Traumatic stress and quality of attachment: Reality and internalization in disorders of infant mental health

This article describes the interface between the fields of attachment and child trauma, their respective contributions to an understanding of infant mental health disturbances, and the clinical applications of an integration between attachment theory and trauma‐informed treatment and research. The organizing theme is that a dual attachment and trauma lens must be used in the assessment and treatment of infants and toddlers with mental health and relationship problems. The quality of attachment is an important factor in children's capacity to process and resolve traumatic experiences. At the same time, traumatic events often have a damaging effect on the quality of existing attachments by introducing unmanageable stress in the infant–parent relationship. It is argued that trauma in the first years of life needs to be assessed and treated in the context of the child's primary attachments. Reciprocally, the etiology of attachment disturbances should include an assessment of possible exposure to trauma in the child and in the parents. Current conceptualizations of attachment and trauma are reviewed from this perspective, and a clinical illustration is presented to highlight how a traumatic stressor can trigger behaviors reminiscent of disorganized attachment.     

On the Dialectics of Trauma in Tennessee Williams�� A Streetcar Named Desire

Blanche DuBois, the tragic heroine of Tennessee Williams' A Streetcar Named Desire, has always been read as either "mad" from the start of the play or as a character who descends into "madness." We argue that Streetcar adumbrates elements of trauma theory, specifically symptoms of post-traumatic stress disorder such as involuntary reliving of traumatic events, dissociation, guilt, shame, denial, the shattering of the self, the compulsion to repeat the story of trauma, as well as the early stages of recovery from trauma. We are the first to employ trauma theory as a critical framework through which to view Blanche and the dramaturgical devices used to concretize her post-traumatic state of mind. Williams' heroine speaks from traumatic experience and not from psychic fabrications. Indeed, we contend that the play traces Blanche's deliberate and self-conscious working through and mourning of the traumatic losses of the past, including her idealized, narcissistic conceptions of herself within a traumatic present. Thus she is more attuned to the most disturbing parts of reality and exhibits tragic insight born of traumatic experience. Critics who see Blanche as "mad" do not fully recognize her struggle to come to terms with trauma and loss within a culture of denial. We conclude that Streetcar stages the inextricable relation between the individual and social dialectics of trauma.     

Keeping mother alive: psychotherapy with a teenage mother following human trafficking

The power of new traumatic events to reignite memories and the distress of traumatic experiences earlier in life is well known to psychotherapists. When the recent trauma has been extreme, the task of assisting the patient to understand their response in the light of their earlier experience can be doubly challenging. This paper describes the therapy with an adolescent girl and her infant daughter, following the girl's escape from illegal detention, physical abuse and forced prostitution, after she was trafficked to the UK from Eastern Europe. The discussion works towards developing an understanding of the emotional interchange between the mother and infant, and the influence of the mother's traumatic experiences, on that interchange. Projective identification could be seen to occur from the mother, into her daughter, in a reversal of the situation traditionally described. The function of this for the mother and the impact on the developing infant, are considered.     

Allergic to People: Building Bridges in a Ripped Psychic-Soma

An exploration of the use mind/body metaphors in a woman whose physical, environmental and psychoneurotic trauma culminated in an irreversible colostomy. She lived in a world of concrete symbols, her primary process damaged such that she could not create generative symbols to process her trauma. She regressed to a state of infantile megalomania, recoiling from the external reality of subjective others. Her introjective disorder mirrored her digestive disorder as she could absorb neither good objects nor good nutrients. The analytic situation has been an auxiliary fecal container and we work to bridge her mind body split with mind/body metaphors. As she reclaims lost development mastery, she displays a symbolized sphincter. As her capacity to form symbols grows, she rages and mourns for the loss of her fantasized ideal parents and her ideal body.     

'NEVER TWICE WITHOUT THRICE' AN OUTLINE FOR THE UNDERSTANDING OF TRAUMATIC NEUROSIS

Following the review of Freud's work on trauma (1916-17, 1920, 1926, 1933, 1939), this article proposes to view the traumatic scene as a screen which acts as an active process in the case of many victims who, like Mrs D, break down a few days after being assaulted. After a first attempt at denial, the ego is submerged with repressed content. Repetition is seen as a means of abreacting the trauma by seeking to bind the enormous quantity of excitations that cannot find discharge. Repetition, because of its compulsive quality, fails. The victim remains in a state of helplessness against which she resorts to denial, splitting and projection (Freud, 1920, 1926). This strategy is seen, however, as maintaining the victim in a state of helplessness. Thus, I suggest that, overwhelmed, the ego finally resorts to a multi-levelled system of defence. On a first level, fixation to the trauma, like in screen-memories, gives way to a first displacement. On a second level, the adoption of an identity built upon being a victim contributes to the strength of this displacement. On a third level, identification with the aggressor consolidates this defensive strategy by giving meaning to the hostility awakened by the sexual assault.     

Noah’s Ark: technical and theoretical implications concerning the use of metaphor in the treatment of trauma1

In this paper, using my clinical work with a 3-year-old boy who lost his hearing when he was between 9 and 12 months old, and whose disability was only discovered when he was 22 months old, I will explore two issues of paramount technical importance when working with trauma. Firstly, it is crucial to create a boundary around the traumatic event, so that life before, during and after the trauma can be circumscribed and the traumatic event explored and hopefully understood and integrated. Secondly, it is of paramount importance to establish the level of developmental organization at the time of the trauma, especially in relation to the capacity to integrate bodily affects into mind. I will show how trauma and its vicissitudes are directly dependent on the person’s capacity to resolve the splitting that trauma creates in the mind, and also the key role played by the use of metaphors in the process whereby trauma becomes thinkable and can therefore be integrated into the self.     

Between Symbol and Antisymbol - The Meaning of Trauma Reconsidered

Within psychoanalysis, it has usually been assumed that what makes an external event traumatic is the personal meaning of the event for that individual, i.e. how it resonates within his/her internal world and in relation to the infantile conflict. Such an assumption, which implies that a trauma operates as a symbol, is compared with the contrasting view that a trauma rather destroys the capacity of symbolization, and discussed in relation to the psyche-soma issue. It is finally maintained that psychic trauma forces upon the victim a vast and difficult transformation, in relation to which the body can be used as an antisymbolic device to resist mental change.     

Traumatic Incident Reduction

Abstract

Traumatic Incident Reduction (TIR) is a person-centered, yet intensely focused approach to trauma resolution, based on the principle that the very act of trying to repress painful memories is what holds them in place and gives them power over the individual. TIR consists of a safe and structured method for reviewing the contents of a past trauma repeatedly at a pace and with a degree of exposure determined by the client. By applying the TIR technique to a traumatic memory in a one-on-one setting with a trained facilitator, the client can discover what he or she needs to know in order to achieve a permanent reduction or elimination of the memory's traumatic aftereffects.     

A Phenomenology of Emotional Trauma: Around and About the Things Themselves

This paper seeks to provide a noetic analysis of emotional trauma. It highlights three essential features of trauma, as well as one non-essential feature, and attempts to make sense of them phenomenologically. The first essential feature of trauma that the paper considers is the disbelief that pervades traumatic experience. When traumatized, we cannot believe that the traumatic event has taken place. This is because we will, not for the event not to have happened??we cannot will something that is in the past??but to believe that it did not happen so as to shield ourselves from our painful emotional response to it. The second essential feature of trauma is our inability to distinctly categorially intuit the central state of affairs around which our trauma revolves. The traumatic situation is literally unthinkable by us, for it is incongruent with both our expectations regarding the subject of the trauma and our horizon of sense more generally. The third essential feature of trauma is the temporal disorientation that it brings about. Such disorientation arises from our prolonged and single-minded attention to an increasingly complex categorial object: the traumatic situation. Finally, the paper considers a non-essential feature of trauma, namely, how traumatic experience can motivate phenomenological and scientific reactions.     

Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.     

An interpretation of Babette's Feast as a parable of trauma

In this paper I use the film Babette's Feast as a parable to portray the impasse that often arises out of the experience of complex trauma. The experience of such trauma invokes a crisis of reality. It overflows the boundaries of rational containment. There are no mechanisms with which to apprehend such an event, and consequently it cannot be comprehended; because it cannot be comprehended it cannot be processed. The film Babette's Feast encapsulates the predicament of the individual ensnared in the web of trauma. Although removed from the location and events of her trauma, Babette remains the resident of an austere and colourless environment, her gifts repressed, her brilliance unseen. Healing comes to Babette through her willingness to revisit her true self, a self that has been crushed under the weight of grief and trauma. This revisiting costs her all she has. Yet, it is in this revisiting that she not only frees herself from the austerity of her environment but also engenders purpose and hope within the community who have taken her in. The dissonance of her life is paralleled by the dissonance of the life of the community in which she lives; it is the harmonizing of these dissonances which cannot be spoken that finally gives articulation to the incoherence of Babette's trauma.     

Los Degradados: Out,down, dead: Transmitted and inflicted trauma as encountered in the analysis of a 6‐year‐old girl1

The author presents the analysis of a precocious traumatized little girl, which reveals the ways in which historical trauma is transmitted and intrafamilial trauma is both disguised and represented. The play as it evolves is seen to simultaneously communicate what the child struggles with and to resolutely try to hide what has actually happened. Analyst and child together participate in play which utilizes displacement, enactment and interactive enactment, the latter play mode being the very hallmark of profound traumatic experience. Carlotta, the child, helps the analyst to follow her quest for meaning making even as the interaction between them adheres to and departs from the deepening pentimenti of traumatic experience, which needs to be unraveled and reconstructed in order that her own developmental progression can be rejoined. The analysis facilitates Carlotta's capacity to play in a more unfettered fashion and to assist her family's recovery as well.     

The countertransference: When painful traumatic traces sustain the countertransference and reveal themselves to the psychoanalyst … 14 years later!

Although she experienced, as did the many psychoanalysts before her, the countertransferential dynamics of disgust towards a patient presenting great deficiency in terms of mentalization capacity, the author strives to understand what urged her to tolerate the patient, to invest in her and lead her to develop a capacity for internalization, after 6 years of analytic work filled with transgressive‐transferential acting‐out. Fourteen years later, she becomes aware of the way in which the revival of some grief related to traumatic traces in her own lived experience, sustained, without her knowledge, a saviour/countertransference, creating a specific transferential‐countertransferential spiral which rescued a situation whose advent could have been compromised. This could happen thanks to what she refers to as the unique inter‐relation between her and this particular patient.     

Vicissitudes in adult life resulting from traumatic experiences in adolescence1

The author deals with the diffi culties in combining the concepts of trauma and phantasy. He evaluates Freudian observations relating to chance and trauma. He considers traumatic effects of chance in relation to the rupture of a narcissistic phantasy of invulnerability. The narrating of traumatic events may awaken in the analyst tendencies to repeat the aggression of these traumatic events towards the subject. The accusatory interpretation can be one of the means by which this repetition is established. The author explores a type of trauma which is essentially related to the disturbance of the structure which contains the ideals of the subject. This disturbance is a consequence of disillusionment resulting from the loss of an object who was the depository of these ideals. Trauma generates a state of mourning for lost ideals. The author describes traumatic events which occurred in a patient's life at puberty; paradoxical behaviours in the patient's parents caused the patient to have new traumas. The reluctance to explore the derivatives of the unconscious, and to investigate possible meaning in symbols, was a central problem in this patient's analysis. The author discusses disturbances in symbolization, and he examines the subject of projective identifi cations that were received by patients from their primary objects.     

Performative and enactive features of psychoanalytic witnessing: The transference as the scene of address

This paper will attempt to broaden the conception of witnessing in analytic work with traumatized patients by extending the idea to incorporate the patient’s developing and varied capacity for witnessing, as well as a witnessing that occurs within the analytic relationship itself. Actions occuring as part of traumatic repetition are understood to represent memory phenomena and are distinguised from dissociated self‐state experience. These experiences are not therapeutically intended to be symbolized, but rather lived‐through with the analyst, thus transforming the patient’s own relation to the experience. I suggest that the scene in which this living‐through takes place is the transference–countertransference matrix, and that it is the analytic encounter that allows traumatic repetition to take on the quality of a communication, an address to another, rather than remain meaningless reproduction. A clinical vignette illustrates the turning of trauma’s imperative for witnessing into an address in the analytic encounter.     

Displacement as trauma and trauma as displacement in the experience of refugees

This paper investigates the relations between displacement, home, trauma and the self in the experience of refugees, which has become an issue of unexpected and far-reaching proportions in recent times. It questions to what extent and under what conditions displacement in the world may be traumatic and how trauma may be considered the effect of an inner displacement. Refugees’ lives are marked by forced migration that is related to a certain suffering due to the changes in their family, relational, social and cultural lives. The paper explores the extent to which these changes can represent a break so significant as to be traumatic. It outlines the way in which traumatic experiences can produce an inner displacement and reorganization of one’s mental life that leads to a focus on traumatic complexes. Under the most severe traumatic conditions, this can be understood as a displacement of the central axis of Self, in which the ego complex yields its position to other complexes, with a deep change in the organization and functioning of self. The experience of refugees highlights the way in which we live in a matrix of conscious and unconscious links between inner and outer worlds that need deeper and simultaneous consideration to understand their implications and mutual resonances for the psyche. Clinical cases of refugees will illustrate some aspects of these interconnections.     

The basic traumatic situation in the analytical relationship1

The author attempts to develop a concept of psychic trauma which would comply with the nucleus of this Freudian notion, that is, an excess of excitations that cannot be processed by the mental apparatus, but which would also consider the functions and the crucial role of objects in the constitution of the psychism and in traumatic conditions, as well as taking into account the methodological positioning according to which the analytical relationship is the sole possible locus of observation, inference and intervention by the psychoanalyst. He considers as a basic or minimal traumatic psychoanalytical situation that in which a magnitude or quality of emotions exceeds the capacity for containment of the psychoanalytical pair, to the point of generating a period or area of dementalisation in the psyche of one or both of the participants, of requiring analytical work on the matter and promoting a signifi cant positive or negative change in the relationship. Availing himself of Bion's theory about the alpha function and the metapsychological conceptions of Freud and Green concerning psychic representations, he presents two theoretical formulations relating to this traumatic situation, utilising them according to the ‘altered focus’ model proposed by Bion. He presents three clinical examples to illustrate the concept and the relevant theoretical formulations.     

Girl Who Wrote to Primo Levi. The “Foreign Body” Speaks

Through the exposition of a clinical case, the author explores how a sexually abused woman can set up strategies for psychic survival to the feeling of catastrophe and how she can attempt to communicate and share it. The clinical case connects childhood sexual abuse trauma and the trauma of surviving concentration camps. The paper refers to two main achievements of Ferenczi’s research: (1) the consequences of the traumatic experience and of the disavowal of it, such as dissociation, fragmentation, psychic agony; and (2) the focus on countertransference as emotional sharing and as receptiveness to the deep, unconscious and unspeakable communications, which can transfer to the psychoanalyst through somatic ways.     

The inner witness

The inner witness is a mechanism that develops in response to a reasonable experience of infantile helplessness, the resulting maternal impingement and the presence of a sufficient experience of a third. Being crucial to the subject's capacity to shift between the first person and the third person of experience, it also has an essential role in coping with trauma. Three types of testimonial narrative are differentiated in terms of the presence of the inner witness in their syntax. The first mode is one in which the inner witness is accessible, enabling the imaginary shift between the voice of the victim and the voice of the witness. The second mode, which remains a 'first-person' mode of report, preserves and enacts the traumatic memories and the traumatic features. The third, psychotic mode attacks both the first and the third person, separating the subject from both his memories and his sense of selfhood. This mode can evolve as a reaction to an adult massive trauma, but is more likely to emerge as a result of early traumatization. The above ideas and their implications for recovery are illustrated by a case study and through a reading of Samuel Beckett's Waiting for Godot.     

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.