mental illness. If the patient is also a user of alcohol or drugs, the interaction of drugs will aggravate the mental and psychological disorders of the infected person. Studies have shown that the heavier the physical discomfort and symptoms caused by AIDS, the more likely it is to increase the concern and anxiety of the infected person about the disease, thus exacerbating the original emotional problems. Finally, because of the change of their own image, especially in the later stage of AIDS, self-esteem of infected people was often hurt because of the so-called typical “AIDS appearance” like extreme emaciation, skin damage. In particular, those infected in rural areas often suffer from poverty and can’t afford high treatment costs. In addition, the psychological problems of infected persons are closely related to the occurrence of their previous high-risk behaviors. Studies have found that when asked about the initial psychological feelings after learning of the infection, the proportion of “refusing to accept” infected by sexually transmitted people is as higher as 34.29%, while infected people who are transmitted by blood feel “unacceptable and helpless”. Compared with the above two, the psychological

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feeling of drug addicts is more intense, the proportions of “refusing to accept”, “fear”, “loneliness”, “suicidal thoughts” and “pain” are very high, and sexually transmitted infected people hope that the less others know how they are infected, the better it is. In the support of AIDS people, domestic and foreign research has shown that: to provide appropriate psychological care and emotional support for infected people can reduce mental stress, delay the onset period, prolong survival time, and improve the quality of life. improve the compliance of treatment and make the antiviral effect of the drug more durable, so as to achieve better therapeutic effect. Deng (2005) help infected people proactively avoid high-risk behaviors, and take effective preventive measures to actively protect others. Appropriate psychological support also contributes to the harmony of family relations among people living with AIDS, and it can be their families, friends, health service personnel, community volunteers, professional social workers, non-governmental organizations or other social groups that provide psychological care to those infected. It can also be a mutual aid group made up of people living with AIDS. The way of psychological support can also be aimed at different patients, different stages of development using a variety of psychological intervention methods. The first is psychological counseling, a service that does not rely solely on drugs has increasingly become an important part of holistic treatment and care for people living with AIDS. Domestic studies have shown that psychologists and clinicians work together to supply psychological counseling with infected people. It can significantly reduce the degree of psychological depression and anxiety, and improve their quality of life and social support status through listening to build trust with them, and to provide them with psychological support. In group psychotherapy, infected people can face reality, accept themselves, reduce loneliness in the process of experiencing interaction and self-help methods, so as to achieve mutual support, rebuild life confidence, improve the quality of life of the treatment purposes. Second, studies by Heath and Rodway (1999) found that in peer education, most infected women want to communicate with other counterparts, so that some infected people in better condition provide psychological support services to other patients to help them accept reality and provide the information that best meets their needs, in order to achieve good results that the medical treatment can not achieve. In recent years, the academic community has also become increasingly aware that the support and psychological care of infected people can not be separated from the comprehensive support of communities and families. Community support for infected persons includes both basic medical care for patients and families, as well as economic, cultural and social interactions. The establishment of social support network can decrease the depression of infected people, contribute to the individual’s ability to anticipate and cope with life routines, improve the quality of life, and relieve negative emotions. Infected people with adequate social support are better able to adapt to the disease than those who are not adequately supported, and reduce negative emotions such as anxiety and depression, adapt to post-illness roles, establish new relationship models with friends and family, and reduce the sense of social isolation in order to live an active life.

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Community support programmes for infected persons in some developed countries began in the late 1980s and the 1990s. Over the past more than 20 years, they have evolved with considerable experience in providing psychological care to those infected through the community support. The United Kingdom has established a community service network of various NGOs and volunteers, which, in addition to providing health care for infected persons, provides psychological counselling to them and their families to bring patients’ family connections into harmony. Many parts of the United States emphasize providing long-term care to infected people through community support programs, conducting psychological counseling, providing spiritual and emotional support, helping themselves, spouses and other family members overcome fear and emotional frustration, accept reality and reduce shame, and proactively seeking community care and help. In some community support systems in Australia, there are many informal support groups of community residents who provide psychological and emotional assistance to infected people, their families and friends, reduce the isolation of infected people from society and reduce their sense of shame as a result of HIV infection. At the same time, infected people can also exchange experience through emotional support to alleviate pain and adopt self-help measures to deal with the disease. In addition, in the Canvanca community in the hard-hit area of AIDS in Uganda, infected people can seek psychological counseling from senior experts through hospitals, AIDS information centres and AIDS support organizations, as well as experts to coordinate family relationships. Meanwhile, religious organizations also play a very important role in community support. When Christians visit a patient, they usually bring friendship, understanding, and support to the patient’s home, giving the patient great psychological support. The family is the cell of society, so family care is a kind of nursing service provided to patients in the family by professional and non-professional caregivers as well as the families of patients. The aim is to provide quality and appropriate care for infected persons so that they can maintain an independent state of life and maximize their quality of survival. Family care can be divided into health care, treatment services, psychological recovery, long-term maintenance, family pressure relief and other forms (Sun 2011). The psychological care of infected people based on the family can not only relieve the pressure of hospitals, families and communities, but also enable infected people to receive better care. Australia developed a family care plan for people living with AIDS in the early 1990s, which included psychological support and mental health services for people living with AIDS. The implementation of the scheme has improved the living conditions of infected people and met the spiritual needs of those infected. The French Community established the AIDS organization in the early 1990s to train nursing staff in special skills and provide psychological support and care services to patients in the course of the family care programme.

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However, many developing countries, including China, have not experienced the development of social support and guarantee for vulnerable people in Europe and the United States. Therefore, the model of community support and family care for infected persons suitable for Chinese social and cultural background has not yet been established. But in recent years, the Chinese government has also made great efforts in AIDS care. Some exploratory research on the model of community care for infected people has been done. But looking at the study of infected people in Chinese academic circles, the author finds that analyzing the psychological obstacles of infected people from the angle of psychoanalysis is in a state of “collective loss of voice”. Support for infected people is thus caught up in a non-professional, nonoperational model that everyone can do, but often “don’t actually understand the fear of infected individuals.”

2.3 Policy Guarantees Related to AIDS 2.3.1 The Successive Introduction of AIDS Prevention and Treatment Measures Over the years, in order to curb the spread of the AIDS epidemic and reduce the negative impact of AIDS on individuals and society, the Chinese government actively carries out the prevention and treatment of AIDS and adheres to the principles of “Prevention, publicity and education first, combination of prevention and control, treatment of symptoms and root causes, and comprehensive management”. Health authorities began with the AIDS prevention and treatment process as early as 1985. In September 1986, China set up a national “AIDS Prevention Working Group”, followed by a special leadership group or coordination meeting system in the country’s 31 provinces, autonomous regions, province-level municipalities directly under the Central Government (except Hong Kong, Macao, Taiwan region). National AIDS prevention and control programmes were developed in 1987. Since 1994, the nation has further strengthened AIDS prevention and control, and successively promulgated a series of normative documents. For example, China’s first local regulation on the fight against AIDS, “AIDS Prevention and Treatment Measures in Yunnan Province” was also formally implemented in March 2004. The promulgation of this series of policy measures and laws and regulations provided policy and legal guarantee for China’s AIDS prevention and treatment work, and made a crucial contribution to China’s AIDS prevention and treatment. Meanwhile, it also shows that the Chinese government’s political attitude towards AIDS prevention and treatment and demonstrates its firm determination to curb the AIDS epidemic.

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2.3.2 Institutional Guarantee of AIDS Medical Service System For decades, the Chinese government’s involvement and intervention in the spread of AIDS projects and content concentrate mainly on the following aspects. The first is HIV testing. People can carry out free voluntary counselling and examination (VCT) for the early detection of infected persons. Advisory and testing is undertaken by all levels of disease prevention and control agencies and their selected medical institutions, involving free range of AIDS counselling and initial screening tests (multiple screening of high-risk groups). Those who are tested positive for two times, were recommended to do further confirmation tests. Local governments may grant appropriate subsidies for the cost of confirmation tests that they cannot afford. The second is mother-to-child infection, which is one of the important ways of AIDS transmission. In order to cut off the route of transmission, the Chinese government has fully played the role of a three-level maternal and child health network. Health care institutions responsible for maternal health and midwifery services provide free AIDS counselling for pre-marital health care groups and pregnant women; conduct risk behaviour assessments; and recommend and mobilize free HIV antibody testing for premarital health care populations and pregnant women. The last is treatment and care. On December 1, 2003, Premier Wen Jiabao, Vice Premier Wu Yi announced the four-free and one-care policy to combat AIDS. “Four free one care” mainly refers to: providing free antiviral drugs for rural and urban residents with financial difficulties who do not participate in the basic medical insurance and other medical security system; free counselling and screening for those who voluntarily undergo AIDS counselling and testing, provision of free mother-tochild blocking drugs and infant testing reagents for pregnant women infected with HIV, exemption from school fees for orphans of infected persons, inclusion of AIDS people living in difficult circumstances in the scope of government assistance, and provision of necessary life benefits in accordance with relevant national regulations, active support for AIDS people to carry out productive activities to increase income, strengthening the dissemination of knowledge on AIDS prevention and treatment, and eliminating discrimination against people living with AIDS. In addition, the State has also given appropriate relief to the cost of treatment drugs for common opportunistic infections among AIDS populations with economic difficulties in the severely affected areas. As breastfeeding increases opportunities for mother-to-child transmission of HIV, the Ministry of Labour and Social Security (now integrated into the Ministry of Human Resources and Social Security) include into the scope of medicare reimbursement Zidovudine (ZDV) capsules, tablets, stavudine capsules, didanosine dispersants, tablets, chewable tablets and granules, Lamivudine tablets, as well as Nevirapine tablets, capsules and other AIDS treatment drugs.

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2.3.3 Funding Inputs for the Implementation of the AIDS Policy Since 1996, the central finance has begun to allocate special funds for AIDS prevention and control, and the investment in AIDS prevention and control has been increasing. The cost of free voluntary counselling and testing for AIDS, the cost of AIDS screening reagents in severely endemic areas are covered by the central government. The cost of AIDS screening reagents in other regions is borne by local governments, and other AIDS counselling and testing related costs, such as counselling rooms, reagent management, training and publicity, are accomodated by local governments. The cost of drug treatment of AIDS common opportunistic infection is reduced, costs in endemic areas of AIDS people with antiviral treatment of free drugs, mother-to-child blocking of free drugs and infant testing reagents are arranged by the central finance. The costs of antiviral treatment drugs for AIDS populations in other regions are borne by local governments. The Ministry of Health (later renamed the National Health and Family Planning Commission) provides financial support for the demonstration area with the central financial subsidies, and local governments at all levels provide supporting funds in accordance with the central and local proportion of not less than 1:1, three-level joint commitment by the provincial, region (city), county, provincial matching ratio of no less than 50%, supporting funds in poor counties borne by provinces.

2.3.4 Project Configuration for AIDS Prevention, Involvement and Intervention It is generally accepted internationally that in-depth, lasting, scientific and correct publicity and education is one of the effective measures to prevent and control the spread of AIDS. However, in China, the development of publicity and education work is still very uneven, particularly weak in rural, remote and ethnic minority areas. China is currently strengthening publicity and education efforts in rural areas, schools, detention and compulsory management sites by increasing media publicity, making operational entertainment venues a focus of publicity, conducting in-depth and detailed publicity on the characteristics of young people, women, mobile populations, high-risk groups, vulnerable groups, and travellers, promoting the construction of urban public welfare billboards and other measures to popularize AIDS-related knowledge, combat discrimination, and create a good social environment for people living with AIDS. The promotion of condoms is a low-input, cost-effective intervention means to prevent and control the sexual transmission of AIDS. Condom supply is mainly commercial marketing, at the same time, free distribution for infected people. 100% condom use projects have been promoted and implemented in entertainment venues of Hainan, Sichuan, Hubei and other provinces. At the same time, methadone maintenance therapy and cleaning needle exchange are carried out to reduce drug

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users’ sharing of syringes (Policy Analysis Report on AIDS Prevention and Treatment in China 2011). In response to the prevention of AIDS among drug addicts, the former Ministry of Health, the Ministry of Public Security and the State Administration of Food and Drug Administration have established a national working group on methadone community maintenance treatment, and a national guidelines for the treatment of addictive drugs have been introduced, and a methadone community maintenance clinic and a cleaning needle exchange site have been approved and launched.

2.4 Development of AIDS NGOS in China An NGO is another sector that corresponds to the public sector, the private sector, also known as a non-governmental organization or a non-profit organization. Some public goods and services, which are not available to the Government or are not readily available, or which are inefficient and costly, can then be completed by nongovernmental organizations. The World Bank argues that the effectiveness of public projects will be made more significant if non-governmental organizations absorb high-risk actors infected and transmitted by HIV as staff or represent the interests of such persons (Policy Analysis Report on AIDS Prevention and Treatment in China 2011). In practice, NGOs have played a huge role in investigating the behavior habits of marginalized people, helping them to change their behavior patterns, changing their misconceptions through facts, and providing reference for government decisionmaking. All will be discussed in detail in the preceding part of this section.

2.4.1 The Development of AIDS NGOS in China In the AIDS response, national experience has shown that non-governmental organizations have the flexibility to reach directly target populations for intervention, and have unique advantages in the fight against AIDS, compared with governments. The Russian experience, for example, shows that collaboration between nongovernmental organizations and governmental agencies plays an important role in blocking the spread of the AIDS epidemic. Thailand’s network of people living with HIV has progressively improved the availability of antiviral drugs through various legal and policy advocacy activities, providing comprehensive services by volunteers and infected persons, assisting in follow-up and improving drug compliance. In addition, efforts have been made to provide community support for orphans and to reduce social discrimination against people living with AIDS. As AIDS prevention and treatment is a systematic project involving many aspects of society, China, drawing on foreign experience, has also witnessed a number of non-governmental organizations

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that have developed rapidly and played an important role in the prevention and treatment of AIDS. The first non-governmental organization engaged in AIDS prevention and treatment in China is China STD and AIDS Prevention Foundation, which was established in October 1988. The rapid increase in NGO governance in the area of AIDS management is mainly after 2002, a trend linked to changes in our Government’s AIDS governance policy in 2003. The organizational forms of AIDS NGOs include: registered non-governmental organizations with a government background, including nationwide STD and AIDS associations, and organizations established in various localities that are led by all levels of government but are not subject to the central level of isomorphic organizations, such as the STD and AIDS Association in B City. In addition to the incorporation of government departments to form non-governmental organizations recognized by national laws, there are also a large number of three types of grassroots organizations (organizations of infected persons, civil society organizations, foundations) that cannot be registered in government departments. Wang Ming, researcher of the NGO Institute at Tsinghua University, as well as Niu Caixia of the School of Public administration, found that more than half of the NGOs in the field of AIDS prevention and treatment are unregistered. According to the 2012 China AIDS Social Organization Directory, non-governmental organizations accounted for more than 80%. It contains nearly 65% of infected groups, with the goal of improving the survival of groups. The number of organizations is distributed as shown in Fig. 2.1. Among them, self-help organizations for the infected are established spontaneously by infected people. They simply can not obtain government registration, but serve infected people long-term in the grass-roots front line, and are accepted by infected people. However, because of different capacities and development of the organizations of infected people, there are also great differences in the ability of the organization to work and the effect of intervention. These grassroots organizations are active in the forefront of AIDS prevention and treatment to varying degrees, providing care and assistance to people living with AIDS, orphans and their relatives, and working on the promotion of AIDS-related knowledge, anti-discrimination and self-rescue. At the same time, among sensitive groups that are inconvenient for the Self-help Organizations for the Infected 6.06%

8.66%

Civil Organizations, NGOs and Social Organizations

8.66% 4.33%

Foundations and Sponsors 64.94%

UN agencies and Multilateral Institutions

7.36%

Private Enterprises Government Departments or Projects

Fig. 2.1 Distribution Chart of AIDS Prevention and Control Organizations in China

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government to intervene, such as sex workers, drug users and gay men, the infected organizations have also gradually carried out work, and some progress has been made. At present, the main projects carried out by these civil organizations focus on three aspects of publicity and education, behavioral intervention and care and assistance. Among them, publicity and education is mainly committed to promoting the popularization of AIDS prevention and treatment knowledge and related research, training, promotion and other activities. Behavioral intervention are mainly aimed at adolescents, women, mobile populations, drug users, homosexuals, entertainment service personnel, etc., to carry out targeted behavioural involvement and intervention actions. Care assistance mainly includes the reduction of discrimination training, the provision of psychological care to people living with AIDS, helping infected people to help themselves, the adoption of AIDS orphans and so on. According to a survey conducted by the NGO Research Institute of Tsinghua University in 2005, 157 NGOs working on AIDS prevention and treatment in 24 provinces, municipalities and autonomous regions, including Yunnan, Xinjiang and Henan province, a total of 61 mainly conduct activities like advocacy, education and training for the main activities of the largest number of NGOS, accounting for 38.9%, a total of 32 organizations committed to the medical care, assistance, counseling, orphans foster care, accounting for 20.4%; a total of 8 organizations engaged in behavioural intervention, accounting for 5.1%; a total of 5 organizations engaged in legal aid, accounting for 3.2%; 8 organizations engaged in fund-raising and financing, accounting for 5.1%; and a total of 43 organizations carrying out comprehensive prevention and control work, accounting for 27.4%. However, there is no NGO specializing in the psychological guidance and emotional support of infected people, and there is a lack of relevant professional staff and work patterns.

2.4.2 Actions Taken by AIDS NGOs In the field of AIDS prevention and treatment, a considerable number of NGOs provide support and care services for infected people, some of them specifically for infected people, some only as one of the organization’s tasks. Because of the fact of HIV infection, infected people are faced with many common problems and difficulties, thus they share common needs and demands. As a result, they have set up organizations spontaneously or with the support of governments and other organizations and individuals. However, the different modes of operation, funding capacity and objectives, the support content, support size and support style provided by relevant NGOs to infected people also vary, but in general, these NGOs do provide much valuable support to infected people. First, help people living with AIDS to access the resources of the government, foundations and society. Because AIDS people often find it difficult to directly access these valuable support resources, AIDS NGOs, as a bridge between AIDS people and all kinds of resources, can bring together infected people. Under the leadership

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of their core figures, they jointly find support resources, broaden the channels of resources, and help infected people to safeguard their legitimate rights and interests. Compared with the government, NGO can fill the gap of governance. Because directly facing the grassroots, civil organizations work in a flexible way, with low operating costs but high efficiency and remarkable actual work effect, so there is the work advantage an official agency can not replace. Secondly, through the interaction and mutual assistance of the internal members of AIDS NGO, they create a support network for people living with HIV, and perform the support functions of emotional communication, information sharing, resource exchange, psychological and spiritual mutual assistance and promotion. Because of the pro-people nature of AIDS NGOs, they have more in-depth access to special social groups that are difficult for the government and the general public to reach, and are easily able to gain their trust. In particular, many AIDS NGOs are composed of infected people, facing many common difficulties, needs and interests, so it is often easy to resonate emotionally, act to form a joint force, achieve complementary resources. Finally, help patients repair and improve the traditional individual support network. On the one hand, the inclusion of relatives of the AIDS population in the scope of work can make them have anti-discrimination education and training, create opportunities and conditions to increase the communication between patients and their families, thereby increasing the support from their families. On the other hand, we actively carry out anti-discrimination propaganda, change the attitude and concept of the general population, the media, work institutions, in order to create a tolerant and harmonious social environment for the AIDS population.

2.4.3 Criticism and Reflection on AIDS Governance and In-Place Action China has achieved fruitful results in AIDS governance and action, it has also slowed the epidemic and spread of AIDS to a certain extent, and the living conditions of infected people have improved even more. However, the existing governance concepts and governance actions lack a certain degree of implementation deviation and the phenomenon of not being recognized and applied, mainly reflected in the following aspects. First of all, one-sided emphasis on AIDS prevention. AIDS is considered as torrent and monster, on the other hand, emphasizing that AIDS governance should be “enemy outside the country”, on the other hand, the focus of governance to high-risk groups, once appeared to the trend of where everyone situation. This line of thinking deliberately expands the division standard and operation method of behavior in the specific work of public health, into the classification and characterization of individuals and groups in the sense of social stratification. It actually provides the theoretical basis

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for the proliferation of AIDS discrimination, and constitutes one of the main reasons for the weak prevention and treatment of AIDS. Secondly, AIDS has been constructed as a social problem. Although such a basic consensus “social problems should be solved by the whole society” has spread for many years, there is a deviation in the implementation. Since the early 1990s, the “multi-sector cooperation” proposition of AIDS prevention and control has been regarded as the leading idea of the government. This is more regarded as a panacea, but it is only the residual thought of “all-around government” in the previous planned economy period, which runs counter to the trend of division of social management and specialization that has begun at that time, and instead creates an awkward situation in which “all sectors cannot cooperate with one another”. In particular, this kind of proposition mainly stays on the level of public power, seriously binding the participation of other social forces, and also hindering the whole society to solve the AIDS problem together. Thirdly, since the twenty-first century, although various non-governmental organizations have sprung up and achieved increasing results in the actual work of the AIDS prevention and treatment, the idea of “community subjects” has not been expanded in the field of AIDS so far. Theoretically speaking, there is still some tension between the two thinking lines of social governance and community subject, and there are indeed community struggles and conflicts in practice. Therefore, although the idea of taking the community as the main body may push the cause of AIDS prevention and control in China to a better new stage, it often lacks enough attention and full use in the actual practice, and lacks a new integration force that can lead the development of other aspects of the society. Finally, though AIDS NGOs play an irreplaceable role in the support and care of people living with HIV, the grassroots organizations for the services of infected people are also different, because infected people are spread throughout all provinces, autonomous regions and municipalities in China. Even if some achievements have been made, the working methods of each organization often vary. In addition, while organizations focus on the psychological state of infected people, they are often infected with feelings such as “you don’t actually understand my fears”. Generally speaking, in the support and care of AIDS people in China, the support and help of psychological motivation has not received due attention. The first thing that comes to mind is still the treatment of AIDS. Admittedly, attention to health is primary and necessary. It is beyond reproach “to solve the survival and life problems of infected people” with the pursuit of social resources. It plays a great role in helping the AIDS population out of the predicament. However, in the psychological level of AIDS people, the corresponding intervention appears to be overstretched and insufficient, especially carrying out psychological motivation and support treatment from psychoanalysis and psychotherapy. It has become a weak loophole of many grassroots organizations.

Reference

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Reference Journals Heath, J., & Rodway, M. R. (1999). Psychosocial needs of women infected with HIV [J]. Social Work in Health Care (3).

Chapter 3

The Relational Psychoanalysis: The Way of Relationship Construction and Deepening Treatment

Psychotherapy, especially the psychological treatment of psychoanalysis orientation, has not been free from the connection with relationship from its inception. Freud in early days suggested that psychological problems arose from unsound relationships, even in his later analysis of the internal expectations and defensive conflicts of individual isolated minds, emphasizing that there was no point in exploring the relationship. Since the 1950s, many psychologists have been thinking deeply about the relationship. With the deepening of the emphasis on relationship issues, the basic viewpoints and practical techniques of psychotherapy theory have also changed accordingly. In particular, Kohut first proposed in 1971 that, on the basis of adhering to the theory of isolated psychic theory and instinctive drive, we should realize the self-object demand that the analyst had aspired to but had not been satisfied before, by using three different types of relationship. In order to accurately describe the relationship of self-object, Kohut introduced the concept of self-object relationship. He believed that all people, whether mentally healthy or not, needed the support of self-object relationship in their life, in order to maintain their own sense of integration. Kohut and his successors also believed that the relationship was very important if the individual wanted to develop into a healthy, integrated and continuous self. Stolorow and other scholars emphasized that people’s demand for the relationship between self-objects was also in line with people’s need for emotional coordination. The part of emotional coordination in the function of self-object is the important aspect of the relationship that promotes self sense of integration and the active experience of self. One of the basic hypotheses of the theory of self-psychology and inter-subjectivity is that human beings are pursuing a state of healthy coordination, and they always want to devote themselves to a new relationship, from which they can experience new self-object and satisfy the psychological needs that they once aspired to but have not realized. It can be seen that whether a good change in the process of psychotherapy can occur depends on the dual dynamic system of the construction and deepening of the relationship.

© Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9_3

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The development of the relational psychoanalysis. If Studies of Hysteria, published in 1895 by Freud and Breuer, marked the rise of psychoanalysis, the field of psychoanalysis has continued to experience development, correction, adjustment, steering and change in the more than 100 years since then. Freud and his successors made unremitting efforts in theory and practice, which brought about the prosperity of psychoanalysis. Like the different galaxies and the world after the Big Bang, Freud’s personal discovery as the chief designer outlines the universe of psychoanalysis, lays the foundation and framework for psychoanalysis, and depicts a grand blueprint for psychoanalysis. And his followers have actively developed other different directions, forming a prolific and rich school of psychoanalysis thought. In particular, the theory of object relations theory, which emerged from the United Kingdom, sets off a new turn of psychoanalysis or a paradigm shift. It is shifted from the drive model to the relational model, and the focus of emotional life is changed from drive to relationship with others. Similarly, Freud’s concept of the subject is also shifted to the inter-subjectivity. In the process of this transformation, the subject and the object connect together to form a main object of the whole. However, the term “inter-subjectivity” has not been included in the textbook of psychology. In this book, the author attempts to use the term “relational theory” to expand the connotation and extension of the relationship under the concept of inter-subjectivity. First of all, the dialectical unity of mutual subjects formed by introducing the meaning of inter-subjectivity in the original relationship. Secondly, it includes the relationship with self, so that the self becomes the unity of subject and object. Thirdly, the word contains a kind of accumulation of traditional Chinese culture, which is not exactly equivalent to the western “relation”, but is reflected in the meaning of the monk saying “yuanhui (lot or luck)”. Finally, it is to distinguish it from the word interpersonal relationships in modern Chinese, and meanwhile from relational psychoanalysis, which has been advocated by Mitchell and others since the 1990s. In order to better explain the meaning of the term “relational theory”, it is necessary for this book to review the development of psychoanalysis from the beginning, in order to sort out its meaning used in this book. Mitchell and others divided the important schools of psychoanalysis into two camps according to their development: Freud’s drive model based on instinctive drive and a relational model emphasizing the importance of the relationship with others. The drive model includes the psychoanalysis created by Freud and the self psychology system, while the relational model contains the theory of object relation, the self-psychology of Kohut and the various theoretical schools of recent development.

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3.1 The Classical Spiritual Analysis Represented by the Drive-Conflict Model (1) The appearance of psychoanalysis and the development of drive model The history of psychoanalysis begins with an analyst named Bertha Pappenheim. Freud and his older colleague and mentor, Breuer, gave her a pseudonym of Anna O. At first, She was a research participant for Breuer rather than Freud. Breuer was in charge of the treatment between December 1880 and June 1882 of Anna O., who had long suffered from hysteria. At that time, in the absence of any organic lesions, she showed a range of symptoms such as strabismus and inability to move limbs. The medical diagnosis at the time attributed it to brain disease, but Freud and Breuer took over and offered a psychological explanation for it. The key to this explanation came from Breuer’s treatment of Anna O. In the case of ineffective treatments such as hypnosis, Breuer found that once Anna O. began to speak, especially when Anna O. linked the circumstances of hysteria to the events that triggered the symptoms, the emotions generated were released, and mental stress was relieved, her symptoms faded. Anna O. herself called the method “talk therapy”. Breuer also eased her symptoms through this method. On the basis of this case, Breuer and Freud published Studies of Hysteria in 1895, and from then on Freud embarked on a psychoanalysis journey, and Anna O. later became not only a psychopath, but also a pioneer in social work. Freud began with the earliest differences with Breuer in the cause of repressed memory, and put forward the hypothesis of the geographies model of the mind based on the study of hysteria, and divided its region into three different regions of unconsciousness, consciousness and pre-consciousness. In 1923, Freud found that the geographies model was no longer sufficient to understand the conflict. The increasing clinical experience and the concept of gradual integrity led Freud to infer that unconscious desires conflict with impulse and defense, rather than with consciousness and pre-consciousness. In this conflict, the hypothesis of a new structural model becomes a necessary model to explain the basic composition of the mind, including id, ego and superego. The academic community is increasingly inclined to use id directly or its transliteration, which is closer to Freud’s exposition. In this book, all use id except direct reference. The structural model puts its main components in the unconscious, and the important borderline is between id, ego and superego. They are no longer regional division, but three very different internal agencies. Id is “a big pot full of boiling excitement”, which is excited, savage, unstructured and impulsive energy; The ego is a collection of many management functions that control the impulse of the ego; Superego is a set of moral values and self-critical attitude, which is mainly composed of the image of the endogenous parents. On the basis of these two hypotheses, Freud’s psychoanalysis has two basic propositions: the first claims that psychological processes are unconscious, and the second claims that instinctive sex impulses play a very important role in the cause of neurological and psychological diseases. Freud’s two

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basic propositions, i.e., the meta-psychology model, basically cover the main ideas of Freud’s classical psychoanalysis, and also lay a solid foundation for the subsequent development of psychoanalysis. (2) Theoretical extension and academic monopoly of self-psychology Freud mainly focused on the exploration of unconsciousness and the establishment of the theory of unconsciousness in the early days. Since then, it has inevitably developed into putting forward the personality structure of id, ego and superego, and begun to study ego systematically. Therefore, Freud’s later period witnessed the enlightenment of self-psychology, which was inherited and advanced by many self-psychologists, such as Anna Freud and Heinz Hartmann. As Freud’s daughter, Anna thought her father attached too much importance to id, but she thought that the focus of theory research and treatment should be on ego. She put the analysis of ego as the starting point to solve all psychoanalysis problems, and classified the position of ego in psychoanalysis research. However, Anna’s self-psychology was not entirely beyond her father’s point of view, because she believed that ego is still subject to id. “In appropriate circumstances, the ego is not against instinctive impulse, the intruder, but to make their own energy at its disposal”. Although Anna gave ego a legal status, her understanding of ego only resisted and defended id, making even more inseparable from id. The key task of developing selfpsychology was to let ego be separated from id and made ego become an independent structure. This work was continued by Heinz Hartmann, who published the book Ego Psychology and the Problem of Adaptation in 1939 of Freud’s death. In the book, he proposed a conflict-free ego sphere, thus delineating an independent research scope for ego. In addition, he also raised self-autonomical and the fundamental function of ego—the problem of adaptation. Adaptation is the result of ego trying to maintain a balance between people and the environment within psychological mechanisms. The introduction of the concept of adaptation makes ego avoid the conflict with id and the superego, and turns to the interaction between man and the external environment. These thoughts mark the formal establishment and development of psychoanalysis self-psychology, but the self-psychological scholars represented by Hartman limit the vision of psychoanalysis. They focus on the development of common people’s self-psychology into their theory, and make psychoanalysis embark on the path of conservatism. They contribute to the prosperity of self-psychology, but also cause the self-psychology to dominate the psychoanalysis. Consequently, many conflicting theories were expelled from the academic circles of psychoanalysis, inhibiting the contention of the classical psychoanalysis of different schools. The core assumptions of the above drive model are: Sex and attack instinct drive is the primary psychological unit of emotional life; psychology is in essence unitary and conflicting. According to this view, we are driven by instinctive forces such as libido and desire to attack, which are described as a mixture of these antisocial body tension; we are in a conflict between instinctive drive and the secondary requirements of social reality; Psychology is made up of a complex compromises between the impulse to express it and the defense used to control and guide these impulses; The analysis and

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inquiry contains the revelation of the baby’s instinctive impulses. At the same time, analysts should maintain the attitude of neutrality, anonymity and inhibition in the analysis of the situation, anti-empathy is considered to be a kind of interference to the analysis process, which must be analyzed and dealt with accordingly (Greenberg and Mitchell 1983).

3.2 A Paradigm Shift Characterized by the Development-Inhibition Model (I) The shift in the object relationship of psychoanalysis theory In general, the prosperity and development of self-psychology in the United States has brought psychoanalysis to a stage where too much emphasis is placed on conflict between ego and id, with too much emphasis on innate biological factors. Prior to this, a large number of British psychoanalysis scholars began to change the theoretical basis of classical psychoanalysis, instead, emphasized the impact of early mother and child relations on children’s psychological development. It formed the theory of object relations. Objects do not mean the inanimate object, but the object of human nature with emotion, such as love, hate and longing. The concept was first used by Freud in the context of discussing instinctive drive and early mother–child relations, while in the object relationship theorist, the attention to object and the relationship between objects exceeded the concern for instinctive desire. They paid great attention to the influence of the relationship between personality formation. The internalization of the external relationship experience in infancy forms the internal object, which in turn will affect the individual’s experience of external relations. In other words, the internal object formed in early childhood is like an intrinsic model, which affects the individual’s perception and reaction to other people and things in later life. Important representatives of the school of object relations include Melanie Klein, William Fairbairn, Harry Guntrip, Donald Winnicott and others, who consider themselves to be the mainstream of psychoanalysis, but have in turn changed the mainstream in some important ways. They have come up with less uniform theories, and some have even had to develop independent theories. Klein became a bridge between Freud’s theory and the theory of relationship between objects. She retained Freud’s emphasis on instinct, but thought that instinct had an intrinsic connection with the object. She changed Freud’s view that the drive was non-object, and thought that the drive was a relationship inherently oriented towards the object. From the beginning of life, instinctive drive appears in the background of an object relationship and is adjusted by the object. Babies looking for breasts and food are not just for the release of energy. The emphasis on both instinctive drive and object relationship is significantly different from Freud’s view that drive has no goal. Klein and Freud also had different views on the structure of personality. Klein believed that the ego existed at the time of the birth of the baby, and that

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even the superego was established as early as the beginning of life. She stressed the importance of the original inner fantasy world of babies, a fantasy world of danger and anxiety associated with persecution and hostility, linked to part of the object, from the baby’s own death instincts. Babies control strong needs, fears, and anxieties by constantly using mechanisms such as projection, internal ejection, and division, making themselves feel safe and establishing object relationships. She looked at development from a new perspective, and described two basic mental states of an infant’s early experience with a state of paranoid division and depression. Fairbairn created a pure model of object relations, believing that man was driven by seeking the object, completely denying Freud’s assumption that people were driven by instinctive drive. He believes that people have a basic tendency to establish relationships with others, and that children who suck their thumbs do not want to gain pleasure from the mouth, but use their thumbs as substitutes to replace the lack of or inability to satisfy the object relationship. The object is not only the reappearance of the internal character or psychology, but also the function of psychological activity. He believes that the ego has self energy, is the internal drive to build the relationship. He denied the role of id, fundamentally changed the meaning of ego, and reshaped the ego theory through the multi-substructure theory of ego. Winnicott never explicitly split from the Freud School’s tradition, but his thought-provoking imagination of early development had a wide range of influences both within and outside the field of orthodox psychoanalysis. In addition, Winnicott’s parental functions, such as the supportive environment and the transitional object, also provide a new development metaphor for thinking and analyzing relationships and procedures. (Ii) Model transformation of self-psychology represented by Kohut The founder and representative of self-psychology is Kohut, who shifted the focus of psychoanalysis research from instinctive drive or ego to self, and raised the position of self in the personality structure to an unprecedented height. He sees self as the core of a person’s spiritual world. He thinks that self is a power source in itself, is the driving force of the whole personality development, so the development of the whole personality has nothing to do with the instinctive drive. Through the clinical study and treatment of narcissistic personality disorder, he took a step forward on the basis of self sense put forward by Winnicott and other object relationship theorists, and took self, self-object, pathology and treatment as the core of his theoretical and clinical research. On the basis of the theory of object relation, he replaces the driving force model with his self model, and constructs self through the object relation, and forms a new theoretical model in the internal development of psychoanalysis. Kohut’s theory is integrated beyond the traditional drive model, and most of his views come from his psychoanalysis of narcissistic personality disorder. In the view of personality structure and treatment, he deviated from the driving force model. First of all, in the personality structure, the drive model sees the neurosis patient as a person with a complete structure, with a structure that is understood by the id-ego-superego, with a variety of adaptive and defensive functions. The driving force model uses the depression, the Oedipus conflict and so on to understand the pathology, but Kohut

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shifts his research focus from the instinctive drive or ego to self, and sees self as the core of a person’s psychological world, the instinct and the ego being subordinate to self. Secondly, in the view of psychoanalysis and treatment, Kohut, through the study and treatment of narcissistic personality disorder, concluded that narcissism and self obstacles meant that the true central structure of personality was flawed. That is to say, he thought it was a flaw in the self structure, not an id-ego-superego conflict caused many people to get sick. Freud regarded narcissism as pathological and unable to analyze treatment. Kohut thought that the essence of treatment is to enable the patient’s defective self to continue to develop though hindered by the early traumatic failure of self-object. The purpose of psychoanalysis therapy is to make up for the defects in the self structure. As long as the defects are made up, the scope of consciousness and ego will be expanded, and the instinctive conflict in the unconsciousness will be solved. Self-psychology is a new theoretical model in the development of psychoanalysis after driving force model, ego model and object relation model. We can think that Kohut’s emphasis on self is to sublate the traditional psychoanalysis model on the basis of the theory of object relation, to replace the drive model with the self model, and to construct self through the object relation. It is a new theoretical model in the internal development of psychoanalysis. After Kohut, many of his followers expanded self-psychology, especially the analysis of the concept of inter-subjectivity, enriched the theory and practice of the relational psychoanalysis, and formed another paradigm fusion and transfer of psychoanalysis with Mitchell and other scholars. The author will do a detailed discussion of this part of the content of in the next section. Kohut’s self theory and the relevant viewpoints of the theory of object relationship are similar in many aspects to the views of Fairbairn, Winnicott and other object relational theorists, all of which emphasize the role of relationships. However, the theory of object relation focuses on the influence of object relation on the way of individual perception and the relationship between individuals and others, while selfpsychology has always taken self and self-object relationship as the focus of attention. Moreover, in the use of the object, there are obvious differences between the Kohut and the object relationship theorists. He uses the concepts of self-object and real object to express the experiential quality of the object relationship, rather than the concepts of partial object and complete object commonly used by the theorists of object relation. He proposed a core concept, self-object, defined as such a person or object: the person or object that is used to serve self as part of himself or to provide a function for self. Kohut believes that the formation of self-object empathy is the prerequisite for the treatment of their own obstacles, only the formation of self-object empathy relationship, patients can continue their childhood hindered development process in the analysis of the situation, in order to develop a psychological structure to make up for their own defects, in order to get real treatment. Unlike the drive model, the core assumption of the relational model is that the relationship with others is the primary psychological unit of emotional life, and psychology is essentially double and interactive. According to this view, human beings are considered to shape and be inevitably rooted in the mechanisms of relations

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with others, rather than being described as a mixture of various physiological forces, which means that people struggle to maintain their connection with others, while also striving to differentiate themselves from others. The basic unit of research is not an isolated individual who is in fierce conflict with external reality as a desire, but an interactive field in which the individual strives to connect with others and express himself. Desire is always experienced in the context of the relationship and obtains meaning from the situation; the mind is configured by the relationship, and people can only be understood in past and present relationship situations, and the analysis process involves a kind of participation in these relationships and their internal images, as well as observation, revelation and transformation. Analysts are no longer required to maintain an objective and neutral attitude, and anti-empathy is seen as a powerful means of promoting analytical change, rather than a distraction from analysis.

3.3 Integration Model with Relational Theory as the Core (I) Relationship-conflict model of Mitchell and others Relationship-conflict model is a third choice, which is different from the driving conflict model and the development-control model. It holds that the psychology is interactive, and its basic component is the relational configuration rather than the drive and its derivation, and it also emphasizes the importance of the conflict and describes the conflict by the terminologies of the relationship (Greenberg and Mitchell 1983). Mitchell is a case manager of the relational psychoanalysis, and other representative figures of the psychoanalysis also include Lewis Aron, Irwin Hoffman and Donnel Stern. The relationship model of Mitchell and others discards the theory of drive and the theory of pure relationship, and focuses on the integration of various theoretical schools within the relational model under a framework of universality and continuity. In order to achieve the goal of integration, Mitchell proposed a new integrated theory tool—relational matrix. Mitchell treats the relational matrix as a framework for organizing principles and interpreting clinical data, which corresponds to the concept of drive in Freud’s drive model. Mitchell uses the relational matrix concept from the perspective of paradigm, which contains self, the object, and the various modes of interaction between the two. According to this view, human psychology is essentially made up of relational substrates. Moreover, the concept of relational matrix also transcends the simple internal and external division, so the use of relational matrix to think about the human mind can help people look at the human individual from a more abstract and comprehensive point of view, so that human individuals both accept self-regulation. For Mitchell, therefore, it is most useful only in this way to look at psychological issues in a relational matrix that includes both psychological internal and interpersonal relationships, because it transcends simple internal and external antagonism.

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Mitchell also talked about problems of self, which is defined and experienced mainly by opposing and establishing relationships with others. The self-model is an organizational model in the context of interaction, acting as a conduit for connecting with others, or as an explanation of how the connection will be maintained once it is established. Therefore, using the dimension of time and space to think about self will make us have a relatively rich experience of our own ability. The self-model of object relation theory emphasizes multiplicity and discontinuity. Self experience is discontinuous, and different self-organizations are formed around different images of self and objects, and come from different relational models. Individuals, on the other, are synthetics of these complex overlapping tissues. But in Mitchell’s view, the existence of self does not change over time, and the continuity of subjective experience is its heart. In a nutshell, Mitchell has made a theoretical integration of the drive model and object relation model of psychoanalysis, reinterpreted some important concepts of psychoanalysis, and combined different relational models, thus proposing a unique and integrated relational model. Apart from Mitchell, Hoffman’s theory influenced Stern and Mitchell. He, in The Patient as Interpreter of the Analyst’s Experience, argued that sometimes patiens can help analysts discover the reality that analysts are unaware of, and emphasized the constant awareness of analytical relationships during psychoanalysis. Psychoanalysis, he argues, is an understanding experience that translates the experience into a particular pattern. But there are many different kinds of these patterns. When we understand the human experience, it is always inevitable to have ambiguity and uncertainty. Therefore, in Hoffman’s view, the shift of contemporary psychoanalysis is not a shift from the drive model to the relationship model, but from positivism to constructivism, where analysts and patients together constitute the participants in the analytical relationship, forming Hoffman’s constructivist view (Hoffman 1991). The key word for Stern’s theory is “unformulated experience”. The undeclared experience is akin to what Stern says unconsciousness. He believes that unconsciousness is not repressed desire or motive, but an undeclared, undefined, unsymbolized experience (including a vast field of feeling, perception, and thinking), a process from common chaos to creative barriers. And some of the unconscious unformulated experience wait for the experience and construction of analysts and patients. In Stern’s view, analysis is a gradual process of language construction with analysts and patients. The experience of patients is not all pure past experience, but also includes the experience to the analyst, connecting the understanding of interpersonal relationship and the construction theory in cognitive psychology in the context, which led to the development of the theory of later relationship. Aron, however, focuses on the experience of patients and the subjectivity of analysts. In the course of the analysis, he believes, the patients’ curiosity about analysts, and the discovery of the individual subjectivity of analysts are a process of treatment. This analysis process is determined by both sides, and it is a common construction of the relativity and absolute nature of truth. Borrowing Winnicott’s words, Aron argued that there was no such role as patients in the world, that they were always associated with analysts, and that the two parties were full of interactivity and inter-subjectivity. Because the influence of the analyst’s subjectivity on

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the analysis of patients can not be ignored, the treatment concepts of all psychoanalysis (such as empathy, impedance, anti-empathy), in Aron’s view, are jointly constructed and decided together by them. Although the relationship between the two sides in the treatment is interactive, but interactivity is not equal to reciprocity. For example, mother–child relationship is also interactive, but not the other. For Aaron, the purpose of the analysis is not to achieve the equivalence of the analysis relationship, but to achieve the acquisition of certain specific abilities, especially to experience the subjectivity and objectivity in the relationship (Aron 1991). Moreover, although Thomas Ogden did not consider himself to belong to the psychoanalytic school of the relational theory, he put forward the new subject concept of the analytic third in The Analytic Third: Working with Intersubjective Clinical Facts. As the subject of an analysis, it occurs between patients and analysts as separate subjects. In the context of analysis, there is a unique dialectical relationship: No patients can set aside his relationship with analysts, and none of the analysts can put aside the relationship with patients, so patients and analysts are interdependent and interact with each other (Ogden 1994). The analytic third creates an analytical relationship in the analysis, which has self psychological treatment objectives, role definition, value system, etc (Ogden 2004). In the process of analysis, the three interact with each other and construct each other. But the analytic third is an unequal structure, because it is derived from the context of the analysis relationship, defined by the role of patients and analysts in the relationship, is used as a medium to understand the experience of patients, emphasizing the inter-subjectivity in the analysis (Ogden 1994). The relation-conflict model criticizes the psychological monism hypothesis held by the driving conflict model and the development-inhibition model, discards the driving force in the drive-conflict model, and corrects the neglect of the conflict of the development inhibition model. Like the drive model, it believes that the primary psychological struggle in the human experience is a conflict between strong desires, wishes, and fears. Meanwhile, like the developmentinhibition model, it is considered that the basic component of psychology is a derivative of the relational configuration rather than the driving force. In the relation-conflict model, the two sides in the primary psychological power conflict are the various relational configurations, which are the inevitable conflicting passions in any single relationship, and are the competitive and inevitably inconsistent propositions between different major relations and identities.

The relational conflict model is essentially bidirectional, dual and interactive. It holds that psychology is interactive, the basic component of which is relational configuration rather than the derivative of driving force, emphasizing the importance of conflict, and using relational terms to describe conflict. As Aron describes it in defining the essence of the psychoanalysis of relational theory: the psychoanalysis of relational theory is neither a unified or integrated school of thought, nor a single theoretical point of view, but a diverse set of theories that focus on individual, inner, and interpersonal relationships. Bringing together so many genres of relationships is neither a common psychological metaphysics (metapsychology) nor a common criticism of classical psychological metaphysics, although it is undoubtedly a common

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element of many relationship subject articles. What many relationship theorists have in common seems to be that they all emphasize the analysis of the interrelationships and interactivity between people and analysts in the process of psychoanalysis. (Ii) post-Kohut psychology of relational theory orientation In his 1988 book, Relational Concepts in Psychoanalysis an Integration, Mitchell proposed two innovations: first, the development of his own unique theory of integration, that is, the relational conflict theory, the other innovation is the creation of a framework structure for accommodating relational theory, which includes three dimensions, namely, self, object and interpersonal interaction. Different thoughts of the relational theory can be integrated into this framework, so that different theorists can use their own way to integrate the relational concepts or relationship theory into the relational psychoanalysis. The theoretical basis of relational theory’s self-psychology comes from Howard Bacal and Kenneth Newman’s views and thoughts. Bacal and Newman believe that self-psychology is actually a theory of object relations. What is omitted from the theory of object relation is self concept, while what is ignored but obvious by selfpsychology theory is that it tacitly holds that a special object relationship, the relationship of self with its self-object, occupies a central position in the self development (Bacal and Newman 1990). The authors insist that the self-object and self, that is, the relationship of self-object, implies a special object relationship, which is the decisive factor of the self experience and the medium of the self development (Bacal and Newman 1990). Or, they think it should be self and its objects that occupy the core. They point out that when an object is internally experienced in a relationship to provide a function that evokes, sustains, or positively influences self sense, it is a self-object. By focusing on the importance of self-object functions and subjective experiences, they argue that Kohut inadvertently omits the object that provides this function. In short, Bacal and Newman argue that self-object is best understood as the object of self. Their position is unique in self psychology, because the important distinction between object and self-object seems to have been lost, or at least obscured. This distinction is so crucial for the organization of Kohut’s self psychological views. They also agree with the core ideas of the main object relationship theorists, and believe that these ideas describe some aspects of self more clearly (Bacal and Newman 1990). Kohut originally conceived that narcissism had a path of independent development: independent of the known and accepted course of love and hate attributed to the object. Over time, when he moved his research on the self to the center, he seemed to modify the dualism when self and self-object became the basic characters of all pathology. Along with his emphasis on the self-object of Oedipus, he made these a central issue in this stage of development, and thus relegated object love and hate to the secondary role in empathy neurosis. In this way, self becomes the core, and the independent object goes to the edge. Bringing the object of an independent creation center back to its primary position does require the establishment of a relationship model between self and the object. Bacal and Newman’s ideas provide a theoretical

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basis for such efforts. The emphasis on the relationship between self and the object leads to the focus of the theory of relationship theory on self-psychology, focusing on requiring people to attach importance to the present, the demand and the role of others, and to integrate these factors into the evaluation of growth and development. Traditional self-psychology simply avoids this field, and in the field of psychotherapy, any treatment that does not recognize the status of others as a separate entity cannot claim to be comprehensive. The self-psychology of relational theory and the other field of the standard view on the self growth and development are different. It is related to a proposition put forward by Kohut that moderate frustration is a necessary condition for the structure of the mind. The view of moderate frustration has been questioned by some people, and Bacal is the one who pioneered it. Bacal tends to re-examine the issue on the basis of the concept of optimal gratification, the objective of which is to prove the importance of the latter (Bacal 1985). Bacal also suggested that any discussion of the concepts of moderate frustration and moderate satisfaction would inevitably be embroiled in insurmountable theoretical difficulties and endless arguments, out of a more effective and inclusive concept of moderate response. Moderate response is defined as the analyst’s mirror reflection in the specific analysis of people and their disease in the context of the special moment, with the most important role in treatment. Empathy is the process by which analysts understand and patient by turning to their inner world. A modest response refers to the actions that analysts convey their understanding to the analyst. Bacal (1985) He explores the moderate response in his own conceptual system of psychological therapy, leaning toward the idea of a moderate environment, which implies that growth occurs in a life cycle and treatment situation without setbacks, which, obviously, is very different from the traditional concept of self-psychology (Bacal 1985). Another development of self-psychology with the orientation of the relational theory is the establishment of the theoretical system of inter-subjectivity, which is mainly composed of the theories of four long-term cooperative self-psychologist Robert Stolorow, George Atwood, Bernard Brandchaft and Donna Orange. The so-called inter-subjectivity refers to such a perspective in which each individual’s experience and action is seen as embedded in the interaction of the world of another person’s experience. The construction of the theory of inter-subjectivity is composed of six stages, and these six stages and their main ideological viewpoints can be summarized as follows: first, they prove through psychological biographical research that various psychoanalysis theories derive from the individual subjective world of their founders, therefore, psychoanalysis needs a theory about subjectivity itself and a unified structure, which can not only explain the phenomena revealed by other theories, but also explain the theories themselves. The case managerpiece in this stage is Faces in a Cloud: Intersubjectivity in Personality Theory, co-authored by Atwood and the Stolorow. Second, they introduce the concept of inter-subject field as the basis of this unified theoretical framework. The inter-subject field is a system composed of the subjective world with different organizational structure and interaction. The case managerpiece in this stage is Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology, co-authored by Atwood and Stolorow.

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Third, they apply the inter-subjectivity principles to a series of important clinical problems, such as empathy and impedance analysis, therapeutic effect, edge and psychiatric treatment, etc. The case managerpiece in this stage is Psychoanalytic Treatment: an Intersubjective Approach, co-authored by Stolorow House, Brandchaft and Atwood. Four, they return to the four-pillar concepts of psychoanalysis theory—unconsciousness, physical and mental relations, trauma and fantasy, and reposition them from the perspective of inter-subjectivity. The case managerpiece at this stage is the context of existence,: The basis of inter-subjectivity in psychological life Contexts of Being: The Intersubjective Foundations of Psychological, co-authored by Stolorow and Atwood. Five, they are devoted to exploring the deep philosophical ideas of the practice of psychoanalysis, which they call context theory. The case managerpiece of this stage is Working Intersubjectively: Contexualism in Psychoanalytic, co-authored by Orange, Atwood and Stolorow. Six, they penetrate the philosophical basis of psychoanalysis theory and practice, expose and deconstruct the hypotheses that support the traditional and many contemporary psychoanalysis ideas. These hypotheses are largely the legacy of Descartes’ philosophy, and at the same time lay the foundation for the psychoanalysis psychology of the post-Descartes era, which is rooted in the context of inter-subjectivity. The case managerpiece at this stage is Worlds of Experience: Interweaving Philosophical and Clinical Dimensions in Psychoanalysis, co-authored by Stolorow, Atwood and Orange. In this way, through long-term thinking and practice, the theory of inter-subjectivity is built into a macroscopic theory about psychoanalysis, not just a psychological metaphysics or clinical theory. The theory of inter-subjectivity does not preclude the tradition of psychoanalysis focusing on the inside of the mind. On the contrary, it places the internal mind in the context for research. In the view of inter-subjectivity theorists, the problem with classical theory is not that it focuses on the inside of the mind, but that it does not realize that the inner world is deeply dependent on the veins, because the world forms and evolves in an active system. The concept of an inter-body system focuses not only on the world of individual experience, but also on embedding with other such worlds under the influence of continuous interaction. In this way, the gap between the internal psychological world and the field of interpersonal relationships is bridged. Further, in the view of inter-subjectivity theorists, the distinction between one-man psychology and two-person psychology is outdated, because individuals and their inner worlds are a subsystem, Is included in a more inclusive, relational, or interrelated upper system. Ghent two people psychology still embodies Descartes’ philosophy of isolating the mind, which is inherent in Freud’s psychoanalysis thought. This notion does not recognize the fundamental role of relationships in the formation of all experiences. Many disputes in contemporary psychoanalysis stem from the distinction between one-man psychology and two-person psychology, while the theory of intersubjectivity focuses on the mutual composition of the inner experience and the field of the subject, completely eliminates this distinction, and also eliminates many controversies in the invisible. The theory of inter-subjectivity holds that in psychoanalysis situations, analysts should recognize that they and analysts constitute a solid and

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lasting psychological system that cannot be studied separately without undermining the integrity of the analytical experience. Moreover, the theory of inter-subjectivity does not propose a set of technical rules for psychoanalysis, and it even criticizes the concept of psychoanalysis, believing that it relies on the assumption that an isolated mind (analyst) should do something to another isolated mind (patient). In fact, the theory of inter-subjectivity is not defined by technology, but through the sensitivity of thinking and work between analysts and analysts. This sensitivity can be described according to certain attitudes. This ensures that the concept of inter-subjectivity can continue to develop towards a widening and inclusive perspective.

3.4 Special Insights of Self-psychology in Psychological Therapy 1. Self and self-object as interpretation items of psychological treatment (I) definition of self Emphasizing the centrality of self experience was considered by some psychologists to be Kohut’s main contribution to psychoanalysis science. However, Kohut, the founder of self-psychology, has never given a clear definition of self. It is because he believes. Self, like all reality—physical reality (which we perceive through the senses of the world) or psychological reality (which we perceive through the data of 神入 the world)—is inherently unknowable. We cannot penetrate self through 神入, and we can only gain psychological manifestation by being perceived by 神入. In the early days, Kohut thought that it was a content of self-psychological devices, but not one of the components of this psychological device, that is, it was not one of the psychological actors. Kohut at a later stage thought that self was the most important psychological structure at the core, and that its formation and destruction were at the center of growth and development. It is a spatially cohesive, time-continuous unit, the core of initiative, and the recipient of influence. Structurally, it is a bipolar structure (or bipolarself) that contains three components. One pole is ambition, which prompts the individual to fight for power and success, and the other pole is the ideal, which is the goal that the individual yearns for and pursues. The field between the two is made up of talent and skill. Aspiration provides the driving force for individual activities, and the ideal guides and provides direction for the individual’s activities. Both constitute the conditions for individual action. The flow of continuous psychological activity between the two poles of self is called tension arc, that is, the eternal flow of actual psychological activities, established between self poles. That is to say, a person’s fundamental pursuit of the direction lies in promoting his aspirations and guiding his ideals. In other words, the individual, driven and guided by ambition and ideal, uses basic talents and skills to engage in certain activities. Kohut in his last book, How Does Analysis Cure?, wrote that talent and skill are independent of ambition

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and ideal, and have a unique development path. Although Kohut does not explicitly propose level-three self, but it is essentially three level, or called tripolar self. After Kohut, Stolorow and others put forward their opinions on Kohut’s “self” and expounded their position. They argue that, after the publication of The Restoration of the Self , a vague conceptual problem in the literature of self- psychology is that the term “self” is used both as a reference to a psychological structure (a construct of experience) and as an alleged force (initiator of action). In Structures of Subjectivity: Explorations in Psychoanalytic Phenomenology, they discussed the issue, arguing that (Atwood and Stolorow 1984). Self is a psychological structure, through which self experience obtains cohesion and continuity, by virtue of which it experience presents unique form and continuous structure … It is important to make a clear distinction between the concept of itself as a psychological structure and the concept of the person who acts as the subject and force of the experience that launches the action. As the structure itself falls squarely within the field of psychoanalysis, and the ontology of the human being as a force, in our view, lies outside the scope of psychoanalytic inquiry. For only the former is accessible through empathy. In order to avoid causing confusion and misunderstanding, self from the perspective of the relational theory studied in this book refers to a psychological structure and an explanatory item of psychological treatment, defined by Stolorow and others. (Ii) The theory of self-object Kohut believes that self-object and the development of self have an inseparable relationship. Self-object refers to the reappearance of others or inanimate objects and abstract concepts in psychology. It is not experienced as a separate and actual existence, but as an extension of self needs. Since the self-object provides an important function for self, it has become the structure of self in the process of development through transmuting internalization. Throughout their life, people have three basic self-object needs, namely mirroring, idealized and twinship, and the development of self depends on whether the self-object can meet the individual’s self-object needs. Therefore, if treatment is to be obtained from psychoanalysis, the so-called relationship between self and self-object must be mobilized, which is essential for the development and maintenance of self. The development of personality moved from relying on the original self and self-object relationship to the mature one. According to self-psychology, each person’s self experience is formed by interacting with others over time. The actions and responses of these people are experienced as part of self (self-object). Self-object is an experience of the internal and loaded emotion of others. The nature and motive of self-object function in the self repair, maintenance and regulation with the passage of time is the research field of self-psychology. When self becomes mature, the individual’s dependence on the interaction of self-objects decreases gradually in order to maintain the self structure. However, everyone will always need a positive self-object experience throughout their lives. In the case of the self crisis, especially when problems of the relationship

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between self and the self-object appear, it will bring about the breakdown of the selfobject connection, thus breaking the internal balance. Joseph Palombo first thought about the question of grief from the self-psychological point of view, and pointed out that in self-psychological model, the loss of important self-object is regarded as a loss of self-object relationship, which causes the imbalance of self-esteem, and further sadness and psychological discomfort (Palombo 1981). In addition, Stolorow and others have expanded and improved the concept of self-object. They put forward that, in all stages of life, the self-object function fundamentally belongs to the category of integrating emotion into the self experience structure, and the demand of self-object connection belongs to the demand of coordinated response to emotional state. This coordinated experience plays a crucial role in the uninterrupted process of self-differentiation and in the belief in the effectiveness of a person’s self perceived reality. Clinically, the expansion of the concept of self-object function and self-object empathy allows analysts to perform psychoanalysis therapy on very primitive borderline and psychotic states, which were previously considered by many people (including Kohut) impossible. Stolorow and others stressed that the expansion of the concept of self-object function corresponds to a more varied and unique concept of the self structure. Consistently insisting on the use of the empathy enables analysts to move towards understanding their own multidimensional nature, which stems from the diversity of self-object experiences located at various levels of psychological organization. (Iii) the self structure and its hierarchy Arnold Goldberg’s self model is purely psychological. In his book A Fresh look at Psychoanalysis, he uses the conceptual framework of structuralism to analyze the self structure, and describes that doing so can enable people to explain a large number of psychological phenomena. In particular, he emphasizes that the self structure dimensions extended over time and space, and self is seen as an open and stable structure that can grow and change. Self is a stable construction at a certain stage of life and will follow some rules and change during growth and development. Goldberg divides the self structure into three levels. The first level is the basic component or the building material of the self structure, which he vividly likens them to bolts and nuts. The second level is the basic structure or construct. It is composed of self-object empathy as described by Kohut, which plays a special role in regulating and maintaining self-esteem. The third level is a large number of observable activities or manifestations, which are not the operation of the structure, but are very important compared to the previous two. Basically, Goldberg describes self as a structure consisting of the form at one end and the special content at the other end. The main pathology is related to the form or the self model, while the secondary pathology is related to its content and significance. In fact, Goldberg argues that the psychoanalysis before self-psychology focused too much on secondary pathology, that is, too much on the content or meaning produced by the self structure, such as the various ways in which the Oedipus conflict existed. According to Goldberg, this focus on content is anachronistic, and what deserves our attention is the form or

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model, that is, the main pathological relationship associated with the self integration. Goldberg provides an example of an edge-type patient who, in treatment, ostensibly moves from borderline pathology to narcissistic personality disorder, and finally to the Oedipus conflict. But once the treatment is over, the patient returns to its original marginal operation. Goldberg commented sharply that this may be the result of too much attention being paid to the content in treatment, that is, the secondary pathology, and insufficient attention to the main pathology, that is, the form or model of the self system structure. He thinks that the whole form of self is its essence, which is composed of various self and self-object relations. Ii. 神入 and Introspection: Functional transformation from analysis to treatment (I) Methodology of psychoanalysis in the introspection of 神入 Kohut Kohut adhered to the empathic-introspective psychoanalytic methodology for a lifelong time. Long before the formal creation of self-psychology, he had established the position of the empathic-introspective method in psychology and psychoanalysis. In his 1959 paper, Introspection, Empathy, and Psychoanalysis: An Examination of the Relationship Between Modes of Observation and Theory, empathy is vicarious introspection, and is also the way we can understand another person’s internal experience. He points out that an experience or action can only be regarded as a psychological category if it is observed through introspection and empathy, and that any other observational model falls into the realm of physics. In this way, he defines the legal field of psychological research. In addition, he stressed that introspection and empathy are the basic components of psychoanalysis research. With the establishment and development of self-psychology, Kohut constantly improves the understanding and interpretation of the empathic-introspective methodology. In Reconstruction of Self , he makes it clear that the content of psychoanalysis is determined by the attitude of the observer’s empathy and introspection. Or that part of the reality can be obtained through introspection and empathy. In his view, empathy and introspection embody the essence of psychoanalysis and are a sign of the distinction between psychoanalysis and other scientific studies of human nature. In the study of the science of human nature, psychoanalysis is the only science that combines the theory of empathy with experience-near and experience-distant in basic activities. In other words, psychoanalysis is a unique science, as it is always based on data obtained through introspection and empathy. Some of self psychologists after Kohut started with their respective theoretical standpoints, and developed the empathic-introspective methodology. Some have expanded their applications, and some others have further put forward new insights, and some have made comments from the point of view of opponents. These enrich the methods of self-psychology from different aspects, and think that empathy is not only a method of studying psychology, but also a kind of treatment support.

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(Ii) Analysis of the function of empathy Ernest Wolf also strongly agrees with Kohut’s empathy-introspection position to limit himself to this perspective in clinical situations, rather than relying on resources other than the treatment for inspiration or guidance. In his view, the analyst, as a participant, needed to put himself within the patient in the course of the analysis, focusing on trying to gain a subjective experience of understanding the patient. In order to achieve this, analysts, in addition to all the information obtained through external observation, need to analyze his replaced introspection to the patient, which is the position of empathy. Wolf analyzed and elaborated on the three functions of empathy: The first is to define. Two types of data in psychology-external observation data and introspection data-are obtained through different areas of observation. External observations come from areas outside the observer’s field; while the introspection data come from areas within the observer’s field. Most science and college psychology involves external observations, similar to natural sciences. The field within the observer is defined as the field of depth psychology, in which the data is obtained through introspection and empathy. Psychoanalysis is the most remarkable depth psychology, also determined by its data collection methods. However, Wolf also points out that this does not mean that psychoanalysis has no external observations, and he believes that it is a combination of external observational data and depth psychology derived from introspection and empathy data. However, without empathy, there is no psychoanalysis data and no psychoanalysis science, so empathy has a defining function in the process of constructing psychoanalysis theory. The second is to process. The processing function of empathy is the process of obtaining the information specific to psychoanalysis. Similar to other psychology, psychoanalysis uses various types of information or resources about the patient. They may include direct observation, including behavior, especially speech acts, as well as other relevant information about the patient, such as personal history, family history, analysis history, etc. Although the information used for psychoanalysis does not strictly belong to psychoanalysis, the private experience can only be approached through self-introspection. As they are only the analyst’s observation of an object, and psychoanalysis involves an individual’s internal experience, the basic psychoanalysis data must be attributed to the individual’s private experience. For analysts, to have some ideas about the patient’s internal experience, he has to put himself in another person’s experience to feel it, that is, replaced introspection. The third is to self support. In our daily lives, we all realize that it feels good to be understood by another person. Being aware of the internal experience and responding to it with positive and warm emotions will promote a person’s development. By trying to listen to empathy, trying to get in coordination with each other through replaced introspection, the analyst can gather data from the patient. As a byproduct of this listening activity, analysts will enhance the self cohesion, self-esteem and happiness of the patient. Empathy listening has beneficial effects, regardless of the content of the information obtained, or whether the analyst will make mistakes in the familiarity with the patient’s experience.

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Patients usually get upset, anxious, or depressed when they start treatment. In most cases, people will notice that when analysts pay attention to listening without interrupting (in addition to occasionally clarifying the problem), patients will have a better feeling. In general, the initial impedance phase of treatment is often accompanied by a harmonious self-object relationship phase, when patients feel relatively good, the symptoms are somewhat reduced, and the initial tension seems to be excluded from the relationship. This does not mean that there has been any improvement in their condition, which depends on their experience of a harmonious self-object (analyst) relationship with empathy. This phenomenon has been described in the past as proof of “empathy healing” or good healing alliances. From the point of view of self-psychology, this kind of empathy makes the patient himself take the analyst as a self-object and experience it as part of the self structure. The self of the patient is enhanced, and accompanied by increasing happiness, experience a more cohesive self. Although the role of empathy in psychoanalysis therapy is only a by-product at the beginning, it increasingly becomes a key to psychotherapy, and plays an irreplaceable role. It is manifested in: first, empathy brings the relationship between patients and analysts closer, similarly, analysts gain more trust from patients, and second, analysts can better understand the situation of patients, and finally, in form, it is the treatment of a relationship, but in essence, it has played a good supporting role for the patient. (Iii) Analysis and treatment of empathy and inter-subjectivity Scholars such as Stolorow, Brandchaft and Atwood, the representative figures of the theory of inter-subjectivity, clearly support Kohut’s view that anything that cannot be understood through empathy and introspection is outside the scope of psychoanalysis studies. In fact, they make the use of empathy-introspection method one of the three basic contributions of Kohut’s self psychology. These three basic contributions are closely related: ➀ firmly applies the exploratory empathy-introspection model to define and limit the fields of psychoanalysis; ➁ attaches importance to the primacy of self experience; and ➂ the function of self-object. These three principles constitute the theoretical infrastructure of self psychology. The inter-subjectivity theorists believe that the exploratory empathy-introspection model refers to the attempt to understand human performance from the perspective of self subjective reference frame rather than beyond. They point out that Kohut, when proposing the exploratory model to define and limit the field of psychoanalysis, was not fully aware of its significance. That is, Kohut reconstructs psychoanalysis as the independent science of human experience, and has taken a huge step towards the depth psychology of human subjectivity. They also point out that Kohut’s exemplary contribution was recognized by other psychoanalysis scholars who tried to liberate the phenomenological insight of clinical psychoanalysis from the bed of Procrustes of materialism, determinism, and modern metaphysical materialism (Guntrip 1967; Schafer 1976).

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Besides, they fully accept Kohut’s proposition that the empathy-introspection model defines the nature of the psychoanalysis. In their view, the concept of the intersubject field is a theoretical structure that precisely matched the exploratory methodology of empathy-introspection. Their inter-subjectivity approach is the natural and consistent application of this position and leads them to theoretical conclusions. In their view, psychoanalysis is a science of inter-subjectivity, focusing on the analysis of the interaction between patients and analysts in the subjective world. This shows that the centrality of introspection and empathy is guaranteed by the fact that the observation positions taken by these authors have always persisted in the so-called field of inter-subjectivity rather than outside. That is, information beyond empathy and relationships becomes unimportant and even irrelevant to analysts. In addition, the intention of the inter-subjectivity theorists to use this perspective lies in the high degree of focus on the effects of the interaction of analysts and patients, who believe that the analyst’s perspective can influence the self structure of patients in a decisive way. And pathology itself is understood as a two-person event of the interaction of patients and analysts. The theorists believe that the patients do enter the treatment with special self-object needs and pathology, but how these needs are satisfied and responded to in the field of inter-subjectivity psychoanalysis, so that they can significantly affect the severity of pathology and the process and results of treatment. For them, each diagnosis and treatment process can only be understood in one field, which consists of two individual subjective inner worlds interacting with each other connected by the inter-subjectivity of the empathy-introspection stand. In terms of treatment, the stand decisively shaped the therapeutic dialogue in a completely different direction. The exploration of continuous empathy of the analyst is helpful to the formation of a inter-subjectivity system, in which patients increasingly believes that its deepest emotional state and needs can be understood through empathy. This, in turn, encourages patients to develop and expand their self-reflection skills, while insisting on a clear expression of the more vulnerable and hidden areas of their subjective lives. Equally important, patients gradually established analysts as an understanding existence. The analysis found that the development trend of the collapse has been restored … the attitude of continuous empathy has a central place in the process of establishing, maintaining and continuously enhancing the self-object bond with the analyst, which constitutes a basic component of the psychological transformation of therapeutic change. This suggests what was previously thought to embody therapy can be understood on the basis of special bonds, which are established by the patients’ experience and their desired understanding. In general, as treatment progresses, it is possible to establish common goals between patients and analysts and to work together in good faith. The later inter-subjectivity theorists interpreted and explained the treatment of empathy. They point out that this inquiry seeks to interpret the unconscious organizing principle (empathy) of patients, the unconscious organizing principle of the analysts’ experience (introspection), and the fluctuating psychological realm (intersubjectivity) created by the interaction between the two. Unlike neutrality, empathyintrospection inquiry does not seek to avoid, minimize, or deny the impact of the analysts’ psychological structure on the patients’ experience. On the contrary, it

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acknowledges that this effect is inherent in the profound and subjective nature of the analytical dialogue and consistently seeks to analyse it. They stressed that the position of empathy-introspection inquiry, like a neutral position, can be used for a variety of psychiatric treatments and to self reflect without interruption during the analysis and treatment. They also stressed that in the position of empathy-introspection exploration, there is no advocacy of negation or ambiguity in the analysis of asymmetries in patient-analyst relations. The meaning of this asymmetry should be studied rather than obscured. (Iv) Treatment methods and cure standards for empathy therapy of psychoanalysis Kohut believes that empathy has a therapeutic effect in a broad sense. The so-called therapeutic effect of empathy, in fact, refers to the role of empathy to create a good therapeutic atmosphere for psychoanalysis therapy. But what really plays a therapeutic role is the understanding and interpretation that is based on the empathy and produced by analysts. And empathy must run through the entire healing process, and only in this way can psychoanalytic therapy succeed. Understanding and interpretation, the two steps of an analyst’s treatment, are the essence of treatment and constitute the basic unit of treatment. Understanding and interpretation are interrelated. On the one hand, understanding is the premise of interpretation, and interpretation is the deepening of understanding. On the other hand, in psychoanalysis therapy, understanding and interpretation are not separated, usually combined with each other, and staggered. Analysts sometimes understand, sometimes interpret, alternating fast, almost indistinguishable. It is the analyst’s understanding and interpretation that causes the patient to suffer a moderate setback and prompts him to deformingly internalize the self structure and its self-object function played by the analyst. Bacar, on the basis of moderate frustration, put forward the concept of moderate response, that the analyst’s demand in this appropriate way satisfied, and the process itself is therapeutic. In Bacar’s view (1985), this common healing factor is the experience of the patient’s moderate response to the analyst, is a deeply understood feeling, is a feeling of reducing frustration and tension, and is even a rich and satisfied feeling; and the quality of the treatment relationship at the moment assure analysts that his response is available to the patient. Thus, the harmonious self-object relationship is established or restored, which satisfies the individual’s self-object demand. Bacar believes it is also an implicit assumption that all psychotherapy, whether psychoanalysis or not, is based on. The cure standards of psychoanalysis are actually the standard of mental health. Self-psychologists believe that mentally healthy people have established at least part of the personality structure, and ambition, skills and talents, as well as idealized goals, constitute a functionally normal complete continuum. Thus, self-psychology defines mental health from two aspects of structure and function. As far as the structure is concerned, the self structure should be complete, and the defects in it will be compensated; and in terms of function, the self can play its full role and vitality. The complete self structure and the compensated defect is cause, and the normal self function and vitality is effect.

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Self-psychology holds that as long as two of the three components are sound, the self can play a normal role. Therefore, if psychoanalysis treatment can make up for the defects of the two components in the self structure, the other component, the self function can be restored to normal, and their own obstacles can also be cured even if there is a defect. Generally speaking, what is compensated and consolidated is the less defective component in the self structure, and the psychological structure formed is the compensation structure. In the process of psychoanalysis treatment, the formation mechanism of psychological structure is like the normal development process. If the analyst acting as self-object can use empathy, and accurately understand and accept the patient’s selfobject needs, and make appropriate interpretations, the three steps of analyst’s understanding, interpretation and moderate response are repeated, the self-object function played by the analyst is transformed into the corresponding self structure, so that the defects of the self structure are compensated and its function is restored. The earlier preliminary form of self and self-object relation is changed into that of the normal connection with adult life. Iii. Contribution of self-psychology to psychotherapy If psychology has a long past, a brief present, and an uncertain future, selfpsychology, compared with psychoanalysis, has a long past which incorporates the history of psychoanalysis almost every step. The brief present is only reflected in the past twenty or thirty years, especially the broad development of self and self-object by Kohut and his successors. The in-depth exploration of empathy and introspection, the further consideration of relations, and the continuous attention to inter-subjectivity gradually entered people’s vision, greatly expanding the theoretical and practical boundaries of psychotherapy. (I) Enriching the theoretical perspective of psychotherapy Theoretically, self-psychologists have developed the methodology of empathyintrospection put forward by Kohut from their respective theoretical standpoint. Some extend their application, some further put forward new understanding, some stand in opposition and put forward opinions, enriching the theory and model of psychotherapy from different aspects. For example, Hagman’s theoretical model on grief not only complements the theoretical guidance of psychotherapy in the field of grief research, but also provides a new perspective for psychotherapy to look at life and death. And Stolorow, from the standpoint of inter-subjectivity, thinks that psychotherapy of psychoanalysis is formed in the interaction between subjects. In this interaction, analysts and patients have made significant contributions. Analysts make the patients feel deeply understood through the continuous exploration of empathy. From the depths of subject world, the patient weaves this understood experience into its unique and mobilized self-object needs, so that the thwarted process of self-object development is restored. These self-object functions played by analysts promote the analysis of human cohesion and the integration of emotion and experience, in the

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analysis of human and analyst interaction between the main field, in the course of treatment to obtain the treatment of both sides of the in-depth discussion, in order to give full play to the role of psychotherapy. In addition, on the basis of Kohut’s view on the relationship between self, self-object and self-object, the psychologist takes a critical attitude to explore the theory, further expands the concept of selfobject, puts forward self structure and its hierarchical model, and puts forward a new understanding of his own psychology from the orientation of relational theory. Thus, to a certain extent, self-psychology embodies the characteristics of the multiorientation and post-modernity of its theory, which not only enriches the theoretical system of psychotherapy, but also provides enlightening theoretical resources for the practice of clinical treatment of contemporary psychoanalysis. (Ii) Expansion of the practice frontier of psychotherapy Clinical treatment Practice is the soul of psychotherapy, each of which has an influential school of psychotherapy theory or orientation, needs to prove itself in clinical terms, in order to obtain the respect and recognition of other schools or orientations, self-psychology is no exception. In clinical practice, on the basis of psychotherapy practice, self-psychology will focus on the treatment of more psychological conditions, actively explore, greatly expand the scope of treatment practice, enrich the content of psychological treatment. For example, the application of self psychology to sexual psychological problems, addictive problems and suicidal problems and other aspects of treatment. In the form of treatment, self-psychology is not confined to the traditional form of treatment, there are husband and wife treatment, family therapy, group therapy, short-range treatment and other common forms of contemporary psychotherapy, but also used in psychiatric analyst training supervision. In addition, the development of self psychology is not entirely confined to the internal psychological treatment, but also from the outside of psychotherapy to absorb energy and extend outward. The penetration of medicine, education, social workers, carers and other occupations in self psychology, so that many help workers, including medical personnel, teachers, consultants, social workers and so on, can apply the content of self psychology theory and practice to the solution of the problem of working objects, and develop into the ordinary people can understand themselves, analyze others, A powerful tool for adapting to increasingly complex social relationships and improving living standards and quality. (Iii) deepening the understanding of the relationship in psychotherapy More and more self-psychologists have found self is faced with an increasingly complex situation of psychotherapy. In this context, the subjective experiences of individual human beings, including the self producing this experience, are distributed in a vast network of relationships, and each of us is an integral part of that relationship. Therefore, self-psychology needs to grasp how to explain the meaning of the subject experience in this dynamic and relational inter-subjectivity network, so as

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to construct a new picture of psychotherapy. Theoretically, self-psychology emphasizes the understanding and insight in the relationship, focusing on the disintegration, restoration and reconstruction of itself and the object in the relationship. In practical treatment, self-psychology has long gone beyond the Kohut era to pay attention to the single category and object of narcissistic personality disorder treatment, but more and more widely used in the construction of relations and the development of inter-subjectivity. Self-psychology has changed from monomer psychology to multibody psychology, forming a combination of one-man psychology and two-person psychology, which explicitly places self, self-object and self-object relationship at the core of relational theory, and pays attention to the concern of people’s need for awareness and the role of others under the existence of relationship. This paper emphasizes that analysts’ analysis, moderate response and treatment of analytic people’s empathy from the perspective of inter-subjectivity, and always puts their own and self-object experience in the core position of analysis (clinical) thinking in the relationship.

References Monographs Bacal, H., & Newman, K. (1990). Theories of object relations: Bridges to self psychology [M]. Columbia: Columbia University Press Greenberg, J., & Mitchell, S. (1983). Object relations in psychoanalytic theory [M]. Cambridge: Harvard University Press. Mitchell, S. (1993). Hope and dread in psychoanalysis [M]. New York: Basic Books.

Journals Aron, L. (1991). The patient’s experience of the analyst’s subjectivity [J]. Psychoanalytic Dialogues (1). Aron, L. (1996). A meeting of minds: Mutuality in psychoanalysis [J]. Proteomics (8). Bacal, H. A. (1985). Optimal responsiveness and the therapeutic process [J]. Goldberg Arnold Progress in Self Psychology (1). Guntrip, H. (1967). The concept of psychodynamic science [J]. International Journal of Psychoanalysis (1). Hoffman, I. Z. (1983). The patient as interpreter of the analyst’s experience [J]. Contemporary Psychoanalysis (3). Hoffman. I. Z. (1991). Discussion: Toward a social-constructivist view of the psychoanalytic situation [J]. Psychoanalytic Dialogues (1). Ogden, T. H. (1994). The analytic third: Working with intersubjective clinical facts [J]. International Journal of Psychoanalysis (1). Ogden, T. H. (2004). This art of psychoanalysis:Dreaming undreamt dreams and interrupted cries [J]. International Journal of Psychoanalysis (4).

References

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Palombo, J. (1981). Parent loss and childhood bereavement: Some theoretical considerations [J]. Clinical Social Work Journal (1). Schafer, R. A. (1976). New Language for Psychoanalysis [J]. International Journal of Psychoanalysis (10).

Chapter 4

Mutual Influence of the Infected

4.1 The Course of “Dying to Live” Among those infected in China, X can be said to be a legend, not only because he has been fighting against “AIDS” in Chinese grassroots, but also because his experience is dramatic. According to incomplete statistics, X can be laughingly said to be the longest living of the infected people in China. True, this may be a joke, but it demonstrates that he as an infected person, not only changed his own destiny, but also affected the lives of others in the fight against AIDS. The following is X’s reflections: I was diagnosed in 1997. At that time, in addition to fear, we have no understanding of AIDS. I was the same, and my mind was blank like being thunderstruck. How can I be infected, how can it be passed to me, who infected me, am I about to die, and will die terrible? Then the thoughts flashed in my head. Thinking of dying soon, I began to worry about whether it would infect my family. Because there was no network at that time, there is no way to obtain relevant information, even few people said clearly what AIDS is. We just vaguely know that if there is such a contagious disease, people will die quickly. Then it is the disease resulting from homosexuality, “love” between people with the same gender. I looked at the test sheet several times, including the name and the positive result. You know, it wasn’t a joke. Later, I went to the provincial CDC (then called the epidemic prevention station) to re-examine.

X said he could not have imagined that he would be infected with the disease, only remembering the brain blank. Because at that time, AIDS is not what is now considered a controlled chronic disease, but a death sentence of infectious diseases with a very strong stigma. Perhaps one day the infected was carried out “shooting”. It was out of the shadow of stigma and such fear that he was about to die that X chose to inform his family. His family was so shocked that X was dispelled by their parents even without eating dinner. However, X believes that even if he dies immediately, he can’t shame his family. After being kicked out of his home, he left his hometown overnight and boarded a train to City B. At that time, there was no hospital in the country that had a dedicated ward for people living with HIV, including YD hospital. Later, because there were infected people who needed to be hospitalized, they were admitted to the hospital next © Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9_4

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door to morgue under the arrangement of YD Hospital. It also became a temporary ward in the infection department. Now think about it, that’s truly “dying to live”. The term first appeared in this interview. The author realized that the interviewee (i.e. the patient) had some kind of self-conscious or unconscious “theoretical” ability, so I especially remembered the term he used, and then the whole research process proved that X is really a good theorist, although he himself never took pride in it. I live next door to the morgue for three months. Almost every night, I saw someone in the morgue making up for the dead, and when it’s not dawn, it’s pushed out to be cremated. On the contrary, with the accompanied pain, I feel that death is so close to me. Especially at night, lying alone next door to the morgue, I felt unusually lonely and cold. All night, I could not sleep, unable to tell whether the body is in pain, or the heart in the blood drop. I really hope to be able to release all the pain upon death. I couldn’t count how many nights, I was crying to sleep, holding the quilt. But because of the fever, pain that has been accompanied, I woke up from coughing and coldness from time to time, and I felt helpless and fearful facing death.

X at first has only a vague understanding of AIDS, thinking that the disease will rot around, with many tumors in the body, and will soon die. Not only is there no cure, but it is highly contagious and frightening. In this way, X alone endures fear, loss, self-shame, and the stress of death. Facing death, disease and the rupture of the relationship around him, he deeply felt that more terrible than AIDS was not death but the loneliness of no one to listen to and help, and helplessness of nowhere to understand AIDS-related information, but also self-blame and panic in the face of people’s gossip. He suddenly felt that he might be frightened to death by AIDS rather than dying of the illness. Those three months were the beginning of X’s journey of “dying to live”. He began to think: to live or to die. In fact, he tried many times committing suicide. Alone in city B, death meant everything ends. At that time he wanted to jump off the building, but didn’t succeed due to fear and lack of courage. He also imagined lying on the tracks of the subway, but seeing the subway ride through, he retreated. He also tried making self-destruction, but after three consecutive days of coma, he miraculously woke up. At that time, he thought, since there is no courage to die, then he tried to live well. Just at that time he learned that Dr. He Dayi, a Chinese American, developed cocktail therapy. He thought, he must live. Because he’s been in business before, there are some savings and assets. So, in order to survive, he sold his house, went to exchange dollars in the black market, and then bought medicine from abroad. Because of the strong side effects of the medication taken, X developed a rash, accompanied by itching, fever and vomiting. It seemed to be bugs crawling on the body, and what seemed to be burning in the belly. At that time, the doctors and nurses were still very concerned about me, which also gave me some comfort in my heart. Although they did not understand my pain, but did not give up treatment for me. In addition, on the advice of the nurse, several of our infected people helped each other. Because my skin was itchy, a few infected people gently rubbed my body to prevent me from scratching my skin to cause an infection. And I told them my own story, what I knew about AIDS, how to treat AIDS abroad, and so on. In order to strengthen nutrition and enhance immunity, we jointly prepared a meal in line with their diet structure. Under the careful care of doctors and nurses and infected people, my rash backed up, and I took some Chinese medicine, and I didn’t get a fever.

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Although the dangerous period passed, but I knew that drugs bought from abroad with the huge amount of money, can not really cure AIDS, but just a kind of control of HIV virus and inhibition of its growth. I still could not escape the prison of death. Looking back, AIDS had completely changed my life. Because of AIDS, my family no longer accepted me, and friends suddenly disappeared. At that time, although there is no such network, mobile phone or something, but the news spread very quickly. All of a sudden people around me know I was infected with HIV. At that time, I was in a situation where there was virus but no friend, there was fear but no comfort, and there was discrimination but no support.

After taking antiviral drugs for a while, X’s condition was under some control. Gradually adapted to the side effects of the drug, he began to rethink how he wanted to live. At that time, the medicine was bought from abroad, especially expensive, and the side effects were great. He thought at the time, since AIDS is a disease of the immune system, then, they can improve their own immunity to fight against HIV? In order to improve my immunity, I pay special attention to the diet. Before the infection, I do not cook at home, and now, I rarely eat outside, and can cook a good dish. In order to improve my immunity, I adjusted my diet, quitted smoking and alcohol, reduced the food and behavior affecting health, and tried to restrain from the desire to eat. In order to improve my immunity, I also strengthened exercise every day like running, playing ball, practicing taichi and so on. I ate and worked as planned almost every day. At the same time, I wore a mask when going out. At first people think I am afraid of being recognized by others, in fact, I intended to avoid infection to protect myself. In addition, I also participated in some antiviral drug tests of Chinese medicine. It is a drug with China’s independent research and development to improve human immunity. It performs the function of detoxification of heat, circulation of blood and invigoration of Qi. For people living with HIV and AIDS (CD4 lymphocytes between 100 and 400/mm3 ), there is an improved CD4 lymphocyte count. It can improve symptoms such as fatigue, hair loss, loss of appetite and diarrhea. It can improve the function of body. In short, I worked and lived on routine, did the uttermost to improve immunity to combat HIV. I once thought that living so carefully would be healthy.

However, at that time the drug is not so convenient or effective. Although his own efforts play a role, it still can not compete with the replication and growth of HIV. Moreover, X is faced with not only the situation of lack of medical care and medicine, but also rushing to raise money for drugs. Lack of friends he can only face alone. After about a year, X was hospitalized again. Despite my body felt uncomfortable this year, I survived by virtue of efforts. And this time, it’s really almost “dying”. Due to poor mental health or perhaps the effect of drugs, my face was always black during my hospital stay. Whenever someone asked, my heart was shaking, thinking: it is all over, the drug is useless, their own efforts are useless, I am about to die, and the virus has invaded the skin. I have always remembered the idiom “concealing a malady for fear of taking medicine”, and the disease is symptomised first on the skin and then to the body. It was the same with AIDS. I am more so (fear), the more bad physical condition, weight loss, the more people lose weight.

That Time X’s condition is very serious, complicated by many concurrent opportunistic infections. Intravenous feeding are performed non-stop for 12 h a day. He felt drowsy and could not tell whether it is night or day. Perhaps it was the effect of drugs, or the cause of opportunistic infection, he felt that he could not control himself, paralysed in bed all day without self-care. The hospital has twice issued a critical notice, and he felt desperate for himself. Because always insisting on not

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telling the family, he has no family care, but during the hospital, the careful care and careful care of YD hospital doctors, nurses and some patients revive X. I really thought I was going to die, dying in a foreign land, and dying from this disgraceful AIDS. Although the drugs later brought my condition under control, I still needed hospital treatment. Lying in a hospital bed every day, I felt my efforts for more than a year were not able to fight against HIV. On the contrary, the body had a little discomfort, so I became very nervous, and was thrown into panic all day. On the one hand, the lack of understanding of AIDS made me fly into a panic at the mere rustle of leaves in the wind. On the other hand, few people can help me. During the hospital stay, I had to depend on myself except the doctor, nurse and a few patients. However, in retrospect, if it were not for these sick friends, I might not have lived now. At that time, they took care of my life, and prepared a meal for me. Worried about the food outside dirty, and insufficient nutrition, they did cooking with small coal stove to cook vegetables and porridge downstairs. Especially those days when I was seriously ill, I needed their help even going to the bathroom. You do not know, when I was admitted to the hospital, I, as thin as firewood, was carried to the hospital. Under everyone’s careful care, I came alive a month and a half later, but also gained a lot of weight.

In those days, X’s guilt and fear often arise, with nightmares from time to time. On one occasion, X dreamed that he told one friend he was infected with HIV, its cause, feeling and physical condition. As a result, it became an open secret by word of mouth, as if the whole world knew that he was infected with HIV. At that time, there were always nightmares: people were chasing me, and kept me running. Edging home, suddenly, the sky began to rain, and all the people chasing me disappeared. Somehow, home is in front of me, my father, my mother, my brother are all in, but the rain at home is greater. I couldn’t manage to go back, like the ghost in the movie to hide the road, only looking at my home from afar. Seeing the house is about to fall, I screamed out my voice, but they could not hear or see me. The house is about to collapse in the rain, and parents are disappeared. I was startled and woke up. When I woke up, my head was full of sweat, and my heart was bumping. Such a similar dream appeared many times, which I didn’t believe ago. Sometimes the dream could be picked up even waking up. I remembered a sick friend saying, don’t worry, and dreams are opposite to reality. But I thought that dreams were my status quo: a home not available to me, and me rejected by the world.

X believes that in hospital, chat and mutual assistance with patients is the most happy, because everyone’s understanding of AIDS is very little. Unlike now, all kinds of information explode. Due to the lack of AIDS-related knowledge, it is difficult to find some professional information. On the contrary, timely and useful sharing among one another is conducive to knowing each other, and getting relief and understanding from companions. With each other’s help and sharing, X has a better understanding of AIDS and its related content, and indeed relieves his stress and fear of the disease. He no longer feels that he is the only person in the world infected with HIV. Consequently, his sense of guilt is reduced. Like life-saving straws, he is pulled out of the abyss. X finally survives his battle with HIV again, and he has since remembered his second new lease of life. In his most difficult time, not only the doctor’s superb medical skills, but also the care, consideration, understanding and recognition of the sick friends, give him courage and hope to survive again after a narrow escape from the serious disease. After this illness, X deeply realized that for the treatment of

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AIDS, it is urgent to change the current situation of lack of medicine, meanwhile, to strengthen the support and care of infected people. X often says, it’s like walking on two legs, and both are essential. The year before 2000, there is no effective antiviral drugs input, there is no peer help and understanding either. Infected people like sitting in a wheelchair, without a single leg, felt helpless in the fight against AIDS. So he was determined to devote himself to the field of AIDS intervention, and to provide support and care services for those infected. It was not long after that, in 2001, X got to know Y, a person who can give him real understanding, support and help. Y is not infected, but he was just trying to help X, especially when X feels helpless. X said that for a while, he had to call Y every day to calm lying, in the bed telling Y all his pain and heartache. Y will also listen carefully, let X feel that in this world, Y is the most understanding of their own, as if more than they know their own general. For the suffering of homosexuality, hatred of AIDS, for the world around the prejudice, he can feel the same. In front of Y, he can put his emotions directly vented, but also can get Y’s response and support, that feeling, let him very attachment, but also satisfied. X said that I have known Y for more than a decade, they do not support each other care, especially in their own body has a lot of discomfort, Y’s presence, give him care and relief, is his time and time again to overcome the virus, brave face the driving force. X smiled and said, “Y always says, I’m like a child compared with him.” You do not know, it can be said that Y cured my hands trembling problem. For a while, I found that I didn’t like going out but staying at home all day. I began to feel headaches and chest tightness. At first the symptoms were mild, but as time went on, I got worse and I even rubbed my chest and head when I was in pain. Along with these pains, I became more and more depressed, with headaches and chest tightness. Later, one of the hands tremble. At first I thought it was due to physical weakness, but then the symptoms did not abate. At thought of AIDS, or the body appears abnormal, even if it is a small red dot, my hands will be involuntarily trembling. And the more you want to control, the less you can do it. If there are others present, I can’t even hold a glass of water to take medicine. I think it’s all caused by HIV. One night, I felt like I was about to leave, and I had a feeling of breaking down, with a constant message of death in my head, and my hands shaking even more violently. Later, Y found out my hand shaking problem, suggested that I see a psychologist, and told me that this is not because of HIV, but caused by my stress. Y told me that when he was nervous, he would also have a problem shaking his hands and legs. When I heard Y’s words, I felt myself suddenly relieved, knowing that this was not a precursor to death, and the hand shaking is miraculously not so violent. I went to L hospital to treat my hands shaking, a specialist hospital for mental illness. After seeing a psychologist, I did not say that I was infected. The doctor gave me some pills, and asked to take twice a day. For fear of shaking again, I took the medicine every few hours, in order to suppress the hand shaking. I finally became heavily dependent on the drug, became more closed, no longer willing to contact the outside world. The business also suffered heavy losses, and eventually it had to be transferred to others. It should be said that that time was the lowest valley of my life, burdened with physical illness, psychological distress, business frustration, drug dependence and conflict. Because I did not disclose to the psychiatrist the fact that I was infected with HIV, I took conflicted psychotropic drugs and antiviral drugs, eventually leading to all kinds of discomfort. Y noticed that I was in bad shape, knowing that I was dependent on drugs in order to suppress hand shaking, and that I was reluctant to meet others because of hand shaking. He understood my concerns, saying: “I understand

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4 Mutual Influence of the Infected that you want to serve the infected, help them, but also worry that hands shaking will affect your understanding and trust. You are to set an example for everyone, rather than a person who is frightened by AIDS.” His words seemed to wake me up again, and he said, “You are an open infected person, then why can’t you are worried and fearful, why can’t you show the world your depression?”.

Y thinks X’s trembling hand is caused by psychological stress. Although out of fear of AIDS, X is more manifested in a fear of his poor status, fearing that trembling hands will affect his image in society, especially among infected people. As a result, X chooses to escape, either taking medication or opting for self-enclose. In Y’s view, X’s escapism is the most harmful. Although escaping for a moment avoids hand trembling, it provides a sustained impetus for the vicious circle of hand trembling next time. Therefore, Y advises X to calmly treat hands trembling with the ordinary heart. When the symptoms of hand trembling appear, do not restrict the symptoms, or not try to say to themselves to let the hand stop shaking. He should frankly accept the phenomenon of hand trembling, and openly admit the psychological pressure brought about by AIDS. In this way, it not only effectively breaks the role of psychological interaction, and thus prevent the vicious circle of hand shaking, but also can cause many infected people to pay attention to psychological pressure, pay attention to psychological support. It has become one of the focus of attention of A organization in the future. Later, under Y’s careful care, X received more support and love from Y. When his hands tremble, Y will encourage X to do his good dishes, both to alleviate the problem of hand trembling and to make life full of joy. In front of the public and infected people, he confessed his problem of hands shaking, and always half-jokingly said: “HIV is nothing, because it could not attack my body, but began to attack my psychology, once scared me to tremble. However, it couldn’t scare me to death. None of you is beset with the problem of hand shaking, and you are better than me.” With Y’s company, X also adheres to daily exercise, so his body began to recover, and the hands gradually become less shaking, which let X regain self-confidence, and hand trembling problems also gradually disappeared. It was with Y’s support that they co-founded Organization A and established a loving home for those infected. In order to do a good job of the protection of A institution, the author uses a very common name in AIDS organizations, but also can reflect their intentions in the organization’s name. The development of Organization A cannot be separated from their side-by-side fighting against HIV and cooperation with each other. The purpose of our establishment of organization A was simply to help people like me. Because of the lack of understanding of AIDS, coupled with the fear of AIDS, infected people were often self-enclosed, did not contact people, and even more refused to take medicine. To put it bluntly, many infected people are scared to death by themselves, or delayed by their own ignorance. The simplest point, when you say to infected people that AIDS is a chronic disease, many of them do not believe what even the doctor said, but they believed what we said. Why? Because you intellectuals can only talk with to-the-ground experience, but we explain to them that I am a living example. I’ll tell about my illness and explain it to them. Sometimes, they don’t open their mouths, but I know what they want to ask. So they believe in us and rely on us. Some infected people, will not even go to hospital without our escort. Like C, it’s all day with us, helping us cook, more punctual than we are

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at work. Sometimes I say, we also can’t pay you, but you work so hard. You needn’t come every day. C said, I just love to come here, love to listen to your chatting, listen to you tell them about your life, how to understand AIDS, how to survive. In fact, from the point of view of our organization, simply put, the care of infected people can be divided into two aspects of concern for their lives and survival. That is to say, the care of infected people is not a temporary job, nor just letting them take medicine on time, and organize communication. In our view, this is more of a whole care concept. In fact, we found in our service that if the infected persons accept our intervention from the first diagnosis, then the work will be much easier to carry out. Because, first of all, we start with positive notification, because the diagnosis is to go through the laboratory, and during this time, the infected person is often abnormally anxious. Generally speaking, infected people, knowing the result of first screening positive blood-taking in the hospital, often experience such a simple reply “go back and wait for the results”. Our experience has revealed that at this time, if they receive real support, they will become particularly trusting, dependent on you. It can help them get through the week better, and lay the foundation for the work that follows. In fact, our biggest headache is often blood screening by other organizations or their own, or after blood collection in the hospital, they suffer for a week. A week later, they suddenly received a notification from the hospital or the CDC to get the results, but the results are positive. At that time, the infected person often collapses at once. We have seen a lot of examples like this. When he feels the earth is falling apart, or after a long time, he heard that Organization A can provide them with supportive care, but it would be difficult to carry out care for such infected people. Of course, not that we can not care such an infected person, but his resistance is more intense, less likely to trust us.

The treatment of infected people should not only seek to repair the damage and restore the balance of life, but also improve the survival and quality of life of infected people, to help infected people overcome feelings of hopelessness and helplessness. The latter is often not available in hospitals. Infected organizations can bring their expertise to the aid of those infected, help them solve life, survival and life problems, and get back on their feet. Together, they and infected people form a combination of the fight against HIV, and meet the challenge of AIDS. As X says: “In our organization, we don’t speak so much, but being sincere and patient. We can think of what they think, form a community with them, and realize self-help through helping each other. In my opinion, the phrase “dying to live” is really powerful. In the fight against AIDS, there will never be so smooth sailing, where everyone has to go through several big ups and downs. And at this time, we can grow up with someone else’s good support and care. I do not have too high an intellectual level, and I just tell them how I survived, how to live so long just according to my own illness. Of course, the role of drugs is necessary, but people can not look forward to drugs all day. My hand shaking is the best example that the result of looking forward to drugs alone is drug dependence. It is the same with AIDS. Perhaps AIDS did not put you down, but the treatment of AIDS drugs first put you to the hell. Therefore, I tell infected people, first of all, have self-confidence, believe that you will be able to defeat HIV. Then improve immunity, use you own body to fight against HIV virus, and fight the damage caused by taking antiviral drugs. We often say that body is the capital of revolution, and the reason why I can live so, is that I believe in myself, believe that HIV virus can not take me to the hell, such as a firm confidence, strengthening physical exercise, improving immunity, reasonable diet and improving the quality of sleep, taking medicine on time and so on. Don’t ignore these small things, but they concern the lives of infected people and the determination to fight against HIV. Therefore, in the process of intervention in the infected people, the first thing to do is to let the infected person believe in themselves, believe that

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4 Mutual Influence of the Infected their own efforts can to a certain extent suppress HIV. The infected should realize that the power of people’s beliefs are enormous and that their personal potential is infinite. Third, you can also join our team to help others, because only in the process, you can get the recognition of others, and realize your own value. They should trust us and our organization. As you know, there are a lot of organizations now. Especially with the development of the Global Fund and The China-Gates Project, there are many infected organizations, some organizations with only one or two people. Of course, we don’t care, but there are too many organizations breaking the head for the project, so that infected people always have a feeling of being used and deceived. Many organizations bring people together, register, eat and take pictures, and pay for them. In this way, it undermines the services that were originally targeted at infected people, making them feel distrust on many organizations. We also often say that in the past few years, the work of organization A is becoming more and more difficult to do, and the reason is here. Therefore, it can be said that we are doing our best to make the infected believe in our organization, and believe in his own manager. We adopt a lifelong intervention mode of lifelong companion, both concerned about the life and safety of the infected person, but also care for the survival of the infected person, providing all kinds of support and care he needs for the infected person. We strive to become their most reliable person. Each of our manages up to forty infected people. Moreover, as long as the case manager does not leave, he has been responsible for them. I and Y, for example, support and care a total of hundreds of infected people, and now there are nearly a hundred people in contact. Among them, many infected people themselves have become a manager, or important personnels of other groups and even the person in charge. Our intervention model passed on.

During his internship with Organization A, the author saw for the first time a confirmed report of an infected person with the HIV antibody test result: positive. The following corresponds to a line of English: Testing result of HIV antibodies: positive Positive, in the field of AIDS, refers to the positive reaction, that is, confirmed HIV infection. In a sense, for many infected people, this means sentencing them to death, not only physical death, but also mental death, interpersonal death, emotional life death. Amazingly, this English word also contains the meaning of being positive, enterprising, brave. In order to help infected people to be proactive and brave to face AIDS and its related effects, Y and X summed up the life support and survival care for infected people of intervention in practice, thus solving the relationship between infected people and themselves, and others, especially with a manager and A organization. They themselves are reconstructed through the change of relationship.

4.2 The Psychological Dynamic Analysis from Disintegrating to Restoring 4.2.1 Fracture of Self Development The method of self-psychology focuses keenly on the individual self, and thinks that it decides the individual experience and its development potential, which is the essence of Kohut’s theoretical orientation. Although Kohut has not provided a clear definition of what self is, in the view of personality, self-structure is spatial cohesion,

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lasting in time, the positive core, and the recipient of influence. In the concept of personality development, the development of self is the main axis. It depends on whether the self-object environment can meet the individual’s self-object needs. In the concept of personality mechanism, it is considered to be a three-tier structure, but no further explanation is made of the three-level structure, including ambition, ideal, and their middle areas of talent and skill in between. Its three poles have a dynamic effect, and there is a tension gradient and tension arc between ambition and ideal. Ambition provides the impetus for individual activities, and ideal provides direction. Individuals, driven and guided by ambition and ideal, use basic talents and skills to engage in certain activities, so as to achieve the development of personality. In the aspect of psychopathology, although the concept of self is mainly applied to people with psychological defects, he has also suggested that the individual’s life is accompanied by self. When the individual is in danger, especially when the relationship between self and object is in crisis, it will bring about the fracture and disintegration of the self structure, and then break the internal balance of self, cause the imbalance of self-esteem, and promote psychological discomfort and psychological barriers (Palombo 1981). Kohut also believes that psychological discomfort and psychological disorders are actually obstacles to the self development and self disintegration (defects in the self structure in essence). After suffering traumatic setbacks, the individual can not achieve transmuting internalization. In the view of psychotherapy, Kohut believes that the essence of treatment is to provide an patient with a series of opportunities to compensate for the self defects through the satisfaction of the self-object needs. Looking back and forth on X’s illness and life course, in 1997 he was informed of HIV infection. Because he and his family know nothing about AIDS except fear, he was kicked out of the house by his parents, and from then on began a life of drift alone. Since there was no hospital in the country at the time that could be dedicated to the treatment of people living with HIV, he experienced three months of “dying to live” next door to the morgue of YD hospital. Because of the physical and psychological torture caused by AIDS, he has repeatedly tried to suicide to end the coexistence with HIV. Due to lack of medical care and support and care, he was again admitted to hospital with opportunistic infections and experienced physical and mental torture. Also because of the fear of AIDS and its stigma, it eventually led to him self-enclosed and the formation of drug dependence because of hand shaking. Thus, we can indeed use the terminology of self-psychology: in such a crisis, the self experiences the process from the break of the self-object bond to the breakdown of the self. (1) The break of the self-object bond The collapse of self is usually not a one-off process, but it often goes through the process of the break of the self-object bond to the disintegration of self. Patients may soon feel the “feeling of fragmentation” brought about by the self collapse, but they may also be delayed for days or years, depending on the individual’s self development and satisfaction with the self-object needs.

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The fracture of the self-object bond manifests itself as a state of shock, doubt, and fear. In 1997, X was suddenly told of HIV infection without any psychological preparation, and without knowing anything about AIDS. “I was like being thunderstruck, and my mind was blank. How could I be infected? How did it infect me? Who infected me? Am I going to die soon? Is it going to die terrible? Then the thoughts flashed in my head.” At this time, X’s state results from the fact that he did not know anything about AIDS but a word of understanding from medical staff informing him. Psychologically, it’s hard to accept the incurable infection. In addition to the shock, he has experienced a sense of anxiety and doubt. X showed doubt about the test results and “why is me” doubt, meaning he can not calmly face and accept the reality, but with a little luck whether it will be which link of the hospital test ingress went wrong. “I looked at the test sheet several times, including the name and the positive result. You know, it’s not a joke. Later, I went to the provincial CDC (then called the epidemic prevention station) to be re-examined.” During the period of survey by the author in A organization, I also often hear, and see this situation. Although the reaction of the infected person may be different, this is the situation the individual usually face after learning of the infection. Like X some infected people may question the test results, some retest more times in different CDC, some deny it completely, even triggering anger, while others are simply silently suffering from the fact that they are infected with HIV, or are out of connection, or accept further intervention. But at this time, from the self-psychological point of view, the self of AIDS population, including X, has not yet disintegrated and divided. When all settles, fear ensues. For example, out of fear of AIDS, death and infection, X was evicted from the house in the night of informing parents, and went on the road to drift from then on. Next door to the YD hospital morgue, he not only experienced the pain, but also experienced the helplessness and deep fear before death. Obviously, X not only suffers from physical pain, but also bears the psychological pressure. To date, the author would ask, what kind of patients would be placed next door to the morgue? This is not only because of the infectious AIDS, but also because other people cannot help but dodge them. In the eyes of the time, being infected with HIV virus means only one step away from death. At this point, the internal balance of the self is frozen, and its experiences are dominated by anxiety, acute nonspecific anxiety, and fear. X’s bond with health breaks down, and the relationship struck off one by one. He lost his active commitment to life and showed depression and even suicidal thoughts and behaviors. In response to this anxiety and to get rid of the fear-shrouded situation day and night, X chooses to end this inhuman life by suicide. As we often say, death means everything ends, and obviously X reacts to this emergency trauma in this way. The author in A organization found that after learning of the infection, many infected people have thought of suicide to fight against HIV. Because in their view, rather than experiencing this feeling of life accompanied by HIV, it is better to solve all the problems through death. But after contact with Organization A, their survival goal was changed to “healthy survival till successful development of antiviral drugs.” Fortunately, X’s several suicide attempts have not been successful, because of the learning that Dr. Ho Dayi’s cocktail therapy can effectively suppress HIV, so that X

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has the determination, courage and action of “dying to live”. X’s self experience has resulted in an enhanced sense of organization and concentration, and a strengthened connection with health, which has the ability to handle many practical matters: X sold his property for this to buy antiviral drugs; X endures the erosion of the strong side effects of antiviral drugs and fights tenaciously against HIV; X adhered to daily exercise and a reasonable diet to improve his immunity. Overall, because AIDS is a condition that everyone feels vague, X is also in a state of understanding at the moment. There is often a defensive split between the realization of possible death and the belief in the promise of survival (cocktail therapy and self-regulation). As Freud said, opposition (giving up object) can be so strong that it is aversion to reality. In some cases, the negation of the loss of reality can be powerful and stubborn. The self-state at this phase is described as self-reinforcing in response to an attack on its integrity. So, X takes high-price antiviral drugs from the United States, meanwhile, strengthens his own exercise in the hope of trying to evoke a habitual response to his health in order to maintain its integrity. (2) Self collapse Self collapse is the feeling “I’m going to break down” that every individual will experience at some point in life. It starts with a slight embarrassment, as the author meets an old friend on the road, only to find himself forgetting his name when the old friend is introduced to his wife; or a sense of shame, when a doctoral student is ashamed of not being able to answer a key question in his thesis session, and more likely to experience torturing fears and threats, such as the fear of AIDS and death threats from opportunistic infections. In his writings and papers, Kohut had a clinical record that anxious, frightening, and utterly unmoving self-collapse may appear in any situation that insults the selfesteem of the individual, even in psychotherapy scenarios. White and Weiner (1986), through self-psychological model for more than a decade, declare: “We can confirm that Kohut’s extensive experience of self disintegrating phenomenon is not unique to him.” The breakdown experienced by the infected person is, in X’s words, a feeling of “I’m going to fall apart.” X with their own efforts, had more than a year of relative health, and then again because of opportunistic infection sedative hospital. During his stay in hospital, he felt unable to control his body, paralysed in bed all day, and sometimes was unable to take care of himself. He had been desperate for himself, and the hospital had twice issued a critical notice. Later, X described the hospital as a lifelong death. At this time, his own experience is exhausted and empty, his self-object needs are therefore not met, and his ability to sustain himself has been lost. He has no way and is not willing to inform his family, and there are few people around who can give himself support and care. In this case, X often nightmares, always dream of their own aids and defection. “People are chasing me and don’t let me stop, and I kept running. It is not easy to get home soon, but like “ghost building the wall, I can’t find a home to return, and I am rejected by the world.” In addition, because of the

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negation of their own efforts, X experienced depression, diffuse anxiety, insomnia, suspicion, confusion and other states. Up to this point, X is still worried about not the medical treatment of AIDS, but even if he dies, he is also killed in a disease that shames himself and his family. That is to say, for X, the fear of HIV infection, not only because of death, but also because of the stigma of the disease itself, and the breakdown of the relationship brought about by the HIV virus. Few people can and are willing to help him, and ironically, what X most need is no longer the treatment of drugs, but the emotional support of someone else. During the hospital stay, X spontaneously formed a good mutual assistance group with the sick friends. The help with each other, really like a root of life-saving straw, pulled him out of the helpless abyss. X finally survived the opportunistic infection. “A month and a half later, I actually came alive and gained a lot of weight.” (Infected Person X) Self-psychology believes that, despite the extremes of self, it should be noted that in the vast majority of cases, the cohesion of the core self is relatively stable and less susceptible to too much influence. At this moment, although X’s self has been seriously conflicted and destroyed, the individual will spontaneously devote self to the process of repairing in order to maintain its structural integrity. During the survey, infected people often mention, and also like to share their course of getting sick after HIV infection. They generally say that what really makes them feel broken is often unrelated to the severity of the disease. On the contrary, when they are at risk, they tend to arouse their desire for survival, and what really makes them feel broken is a sense of helplessness and the despair of less people caring for less, which is the last straw that overwhelms the camel. For example, X’s self state at this stage, because of the breakdown of the self-object relationship and the self-object needs, are not satisfied and frustrated. The previous integrity of the emotional structure of inclusion and regulation was disturbed. At this time, a mirrored, emotionally coordinated supportive compensating object environment is extremely important for the individual’s patience at this stage, the powerful emotional state and the process of dying to live. However, X at this time, has nothing but HIV. Despite his many expectations and longings, the realistic objective environment doomed his despair, which was one of the root causes of X’s emphasis on the importance of lifelong companion. During this period, X’s self state was frustrated by the destruction of the demands of the self-object and the collapse of the fantasy structure. The integrity of the emotional structure that had previously been contained and regulated was disrupted, and the determination to respond calmly to the reality of HIV infection was shattered by storms of grief, panic and anger. Stolorow et al. emphasize that sound functions and continuous cohesion experiences of the self arise from the presence, interaction, and emotional adaptation of the object. The self-object experience is a circulatory system that requires the presence of self and the object in coordination, either truly or potentially present. When this bond breaks down, the mutually adjustment system of inter-subjectivity collapses, and the sadness, despair, and collapse of the infected person follow. Although X survived opportunistic infections, it did not reduce his anxiety about AIDS, but fear of opportunistic infections. He became more and more depressed because of his

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fear of disease; he became dependent on drugs because of his fear of shaking; and he became more self-enclosed because he was afraid to speak to the world about his state. He dare not really face his fear of AIDS and triggered by psychological discomfort, he automatically closed the emotional communication channels with others, leading to business failure and a vicious cycle. There is nothing more than this in life, the common loss of the self-object needs of repairing, maintaining and regulating the core self, leading to a state of complete despair and collapse, and further the eventual collapse of X’s self.

4.2.2 Pursuit of the Self-Object Demands Over time, each person’s self experience is formed through interaction with others whose actions and responses are experienced as part of self (self-object). Self-object is an important concept that forms a responsive environment in which an individual is needed from birth to ensure that the core self can reliably develop into a mature cohesion self. Internalizing a stable self-structure requires a self-soothing experience. Parents usually tend to be providers of that experience. With the fault of parents, or the break of the self-object bond and the collapse of self of the individual in the late stage, it is necessary to find a new self-object in the living environment. Through the satisfaction of the self-object needs, we make up for the defects of the self development and the fracture of the self structure. Because the self-object is the experience of the inner and loaded emotion of others, the individual’s dependence on the interaction of the object in order to maintain the self structure is gradually reduced when the individual matures. However, each person always needs a positive self-object experience throughout his life. When they are faced with crisis, fracture and disintegration, individual adjusts, maintains, repairs and reconstructs its self structure through the acquisition and satisfaction of the self-object demand. In the field of psychotherapy, analysts often have to be the absent self-object of patients, and in the field of social work, social workers often consciously or unconsciously become the self-object of the service object in the process of helping others to help themselves. Self-psychology is born because of the emergence of special cases with stable clinical traits: unstable self-esteem, extreme sensitivity to failure, disappointment, and contempt. It is not the detailed examination of symptomology that reveals the nature of these case disorders, but the emergence of the self-object demand in the therapeutic relationship, which is the main reason why self-psychology has become an important branch of psychoanalysis. Kohut has his own ideas about the factors that shape human’s self and cause psychological change. From these broader perspectives we can glimpse his understanding of the unresponsive environment. Kohut came to the conclusion that the changing social environment of the twentieth century tried to influence human experience, not only from clinical evidence, but also from poets, artists, dramatic works and literary works such as Picasso, Proust or Kafka. Therefore,

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the inability to satisfy the self-object needs eventually leads to inner emptiness, selfloss, and self-collapse. As a result, more and more people with self-pathology came to seek treatment. For them, the core self needs to develop, and the development of core self is often based on the satisfaction of the needs in the self-object relationship. Palombo (1981) points out that in self-psychological model, the loss of self-object relationships can lead to an imbalance in self-esteem. The therapeutic theory of selfpsychology under the perspective of relationship theory is essentially the deforming internalization of the structure and function of the lost self-object, the basic goal of which is to satisfy of the self-object needs. Kohut believes that the relationship between self and self-object exists from birth to death, and if it is more precise, it is bound to be said this way: If a person in his or her life, to experience a complete and harmonious individual in the time and air, can be linked to its past, but also meaningfully towards a creative and productive future. At every stage of his life, he must experience certain characterizations in the human environment that can respond to him, provide him with idealistic strength and calm, be able to like him and exist silently, and be able to properly grasp his inner life, respond to his needs in the same way and give appropriate support when support is needed.

Looking at his views in his whole life, he believes that the self-object needs include mirroring, idealization and twinship. In the normal development process of self, the need for mirroring is understood as the need of recognizing and appreciating the ability to be competent (all-round); the idealization need refers to the need for protection and support when they are not competent and create pressure or tension; the twinship needs are also called the other me need, meaning as if it were understood by someone like himself. In this relationship, the counterpart is like himself, and the individual think that they should have the needs of a close companion by the recognition of others. Both sides experience each other’s feelings as if they were their own. And its development arises in the skills, talents and experience when the needs of the mirror and idealization have not been met. It is generally believed that when one of the self-object needs is not satisfied, it does not cause the self disintegration. Similarly, in the treatment of self-psychology, as long as two or more of the self-object needs are met, it can bring self-repair or maintain self-esteem and self cohesion, guide the improvement of the self-object, so as to reconstruct self. The course of X’s dying to live is the process of constantly pursuing the selfobject demand. In the early stages of infection, X gradually found that relying on drugs alone can not achieve a real cure because the speed of drug changes far less than that of HIV, and it is accompanied by strong side effects. AIDS belongs to the immune system disease, so in daily life, X on the one hand strengthens exercise, pay attention to health, on the other hand, he introduced his method to other infected people, both hoping to achieve a re-connection with health, but also eager to get the appreciation of others and the satisfaction of the mirroring need. However, the fight against HIV can not rely on his own efforts, X is admitted to hospital again after a year of discharge because of opportunistic infection. During the hospital stay, in addition to the active treatment of medical staff, X found that the support and care between infected people gave him a great mental motivation. When he is stressed or nervous, the care and attention provided to him by the doctors, nurses, and especially

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other infected people satisfies his idealization needs. What AIDS brings is not only physical pain, but mental burden. X increasingly realizes that, in addition to the care and help between infected people, support and understanding between friends and family members, can really find a can ememin, identify with their own others or organizations, it is more conducive to find others or organization echoing yourself to alleviate the psychological pressure caused by HIV infection, enhancing dying to live courage and confidence, and finally satisfying the desire of the twinship needs. (1) Reflexive reinforcement of the mirroring need Kohut argues that people with self flaws tend to have the need for mirroring: patients need empathy-like encouragement from analysts for their achievements in order to gain that “light in the eyes of the mother”. Wolff pointed out that Kohut used two ways to express the term “mirroring”, one to affirm several types of empathy, and the other strictly the need for mirroring, corresponding to the idealization need. Wolf thinks this will lead to some confusion, limiting the demand for mirroring in the second sense. Wolff believes that it refers to the need to rebuild self to be accepted and affirmed by the self-object. It is manifested as an analyst affirming self of the patient by acknowledging, appreciating, or praising him or her (Wolf 2002). According to Kohut, the mother-like self-object encouraged mirroring is essential to nurture children’s healthy ambition, and that the individual’s subsequent self ingredients can be bred by either parent. And this positively recognized mirroring need is essential to the development of healthy self-esteem, not only effectively functioning with self-esteem, but also achieving a higher form of narcissism, which is very important in the contribution of mankind to civilization. However, the whole field of human needs has been neglected and demeaned over the centuries, and we have a harsh description of it: “It is indecent to praise others in person.” But in clinical studies, more and more self-psychologists find that the response, applause and recognition of the same tone will bring the individual’s reflexive reinforcement, and re-guide healthy development of self. In the course of AIDS treatment and intervention, infected people often feel it a shame and full of doubts because of the stigma of AIDS. When the author surveyed in A organization, he often heard the infected people are concerned about the drug and treatment. Although the medicine is free, we also have to spend a lot of money testing, and spend a lot of time receiving this treatment, and ultimately can not give us any guarantee. I feel very ashamed and hopeless about this. So far, I have not found out whether the drug helped me, but can not randomly stop from the drug. Also, I have to face the risk of exposure. At the same time, I didn’t find out why I needed this treatment anyway, and why couldn’t I manage my own life? (the infected D).

X had the same confusion and frustration that year after contracting HIV. Everyone saw it as a flood beast, including his family and himself. He is eager to get the recognition and understanding of others, but also want to get the support and care of his family. But this desire can not be achieved even in the dream. Fortunately, he received recognition from sick friends, the mutual help between them strengthened

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his belief, and encouraged him to fight against HIV. Consequently, the reflexive reinforcement of self was strengthened. He, while receiving drug treatment, plays the subjectivity and initiative of the self, and makes efforts to manage his own life. After recognizing the immune cause of AIDS, the ambition in his self structure is strengthened and exaggerated. In order to obtain the recognition of the public, especially other infected people, in order to get rid of the stigma brought about by AIDS, but also to allow himself to live on, X attaches importance to the immune system, and makes efforts to improve his immune function to combat HIV and other viruses. In order to improve my immunity, I pay special attention to my diet. Before the infection, I basically didn’t cook at home, but now I rarely eat outside and cook good dishes. In order to improve their immunity, I adjusted their diet, quit smoking and alcohol, affect the health of food and things, and then want to eat will also try to restrain, and then want to do will give up. In order to improve my immunity, I also strengthen exercise every day: running, playing ball, practicing tai chi and so on. I eat almost every day as i ask, doing every day. At the same time, go out will wear a mask, at first people think I am afraid of being recognized by others, in fact, not, I am to avoid infection, to protect themselves. In addition, I also participated in some antiviral drug tests, eating Tang grass tablets. In short, every day on time, life is also extra regular, do their best to improve immunity, and fight against HIV.

Thus, X’s understanding of HIV has changed from a single emphasis on medical treatment to the pursuit of health. Although X himself does not realize the importance of this change, it is this change that not only causes his own changes, but also forms A organization’s important concept of intervention. X’s process to fight against HIV through his own efforts not only improves his own immunity, but also expectedly gets the recognition of others, especially other infected people, to encourage themselves to develop health and aspirations based on mirroring-needs. It is hoped that they can be modified through the real experience, thus leading to the transmuting internalization. “I tell them my own story, what I know about AIDS, how to treat AIDS abroad, and so on. In order to strengthen nutrition and enhance immunity, we have prepared a meal that is in line with our diet.” X’s self-fitness method has also been emulated by many infected people. Everyone are willing to ask X for advice when having any doubts and worries about AIDS, and X is also enthusiastic into it, tirelessly help to the infected people in need. While with other infected people, X feels that he once again proves himself to himself, but also to others that he is not only lovely, but also capable. X is still the object of admiration. As Kohut says, it cannot be imagined, as we have longed for all-powerful parent images throughout our lives, in the hope that it will be fortunate enough to be revised into a nourishing self-object. We also tend to look for omnipotent feelings of joy, in which we can control the universe again. Hopefully, this almighty sense of joy will also be fortunate enough to be revised into a healthy ambition that is a necessary part of our healthy tripolar-self. In a form where ambition is exaggerated, individuals believe that they are omnipotent (I’m great, and you admire me). Kohut’s concept of exaggeration is well suited for this kind of behavior that seeks recognition for the self uniqueness. If exaggeration can be understood as a demand for recognition, then there is no need to stir up a belief that it should be stopped at any cost, no matter how

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basic ally it contains. We can thus believe that if a human environment that responds to the needs of others can stimulate self-growth, then a sensitive acceptance of the mirroring need can open up a potential source of creativity. (2) Indefatigable pursuit of idealized needs Kohut’s concept of the mirroring demand can be seen in the ambition of the tripolarself, while the idealized demand can be seen in the ideal pole. Kohut believes that the same holding and carrying of a mother or father gives children the opportunity to experience “the experience of blending with the idealistic almighty of the selfobject”. Similarly, self components of individuals later acquired and rebuilt to obtain meet the idealization need in the support of good self-object. Kohut initially believed that the baby was trying to maintain the initial sense of perfection and omnipotence by injecting “absolute perfection and strength into the original object, i.e., the adult.” (Kohut 1966) It’s a picture of the early idealized parent imago, highlighting the close relationship between idealization and the need for narcissism. When parents inevitably let their children feel the frustrations that can be endured, children internalize the idealized quality of the parent imago they appreciate. These qualities and functions are then gradually supplemented by children through transmuting internalization. This just-in-the-right experience of frustration also helps tame and direct the exaggeration of one’s ambitions. Children’s desire to idealize their parents’ imago will also appear in therapy, as it does in life with the question: Will you be there when I need you? When I feel hopeless and helpless, can I rely on your strength and care? (Kohut 1966). X, at the beginning of HIV infection, came alone to B City. Although no hospital in B City at that time can be dedicated to treat infected people, he is still full of hope for drug treatment. Especially after learning of Dr. He’s cocktail therapy, he sold his assets and was treated meanwhile bearing the side effects of antiviral drugs. There is no denying that the drug did have an effect and saved his life several times. But the drug did not give him psychological motivation and support, and let him feel that single hope on the drug and medical staff can not let him live well. Perhaps one day, it is not AIDS that killed him, but long-term use of antiviral drugs and the fear of AIDS killed him. He acknowledged the therapeutic effect of the drug, but it did not meet his true idealization needs. On the contrary, X from their own experience, recognized that in adhering to drug treatment at the same time, the help between the infected person, promoted his pathological or psychological recovery. It’s really a kind of satisfaction that you’re there when I need you. “Several of our infected people helped each other because my skin was itchy, and in order to prevent me from causing an infection due to scratching my skin, a few infected people gently rubbed my body… Under the careful care of doctors and nurses and infected people, my rash went on, and I took some Chinese medicine, and I didn’t get hot.” Kohut first realized that a developing cohesion self was essential to the satisfaction of personal stability. He initially focused on self creative abilities and found that it was inherently inherent in the core of the individual. As Kohut points out, the main part of the psychological elements that creative people have is shaped by idealization

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(Kohut 1966). Kohut never deviated from his high comments on idealization, seeing it as a second chance to achieve the core elf after the healthy ambition was obstructed by the failing mirroring self-object. During X’s hospitalization, infected AIDS patients act as his idealized self-object, satisfying X’s search for where you are in hopelessness. With the internalization of good self-object, idealized values and power open to everyone. Whether the selfpsychological treatment, or the lucky finding of a good self-object, it seems to build a safety valve not only for self-psychology, but also for human beings. In addition, X believes that the chat and mutual assistance with patients is the most happy, and everyone’s timely and useful sharing makes them know each other, and get relief and understanding from the sick friend. With each other’s help and sharing, they have a more understanding of the AIDS and its related content, but also really alleviated the pressure and fear of the disease. They no longer feel he is the only person like this in the world, thus sense of guilt is reduced. In the interaction with the patient, X experienced the recognition and understanding from the sick friend, but also felt their acceptance of each other. And these feelings and experiences are absent since he was infected with HIV. This kind of friendly mutual help strengthened his courage and confidence to live on. In psychotherapy, the patient begins to look again for idealized images, and perhaps it took a long time before he could believe that such an icon could be found. We hope that analysts will recognize and encourage this “fragile idealization”. Patients need to feel that their idealistic expectations are accepted by analysts, and most importantly, that analysts have empathy understanding of these needs. As Basch puts it, idealization is the need to blend the reconstruction experience with a calm, powerful, intelligent and good self-object. (3) The meet-and-demand twinship needs In his third book, The Cure of Psychoanalysis, Kohut proposes a third kind of selfobject need, that is, the twinship need. Twinship needs are the need to relive the early needs that peak in the incubation period, one need to look at and understand another person who is similar to himself or to be seen and understood by someone who is similar to himself. In general, twinship needs manifest themselves as a need to look, attitude, opinion, and idea. From a development perspective, twinship relationships are associated with playmate fantasies and are important for acquiring skills and abilities. Kohut initially included the twinship need into the mirroring need, but eventually saw it as a third chance to develop the cohesive core itself, and devoted a chapter in his last book, The Cure of Psychoanalysis. The essence of the twinship self-object needs is the similarity of interest and talent, which means to be understood by someone like himself. Lothstein and Zimet point out that twinship needs meet the need to pair and to connect with other members, reducing the isolation of analysts and also supporting their sense of cohesion and relevance. Kohut’s concept of the third kind of self-object need, that is, the need for twinship relationships, is deeply rooted in a very old need, that is, the general similarity, in the ability to do good and bad things, emotions, postures and sound similarity based

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on the feeling of being a person. This basic similarity is “the roadsign of the human world we need”, and within such a sure touch, we do not need to be aware of our own needs. It stems from a good self-object with common skills, talents and experiences, most likely after the need for mirroring and idealization needs cannot be met. X’s ultimate self break-up occurred after encountering Y. Because of being selfenclosed and drug dependence resulting from hand trembling, he felt at the lowest point of life, and X met his twinship needs after encountering Y. X believes that Y is a person who can really give him understanding, support and help. After meeting Y, he had to call Y every day to sleep peacefully, and he could tell Y all about his pain and heartache. Y will also listen carefully, making X feel that in this world, Y understand him most, more than he knows himself. For the suffering of homosexuality, hatred of AIDS, prejudice of the world, he can feel alike. In front of Y, he can put his emotions directly vented, but also can get Y’s response and support. This feeling makes him very attached but also satisfied. X believes that to get to know Y for more than a decade, they support and care each other. Especially when he felt uncomfortable, Y’s presence gave him understanding and relief, and driving force to overcome and bravely face the virus time and time again. X smiled and said, “Y always says, in front of him, I’m like a kid.” “ And we can’t imagine what a person like X would be like as a child. It is also in Y’s support and understanding that X’s hand trembling problem was finally resolved. They also co-founded Organization A, and began to provide infected people with intervention. According to Kohut, the limitations confined to the mirroring or idealized needs are broken by the possibility of the twinship self-object needs, which stimulate the development of individual talent and skill, enabling him to sustain the realization of his goals (such as compensatory structures) and to help the individual. Kohut first introduced the concept of compensatory structure in 1977, which is to make up rather than covering up one of self major shortcomings. In his view, the defensive structure only serves as a cover-up, but the development of compensatory structure repairs selffunction by making up for the failure of the self-object. In case of the hand trembling problem, X once tried to escape (self-enclosed) and cover up (constantly taking psychotropic drugs), and hide worry and psychological discomfort accompanied by AIDS. And Y’s understanding and care at this time meet X’s self-object needs, meanwhile, also act as the compensatory structure related to twinship self-object needs, giving X an opportunity to become a “less traumatic self-object”. For X, Y’s existence and action is a source of true happiness, but also a silent force that exists with another self. Under Y’s support and care, X not only feels its vitality, but Y’s importance has gradually become clear. X believes that doing similar and shared work with Y allows him to experience a sense of confirmation and the joy that comes with it. With Y’s understanding of X in depth, X becomes more confident, but also dare to open up his own psychological discomfort caused by AIDS. In that process, he internalized Y into a reactive, dependent object. As a result, X achieves a cohesive self, as well as an object relationship that reaches the level of differentiation. X builds a healthy self by using such a self-object experience and making efforts.

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4.2.3 Restoration of Self Structure Based on the psychology of drive force, Freud holds that the abandonment of the object is achieved at a great cost of time and bet energy. Like the process of dying to live, X’s self moves from disintegration to reconstruction with the continuous investment of time and efforts. In self-psychological terms, the process is the process of entering the permanent self-structure through transmuting internalization of selfobject. Kohut envisions that the transmuting internalization is a development process in which the original function of the self-object is transformed into an autonomous psychological structure. Although the self-object does not have the original characteristics under normal circumstances, even mature self, as Kohut emphasizes, depends on others for the self-object experience to maintain a normal and adequate level of self-concentration, vitality, and initiative. After contracting HIV, X experienced a series of self-crises, experiencing unmanageable overstimulation involved in a traumatic state to a level of fear. By triggering a blow to self, it often looks like an overreaction to expected human mistakes. However, X is more addicted to the endless echo of over-reaction, forming a residual hidden state of trauma, but also triggering self-disintegration. It was not until the self-object needs of over-reaction were met that the self was reconstructed. The self-object need plays a key role in regulating X’s self and emotion, and then helps to construct the narrative and integrate overall structure into self. From the point of view of self-psychology, the three kinds of self-object needs (idealized, mirror, twinship) put forward by Kohut and his successors are reflected in the self-reconstruction of X’s dying to live. Warm and harmonious environment makes preparations for the self-object needs in conflict. Through rational exercise, dieting and the path to health emulated by other infected people and recognized by authority, it is reflected in X’s daily life and hospital treatment, its unique potential and talent thus recognized, The desire for mirroring reflection in the heart has been met to a certain extent. X’s desire to be satisfied with the idealized self-object needs is also reflected in the careful care of other infected people during his stay in hospital. When X caught opportunistic infection and was discharged from hospital, he again face AIDS alone, “I found that I do not like to go out, but stay at home all day. I began to feel headache, chest tightness, at first the symptoms are very mild…”. At this time, mirroring needs and idealization needs can not be fully satisfied, twinship as a third kind of self-object demand further formed X’s “partner”. Twinship needs have proved to be a need associated with another self or partner in order to reaffirm a sense of self. To clarify the similarity between the two counterparts provides the individual with the training conditions that are not provided by the two basic self-object needs. In Y’s support, care and cooperation, X can encounter and obtain the twinship self-objects to achieve the self-object and its function conversion and adaptation, and thus repair self cohesion and vitality. In the end, many of them are micro internalized as part of X’s self, becoming its enduring conscious image or being completely internalized into the fabric of self experience. The pursuit process of these three needs not only let X suffer a certain setback, but also make it get a

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moderately effective response from the setback, and benefit from the process. It not only meet X’s self-object needs, but also achieve X’s self-esteem and self cohesion repair or maintenance, and finally reconstruct the disintegrated self.

4.3 Way to Involve and Intervene in the Journey AIDS is not a problem purely solved by medical science. We should not stay in the past static medical treatment, but have the dynamics of support and care to maintain and repair the current state. Looking back at the way of X’s self reconstruction, X experienced two serious illness hospitalization from the diagnosis of HIV infection to self collapse during several years. In X’s words, one is “near death”, the other “dying to live”. Because of unbearable AIDS and opportunistic infection, his self disintegrates. It is also these experiences that motivates X to begin the pursuit of the self-object needs, and regain the self-object function lost because the self-object demand is not met, finally to achieve self reconstruction. It should be noted, however, that not all infected people go through the process of self fragmentation to reconstruction, because the absence of such needs, albeit painful, does not necessarily damage or damage the core self structure. Therefore, the successful response of infected people to HIV depends to a large extent on the structural integrity, cohesion and resilience of the core self, on whether the self-object needs can be met, and on the availability of adequately coordinated compensatory self-objects. X, after experiencing this series of setbacks and hardships, deeply realized that the needs of infected people are not only the control of HIV, but also the obtain of full support, care and need satisfied. X actively engaged in the care and intervention of infected people, began with life-affecting intervention process. In the process of dying to live, X realized that the environment in which the infected person is located and the satisfaction of their needs is very important. A mirroring, supportive and promoting self-object environment and intervention relationship not only helps the infected person with therapy, but also promotes their independence, self-reliance and social return. So X and Y worked together to create Organization A. According to self-psychology, the goal of Organization A is to build relationships and repair selves based on the crisis of the infected person, in order to maintain their structural integrity. With this in mind, the intervention focus is the intervention relationship. Aimed to meet the infected person’s self-object needs for mirroring, idealization, twinship, a empathy-based experience of understanding, interpretation and appropriate response reduces any possible traumatic events. As shown in the remarks of X: In the intervention process of infected people, the first thing to do is to make the infected person believe in themselves … At the same time, you have to join us in the team to help others, because only in the process, you can get the recognition of others, realize their own value. Second, it is to convince the infected person that we and our organization, believe in our own manager. Therefore, we adopt a life-long companion intervention model, both concerned about the life and safety of the infected person, but also care about the survival

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Volunteers in Organization A actively act as good and important self-objects of the infected person during intervention, thereby promoting the function of internalizing the infected person’s important self-objects to maintain, regulate and repair self. Then, what affects infected people to see the trainer as their good self-object, and get their acceptance and recognition. And such an intellectual as the author will really only speak the truth? What’s the real difference? In a meal with X, the author asked X further why the infected person will believe him, will believe volunteers in Organization A. X’s answer is “mindful”, which is almost equal to the word “empathy-introspection” in sociological terms. Because we are “mindful”, we really care about how infected people feel. For example, many infected people can not accurately express their feelings at first, and they tend to say, I am afraid and worried, near collapse or so. At this point, we have to distinguish what he feels. I’ve also always told our case managers to distinguish between their complex feelings of shame, contradiction, embarrassment, fear of being ridiculed, or being misunderstood. If these feelings are spoken through our mouths, the infected person will feel that they can be accepted and understood by you, and will recognize you at once. But if you don’t understand these feelings about him, or you can’t say how they feel, he’ll feel like you don’t understand me, and you’re no different from anyone else.

The author asked X: Then how can a manager know these feelings? How can your expression not be a lip service, professionally called “oral benefits” ? We need to be mindful of their feelings. More importantly, speak them out. Don’t say you can understand, and it’s easy to just orally say, but do you really understand? Can you say it if you understand? Did you say something he approved? Can it make a difference to him? In fact, our infected people have experienced too much world inflammation, but if you can do it, with that lyrics, “you give me an affirmative eye, and my love will make sense.” So, how do you do that? For example, it’s commonly believed that the infected person is to seek help, and we are to help him solve the problem. It is necessary to solve the problem, but you can’t make solving the problem a major task. I think our main task is to help them improve their coping and problem-solving skills and change old perceptions. To this end, first of all, we need to feel his feelings, and timely express them. In my opinion, your expression and response are important. If you don’t express it, or say something that’s only lip service, it’s better not to do. When you express your understanding of his experience, it is recognized by him, and when he feels that you understand him, the remaining problems are easy to be solved. He is also willing to find you to solve the problem, otherwise, he is still not at ease with you. So doesn’t it turn into a meal and a prize? (We all laughed at the time). That is to say, they know whether we are kind to them. If we are mindful, they can feel it.

The author continued to ask X: is the expression of this feeling because we are infected or are all in this circle? Not because everyone is infected, like Y, and many infected people in this circle can not do this. It is because they do not know how to understand his feelings and express it. Let’s just say Z, whom you’re more familiar with. He has been rejecting me until he became ill, when Y and I accompanied him to see a doctor. When I expressed my apologies to him that I did not experience his fear in time, so that he endured the suffering in the past six months, he cried and talked to me for a long time. When I gave him our information, I proved to him

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that I could feel his fear, and I could understand his situation. He believed that I would see him as a man worthy of good treatment, that I would listen to him and not exclude him, that I was different from those people, including the doctors in the hospital. You know, before that, Z didn’t trust anyone.

Like most people, infected people sometimes fail to express their complex feelings of shame, contradiction, embarrassment, fear of being ridiculed, or misunderstood. If these feelings are spoken by a trainer, they will feel they can be accepted and understood by others. Reasonable expression not only provides a new cognitive perspective for infected people, more importantly, makes infected people feel that they can be understood and accepted by others, so they harvest a new self-object function. For those who rarely experience the emotionally coordinated response of others, they can improve to express their own emotions if the trainer can properly express their feelings. More importantly, in this way, it promotes the establishment of relationships between the trainer and infected persons. The concepts of “moderate response” and “inter-subject vein” put forward by Stolorow et al. help to re-understand the struggle process of the infected person’s dying to live proposed by Organization A and the intervention mode of lifelong companion. In its early self-object model, Kohut proposed that, in the process of responding to the “moderate frustration” situation, self absorbed the function of the self-object into the self structure through decomposition and transformation. It satisfied the self-object need by using the process of self-object bond and internalization of its function, and completed its recovery. Bacar and Stolorow and others re-expounded Kohut’s concept, arguing that the formation of the self structure does not occur in the state of frustration, but the result of meeting the self-object needs in the context of a moderately responsive experience. In other words, they emphasize the self enjoys progressive development in a inter-subject vein (characterized by coordination and responsiveness); a trainer conveys to infected person his understanding of HIV infection, and enhances the psychological function of the infected person; the intervention relationship should be established in the process and the infected person’s self-object needs should be satisfied. If you use X’s words, it is “Do you really understand? Can you say it if you understand? Did you say something he approved? Can it make a difference to him?” A organization, based on his own experience, guides the perception of infected people, satisfies their self-object needs, helps them to positively face AIDS, and live until the successful development of antiviral drugs in the inter-subject vein, and with the right way of empathy, interpretation and moderate response.

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References Kohut, H. (1966). Forms and transformations of narcissism [J]. Journal of the American Psychoanalytic Association (2). Palombo, J. (1981). Parent loss and childhood bereavement: Some theoretical considerations [J]. Clinical Social Work Journal (1). Wolf, E. (2002). Treating the self: Elements of clinical self psychology [M]. New York: Guilford Press.

Chapter 5

Crossing the River with a Stone: The Exploration of Infecting Love with Love

Y is a homosexual, but not an infected people. Although he has not received a systematic education, he is very concerned about the support and care of infected people, but also completed a number of community care projects of global funds, and participated in the implementation of many research programmes of arts and humanities and social sciences on AIDS. He co-founded Organization A with X and joined in the care and intervention of infected people from the start. His first care object was X. Perhaps it is based on such an experience, or more based on a noninfected person’s identity, so that he has more time and energy to provide services for infected people, but also broke the circle that non-infected people can not really understand, and support the infected, and truly realize support the infected. We’ve been groping this way, and by the time we met X, he’s already revealed the identity of being infected person. Although he has not yet set up an organization, he often went to the hospital to visit infected people, tell them his own experience, help infected people to solve the difficulties and confusion, affect the infected with his own experience, encourage them to face AIDS bravely. Based on X’s experience, we feel the need to set up an organization that calls on more people to join in, thereby changing the helpless situation of infected people. Therefore, we start from X’s own experience, and explore our work from the two aspects of life support and survival care. Life support mainly refers to support for the lives and safety of infected persons. For example, many new infected people has a very low CD4 at the issue of the test result, and our organization has even encountered CD4 lower than 10. At this time, the most important thing is to help him save his life first. And for a large number of infected people, their life support starts with the spread of AIDS-related information. When the organization was first established, there was very little information about AIDS, and now there is too much information. Too little makes you fearful; but too much makes you confused about which to choose. Therefore, the first step of our intervention is to explain to the infected people a variety of AIDS-related knowledge, to help infected people to correctly view their condition. Therefore, life support is to solve the problems of infected people themselves, eliminate the confusion of infected people, enhance their courage and determination to fight AIDS (Case manager Y).

In the face of sudden situations, people will be at a loss, especially being infected with HIV. No one thought they had anything to do with the disease before they were infected, but once infected, it was a matter of life and death. Although we often say © Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9_5

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that HIV is not going to kill people any time soon, people particularly need support and care because they are just diagnosed. First of all, it is pathological. They do not understand AIDS or have many misunderstandings, do not know what kind of harm the disease will bring them. Second, they have no experience in dealing with this, and the pressures from disease, family, society and so on make them feel even more helpless. Finally, in fact, every infected person has a lot of questions about their own situation, but they can not go all the way to ask the doctor. One reason is that time is not allowed, and the doctor can’t give a detailed answer. Second, the doctor doesn’t necessarily know all about it. “Because in addition to hospitals like YD, many other hospital doctors are temporarily transferred from other departments, the level of understanding of AIDS is sometimes not as good as our case manager, and will not be like a case manager patient and meticulous, ready to consult.” Therefore, it is the first step to correctly deal with the relationship between the infected person and AIDS, explain AIDS-related knowledge, eliminate misunderstandings and worries in response to AIDS. Y continued: Even if you are not infected, any one will be heartless to go to the hospital to see a doctor. Our proposed intervention mode of lifelong companion includes accompanying an infected person to seek medical attention. For example, when you arrive here, the first you see is a companion, not a doctor, and his psychological comfort will be different. Second, you will be told what to do every step, and accompany you to complete every step. In addition, in China, doctors are always dismissive of patients. Now the attitude of medical staff in infectious disease hospitals is certainly much better, but you know, most doctors in China are very strong, giving people a sense of distance. These small issues may bring a lot of psychological burden to the infected, not to mention discrimination and privacy exposed. Well, if these infected people have this psychological burden of taking medicine or seeing a doctor, they may have other concerns in addition to the fear of AIDS itself, such as discrimination, so that they are more inferior. At this time, we act as a bridge to act as an intermediary between doctors and infected people. And the full accompanying and care of infected people covered the whole process from the beginning of being tested positive until the end of his life.

From the point of view of lifelong companion, the life support for infected people is more reflected in a kind of health support. X has said that the treatment of infected people should be carried out in line with the combination of medical treatment and social care. The intervention model of Organization A is a good case in point. On the one hand, they provide medical assistance and health support, and correctly deal with the relationship between the infected person and AIDS; On the other hand, they pay attention to the survival care and relationship change of infected persons, so that infected people really feel the right to reliance, maintenance, medical care and cure in the intervention process. Survival care is to solve the problems encountered in the lives of infected people, including giving them a certain amount of psychological support to help eliminate all kinds of worries and concerns, and to achieve a real return to society. Just like X’s problem of hand trembling, it shows that in fact, many infected people have quite large psychological pressure, but they did not finally came out with open-mindedness like X. Most of the infected people, especially those who are initially tested positive in our organization, do not need to take medicine immediately. Strictly speaking, they are real carriers of HIV. They are faced with what we call an existential crisis, and a crisis of his interpersonal relationships. In the face of HIV on

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their own body, they are often unable to cope with the collapse of the relationship caused by AIDS. Maybe his CD4 value won’t affect his life, but he may not be able to figure it out and may resort to extreme measures such as suicide, depression, abandonment of treatment, revenge on society, etc. In most cases, of course, their problems may be more moderate. For example, in the early days, may involve all aspects of life: how to talk to the family, by the school found how to do, and the neighborhood how to get along, or there are many students to get employed, that medical examination will not check HIV this one, test civil servants will not check this ah, what they want to do ah. We will help them sort out these problems and solve them in the first place. Some of the problems that he didn’t need to solve at the time, and it was no use telling him at this time. We’ll just make him feel that you have a lot of work to do. Let’s first tell him what you need to solve most, and you’ll fix it first and then deal with other issues. Sometimes, is really the authorities fans, they suddenly pour out too many too many problems, hate to say I am sorry dad, sorry mom, sorry a lot of people. This time to reduce his sense of guilt, tell him that you are sorry these people, you need to do, or you really feel sorry for them, or your self-blame. So, in the initial stage, we will provide them with some help, the workload is relatively large, the intensity of the work is also relatively large. Because this help is not a one-off, but really repeated: just like today a person new hair (new found a person HIV positive), I told him three questions, perhaps at that time listened to a little better. But after going back, he called again, asked or these three questions, I said again, said it again, he was better. Maybe a few more hours later, he called again, and that’s the kind of communication that’s going to be particularly frequent at the beginning. Then, after a while, there will be different manifestations: some will always keep in close contact with you, he will always ask you questions, and there will be some people, he gradually in the early stages can adapt, they will deliberately far away from you. Because he wants to forget this disease, but as long as he thinks of you, he will think of AIDS, is the so-called other kind of avoidance. Then at that time, to say a bad word, I know that people should be me. As soon as I spoke to him, he remembered the AIDS thing again, perhaps the usual people have a more “hi”, but As soon as I spoke to him, he remembered. Then I’ll probably talk to him about something like how i’ve been doing recently and avoiding AIDS. But I want him to know that you need to pay attention to your health, or there are things you need to pay attention to. In the middle and late stages of HIV infection, complications may occur and require antiviral treatment. At this point, the problem of life support will reappear. So, for every infected person, our case manager, to provide infected people from the initial mobilization detection of late support care such an integrated service. This person is I gave him the test, he yang (he tested positive for HIV), I am responsible until the end of life. In our view, the problem of survival cannot be solved alone, and it is often associated with many life events. So when you influence his attitude and cognition of life, it naturally changes his psychology. In other words, the purpose of survival care is to change the attitude of infected persons to life and the environment in which they live, and to improve their survival relationship. (Case manager Y).

Because Organization A has focused on the support and care of infected people, but also more concerned about the mental health of infected people. They take the form of case manager to work, for each infected person, there is a full-time manager responsible for his survival and life, so to find out a set of their own full-time companion involvement and intervention mode. Of course, the person who implements supportive care may be a full-time manager in Organization A or a volunteer. This kind of support and care, in theory, is from the beginning of positive screening, because there are many infected people are diagnosed, or after taking drugs to seek help from Organization A. Moreover, the manager will also classify the infected

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people, whether the initiative to help, or community mobilization found, from the beginning of the whole process to accept the explanation, or later to integrate into the community organization, these are different. Y says: “Our services vary from person to person. I heard you say, you want to find a mode of care, I tell you, our mode of care is to see people under the dishes, one person a model. Each of our full-time managers takes care of about thirty or forty infected people, while volunteers look at the individual’s situation and will, usually three to ten have.” (A case manager Y) and the support and care for infected people, not simply to see them as a patient, one infected with HIV, but to pay attention to the conflict and helplessness of infected people in various relationships, to realize that the lack of their relationship son-inlaw brings about the social and psychological problems of infected people, Further affect the treatment of infected people and social regression. Therefore, Organization A made a certain distinction between infected people, and different involvement and intervention methods were used for different types of infected people in different states. We generally classify the situation of infected people, and different interventions are made by a manager for different categories of infected people. If the positive screening is mobilized by us, it reflects our yin and yang integration services. That is to say, if you first screen negative, that is of course a good thing, we will introduce you to explain a lot of AIDS-related knowledge, increase your understanding of AIDS and self-protection awareness. There is also those who always suspect that they are infected with HIV, they are mainly psychological guidance. If we mobilize the initial screening is positive, it reflects the concept of our full care. And we’re in this group of people’s flow rate. Refers to Organization A to assist the CDC in completing epidemiological follow-up and investigation of infected people. Over 97%, support and care focus on gaining their trust and working with them to fight HIV. One of the most important is to accompany and explain, in many cases, the infected person is a person secretly to consult or test, the heart would have been very lonely and shy. Therefore, companion is the best intervention, and interpretation better resolves their doubts. Infected people generally before diagnosis, diagnosis, after the drug and after the disease in these stages to consult the state is not the same, to be treated differently. For example, before diagnosis, waiting for the diagnosis of the week, generally their most difficult, all kinds of nonsense, all kinds of worship Buddha. If they can gain their trust at this time, they can better intervene accordingly. We always say that this is the golden time for intervention. If at this time with the infected person to reach a mutual aid cooperation, infected people will be more cooperative, whether it is to take the diagnosis report or later on the drug and flow. At this time, infected people will often take a manager as their closest, the most lovely people, not relatives like relatives, willing to share their own various sorrows and joys. Relatively complex, it is those who have received a confirmed report. Some people get the diagnosis report, they are at a loss: began to doubt the right and wrong report, suspected that the hospital made a mistake, suspected that the test is not their own blood, also suspected that the CDC’s confirmed report was wrong, but also review is worried. At this time, your understanding and interpretation is important, you need to know what he is thinking, what he wants, and really understand where his fears are. The fear of infected people has many, some fear of death, some fear of family members know, some worry about friends and colleagues around them know can not be based in society, and there are all kinds of resentment, this is the focus of their suspicion. Therefore, the most important thing at this time is to cure the disease, explain his understanding of the various relationships around him, to dispel his concerns.

5 Crossing the River with a Stone: The Exploration of Infecting Love with Love Only in this way can we help him to accept the reality of infection and establish confidence and faith in the fight against AIDS. There is also a kind of people just think that it is finally coming, they have problems also come to consult, but often is refused medicine. Appeared in various states also always run to ask you, but once on the medicine, he felt that the earlier the drug, the faster the death. For example, last year I received an infected person E, only 19 years old, infected with HIV, has been refusing treatment. His CD4 is already in double digits, but he just doesn’t get treatment and doesn’t want to take the medicine. He was introduced by a foreigner and hoped I could help him. I contacted him three times, but also the phone is a text message, and finally he finally replied, said because I do not know anything about AIDS, asked me if I can guide him on QQ. I readily agreed, and added QQ friends. E Send a video request directly after I’m certified by my friend. I hesitated, or I agreed. I saw him in an internet cafe, coldly looking at the screen without saying a word. Worried that voice chat will be heard by other people in internet cafes, so on QQ type: “Have you been infected with AIDS?” Don’t be afraid, it’s all right. “I didn’t expect E suddenly on QQ to break the mouth scolding: “Who said Laozi has AIDS, you have AIDS!” You, the AIDS people, should have died!” I was startled by the sudden reaction, and before he could speak, he went offline. In fact, such a reaction, I have also experienced, know that this is a lot of infected people after diagnosis of a performance. Since then, as long as there is any AIDS-related knowledge, training, the survival story of the infected person, I will send to his QQ. A few months later, he suddenly on QQ message to me, proposed to meet chat, he said that was just diagnosed, the mood is very bad, want to get help and worry. Then he read the story of many infected people I sent, want to meet me to chat, I readily agreed to meet him. After meeting, E apologized to me for the last video, I said: “Nothing to be sorry, I just felt that you because of AIDS and suffered a lot of injustice and hardship, in fact, those days, the most suffering is you.” E was holding my hand and crying. We had a good chat that time. When he said that his CD4 was less than 100, I advised him to apply for antiviral drugs immediately, or he would delay his illness. At this time, his eyes were full of melancholy and confusion. He said: “I want to wait and see, in case my CD4 indicator goes up?” I’m afraid taking medicine will make me ugly, I’d rather die than take medicine! “I understand that gay people like him put their face as more important than life, and they don’t want to take the drug because of concerns about the side effects of the drug. I told him that the side effects of the drug had been greatly reduced, and he was worried about the drug statins. An anti-HIV drug, a first-line drug, has been largely phased out because of its too many side effects. Has been phased out in B city, drug use for him more good than harm. Moreover, the risk of not taking the medicine is life-threatening. But he always said, “It’s a big deal, nothing.” “Given his concerns about the drug, he was invited to come shortly after the organization of experts to give lectures on training for infected people, and I said, “If you don’t trust me, you should always listen to the doctor and the experts?” “He said yes, but on several occasions he was happy”. His reason is either not to get up in the morning, or to worry about the embarrassment of meeting a former partner. I interviewed him again, and he kept away. Finally one day, I got a call from him, and I was happy to ask him if he had decided to take the medicine. He said, recently went out a one-night stand accidentally infected with syphilis, he went to a hospital to see a doctor, the doctor said the treatment needs to buy more than 1000 drugs. He is in the hospital has not taken medicine, anxious and afraid, and for a moment he can not get so much money to come, I hope I give him a piece of advice. I said, the best way to treat syphilis is to inject long-acting penicillin or penicillin, which costs as long as a few tens of yuan and works best, but many hospitals in B City do not have this needle. Although he was recommended to a few hospitals, but thought it was a good opportunity to build trust with him, so he put down his job and took him to a hospital near the bus terminal to accompany him to the doctor.

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5 Crossing the River with a Stone: The Exploration of Infecting Love with Love After passing the skin test, the doctor successfully gave him a needle. At noon, I had dinner with him, he said very happy: “Thank you for taking me to see a doctor, but also you to break the fee to invite me to dinner.” “In hindsight, E’s trust in me was much stronger than before and he was willing to come to us for various activities. Later, in my company, we became speechless, willing to tell me his story, more willing to listen to my feedback to him, he was particularly willing to listen to the people I have been contacted over the years. In my intervention and support, finally one day, he expressed his willingness to take medicine, I was really happy, rushed to help him prepare for the procedures, but he felt that YD hospital is too far away from home, want to choose a hospital closest to home. He has not been to work, late to sleep late, living habits are very bad, if you go to YD hospital medical treatment need to get up early, he is extremely reluctant. So I helped him choose another fixed-point hospital and told him the route. He was told to contact me in time when he arrived, and he said yes, but he didn’t get a call from him until I was off work. I called him and he told me that he was still afraid of the side effects of the drug, and that he wanted to wait. Then I called him a few times to get his medication, and he pushed and even lied, always refusing to take the medicine. Until this year’s Spring Festival just after, a strange number connected to my cell phone, he, he told me, he is going to die, want to see my last face. In the strange city of B, only I know him best, I know him best, it is worth relying on him. I immediately realized that his condition was dangerous and drove with X to his house and asked HY (another case manager) to contact YD Hospital. When we saw him at his house, he was already very thin. High fever, cough, pus on your leg. When we were going to take him to the hospital, he still refused, i was very angry, yelled at him: “Don’t take stubborn character, for parents, for all who love you and you love, you must live!” “He was silent and stopped refusing”, so we quickly carried him into the car and took him to YD Hospital. He was good to pick up a life, he said afterwards, did not expect to live to the present, then thought of self-destruction. After all this, he is now living in our loving home because of our care and timely treatment, and his current CD4 is around 300. Of course, there is a direct illness or after the drug to find us, their enthusiasm is generally not high, the understanding of AIDS is more mature. In terms of intervention, it is a way to profit for yourself, and how to say it is a long-standing medical treatment. They have their own way of dealing with AIDS, their intervention, and sometimes, just to play their initiative. For example, ask them to volunteer and help themselves when helping others. Of course, most of our volunteers were infected from the beginning who received the intervention. In fact, under our influence, there have been many new small organizations, because they have benefited from our organization, but also willing to come out to serve more infected people. (Case manager Y).

The work of managers such as X and Y not only provides a way for many infected people to solve life problems, but also wants to be infected, the urgent needs of infected people, care for the survival of infected people, improve the lives of infected people, environmental and social relationships. A organization in addition to office location, despite the funding is particularly tight, or rented a three-bedroom, temporarily called “love home” this three-bedroom love home, the purpose is to play a certain degree of confidentiality, to prevent informed people to seat, to the organization inconvenience. Renting such a house provides temporary accommodation for homeless people. The room is very warmly furnished, completely by the infected person’s own arrangement and management. The rooms are equipped with computers and Wi-Fi, which provide access to relevant materials for infected people, and a special library with books on AIDS and homosexuality. On the one hand, such books can meet the needs of many infected people,

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on the other hand, because they can not buy and read such books as they please, but here they are convenient. F is such a person, and he has been married for many years. He has been infected with HIV for almost ten years and has been on medication. His daily job is to pick up and drop off his children from school, and after sending them to school, he runs to his loving home. Because he likes to read some books about gay literature, and he is not convenient to buy, buy also nowhere to see, in fact, that is, in an event, listening to F chat inadvertently said to go to the book city to read gay literature books, will always attract a variety of side views, so that he is very uncomfortable. I negotiated with X to take some of the money out of the organization and buy a number of books on AIDS and homosexuality, including many “gay literature.” In fact, such a simple act, but let F and many other people are particularly fascinated. Because F is old, the book looks slower, in other places to see and inconvenient, love home to buy books, F from now on take the initiative to take care of the children to go to school every day, send the child to school, they came to see the book, soon to the children out of school, he went away. Over and over, almost as long as the child goes to school, he will appear in the love of the home. (Case manager Y). I also visited the love home, although the house is relatively old, but the layout is very warm. The door is affixed to the duty table, the kitchen and bathroom are also clean, we have a division of labor, someone is responsible for cooking, someone is responsible for cleaning, each of their duties, orderly.

The books on the shelves are also arranged neatly, many of them are from the old book market, there are some specially purchased gay and AIDS books, many of which have been read many times at a glance, the cover is re-bonded up. Why is it dedicated to building a loving home? At that time, there were a few infected people have nowhere to go, homeless, because it is a foreigner, home and easy to expose, in the city of B, but because of the problem of disease can not work, no place to live. There are some infected people, in YD hospital is not easy to get out of danger, many of them do not have the money in YD hospital to continue treatment, and YD hospital resources are more tight, there are not so many beds for them to stay. But once they leave the hospital, they will be homeless and left unattended. After seeing these problems, Y and X decided to contribute part of the funding to provide short-term shelter for those infected. One can solve the problem of living of infected people, and second, it can also facilitate their own and other infected people to take care of each other. For the A organization, which has been stretched, it is a small expense to come up with a sum of money to build a loving home. But it is precisely because of the establishment of this loving home, so that many homeless infected people, find a basis for survival, after solving their survival problems, their lives have improved, and survived. In addition, Organization A has established a special archive to store personal and related information about infected persons. Speaking of the establishment of this archive, some chance, although not the A organization at the beginning of the thought, but they with love infected with the necessity of love. G works in a state-owned enterprise, both in terms of income and social status, because he has been in the gay circle, when there are tests, he was also mobilized. At first he didn’t think he would be positive, so, after the first screening, he was shocked, he said, his sexual partner is stable, how can it be infected? It was hard for him to accept the reality for a while. I told

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5 Crossing the River with a Stone: The Exploration of Infecting Love with Love him that the incubation period for AIDS could be up to ten years, and that it was possible that his partner had infected him. Since there is no final diagnosis, I suggest that he first adjust his mentality, wait for the confirmation report, and suggest that his boyfriend as soon as possible to do the test. At the same time, also introduced to him in detail aids related knowledge, and introduced hiv infection for more than ten years, but still healthy as the beginning of X and G mutual understanding. I found that his eyes had always been very free, his heart should be very contradictory, the sense of panic is particularly obvious. Then agreed with him, i accompanied him to get the diagnosis report, and informed him, any need, can contact me. The third day after he left, it was Saturday, which was usually the hardest day for an infected person to wait for a positive report. I sent him another message, saying that we have a painting training course, by a special art teacher to teach everyone, do not charge any fees, but also reimbursement of transportation costs. He began to be reluctant, saying that he could neither draw nor come out. Finally, in my near-death beating, he finally decided to come, late for more than an hour. But the day’s training he was very happy, between classes to listen to everyone chat together, listen to everyone talk about the experience of fighting AIDS, let him not so worried about AIDS and fear. The next day was Sunday, and he was the first to come to the course. Perhaps after these two days of contact with infected people, but also reflect on their own behavior, he may be infected with HIV facts somewhat accepted. A week later, I accompanied him to get a positive report, which was positive, and he was much calmer. Back in Organization A, I showed him a lot of things about how to pay attention to your health after diagnosis, what conditions need to be taken into medication, etc. He sat silent, holding the report in his hand, and his fingertips were almost breaking it. I suddenly realized that it might be his work identity, family circumstances and other factors that made him wonder what to do with the report. Because a series of future medication, medical treatment and so on need this report, and I am worried that he will damage this report, tear up or lose, which will bring him a great deal of trouble for his follow-up medical treatment. So I tentatively said that if you believe me, I can save the report for you. First, I’ll keep it a secret, and this report is only known to me and X; When i said that, I felt his eyes lit up, he looked at me, and looked at the report, hesitating for a long time said: “Really won’t let others know?” “In fact, that time we did not want to save the file for everyone, I just felt his concerns, think of X that year back the report running around the scene, both afraid of others know, but also worried about loss, and then I help him keep.” I pointed to the safe in the house, which only me and X can open, if you believe me, put it here. After hesitating for a long time, he decided to put it in my place. Just seal the report well in an envelope. G after the diagnosis of less than three years on the drug, the application for medicine is I accompanied him to do. I also helped him with the CD4 test reimbursement, which he felt provided him with a lot of convenience. Later, the treatment card, the medical file all put here, every time before the visit, first come to me to get a visit card, and then go to the hospital to see a doctor to get medicine. Then we wondered if we could build a file room to serve infected people who could not take home records such as confirmed reports. Although for us, there is a lot of work and expenditure, and there are no projects to support it. But we feel that this work is to be done because it benefits infected people. That’s what they need, like he needs to do something today, the CDC wants them to get information, he doesn’t use it, he gives us a call, we have these things here, we can do it for him. If his diagnosis report is lost, in the future to do anything is very troublesome, about AIDS to issue this diagnosis report, his home or shared room put inconvenient, put in our custody here for his convenience and security. But before 2009, no one put it on us because there was not that high level of trust. Now, in our personal file, in addition to the personal care record sheet, there is a copy of the personal IDENTITY card, as well as a series of inconvenient items such as the confirmation report, can be placed in his file bag, including his medical card. Because everyone is more sensitive to infectious disease hospital card, infected people are not convenient to take home, put us here, need to use the time, report his number. So far, more than 400 infected people have put a series

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of information on our organization, we have compiled a file number for each person, the equivalent of an outpatient medical record number, the staff from his file bag to take out what he needs, he used up and put it back. 50% of people put copies of their ID cards here, because it is a word of mouth between them, but also a kind of word of mouth. Last year about opportunistic infection clinic reimbursement, they do not have time, we have their information, help them photocopy directly to the relevant personnel, this thing to do. Also save infected people to run back and forth, also will not lose the opportunity to reimburse, they just call us can do. We don’t really need these things, they need them. These things, not I need to do, but only after I have done, can reflect the care of the infected people, and only do these things, he can more believe in me. (Case manager Y).

Through Organization A’s involvement and intervention of infected people, their first medical treatment behavior is basically accompanied by a case manager, unless the infected person is unwilling. For example, screening, to get a diagnosis report, apply for medicine, and even include emergency medical treatment, and so on. We have an infected person H, very thin, because there is nowhere to live, temporarily live in the love home. One morning, when he had a high fever, YJ (another case manager) called me and we took him to YD Hospital overnight. He had PCP pneumonia and needed hospital treatment, but the bed was tight and we called the head nurse, contacted the doctor, and finally arranged a bed for him in the corridor. Now, he has become our volunteer, as long as he is not busy, he will come to help, he himself also took care of nearly ten infected people. He thought it was Me and X who gave him the confidence that there would be nothing to do as long as we were with us. He often said that if it hadn’t been for us to take him to the hospital in time and contact him to a doctor, he might not have lived now. He always said that he is now a part of the effort, X is a role model, the best proof. As long as you see X is still for the organization, for the cause of AIDS, he believes that can live to the success of antiviral drugs. (Case manager Y).

Y said they have concluded that they can provide 33 involvement and intervention services for infected people, including: psychological support, free access to CD4 and viral load testing, to assist in obtaining free antiviral drugs, file management, loving home living, the first time to see a doctor, to take a confirmed report, to assist infected people to apply for low insurance, help them do a good job of drug compliance, on time to take a few medicine, urge them to continue treatment, help family positive notification, and so on. In the infected person’s positive notification, we will make a detailed assessment of the infected person in the early stage, neither vague lying, nor direct notification and let the infected person without any preparation. In fact, before the notification, many infected people have a certain degree of psychological preparation, but they are not willing to accept this fact for the time being. In forming a family member, because of the risks involved, it is up to the infected person to decide whether to tell. We will help them analyze, you tell the family what will be the consequences, you do not tell what kind of problems, you choose which way to inform the family will be more appropriate, and so on. Because after all, the privacy of infected people is still very important, the need for infected people to do their own full consideration. There is an infected i, graduated from college, at home is an only child, is in the civil servant son before the medical examination, came to us here to find out. His health is still better, he came to us to ask what to do. Because the civil servant’s medical examination, will certainly test positive, but if not, he can not explain to his parents. In the eyes of his parents, he is a very good child, his parents have high expectations of him. He didn’t know exactly how to tell his parents that we had analyzed the pros and

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cons with him for this. As it turned out, his parents would accept him no matter what, but he needed to determine how to tell his parents, which would make them more receptive and more at ease. We’re here to help him practice how to tell his parents (I say, you’re a roleplaying). Yes, it’s role-playing. Because his parents loved him very much, but also relatively strong, he worried that he could not be very accurate in their intentions. So, X and I, in your words, have played the role many times, in which he played both his parents and himself, assuming all kinds of scenes, mimicking all possible situations. He practiced for a long time, and had decided to go home to inform his parents, but suddenly backed down again. He felt that we should go home with him. Because his home is in the northeast, we work very much every day, it is difficult to find time to accompany him for a few days. Finally, he decided to use the phone to inform, to see the parents’ reaction before the next step. On the day of the phone call, he came to my office early and wrote all the things he had to say to his parents on paper, asking me to read it and revise it. And, when you’re on the phone, make sure I’m there and sit right across from him. He was not so much a hands-free phone call to his parents as my other companions, and I was always ready to help him organize all kinds of manuscripts, pacifying him and helping him. In this case, he finally told his parents about his HIV infection, and asked me and X to testify to his parents, AIDS is really long-term survival. Later, his parents came to see our organization and see how long X could live so long. In the words of his parents: “With you, I’ll be at ease.”

In fact, for the survival of infected people, there are many jobs by the A organization of a manager to complete. Including food and clothing, what needs attention, what is affecting the health of infected people. For example, you can’t stay up late, because it will reduce the CD4 of the infected person, destroy the infected person’s immune system, resulting in a decline in immunity. Therefore, Y will tell the infected people, from the various aspects of food and clothing should protect themselves, but also will tell them that even if you and the average person’s CD4 number is the same, but the quality of CD4 will be different, and the law of life is very necessary and beneficial. Y will also tell them how to identify some opportunistic infections and how to avoid some opportunistic infections. This communication is readily available and runs through the individual’s entire process from infection to end. There is also an aspect of our lifelong companion in the hospital, I can directly go to serve those who are more in urgent need of services. For example, in the hospital, many patients admitted to the hospital for infectious diseases, may not let the family know, on their own in the hospital alone, may be more busy medical staff, this time, we can help them well. For example, clinical care this matter, because the nurses are basically female, some male infected people have done some surgery, or the body is relatively weak, he is not convenient to go to the toilet and other issues, we can help. These problems seem to be small things, but significant for the infected, we have seen, some infected people, not to mention infected people, some patients sick in hospital, his family came, but also from afar to see on the go. When X was paralysed in bed, he would have not had the courage to survive had it not been for the help of other infected people. So, our service is sometimes very small, but full of love. For example, we say that many infected people to take the drug when they dare not take the medicine, it is possible to feel that once taken the medicine, that is a lifetime thing. Because every day need to take a little medicine on time, in case you forget how to do, will not be found by others what. They will have more psychological burden, and then will worry about going to the hospital, the use of health insurance will not be found by others, will not be hit by relatives and friends, they will have these concerns. So we’re going to try to help them allay these concerns. We will work with infected people: such as drug compliance training before taking the drug, medical check-up reminders after taking the drug, and as they begin to take the drug for a period of

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time, they need to do frequent physical examinations, starting with half a month, then one month, two months, and so on. At the same time, we will also open up infected people, as far as possible to give them more humane care, in order to ensure their health. For example, drug compliance, you can’t say the doctor said, you have to eat, but he does not eat, this situation, I will tell them, eat why good, do not eat, why not good, but also eat on time. Tell him that the state has privacy protections for infected people, with dedicated clinics, wards and green channels, to allay their concerns. (Case manager Y).

Y always said that AIDS involvement and intervention is not to love. AIDS was called “AIDS”, and now many organizations will use “love” as the name of the organization, such as love home, love home, love home, love ark and so on. A organization in the involvement and intervention, but also stressed the love, love and treasure between infected people. They use love to pass on love, love to infect love, and to nourish love with love.

5.1 Support and Cure by Empathy Freud first described empathy as the feeling into another person. Freud’s position on empathy transited from his surgeon-like indifference in 1912 to his understanding of compassion in 1913, and his embrace of empathy in 1921. Freud made it clear that empathy understanding was the only way to make it possible for us to express any opinion about the spiritual life of another person. Kohut adhered to the psychoanalysis method of empathy for a lifelong time, and he also defined empathy as the most important method of psychoanalysis. Until his death, his last article (1982) “Introspection, Empathy and Psychoanalysis: An Examination of the Relationship between Observation Patterns and Theory” is also devoted a great deal of space to talking about empathy, which he holds is the basis of psychoanalysis. Not only does he describe it as an understanding of another person’s self-object needs, but he also sees it as “a strong emotional bond between people”. Kohut once sharply emphasized the concept of experience-near empathy (Kohut 1959), which was cited by the anthropologist Geertz in interpreting the native’s point of view and became famous in contemporary social science. And he thus launched his exploration of self-psychology, which is also his last message in the last paper. Kohut further points out that empathy is a kind of gathering of information and resources, also a necessary prerequisite for success in achieving the same tune. Empathy is therapeutic. He stressed that if the mother wanted her response to her child to be positively experience by her child, she needed to be in the way of empathy. He went on to emphasize that in clinical experience, empathy itself, simply the emergence of empathy, is beneficial and has a wide range of therapeutic effects, not only in clinical settings, but also in human daily life. Wolf, in his functional division of empathy, suggests that it has a supportive function for self, which, while a by-product of empathy, enhances the cohesion of the patient and increases his or her self-esteem and well-being.

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The development of modern medicine provides strong evidence for therapeutic effects of empathy, especially in the basic defense of the body—much scientific evidence left a deep impression on us the effective role on the immune system. Beginning in the 1970s, researchers have found more and more complex connections between the hypothalamus of the perric brain, the target region that brings together our perceptions, and our immune systems. Simonton’s use of guided imagination and belief to focus on white blood cells to destroy cancer cells. It has yielded exciting results. In particular, patients survive after being diagnosed with advanced cancer. Doctors offer a way to guide the imagination and execute it, and the resulting hope seems to activate the part of the immune system that destroys cancer cells. So, the researchers found that feelings of helplessness, whether in humans or animals, slowed the immune system, while feeling the attention, care and help of others stimulated the immune system. There are increasing medical questions about the relationship between personal feelings (including self-perception) and the cause and effect of a deadly disease. Herbert Spector, a neurophysiologist who worked at the National Institute of Health, points out that it has long been known that patients’ own attitudes are important to their recovery, but modern medicine sees them as trivial. The new study clarifies the fact: attitudes matter (The New York Times, 22 October 1985). Thus, there is growing evidence that empathy has a positive effect on the treatment of diseases. This is consistent with Kohut’s final conclusion, which comes from Kohut’s experience working with his patients and has long been confirmed by other analysts: empathy itself has benefits and effects for those who receive it. The findings suggest (and the latest research supports) the immune system is most dynamic in an empathy, and stress-free environment. In his book The Cure of Psychoanalysis, Kohut argues that the intervention methods of psychoanalysis should be carried out in two steps: one is to allow the patient to experience the feeling of being understood again and again, and the other is the interpretation following, which Kohut calls “the basic unit of treatment”. The so-called understanding, according to Kohut, refers to the process of guiding the analyst to grasp the analysis of people’s thoughts, emotions, and communicate with the patient in these regards based on empathy. The interpretation, or more accurately, the interpretation of the intervention made by the analyst, is also based on empathy. Kohut is to further demonstrate that analysts have fully understood the patient, and that it is a further extension and deepening of empathy. Understanding and interpretation is to give the analyst a correct dynamic analysis and the re-reconstruction of phylogenetics, and to internalize self-object functions played by the analyst into the self structure and function through transmuting internalization, so as to meet the analyst’s self-object needs, forming a healthy, integrated and continuous self. During the survey in Organization A, the author not only conducted an interview with Y, but also participated in the observation of managers including Y of care and support with love. Because the biological properties of HIV itself is to destroy the body’s immune system, and then cause individual opportunistic infection and lead to the crisis of life. Although managers of Organization A do not realize such theories and methods like empathy, they start from their own experience, support and help infected people to meet their self-object needs. In the survey, the author found that

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the intervention process of managers emphasized understanding and interpretation, set in place for the sake of the infected people, think what they want, anxious their urgent; The implementation of two-handed grasp, both hands should be hard support care line, to help infected people better deal with HIV, out of a response to the DEATH of HIV virus love road. With their own love to infect, move every one who comes to seek help for the infected, in the practice of helping people to serve as a simple infected person “good self-object”, invisibly carry out a combination of understanding and interpretation of empathy the healing of support.

5.1.1 Understanding the Dynamics of Therapy (1) Having access to medicare: understanding promotes the internalization of the self-object Using an empathy approach, Kohut discovers that people diagnosed with borderline personality disorder are able to establish the specific self-object connections he needs with the analyst when he feels that his age-old subjective state is understood by analysts. In other words, the empathy approach of self-psychology seems to offer a possible way to save the most serious pathological conditions. Kohut argues that psychological distress should not be seen as a disease in particular, but rather as “a stop in the search for a new spiritual balance”. Mr. and Mrs. Shane further suggested that the loss of self-object needs meant the miss or loss of narcissistic support. They point out that in order to address the loss of self-object needs, it must be met through empathy response. They believe that by understanding feelings and internalizing good self-objects not only can effectively compensate for this loss, but also can alleviate self trauma and the failure of the self-object need, so that the self can carry on and recover. Similarly, the AIDS population is of course far less serious than the people of borderline personality disorder in the severity of psychological distress. But in real life, they are always on the edge of life and burdened with varying degrees of psychological pressure and mental illness resulting from AIDS. Their circle of life is peeled off, they are in a society that 谈艾色变, and they experience the threat of HIV and opportunistic infections. In order to protect themselves, but also to protect their families, they had to close themselves up and became marginals. There is a lack of support and care of others for their inner world and emotional life. They not only look forward to the cure of AIDS, but also search for a spiritual station to calm their mental state. Therefore, managers in Organization A, including Y, use empathy, and put forward the intervention mode of lifelong companion, and act as a good self-object of the infected person. It not only produces a good understanding of the situation and feelings of the infected person, but also broke their worry “in fact, you do not understand my fear”.

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The lifelong companion mode is based on X’s previous illness experience, reflecting support and care of one life affecting another. It is based on the painful experience of X that we think of the situation and crisis that infected people may face now. Starting from X’s own experience, we explore the idea of working from the two aspects of life support and survival care… We propose a full-time companion involvement and intervention model, which includes accompanying infected people to seek medical treatment. For example, when you get here, the first thing you see is a companion, not a doctor, and his psychological comfort will be different. Then, every link will be told what should be done, the first time will accompany you to complete … Most of China’s doctors are very strong, let people have a sense of distance, from these small issues, can bring a great psychological burden to infected people, not to mention discrimination and privacy exposed. Well, if these need to take medicine or need to see an infected person, they have this psychological burden, may let them in addition to the fear of AIDS itself, there may be other fears, such as discrimination, so that they are more inferior. At this time, we act as a bridge to act as an intermediary between doctors and infected people. And for the infected people’s lifelong companion and care, but also covered from the beginning of the sun until the end of the whole process.

Y and X intended to do their best to help infected people cope with various difficulties and crises with the lifelong companion mode. But it is this companion that plays a great role in support and treatment, and even changes the understanding of AIDS of infected people. They make efforts to move towards the “dying to live” process. Self-psychology holds that if the analyst uses the term “self-object”, it means that the analyst ultimately has a task to try to become a good self-object of the patient. The damaged self of the patient indicates the lack of his or her self-object need. So if the analyst accepts this request, it means that he will try to understand, as the analyst is unbreathing, that it is needed and used for development, a healthy emotional oxygen of his own. Meanwhile, he will try to fill the void as a stranger. “At this time, your understanding and interpretation is very important, you have to know what he is thinking, what he wants, to really understand where his fear is, the fear of the infected people there are many kinds, some fear of death, some fear of family members know, some worry about friends and colleagues around know can not be found in society, there are all kinds of resentments, That’s what they suspect.” Thus, once the case manager becomes the needed and desired provider for the infected, he can not only alleviate the suffering of infected people, but also help them generate hope through our lifelong companion. While meeting the minimum requirement to keep an infected person alive, they also provide them a sense of satisfaction. Like all those who meet needs, a case manager tries to meet the needs of every infected person to soothe themselves. For example, when learning that many infected people, including F, may have difficulty reading books related to homosexuality and AIDS, they took out a portion of the funds to buy a batch of books. Meanwhile, they provided a place for free reading for the infected people. This practice not only meets the needs of F and others, but also unites the organization’s centripetal force, winning the infected people’s recognition. And considering I’s fear of telling the family his positive notification, X and Y help him to play role-playing in

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their own office, and accompany him to inform their parents of his own infection by phone. Because of prior full preparation and repeated exercises, I’s parents accepted the fact that their son was infected with HIV, and came on a special trip, take a look at our organization and see how X can live so long. In the words of his parents to case manager Y: “With you, I am at ease!” It is also because Y keenly noticed that G’s fingertips were almost breaking the confirmed report, that Y realized that perhaps his work and identity, family environment, etc., make him not know how to deal with the report, then tentatively put forward the recommendation to keep the confirmed report for G. And this understanding with empathy as a prerequisite is extended to all infected people receiving intervention help, and provide archival care services for the infected people, relieving the worries for many infected people, including Modell found that analysts can provide implicit satisfaction through their stable, trustworthy, and unique perception of the patient’s identity. It can be seen that satisfaction can be seen as an integral part of empathy understanding. The various support and assistance provided by a case manager for an infected person invisibly turn himself into a potentially good self-object to the infected person, which happens to be the one the infected person has never had before. Especially after they are infected with HIV, they are often faced with the fracture of relationship and lack of support. The support and care of a case manager is similar to the internalization of self-object found in the treatment of their patients by Kohut and his colleagues. It can be seen that a case manager acts as a good self-object in the “dying to live” involvement and intervention of the infected. In fact, case managers not only have an empathic understanding of the hard life of the infected person, but also provide them some revised goal that can be achieved. For example, case managers encourage them to strengthen physical exercise and adjust the diet and living, so that the infected people have hope and help them reduce the fear of AIDS, enhance self-confidence, and relieve the constant mental pain. The lifelong companion model proposed by Organization A establishes a long-term cooperative intervention with infected people. The case manager works with the infected person to construct an active management model. This model focuses on the independent arrangement and management of the infected person’s affairs (exercise, living, taking medicine) and the tolerance of the resistance that comes with their fear. Whether it’s HIV infection that causes an overstimulation to an infected person, causes them to feel a great shock, arouses their anxiety, degenerates into a state of self-protection and avoidance of self-collapse, or anger, fear and despair brought with discrimination, concern and inaction by doctors, friends and family members, and the public, all these are the reasons why their self-objects are trying to build up a high wall of resistance. A case manager must imagine what it’s like for the infected based on his personal experience and empathic understanding, and what he needs to provide for the infected at the moment. Just as the author can try to imagine what it would be like for a dancer not to live on dancing, but because the author is not a dancer, he may not be able to imagine how the loss of such expression harms a person’s selfesteem. However, if the author can imagine what it would be like to lose a precious skill, for example, the ability to speak and read as a scholar, then he can imagine what kind of loss and anger it is for a dancer. Here the author’s concern is not the

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loss of experience or career, but the loss of creativity, which is precisely the true empathic understanding. Only on this basis can a case manager (though he himself not necessarily know the name of this method) have a better chance of becoming the good self-object that the infected person has long been looking forward to. Organization A, while maintaining the lifelong companion, also provides ward visiting services. Case managers will visit the wards of YD hospitals on a regular basis, regardless of whether or not they receive the involvement and intervention services of Organization A. By communicating with those infected and accepting every infected person, “we never ask them why they are infected unless they are willing to express it, but for us, we are intent on helping them” (a case manager Y) to express our understanding-based experience. “And more often, we listen to their voices. When it comes to sadness, a case manager and the infected person will always be in tears” (a case manager Y). At this time, coordinated listening is a kind of empathy and understanding, expressing a coordinated response to the emotional state of the infected person. As Stolorow said, we look for experiences in our own emotional experiences that match the emotional experiences of the patient, and the most important thing is to be with the patient to make him feel the companion and understanding. Of course, we also help them with some daily routines, such as medicare and underinsured reimbursements and applications… In the hospital, many patients admitted to infectious disease hospitals may not have let their families know that they are alone in the hospital. Maybe the health care provider will be busy, and at this time we can help them well. Also because the nurses are basically female in the clinical care, we can be helpful when some male infected people complete their surgery, or their body is relatively weak, or they are not convenient to get up to the toilet, etc. These issues may seem trivial, but they are of great significance to those infected. (case manager Y).

The actions of case managers or someone else make the infected person feel that they are no longer abandoned, but they are dignified. When X was “paralysed” in bed, he did not have the courage to survive without the help of other infected people. So, our service is sometimes very small, but full of love (case manager Y). Now, recognized and supported by YD Hospital, weekly visits to the ward to visit infected people has become a routine of Organization A. And understanding-based experience for the infected can indeed play a role in regulating the body and mind of infected people. Every Tuesday afternoon, it’s also the most lively time in the YD hospital’s infection department. We talk to infected people and tell them the stories of many other infected people, especially those who have been hospitalized here. Like Xiaofeng, his affairs has progressed in the past few days. Xiaofeng was rejected by the hospital because of HIV infection, and later obtained the success of the operation by modifying the medical records. After the Xiaofeng incident was reported in the media, Li Keqiang, the then vice-premier of the State Council, met with Brother Hu, the main advocate of the Xiaofeng incident. This is a landmark event for the operation of an infected person. When we tell it to the infected people, it brings great encouragement to everyone, and constantly someone clapped hands. We will listen to the interaction and sharing between infected people. (Case manager Y).

It is in this situation that we encourage the infected to express their thoughts and worries, and expressions and responses of a case manager accordingly reflects the

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understanding and support. In the author’s opinion, does this not reflect the empathic understanding of self-psychology? This ward visit and understanding-based experience changed the history of no visits in the infection department, also warmed many heartbroken infected people for lack of visit and companion. The case manager’s understanding makes them experience the feeling that they are still cared about. To put it simply, there is a firm belief that there are people who really care about whether they are alive or dead. It also lets the infected people realize that as long as there is a ray of vitality, they should strive to survive. The author believes that this is the basis of empathy. After diagnosis, the infected face the exclusive family, medical institution and society due to their misunderstanding. The accumulation of similar experiences strengthen their belief that there is no hope. And a case manager’s understanding makes infected people reach a very important consensus, that is, the cure of AIDS is promising. Through understanding, a case manager accepts every infected person with sincerity, accommodates their concerns with love, ignites their hopes with confidence, encourages everyone to be always grateful, and helps them aim to have fun in life and improve the quality of life. The understanding-based experience, to a certain extent, reduces the physical and mental pain of the infected, and then stimulates their motivation to survive, and ultimately contributes to the formation of a solid and cohesive self. In addition, the understanding can also effectively solve many psychological problems in combating HIV. For example, the problem of medication can not be simply equal to resisting treatment, because many different problems will arise. A case manager can not be generally advised them to take the drug. Because some hide the fact that they are infected, so it is not inappropriate to continue to take daily medication; some are worried about the side effects of drugs, for example E, seeing face value more important than life, worried about that the drug will make him ugly. Others are worried about that regularly getting medicine in hospital will reveal their identity, and so on. Therefore, only after understanding their confusion, can they be remedied to dispel their concerns and to solve their problems. In short, the involvement and intervention mode of the lifelong companion proposed by Organization A provides care and support for the infected through the expression of understanding-based experience. Their needs are understood, also their difficulties and fears are shared. The case manager, acting as and transmuting into a good self-object, helps them achieve a cohesive self and further to have access to medicare, realize self support and recovery. (2) Having access to proper care in sickness: the satisfaction of the self-object needs through understanding Understanding, as a unique human ability, allows one person to feel the spiritual life of another and try to care for it, and on that basis, try to participate. In a broader sense beyond treatment, empathy is what we all need when trying to feel and understand the spiritual lives of others, including those who are close to us, strangers, and every infected person.

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Understanding is a satisfaction in itself when we define empathy as beneficial to specific therapy. Case managers in Organization A not only provides support and help essential to life for the infected person, but also strives to improve their survival environment and social connections, and tries to help them reduce anxiety, low selfesteem, sense of helplessness, and feeling abandoned by the loved one. All these help them alleviate some of their pain and restore hope for the future. For example, when X and Y rented a loving home, it is because they learned that the infected have nowhere to go, in a homeless situation, and felt that the infected need a love hut of their own, leaving themselves take care of each other, thereby improving their survival and living environment and finding their own belonging. They can realize their own value in each other’s care, and get the recognition of others and the satisfaction of their own needs. For example, J moved direct from the hospital to the loving home, when her condition was stable, but no family members visited her from hospitalization to discharge. X and Y saw this in the eyes and kept it in their mind. Worried about that J was self-absorbed, they brought her to the loving home, and asked her to take care of everyone’s living. J was greatly encouraged by this, not only keeping the loving home orderly, but also guiding other infected people together to exercise and prescribe regimen. Considering the inconvenience of the infected person carrying the drug, she personally woven a small portable bag containing the drug, which later inspired a project of the Global Fund. The author had the honor to meet J who came to the meeting at the loving home. She sets up an organization serving the female infected in her hometown. She says: “At that time, I thought that HIV infection is a very humiliating thing, so it is right she was abandoned by the family. But it is X and Y accepted me, also gave me a heavy responsibility, and let me rekindle confidence in life.” Based on understanding and trust of X and Y, J not only completed the task, but also gave full play to her subjectivity. She won the affirmation and appreciation at the loving home, and met her mirroring need “I am omnipotent”. As a symbolic change, J not only expressed warm thanks to X and Y, but also stopped abandoning herself, and threw himself into similar work. When J felt that X and Y were more reliable in understanding her as an empathic self-object, and when she became more confident as a result of X and Y’s understanding, she naturally began to think about the satisfaction of her self-object needs. In the process, she achieved a cohesive self, as well as a differentiation level of the object relationship. X and Y was internalized as a mirroring and dependent self-object. The practice of Organization A is based on the idea of empathic understanding, and in a sense, they are spontaneous in providing an empathic understanding of the infected. Y said that 33 care services could be provided to infected people. It is through the empathic understanding and care that they gain their trust and establish a good cooperative relationship. It is this understanding and care that help infected people to strengthen confidence in fighting against HIV, and win the recognition of infected people. “The most important is to accompany and understand. In many cases, infected people secretly consult or do testing, they feel very lonely and shy. Therefore, companion is the best intervention, and explanation better resolves their doubts in the heart. At this time, infected people will often take a case manager as

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their closest and most lovely friend, not relatives but like relatives. They are willing to share their own various sorrows” (a case manager Y). For example, H, an infected person living in the loving home, caught sudden PCP pneumonia at midnight. Case managers Y et al. rushed him to YD hospital, and applied for a temporary bed in the corridor due to lack of beds in hospital. H thought it was me and X who gave him the confidence that there would be nothing to do as long as he was with us. He often said that if it hadn’t been for us to take him to the hospital in time and contact him to a doctor, he might not have been alive now. He always said that he was part of the effort, and X was a role model and the best proof. As long as you see X is still busy with the organization and the cause of AIDS, they believe that they can live to the success of antiviral drugs. (Case manager Y).

“Living to the success of antiviral drugs” said by X has now become the Survival target of many infected people in Organization A. It may sound a little out of reach, but it reflects the infected person’s trust in a case manager, and the confidence of “dying to live”. Obviously, it is the understanding and care of case managers such as X and Y that not only gained the trust of the infected person, but also saved their lives many times. Many infected people even list case managers as their emergency contacts. When they are under pressure and unexpected events beyond control, they can get the help of a case manager and meet their idealized needs through the case manager. In the involvement and intervention, the lifelong companion and understanding of the infected person by case managers give them access to delve into the fundamental problems, enhance the understanding, feel the fear of infected people and their hopelessness to trust others again. E is a typical example. Y and E’s first meeting was on the network, when E was just been diagnosed. Y’s goodwill inquiry directly led to E’s slur. When they met in City B, E apologized to Y for his rude QQ chat. Y said: “There was nothing to be sorry, and I just felt that you bore a lot of injustice and hardship because of AIDS. In fact, you suffered badly in those days. Hearing these words, E was holding my hands and crying.” (case manager Y) Y’s words directly close the distance with E, and continued contact since then, especially Y’s active help with E to consult medicine, understand his concerns, and be concerned about his health, finally gained E’s trust. All these let E feel that in this strange city B, only Y knows him best, understands him most, is worthy of his dependence. Although twists and turns appear during the whole involvement and intervention of Y to E, Y tries his best to meet E’s various needs, and ultimately saves E’s life, because Y is well aware of the contradictions, helplessness and fear of E in this stage. So, as Brandchaft discovered, Kohut’s approach really offered a possibility, and a developmental approach to avoiding the tragic impasse in the negative therapeutic response. By understanding E’s rage and the great fear of abandonment behind the rage, Y develops E’s ability to trust others, and to rely on a case manager as a trustworthy self-object, realizing the desire of an infected person to have close companions and to meet their needs of twinship self-objects. With the case manager’s understanding and care and the lifelong companions, the infected saw the possibility of developing altruism, and their cohesive self finally get into empathy and start growing again. At the same time, the infected found that he

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is not alone in this need. All these benefits will be strongly linked to the experience of a case manager, so that their self development off the right track re-open or redirect, pointing to a healthier, and more productive direction. As a result, the infected have gained understanding and recognition, and his mirroring, idealized or twinship needs are also recognized and met. Self-psychology emphasizes the primary role of self-object needs in the self experience. The self-object function is essentially to integrate the self-object needs into the self experience structure; in all stages of life, the core of the self-object needs is the need for coordinated response to the self-object function. It is through the self-object experience that the selfexperience one is clearly expressed. Self-objects play their function of differential experience, which is curcial to a complete self-structure, and help infected people to develop and maintain the self-object relationship. It in turn provides stability, cohesion and vitality for the self experience, giving the infected access to proper care in sickness.

5.2 The Interpretation of the Healing of the Occurrence of Reconstruction Like traditional psychoanalysts, Kohut values the role of interpretation in the healing process. In his final speech at the Fourth Conference on Self-Psychology in 1981, he said that the most important insight in the psychoanalysis healing was that analysis was ultimately cured by giving interpretation. Because analysts are able to build empathy-based connections with patients, understanding the internal world of patients will become more accurate and rapid. On the basis of understanding, Kohut believed that analysts must move from understanding to interpretation, from showing that he was at tuned to patients’ inner life, feelings, thoughts, and fantasies, to the next step—interpretation. Only when analysts interpret their inner experiences and emotional responses can the treatment succeed. As a result, Kohut describes the development from understanding to interpretation as a move from a lower-level form of treatment to a higher form of cure. Anna Ornstein (1984), in her collaboration with Kohut, also repeated that self-psychological approach must begin with empathy and try to understand the complex emotions of patients. Only when an analyst succeeds in establishing himself as a patient’s needed and accepted self-object through empathy analysis, can he go into the next step—interpretation. Interpretation is the reconstruction of the psychological response and the internal conflict of patients. Kohut believed that the process of interpretation was essential, and without interpretation, empathy would be incomplete. That is to say, the reconstuction not only psychologically deepens the patient’s understanding of himself, but also makes him trust the truth and reliability of the empathy. Then it promotes the understanding and co-construction of the self-object experience between the analyst and the patient, satisfying the self-object needs.

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The Freudian school positioned the therapeutic role in interpretation, which was largely conceived as a cognitive process through which analysts passed new knowledge or insights to patients. Relational theorists emphasized that therapeutic role existed in the new experience that analysts and patients build together in their relationship. For self-psychologists, the therapeutic effect was generally thought to stem from the provision of the self-object needs, which met the developmental need stoicness of the patient. Atwood and Stolorow argued that interpretation was a solution that analysts communicate to patients in its universal sense. On the one hand, by conveying to the patient his understanding and interpretation of cognition, the analyst’s cognitive insight is transmitted into the patient’s psychological function through the interpretation program; on the other, it is emphasized that the therapeutic effect comes from the self-object experience making the patient feel understood. The two aspects are equally important and inseparable, and together they form the interpretation of healing. In the involvement and intervention of infected persons, organization A, based on X’s experience, puts forward the lifelong companion mode of involvement and intervention, including life support and survival care. In terms of life support, the analysis and narrating of a case manager corrects the wrong understanding of AIDS, constructs a new understanding of “dying to live”, achieves a re-understanding of selfunderstanding, and improve the psychological function of infected people. In terms of survival care, the case manager’s verbal and non-verbal interpretation response changes their wrong attribution, alleviates their fear and resistance of to AIDS, enhances the emotional connection with the individual case manager, and obtains the understanding and experience useful to the infected. The co-constructed self-object functions meet the three aspects mirroring, idealization and twinship needs, forming a unified self-structure. (1) Having access to medical treatment in sickness: interpretation leads to a reunderstanding of self-understanding Wolf had a very broad definition of interpretation. He argued that the interpretation includes meaningful activities that analysts generally brought to the patients’ psychological changes. This change might be better (i.e. therapeutic), but it might also be unsuccessful or even anti-therapeutic. The interpretation activities included in this definition referred to speech statements and any other involvements and interventions consciously directed by analysts, which was why the psychological world of the infected changed. It is clear that Wolf believed that therapeutic interpretation is experienced by patients as an involvement and intervention that is targeted by analysts. Case managers in Organization A often pay special attention to the properties of AIDS, emphasizing that AIDS is a “chronic disease which can be controled by continuous take of drug”, emphasizing “living to the success of antiviral drug research and development”. The emphases have become the motivation of many infected people to live. Its purpose is to eliminate the one-sided understanding of and discrimination against people infected with AIDS. It is also to let them firmly believe that: AIDS to

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some extent can be equated with heart disease, diabetes and other chronic diseases, providing an 发生学 analytical framework for infected people to correctly respond to AIDS. On this basis, by telling their own personal experience or the real events around, case managers not only strengthen the confidence of the infected to accept involvment and intervention, but also alleviate the infected’s concerns about AIDS and its opportunistic infection, especially for complications. For example, Y always said X aggravated the disease because of self-doubt and negation, fear of the disease causing hands trembling. Finally under the support and care of Y and many infected people, X really realized the de-specialization of AIDS, and symptoms of hands trembling brought about by fear of the disease also disappeared. “The most important thing is to take medication for the disease, to interprete to the infected the understanding of various relationships around him, and to dispel his concerns. Only in this way can we help him to accept the reality of infection and establish confidence and faith in the fight against AIDS.” (case manager Y) What case managers do is to change the past experience of infected people, to liberate them from the past sacrifices, and to bring them new awareness. Through the interpretation of case managers, new cognition is accepted by the infected as a meaningful idea of their internal experience, and many infected people are relieved, especially those with suspected conditions. Consequently, they have a feeling of being understood. Of course, every case manager of the Organization A will not forget to interpret the life meaning of HIV infection. Three months after X lived next door to the morgue, his proposal of “dying to live” has become a new interpretation of life by case managers in Organization A. They always share a passage from X with the infected: In fact, HIC infection is not exactly a bad thing, perhaps the extreme lys, I have never valued health, value life. Isn’t it said that AIDS should be regarded as a gift of life? Infection only found that AIDS is a touchstone, it tried out of my circle of friends and relatives, but also changed my circle of friends and relatives, but also changed my attitude towards life. Let me be more cherish life, rather than as before, think that everything does not matter. I sometimes feel that only now, is to enjoy the beauty of life, my wish is to live healthily to the success of antiviral drug research and development.

In the research, the author found that a case manager has never forgotten to pass the “dying to live” belief to each infected person. That is, a new life experience with HIV strengthens the courage and determination of AIDS population to live, interpreting the meaning of life after HIV infection. Although this is not the operating standards required by Organization A, and Organization A has never had any operating specifications, the understanding and conception is deeply rooted in the hearts of each case manager. If a case manager’s interpretation has a therapeutic effect, it shall provide a new experience that is deeply understood by the infected person. The interpretation and communication of a case manager helps the infected enjoy a new or enhanced cognitive understanding of AIDS and life. This not only provides the infected person with previous experience, but also promotes the possibility of self-understanding. When the unfathomable past and the troublesome present become understandable through interpretation, a re-understanding of self-understanding is created through

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new experiences in the context of original self-object relationships. And the new selfunderstanding promotes the historical sense of self-continuity, making the structure of people’s current experience meaningfully linked to past experience. Many selfpsychologists have also elaborated on the importance of the therapeutic effects of this experience. Stolorow believed it was reflected in that the tuned interpretation arouses and enhances the patient’s experience. Buirski and others made similar claims that any interpretation of a new cognitive understanding had been found to have therapeutic effects. In other words, the new cognitive understanding not only satisfies the desire to be understood, but also performs the function of understanding all human life experiences, and promotes self-understanding, self-contouring, self-continuity, and self-cohesion. (2) Having access to medical treatment in sickness: interpretation contributes to the common construction of the self-object functions Some self-psychology critics mistakenly assume that the therapeutic effect is primarily to provide an empathic understanding of the patient. As a result, they have dismissively concluded that self-psychology is a superficial treatment because it is only another version of an untrustworthy corrective emotional experience. One of the reasons why critics fail to grasp the richness and depth of self-psychological treatment methods is that it is difficult to realize the self-object functions through interpretation and to satisfy the self-object needs. The essence of healing, Kohut once said, was to increase the psychological structure by providing the patient with a moderate frustration of his needs or desires with the right interpretation. In accordance with Kohut’s view that the healing process evokes moderate frustration and transmuting internalization, Bacal et al. suggested that the healing process involved a corrective self-object experience. Psychological distress stems from the desire for primitive development, and through the repair of the desired self-object bond, the thwarted developmental desire will be re-mobilized in a safe and coordinated self-object relationship. Therefore, the internalization of the patient’s self-object experience (the experience of promoting individual selfintegration) was the essence of those “correct” and “therapeutic” experiences in the course of treatment. Buirski and others further pointed out that the role of interpretation in the self-psychological treatment is precisely in the enhanced cognitive understanding, the experience of feeling understood, and the realization of self-object functions. This coincides with the views of Atwood and others. In the lifelong companion of the survival care of the infected person, the interpretation is not only a method, but also an art, reflected in the involvement and intervention relationship established by a case manager and the infected person. The lifelong companion cannot do without one-on-one interview between a case manager and the infected. The goal of the interview is to deal with self-blame, fear and other frustrations experienced by the infected, and to establish a coordination and cooperation mechanism to jointly combating AIDS by giving full play to their subjectivity. Through the common discussion and reinterpretation of the frustration, adjustment and repair of the fracture of the self-object relationship caused by negative

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emotions, they form the self-object experience based on the understanding of case managers, accepted by the infected person himself, to promote and internalize the rich self-object functions of case managers, and meet the self-object needs development. Because AIDS has its particularity, infected people often face legal, moral and ethical criticism. It is often seen by the public as “dirty disease” or “shameful disease” and so on, so HIV infection is often considered to be immoral or voluntary. Thus, it increases the public condemnation and negative emotions of AIDS population, exacerbates the existing stigma, so that infected people contribute to psychological problems like low self-esteem and self-incrimination. At this time, you have to change their wrong attribution of AIDS, in fact, these perceptions are not all from themselves, more public ity is misleading. Therefore, it is necessary for us to work with them to focus first on the experience and feeling of the injured person infected, rather than the public’s evaluation of him… Sometimes, it is true that the authorities are fans, they suddenly pour out too many too many problems, showing a strong self-incrimination and self-blame. For example, K, he diagnosed after he said to me: “I’m sorry dad, i’m sorry mom, I’m sorry a lot of people.” “That guilt is obvious. This time to reduce his sense of guilt, tell him, I can understand your helplessness in the face of the world, but I can more appreciate your self-blame. I hope you can re-harvest the trust of others through your own efforts. HIV infection should not be the end of life, like X, it should be another starting point in your life. And I hope that in the process, we can work together. (Case manager Y). It can be demonstrated from the above-mentioned remarks Y can understand k from the perspective of the infected person, more accurately explain and interpret K’s current emotional experience. Y is not only concerned with K’s self-blame and attribution, but how to turn K’s self-blame into self-confidence. Y’s purpose is to change the negative attribution of the infected person, and work with him to construct a path of exploration of self-confidence growth through emotional coordination response. And it is this process that satisfies the desire of the infected person for the mirroring need. In other words, the case manager focuses on the process of cooperation between himself and the infected, rather than the result. The case manager encourages the latter to play their subjectivity in face-to-face conversations. In the discussion between a case manager and an infected person, the interpretation constructed from the experience of them is a belief system. Infected people accept the interpretation of a case manager, which is experienced as a personal significance to help AIDS population reconstruct themselves. In Organization A, the author also has contact with many infected people, especially those who are initially positive or newly diagnosed. They believe that they have been convicted of chronic death, often manifested in a strong sense of fear and being endangered. They fear the disease itself: fear of the adverse effects of various treatments on their bodies, fear of the symptoms caused by the disease, and their fear of the resulting death, especially in loneliness and pain. Meanwhile, they also have fears about the spin-off spawning of AIDS: fear of the high-cost treatment, fear of the pressures that may come from the surroundings, fear of being abandoned by their families, by relatives and friends, and by doctors. These fears surround the AIDS population, so that they are overwhelmed and sleepless.

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At this stage, the method of a case manager is to express their feelings of fear to the infected, so that the infected person can be emancipated from the despair, stigma and fear. The case managers will first solve his most urgent, most fearful, and emergent problems. Through the interpretation of these problems by a case manager, the stereotype of the infected on AIDS is changed and their conscious concept and false perception can often be mitigated. More importantly, in the interactive communication with the infected, a case manager will respond to the needs of infected people in a timely manner. Their joint efforts can respond to AIDS and its accompanying diseases and fears in a timely and effective manner, and arouse the infected’s selfaffirmation. However, it is much more difficult to change conscious or unconscious attitudes and anxieties that are transferred from past experience. For example: L, after the diagnosis, could not accept the fact of HIV infection. He was even sick of the word AIDS and others could not talk with him about the word AIDS. At this time, I found that L formed a shield by showing a lot of fear and evading the word AIDS. To put it bluntly, he was not willing to face the reality but willing to hide in his fantasy environment. So I turned to talking to him about health and the realization of self-worth. Because he studied art, I invited him to our organization to teach the infected to paint and to participate in our sports activities. He accepted it in the end. In the course of his contact with the infected, he felt the joy of being helpful and respected. I remembered when he gave a lecture, he first blurted out the word AIDS, but he did not know. In the course of our interview, I pointed out his progress, and he realized that he had been reluctant to admit his fear of AIDS. (case manager Y).

It can be seen that the common construction and interpretation with L on the experience of fear makes L realize that his fear played a role as a shield, avoiding the indifference to HIV infection, and forming a protective armor against a threatening world. This fear can protect AIDS population to some extent in their early survival, but the exclusion of a case manager and other good self-objects is not conducive to their long-term development. At this time, the lifelong companion of a case manager who is consistent, kind-hearted, good at listening and non-morally inclusive can work with the infected to construct what he sees as fear. It will passivate the fear of AIDS people and meet their hopes of timely help and understanding to stand in his point of view to understand and interpret his fear, also to explain the reasons behind this fear. Since Freud, psychoanalysts have questioned whether pure language interpretations can have therapeutic effects. Buirski et al. believed that nonverbal interactions were also of considerable importance for therapeutic growth. Considering the original structure of conscious recognition and revaluation of experience and the emergence of new organizational principles, non-verbal expressions are also an important part of interpretation. By expressing subjective experience to patients through non-verbal interpretation, psychoanalysts provide a vital self-object function that promotes the integration of self cohesion and emotional experience. In the lifelong companion of the infected, the case manager is not only an observer expressing opinion, but also a responsible actor in action and interaction. In the interview, the author found that the lifelong companion meant working with the infected in the fight against HIV. In this process, the infected and case managers are connected when the latter also

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took the initiative to assume part of the responsibility, and made the former have an effective experience. This experience is completely opposite to the expectation of always feeling helpless and powerless, not only enhancing the self-confidence of the infected, but also greatly reducing the pain and stigma. The verbal and non-verbal interpretation meets the infected’s desire for mirroring and idealizing needs. In addition to the fear of AIDS itself, there is a special fear, the so-called impedance. As Wolf emphasized, it was not the patient’s fear of himself, his sexuality, attacks or other impulses that initiate resistance, but the repetition of past experiences around him. The rejection and impedance of an infected person is mainly manifested in the refusal to accept medication. For those who refuse to accept medication, to be honest, it is their experiences here or there that cause dismay. For example, many infected people dare not take the medicine when they need to do so. They may feel that taking the medicine is a lifetime thing. They need to regularly set the target to take medicine every day. They will have more psychological burden like: In cases of forgetting, how to do it? Whether it will be found by others? Whether the use of health insurance will be found by others when going to hospital? Whether they will meet their relatives? So I’m going to try to reassure them. (case manager Y).

However, these concerns often echo the previous life experiences of the infected. To change their concerns requires case managers to make joint efforts with the infected person. For example, compliance training before taking the drug, accompanying infected people to apply for drugs, find a doctor to take medicine, check-up reminder after taking the medical. In the early stages when they take the drug, we need to remind them of frequent physical examination, every half a month, every a month, or every two months, and so on. Of course, it also includes the measures you should do if you forget to take your medication, and so on. In response to the medical concerns, we will also give our suggestions, tell them that the country has privacy protection measures like supporting special outpatient clinics, wards and green channel for infected people to reduce their concerns. (case manager Y).

At the same time, there is a need to change the frustrated developmental needs, and change the principle of organizational experience of infected people. Through interpretation, their understood self-object experience is satisfied. M was diagnosed with CD4 less than 350, and he showed a blank face for the future, saying he didn’t know what to do. He was the first time to experience such a big thing, he is not afraid of death, just feels god is not fair to him. They just think that if someone told him sexual behaviors between males will lead to the infection with HIV, perhaps he will not be infected. But at that time, no one told him. I noticed that M always attributes the problem to the outside world and does not consider how to deal with it in terms of his own initiative. I went on to say, so if God now gives you another chance, it is to accept our support and care, to exercise more, to eat a reasonable diet, and, if necessary, to receive antiviral medications, would you like to? a lot of people say that. M said that he felt there would be a lot of side effects after taking the drug, and it’s going to make people dependent. and someone would take us all under control. These remarks were of course a fallacy, and I didn’t believe them. At this time, I thought, the attribution of HIV infection by M was not necessarily that no one had told him, but just he did not believe, or he had a hint of luck, thinking that one or two sexual behaviors between males might not

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be so coincidentally infected. It’s not just his performance, but the common phenomenon among many gay men we’d been exposed to. Of course, at this time, I didn’t talk to him about whether to learn of the route of infection, which was probably his life experience. And what I cared about was whether he was willing to accept my intervention and to take the medicine, whether his current refusal to take the drug was also based on such a lucky psychology. The reason why he was not willing to take the drug was that perhaps he felt he was not so unlucky and his CD4 would come up. So, as a professional, I todl M, the drug didn’t have so many side effects that you heard of. If you did not want to take the drug, then, when you faced an opportunistic infection one day, you would be regretful like today. If someone had told you that you would be infected with HIV for homosexual behaviours, maybe you wouldn’t have. Similarly, if you listen to me, the likelihood of an opportunistic infection is reduced if you choose to take intervention and medication. M didn’t defend himself any more, and I knew he believed me, he asked me a lot about the drug, he received our training in drug compliance, and after half a month, I accompanied him to complete the application. (case manager Y).

In traditional psychoanalysis, interpretation comes from a one-man position, and analysts are authorities about the truth of the patient’s internal experience. Nevertheless post-modern thought emphasizes the co-construction of personal meaning, and attaches importance to the accuracy of interpretation. It is on this stage that different views of historical truth and narrative truth are seriously opposed. It is well known that Freud pursued the truth of history. He used archeological methods to seek to unearth buried subconscious layers and reveal the true memories of past experiences. An important tool for exploring the past is interpretation or origin reconstruction. However, modern relationship thinking abandons the concept of historical truth and supports hermeneutics and constructivism methods. As Mitchell put it: Patient’s experiences, associations, and memories can be integrated or organized in countless ways. The resulting organizational structure is a kind of double creation, partly shaped by the analysis of human data, but inevitably by the analyst’s thinking or theoretical model. The significance of clinical data does not exist until it is named. This meaning is not discovered, but created.

Buirski et al. pointed out that, from this point of view, there is no point in using the criterion of accuracy for interpretation or explanation. The interpretation made by the analyst to the patient represents the analyst’s experience on the subjectivity of the patient, which is filtered through the analyst’s subjectivity, including the analyst’s theoretical system. Interpretation is the product of context, and it is formed in the analyst’s heart in that context. Therefore, the interpretation constructed by the case manager and the infected is not the expression of some kind of objective truth about the experience of the infected, but a way for the case manager’ empathy with the infected in this moment, this place, and this context. This particular experience is bound to change with the change in the context of involvement and intervention. In hermeneutics and constructivism, interpretation is not about the 逐步趋近 of the patient’s past truth, but about the analysis of the current subjective empirical sttructure. In the process of interpreting an infected person, the meaning of interpretation to the infected depends on the selfobject function provided by the concept. We judge the clinical effectiveness of an interpretation or analysis, not by approaching a certain standard of truth (for example

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the real cause of HIV infection), but by whether the infected person finds that the interpretation has personal significance (whether not to accept the drug will repeat the original infection). It is a meaningful interpretation of the infected person, and a new way of leading the infected person to construct their experience, that is, a new co-construction interpretation to promote the realization of the self-object function. In the survival care stage, infected people often have no ideal self-object, so others can not meet their missing self-object needs. Consequently, it brings about some kind of disintegration of the self, accompanied by fear and worry and other negative frustration emotions. In the involvement and intervention of the lifelong companion by a case manager, he who cares about and understands the infected person plays a good role as a good self-object, promoting the establishment and connection of the involvement and intervention relationship between the infected person and the case manager, meeting the self-object needs of the infected person, and then improving the self development. The case manager’s continuous empathic inquiry builds an interpretation, so that the infected person deeply appreciate a kind of satisfaction. From the depths of self main world, the infected person weaves this empathy experience into its unique mobilized self-object desires, which restores the frustrated development process. At this stage, the role of interpretation is to provide this self-object function, to meet the self-object needs of the infected person, and through it to resume the treatment process. Thus, interpretation plays a role at two levels: one is the cognitive level; the other is the development level. A case manager’s new cognition of AIDS and life is absorbed by the infected, and then was internalized into their self-understanding. Moreover, in the course of actual involvement and intervention, the two levels are not separated, but are tied together. Interpretation can deepen and consolidate the therapeutic effect of empathic analysis. Through the interpretation of a case manager, from the perspective of 发生学 to further consolidate this structure, so that infected people in the process of dealing with AIDS can actively face and understand this stage similar to the inner experience, in the joint efforts with a case manager, not only give full play to the selfservice brought by a case manager, and to develop and improve their own structure To form important psychological functions. It should be pointed out that in the method of treatment under empathic analysis, understanding and interpretation is not so clear-cut as discussed above. On the contrary, in the actual process of involvement and intervention, they are usually combined and staggered. It is precisely because the analyst’s understanding from time to time, or sometimes interpretation, brings the patient the feeling and experience of a moderate response, the patient satisfies their self-object needs and achieves the cure of psychoanalysis.

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5.3 Effects of Moderate Response If empathy is the process by which analysts understand patients by turning to their inner world, a moderate response is the actions that analysts communicate their understanding and interpretation to patients, based on the treatment of the relationship between analysts and patients (Bacal 1985). The concept of optimal responsiveness here was developed by Bacal through optimal frustration, whose origin is unclear. For now, Kohut is the first person to use it in psychoanalysis. Kohut and Seitz define optimal frustration as an experience that is essentially related to experience satisfaction in the course of treatment. It can thus be argued that the empathic understanding and interpretation between analysts and patients inevitably leads to manageable and minor non-traumatic failures, leading to the failure of the patient’s mental state and needs to obtain timely and accurate observation and satisfaction, thus causing frustration in his heart. Kohut named these failures as optimal setbacks, which he said were beneficial to the growth of the patients, as it triggered them to transmutingly internalize the self-object functions that had been played by the analysts to form their complete and healthy self structure. Kohut puts optimal setbacks at the center of the transmuting internalization process and as the essence of the analytical healing process. After Kohut, many of self-psychological theorists criticized the concept of optimal frustration and developed other concepts that more accurately reflect how the cure occurred to replace optimal frustration, the most important of which was the concept of “optimal responsiveness” put forward by Bacal. Bacal put forward the concept of optimal responsiveness on the basis of optimal frustration, which is that the moderate response refers to the analytical response, and has the most important therapeutic effect in the context of a particular patient and its disease (Bacal 1985). Bacal argues that optimal responsiveness is an analyst’s effort to communicate his understanding and interpretation to a patient. Because there is a fundamental tendency toward growth and development in everyone, a moderate response from a self-object analyst opens a new path for the patient to satisfy his experience. In analytical contexts, harmonious or reciprocal resonance occurs between the analyst and the patient, who feels understood by the response. “At the moment I really understand what’s going on in the patient, and I know he really understands what I’m doing (Bacal 1985). The accuracy of empathy insights of analysts is confirmed by patients’ expressions of analysts’ current psychological activity. The process of the transformation of the analyst’s function into that of the patient begins. From their point of view, this interaction is moderate, and the analyst satisfies his needs in such a appropriate way, a process that is itself therapeutic. In Bacal’s view, the common healing factor is the patient’s experience of a moderate response to the analyst, a feeling that is deeply understood, a feeling of reducing frustration and tension, and a feeling of satisfaction. At the moment the quality of the therapeutic relationship allows the analyst to confirm that his response is available to the patient, thus establishing or

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restoring a harmonious self-object relationship and meeting the individual’s selfobject needs (Bacal 1985). Bacal argues that this is also the implicit assumption underlying all psychotherapy efforts, whether psychoanalytic or not. In the process of self-psychological analysis, understanding the relationship between analysts and patients is becoming increasingly important in the analysis. The countless repetitions of the two steps of empathy (including understanding and interpretation) and moderate response have realized the patient’s eventual transition from the early primitive self and self-object connection to the higher form of self and self-object relationship with the normal connection of adult life. In self-psychological terms, the analyst’s moderate response must correspond to the patient’s self structure, self-defect and inadequacy degree, and be aimed to meet the self-object needs of the patient. Organization A’s lifelong companion of life support and survival care for the infected features a case manager’s response, in addition to the understanding and interpretation of empathy. Moreover, their response was moderate and effective. People often feel overwhelmed when faced with unexpected situations, especially when infected with HIV. Once infected, it is a matter of life and death. Although we often say that HIV is not going to kill people soon, many people will feel extra confused and fear, often will also have escape, desperation, resistance and other acts when learning the fact of being infected. First of all, they do not understand AIDS or have many misunderstandings, like pathological aspects of what kind of harm the disease will bring them. And each infected person has many questions about their own situation, but they can not go all the way to ask the doctor. One reason is limited in time so that the doctor will not give you detailed answers; the second is the doctor not necessarily understands. Because except hospitals like YD, doctors in many other hospitals are temporarily transferred from other departments, many medical staff do not know much as the staff of Organization A. Therefore, in the intervention process, we are professional, leaving the infected person believe that every case manager in our organization are professional, and can give a professional, comprehensive response and answer to AIDS-related issues. Therefore, the first step of our intervention is to help infected people understand a variety of AIDS-related knowledge, to help infected people to correctly view their condition. Infected people should realize that AIDS has now become a controlled chronic disease, to achieve the de-specialization of AIDS, and to eliminate the fear of the infected people.

It can be seen that the case manager’s response to the infected person is first reflected in his professionalism, with professional knowledge to respond to the problems of infected people. And it is this professionalism and timeliness that get the recognition of infected people often from the very beginning. Because in the eyes of infected people, the response of a case manager is useful and moderate to them. Second, because infected people do not have the experience to deal with this, and the pressure resulting from the disease, family, society and other aspects will make them feel more helpless, and they are full of fear of the future. We tend to choose live examples around us to respond to the fear of the future of an infected person. Perhaps the doctor and the infected person will say that AIDS is nothing, including you may say a lot of big truths, but we, only tell the infected people the example around, such

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as X and Z and so on. Let infected people realize: believe in yourself, adhere to medication, strengthen exercise, often pay a visit to the organization, do not have to fear AIDS, will live as well as X, or even better than X. (case manager Y).

At this time, case managers including Y will use the language and action more close to the infected person, to respond to the helplessness of the infected and to make them confident. The infected are convinced that they can do what others can do. Because HIV infection is a very shameful thing, many infected people secretly come alone to counseling, testing. AIDS people often hide their infected identity, and they are more sensitive than other groups of people, perhaps without paying attention will hurt the infected people, and break the trust and intervention relationships that are not easy to build with the infected. Therefore, Organization A put forward the intervention mode of the lifelong companion, with a dedicated case manager to provide patient and meticulous care and support for the infected person. Infected people can consult a case manager, and ask for help at their convenience. This is a companion and a moderate response to an infected person. For example, for many infected people initially diagonized with a positive test, a case manager needs to help them to sort out whether it is a life crisis or affect the survival of all kinds of problems, to help them reduce their sense of guilt, and each infected person to maintain close contact, at any time to accept the infection of the consultation. For example, sometimes the infected person forgot to take the medicine, maybe it was 9 p.m., but he still will call you, or need you to tell him what to do. Of course, because many of our case managers are infected themselves and need a reasonable break, we will make it clear to them at the beginning of the intervention work, such as 11 p.m., you have an emergency, how to do, can come to me. My phone is turned on 24 h. That’s why many of those infected by Organization A’s involvement and intervention are their own case managers, and many infected people (like E, H and Z) are sent to the hospital with their own case manager son and I in the event of a sudden illness. (Case manager Y).

Bacal believed that the concept of self-object need could be effectively retested on the basis of the concept of moderate response. Since the goal of the self-object need is to forge the connection with the self object, it can be better understood as the creative aspect of the demand. In fact, this is true for almost every infected person, but this is especially important for individuals experiencing opportunistic infections. Among these infected people, they often experience severe pains and sufferings and loss of an interpersonal relationship, their self development has been seriously hindered. These infected people sometimes create what Bacal calls fantasy selfobject around a core character, but its original idealization or mirroring function has little correspondence to the infected person’s previous experience. The emergence of a case manager and the establishment of a full-length companion relationship comprises the compensatory structure of the broken self of infected person, restore and develop the infected person’s self, especially the commitment “when you are in need, I will be there to recognize you, accept you, support you, and care for you” (a case manager Y). A moderate response from a case manager to an infected person throughout the journey can also effectively relieve an extremely painful state of mind felt by an infected person and increase the pressure on them to cope with the particular vulnerability of HIV infection. In this way, the infected person may begin to develop trust in

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a “good enough” self-object; in this way, a moderate experience of the infected person to a case manager can occur; in this way, the infected person can apply that experience to the repair of self structure and the new structure of it can be built. Wolfe has described the method of moderate response as follows, and the decision to respond correctly to the analytical requirements (which are extremely subtle or direct to experience) should depend on a correct understanding of the current analytical context and the genetic context. It is therefore no different from any other analytical understanding or involvement and intervention. Whether to accept or reluctantly comply, whether to firmly refuse or not, or not respond at all, these decisions are among the elements of the analytical analysis of the full understanding of the analysis process to use the choice of action. Wolf Winnicott expressed similar thinking earlier, noting that the real function of analysts is not to provide a correct interpretation, but to respond to the appropriate and effective understanding of their analysts. Y is to see E so pay attention to their appearance, Empathy his true belief to live may be for the person they love, so, in the emergency before the hospital roared “Don’t take stubborn character, for parents, for all who love you and you love, you must live!” (case manager Y) The effect of moderate response to E worked, and E eventually stopped refusing medication. Winnicott also suggested that some patients have satisfying early experiences that can be found in response, and the early experiences of others are flawed or distorted so that analysts are the first in their lives to provide some kind of environmental necessity. There are great differences between the two types of patients. It can be seen that moderate response exists in any analytical context, including, of course, interpretive analytical therapy. In the recognition of X’s hands trembling is caused by its anxiety about AIDS and opportunistic infection, but also to their own as an open identity of the infected person, but aids scared to appear hands trembling problems, and finally have to need to use drugs to maintain, Y to X hands trembling response, accurately explained the reasons for X hands trembling and suggested X open-mindedly face their own hands trembling problem Not only did X get rid of its dependence on drugs, but it also managed to overcome the problem of hands trembling. It can be seen that this kind of good self-object of the moderate response, in the infected person’s own anxiety or self-despair, through the understanding and interpretation process to be expressed, to promote the infected person through the transmuting of internalization of the self-object function internalization of a case manager to make up for their own psychological structure, the formation of a healthy integration of their own. In most cases, though, these responses are communicated primarily through verbal interpretation. However, the fundamental response is to touch the heart of patients, and really meet their mirroring, idealizing or twinship needs. The response should also be diverse, not a “well, yes, I understand your worry and fear” and so on, or not limited to the oral expression of interpretation. In the book Self-Psychology: Theory and Practice, White and Weiner present a case in which Sandra kneels on the carpet next to the phone when calling her new boyfriend, holding the analyst’s hand in one hand and the phone in the other. In this case, they all need analysts to express their response to empathy by touching their body. Empty nipples for patients by Kohut, a

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blanket for Beth by Carlton, a bottle of beverage for patients by analysts to address their psychological needs like thirst are responses that cannot be provided by verbal interpretations. Lucyann Carlton, the current president of IAPSP, has spoken about a case she has analyzed. In the analysis, her patient (Beth) asked her to hold, hug, or circle her, and she said a long way to explain the request, but to no avail, finally, came up with a way to solve the problem, and she helped Beth find a blanket with smooth texture. Finally, Beth took the blanket away and left a message: “I held the blanket tightly and it comforted me”. In the involvement and intervention of the infected, when it comes to sadness, there will always be a case manager and infected people together crying with tears; when it is inconvenient for the infected to enter the washroom, there are case managers to help them; when the infected suddenly fall ill, case managers will always send them to hospital. And these responses give the infected to make sure once again that they are not alone, and that if they pursue anything they want to do, the case manager will not leave them alone, and will respond appropriately to any reasonable needs of them. Overall, if the response of case managers in Organization A is moderate, then their efforts will be to promote the growth of infected people. As involvement and intervention (self-object relationships) mature, the self of infected people becomes stronger, freer, more flexible, and more resilient. However, while understanding and interpretation is the primary means by which a case manager delivers a moderate response to an infected person, it is not sufficient or appropriate in every case. Therefore it requires a long-term process, which reflects the philosophy of lifelong companion emphasized by Organization A from the beginning to the end of life.

References Bacal, H., & Newman, K. (1990). Theories of object relations: Bridges to self psychology [M]. Columbia: Columbia University Press. Bacal, H. A. (1985). Optimal responsiveness and the therapeutic process [J]. Goldberg Arnold Progress in Self Psychology (1). Kohut, H. (1959). Introspection, empathy and psychoanalysis: an examination of the relationship between mode of observation and theory [J]. Journal of the American Psychoanalytic Association (7).

Chapter 6

Self-restoration in Relationship Co-construction

6.1 Subjective Feeling of Helping Themselves and Others Z was diagonized with a positive result in March 2012. He had heard of AIDS before, but always felt that it was a “distant ghost-like thing, heard but never seen”. He simply did not believe that AIDS was so close to himself. In his words, AIDS phamphlets used to be like a flyer in the park, noticed but never read. People may never realize that HIV is around them. December 1, 2011 was the 24th International AIDS Day, and the theme of the year was “Taking Actions and Getting to Zero”. As usual, many AIDS organizations and agencies carried out AIDS-related campaigns, with no exception of Organization A. Its work included AIDS prevention and exhibition, free distribution of condoms and rapid detection of HIV virus (hereinafter fast testing) and so on. Z was tested positive in the fast testing. I happened to be in the nightclub, and the fast testing is given for free as a gift. In the hustling and bustling of a group of friends, I did the fast testing, but the results were positive. At that time, because the error rate of rapid detection is still relatively high, the staff suggested that I do further blood testing, that is, initial screening. I directly rebuffed. When X learned that I had rejected their blood testing, he came over and handed me a business card and said, “Whenever you have any needs and doubts, you can call me at any time.” (Infected Z).

Z was not happy in the Spring Festival of 2012, because the result of the fast testing made him nervous. Considering his experience, Z began to be worried about whether he was infected with AIDS. Although there is no physical discomfort, there are still many speculations inside his heart. The thought of the result made him restless. He consulted much AIDS information on the network, and found that the complex variety of information had him puzzled. When he saw the question of the fast testing, he was happy, hoping that he was one of those misdiagnosed; when. After struggling for months, he re-purchased a mobile phone card and dialed X’s phone, hoping to protect his privacy while doing counseling and testing. X told me that the blood-drawn screening was completely anonymous and free, and that I could just leave a cell phone number to inform the results and name. If the © Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9_6

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initial screening is negative, there is no need to be worried about this; if He suggested that I should start with an initial screening so that it would be safe for myself and my family. Because their organizations can draw blood, I didn’t have to be worried about the risk of exposure. (Infected Z). Z took X’s advice because X’s phrase “to myself, to his family is safe” moved him. So, Z chose to take a leave of absence on a Wednesday morning, and he thought Wednesday should be the time when the least turnover in the A organization. He was “fully armed” to go, walked to the A organization near, put on the ready sunglasses, masks all put on, dialed X phone. X personally picked him in, although he had a certain understanding of AIDS, but still took a deep breath, after going in, he said: “At that time even breathing is extremely careful, for fear of contracting HIV.” “ I remember talking to me a lot about AIDS”, about treatment, about survival and so on. In fact, the most impressive, on the contrary, he as an infected person, not only his own very healthy, but also in that meeting, he has received several phone calls, not infected people call edgy, is to arrange this arrangement for the organization that, always kept busy. In particular, a foreign infected person called for help because the local doctor did not know about the drug, the infected person has suffered severe liver damage (injury) and continued to take Nevirapine (an antiviral drug). X advised him to talk to the doctor, explain his situation, and ask for a change of medicine. If the local capacity to change drugs, X recommended that infected people come to The City B, he is responsible for contacting the YD hospital doctortor to change medicine, and repeatedly reiterated the importance of the change. I thought he was very professional, from the use of antiviral drugs to life after contracting HIV, he could do anything. More let me feel that AIDS does not seem to be as terrible as imagined. Also, I’m still likely not to be infected. In this case, I decided to do positive primary screening. However, despite my constant prayers, I was unable to change the fate of the positives. X suggested that I have a positive diagnosis, because this is to send the diagnostic laboratory, about a week before the results. I thought to myself, this time is really over, the inner heart of that trace of luck also disappeared. And many infected people are not the same, they yang, have thought, will not be the hospital wrong what, I knew that moment, I can not run. Later X told me a lot, and I didn’t listen. X said he would help me send the diagnostic laboratory, i do not have to worry, more nutrition and exercise, adjust the mentality. If you have time, come to their activities. But the news of the diagnosis laboratory was rejected by me, because at that time I knew That I was infected, no longer need to do anything to confirm, not to ask them for help, no one can help me. AIDS is a terminal illness, but also my reward. (Infected Z) We often say that the authorities are obsessed with bystanders. When Z is still hopeful that he will not be infected with HIV, the mental state is optimistic. He not only secretly admires X’s omnipotence, but also to a certain extent broke the stigma of AIDS awareness. At least in his eyes, X’s appearance is not the stereotype of the infected person’s thin, dying state. However, once he learned that the primary screening was positive, he determined that he was infected. The perception of oneself and AIDS has changed dramatically, and the thoughts of fear, despair and death are constantly flashing in the mind. In fact, on the way

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back, I think of death. I thought I was very strong, the early stage of AIDS also have a lot of preparation, but did not expect to wait until the diagnosis, afraid to die. I was like, “Now there’s a car accident, let the car kill me.” I can at least leave a sum of money for my parents and a fortune. After getting out of the car, I ran home desperately, and i sat there in my eyes all the time. I eat a large daily meal, can eat two bowls of rice at a time, but that day I ate a total of half a bowl. Then I said to my mother, “No one will move after this bowl, I will use this bowl.” “My mother saw it and said, “What’s your problem?” What’s on your mind? “I said, “Nothing.” “My mother said, “No, you’re not a small thing.” Because from small to large, I have not seen you have this kind of face. “When I finished, I said, “It’s all right. “Back in the bedroom, I started sorting my stuff and wanting to leave my parents some money so they could get through their old age. I would not tell them, just want to die alone, I hold such a mood (Infected Z). The days of learning about the positive initial screening have been extraordinarily long and have been a torture for Z. Fortunately, X often called him, or sent QQ messages, and chatted with Z, easing his anxiety. Chat content would not basically turn to the topic that he might be infected with HIV, but X could chat with Z for a long time. X told Z about his experience that he lived next door to YD hospital morgue for three months, that he had been carried to the hospital, that the original medicine was the kind of medicine like flushed coffee hard to drink, but now these conditions have improved. He is in good health at the moment, and it’s not as scary as people think or the media advocates. Now the drug is also relatively simple to take, and the side effects are much smaller than before. AIDS has become a chronic disease, not different, in essence, from diabetes and hypertension. Z felt relaxed and was asked to participate in activities organized by Organization A. Although there was X’s comfort and encouragement, Z’s mood still fluctuated. When there was news from X, he felt full of confidence, thinking that he could bravely face AIDS like X. Because he felt that X was a man to be trusted and reliable. But often the more he was worried, the more he wanted to get information about AIDS from various other sources. Especially on the network, he felt nauseated in the face of extensive information. Because of the fear and pressure of AIDS, he became reluctant to talk about AIDS, listen to AIDS, dislike and even hate the word. Later, as soon as he heard the content with AIDS, he flew into rage. Finally he decided to change the phone card, cutting off contact with X, and not attending the Organization A’s activities, without completing the final diagnosis. Perhaps it was because the fear of AIDS and the unbearable pressure destroyed his will and immune system, he finally fell ill. I became ill on May 28, 2012, because at that time my mood is not good, I could not eat all day, and the psychological burden was also heavy. He was admitted to hospital and had been there for 28 days. After discharge from the hospital, my bowel motions were not still smooth, but in general the stomach was not painful. I had been to see the doctor in many hospitals, but I dared not tell the doctor that I was perhaps infected with HIV. Then, on 6 August, I remembered very clearly that I was severely ill. Initially there was high fever, stomachache, and no bowel motions for a week, but the whole stomach floated into a large bubble. Then I was hospitalized. Living in surgery department, I did not want to live that night. Because I was treated with intravenous feeding, my father took the medicine bottle to accompany me

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to the bathroom. But I went straight to the window, I just wanted to jump off the building to commit suicide and hide my secret of infection. One leg on the window, I was pulled down by my dad. I was crying in the bathroom. The doctor ran over and carried me to the rescue room and asked me what was wrong. I said, “nothing, no, no, no, no, no, no, no, no, no”. They asked me too much. (Infected Z).

In this way, under everyone’s inquiry, Z admitted that he may be infected with HIV. He brought much panic to the hospital, and doctors complain his concealment of illness. The operation, which had already been scheduled, turned into a routine blood-drawing. “I knew then that they were testing my AIDS”. As a result, the next day the hospital told Z that he was advised to do conservative treatment, and to consider being discharged from the hospital, and to take some medication. “When I heard the news, I really regret not jumping early, and regret telling them my infection with HIV. The little hope was completely destroyed, the last straw can be expected to break” (Infected Z). In the face of prevarications and refusal to give me treatment, Z thought of X original words: “Whatever needs and doubts, you can call me at any time.” So again, X called and asked him for help. X readily accepted Z’s help, and suggested that Z should go to YD hospital infection department with his companion. After listening to my condition, X suggested that I go to YD hospital, and call him when I was in hospital. He helped me contact the infection department head nurse in advance. The next day, I was accompanied by my family to YD hospital. That was my first time to this hospital, and my heart was still filled with fear. When I got to the hospital, I called him, and less than ten minutes X and Y showed up in front of us. Accompanied by them, I was admitted to the infection ward. After a consultation with a specialist in surgery and infection, I underwent surgery at YD Hospital three days later. In fact, the operation is very small, only a laparoscopic surgery with a small wound, but the previous hospital rejected me. This illness and medical treatment in hospital had a large impact on me. Without X and Y’s timely help, perhaps my life had been over. It took less than half a year from suspicion of my infection to the sudden illness in hospital. Although there was guidance and help from X, I always felt that I was intimidated by AIDS. It was because the messy AIDS information on the network interfered with my judgment, so that I have a feeling of disgust, and the other was because of my own fear and despair, I took the initiative to choose to lose contact with X. Consequently, it did not help correctly respond to AIDS, but it even delayed my treatment. (Infected Z).

Z’s operation was successful and his recovery was good. During his stay in hospital, X and Y visited Z several times and briefed Z on their involvement and intervention mode of lifelong companion. They also invited him to participate in some activities in his spare time, and to communicate more with the infected around him. “You will feel that the original HIV infection is not as terrible as imagined. In fact, as long as you accept our support and care, and adhere to take the medicine, you can live very well. X is only one those who live well” (Case manager Y). The staff in Organization A meticulously took care of Z. Although Z underwent celiac surgery in the infection, therefore he got to know many other infected people. During the hospital stay, Z felt the thoughtful care of X and others, which is support and care not from relatives but beyond them. He also felt the warmth of

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being understood and supported, so his fear and disgust of AIDS correspondingly decreased. X gave me pamphlets summarizing their response to AIDS, including how to healthily strengthen nutrition and diet, how to exercise, especially including a lot of AIDS expertise. In X’s words: “We carefully organized, and each item is confirmed by AIDS experts. Now the network is a good thing, but the network AIDS information is too complicated to know whether it is correct or not. Especially for the same problem, there are often different or even contradictory explanations, leaving people having no choice. We know that the complex information is wrong and harmful. Last time when you came to the screening, we did not provide you with this information in time because you are not sure whether you are infected, also do not know whether you can easily have access to portable reading, and you were determined to refuse to confirm the test and hurried away. Surpsisingly, during the half years you lose contact with us, you experienced so many setbacks and pains, and bore so much sadness and grievance.” (Infected Z).

X’s words let Z at that time had an intersection of hundreds of feelings. X seemed to have understood him before Z had time to tell the hardships of the past six months. Z then without reserve confided his fear of life for half a year, and his dislike and even resentment of AIDS. Inconsistent AIDS information on the network caused him to extreme panic. In the end, it led directly to his rage at the mere hearing of the word “AIDS”. That day we chatted for a long time and felt congenial. The biggest feeling X gave me was he was reliable. It was not only because he was professional, but also because he understood me. Perhaps it was also my too long depression during the past half year, I was unable to find an object to tell my experience. X has very small eyes, always squinting, and listens to every word of me, as if he know my experiences. After that chat, especially after reading AIDSrelated information, I no longer feel that AIDS is so terrible and disgusting. The detailed knowledge in the pamphlets gave me confidence, and X’s professionalism made me feel that they could be reliable and trusted. If I had such a piece of information, I might not have lost my contact, I wouldn’t have fallen ill so quickly either. (Infected Z).

After 23 days in YD hospital, Z went through the discharge procedures and had a good rest to recuperate at home, because his condition had been controlled, postoperative recovery was also good. At the time, Z’s CD4 was around 350, and doctors and X both recommended that he start taking antiviral drugs. Although Z was very grateful for the timely help of X and Y, and also experienced the effectiveness of medical treatment, Z was still concerned about taking antiviral drugs, fearing the negative effects of long-term drug taking, hoping to maintain the activity of his own immune system through his own efforts. Finally he refused to take the drug. He established the involvement and intervention of lifelong companion with Organization A, and his case manager is X. During Z’s hospitalization, X also made a special trip to communicate with Z’s parents about HIV infection, dispelling the family’s fear and misperceptions of AIDS, and mobilizing the whole family to devote themselves to Z’s care. Compared with other infected people, Z is happy, because his family did not abandon him because of his infection. After a month’s rest, Z returned to his job, during which he also participated in several activities organized by Organization A. But he has not applied for antiviral treatment.

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At the end of 2012, because I had a lot to do in the work-unit, my energy ran out, and I felt tired. You know, we were actually more sensitive, perhaps the usual small situation would startle us. Just in time, I always felt very tired, unconsciously reaching out to touch my lymph nodes and always feeling bigger than before. Because the next day was Saturday, I planned to go to hospital to check CD4. Although I almost did not get sick after the discharge, there were some doubts in my heart. So I called X at about nine o’clock in the evening to tell him my concerns. X said that if I had time, I could go to Organization A to talk with them. If necessary, he accompanied me to the hospital to see a doctor. I was very happy, and then agreed to meet in the morning in the loving home (because it is closer to YD hospital). Perhaps because of fatigue, or the insomnia resulting from anxiety at night, I woke up the next day nearly noon. As a result, it delayed the agreement with X. Surprisingly, X had been waiting for me in the loving home. Although X still suggested I start applying for antiviral drugs, he stressed more: “When you have a strong heart, HIV is weak. It is the most effective treatment of AIDS to strengthen exercise, to have reasonable rest and structured diet, and to supplement them with drug treatment.” He also told me about his experience of hands trembling for being scared by AIDS, and asked me not to think of AIDS so terrible out of thin air. He asked me to recall that due to fear of AIDS, I was hospitalized not long after my suspicion of being infected. But I kept healthy when I didn’t learn of the result. It was not HIV virus itself but the fear of it knocking me down. Strange to say, although I missed the CD4 test that day, I was resurrected with blood perhaps because of a good night’s rest, or my approval of X’s analysis when I reached out again to touch the lymph nodes, and it seems not so big. (Infected Z).

In that interview, X did not just to solve Z’s current problems, but also to enhance Z’s ability to cope with AIDS. The purpose is to let Z understand that the treatment of AIDS problem can not be simply solved, but it needs his active cooperation. Although Z has never received antiviral treatment, the interview enhances Z’s determination to deal with AIDS. He no longer has a variety of inexplicable fear of AIDS. Z decided to take the medicine in March 2013. His CD4 value has been kept between 300 and 400 from discharge to the drug taking. Because he has a full and correct understanding of AIDS, he is no longer as panicked as before. Coupled with the careful care from his parents and his reasonable exercise, he will also actively participate in some activities in Organization A, and maintain a good involvement and intervention with X. Z didn’t go to hospital this half a year. When encountering AIDS-related issues, he will choose to discuss with X, face together, and jointly solve. One night, I dreamed that I went to hospital to have physical examination, but when the doctor saw me, he said nothing and left. Somehow, I came out of the hospital. Neither going home nor going to the work-unit, I found myself sitting on a plane, not knowing where to go. When the plane suddenly began to land, the flight attendants were scared as if they were going to faint. They asked everyone to take the life-saving equipment out of their seats, as if the plane was about to crash and make an emergency landing. I ignored everyone’s obstruction and rushed to the cab, but the door was locked. No matter how I pulled it, it didn’t open. Then I used my foot to tramp on it, finally the door opened. I saw the pilot has died of illness, like AIDS. I pushed him away, and I drove the plane. At first the flight attendant stopped me for fear that I couldn’t drive. Later, watching me drive the plane very steady, I was relieved when I landed the plane safely. Everyone clapped and celebrated, including the pilot, and he was fine. I became a hero all at once. I thought this dream was to tell me that I have to rely on my own efforts to combat the virus. (Infected Z).

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However, X does not fully agree with Z’s point of view. He believes that the infected people can rely on their own efforts, but, to deal with AIDS, they can not completely rely on themselves. Others’ care and support and drug treatment are also necessary. In fact, we are usually very concerned about our own health, and believe that we can rely on our won efforts to effectively improve immunity. Your viral load will be reduced to a very low level after taking the drug. Plus your usual attention, especially to the diet and physical exercise, you can maintain a better level of health. When we show infected people how to improve their immunity, we are also loyal performers. I had the same idea with you, but then because the first generation of drugs bought from the United States was too expensive and had too many side effects, I had to choose to rely on my own exercise to improve immunity to deal with AIDS. As a result, a year later, I almost couldn’t bear it, and the critical notice was made twice. I had a narrow escape from death. Like cocktail therapy, the treatment of AIDS can not rely solely on one way, but should be combined with a variety of methods. It is no coincidence that this is the case with antiviral drugs, and in the use of treatments. Like me now, I take medication every day, coupled with self-regulation, I am healthier than before and value health more. We often say that a disease can be cured by treatment and recuperation. But you can not neglect the role of treatment, if not, depending on the maintenance is certainly not useful. Just like in your dreams, you want to be saved, first you have to have a plane to fly, otherwise, how do you play your part. (Infected X).

It can be said that X finally changed my understanding of taking the drug, changed all my previous experience, and finally, after careful consideration, I decided to take the drug. Although taking the medicine was a painful thing, I persisted. (Infected Z). After taking the drug, Z’s response to the drug was not large. He was very healthy, CD4 value remaining at about 540. He was also more active in attending activities in Organization A. Six months later, Z proposed to X that he hoped to become a volunteer of Organization A. Using the usual leisure time, he helped others and share with other infected people his experience of getting sick. Moreover, he would like to enjoy self-help. Because he felt so much love from Organization A, he can’t be isolated from it. Y and X and the process of helping others have given him greater support and understanding. In fact, I found Organization A that self-help has two meanings. The first is to help those in need change themselves. Just like me, if not X’s help, I would have been dead. I enjoy the “dying to live” process with their help. So, I think I want to live, and the result is to survive. On the other hand, I think, in the process of helping others, I also helped myself. I think that’s probably one of the reasons X has been doing it all these years. I now have an attachment to Organization A, to X and others, which has also realized my value and gained recognition from others. All these come from the connection with X (Infected Z). In the involvement and intervention process, Z not only helps infected people, but also improves his ability. Perhaps it is because they always think and experience from the perspective of the infected and because this process of helping others is a kind of sublimation regardless of each other, gradually, Z discovers that he is falling in love with this helpful process and the relationship with X’s involvement and intervention. Z says, one thing he is particularly proud of now is that the infected person who involves and intervenes with him sees him as the closest person. For example, some

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infected people are afraid to tell their families about their illness, but are willing to leave Z as the emergency contact in the hospital. Out of trust in Z and Organization A, they keep their archives in Organization A. It can be said that Z has access to growth, harvest affirmation, realize his own value, and restore his self in the process of helping others and obtaining self-help.

6.2 Self-restoration Under the Co-construction of the Relationship Since the birth of psychoanalysis school, its theory and viewpoint have been continuously improved and revised by later practitioners. In its early stages, Freud pointed out that the formation of neurosis was associated with “sexual abuse in childhood”, which played a very important role in the emergence and treatment of psychological problems. In modern psychological terms, Freud’s psychoanalytic methods were used to help those patients with post-traumatic stress disorder. However, with the accumulation of treatment experience and careful observation, Freud overturned his own previous assumptions about the causes of neuropathy. He believes that the “real” experience that that analysts can recall does not really happen, and they are just childhood fantasies or expectations of this change of concept, so that the theory of neurosis gradually developed from mental trauma to “isolated mind”. Freud believed that the sexual assaults in analysts’ memories were in fact fantasies of their childhood Oedipus or Oedipal complex, not real events. Freud’s revision of the theoretical viewpoints marks the birth of the theory of “isolated mind”. The theory focuses on and analyzes the conflict between the internal expectations and defense of the individual’s “isolated mind”, but pays little attention to the problems of interpersonal interaction, and even thinks that it makes no sense to discuss the relationship, interaction and so on for individual psychotherapy. In other words, the theory holds that psychological problems arise entirely from the conflict between the internal expectations and defense of the individual’s “isolated mind”, which has nothing to do with bad interpersonal interaction. However, since the 1950s, many psychologists have thought deeply about relationship issues under the influence of the theory of the object relationship put forward by Fairbairn and Winnicott. At the same time, the idea that human mental or psychological problems arose from poor interpersonal interaction sedatives by Harry Stack Sullivan posed a huge challenge to the traditional view of “isolated minds”. In 1988, with the publication of Mitchell’s book Relational Concepts in Psychoanalysis, interpersonal interaction, relationship and other issues were widely accepted and valued. The publication of this book can be regarded as a revolutionary event in the development of psychoanalysis theory. With the theory of relationship as the theme, the book introduces the theory of British object relationship theory, interpersonal relationship theory, self-psychology and many other related theories related to relationship issues. With the deepening emphasis on relationship issues, the basic viewpoints

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and practical techniques of psychoanalysis theory have changed accordingly. Many modern psychoanalytic theorists acknowledge the importance of the relationship between analysts and patients (this book calls the consultative relationship). Good consultative relationships are essential for effective psychotherapy. Kohut made an important contribution to the development of psychoanalytic theory. In 1971, he first proposed that psychoanalysis theory and technology should be applied to the analysis and treatment of narcissistic disorders on the basis of adhering to “isolated mind theory” and “instinctive drive theory”. It injected fresh blood into psychoanalytic theory. According to Kohut, the self-object needs that patients have longed for but not yet been met (mirroring, idealized, and twinship needs) exist in the consultative relationship, and by the consultative relationship, the patient wants to have an experience that is not realized in infancy, which is necessary to develop healthy narcissistic traits. Since then, Kohut has made the point that all people, whether mentally healthy or not, need to meet their self-object needs throughout their lives in order to maintain their sense of unity. It is important to stress that the relationship background is very important if the individual wants to develop a healthy, integrated, continuous self, and that only in this relationship can the self-object needs be met, and the individual is able to reconstruct the healthy and mature self. In order to accurately describe the nature of the self-object relationship, Kohut introduced the concept of self-object relationship. For grown-up children, the selfobject function provided by the caregiver can help the child develop a unified selfstructure, while children and adults who are less experienced in the self-object are more likely to develop a weak self-structure. Kohut describes the self-object as the experience of self and others helping us develop our own sense of self. In other words, the object is such that it can provide us with the psychological functions we need for healthy self, which in turn can promote the development or recovery of our sense of integration. According to Kohut, self-psychology holds that self and self-object relationships are the essence of the spiritual world of all, and that the socalled transition from dependence on others (symbiosis) to completely independent metamorphosis simply does not exist, even more absurd than the biological world’s so-called transition from oxygen-demanding to anaerobic. Looking back on the journey of infected Z from a quick positive to becoming a volunteer, his relationship with X has gone through a twist. But based on understanding, interpretation and moderate response on the basis of empathy, it finally constructed a new and collaborative intervention relationship, and it is applied to the support and care for more infected people. Through the lifelong companion and support care of X and other case managers, we can understand the inner feelings of Z, make Z regain the new relationship experience, and adjust the previous principles of experience organization to meet Z’s self-object needs, and realize self recovery and reconstruction in the relationship co-construction.

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6.2.1 The “Cocktail Intervention Therapy” Under the Relationship Co-construction Cocktail therapy, formerly known as High-Efficiency Antiretroviral Therapy (HAART), was proposed in 1996 by Chinese-American scientist Dr. He Dayi to treat AIDS through the combination of three or more antiviral drugs. The application of the therapy can reduce the resistance produced by single drug use, maximize the suppression of the replication of the virus, so that the damaged body immune function partly or even all recover, thereby delaying the progression of the disease, prolonging the life of infected people, and improving the quality of life. The therapy mixes protease inhibitors with a variety of antiviral drugs, so that AIDS is effectively controlled. In the study, the author found that Organization A did not emphasize technical specifications, but think that they on the contrary limit the play of individual subjectivity. Although there is no certain technical regulations for the support and care of infected people in the involvement and intervention in Organization A, they combine and apply understanding, interpretation and moderate response into their practice. Based on empathy, workers in Organization A exercise the individualoriented involvement and intervention. The co-construction of the involvement and intervention relationship of lifelong companion help the infected person to deal with the life and survival problems brought about by HIV, realizing the social return of the AIDS population. Therefore, the author refers to it here as “cocktail intervention therapy”. The therapy alleviates the isolation and self-blame of infected people, reduces their worry and fear of AIDS, maximizes the satisfaction of their self-object needs, solves their problems in life and survival, restores their healthy, integrated and continuous self. (1) Self-collapse resulting from lack of relationship Self-psychology holds that the self-object need is related to “relationship”. Careful caregivers will meet the baby’s needs in time; analysts also integrate their theoretical assumptions and information obtained through empathy, give the patient a reasonable interpretation, listen to the patient’s emotions, identify their unconscious activities, explore their own similarities with the patient, and attempt to understand their inner world from the perspective of the patient. However, these activities do not necessarily provide the patient with the self-object needs he or she desires, because the nature of experience also depends on the patient’s own understanding of the experience. That’s whether the analyst’s response is moderate in the patient’s organization of experience. Whether a good transformation in this process can occur depends on the dual dynamic system: the construction and deepening of the relationship. We refer to the experiences that can promote emotional integration and selfintegration as self-object experiences. The self-object relationship sits in essence to promote individual growth, to promote the transformation of self experiences and improve the ability of emotional integration and self-integration. One of the

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basic assumptions of self-psychology and the inter-subjectivity theory is that human beings are pursuing a state of health coordination, and even those disorderly or illadapted behaviors are a form of expression that patients pursue the state health. People always want to engage in a new relationship, from which they experience new self-object experiences and meet the psychological needs they once craved but did not achieve. This is actually one of the pieces of evidence that patients pursue the health coordination. Most patients don’t retreat to depression or isolation, but they choose to build new relationships with analysts and find the self-object experiences they had been craving. This behavior is commendable in itself, because it is behind the pursuit of health. Take Z who was tested positive in 2011 as an example. He rejected a proposal from Organization A for further blood screening. At that time he did not understand AIDS, and think AIDS is far from him like “a ghost heard but never seen.” AIDS is after all a fearsome disease, and especially linking his own behavior, Z was inevitably mentally disturbed. “When learning that I had turned down their blood test, X came over and handed me a business card and said, ‘Whatever needs and doubts, you can call me anytime.’” (Infected Z) It can be said that X’s response to Z at the time was moderately effective, because he was able to understand Z’s reaction after learning of the quick positive test, and then handed his business card to Z. As mentioned above, everyone has a health need, and Z is no exception. The only difference is that because of the stigma of AIDS and the public’s fear of it, X feels anxious that Z will feel helpless when he really wants to pay attention to, and test HIV virus. Therefore, he did not rush to emphasize that Z needs to be retested, but look forward to Z’s active contact by handing over business cards to. As X expected, Z reached out to him after the Chinese lunar new year. X introduced to Z the issue of the initial screening, and especially the words “It is safe for both yourself and your family” (infected person X) to a certain extent established Z’s trust in X. So Z decided to go to Organization A on Wednesday morning and, if possible, have a screening to dispel his inner nerves. “Because their organization can draw blood directly, I don’t have to worry about the risk of exposure” (Infected Z). It can be seen at this time X’s empathy and response to Z is effective, though Z are still “fully armed” to Organization A. X did let Z eliminate many concerns, which also just reflects the purpose of X to influence one life with another life. It also lets Z feel the professionalism of X. After contact with Z, the author found that, in fact, Z was a very cautious person. But he was first screened on his second contact with X, illustrating that X really gained Z’s trust. The trust was not the institutional type, but a traditional interpersonal one. Organization A’s involvement and intervention have a special focus on their professionalism. They believe that professionalism is the premise of establishing a relationship with AIDS groups, is the insurance to gain the trust of infected people, and to have an effective response to them. As X says: In the process of intervention, we first express our professionalism. We let the infected believe that every case manager in our organization is professional, and can give professional and comprehensive answers to AIDS-related questions. We let them realize that AIDS has

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now become a controlled chronic disease, achieving the de-specialization of AIDS, and eliminating their inside fear. (Infected X).

Obviously, the case manager’s response to the infected person is first reflected in their professionalism. That is to respond to the problems of infected people with professional knowledge. It is such a non-targeted response that lets Z feel that X can be relied on. So there is a decision for him to draw blood screening. From this point of view, X’s empathy and response are effective and proportionate. Some psychologists disdain that if they want to make the patient feel the selfobject functions he needs from the Consultant-Visitor Relation, the analyst should falsely and with a false enthusiasm care for the patient. In fact, what analysts really want to try to do is to provide the necessary self-object experience felt by the patient. In general, this requires the development of a new, repeatable self-object relationship, which returns the coordinated response to the patient’s emotions by maintaining a state of emotional coordination. In other words, analysts hope that psychotherapy will make patients feel they can be understood and accepted by others. After the positive screening of Z, although X had an empathic understanding of his various worries and concerns, he did not urge him to do positive confirmation. On the contrary, he caught contact with Z from time to time, and invited him to participate in their activities. The communication and story-telling of himself reduced Z’s fear and worry, and built a trust relationship with Z, so that Z felt that he could be understood by X. As Z said, when there was news of X, I felt full of confidence, and thought that he would bravely face AIDS like X. From this the author can infer: X is connected with Z, builds a relationship structure of understanding and trust, provides a repeatable self-object experience for Z, and helps enhance his self understanding through the integration of recognition, understanding and response. In the author’s opinion, although X’s empathy alleviated Z’s concerns, his response, in general, is not completely moderate. He evoked Z’s pursuit of a healthy state while caused a negative therapeutic response facing the avoidance of traumatic experience. First of all, although many infected people would refuse to do further diagnosis because of the fear of AIDS, they were also generally skeptical of tests, including X. However, Z not only refused to send the blood to a confirmed laboratory, but held the opinion according to his previous organizational experience principles, “I understand that I have been infected, and I no longer need to do anything to confirm, not to mention their help. No one can help me, and AIDS is terminal illness. It is my retribution” (Infected Z). Unfortunately, X didn’t fully immerse himself in Z’s inner experience, nor did he understand the crisis and despair of the therapeutic relationship from Z’s perspective. If X could accurately interpret Z’s emotional experience, Z might feel that he was understood by X. It would also be more free to examine other aspects of the relationship at a deeper level, for example, Z’s attribution of HIV infection. Because the focus on the patient’s subjective feelings could promote the laxity of his or her self-defense, other feelings or ideas that were not easily detectable would surface. Secondly, although Z firmly believe that he is infected with HIV, he is particularly worried about AIDS, and led to commit suicide.

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In fact, on the way back, I thought of death. I thought I was very strong, and had a lot of preparations for AIDS in the early stage. I did not expect to be scared to death before the diagnosis. I was thinking, now a car accident killed me, then I could at least leave a sum of money and a large fortune for my parents … Back in the bedroom, I began to sort out my own things, wanting to leave some money for my parents so that they could live well in old age. I didn’t tell them, I just wanted to die alone, and I felt that way. (Infected Z).

With the fear of AIDS, Z began to look for a variety of AIDS-related information on the network. Although X also contacted Z from time to time this period, and gave him comfort, Z was even sick of AIDS in the face of extensive information. Because of the fear and pressure of AIDS, he became reluctant to talk about AIDS, listen to AIDS, and even hate the word. Later, as soon as he heard the content related to AIDS, he would fly into rage. He simply changed the mobile phone card, cut off the connection with X, did not go to participate in Organization A’s activities, and did not complete the final diagnosis. Freud observed a phenomenon in which he made the so-called “right’ interpretation to some patients, they got worse instead. Different psychologists gave different interpretations of this phenomenon. Some people thought that patients are deliberately thwarting analysts; others thought that they have a tendency to be abused deep inside, or that it is a manifestation of unconscious guilt. However, if you look at it with the theory of self-psychology and explore this negative reaction from the perspective of pursuing a healthy state, we will find that the patient may experience some threats in the so-called “right” interpretation, so he will react negatively. And analysts’ differing tunes of empathic understanding of patients may convey this potential danger. Z’s negative treatment reaction was ignored, because X was absorbed in the fact of Z’s HIV infection. At the same time because of no way to judge the complex AIDS information, Z had an emotional aversion to AIDS. Instead of realizing the desire for self-object help and need, X’s ties with Organization A was cut off. It both suspended the ties and hindered the way in which the self-object needs are met. Kohut saw the process as a moderate setback, with which patients can complete the transmuting internalization. Bacal believed that it was indistinguishable from traumatic ones, and that moderate response was the key to healing. From selfpsychological theory, perhaps Z’s performance at this time was not actually an impedance to X, and it just meant that Z suffered some trauma in the treatment, which came from that X could not give his understanding of the same-tune reaction to Z. Z’s replace of the mobile phone card triggered the interruption of support, which in turn led to the break of Z’s self-object bond. The author can conclude that, because of the break the relationship and the bond, Z once refused to contact X. Also the fear of AIDS destroyed Z’s willpower and his immune system. Unbearable pressure on him, he finally fell ill. Z neither had the courage to admit to parents, nor did he dare tell the hospital the fact he was infected with HIV. Facing the helplessness of the hospital and the physical and mental distress caused by the disease, Z couldn’t disclose to the public that he might be infected with HIV, but also endure, but he could only bear the abdominal pain and the fear of AIDS and opportunistic infection. Z’s surrounding relationship can not give him

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more support and care for subjective feelings, and the desired self-object needs are still unable to meet. Z thus constructed his own principle of experience organization: “It is my retribution to be infected with HIV virus, I am destined to the sin, and I am worthless, not worthy of care.” (Infected Z). In real life, there are not only good and beneficial self-object experience, but also bad objects and destructive relationships. That is to say, there are many relationships in real life related to division, trauma, and defense. Z’s self is falling apart after a series of traumatic setbacks. Overwhelmed, he chose to jump from the building on August 6, 2012, to cover up his HIV infection in order to end this symbiotic torture with HIV. However, Z was dragged back by his father as he jumped. In the helplessness, he finally admitted the fact that he was infected, but it led to the disguised prevarication of doctors in the hospital. As Kohut mentioned, that anxious, horrifying, completely paralysing self-collapse could occur in any context that insulted an individual’s selfesteem, even in the context of psychotherapy. At this point, Z’s self disintegrated. Self-psychology believes that self disintegration results from the lack of selfobject needs. Like Z, he cut off the link with X, unsatisfying idealizing, mirroring and twinship needs from this involvement and intervention relationship. Besides, he couldn’t, also dare not admit to the family and the hospital that he was infected with AIDS. His self went from the break of the self-object bond to the edge of self collapse, which triggered his suicide action. In the case of unsuccessful suicide attempt, he finally revealed the fact that he was infected with HIV, eager to get care and attention. However, the hospital suspended his treatment in disguise, and “the last straw of expectation struck out”. Because it was not possible to establish effective therapeutic relationships from elsewhere, and get a self-object experience, Z’s self was disintegrating in the breakdown of the relationship at this point. (2) Relationship reconstruction to achieve self integration Based on Winnicott’s claim that “there is no baby, only a pair of care combinations”, Bacal suggested that there has never been an patient, only a pair of analytical combinations. If they are further extended, I think: in Organization A’s support and care, there has never been an infected person, only a pair of involvement and intervention combination. It is well known that AIDS is a worldwide problem. According to Jay Levy, a professor at the University of California, San Francisco, one of the world’s first scholars to isolate HIV, after more than 30 years of hard research, our research on AIDS are currently only at the level of the fifth grade of primary school. The medical cure for AIDS is still a long way off and may require more than a generation of hard work. As mentioned earlier, the prevention and treatment of AIDS is not only a medical problem, but also requires the broad participation of the whole society. The involvement of support and care co-constructed with the infected, relying on “cocktail intervention therapy”, has a good performance in meeting their self-object needs and help them better cope with HIV virus. Kohut held that people had the pursuit of the self-object needs in their whole life, eager to get acceptance and recognition, thus promoting self-acceptance and recognition. They are eager to get their self protection and reinforcement through

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their own connection with others, and more eager to have another self, independent of each other but heart-to-heart, which can fully understand their own thinking (See Chap. 4 of this book). Although an infected Z experienced the breakdown of the relationship and self-collapse, he still had a desire for the self-object needs. In a desperate situation, Z thought of X’s original words, then called X again and asked him for help. X readily accepted Z’s request for help and offered to accompany him. Z’s operation was successful and his recovery was good. During the hospital stay, X and Y visited Z several times, and introduced Z to the involvement and intervention mode of lifelong companion, asking him to participate in more activities in his spare time, and to communicate with the infected people around him. The staff of Organization A took the best care of Z. After Z’s self-collapse, X’s timely appearance and help, and the meticulous care by members of Organization A met Z’s idealizing needs “I need you”. The empathic listening, understanding and communication of X and Y to Z made him feel that he was no longer lonely, and many other people stood aside with him. The practice eased Z’s aversion to AIDS, and changed his organizing principles for experience to protect himself by refusing. But Z’s and X’s involvement and intervention relationship were not established. As Bacal argued, a match between analysts and patients doesn’t have to be a good one in the first place. It can be developed from the analyst’s ability to respond in an appropriate manner or by his desire to examine the inter-subjectivity context in which his interaction with his patient takes place (Bacal 1985). In general, developing a new, repeatable self-object relationship requires the analyst to maintain a state of empathic understanding and to respond in a coordinated manner to patients’ emotions. In other words, analysts hope that psychotherapy will make patients feel they can be understood and accepted by others. What all analysts can do is to accept their feelings and verbal expressions, and try to explore the roots of their feelings. When X realized that Z might need to acquire AIDS-related knowledge, he did not respond in a timely and appropriate manner. “We know that the clutter of AIDS information is wrong and harmful. The last time you (Z) came to the screening, we did not provide you with this information in time, because you are not sure whether you are infected, also do not know whether you can easily enjoy portable reading, and you were determined to refuse to confirm the test and hurried away.” (case manager X) Thus it interrupted the involvement and intervention relationship that could have been established. “Consequently, you experienced so many setbacks and so much suffering and grievance during half a year that you lose contact with us.” (case manager X) Now X’s empathy meets the idealizing self-object needs of Z, “when you need me, I was there at any time to contact me”. Moreover, Z feels the acceptance and recognition, closing the distance between their hearts. Z finally confides to them his fear of life during the past six months. And X’s empathic listening, understanding and congenial responses, to a certain extent, even meet Z’s desire for twinship needs. “Because he understands me… listens to every word I say, as if he knew and understood the experience.” (Infected Z) With X’s empathy and moderate response, Z accepted the Organization A’s lifelong companion involvement and intervention pattern, his case manager is X. Although the involvement and

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intervention relationship between X and Z was established, Z never received the treatment. On the one hand, he feared taking drugs and his refusal formed self-preservation (which was his long-standing experience organizing form); on the other hand, his self was still in disintegration and it required further support and care to unite his self structure. Z chose to be discharged after 23 days in hospital, and at that time, his life was no longer in crisis. The involvement and intervention of Organization A was turned into the survival care and companion. X realized that refusal was its primary performance in Z’s principle of conduct. His refusal is an effective means for him to form self-protection from refusing to draw blood during a quick examination, refusing to be diagnosed after a blood test, refusing treatment in sickness, until the refusal to take the drug and be involved and intervened in Organization A’s activities. In order to change Z’s habitual rejection and urge him to take the medicine as soon as possible to avoid follow-up opportunistic infection, X communicated with Z’s family, eliminated his family’s fear and false perception of AIDS, and mobilized the whole family to care Z, establishing a good family relationship. The care of family members improved Z’s immunity and self-confidence. Meanwhile, the support and care to Z made him feel the new experience of “being together with him”, and feel the companion of involvement and intervention, which went beyond all other technologies and practices. The companion required X to mobilize all of self psychological energy to change Z’s subjective understanding. X realized that to really achieve this purpose, he needed first of all to confirm the other party’s subjective feelings, rather than relying only on advice, preaching or AIDS knowledge training. The key was to let Z and X understand the feelings of X, appreciate X’s empathy, recognize his unreasonable principles of experience organizing, accept X’s interpretation and response, learn to understand his self and past experience from a new perspective, and form new principles of experience organizing through self understanding in the relationship. But it never changed Z’s principle of refusing to take the drug until Z and X discussed a dream. Based on self psychology, Z’s dream was clearly undefended, with a desired exaggeration and a dream to save the illusion. Z unconsciously thought that the treatment of AIDS was like the plane about to crash, even professional doctors and nurses (pilots and flight attendants in his dream) are powerless. He had to rely on himself, which was reflected in that his bravery and heroic rescue feats won praise in his dream. And X’s interpretation played a very good moderate response effect. Fortunately Z changed his previously unreasonable principles of experience organization. Whether it is the common discussion of AIDS, or the analysis and interpretation of the dream, all these made Z feel that his feelings could be accepted and understood. He and X were not in a simple relationship of consultation and visit, but a cooperation to jointly respond to AIDS. As involvement and intervention continued, Z kept experiencing that he could be understood by X. This feeling helped to promote Z’s cognitive ability, emotional integration ability, and self-esteem and self-integration. Z finally decided to take the drug, because this cooperation of involvement and intervention made Z feel X’s congenial understanding and support, meeting the X’s twinship self-object needs.

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The companion of this modest response by a good self-object is likely to be the human power so needed by the baby, so recognized, so loving and so required by many adults in their anxiety or despair. It is this kind of involvement and intervention mode of understanding, interpretation and moderate response that builds harmonious involvement and intervention relationship together, urging Z to transmute and internalize X’s self-object function to make up for its self-psychological structure. The fact proves once again that X’s understanding is correct, and his response to Z is moderately effective. After taking the drug, Z’s CD4 value increased significantly, reaching the general level of the average person. This reinforces Z’s confidence in fighting against HIV and the idea of becoming someone like X and Y. Buirski et al. (1999) believed that analysts paid more attention to the subjective feelings of patients, tried interpreting their understanding of the latter, and using language to analyze the feelings of the latter, and giving recognition, interpretation or exploration. Their response could well change the latter’s old experience organizing principles. Through these acts, the patients realized that their feelings coudl be accepted and understood by others, and that they can accept help from others. And this kind of mutual assistance was constructed together, and the self-object needs were also jointly satisfied. Buirski et al. further believed that the transformation of self value needed to set the self-object relationship as the background, in which there must be a person who could understand patients’ subjective feelings and respond. In this way, the patient might feel accepted by others, and the elaboration of the experience organizing principles also promoted their self understanding. All therapeutic relationships needed to exist in self-objects and development space. The self-object in involvement and intervention relationship refers to the need of the patient to feel the satisfaction of the self-object needs in the involvement and intervention, where once the relationship of the selfobject needs is established, the psychological development and transformation may occur. As Winnicott put it, to control and utilize the environment, the self-object in the therapeutic relationship provides the patient with an emotionally coordinated relationship experience. Once established, the self-object becomes the background of the patient’s subjective experience. This also coincides with the involvement and intervention focus of Organization A: the establishment of a lifelong companion of involvement and intervention relationship. Only in this way can the psychological transformation process of the infected person occur.

6.2.2 New Experience of Helping Others Help Themselves The Shane and Shane believed that the therapeutic relationship gave the patient a new relationship experience. They feel they can be understood and accepted by others in their new relationship. This new experience promotes the formation of the patient’s new experience organizing principles and the improvement of emotional integration ability. Because the therapeutic relationship is co-built, the analyst will also get a new relationship experience during the therapy. In the process of dealing with AIDS,

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Z not only changed the old principles, but also by the influence of X and Y, he finally volunteered to become a case manager and also embarked on the role of affecting others, feeling the relationship experience of “helping others help themselves” with a new identity. Six months later, Z proposed to X that he hoped to become a volunteer of Organization A, using his usual leisure time to help others and share with them his feelings of falling ill. Meanwhile, he was helping himself. In such an involvement and intervention like Organization A, he felt the love that he had never experience before. He had been inseparable from Organization A, X, Y and the process of helping others gave him greater support and encouragement. In the process of involvement and intervention, new relationship experiences also brought new feelings, allowing Z to develop new experience organizing principles to understand these feelings. When he felt that X could understand and accept himself, his new principles sat this way: “It seems that not everyone is rejecting me, that there is always someone who can accept me, and that I don’t need to protect myself by refusing.” (Infected Z) During Z helping others, the new experience not only helped himself, but also helped achieve his own mirroring needs. With the satisfaction of mirroring needs and the experience of new relationship, Z changed his old experience organizing principles, and developed new ones. “I am valuable, and I can help more people.” (Infected Z) In the involvement and intervention process, he both helped the infected person and improved his ability. Perhaps it was because he always thought and experienced from the perspective of the infected person, also because this process of helping others is a kind of sublimation regardless of each other, gradually, Z found that he began to fall in love with this process of helping others. Z said that he was now particularly proud of his involvement and intervention of the infected people, and all regarded him as the closest person. It is obvious that Z’s missing self-object needs are fully satisfied in the coconstruction of involvement and intervention relationship, and his self restoration is inseparable from the co-construction of the relationship. In the involvement and intervention relationship, the mirroring and idealizing needs are transformed into his compensatory structure. Z realizes not only his self restoration, but also the value concept of helping others help themselves. Z has been volunteering in Organization A for almost two years, and now he has taken over five infected people. Because he still has work on weekdays, he can only use Saturday and Sunday time to care for infected people. The author asked him if such an over-loaded job would have an impact on his own health, after all, it sounds like he’s working seven days a week. But his answer really surprised the author that, in his view, Saturday, Sunday and the mutual assistance between the infected people, is his most relaxing, and his most happy time. What he is now considering is whether he should quit the job and devote himself to involvement and intervention. Because his job did not give him a sense of accomplishment, and in his view, Saturday and Sunday care, also helped himself in helping others. As Buirski and Haglund (1999) said, the best state of an individual’s mind and body is to try to understand and care for another person and to be able to find the same response from the proper self-object.

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In my dealings with infected people, I often reflect on myself, reflecting on how to better intervene in especially those who are similar to himself. This year, for example, an infected person, T, was admitted to YD hospital, and he was particularly uncooperative. He had a very strong drug reaction, but he did not inform any family members. In fact, doctors and nurses took good care of him, but he still threatened to be discharged from the hospital, unwilling to be treated. In general, the hospital also had no way, just I went to see an infected person. The head nurse told me this matter, and I looked at his state, I understood a lot, this is not me? He simply couldn’t accept the sudden infection for a moment. I naturally thought of the scene of my jumping off the building, but that year, I was forced to say that I was infected with HIV, when there is no nurses or doctors willing to bind my wounds, let alone treatment. So I went to say to him: “A few years ago, I was infected with AIDS like you, but no hospital dare to accept me, for this I also tried jumping off the building to commit suicide, but I did not succeed.” Fortunately, YD hospital operated on me, and Organization A gave me a different care so that I could live to this day. I am also joining in caring the infected people, and when you have any needs, you can find me, and I am very willing to serve you. However, if you really do not want to receive treatment, then you go through the discharge procedures, and do not have to toss so much. Your situation can not last long without taking medicine. Resources and opportunities can also be left to those who are willing to be treated, and many people are waiting for them. Suddenly he didn’t make a fuss, and he looked at me and said, “How long can I live with this disease?” I said, “I can’t predict how long you can live, but this disease has been spred to China for twenty or thirty years, I have seen a lot of them living for a dozen or twenty years, and now each is very healthy.” He didn’t talk, he didn’t make a noise, and I handed him my business card. I know, he will come to me, and soon after, he calls me and becomes one of my interventions. For fear that his family knew, he asked me to help him keep the secret of HIV infection, and wrote my name in the hospital’s emergency contact column. In hindsight, I was wondering how my family would be sad and miserable if I did jump off the building, and how they would live in the community if my HIV infection came to light. Infected people can not just use death to solve everything, on the contrary, only when you live well, it is the best return to yourself and your family members. I will always share these feelings with other infected people, also always think of that Y once said to an infected person: “Don’t take the stubborn character for granted. You should choose to live for the person you love, and the person who loves you.” (Infected Z).

In the process of helping others help themselves, Z’s empathy and moderate response to other infected people helped him challenge his old experience organizing principles and, and establish new health organizing ones. In involvement and intervention, Z’s new experience brought new feelings that others understood, accepted and approved him when he felt that he could understand and accept others. Although we often say “teaching benefits teacher and student alike”, the professional understanding of helping others is always limited to “teaching how to go fishing” before. Z told me that he had much harvest in the involvement and intervention, which in turn could give back to others in a timely manner. This was an interactive process. He felt that the guidance of others is also in caring for himself. He always strengthened his courage to live in the support of others, also could pass his own experience and confidence to others who came to accept involvement and intervention. That’s why, over the years, many of those infected with the help of Organization A had set up their own organizations to join in the involvement and intervention efforts of helping others help themselves.

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Just when the author was sorting out the interview materials, he received a call from Z, who invited me to attend his birthday tomorrow. In the loving home, he had the honor to participate in their activities for Z’s birthday. Y bought meat and vegetable early in the morning; X personally cooked for everyone. Because of the limited space, venue, table and chair, we put a few tables together; because there were not so many chairs, we stand around the table; because the tables put together were too long and not convenient to eat, we all stood around the tables, eating and chatting. Z made three wishes on the spot: first, he hoped that antiviral drugs did not have so many side effects; second, he hoped that AIDS could be cured early; third, he hoped that long live X, Y and others present. When he did so, many people were crying because they knew that over the years, without Organization A, and the efforts of X, Y and others, many people might have passed away. X, Y and others not only helped infected people to build confidence, but also changed their response to AIDS, and became their psychological and spiritual pillar to fight against the virus. Z said: “In the process of dealing with everyone, we are passing a love and a congenial care to let every infected person feel that we are with you.” (Infected Z). Looking back on Z’s process from self disintegrating to restoration, the author found that the lack of self-object needs caused a traumatic setback, and through the repeatedly empathic understanding, interpretation and moderate response, Z satisfied his own self-object needs, formed a compensatory structure, and completed its self restoration. All these can not be separated from the joint construction of the involvement and intervention relationship. Like words spread in the infected people, no infected person does not want to live, resort to Organization A in emergency, believe in X and live forever. In Organization A, case managers including X, Y and Z, provide the infected, not only the attention of individual diseases, but also their health and even the pursuit of personal quality of life, to enhance the well-being of infected people as their core value of involvement and intervention.

Reference Bacal, H. A. (1985). Optimal responsiveness and the therapeutic process [J]. Goldberg Arnold Progress in Self Psychology (1).

Chapter 7

Re-Exploration of Self-restoration and Intervention Mechanism

People who engage in psychotherapy (especially psychoanalysis) know that the mastery and application of psychotherapy is not easy, and it requires learning and experience from analysts. Those patients involved in psychotherapy can’t improve once and for all. Before studying psychology, the author has always thought that the process of psychotherapy is very similar to playing chess, depending on the counterpart’s move. Further study reveals that, in fact, it is not the case, because the chess game starts clearly, the rules of chess are determined, but the beginning, process and end of psychotherapy are unpredictable. No more authoritative works may not clearly state how psychotherapy unfolds step by step, but even so, it does not show that psychotherapy is a kind of individual play that has almost no readymade mechanism to follow. after all, from the date Freud established the school of psychoanalysis, the discussion of mechanisms and models has never stopped. Therefore, the author attempts in this chapter to delve into the “dying to live” self-restoration mechanism in the involvement and intervention relationship. It is hoped that this mechanism can be applied into other professional work.

7.1 The Mechanism Exploration of Self-restoration At present, there is still a gap between theory and practice to use psychoanalysis related theories to solve the psychological distress and discomfort of AIDS population. Based on self psychology, the damage caused by panic, anxiety and the fracture of the surrounding relationship of individuals after learning that they are infected with HIV, often lead to the break of the self-object bond, break the inner balance of their self, result in the temporary fragmentation and collapse of their self, then hinder their initiative and creativity to respond to AIDS, and finally affect the treatment effect and the goal of the whole society to work together to “move towards zero AIDS”.

© Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9_7

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Therefore, it expands the application scope of relational theory and self psychology, and develops a system of self change specific to the infected to explore their psychological dynamic mechanism from self collapse to restoration. In practice, it helps to construct an involvement and intervention approach for their support and care, helps them to better accept intervention and treatment, and to reconstruct their relations and return to society. More importantly, the self-restoration in the involvement and intervention relationship and the more macro social environment further deepen the understanding of the relationship and support for treatment. Kohut believed that self development and self-object has an inseparable relationship. Self-object provides dynamic analysis for self maintenance, adjustment, repair and reconstruction, and everyone always needs a positive self-object experience throughout his life. The concept of “transmuting internalization” provides the phylogenetics basis for self-restoration, and provides the individual with a station on the road to seeking a new spiritual balance. Kohut envisioned that the transmuting internalization is a developmental process in which the original function of the selfobject (both in early childhood and in the context of analytical therapy) is transformed into self psychological structure. Although in the “dying to live” process of involvement and intervention, the self-object as a case manager does not have primitive characteristics, but the infected person often has a mature self structure before. As Kohut emphasized, even a mature self must rely on others to obtain the self-object needs to maintain normal and adequate self concentration, vitality and initiative. Therefore, only people with full internalization and mature self structure can frankly face the status quo of HIV infection, and the response to HIV virus has become a psychological work for the infected. The mechanism exploration from self disintegration to restoration is deeply influenced by Hagman’s grief model. Hagridmen expanded the study of the Shanes, and put forward a theoretical grief model from the position of self psychology. The process of grief is divided into five stages of shock stage, search stage, psychological disintegration, psychological recombination and new identity. Hagman believed that grief is essentially the loss of transmuting internalization of the self structure and function, and its basic goal is to transform the lost self-object function. The grief model happens to construct a process that causes the self from disintegrating to restoring through external stimulation, and it provides a guiding model for the self-restoration of the AIDS population. Inspired by the Grief Model of Hagman, the author analyzes the “dying to live” involvement and intervention course of the infected person on the vertical time axis, and thinks that HIV infection can be experienced as a self crisis by the infected. When individuals are psychologically troubled by HIV infection, their self may experience greater damage, a psychological metabolic disorder, even depression or suicide and other extreme behaviors in some cases, resulting in the fracture of the self-object relationship and self disintegration. There is no denying that even if they continue to have a cohesive self, they will still experience intense pain. The “dying to live” process of the infected is essentially the process of transmuting internalization of the selfobject function. The involvement and intervention relationship jointly established with case managers satisfies the self-object needs, and develops the compensation

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structure, internalizing the self-object function into the self structure, and finally realizing self-restoration. Based on this, the book proposes five different stages of spiral change from disintegrating to restoration: self disintegrating, spontaneous action, self ignorance, active repair and subject stability. First of all, in the author’s opinion, self disintegrating and restoration don’t show a non-linear or functional relationship, but a spiral change. Second, because individuals have a mature self-structure before HIV infection, and their selves generally have spontaneous repair function, the information of HIV infection does not necessarily immediately and directly lead to self collapse. Therefore, the author believes that the self state of infection in the early stage is in the middle stage of spiral change, i.e., the stage of self ignorance. Individuals may directly upward enter the active repair stage for recovery and stability, or they may fall down into the stage of disintegrating, and then develop to form a complete self-structure through the transmuting internalization. Finally, the five stages seem to have a clear division and separate discussion, but in the author’s view, it is not so clear-cut in the actual development, and nor is it possible to pass through these stages in a fixed way. The five stages can be used as a guide for self development and restoration.

7.1.1 The Stage of Self Ignorance: The Fracture of the Self-object Bond When they learn of HIV infection, individuals are often shocked, suspicious, and numb. They often feel a blank mind, like being thunder-stormed. Some may soon admit the fact, like Z after the initial screening positive: “I know that I have been infected, no longer need to do anything to confirm, or ask for their help. No one can help me.” (Infected z) There may also be denial: “Who told you I have AIDS, not me but you” (Infected E), or be psychologically difficult to accept but with a little luck, “Later, I went to the provincial CDPC to be re-examined” (infected X). Because of the vague understanding and fear of AIDS, they are now in a state of ignorance, and the degree of acceptance of HIV infection will directly determine the length of this stage. At this point, their internal balance is frozen, and their self experience is dominated by worry, anxiety and fear: “I feel a kind of helplessness and fear near death.” (Infected X) and “I’m not going to tell them, I’m going to die alone, and I’m in this mood.” (Infected Z) But at this stage, self fractures and disintegrating have not yet occurred. In fact, an enhanced sense of organization and concentration may occur in the self experience in response to this urgent trauma. HIV infection led to the break of the self-object bond, such as X not only was expelled from home, but also experienced loneliness and cold next door to the morgue; Z actively cut off the link with X, and silently bore physical and mental torture in hiding his HIV infection. At this point, the experience of health by the infected was strengthened, and efforts were being made to deal with many of the real-world issues associated with health: X began actively looking for treatments for antiviral drugs, selling properties to buy

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drugs from the United States, and Z was searching online for information about AIDS in pursuit of inner peace. In general, infected people on the one hand need to face the fear and the threat of death of AIDS, on the other hand, there is still hope for treatment. The self state at this stage can be described as a reflexive reinforcement in response to an attack on its integrity. Eventually, under normal circumstances, they would try to evoke a habitual response to the health self, and move on to the next stage. As mentioned above, only people with mature and fully internalized self structure can face the status quo of HIV infection, and actively seek the satisfaction of the self-object needs and self adjustment. For most infected people during the period of self ignorance, they tend to move down spontaneously, trying to repair or establish a connection with self-objects.

7.1.2 The Stage of Spontaneous Action: The Repair of Self-object Bond Recognition of reality and the face of death leads to urgent efforts to maintain or restore the self-object bond. When an infected person tries to repair a relationship with the self-object, it shows the original emotional state. Crying, screaming and sobbing are the original pleas of the individual’s primitive self to the self-object. “I can’t tell how many nights I’ve been crying and falling asleep with my cotton”. (Infected X) “I was crying in the washroom. The doctor ran over and carried me to the rescue room and asked me what was wrong. I said, ‘No, no, no, no, no, no, no, no, no, no, no, ‘They asked me too much” (Infected Z). Despite the pains, these emotional states (based on self experience) are still the efforts of the infected person to repair the self-object bond. Although the individual may return to the more primitive mode of emotional expression, gradually, the unused experience and lack of response of the self-object reduce efforts to reconnect, and the self-object began to accept reality. “People are chasing me, don’t allow me to stop and I’m running, and I’m not going to stop. It is not easy to get home soon, but like ‘ghosts building the wall,’ there is no a home to return. I was repudiated by the world.” (Infected X) “I knew at the time that they were testing me for AIDS” (Infected Z). Because in the vast majority of cases, the cohesion of the core self is relatively stable and less susceptible to too many effects. So, the individual can act spontaneously, eager to blend in with the ideal object, fantasizing about the presence of a respectable, lovely object, hoping to evoke the desired response from others. It is aimed to maintain the structural integrity of self by spontaneously investing in the process of self-repair. For instance, X spontaneously formed a good mutual assistance group with sick friends, and with their help, finally survived this opportunistic infection. “A month and a half later, I actually came alive, but also gained a lot of weight” (Infected person X). Z was not so lucky. When he finally had courage to admit that he was infected with HIV, he was refused by the hospital. The self state of

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the stage can be described as responding to the intense pain (grief) of self-harm and acting spontaneously. The urgent efforts of the infected through emotional expression (crying, regret, despair) and recourse to action (building mutual assistance and admitting facts) are made to repair the self-object bond. However, the monotonicity and instability of self experiences can lead to the ultimate self disintegrating.

7.1.3 The Stage of Self Disintegrating: The Disintegrating of Self Structure Self-disintegrating refers to the phenomenon that the individual experienced the feeling “I am about to collapse” at some point in life, as X’s feeling of fragmentation. The individual’s self experience is exhausted and empty, even with temporary fragmentation and the eventual collapse. Due to HIV infection, his self-object relationship broke down, and his function of maintaining self had been lost. Infected people experienced depression, diffuse anxiety, insomnia, suspicion, confusion, etc., “I have a feeling of being fragmented … It turned out to be dependent on drugs, I became more closed, no longer willing to connect with the outside world, and my business suffers a heavy loss, eventually having to be transferred to others” (Infected X). “When I heard the news, I really regret not jumping off the building a little earlier, and regret telling them about my HIV infection. There was a little hope completely destroyed, and the last bit of hope also died.” (Infected Z) During this period, their self states felt frustrated, because of the breakdown of the self-object relationship and the unsatisfaction of self-object needs. Previously, the integrity of the emotional structure of inclusion and regulation was disrupted, and the attempt to calmly accept HIV infection and the determination to actively fight against HIV were shattered by storms of grief, panic and anger, which led to self collapse and the individual’s path to the lowest point of life. But in general, in the experience of HIV infection, self-collapse is only partial and temporary, and the individual will eventually actively pursue the self-object needs.

7.1.4 The Stage of Active Repair: The Pursuit of the Self-object Needs Self-repair refers to the phenomenon that by establishing the self-object relationship, the self-object can continue to provide unmet self-object needs (mirroring, idealizing and twinship needs), which is consistent with the individual’s previous self-object functions. For instance, X obtained the mirroring needs of being recognized by other infected people, the idealizing needs of timely access to help, and the twinship needs of getting Y’s coordinated understanding. Similarly, Z was satisfied with the idealizing and twinship needs provided by X, and meanshile harvested the mirroring

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needs in helping others help themselves. It is through the support and care of the new self-object (like case managers, other infected persons, or others) that the self-object function is gradually fully internalized into the structure of the infected person’s self experience. The support and care provided by the self-object has built a selfobject relationship with the infected person, met the self-object needs, and provided a dynamic function to maintain and repair the infected person’s current state. Gradually, these lost self-object functions are repaired by the establishment of involvement and intervention with case managers, and the infected person gains a new experience in the self and self-object relationship. Although one of the objectives of involvement and intervention is to provide missing self-object needs, the ultimate goal of this stage is not to meet the selfobject needs of infected people, but to repair their cohesion and vitality through the transformation and adaptation of the self-object and its functions in the self structure. Eventually, the self-object functions are integrated into the self structure and maintains and restores its integrity. It should be noted that the internal psychology cannot be fully successful unless the self structure develops before HIV infection, has a pre-formed capacity to accept specific fusions, and the involvement and intervention process takes place in the context of a reactive self-object relationship and environment. For example, even if mentally ill people with serious self-defects were infected with HIV, it was not possible to achieve the cure of psychoanalysis simply through the involvement and intervention mode of support and care. They need to receive the treatment and help of professional psychiatrists.

7.1.5 The Stage of the Self Stability: The Reconstruction of Self Structure In self-psychological terms, the “dying to live” process of the infected is the process that its self-object goes through transmuting internalization and enters the permanent self structure. The self-object need plays a key role in regulating self and emotion, and then helps to construct the narrative and integrate it into the overall self structure. The three kinds of self-object needs put forward by Kohut and his successors were eventually micro-internalized as part of self or its lasting conscious image, realizing the process of the self structure from disintegrating to restoration. At this time, the infected person has formed a compensation structure in the involvement and intervention relationship, provided the basis for self restoration, regained the self-object function lost due to the fracture of the self-object relationship, actively engaged in the new self-object environment and reconstructed self. Just as X, with Y and other infected people’s help and recognition, finally set up Organization A, affecting other infected people with his own life experience, Z also actively engaged in the ranks of volunteer case managers, applying life experience in helping himself by helping others. Re-established self happily enters new experiences and initiatives,

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with individuals possessing a more stable emotion, a more dynamic and cohesive self experience, and maintaining the integrity of the subject’s self experience. When self experience is once again cohesive and energetic, it does not mean the end of the involvement and intervention process, nor does it mean that the infected person is moving towards the complete psychological health. The reality is far from simple, because the self-restoration of the infected person is not a linear one-way development, but a process of multiple isoxeliation. In the process from self ignorance to self restoration, the infected will generally go through stages of spontaneous action, self disintegrating and active recovery, and finally reach the subject stability stage. However, when they again face a different self-crisis, it may fall back into action and collapse, forming a circular process. For example, many infected people face the ordeal and fear of opportunistic infections, as well as life and survival crises of broken relationships caused by identity exposure. Thus they return to the temporary self fragmentation and even collapse. While compensatory structures can cope well with this situation, it should be noted that this is a process that takes time to accumulate and continue to develop. It is particularly important to note that every crisis of one’s self experience is not a complete degeneration, but rather a pattern of recycle. Most of them will have to go through recycle, and some even repeat many times. But each recycle of involvement and intervention is helpful to them, improving the ability to cope with psychological distress. In other words, recycle is not the beginning of a new dead one, but the process by which individuals accumulate psychological dynamics, in order to achieve the qualitative change of self-restoration. This also coincides with the organization’s lifelong companion mode, and truly achieves the involvement and intervention of support and care for infected people. In summary, this section, based on the sick course of the infected person, proposes the dynamic change mechanism of self from disintegrating to restoration in the relationship, drawing on the theoretical development of Kohut and his successors. The author believes that, as the core of individual psychology, the self development and change affect the individual’s physical and mental health. Although the individual generally has a more mature self-structure, this can not avoid the external environmental change causing self crisis. When self experiences a crisis, its three-tier structure may change, or quickly lead to its collapse, but the process is more likely to last for days or even years. The crisis is first embodied in the fracture of the selfobject bond, where the individual will generally be in the stage of self ignorance, and show a sense of confusion, shock and doubt towards the sudden crisis. But then, the individual will spontaneously search for broken self-object bond, trying to establish a connection. If not, the individual will fall further into the stage of self disintegration, experiencing a feeling of fragmentation, or feeling at the lowest point of life. Self disintegrating may occur in any two or the entire three tiers of the self structure. The three-tier structure corresponds to three basic self-object needs, and when there are two or more of the self-object needs are met, the compensation structure will be formed, thus repairing the fractured self. Therefore, self repair is often reflected in a certain degree of self-object relationship, which can be either a pre-existing native relationship or a new one that has recently developed. In these relationships, a good self-object obtains an unmet self-object need. And the self-object may be the

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individual or others. Finally, the establishment of the self-object relationship and the formation of the compensation structure reconstruct the fractured self. It should be noted that, first, self disintegration and restoration show a spiral change. In the continuous involvement and intervention relationship, recycle is a process from quantitative accumulation to qualitative change. Second, there is no established trajectory of change in self disintegration and restoration. Third, in the process of this change, the self-object and the self-object relationship provides the dynamic and phylogenetics basis for self-restoration. Fourth, this process focuses more on the main pathology of self, that is, focus on self structure and mode rather than content. Applying this mode to other helper professions not only breaks the traditional self-psychology’s pursuit of the primitive self-object needs, but also makes the treatment of psychological distress and discomfort into the construction of mature self-structure by paying attention to self structure and mode. Therefore, self crisis is a kind of crisis of self structure, and self restoration is that the self-object needs are satisfied, the self-object functions are internalized, and finally the complete self structure is restored in the self-object relationship.

7.2 The Intervention Mechanism of “Dying to Live” In the spiral cycle mode mentioned earlier, recycle must be closely related to the satisfaction of the self-object needs. The role played by a case manager in it directly affects the self-restoration of the infected. Therefore, in addition to vertical and timebased exploration of the infected person’s self-restoration mechanism, it also needs to analyze how a case manager establishes the involvement and intervention relationship with infected people, and how to meet their missing self-object needs from the perspective of horizontal space. From the perspective of self-psychological theory of therapy, the “cocktail interventional therapy” based on empathic understanding, interpretation and moderate response has changed the awareness of the infected about AIDS, met their self-object needs, and internalized into their integrated self-structure. Self-psychology holds that in the course of self development, if the connection with a certain self-object breaks down, self structure will be defective and lead to its eventual collapse. But the individual may turn to other self-objects, trying to satisfy the self-object needs, strengthen other components of self structure, and rejuvenate self vitality through the connection with other self-objects. The other reinforced self components comprise the compensation structure. If successful, it will restore or reconstruct self, and if not, it will also lead to self disintegration and self obstacles. In the self-psychological treatment of relational theory orientation, the analyst values establishing and developing a new self-object relationship with the patient, and making up for the defects of self structure by using such treatments as empathy and moderate response. If successful, self obstacles will be cured, and self will be rejuvenated and reconstructed. Guided by this theory, this book analyzes the “dying to live” involvement and intervention mode proposed by Organization A. It is believed in the mode that HIV

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infection should not be the end of life, and infected people should not be accompanied by death. Just as there have never been AIDS patients in medical science, HIV may be a gift from God for those infected, opening another window in their lives, making them brave to face death and bravely go to the road of love and life against the virus. Therefore, the author tries to put forward the dynamic analysis and phylogenetics evolution of the involvement and intervention process of a case manager from the perspective of horizontal space, and develops a set of self system and psychological dynamic model to explain the “dying to live” involvement and intervention mechanism. To be specific, the author analyzes during the involvement and intervention, how the case manager acts as the self-object of the infected person, how he performs the self-object functions, and what dynamics and occurrence mechanism empathy and moderate response provide in meeting the self-object needs of the infected person. Through transmuting internalization, the self-object functions played by a case manager are transformed into the corresponding compensation structure, and finally self functions reconstruct and a mature self restores.

7.2.1 Mature Self: The Appropriate Intervention Object and the Final Intervention Target Kohut believed that self was the most core psychological structure, and its formation and destruction was at the center of growth and development. The development line of self psychology to self formation and correction illustrates that, a mature self is generally formed in the innate basic structure and physical needs, and satisfies the self-object needs through the establishment of the primitive self-object relationship. Because self will accompany the individual’s whole life, the mature self may disintegrate facing external real-world conflicts in self development. Kohut and his successors believed that the defects of self structure led to many people’s psychological distress and psychological disorders, and the essence of treatment was to enable the patient to develop and form a mature self-structure. Therefore, the mature self may also be formed in the newly-built self-object relationship, where the defective or collapsed self fully internalize and reconstruct a mature self structure through the satisfaction of the self-object needs and the development of compensation structure. The mature self helps the individual to maintain a good state of adaptation in dealing with the external real world, which in turn further consolidates the individual’s self structure, and finally achieves continuous adaptation and smooth self development. The appropriate involvement and intervention object of Organization A is the individual who has a mature self-structure before HIV infection, otherwise this involvement and intervention could not be completely successful. Organization A proposes a one-stop service of lifelong companion, and its involvement and intervention objects include HIV carriers in the primary screening and AIDS patients with serious opportunistic infections. Physiologically and pathologically, all stages of HIV infection are covered. But from the point of view of psychotherapy, case managers including X

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and Y have not received systematic psychological treatment training, but treat others from their self experience. They can not analyze or treat serious mental problems, just simply exercising the involvement and intervention therapy with empathy and moderate response, affecting every infected who receives help with their own life and helping them get rid of psychological distress and discomfort. In addition, the infected who have serious self-defects before contracting HIV virus can not accept specific fusion in the involvement and intervention process. Therefore, the mature self-structure of the involvement and intervention objects is conducive to self restoration, the effective development of involvement and intervention, and even dying to live and return to society. In this regard, the experience of many case managers is that for some infected people, access to empathy with a case manager is valuable; while for others, it seems like a disaster of drowning. The former will grow steadily with the help of a case manager; while the latter will be at a loss, seemingly deaf to the words of a case manager. Others even respond with disgust, confrontation, retreat, or refusal to be involved and intervened, and persistent poor adaptation. Although Organization A provides life support and survival care for infected people, each case manager pays more attention to the development of the subjectivity of the infected person. In addition to attention to the infected person’s self feelings, the joint establishment of a harmonious involvement and intervention relationship, and the comprehensive application of the empathic understanding, interpretation and moderate response meet the self-object needs, develop and internalize the corresponding compensation structure, reconstruct the self broken or disintegrated by HIV infection and form a fully internalized mature self. Thus they can be well adapted to the external real world and form a continuous state of adaptation.

7.2.2 Self Disintegration: Poor Adaptation and Internal and External Conflicts The previous part has made a detailed discussion of the sense of self-fragmentation and disintegration of “I’m about to be broken”. However, it is important to stress that self collapse does not happen only after the setbacks of mature self. In general, the disintegrating self occurs in the context of poor adaptation and internal and external conflict. The breakdown of the self-object bond and the breakdown or loss of the self-object relationship, or the loss of a positive effect (e.g., empathy or moderate response), or the inadequate normal process of establishing a psychological structure (e.g., defects in the formation of a compensation structure) lead to the loss, depletion or division of a temporary cohesion, and cause self fragmentation and disintegration. When the external real world of the individual infected with HIV virus changes, he or she will face the fracture of the self-object bond and the lack of available good self-objects. The change and loss of the self-object environment often result in the weakening or disintegration of the infected person’s self experience, and finally self disintegration. But during the involvement and intervention for infected people,

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many of their self disintegration do not occur directly after a mature self, as they often spontaneously try to repair or establish a self-object bond. For example, X had a narrow escape from death and formed a mutual assistance group with other infected patients. He not only received daily life care, but also successfully survived. At this moment, the self development and changes of X was just in the stage of spontaneous action, and his self disintegrating occurred in the recycle caused by the defects of compensation structure. Although X to a certain extent obtained the recognition of patients and timely help of Y and other infected people, he did not form a perfect compensation structure at that time, and the lack of self-object needs caused his self disintegration. Of course, self disintegration may also occur directly in the involvement and intervention of empathy and response. For example, Z, in the failure of X’s empathy, showed aversion to AIDS, and finally, cut off the connection with the good self-object, and ultimately lead to self disintegration. In addition, even if infected people to a certain extent can well adapt to the impact and abuse of AIDS, it may also directly lead to self collapse in the face of opportunistic infection and other unexpected situations. To sum up, self disintegrating may occur in any poor adaptation or internal and external conflict. If the infected person still refuses all involvement and intervention, it will lead to the infected person towards continuous poor adaptation. Consequently, they can not really cope with the problems caused by AIDS, or truly return to society. Therefore, all case managers try to seek the therapeutic effect that understanding, interpretation, and a moderate response exert on self disintegration. At this time, the relationship between the infected person and the case manager works as a bridge. The empathic inquiry mode and the expression of moderate response are used to determine the involvement and intervention relationship with the infected person, restore the self-object functions, thus helping to repair self into the original healthy status.

7.2.3 Self Repair: The Organic Combination of Empathy and Moderate Response Kohut and his successors have acknowledged empathy’s general therapeutic role, that is, the understanding and interpretation based on empathy and generated by analysts constitute the basic unit of treatment. The experience of the patient’s moderate response to the analyst is a feeling that is deeply understood, a feeling that reduces frustration and tension, and a feeling that is enriched and satisfied. The complete healing process consists of three steps: understanding and interpretation based on empathy and a moderate response to the patient. Only by carrying out the whole process of involvement and intervention therapy with empathy and moderate response, can we establish or restore harmonious self-object relationship, meet the individual’s self-object needs, form a new experience, and succeed in psychoanalytic therapy.

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In the process of involvement and intervention for infected people, a series of organic cooperation based on empathic understanding and interpretation and moderate response can be carried out from the following four aspects to repair the self. (1) Understanding to provide a dynamic analysis of symptoms and defects In general, self-psychologists see patients’ symptoms as the best tool to protect the fragile self from re-trauma, or to resurrect and recombine exhaustion and broken self. From self-psychological point of view, after the individual infected with HIV, the symptoms show the defects or loss of self cohesion or vitality, and the efforts to repair or recombine the weakened self. At this point, the case manager’s empathic understanding expresses a shift from the behavioral level (e.g., the infected person’s refusal to take medication) to a dynamic level (e.g., the infected person has an experience organizing principle but has no trust in other resources). Of course, the case manager’s understanding of the symptoms and defects of an infected person also includes whether he or she is faced with temporary symptoms or persistent defects. At this time, empathy is helpful to understand the infected person’s self experience, analyze which defects are obvious, and whether these defects are acute or chronic. In other words, whether an individual has ever been given the self-comforting and regulating function to maintain self-esteem and regulate emotions. Thinking about these issues, the author finds that empathic understanding is essential and promotes the formation of good self-objects. (2) Interpretation to provide phylogenetics transformation for adaptation In self psychology, analysts need to understand how patients try to compensate for their self defects. In other words, analysts need to know the scope of their defensive adaptation and compensatory structure, and how to deal with any trauma and self-object failure in their experience. The vast majority of people have specific coping styles to maintain cohesion, competence, or adaptive function and avoid anxiety. These ways of dealing with annoyances and maintaining a viable self-experience include both internal mechanisms (their self structures) and external support (the required self-object function provided by a case manager). Similarly, the reason why infected people come to seek treatment is that some factor triggers their sense of incompetence. Often, the trigger is a loss of an important self-object or a new challenge in dealing with HIV. This promoting stress destroys the previous adaptation of the infected person and overuses it until these adaptations are unsustainable. Although the usual defense efforts will double, this emergency will eventually fail. At this point, the underlying problems are more likely to enter the treatment field and may therefore become the focus of treatment. In other words, a case manager must establish a phylogenetics connection and transformation between the current problem (caused by some kind of stress) and what happened in the infected person’s previous life. When this idea can be changed based on an interpretive response to an infected person, it creates a focus for treatment. As the Shanes said, the focus

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of treatment is not a problem, but the construction of interpreting it. The interpretation of a case manager changes exposed structural defects of the infected, completes the phylogenetics transformation of adaptation, and helps to form a new self-experience. (3) Mobilization of forces with a moderate response In the process of involvement and intervention, it is important to focus on the strength of the infected. We should focus on what has been used in the past to maintain or repair vitality and cohesion, and where infected people continue to demonstrate this strength now. A case manager needs to emphasize the power of triggering and nurturing infected people, focusing on how strength no longer serves them, rather than on the discussion of the attribution of HIV infection. From a case manager’s point of view, an infected person has the resources to deal with their problems, and the case manager’s job is to mobilize those resources through a moderate response. The infected should be described as the initiator of the current change, not just the victims of the past, and the power of the infected should be seen as a lever to help them solve their problems. As Basch argued, patients come for treatment because their power no longer works. This idea of promoting automatic recovery of infected people as a treatment goal has also been taken seriously by other self-psychologists. Consistent with this, a case manager should pay attention to the right thing done by the infected person and respond appropriately. Responding to the needs that an infected person hopes to receive from a case manager is useful for identifying the resources and limitations of the infected self, and reinforces the efforts as an active collaborator. Sometimes, the forces of a moderate response also involve re-constructing previous experiences rather than re-linking them. For self-psychologists, a moderate response is a familiar process, and the experience of a moderate response helps to repair the connection of the broken self-object, and encourages analysts and patients to gradually develop their self-object needs and strengthen selves in the co-constructed relationship. As Shelby pointed out, analysts are not only facilitators of the process of rebuilding self-object relationships, but also essential players in the process. This is important for understanding the role of an infected person in providing a nurturing and supportive self-object relationship, which can be exploited as a prerequisite for the infected’s dying to live. (4) The function of empathy and moderate response to change the self-object The involvement and intervention methods of empathic understanding, interpretation and moderate response provide important self-object functions for the self restoration of the infected. First of all, the empathy of a case manager provides a dynamic analysis and the phylogenetics transformation for the “dying to live” process. Without it, understanding would not be thorough enough, and interpretation would not be deep enough. The understanding and interpretation of a case manager can not only deepen the infected’s understanding of themselves, and make their own thoughts and emotions acceptable, but also make them

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realize the depth and breadth of the case manager’s understanding and interpretation of them. Further, an empathic involvement and intervention relationship is established between the infected and case managers. Secondly, the psychological structure formed by the understanding and interpretation of a case manager is often fragile. And a moderate response based on a case manager’s careful consideration can consolidate the psychological structure formed by understanding and interpretation, so that the infected can recall the case manager’s response to them and form a compensation structure in the process of late repair. In this way, if internal experience and emotional response similar to previous stages in the later response to AIDS, infected people can be positive, reduce dependence on a case manager, and perform important psychological function replaced by case managers. In short, in the process of involvement and intervention, the important role of treatment is to convey their understanding of the action through the empathic coordination and the basic unit of understanding, interpretation and moderate response. The case manager is focused on the adjustment, maintenance and repair of the individual after the self fragmentation and collapse; while the infected devote themselves to transforming the self-object functions and internalize the supportive atmosphere of the moderate response to the analytical relationship with the case manager’s empathic understanding and interpretation. All these are aimed to build a harmonious involvement and intervention relationship with the infected. The self-object functions carried out by a case manager meet the self-object needs, and promote the formation of the compensation structure of the infected.

7.2.4 Self Restoration: Focus on the Satisfaction of the Self-object Needs and the Formation of Compensation Structure In any treatment of limited resources, the analyst must decide where to focus on his or her treatment. All forms of treatment deal with this problem in this way or another. From self-psychological point of view, the focus of a case manager must be on the new experience of the infected person, on the involvement and intervention relationship between the infected as a new self and self-object and the case manager in the process of involvement and intervention. The self-object relationship is the basis for change. The success of treatment depends more on whether the internalization and needs of good self-objects can be met quickly in the right place. The so-called self-object needs here refer to the potential of infected people to rely on the support and care of a case manager. The satisfaction degree of the self-object demand in the involvement and intervention relationship is more helpful to promote the formation of compensation structure, and provides another way for self development and reconstruction of a mature self.

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Focusing on the formation of compensation structures can repair the self-collapse caused by potential self defects or recent injuries, as infected people tend to restart thwarted self-object needs in the satisfaction of their self-object relationships. They also take a case manager as a source to make up for the self-object experience, and the case manager as a good self-object will direct empathy and moderate response to the possible therapeutic focus, thus forming a complete compensation structure and a mature self through full internalization. When the case manager is positive and satisfied with any reasonable self-object needs that arise in the involvement and intervention relationship, the infected person’s self will be strengthened. Otherwise, his or her self would be threatened and symptoms might worsen. Inadequate satisfaction of the self-object needs will lead to defects in the formation of compensation structures, which can lead to re-trauma of instable self and repeated return to the state of self collapse. But as mentioned earlier, the recycle here is not a pure involvement and intervention failure, but rather a preparation for the qualitative change (self-restoration) from quantitative accumulation (forming a compensation structure). To sum up: the “dying to live” involvement and intervention process of the infected is closely related to their involvement and intervention relationship. Successful selfrestoration occurs in a reactive, supportive and nurturing self-object relationship. It reflects the analysis and treatment of the inter-subjectivity of the infected person and the case manager. The solution to problems is no longer the work of a case manager or the infected person independent of each other, but the empathic understanding, interpretation and moderate response in the inter-subject field. Without an empathic atmosphere and the inter-subject field, those who have been suffering from traumatic self-injury would not be able to engage in the recycle described earlier. In fact, when an individual resorts to defensive means to support himself in the absence of an important self-object, there may be suppression and distortion of self development, which eventually results in self fragmentation and disintegration. The nurturing environment of inter-subjectivity involvement and intervention relationship provides the support and relationship experience of empathic understanding, interpretation and moderate response for infected people. From self-psychological point of view, the goal of involvement and intervention for infected people is to repair and rebuild self after a basic self-object connection ruptures. The infected person strives to be connected with the lost self-object to protect his or her regulatory function and restore his or her self in the deepening of the relationship. At the same time, the fully internalized mature self deals with the external real world, including HIV infection, to achieve a continuous state of adaptation, which is formed and maintained in the self-object relationship. Research is a craft—unlike a craft but a real craft. It is the same with the involvement and intervention for infected people. It is an art, not just a technology. Here, the author also does not advocate the use of “technology”, because it often means fixed standards and steps, emphasizing programming procedures. Although the self restoration and the involvement and intervention mechanism for infected persons are divided into several steps and levels, in fact, the whole involvement and intervention process is not so clear. There is no strict distinction between the stages.

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Therefore, although the author explores the involvement and intervention mechanism, his concern is the process of treatment, neither specific details, nor simple results. Focusing on the process is more important than focusing on results, and this is the essence of therapeutic involvement and intervention.

Afterwords

The revision of the manuscript is coming to the end. As a researcher, I do not pursue cold-eyed perspective and neutral value in writing, only hoping to build the process from disintegration to self-restoration of AIDS population from a personal point of view. More importantly, I delve into their “dying to live” intervention mechanism, analyse the structural form of the self system and its change model. I have met AIDS research for more than ten years, and also participated in many seminars, large or small. However, the understanding and thinking of myself originated from my pursuit of the doctoral degree in Fu Jen Catholic University of Taiwan. Now it seems time to think about me and self. It is believed that this is also beneficial to the exploration of self-restoration mechanism, and this is used to think about the research oriented to relational theory of self psychology and its therapeutic fields. Seen from the structural form or model of the self system, many individuals may be consistent in “main pathology” of the psychological distress and psychological discomfort. That is, the change of the self-object relationship and the satisfaction of the self-object needs affects the individual’s self structure, setting off or curing the individual’s psychological problems. This will expand the scope of self psychology, and challenge its “unanalyticality” claimed from its inception. I have talked to people more than once about how I might have had two outcomes of easy graduation or retreat if I hadn’t come to Fu Jen Catholic University in Taiwan to study for a double training doctoral degree. And it is the charm of the University that makes me introspect myself in the study and thesis writing from time to time. Perhaps this is also a unique feature of the University. Just as a case manager must feel the course of the AIDS population being infected through the empathic understanding echoing their experience and based on their daily lives, I feel such an experience in the course of writing the thesis. Not that I am experiencing similar self-disintegration and restoration, it is only because it is the true embodiment of emapthy. Although I can’t imagine how HIV infection will be a blow to people living with AIDS, I can feel what kind of loss, and reflect on the meaning of this sense of loss to my self. Before coming to the University, limited by the influence of scientism, I misundertood the concept of psychoanalysis. When I first learned psychoanalysis, I was ignorant of it, and my personal state was: “One step away from psychoanalysis to © Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9

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psycho-fracture”. It’s just that I’m making fun of myself, but through the enlightenment of Prof. Wei-Li Soong, I’ve come to realize how deep my misunderstanding of Freud’s psychoanalysis. It is also thanks to him that I attend courses like relational psychoanalysis and begin to step on the journey to think about self and self-restoration. I started with a research topic, but I’m a little muddled about specifically how to carry out research, especially to look at the course of infected people getting sick from the field of psychology. With the help of Prof. Soong, I solve my confusion and realize that it is “psychological motivation” and “psychotherapy” that give infected people a new life. However, at first I still didn’t understand the two terms. Psychotherapy has more than 200 kinds of therapeutic methods in general, but I do not know what to do and which to choose. Fortunately, my first introduction was to discuss self and its changes in relationships, and the scholar Fosshage combed through the concepts of self and self-object put forward by Kohut, and suggested that self psychology should emphasize the uniqueness of “core self”. When I first read the article, I felt more confused, and the introduction can only be expressed on the literal meaning. Soong’s supplement and enlightenment let me have a great understanding of self-disintegration and selfrestoration proposed by Kohut. I suddenly felt that the “dying to live” process of an infected person was precisely in line with the process of Kohut’s self from disintegration to restoration. This thought really excited me for a long time, and soon I fell into the study of Kohut’s self psychology. I borrowed Kohut’s series of books from the library, Analysis of Self , Reconstruction of Self and The Cure of Psychoanalysis, only to find that these three books, for me, could not be understood at all. Fortunately, I found Theories and Practice of Self-Psychology co-authored by White and Weiner, and Wang Lifei’s Psychoanalysis Lecture Hall: Self-Psychology. From then on I began a long reading and understanding. In self psychology, Kohut analysed narcissistic personality disorder, breaking Freud’s “unanalytical” hypothesis. He held that individual’s self defects, not conflict, were the main cause of psychological distress, and the self defects resulted from the unsatisfaction of the original self-object needs. In the later analysis and treatment, the analyst gives full play to self-object function, meets the original self-object needs of the patient, makes up for the defects of the self structure, and realizes the cure of psychoanalysis. However, I felt more anxious after discovering that the psychological distress of the patient is mostly formed in childhood when the original self-object needs are not satisfied, and when I understand how the patient’s self is moving towards reconstruction. According to my original vision, I wanted to borrow Kohut’s self reconstruction to analyze the infected person’s “dying to live” process and intervention mechanism. But if the self flaws stem only from the absence of the original self-object needs, then my experience will be out of place. The experience of having contact with infected people made me believe that the psychological problems of people living with AIDS do not stem from the unmet self-object needs. Most of them had a mature self structure before they became infected with HIV.

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Am I using a theory to explain a phenomenon? So whether this theory is appropriate for the phenomenon is extremely important. Or is it just because I know best about self psychology, it seems to be another electric screwdriver that I just got into my hand, and I want to try when I see any screw protrusion? At this point, the connection between my self and self psychology (the self-object) broke, and I also developed my own doubts about the self. Of course, this feeling is also related to my own reality: I hope that during the two years in Taiwan, I complete the doctoral class in the psychology department and also start the writing of doctoral thesis. And it is not easy to find a research perspective, consequently, the break of the link makes me experience a sense of stress and loss. At this time, I have a little confusion. However, as Kohut said, the core self has a stable internal structure, will spontaneously repair and reconstruct the self-object bond. After the inner reluctance and further study, I found that the original self accompanied the individual’s whole life. Throughout his or her life, everyone needs a positive self-object experience to maintain self perfection. Goldberg pointed out that psychotherapy was divided into two levels, and that psychoanalysis before self-psychology focused too much on secondary pathology, that is, over-focusing on the content or meaning generated by self structure, for instance the ways in which the Oedipus conflict exists. Goldberg argued that this attention to content was anachronistic and what deserved our attention was higher-order theoretical forms or models, that is, the main pathological relationship related to self integration. He argued that : “The whole form of self is the essence of self structure, which is composed of various self and self-object relationships” (Shane, 1991). What I understand about the treatment of people with narcissistic personality disorder by self psychology happens to be focusing too much on secondary pathology in treatment, while ignoring the primary pathology of the form or model of self system structure. From the main pathological point of view, whether it is narcissistic personality disorder or HIV-infected people, the structural form of their self system and development model is connected. It is worthy of further study. At this point, my concerns in the thesis writing seem to have been addressed. The solution here is similar to that of an infected person, finding a connection with the self-object in the relationship, and then developing self structure. So I picked up Kohut’s three books and the classics of many of self psychologists. They became my self objects, always spontaneously making connections as I was obstructed in theis writing. What’s more, in the course of field work, I have had a lot of contact with infected people, and I have also eaten together, lived together, worked together with them. In the process of getting along, I found that Organization A has an excellent reputation among those infected. In the words of an infected person, “We found the organization and sense of belonging”. Correspondingly, in B city with many organizations for the infected, there are contradictary comments on organizations and staff. For example, the so-called intervention means registration, eating and taking pictures. I can’t help but ask, is this support a few talks, some medical information, a few words of comfort, or empathy similar to “everybody is such like”, “I understand your feelings”. Can this work? If

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not, what would it be? How Organization A applies empathic involvement and intervention? How does a case manager who has not received any professional training use empathy in this psychoanalysis method? In order to solve my confusion, I temporarily put aside the connection with the theory of empathy, and immerse myself into the field survey of Organization A, hoping to establish a new relationship with them to feel and to experience what is affecting the infected, what makes Organization A superior to other organizations, and so recognized by the infected. In the course of field work, I learned a word called “affinity”, emphasizing a true understanding of the infected person in the involvement and intervention with the infected person. What is embodied in this is a kind of intention and emotion input. Just as in the classic sci-fi movie “Invasion of the Body Snatchers”, humans are controlled by their replicas, which are similar in every way to themselves except “humanity”, including their own memories, facial features, and preferences. In the film, the first little girl to notice the main character has these characteristics describes this feeling. She (the main character’s niece) interprets this as “Uncle George looks like Uncle George, but he’s not, he’s right, he’s doing the right thing, but he’s missing something. He looked at me differently as Uncle George. He can’t see me, so he’s not Uncle George.” The “new” human beings in the film lack human nature because they lack emotion and love. When people ask about love and joy, their answer is that they can live without these feelings, and that they can cause them trouble. But without these emotions, there is no longer trust between people, no longer recognition, help and understanding, no longer the self-object needs and emotions that Kohut discussed. Now recalling What X said about “affinity” and Z’s resistance, I realize the basis is the emotional expression to the infected person, including understanding, acceptance, affirmation and response. These emotions are the most basic thing of human nature. X not only pays attention to the feelings of the infected person, but also devotes himself to the helping profession. As we often say, home is a harbor, because home can provide us with emotional support, not just the help we need. Instead of morally excluding the immature and unacceptable behavior of an infected person, X tries to understand them, no matter how unpleasant the process is. Especially no matter how frustrated the infected person is in front of the doctor or someone else, he can still enjoy X’s understanding and recognition of him. This may be the reason why a case manager is often perceived by infected people as their most lovely and reliable “soulmate”. In Organization A, I take an approach of participant observation, helping them to deal with some documents and projects, and focusing on the establishment of relationships with case managers and infected persons. I experience and think about how this involvement and intervention work can be achieved, and improve our consultantvisitor relationship. This has also become another self-object bond of my thesis writing. In the chat with X, I feel that emotional experience and expression is the first step to get the recognition of the infected person. What the infected person really comes to seek is trust, recognition, companion and relationship. Looking back on the process of building trust with Z, I remembered my third participant chosen is H in addition to X and Y. But when I came back from Taiwan, I found that H had

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been hospitalized for nearly half a year not due to opportunistic infection but a rare symptom. When I went to see H, he was in poor health and could only say a few words briefly. Before going to Taiwan, I also went to chat with him about my thesis proposal. I didn’t expect he had been seriously ill in hospital when we met again. H could not accept my interview, and I would like him to rest assured. But H was still very supportive of my work, and recommende Z. Z promised to accept my interview, only to say that the time would be set. At that time, I vaguely felt that the interview with Z might not have been particularly smooth. Because with the humanities and social science research involved in the field of AIDS, interviews were gradually familiar to many infected people. I was worried about Z’s ambiguous attitude. I met Z in Organization A by chance, and a detail brought us closer and earned me his trust. At noon dinner, he brought up the freshly poured tea to me, but when he touched the cup, he deliberately poured a little of his tea into my cup to see my reaction. I drank all, he laughed and put his hand on my shoulder, and we became close friends after that and he invited me to attend his birthday party. Now, it seems that z’s tentative actions should have profound significance. Is he just trying to scare me away? I don’t think so, he can turn me down if he doesn’t want to be interviewed. Or is it just to test whether I’m discriminating against him? No, the infected or volunteers like Z who has accepted the fact of HIV infection are no longer concerned with external opinions. True reasons are that he is sensitive and wants to better protect himself; meanwhile, it is a kind of relationship construction, that is, whether I deserve his trust, how close I am with him, and whether I can become an insider in his hierarchical circles. If I sincerely treat him, he can have a heart-to-heart with me plus the sincere recommendation of H. Otherwise, he could directly reject me. In order to gain the trust of the infected, I need first of all to establish a deep trust with them in the professional relationship both through verbal expressions and actions. Above all, the premise of all these is the trust between each other. It is this trust-based field survey that always allows me to sincerely interact with infected people and case managers. It is also the understanding, interpretation and moderate response that constantly moved the AIDS population, prompting them to reconstruct self to gain a new life. So is it for me, and so is the infected. In fact, the self of each individual may lose balance and fall low into disintegration, causing psychological discomfort and distress. When the individual’s self is in danger of losing balance, some have a strong ability to recover, and can find a good self-object in real life. They can internalize the self-object function to achieve self reconstruction. But others have no way to find the self-object to restore the self balance, like the infected seeking support and care. They need to find a self-object bond to help them step on the road of self development. The lifelong involvement and intervention mode of Organization A provides such a treatment model of rehabilitation. In this mode, the infected can gradually satisfy the self-object needs to achieve their self reconstruction. However, whether it is the intervention mode for infected people or my connection with the self-object, it is inseparable from the maintenance of the relationship between the two sides. For example, playing table tennis. The participating parties will try not to let the table tennis fall unless it is a game, in order to maintain a continuous mutual

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batting state. And this process is similar to the development of the involvement and my connection with the self-object. The skills of the two sides involved may be uneven. If one player is not technical and not good at control of the racket, the other side will adjust his batting direction and intensity according to his level, so that the ball will just fall in the other side’s batting area. Therefore, in order to maintain the game and enjoy the fun for both parties, the two sides must have perfect interaction. More interestingly, as both sides improve their skills, the difficulty of the game increases. Since the purpose of the game is not to let the ball land, the game is nearing the end when one side feels that the other side do not cooperate or one side obviously want to show off himself and look down on the other side. So is the interventional therapy. If a case manager can not cooperate with each other in involvement and intervention, it can not mobilize the enthusiasm of the infected a case manager, and the involvement and intervention process will not continue. Moreover, focusing on the process is more important than focusing on the outcome. The understanding of one’s self feelings occurs in the course of a case manager’s interaction with an infected person, so the case manager needs to listen to and respond moderately to the emotional experience of the infected person, rather than just “mindlessly” asking, “How do you feel?”. This method of questioning can make infected people feel that a case manager does not understand them, thereby affecting the establishment of involvement and intervention relationships. As Stolorow (1993) said, when we look for experiences that match the emotional experience of patiens in our own emotional experiences, we may not be able to understand them accurately. If we think we have learned about the emotional experience of an patient, we will express it in words, which may be affirmed, denied, or supplemented by the patient. That is to say, the focus of a case manager is to express their understanding of the subjective feelings of the infected person and to implement self reconstruction in the relationship. As far as I am concerned, the construction and maintenance of relationships require not only the alternating of learning and thinking, but also the integration of knowledge and practice. Although this book is revised on the basis of the doctoral thesis, there are still some topics that need to be discussed further in the future. As many infected people say, although AIDS as a gift of God causes them to suffer from disease, it is also a chance for them to reexamine their own health and surrounding relations. So whether AIDS itself can also become a self-object, what role it has on the infected person’s self deconstruction and construction. All these are worth further discussion In addition, in my opinion, the treatment of AIDS should reflect more a de-special operation than the fear of it. The infected I’ve been in contact with in Organization A all have a small goal to live to successfully develop antiviral drugs. If one day AIDS can be cured, perhaps there will be no AIDS problem, just like the history of smallpox and malaria. But I believe that this process of fighting AIDS, professional relations established in this involvement and intervention process, the pursuit of qualit life such as happiness and the self-object will not disappear. This is also reflected in “cultural psychology”, and I am willing to work for the direction.

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So, the last thing I wrote down was not a full period, but a new beginning. For myself, this is also not the end point. It should be my continuous adaptation of the new starting point. I would like to express my gratitude to Professor Wei-Li Soong. Introduced by Professor He Chunrui, I had the chance to be supervised by Prof. Soong. I attended three courses with him every semester, undergraduate, master’s degree and doctoral degree each. The articles concerned with the courses are mainly written in English or ancient Chinese language. Soong is very erudite, proficient in Oracle, English, French, German and Russian language. I would also like to thank the teachers and students who helped in the writing and revision of this book. Thank you to Professor Li Weilun, Professor Wang Xing, Professor He Donghong and Professor Tao Fanying for their valuable comments on my thesis. Thank you to Professor Xia Linqing, Professor Ding Xingxiang, Professor Weng Kaicheng for instructing and influencing me with their words and deeds. Thank you to teachers in the psychology department of Fu Jen Catholic University such as Meijun, Ruoxin and Zongrong for their attention to me. Thank you to students in the courses for bringing me joy. Special thanks to our “Art Therapy” team members: team leader Lin Meili, Xuanhui, Xiaojing and me. The four of us once carried out a semester of art therapy workshop, having heart-to-heart chat, painting togetehr, singing together, analyzing together, discussing together, and growing together in room 219. I also want to thank my colleagues like Huiling, Fangping, Color, Yantang, Daoyuan Gaoqing, Dingrui, Xianhong and Lin Nan for their help and companion during my stay in Taiwan. Thanks to Professor He Chunrui and Ning Yingbin of National Central University, my supervisor Pan Suiming and Professor Liao Fei of Renmin University of China for their recommendation for me to study in Taiwan. Thanks to the founder of Organization A X, case manager Y and volunteer Z, as well as many people infected with HIV for allowing me to conduct my research among you. Your support and trust give me rich data, also the honor to reconstruct my self. Although your names cannot be listed truthfully in the book, I am sure that you can feel my sincere thanks. In addition, I would like to thank the late HIV-infected activist H, who was my full support and guide of AIDS research. I pray for him. Thanks to editors Zhang Xinfang and Li Wenxing of Huazhong University of Science and Technology Press, and the translator Zhao Hulin from Henan Normal University. It was with the help of Zhang that the book was published. Frankly speaking, after my Ph.D graduation, I was somewhat tired, and my doctoral thesis was kept in the dust at home for a long time. If it was not Zhang’s strong support and help, the thesis would also be in my computer for a long time. Li meticulously modified and revised manuscripts, benefiting me a lot. Without the translation of Zhao, my book in English version couldn’t have been published. Thank you for the care and support of Professor Zhu Haishen, Professor Li Yonglin, Professor Wang Liping, and other teachers and leaders in Inner Mongolia University of Science & Technology. Finally, I would like to thank friends and family members for their long-term care and help, especially to my father, mother, uncles, aunts and sisters over the years. Your understanding and help is my driving force. I

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would also like to thank my wife Gao Peiying for more than ten years of companion. This book is also dedicated to our daughter Hou Yunxi. Due to the need for academic research, some materials and data are duplicately cited, which may not be fully consistent. I’m very sorry for any inconvenience. Hou Rongting East Asia Century City, November 2017

References

Monographs Basch, F. M. (2005). Understanding psychotherapy [M]. The Chinese version is translated by Yi Zhixin. Chengdu: Sichuan University Press. Basch, F. M. (2014). Doing psychotherapy [M]. The Chinese version is translated by Shou Tongjun & XUE Chang. Beijing: China Light Industry Ltd. Buirski, P., & Haglund, P. (2014). Making sense togetehr: the intersubjective to psychotherapy [M]. The Chinese version is translated by Yin Xiaowen. Beijing: China Light Industry Ltd. Che, W. (1992) Freudian review [M]. Changchun: Jilin Education Press. Cai, F. (2008). Self psychology: A research on Heinz Kohut [M]. Fuzhou: Fujian Education Press. Guo, B. (2003). New advances in contemporary psychology [M]. Ji’nan: Shandong Education Press. Kohut, H. (2002) The restoration of the self [M]. The Chinese version is translated by Xu Haochong. Taibei: Psychology Press. Kohut, H. (2012) The analysis of the self [M]. The Chinese version is translated by Liu Huiqing. Taibei: World Publishing Corporation. Kohut, H. (2016). How does analysis cure [M]. Chongqing: Chongqing University Press. Lessem A. P. (2014). Self psychology: an introduction [M]. The Chinese version is translated by Wang Jinghua. Beijing: China Light Industry Ltd. Pruyser, W. P. (2014). A dynamic psychology of religion [M]. The Chinese version is translated by Song Wenli. Taibei: Linking Publishing Co. Ltd. Stolorow, R., Atwood, G., & Orange, D. (2002). Worlds of experience: interweaving philosophical and clinical dimensions in psychoanalysis [M]. New York: Basic Books. White, T. M., & Weiner, M. B. (2002). The theory and practice of self psychology [M]. The Chinese version is translated by Lin Xiuhui. Taibei: Psychology Press. Milton, J., Polmear, C., & Fabricius, J. (2014). A short introduction to psychoanalysis [M]. The Chinese version is translated by YU Ping & ZHOU Juan. Beijing: China Light Industry Ltd. Ogden, T. (2008). This art of psychoanalysis [M]. The Chinese version is translated by ZHANG Xu. Beijing: Beijing University Press. Pan, S. (2004). Sex in the age of AIDS [M]. Guangzhou: South China Newspaper Press. Siegel, M. A. (2005). Heinz Kohut and the psychology of the self [M]. The Chinese version is translated by Ye Yuji. Taibei: Yuan-Liou Publishing Co., Ltd. Wang, L. (2003). Lectures on psychoanalysis: Self psychology (1) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2004). Lectures on psychoanalysis: Self psychology (2) [M]. Taibei: Xuefu Culture Co., Ltd. © Huazhong University of Science and Technology Press 2020 R. Hou, Self-restoration of People Living with HIV/AIDS in China, https://doi.org/10.1007/978-981-15-7413-9

169

170

References

Wang, L. (2005). Lectures on psychoanalysis: Self psychology (3) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2006). Lectures on psychoanalysis: Self psychology (4) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2007). Lectures on psychoanalysis: Self psychology (5) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2008). Lectures on psychoanalysis: Self psychology (6) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2009). Lectures on psychoanalysis: Self psychology (7) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2010). Lectures on psychoanalysis: Self psychology (8) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2011). Lectures on psychoanalysis: Self psychology (9) [M]. Taibei: Xuefu Culture Co., Ltd. Wang, L. (2012). Lectures on psychoanalysis: Self psychology (10) [M]. Taibei: Xuefu Culture Co., Ltd.

Theses and Dissertations Chen, B. (2013). Dying to live: a psychological motivation to explore the transformation of life of drug addicts [D]. Xinbei: Fu Jen Catholic University. Chen, J. (2013). A study of the self-identity recognition of AIDS patients: A case study of patients in the village of HL in northwest Hubei [D]. Wuhan: Central China Normal University. Fang, J. (2008). Emotional ups and downs: AIDS patients seek support in difficult situations [D]. Changsha: Central South University. Song, X. (2012). Detachment and fall: a research on emotional adjustment of AIDS patients in Wuhan city [D]. Wuhan: Central China Normal University. Wei, H. (2011). From a theory to a variety of orientations: A study of new self-psychology [D]. Wang, G. (2000). A study of Klein’s theory of object relations [D]. Nanjing: Nanjing Normal University.

Journals Basch, M. F. (1981). Psychoanalytic interpretation and cognitive transformation [J]. International Journal of Psychoanalysis (2). Bai, W. (1996). The impact of AIDS on socio-economic development [J]. Journal of Lanzhou University (3). Cai, F. (2000). Self-psychology: A new paradigm of psychoanalysis [J]. Journal of Nanjing Normal University (social sciences) (4). Cai, F. (2001). On Kohut’s methodology of psychoanalysis [J]. Nanjing Normal University (social sciences) (6). Chen, X. (2008). Analysis of social support status of AIDS patients and nursing countermeasures [J]. Chinese Nursing Management (1). Goldberg, A. (1989). A fresh look at psychoanalysis: The view from self psychology [J]. American Journal of Psychiatry (7). He, Y. (2007). An exploration into social support models for AIDS prevention and treatment in rural areas [J]. Chinese Journal of AIDS & STD (3).

References

171

Jin, F., Bai, L., & Li, H. (2007). A survey of the psychosocial status of HIV/AIDS families [J]. Chinese Journal of Public Health (9). Jiang, Y., Ren, X., & Wen, Q. (2006). An investigation of and research on the exchange and utilization of information on the comprehensive prevention and treatment of AIDS [J]. Henan Journal of Preventive Medicine, 17(4). Jiang, Z., Xiang, Q., & Li, S. (2009). A comparison of psychological interventions for depression in AIDS patients [J]. Journal of Kunming Medical University (7). Kohut, H. (1973). The analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders [J]. Journal of Nervous & Mental Disease (6). Li, H., & Shi, L. (2012). Clinical characteristics and nursing strategies of AIDS complicated with drepression [J]. Laboratory Medicine and Clinic (19). Li H., Luo, M., & He, J. (2004). Community-based care and support activities [J]. Chinese Journal of AIDS & STD, 10(3). Li, N. (2010). The success and bottleneck of ngos in China’s AIDS prevention and control: theoretical research and empirical case analysis - take China’s “love care” as an example. [J]. Chinese Medical Ethics (3). Liu, H., & Sun, M. (2005). The problem of “social exclusion” and government intervention in AIDS prevention and treatment: with HIV/AIDS population and their high-risk population as research objects [J]. Chinese Health Service Management (6). Liu, N. (2005). AIDS, stigma and social discrimination: a quantitative analysis of two groups of people in China’s rural areas. [J]. Sociological Study (6). Maratos, J. (1985). Structure of Subjectivity: Exploration in Psychoanalytic Phenomenology [J]. Group Analysis (1). Milton, J., Polmear, C., & Fabricius, J. (2011). A short introduction to psychoanalysis [J]. Theory of Computing Systems (1). Mitchell, S. A., & Black, M. J. (2015). Freud and beyond: A history of modern psychoanalytic thought [J]. American Journal of Psychotherapy (4). Orange, D. M., Atwood, G. E., & Stolorow, R. D. (1999). Working intersubjectively: Contextualism in psychoanalytic practice [J]. Psychoanalytic Psychology (2). Pan, S. (2001). New questions to sociology posed by AIDS research [J]. Sociological Study (4). Pan, S., Huang, Y., & Li, D. (2006). Analysis of the AIDS “problem” in China [J]. Social Sciences in China (1). Ren, X., Jiang, Y., & Shao, A. (2005). An assessment of multi-sectoral society’s information needs and supply status quo to participate in AIDS prevention and treatment [J]. Modern Preventive Medicine (9). Stolorow, R. D., & Atwood, G. E. (2015). Contexts of being: The intersubjective foundations of psychological life [J]. American Journal of Psychiatry (1). Song, W. (2002). Narrative and consciousness: Another angle for dialogue [J]. Taiwan Studies in Applied Psychology (16). Shi, C., Yu, X., & Wu, Z. (2005). A preliminary study on neuropsychology in HIV/AIDS patients in China [J]. Chinese Mental Health Journal, 19 (5). With Adolescents and Young Adults [J]. Social Service Review (6) (2006). White, M. T., & Weiner, M. B. (1999). The theory and practice of self psychology [J]. International Journal of Group Psychotherapy (3). Xu, Q., Wu, X., & Zhu, H. (2005). The demographic and socio-economic impact of the AIDS epidemic [J]. Population Journal (3). Xu, X., & Qu, Y. (2013). The path differentiation logic of rural AIDS impression management: the practice of AIDS village in XY city of Hubei. [J]. Hubei Social Sciences (6). Wang, D., Ye, H., & Ye, H. (2007). Investigation and analysis of blood safety and AIDS [J]. Journal of Clinical Hematology, 4 (5). Wang, M., & Liu, Q. (2006). Development and related policy recommendations of NGOs in the field of AIDS prevention and treatment [J]. Jiangsu Social Sciences (4).

172

References

Wang, R., Dong, L., & Li, H. (2013). An overview of social organizations to participate in AIDS prevention and control in Xi’an city [J]. Chinese Journal of AIDS & STD (11). Wang, R., & Zhang, Y. (2003). Sociological problems caused by AIDS [J]. Chinese Cadres Tribune (3). Wang, Y., Liu, J., & Xu, Q. (2011). An assessment of the effectiveness of health education for gay men by non-governmental organizations [J]. Modern Preventive Medicine, 7(13). Wu, Y., Zhang, F., & Ji, S. (2005). A comparison of depression before and after counseling for people living with HIV [J]. Chinese Journal of AIDS & STD (4). Wu, Y., Zhang, F., & Ji, S. (2005). The effect of psychological counseling on the quality of life and social support of people living with HIV [J]. Journal of The Fourth Military Medical University (14). Wu, J., Yang, Y., & Li, W. (2004). A survey of psychological needs of HIV/AIDS patients [J]. Chinese Journal of Public Health (7). Xiang, D., & Chen, Q. (2004). Community support for people living with AIDS [J]. Academic Forum (3). Yu, X. (2000). HIV/AIDS-related mental health issues [J]. Chinese Mental Health Journal (4). Zhou, J. (2008). Ethical analysis and public ethical policy choices of high-risk behaviors of AIDS [J]. Studies in Ethics (4). Zhang, N., & Wu, M. (2012). A research on the participation of social organizations in the fight against AIDS: with Gansu Province as an example [J]. China Social Organization (6).