On the Nature and Meaning of Human Finitude

This article considers the interaction between psychoanalysis and philosophy by examining the meaning of human finitude in the work of Freud and Heidegger. Although Freud and Heidegger develop radically different systems of thought, they are surprisingly close in their examination of the human attitude toward death. Freud's philosophical reflections on the nature of death are ultimately subsumed in his speculative theory of the death instinct, which is far removed from the lived experience of finitude. Heidegger's ontological account of death draws from lived experience but neglects the relational nature of finitude. Drawing on the connection between the work of Binswanger and Stolorow, I maintain that finitude is a fundamentally relational phenomenon. While philosophy can help us to understand and formulate an account of human finitude, the relational nature of psychoanalysis can help us bear the trauma associated with death.     

Psychodynamic Group Therapy with Hispanic Migrants: Interpersonal,Relational Constructs in Treating Complex Trauma,Dissociation, and Enactments

ABSTRACT

This article introduces an interpersonal, relational approach to group therapy for Hispanic migrants with significant histories of violence, abuse, multiple losses, and recurrent trauma. Psychodynamic group psychotherapy may help to address trauma symptoms, insecure/disorganized attachment, grief, and isolation with newly arrived migrants. How the relational paradigm in group psychotherapy is contributing to current theories of complex trauma and dissociation is reviewed. Using this modality conveys the importance of examining trauma-driven enactments, dissociation and symbolization involving the members of the group, the group-as-a-whole, and the group leader. Clinical examples and group therapy interventions used to address powerful dissociative enactments are discussed.     

Dissociation,the Analyst's Vulnerability,and the Body: Review of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

This review praises Bromberg's rich and evocative new book for its clinical and theoretical usefulness and elaborates on three broad themes: the analyst's personal role in traumatic enactments, dissociative/addictive uses of the body, and the distinction between life-threatening and developmental trauma. Extending Bromberg's formulations, the author argues that in successful work with trauma survivors, the analyst must be actually (temporarily) traumatized as actual, personal vulnerabilities of the analyst are necessarily engaged. The analyst's vulnerability serves as an internal contact point, opening up a process of unconscious empathy with the patient and providing crucial validation of the patient's experience. The review also explores how bodily processes are used to further dissociation with eating disordered patients and how they become the source of treatment difficulties. When the patient's states of desire have been “detoured” into the body (where they are ruthlessly controlled or attacked) as well as into the relationship with food (where they are temporarily gratified), they are not as available to be mobilized in the analytic relationship. The review also questions Bromberg's assumption that the underlying dissociative mechanisms are the same for life-threatening trauma (or Posttraumatic Stress Disorder) and developmental (or relational) trauma.     

Working in the borderland: early relational trauma and Fordham's analysis of ‘K’

This paper outlines a view of early relational trauma as underlying borderline states of mind, and argues that Knox's 1999 paper on internal working models and the complex provides a basis for understanding such states of mind. The author argues that in addition to internal working models, the complex also embodies and contains primitive defences of the core self. He outlines how these apply on the objective, subjective, transference and archetypal levels, and in direct and reversed forms and applies this to the account of Fordham's analysis of his patient ‘K’, which ended in impasse. The paper explores the dynamic that emerged in that analysis and suggests that it could be helpfully accounted for in terms of the co‐construction and re‐construction of early relational trauma in the analytic relationship.     

Murakami,Connoisseur of Uncertainty: Commentary on Paper by Thomas Rosbrow

My discussion embroiders around Thomas Rosbrow's view of Murakami as a “trauma analyst.” I highlight the ways in which Murakami's writing reflects his keen sensitivity to existential uncertainty and how he seems to understand trauma, much as I do, as a shattering experience that destroys the certainties that organize psychological life and generates efforts at self restoration. Although I share Rosbrow's view that “After the Quake” depicts a character's awakening from the dissociative manifestations of trauma, I spell out how my perspective on this process differs from his.     

Couples Therapy with Childhood Sexual Abuse Survivors (CSA) and their Partners: Establishing a Context for Witnessing

This article proposes a clinical practice for therapy with couples in which one partner suffered sexual abuse in childhood. Such couples often encounter unique difficulties with physical contact, intimacy, sexuality, communication, and trust, and their relationship dynamic may be marked by reenactments of past traumatic relational patterns. This clinical practice is founded on the assumption that establishing the witnessing lacking during the traumatic event in childhood can break the traumatic reenactments in adulthood, and spur recovery. The suggested practice may facilitate twofold witnessing: the couple's therapist witnesses the reenactments of the trauma in the couple's relationship; and the survivor's partner witnesses the trauma's effect on the survivor's personal life and relationship. Twofold witnessing can help break the cycle of traumatic reenactment and help the survivor integrate the events of her life into a more coherent, continuous narrative. The partner's presence also facilitates acknowledgement of what happened to the survivor, and helps the survivor elaborate on her stories of resistance, survival, and strength. Finally, each of the partners is able to appear more wholly and fully, and together to tell the preferred stories of their life as a couple, replete with the multiple relational patterns they wish to live, which may contradict the characteristics of the original trauma.     

A PREOCCUPATION WITH OBJECT-REPRESENTATION: THE BECKETT-BION CASE REVISITED

Taking issue with the notion of a profound reciprocal influence of Samuel Beckett and his analyst, Wilfred Bion, based on supposition all too often passed as fact, the author refutes the idea that Bion's ‘Attacks on linking’ was based on his later‐to‐be famous patient. Choosing, rather, to apply Bion's concepts of transformation and assaults on verbal thought to Beckett's remarkably visual and highly dissociative writing, she finds in the analyst's work a means of exploring a startling preoccupation with object representation and an anxiety of remembrance constant throughout the writer's texts. Is this fixation attributable only to aesthetic strategy or does it say something about the writer's own inner representational world? Relating the writer's obsession to Bion's concepts and, moreover, its dissociative expression to the decathexis and blank mourning explored by Green, she uncovers within it a reflection of the kind of evocative memory disturbance identified with primary dyadic dysfunction. This application of Bion and Green to Beckett veers distinctly less towards psychohistory, however, than to how sublimation has rendered this object‐relational failure an aesthetic success.     

On the early history of male hysteria and psychic trauma

This paper discusses the influence of Jean-Martin Charcot's views on Sigmund Freud's early theory of hysteria and the notion of psychical trauma. We consider the early history of both psychical trauma and male hysteria, for in Charcot's view traumatic hysteria and male hysteria are identical. Freud's two 1886 lectures on male hysteria, delivered after his return from Paris, are crucial to the subject because they present Freud's first impressions of Charcot and his teaching. Some of the ideas presented in the two lectures foreshadow Freud's later generalization of the etiological role of trauma and his theory of the role of psychical trauma in the genesis of hysteria; that is, each hysterical symptom is due to a psychical trauma reviving an earlier traumatic event—the so-called principle of deferred action (Nachtraglichkeit). Several arguments substantiate the thesis that Freud's notion of psychical (sexual) trauma was developed in reference to Charcot's notion of traumatic hysteria, and that the early psychoanalytic theory of psychical trauma is clearly indebted to Freud's encounter with Charcot's male traumatic hysterical patients. The discussed Freudian development points out the major role of (physical) traumata in eliciting psychopathological pictures and in this way is of definite historical relevance for the present-day discussion on the traumatic nature of the so-called multiple personality syndrome and other dissociative disorders, and post-traumatic stress disorders.     

Which Horse do You Ride? Trauma from a Relational Perspective. Discussion of Prince's “The Self in Pain: The Paradox of Memory. The Paradox of Testimony”

Discussing Dr. Robert Prince's clinical case example, the author presents a relational psychoanalytic perspective on working with the traumatized patient. She considers the presentation of his work with a Holocaust survivor from a relational perspective with particular attention to the dyadic interaction, the intersubjectivity and co-creations of patient and analyst, and finally, addresses the role of the “witness” in psychoanalytic work. The idea of the witness has particular currency in contemporary psychoanalytic thinking. The author briefly examines the dimensions of the “witness” from a relational point of view. Consideration is also given to the necessary distinction between adult onset and childhood onset trauma and the repercussions of each for the analytic couple.     

Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

Erich Fromm’s concept of reactive violence

Abstract

This paper explores the current relevance of Fromm’s concept of reactive violence for understanding particular patients and for generating hypotheses about the world we live in. In his discussion of reactive violence, Fromm gives us a nuanced approach to forms of aggression that can be employed in the service of life. According to Fromm, the aim of reactive violence is preservation, not destruction. It is rooted in fear and, he believes, is the most frequent form of violence. This paper traces the evolution of Fromm’s concept of reactive violence, and considers how it might apply to today’s social and political challenges.     

Ferenczi’s Concept of Identification with The Aggressor: Understanding Dissociative Structure with Interacting Victim and Abuser Self-States

No one has described more passionately than Ferenczi the traumatic induction of dissociative trance with its resulting fragmentation of the personality. Ferenczi introduced the concept and term, identification with the aggressor in his seminal “Confusion of Tongues” paper, in which he described how the abused child becomes transfixed and robbed of his senses. Having been traumatically overwhelmed, the child becomes hypnotically transfixed by the aggressor’s wishes and behavior, automatically identifying by mimicry rather than by a purposeful identification with the aggressor’s role. To expand upon Ferenczi’s observations, identification with the aggressor can be understood as a two-stage process. The first stage is automatic and initiated by trauma, but the second stage is defensive and purposeful. While identification with the aggressor begins as an automatic organismic process, with repeated activation and use, gradually it becomes a defensive process. Broadly, as a dissociative defense, it has two enacted relational parts, the part of the victim and the part of the aggressor. This paper describes the intrapersonal aspects (how aggressor and victim self-states interrelate in the internal world), as well as the interpersonal aspects (how these become enacted in the external). This formulation has relevance to understanding the broad spectrum of the dissociative structure of mind, borderline personality disorder, and dissociative identity disorder.     

James Hillman: the unmaking of a psychologist Part one: his legacy

This two‐part essay offers a critical assessment of Hillman's archetypal psychology and enquires into its viability as a psychological model. The first part explores his legacy and reviews the metapsychological frame in which his work operates. It considers the relation between his thought and Jung's, and argues that Hillman's work is not so much post‐Jungian as pre‐Jungian. The second part is primarily intrapsychic; it explores Hillman's character, as discerned through his writings and interviews, and considers his work as an expression of the puer aeternus. It is argued that the puer prefers to live in an eternal dream‐state resistant to growing up: yet denial of the maturational impulse will only lead to it happening anyway but in a negative form. The paper considers how Hillman's model was ‘unmade’ by the missing developmental element of his thought. Development is an archetypal and bio‐psychological necessity, and if rejected it can ruin any system that refuses to take it seriously. In Hillman's case this manifested in the form of a repressed masculine shadow, destroying the credibility of his earlier work. The two‐part paper attempts to weave an objective appraisal with a running commentary based on the author's personal engagement with the man and his work.     

Analytic Work in the Bridge World: Commentary on Paper by Françoise Davoine

This discussion considers the elements of mythos and story telling that frame the case material Françoise Davoine offers and analyzes. In this discussion, I highlight the role of nachtraglichkeit, the nonlinearity of time and temporality that shapes the key events in this clinical narrative. I consider the relational aspects of countertransference, enactment, and personal analysis that shape Davoine's analytic listening and the uncanny effects of historical trauma that enter both analyst and analysand. This discussion also considers the interlocking of speech effects and temporality, the role of unconscious dialogues across history and time, that arise unbidden in clinical work. The analyst's freedom to live imaginatively in a process somewhat outside her clinical management is viewed as a key to the freeing of processes of mourning and rehabilitation in the patient.     

Reply to Reviews of Awakening the Dreamer: Clinical Journeys by Philip M. Bromberg

I reply here to reviews by three inspiring thinkers, Ethel Person, Susan Sands, and Allan Schore who, though uniquely different from one another in their conceptual frames of reference, share a sensibility as clinicians and creative scholars that has led them to engage and appreciate my work in depth while enriching it with their individual perspectives. Ethel Person's review is meaningful to me for many reasons, not the least of which is the fact that we think very much alike about “how we are” with patients despite the diversity in our families of origin. Her thinking, which extends the boundaries established by any one school of thought, transcends doctrine, especially that of “technique.” I am equally grateful to Susan Sands, whose review stimulated a dialogue between us about the similarities and differences in our views of the analyst's personal role in enactments with severe trauma survivors and whether there is reason to distinguish between life-threatening and developmental trauma. My reply to Allan Schore's review satisfies a long-standing wish to engage with him in dialogue about what he refers to in his review as “a remarkable overlap between Bromberg's work in clinical psychoanalysis and my work in developmental neuropsychoanalysis, a deep resonance between his treatment model and my regulation theory” (this issue, p. 755). In my reply I comment from my own vantage point on how our shared commitment to an interpersonal and intersubjective perspective—my interpersonal/relational treatment model and his “Interpersonal Neurobiology” led us to arrive at overlapping views on developmental trauma, attachment, the dyadic regulation of states of consciousness, and dissociation.     

Unlocking the Secrets of the Wounded Psyche: Interview with Donald Kalsched

The last 20 years have seen huge progress in our understanding of the injured psyche. Inner space is opening in a way that is helping us heal the deep psychological wounds that many of us carry. Donald Kalsched has been exploring the archetypal dimensions of the trauma process. His interest arose out of his work as a Jungian analyst: Many of his clients got stuck in their therapeutic journey, or worse, they tried to sabotage it—Kalsched wanted to understand why. He discovered that most of them had suffered childhood trauma. He asked: What is it about trauma that leads people to sabotage the road to healing? What systems come into play to help a child to survive psychological trauma, and how do these systems limit later development? His conclusion was that the psyche's internal response to trauma sets up a “self-care system” designed to ensure the person's survival, but that this defensive system ultimately retraumatizes the person from within, cutting off life-saving attachments to others and eclipsing all possibilities of true-self living in the real world. This theory has had a huge impact because it changes our understanding of what happens in psychological trauma and so opens the door to healing.     

At the verge of unthinkable anxiety: On the relevance of a neurophysiologically informed relational perspective on meaning-making in psychosis

Abstract

This article examines the relevance of relationally oriented psychoanalytic phenomenology as a frame of reference for understanding psychotic states in schizophrenia. The etiology and structural characteristics of such states are examined from both a neurophysiological, and a relational and interpersonal point of view. Many findings indicate organic abnormalities in schizophrenia, acquired through an exposure to physical risk factors and genetic predisposition, but relational traumas also seem to have an impact on the form and content of psychotic states. This may happen through interruptions in the “use-dependent” maturation of the brain in a relational milieu. In addition, at the level of meaning-making, we find that the emotional and relational contexts—both past and present—give the substance or “raw material” for hallucinations and delusions. In a psychotic state, the person also tries to handle basic affects and relational needs, and to make meaning in states of overwhelming chaos and anxiety. Donald W. Winnicott's theory of “a holding environment”, Stephen Mitchell's theory of the relational matrix, and Stolorow, Atwood, and Orange's concepts of a “shattered world” and annihilation anxiety are used as a framework in the analysis of the phenomenology of psychosis. Two case illustrations, one from child psychotherapy and one from therapy with an adult patient, are used to illuminate the theoretical points of view.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Collectively Speaking: The Many Meanings of Naming and Sharing Group Trauma

This commentary on Kathleen McPhillips’s (this issue) “‘Unbearable Knowledge’” paper looks at implications for theory of the model she uses to analyze collective trauma. While affirming the model’s robustness, it is suggested that it has both theoretical and political ramifications that need to be further spelled out. The commentary ends with several questions regarding the leap from individual to collective trauma. These include the importance of maintaining a steady appreciation of multiplicity, which is foundational to relational psychoanalytic theory; second, the need to appreciate the complexity of dismantling a collective dissociative defense; and finally, the significance of spontaneity in healing.     

Contributions of Attachment Research to Understanding Dissociative Attunement

This discussion elaborates the author’s use of attachment theory and research to understanding Susan’s clinical process (see Jacobs, this issue). I have delineated different patterns of attachment, its precursors in infancy, both in infant parent interactions and in parent’s state of mind with respect to attachment. I also link this to how dissociative process can be embedded in a combination of infant disorganization and trauma. I think that clinical applications of the ideas Jacobs and I subscribe to add a great deal to understanding how unformulated experiences with a frightened and frightening parent can lead to a person’s vulnerability to developing dissociative responses to later trauma. The dialogic nature of infant parent attachment experiences can further enrich an understanding of how certain transference–countertransference enactments are manifestations of certain kinds of procedural or relational knowing. In this way, clinicians can further understand the possibilities for psychic transformation as embedded in bearing that which was experienced but which cannot yet be known.