ABSTRACT Mark, a college student with attention deficit disorder, depression, and a language-based learning disability, was seen in psychoanalysis. The analytic work included defense interpretation, elucidation of unconscious themes, and construction of a life narrative. The treatment was multimodal, as is common in working with adolescents and emerging adults with learning disabilities and attention deficit disorder. The analyst prescribed stimulants and antidepressants, and referred the patient for psychological testing, tutoring, and educational accommodations. Understanding the shame associated with learning difficulties was crucial to the patient’s progress. This case report describes the beginning phase of a psychoanalytic treatment. Early transference, in the sense of reviving old objects, included feelings of mistrust and projection of harsh self-judgment. Gradually, the patient developed a reciprocal and collaborative partnership with the analyst that represented features of the real relationship, wherein Mark could internalize aspects of her that were more caring and compassionate than his own attitude toward himself (Abrams, Neubauer, and Solnit 1999). The patient developed the ability to observe himself, to recognize unconscious determinants of his behavior and to make use of the experience of transference.

中文翻译：

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“用勺子从铁笼子里挣脱出来”：一位候选人对注意力不集中的多动症和抑郁的大学生的挫败和挫败感产生了影响

摘要精神分析中发现马克，一名患有注意力缺陷障碍，抑郁症和基于语言的学习障碍的大学生。分析工作包括辩护解释，无意识主题的阐明和生活叙事的构建。这种治疗是多模式的，这在患有学习障碍和注意力缺陷障碍的青少年和新兴成年人中很常见。分析人员开出了兴奋剂和抗抑郁药的处方，并转介了患者进行心理测试，辅导和教育住宿。了解与学习困难相关的羞耻感对于患者的进步至关重要。该病例报告描述了心理分析治疗的开始阶段。在恢复旧物体的意义上，尽早转移 包括不信任感和苛刻的自我判断。逐渐地，患者与代表真正关系特征的分析师建立了对等和合作的伙伴关系，其中Mark可以内化比自己对自己的态度更关心和同情的方面（Abrams，Neubauer和Solnit，1999年）。患者发展了观察自己，识别其行为的无意识决定因素以及利用移情的能力。