Building the Nest: Reworking Adolescent Development in Adult Recovery from Addiction

Using an extended case vignette, the author explores addiction, specifically compulsive gambling and substance abuse, from several psychoanalytic perspectives. Addiction/compulsive behavior is explained as a strategy for managing loss at key developmental stages. The concept of trauma repetition is utilized to understand both the repetitious nature of chronic addiction, and the trauma that underlies it. The process of recovery is chronicled through the therapeutic relationship. A classic children's story is referred to as it threads through the narrative.     

Treating Adults With Complex Trauma: An Evidence‐Based Case Study

This article presents an overview of complex trauma and a case study describing the evidence‐informed treatment of a 25‐year‐old woman with chronic complex trauma symptoms resulting from childhood sexual, physical, and psychological abuse from a caregiver. Treatment followed a relationship‐based, cognitive behavior therapy model across 3 treatment phases. Significant reductions in trauma and general distress symptoms occurred from pre‐ to posttreatment, although firm conclusions about cause cannot be drawn from case studies. Verbatim vignettes illustrate specific interactions.     

Childless

This paper explores the complex interplay that unfolded between analyst and patient around their respective childlessness and aims to draw attention to the larger societal issues of imperative parenthood and the stigma of childlessness. As the analyst confronted her own internal conflicts about motherhood, children, and procreation as a woman living in a pronatalist society (one that encourages increasing birth-rates), she was treating a lesbian patient with a history of childhood relational trauma and sexual abuse who was undergoing fertility treatments. The patient’s experience with assisted reproductive technologies raised complicated questions and concerns within the analyst regarding their emotional impact on her patient and, more broadly, how they might reflect societal dissociation. Themes of trauma, loss, dissociation, and shifting self-states, which emerged during the fertility treatments and wove their way throughout the analysis, are discussed. In addition, the author describes the nature of the therapeutic action in this case.     

Traumatic loss and major disasters: strengthening family and community resilience

This article presents the core principles and value of a family and community resilience-oriented approach to recovery from traumatic loss when catastrophic events occur. In contrast to individually based, symptom-focused approaches to trauma recovery, this multisystemic practice approach contextualizes the distress in the traumatic experience and taps strengths and resources in relational networks to foster healing and posttraumatic growth. The intertwining of trauma and traumatic losses is discussed. Key family and social processes in risk and resilience in traumatic loss situations are outlined. Case illustrations, model programs, and intervention guidelines are described in situations of community violence and major disasters to suggest ways to foster family and community resilience.     

Bereavement and Traumatic Bereavement: Working with the Two-Track Model of Bereavement

Bereavement following loss through death is a universal human experience, but how it is experienced and understood is mediated by many variables. In this article, we stress the importance of a bifocal approach to understanding, assessing and intervening following the loss of significant persons using the framework of the Two-Track Model of Bereavement. This model examines both biopsychosocial functioning as well as the nature of the ongoing relationship with the deceased and the death story in working with the bereaved. It is particularly suited to identify adaptive and maladaptive responses to loss and to optimally focus interventions where needed. Two case vignettes are presented to orient the discussion. Traumatic bereavements, a term indicating the interface between trauma and loss, increase the likelihood of complications following loss and these are considered. Bereavements that occur under external traumatic circumstances increase the risk for dysfunction, symptomatic difficulties and complicated grief. In addition, there are forms of traumatic bereavement that arise due to subjective elements related to aspects of the psychological relationship to the deceased and the relational bond with him or her. Clinically, there is a need to identify and understand the various aspects of the traumas of bereavement and to intervene appropriately. Interventions based on the Two-Track Model of Bereavement will be described.     

Rrepresentations of trauma in infancy: Clinical and theoretical implications for the understanding of early memory

Understanding the nature of the infant's internal experience is a crucial prerequisite for delineating the developmental effects of an early trauma. In addition, to the extent that internal representations of a trauma can be traced over time, traumatic experiences present unique opportunities for the study of early memory. This article will describe case vignettes of children who experienced a trauma in the preverbal period and who evidenced forms of memory of their trauma at subsequent points in time. In conjunction with the clinical material, developmental research bearing on the types of early memories described will be discussed. The clinical data, reinforced by research findings, indicate that preverbal children, even in the first year of life, can establish and retain some form of internal representation of a traumatic event over significant periods of time. The specificity and enduring nature of the internal representations suggest that specific therapeutic interventions over and above general comforting will be required if an infant is to maximally recover from a trauma. The clinical findings have relevance for a number of issues currently under debate in the area of infant memory, including the role of reminders in memory retention, the nature of early memory systems, and the development of autobiographical memory. ©2002 Michigan Association for Infant Mental Health.     

Adolescents in Secure Accommodation in Scotland: Exposure and Impact of Traumatic Events

The current study sought, for the first time, to assess the nature of trauma exposure and resultant symptoms in adolescents (n = 17) in secure accommodation in Scotland. A case study mixed methods design involved analysis of case files, trauma history interviews, and standardized trauma symptom questionnaires with adolescents and program staff in 1 facility. A developmental trauma framework was applied to file analysis. Despite extensive abuse and resultant symptoms identified in files, few explicitly reported traumatization. Adolescents in interview, however, reported numerous domestic and institutional traumatic events. High levels of posttraumatic stress (65%), depression (65%), and dissociation (18%) were identified. It appears adolescent traumatization is pervasive in 1 secure accommodation facility in Scotland. Studies across Scotland’s secure facilities are needed to assess reliability of findings. Indications are that staff in secure accommodation need to have an understanding of trauma exposure, resultant symptoms, and how to respond to traumatized adolescents.     

The Traumatized Patient’s Word and Temperament as Elements of Successful Psychotherapeutic Treatment

I will review the case presentation by Ron Bodansky of two treatments of a primitively organized patient who endured childhood trauma. Drawing on the material, as well as work by Fairbairn and Verhaeghe, I offer two proposals to help explain why some deeply traumatized patients improve in psychotherapy. First, inborn temperament may be more important than the nature of the trauma or the specifics of the treatment itself. Second, the mitigating effect of the treatment may be found in the nature of the relationship between the therapist and patient. By abandoning assumptions regarding the patient’s prognosis, and by providing sustained attention to, and committed interest in, the patient’s stated experiences, all within a specifically therapeutic boundary, patients may develop the language and representation capacities needed to live beyond trauma, and thus be taken at their word.     

Toward a theory of discontinuous career transition: investigating career transitions necessitated by traumatic life events

Career researchers have focused on the mechanisms related to career progression. Although less studied, situations in which traumatic life events necessitate a discontinuous career transition are becoming increasingly prevalent. Employing a multiple case study method, we offer a deeper understanding of such transitions by studying an extreme case: soldiers and Marines disabled by wartime combat. Our study highlights obstacles to future employment that are counterintuitive and stem from the discontinuous and traumatic nature of job loss. Effective management of this type of transitioning appears to stem from efforts positioned to formulate a coherent narrative of the traumatic experience and thus to reconstruct foundational assumptions about the world, humanity, and self. These foundational assumptions form the basis for enacting future-orientated career strategies, such that progress toward establishing a new career path is greatest for those who can orientate themselves away from the past (trauma), away from the present (obstacles to a new career), and toward an envisioned future career positioned to confer meaning and purpose through work.     

Seduction,date rape,and aborted surrender

Abstract

This paper clarifies the dual-layered nature of the “demon lover complex,” with its background of both pre-Oedipal trauma and Oedipal-level desire. It draws on an object relations understanding of the unconscious and dissociated addiction to an internal demon object that has derivations in the personalities of the actual parents, and in the internalization of these parents. The dramatic case of early trauma compounded by adult date rape trauma serves to illustrate how a “developmental mourning process” in treatment can resolve such trauma. It also illustrates how reparation with the mother that partially heals pre-Oedipal trauma cannot immunize anyone against Oedipal-level attractions to a “demon lover” father, as represented in a displacement, resulting in victimized behavior, and in an aborted surrender to heterosexual desire. However, this victimization can be resolved, as seen in the clinical illustration, when the psychoanalyst has an understanding of the mourning process in developmental terms, working with a natural interaction between mourning and transference evolutions in treatment. The case also demonstrates the transitional object role of the psychoanalyst who is involved with the healing of pre-Oedipal trauma through mourning.     

Gef?hrliche N?he

The author examines the association between trauma and psychosis. To illustrate this he presents clinical examples of active and passive experiences of violence by adult psychotic patients, for whom forerunners in the form of childhood experiences of violence were found in some psychoanalytical treatments. They take place in traumatic relationships. Recent empirical studies have shown that trauma plays an influential role in the pathogenesis of schizophrenia. Traumatic relationships have a contradictory structure which possesses an impressive similarity to the schizophrenic dilemma of adult psychotics. The author therefore considers the schizophrenic dilemma as an introspective manifestation of a traumatic relationship, a part of the violent nature of psychiatric institutions as re-enactment of the traumatic relationship.     

Foetal trauma,body memory and early infant communication: a case illustration

This paper presents the complex case of a male patient who started life as an unwanted pregnancy and adoptee in an era of socio‐cultural shame and blame. When able to contact his birth mother later in life, he experienced a number of confronting synchronicities as well as visions which he felt were related to failed abortion attempts and to other pre‐ and post‐natal events. The case material lends weight not only to Freud's, Ehrenwald's and FitzHerbert's assertions that the earliest form of mother‐infant communications is telepathic in nature but that this mode of communication can be retained if emotional trauma inhibits normal developmental processes. Contemporary neuroscience research is presented supporting the hypothesis that emotional memory can become imbedded in the psyche/soma of the foetus. Such memory traces can later emerge into imagery and/or words if the traumatic impingement has been substantial enough and if other defensive strategies are in place. Clinical implications are then suggested regarding analysts’ attention to the emotional conditions underpinning their patients’ conceptions and foetal development; the connection to projective identification components of the countertransference as being aspects of the earliest telepathic mother/infant communication channel and the need for reductive analyses in analyst training programmes.     

Contributions of Loss Events to Loss Distress and Trauma Symptoms in Recently Resettled Refugee Women at Risk

This research examined contributions of loss events to loss distress and trauma symptoms (accounting for trauma events) for refugee women at risk. Participants (N?=?104) responded to the Multidimensional Loss Scale (loss events and distress) and Harvard Trauma Questionnaire (trauma events and symptoms). Loss events contributed uniquely to loss distress (explaining additional 50.8% variance), and made a unique contribution to trauma symptoms (explaining additional 5.2% variance) approximately equal to trauma events. Appropriate response to psychic distress in refugee women at risk requires assessment of both loss and trauma and consideration of cultural differences in ways loss is expressed and meaning ascribed to symptoms.     

Holding it together: Coping with vicarious trauma in sport

ObjectivesVicarious trauma refers to the negative effects that may be experienced after witnessing trauma (such as actual or threatened injury) in others. This study aims to examine vicarious trauma in sports coaches by drawing on the experiences of two trampoline coaches who have witnessed a serious athletic injury. In particular, this study focuses on how these coaches have responded to and coped with this traumatic event.DesignThe study draws on data from thematic, semi-structured, life history interviews that focus on the occurrence of one particular sports accident witnessed by both coaches.MethodMultiple interviews were conducted in which participants were invited to recall the accident, their own responses to the accident, and the coping strategies employed. Interviews were analyzed using a holistic-content analysis in which thematic similarities and differences between the narratives emerged.ResultsThere were three main themes that emerged, these were the need to make meaning following trauma, re-experiencing trauma, and acceptance and avoidance coping. Participants demonstrated the individual nature of coping with trauma. While one participant avoided the trauma by minimizing the events, blocking her emotions and giving support to others; the second participant showed acceptance of the trauma, was highly emotional, and received support from others.ConclusionsThis study demonstrates the difficulties that may be faced by coaches following vicarious trauma. Although each coach presents different experiences and coping strategies they provide some indications of the level and type of support that may be required after witnessing athletic injury.     

Reference-dependent expected utility with incomplete preferences

An important reason why people deviate from expected utility is reference-dependence of preferences, implying loss aversion. Bleichrodt [Bleichrodt H. (2007). Reference-dependent utility with shifting reference points and incomplete preferences. Journal of Mathematical Psychology, 51, 266-276] argued that in the empirically realistic case where the reference point is always an element of the decision maker’s opportunity set, reference-dependent preferences have to be taken as incomplete. This incompleteness is a consequence of reference-dependence and is different in nature from the type of incompleteness usually considered in the literature. It cannot be handled by existing characterizations of reference-dependence, which all assume complete preferences. This paper presents new preference foundations that extend reference-dependent expected utility to cover this case of incompleteness caused by reference-dependence. The paper uses intuitive axioms that are easy to test. Two special cases of reference-dependent expected utility are also characterized: one model in which utility is decomposed into a normative and a psychological component and one model in which loss aversion is constant. The latter model has been frequently used in empirical research on reference-dependence.     

Exposure,Resource Loss,and Posttsunami Trauma

This study analyzed whether survivors’ resource loss mediates the effects of exposure on posttsunami trauma. Fourteen months posttsunami, 416 survivors were interviewed from the nine worst-affected habitations of the Nagapattinam district in Tamil Nadu (India). Exposure was measured using a checklist; trauma and resource loss were assessed using inventories. Findings indicate that the indirect effects of tsunami exposure on trauma via resource loss were a more potent predictor than the direct effects of exposure on trauma. Resource loss was a vehicle through which the effects of exposure passed on to posttsunami trauma.     

TEACHING ABOUT LOSS

In this article, we develop a case for teaching about loss as part of social and behavioral science curricula. We discuss the first author's development of a class that focuses on loss and trauma. This class emphasizes the view of loss as a pervasive aspect of human life and that it is the core experience for other phenomena, including trauma and chronic illness. The course involves a component in which students write about some loss experience that may reflect their personal life. This component permits many students to express pain, sometimes for one of the first times in their lives, regarding the events in question and relate their experience to what they have learned in the course. Significant features of the course are a score of videos and guest presentations, documenting the diversity of loss and people's myriad ways of coping with loss. It is argued that the course and students' experiences in fulfilling course requirements speak to the gains that may be realized by honest, in-depth probing of losses within the context of psychological and other literatures.     

Innovative Assessment of Childhood Trauma and Its Link to HIV and Substance Abuse in Post-Incarcerated Women

Women who are incarcerated often report unresolved early life traumas, which research has linked to subsequent HIV and substance abuse risks. This article presents an arts-based counseling technique used with women re-entering society after incarceration. Women were assessed for childhood trauma (i.e. sexual, emotional, and/or physical abuse) in relation to age of onset and frequency of events using an interactive pictorial assessment technique, Healing Me Timeline activity. The technique allowed women to use color-coded graphs in identifying points along a timeline during which traumatic events occurred and to process insights to foster healthy coping strategies. The timeline activity was an innovative and gender-appropriate method for uncovering the nature and extent of women’s trauma and counseling needs. Facilitators used the counseling tool to assist women in processing personal insights and to make referrals to mental health counseling, medical services, and substance use programs.     

EMDR as a treatment for improving attachment status in adults and children

IntroductionThe purpose of the article is to examine the current literature regarding evidence for positive change in attachment status following Eye Movement Desensitization and Reprocessing (EMDR) therapy and to describe how an integrative EMDR and family therapy team model was implemented to improve attachment and symptoms in a child with a history of relational loss and trauma.LiteratureThe EMDR method is briefly described along with the theoretical model that guides the EMDR approach. As well, an overview of attachment theory is provided and its implication for conceptualizing symptoms related to a history of relational trauma. Finally, a literature review is provided regarding current preliminary evidence that EMDR can improve attachment status in children and adults.Clinical findingsA case study is described in which an EMDR and family therapy integrative model improved attachment status and symptoms in a child with a history attachment trauma.ConclusionThe case study and literature review provide preliminary evidence that EMDR may be a promising therapy in the treatment of disorders related to attachment trauma.