A psychodynamic perspective on early childhood trauma in an adult: A case study

Abstract

This paper uses a long-term case to illustrate, from a psychodynamic perspective, a number of issues arising in working with an adult survivor of early childhood trauma. The paper takes an overview of the case study, identifying issues which are inextricably interwoven in the client's experience of trauma, and which impact on the working alliance. The therapeutic relationship forged with the client is discussed in terms of its intrinsic successes and failures together with the implications of early traumatic experiences for the termination of counselling.     

Working in the Midst of Unfolding Trauma and Traumatic Loss

Abstract

Training developed for New York City social workers in the evolving aftermath of September 11, 2001 is introduced, offering a conceptual framework for clinical practice in the midst of unfolding trauma and traumatic loss. A focus is placed on the shared, collective process of learning and discussion among colleagues, as an effort parallel to work with clients, progressing together to establish meaning and hope through relationships. Professional training framing this catastrophe within trauma and traumatic loss perspectives, and addressing its impact on clinician, client, work, and treatment relationship, is needed. Also providing on-going support, a process of continuity, and a context of community, this training becomes a collective response to the profound impact and complex, evolving needs of this time.     

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.     

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.     

Intertraumatic Dissociative Attachment

SUMMARY

This article focuses on the treatment of couples with a collective personal history of multiple traumatic experiences, and central related concepts. Referred to as the intertrauma couples therapy (InTCT) model, this article outlines an approach to treating trauma victim couples in which each partner has suffered one or more traumatic experiences (i.e., war, rape, criminal assault, incest, community violence, etc.). InTCT is a structured five-phase model of care, derived from a long trauma treatment tradition, and the author's clinical experience in the treatment of multitrauma persons for over 20 years.

This comprehensive, integrative approach to treatment is designed to resolve chronic interpersonal hostility, isolation in marriage, fears of intimacy and engulfment, and the persistent revivifications of partners' traumatic memories as a painful product of daily relational encounters. Unfortunately, these encounters represent trauma structures interacting with trauma structures, with no end or relief to the mutual pain-generating interactional patterns. The phases of the treatment takes the couple from disorganization and intense emotional reactivity to stabilization through integration to an end phase with a post-integration life skills building program for lasting results. Also presented are issues such as attachment, specific trauma responses to include interactive concepts of trauma bonding and systems theory in the context of trauma and dissociation. The article also presents a multitrauma couple case study, and discusses the critical role of therapist's functions.     

Conclusions and Future Directions

Abstract

In the preface to this volume, we briefly considered some of the factors that have in recent years helped traumatic stress become a relatively unitary field of its own. We also noted that some circumstances, the nature of which are not completely clear to us, have to some extent impeded this progress. In this final section, we have two goals. First, we reflect upon the breadth and variety of trauma research in both its content and methods and discuss how this breadth relates to the progression of traumatic stress research as a distinct scholarly endeavor. Second, we review what we believe are some of the important future directions in traumatic stress research as the field continues to build upon its present foundations.     

PTSD Severity and Cognitive Reactions to Trauma Among a College Sample

ABSTRACT

Two hundred twenty-one undergraduate education students were assessed to determine trauma history and cognitive responses to traumatic events. Participants completed a demographic questionnaire, the Cognitive Distortions Scale, and the PTSD Symptom Scale (for those reporting a trauma history). The most common types of traumatic events were domestic violence, natural disasters, and severe transportation accidents. Differences in cognitive distortions of individuals with and without a trauma history also were assessed. Individuals with a trauma history were significantly higher on Preoccupation with Danger and Self-Blame subscales. Number of previous traumatic events and the subscale of Preoccupation of Danger significantly predicted PTSD severity.     

Psychological Adjustment,Coping, and Emotion Regulation as Predictors of Posttraumatic Growth

Abstract

The present study examined factors contributing to reported benefits of traumatic experiences or posttraumatic growth (PTG) in a college sample. Specifically, we examined dimensions typically associated with trauma recovery (i.e., psychological functioning, coping, emotion regulation) and features of the trauma (i.e., number and recency of traumatic events, average, and maximal distress). Participants (N= 193) completed standardized questionnaires measuring these constructs. Results indicated that active coping and subjective well-being independently contributed to PTG, but social desirability and symptom distress were independent of growth. These results were consistent with study expectations. Although not specifically predicted, maximal trauma distress also uniquely predicted PTG. Contrary to expectations, effective emotion regulation did not contribute to PTG.     

The client,the therapist and the paranormal: a response to the special edition on psychotherapy and the paranormal

Abstract

In this paper, I provide a published paper response to the papers in this special edition on the paranormal and psychotherapy articulated largely from my career as a parapsychologist. In the introduction I note the definitional differences between advocates and counter-advocates in terms of what might be ‘paranormal’, although I argue ultimately that definitional differences aside, the therapist’s relationship with the client’s unusual experiences is critical, taking a phenomenological stance which is echoed by at least two of the papers in the special edition. In broad review, the papers make a variety of welcome contributions; historical individually and small sample phenomenological and also more metaphorically in terms of articulations of the haunting nature of collective and intergenerational trauma in the social and cultural sphere. I review the papers from a parapsychological perspective, considering the evidence drawn from parapsychological studies where it supports or adds to the topics of each paper. In concluding this response, it seems clear that therapists often work from first principles when relating to clients’ anomalous experiences, and that the papers of the special edition each offer practising therapists some important evidential and practical insights into working with client presentations of ostensibly paranormal and anomalous experiences.     

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.     

Emplotting the traumatic self: Narrative revision and the construction of coherence

Abstract

In this article we provide a constructivist‐narrative conceptualization of the origins and psychotherapeutic methods for treating trauma. We believe that the experience of trauma ensues when lived events outpace peoples’ abilities to emplot or narrate these events from the perspective of dominant life narratives. The sights, sounds, and smells associated with traumatic events preclude such emplotment. The therapeutic objectives of narrative therapy include finding ways to develop meanings for the trauma and subsequently to integrate these with the dominant narrative. Two case studies are provided to illustrate our conceptualization and therapeutic approach.     

Traumatic Loss: Conceptual and Empirical Links Between Trauma and Bereavement

Abstract

This article focuses on conceptual issues and empirical studies regarding the topic of traumatic loss (i.e., loss that occurs suddenly and under violent circumstances) as a method for linking the field of trauma, and that of grief and bereavement. Several definitions of trauma are presented that include the concept of loss, and additional concepts are suggested that may be helpful in thinking about the two areas together. Also, modes of death associated with poor recovery are noted, and it is argued that these modes are those that make a bereavement more “traumatic”. Some empirical studies on the psychological outcomes associated with traumatic loss are reviewed, and preliminary findings from a new study of traumatically bereaved women are briefly presented     

Developing an Occupation-Centred Framework for Trauma Intervention

Abstract

Experiencing work-related trauma can negatively impact coping abilities and daily life participation. Occupational therapists (OTs) often provide health services to workers who have experienced trauma, including military members, veterans, and public safety personnel. The Occupational Therapy Trauma Intervention Framework (OTTIF) is a novel clinical reasoning framework that matches a client’s level of readiness to engage with a spectrum of evidence-based OT approaches. Using surveys at two time points, evaluation of therapist experiences of using the OTTIF elicited positive feedback that suggests the OTTIF provides a useful occupation-centred framework for evidence-informed occupational therapy practice with clients who have experienced trauma.     

Spontaneous Moments and the Domain of Non-Verbal Communication

Abstract

This paper investigates the impact of non-verbal interactions and spontaneous encounters on the therapeutic process and on a client's structural and behavioral patterns. The following case vignette concerns a client who presents with a pattern of non-verbal relational schemas based on his early traumatic experiences. The non-verbal and verbal role reenactments that unfold between client and therapist will be examined from an intersubjective, dialogical and self psychological perspective. Finally, the paper will explore how important therapeutic shifts may occur by attending to and working through these non-verbal aspects of the treatment, leading to new relational structures.     

An extract of the analysis of the Monkey Puzzle Boy

Abstract

A client who wants his story to be made into a case history presents for psychoanalysis. An artist all his adult life, he expresses his sexual trauma through his art. His more recent artistic output is in the form of avant-garde video montages. The analysis stalls, becalmed by a failure to understand a circumcision event, a punishment for sexual expression. If Ferenczi and the Budapest school model learning from therapeutic errors, freedom of thought, sincerity, and experimentation, then this case history illustrates those. Real sexual trauma and a real circumcision event are entangled with fantasy and art in attempts to come to terms with them. The circumcision event was better understood with multiple readings of Carlo Bonomi’s work, which became part of the analysis. The wider Ferenczi community also became part of the story of the analysis, and in a kind of mutuality the analysis wants to make a contribution to that body of knowledge.     

Violence Exposure and PTSD Among Delinquent Girls

Summary

This study focuses on the unique trauma histories of incarcerated girls. In particular, this study draws upon data obtained from 100 incarcerated adolescent girls, highlighting areas of similarity to and difference from incarcerated boys, including: overall levels of traumatic violence exposure, exposure to unique forms of traumatic violence, psychological symptomatology, and hypothesized trajectories of involvement in serious delinquent activity. In addition, a case example is presented to illustrate our hypotheses about the trajectories of adolescent girls' involvement in serious delinquent behavior, as well as the prominent role of early trauma histories and repeat victimization in these trajectories.     

Aspects of Safe Attachment in the Recovery from Trauma

Abstract

The attachment capacities of trauma survivors were hypothesized to be positively related to their recovery from traumatic event(s). Recovery from psychological trauma is conceptualized as consisting of multiple criteria, and proceeding through a series of stages. The safe attachment dimension of the Multidimensional Trauma Recovery and Resiliency (MTRR) scale was examined through factor analyses, resulting in four factors or subscales. One hundred and twenty-six participants were rated according to recovery status and on the MTRR scale by clinicians from various clinical settings. Recovery status was positively correlated with the overall Safe Attachment dimension and with each of the four separate subscales. Implications for psychotherapeutic goals are discussed.     

Appendix D

Summary

Various issues of central importance to the field of trauma were continually raised and debated at the 1998 Meeting on Trauma and Cognitive Science. These included the representation of traumatic events in memory, the psychological and biological theories available to explain amnesia for traumatic events, the role of therapeutic suggestion in recovered memory experiences, the ways in which memories are recovered and the context in which this occurs, and the implications of our current knowledge about trauma and memory for therapy. This article details these discussions and in some cases provides a more general context from the literature on psychological trauma.