Journeys in the labyrinth: Some difficulties in the psychotherapy of a severely traumatized adolescent

This paper explores the long-term sequelae of chronic early trauma as expressed by an adolescent in intensive psychotherapy. In particular, attention is given to the ways in which intolerable early experience may block subsequent identificatory ego growth by means of a radical defensive detachment from any potential source of help. Healthy maturation is replaced by an elaborate structure of defences aimed at obliterating awareness of unfulfilled attachment needs and providing a constantly available inner sanctum filled with exciting but profoundly unsatisfying sadomasochistic distractions. The technical importance of careful attention to the therapist's countertransference experiences is underlined. It is suggested that the presence of hatred in this area may represent one of the few undistorted communications from the patient, implying hatred of torture and cruelty. As such, when carefully metabolized by the psychotherapist, it may herald the recovery of hope and serve to protect hidden, bullied aspects of the patient's self which are still on the side of life and development.