Sekundäre Traumatisierung

During the past several years there has been a growing interest in the negative effects that therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. As yet it has not been verified that secondary traumatization consists of posttraumatic symptoms and leads to clinically significant distress. In an exploratory study 21 therapists were interviewed who declared that they had experienced an incident of this form of work-related stress. The presented study reveals that in fact such a ?vicarious“ traumatization can arise, even without direct contact to the original trauma. It consists of post-traumatic stress disorder (PTSD)-like symptoms, but in severe cases it can also manifest itself in symptoms which are far beyond the typical PTSD spectrum. Conditions for the development of secondary traumatization are high empathic ability and dissociative processing of the trauma material by the therapist.     

Walking in sacred spaces in the therapeutic bond: therapists' experiences of compassion satisfaction coupled with the potential for vicarious traumatization

The therapeutic bond is at the heart of effective therapy, yet few studies have examined therapists' experience of this bond. Using a qualitative study design, this exploratory study examines the experiences of couple and family therapists in relation to their perceptions of the satisfactions and risks involved in the therapeutic bond. The research was conducted using grounded theory methodology and eight in-depth interviews were conducted with therapists working in five counseling agencies in Sydney, Australia. Therapists described the importance of the 3 component parts of the therapeutic bond: the empathic connection between therapist and client; the role investment of the client; and the mutual affirmation experienced by both therapist and client in the therapeutic process. Walking in sacred spaces with the client was seen as both enriching and challenging for the therapist. The therapeutic bond gave therapists intense satisfaction and posed risks for them, especially when working with traumatic client experiences. However, the findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization. The implications for sustaining couple and family therapists in their work are discussed.     

Primary shame,mortal wound and tragic circularity: Some new reflections on shame and shame conflicts

Invited to contribute some thoughts on recent developments in psychoanalytic thinking about shame, the author starts off with Aristotle's prescient analysis of shame and then focuses on accumulating experiences in the psychoanalytic treatment of patients with severe neuroses, in particular the close relationship of severe traumatization and chronic states of shame, and how this is reflected in shelfdestructive repetitions. Reminiscent of what we know from tragedy and the tragic dimension of human existence, this repetition compulsion shows a built‐in circularity. These circular dynamics have at their core struggles with deep woundedness that can variably be conceived of as primary pain, primary shame and primary anxiety. Consequently, throughout the experiences with these patients goes the absoluteness both of their conscience and of their ideal, what we know as the “archaic superego:”     

Reply to Panel Follow-up Questions

When both therapist and client share a traumatic event, there are multiple levels of vulnerability to traumatization for the therapist. Our personal vulnerability is not only a backdrop for our clinical work but also an acknowledged fact in many therapeutic relationships, a situation that changes the frame of the work. In addition to clinical challenges, shared trauma increases a therapist's vulnerability to vicarious traumatization; VT is defined as the negative transformation of the therapist's inner experience as a result of his or her empathic engagement with and responsibility for a traumatized client. Emphasizing the importance of awareness, self-care, meaning, and community, the article summarizes important steps to anticipate, address, and transform the therapist's experience of vicarious traumatization.     

Verdeckte Spuren deutscher Geschichte

Children of the Second World War are considered here as members of the age group born between 1939 and 1945. The development of these children was determined by coping with the early traumatization by war experiences. Many of them were left alone with their traumatization in the post-war period and obtained no support from the generation of the parents who were preoccupied with their own broken lives. As a consequence they have in common a strange split relationship to their own biographies lacking consciousness about the trauma. They became a self-alienated generation. They borrowed their identity from being concerned about others. By this they fulfilled the delegation given by their parents whose own lives were broken down. As long as the identification persisted, the trauma of the war period remained hidden and was transmitted to the next generation, to the children of the war children. When this dynamic can be detected in psychoanalysis and worked through there is a chance to assimilate emotionally this fate and to reach a positive war child identity. This thesis will be demonstrated by a case study.     

Repetition compulsion and self-psychology: Towards a reconciliation

The concept of repetition compulsion, which has never been fully acknowledged by Kohut and his followers, is re-evaluated in this article within the context of self-psychology. In line with the underlying principles of defensive contact-shunning on the one hand, and non-traumatic empathic failure on the other hand, the repetition can be seen as the twofold expression both of the wish for a new benign relationship and of the dread of traumatic, repeated disappointment. Therefore, early non-traumatic disappointments are initiated by the patient, and role-responded to by significant others. This way, the risk of disillusionment of full-blown expectations is avoided. The repetition compulsion, then, is a complex mechanism: preventive in one part, it protects the vulnerable self from potentially traumatising experiences; thus, it is operated in response to the danger signal of emotional cravings, once the latter are experienced as getting out of hand. Providing novel experiences, in its other part, it can lead to opening the road for change; such curative impact relies on lengthy working through in a safe, empathic, holding environment.     

Client‐centred group therapy for survivors of interpersonal trauma: A pilot investigation

Group therapy for trauma survivors provides an opportunity to share experiences with others in a supportive environment. Client‐centred groups have received very little attention as a way of working with traumatised people. Such groups promise to promote psychological growth following trauma. In this paper we present pilot data from a client‐centred group of six survivors of interpersonal violence who were experiencing complex posttraumatic stress reactions. Results suggested that those who perceived the presence of empathic listening within the group therapy sessions benefited from the group, showing greater positive changes. Clinical implications for working with trauma survivors, methodological considerations and directions for future research are discussed.     

Empathy framework for embodied conversational agents

Empathy is a complex socio-emotional behavior that results from the interaction between affective and cognitive mechanisms. Equipping embodied conversational agents (ECAs) with empathic capacity can benefit from the integration and evaluation of these low and high level capabilities in a hierarchical manner. Following the theoretical background on empathic behavior in humans, this paper presents a framework to equip ECAs with real time multi-modal empathic interaction capabilities. We present the implementation of this framework, which includes basic dialogue capabilities as well as three levels of empathic behavior in a conversational scenario. Our approach is an inclusive stand on modeling levels of empathy and provides a baseline behavior for empathic interaction.     

From Traumatic Language to Posttraumatic Language: The Development of Language in Therapy According to the “Phenomenon of Hope” Model

Hope and language are part of the human development process starting from birth and continuing through all the stages of development. They are tools that help us to cope in complex situations. Environmental failure produces trauma, which damages the “self” and impairs the development of hope and language. The individual experiences “pessimistic hope” and “drained hope” and begins using “concrete language” and “pseudo-language.” Such profiles and languages indicate functional difficulties, including the inability to establish mature intimate personal relationships. When traumatic events such as those experienced in military combat compound childhood trauma (environmental failure), mental and functional difficulties buried by our defense systems may rise to the surface and worsen and chronic complex trauma may ensue. Psychotherapy for chronic complex trauma is complex. The therapeutic approach that is used in the “hope phenomenon” model includes five therapy stages that allow us to examine the effect of a trauma on personality and function. Here we examine the link between the five stages of therapy and the use of language. According to my experience, patients use concrete language and pseudo-language in the beginning of the therapeutic connection. As this connection and therapist-patient alliance evolves and deepens and the client and therapist move through the various stages, the patient then starts to use “plural language.” Concrete language and pseudo-language are used in the pessimistic hope and drawn hope stages, respectively, until a profile characterized by a realistic and mature hope emerges. This profile goes hand in hand with an ability to use plural language. This article examines the development of hope and language in a complex posttraumatic stress disorder (PTSD) patient who was treated using the hope phenomenon model. Consent for the therapy details to be used in this article was given by the patient.     

Psychotherapie, Globalisierung, Hartz?IV

The mental effects of globalization, the economic crisis and unemployment must not be underestimated. In general they have to be looked upon as a complex system of structural traumatization which is causing severe psychological mental disorders, such as depression. Not only that, a psychotherapist has to pay particular attention to this. More than in physical illnesses the psychotherapist has to be solidly united with the patient, which might also result in political action.     

Crying: discussing its basic reasons and uses

Crying can occur in a great variety of contexts, including fulfilment and happiness as well as failure, loss, and sadness or other negative feelings, such as anger and guilt. Despite such differences, we have tried to identify a unitary underlying psychological cause for crying: perceived helplessness. We explore the different crying situations, describing the basic cognitive ingredients and critical steps in the process leading to crying. We start from those situations which directly imply personal frustration and suffering, then we consider empathic crying, crying for joy, and “aesthetic” crying, i.e., crying elicited by aesthetic experiences. We try to show that all of them imply a common core: some frustration (anticipated, actual, or previous), one's attempt to resist, perceived helplessness, and surrender to frustration. Finally, we address both the psychological benefits and costs of crying, either expected or unexpected, showing their links with perceived helplessness.     

Why study group therapy?

Group therapy training is highly valuable for the overall professional practice of psychotherapy. Learning to be a group therapist means learning about shame, resistance, fears of engulfment and abandonment, maintaining a self in relation to others, promoting empathic connection, strong affects in the moment, multiple experiences of the same interaction or event, and group dynamics. These concepts are highly relevant to all clinical work and other aspects of professional life. Training in group therapy should place greater emphasis on its broader applicability.     

Empathy a common ground

Though empathy remains a central concept in psychoanalysis, attempts to explain the operations and functions in the empathic process have been as divergent as the various meanings associated with the term itself. Any explanation of the mechanism of empathy must include how we have access to the inner experience of others or account for the link between the empathizer and the inner state of the object.

In this paper, the authors review different models (Freud, 1921; Kohut, 1959; Basch, 1983, 1988; Buie, 1981; Schafer, 1968; Klein, 1946, 1963) of empathic understanding and note that while these models rely on imitation, identification, merger, projection, or inference as the basis of empathic understanding, each implies only an indirect understanding of the states of others. The authors propose a two‐phase model of empathy that differs from those models reviewed in that their position assumes that the perception of emotion in the other is immediately accessible through isomorphic psychological and physical processes that often result in an experience of resonance of the same emotion inthe self (Beebe, 1990). According to this view, the empathic process consists of an initial perceptual phase that generates affective resonance and a second phase in which complex cognitive‐affective operations contribute to the construction of meaning. We posit that empathic understanding affords the observer direct access to certain qualities of the other's experience. The model borrows from Wolfgang Köhler's (1947) concept of isomorphism and Rudolph Arnheim's (1949) theory of the perception of expression.

Evidence for this model is presented from experimental psychology. A discussion of a case from an earlier paper on empathy by Beres and Arlow (1974) illustrates how the operations underlying empathy contribute to understanding a patient in a clinical setting. Finally, we conclude the paper with a brief discussion of some of the clinical implications of this model.     

催产素对共情反应的影响及其作用机制

催产素是一种亲社会激素, 对人类的共情反应有重要的影响作用, 主要表现为可以促进情绪识别率, 增强对他人不幸的共情关注, 并弱化自身的个体忧伤水平等。从作用机制上来看, 催产素可能是通过促进具身模仿能力, 弱化自我中心主义倾向及调节情感表征过程来影响人类的共情反应的。未来研究可以进一步关注催产素对不同类型共情反应的影响及其催产素影响共情反应的性别差异问题, 并积极将催产素应用于共情缺陷的临床干预中。     

The influence of extreme traumatization on body, mind and social relations

Extreme traumatization affects the individual's relation to others in several social and psychological ways. The post-traumatic experiences are characterized by helplessness, insecurity, anxiety, loss of basic trust, and fragmentation of perspectives on one's own life. Special considerations should be given to the destruction of the ability to regulate negative emotions (extreme fear, distress, anguish, anger, rage, shame) in relation to others and activate internal good and empathic object relations. Destruction of the capacity for symbolization of traumatic experience may threaten the mind with chaotic states against which the 'I' tries to defend itself and find a balanced psychic mise-en-scene. The authors emphasize three dimensions that the analyst should observe in his understanding of the traumatized mind and its conflicts. The proposed dimensions are called the body-other dimension, the subject-group dimension, and the subject-discourse dimension. All three dimensions have specific structural characteristics that are expressed in the analytic relation. Extreme trauma causes disturbances in each of these dimensions. The authors present clinical material from a traumatized refugee to illustrate the analytic work.     

Die Vertreibung aus der Hölle

Developmental conditions that give rise to a pathological bond are described. Such pathological accommodations are therapeutically difficult to handle and seem to be irresolvable. Insights from developmental psychology studies of the earliest phases of mental development indicate that insufficient and non-supporting relational experiences during the critical period of primary dependence are of crucial impact. A sufficiently constant affect attunement is considered as the necessary basis for a “mental umbilical cord” by which the ability to mentalize and a mature theory of mind and hence a stable self can develop. Corresponding deficits yield cumulative mini-traumata, which affect, as internalized pathogenic relational experiences, all subsequent relations. The inner experiences that result from pathogenic introjects are paradigmatically illustrated by two poems of Rilke and Baudelaire. Intrapsychic and interpsychic consequences of primary and secondary traumatization and its inherent massive internal violence are described exemplified by a fairy tale of Hans Christian Andersen. The establishment of an internalized benevolent object, i.e. development of a healthy psychic structure, is a necessary precondition for a working-through of destructive introjects. In this process it is of primordial importance that the analyst becomes aware of and validates the patient’s emerging feelings and vitality affects and shares the patient’s way of experience. In the course of a microanalytic process of attunement-guided interactions split-off and unsymbolized overwhelming affects can be integrated, thereby establishing a basis for self-awareness and self-reflection.     

Promoting an Empathic Dialectic for Therapeutic Change: An Integrative Review

This integrative review is focused on a formulation of therapeutic empathy. We describe the “empathic dialectic” as therapists’ capacity to emotionally resonate with patients’ internal states, such as during ruptures, and to coregulate their own and the patients’ states through mentalization. The first aim was to provide a theoretical framework for the empathic dialectic, by summarizing background literature on the empathic process, intersubjectivity, rupture repair, relational psychoanalysis, and attachment. The second aim was to conduct an integrative review of peer-reviewed articles published between the years of 2016 and 2021. After conducting a review of 28 articles, we sought to identify (1) research that supports the existence of an empathic dialectic, (2) evidence that therapists’ attachment influences the empathic dialectic, and (3) implications of the empathic dialectic for training and supervision. Results pointed to the central role of therapists’ attachment security in the empathic dialectic, and the negative repercussions of therapists’ insecurity when mentalization is underdeveloped. Results also highlighted the role of supervision as a means of enhancing trainees’ self-awareness of their attachment, and its impact on the alliance. As the American Psychological Association embraces a clinical competencies model in its accreditation of clinical psychology doctoral programs, the importance of attaining an integrative understanding of therapeutic empathy has become increasingly imperative. To this end, we conclude by promoting the empathic dialectic as a key clinical competency, and providing further recommendations for training and supervision.

     

Commentary on “deconstructing difference: Gender,splitting, and transitional space”;

This essay identifies Kohut's major contribution as methodological: that psychoanalytic inquiry entails the sustained empathic immersion in the patient's psychological experience. Kohut's consistent employment of this method enabled him to discover that it was not instinctual drive derivatives but selfobject needs that were central to all psychological relationships. This discovery was the basis for the transformation of analysts’ approach to the “narcissistic”; aspects of a wide variety of disorders—a transformation whose theoretical and therapeutic importance rivals the revolutionary approach taken by Freud to the vicissitudes of psychosexuality and its disturbances. The author describes the major areas of progress in self psychology—much of which centers on the growing recognition that the health and vitality of the self depend on complex relational, or intersubjective, selfobject experiences. He indicates how this recognition is changing our perspectives on transference and countertransference and is improving our ability to respond optimally to our patients. He describes how optimal responsiveness constitutes the guiding principle for therapeutic work, and how it may both constitute, and be different from, “being empathic.”;     

More than skin deep: visceral states are not projected onto dissimilar others

What people feel shapes their perceptions of others. In the studies reported here, we examined the assimilative influence of visceral states on social judgment. Replicating prior research, we found that participants who were outside during winter overestimated the extent to which other people were bothered by cold (Study 1), and participants who ate salty snacks without water thought other people were overly bothered by thirst (Study 2). However, in both studies, this effect evaporated when participants believed that the other people under consideration held political views opposing their own. Participants who judged these dissimilar others were unaffected by their own strong visceral-drive states, a finding that highlights the power of dissimilarity in social judgment. Dissimilarity may thus represent a boundary condition for embodied cognition and inhibit an empathic understanding of shared out-group pain. Our findings reveal the need for a better understanding of how people's internal experiences influence their perceptions of the feelings and experiences of those who may hold values different from their own.     

Why the Capacity to Pretend Matters for Empathy

A phenomenological insight in the debate on empathy is that it is possible to directly perceive other people’s emotions in their expressive bodily behaviour. Contrary to what is suggested by many phenomenologists, namely that this perceptual skill is immediately available if one has vision, this paper argues that the perceptual skill for empathy is acquired. Such a skill requires that we have undergone certain emotional experiences ourselves and that we have had the experience of seeing the world differently, which is a form of pretence. By investigating how we retain knowledge of what is real while pretending, that is, how we anchor the experience of pretence in something that is not pretended, the paper argues that we split our experiential perspective into a double perspective, which differs from the cognitive act of understanding what a perspective is. With this notion in hand, we can return to the debate on empathy. It is argued that in order to have the capacity for direct empathic perception, one must have undergone experiences involving a double perspective.