Space and time in psychoanalytic listening1

The analytic situation is by definition traumatic because it evokes hilflosigkeit, the state of helplessness of the newborn infant, which is the prototype of the traumatic situation, and at the origin of the experience of anxiety. The author addresses the chain of associations between the state of helplessness, repetition compulsion, trauma, infantile sexuality, pleasure and displeasure, which lie at the core of the transference experience, and which find their ultimate expression in the analyst's listening. The discovery of the compulsion to repeat instituted a paradigmatic shift in Freud's formulations, emphasizing the process of repetition of trauma, and instituting a link between the network of concepts indicated above. In the clinical example discussed, the author defines the psychoanalytic process by the primacy of sexuality, the erotic passivation in the transference that evokes the traumatic childhood sexual scene. Sexuality and sexual phantasies are at the centre of the elaboration of meaning. Furthermore, the author distinguishes between two types of interpretations, namely ‘open’ and ‘closed’.     

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.     

Searching for a Sensitive Way of Working Through*

This work intends to present aspects of clinical work in which the Ferenczian proposition of neo-catharsis, as re-emergence of repressed affective experience in the transference and countertransference presents itself as a challenge to the analyst, since a standard, classical technical approach results in repetition of past trauma with the analyst as perpetrator. A deviation from standard technique—free association, the principle of abstinence in transference, and interpretation—involving empathic listening, and affective sharing contains the patient’s suffering. The re-emergence of suffering and terror, which represents the repressed affect associated with the traumatic past, but with a sympathetic and sensitive analyst, sharing their experience, is crucial in working through and healing.     

Surviving Deadness in the Analytic Experience

The transference/countertransference (third space) analysis is considered to be central in the therapeutic effectiveness of the analytic process. Less emphasis has been placed on the actual experiences of analyst and analysand in the conflictual reenactment of third space experience and its resolution. This paper recounts the shared experience of a patient who was silent throughout most of the analysis, and my reaction, in fantasy and enactment, to this disturbing experience—both for him and for myself. I argue that it is the affective re-experiencing of past repressed trauma in the analytic space that has a therapeutic impact, leading to growth in the patient and also the therapist. I contrast Freud’s emphasis on insight, making the unconscious conscious, with Ferenczi’s suggestion that the therapeutic impact lies in the repetition of past traumatic experience in the analysis but with the possibility of a different outcome with a more benign object, leading to symbolic representation of repressed trauma. Re-experiencing and symbolization, in the third space, of past traumatic experience can be an exit point from the endless repetition of trauma in internal and external object relations, leading to a new beginning in the patient’s life. Immersed in the experience of deadness in the analysis, which had become a dead womb, the struggle to remain alive and thinking led to a rupture out of the dead womb, like the Caesura of birth, into aliveness and the ability to mentalize what had previously remained unmentalized.     

“They suffer mainly from reminiscences”

Shame is a universal affect that everyone would like to avoid. Responses to trauma include profound experiences of shame, which re-emerge in the transference and can be recognized in reciprocal countertransference responses. Primitive defense mechanisms associated with borderline states such as projection, projective identification and splitting, are often encountered during the course of intensive psychotherapies involving traumatic shame. Attempts to avoid shame reactions may involve regressive reactions, even in non-borderline individuals. Shame avoidance may produce transference-countertransference enactments leading to a negative therapeutic reaction. Addressing shame-related issues may be difficult for both therapist and patient, but ultimately are essential for productive therapy and recovery from trauma.     

The wish to be soothed as a resistance.

As the analyst makes the correct interpretations of resistance in the opening phase of an analysis, the patient begins to feel understood, often for the first time. This feeling allays anxiety and depressive affects, and the patient comes to experience the analyst as a soother. These initial exchanges may lay the foundation for a positive transference which acts as a buffer against turbulent transferences. In some patients this positive transference develops rapidly, often with prompt symptom remission. In others--children as well as adults--the analyst must persistently interpret defensive regressions before a stable, positive transference can emerge. In either case, in order to avoid the analysis of conflict, some patients become resistant to the analysis of the wish to be soothed. Many of these patients have had a childhood filled with traumatic parental stimulation or rejection. Two clinical accounts illustrate these contentions.     

Traumatic effects of political repression in Chile: A clinical experience1

The author examines psychic trauma resulting from human rights violations in Chile. Starting from trauma theories developed by authors such as Ferenczi, Winnicott and Stolorow, she posits the relevance of the subject's emotionally signifi cant environment in the production of the traumatic experience. She describes the characteristics of the therapeutic process on the basis of a clinical case. She emphasizes the need to recognize the damage that may be produced within the reliable link between patient and analyst, pointing out the risk of retraumatization if analysts distance themselves and apply ‘technique’ rigorously, leaving out their own subjective assessments. Therapists must maintain their focus on the conjunction of the patient's intersubjective context and inner psychic world both when exploring the origin of the trauma and when insight is produced. The author posits repetition in the transference as an attempt at reparation, at fi nding the expected response from the analyst that will help patients assemble the fragments of their history and achieve, as Winnicott would put it, a feeling of continuity in the experience of being.     

The preoedipal patient and the pregnancy of the therapist

This article is a contribution to the sparse literature on the pregnancy of the therapist. The therapist's pregnancy is viewed as an event that can facilitate progress for some female patients with preoedipal problems. In these cases, it provides a dramatic opportunity to address developmental difficulties, including separation problems and inadequate ego ideal formation, through the analysis of the self-object transference. Clinical material illustrates the working through of these issues for a patient in whom the therapist's pregnancy was stressful but not traumatic. Therapeutic interventions were aimed at fostering greater differentiation between self and object. A contrasting case is also examined in which the pregnancy was felt to be traumatic and feelings about it largely denied. However, underlying transference issues were eventually addressed.     

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.     

Beyond the what, when, and how of transference: a consideration of the why.

Transference has generally been discussed in terms of its operating to distort the way in which a current relationship is dealt with and experienced because of one's past. In the present paper, emphasis is placed on that aspect of transference which operates as a defense, and which is called into play in response to signal anxiety associated with a "pathogenic complex" and is based on (1) a traumatic experience of stimulus overload or (2) an intrapsychic conflict stemming from instinctual drive pressure which in turn threatens a repetition of the traumatic experience. Clinical illustrations are presented in which both traumatic experience and drive-conflict forces are prominent, leading to a discussion of the here-and-now versus reconstruction of the past, as well as affective/cognitive and interpersonal/intrapsychic factors.     

Trauma Child on The Couch: Transference,Introjection, Identification

This paper attempts to explore some of the psychic processes at work with patients whom I identify as the “trauma child”. The term is a metaphor rather than a diagnosis of “traumatisation”, to indicate patients particularly resistant to maturational processes. They feel blocked and thereby find it difficult to evolve as creative adults. As opposed to the “traumatised” child no particular distressing event can be identified as a cause for emotional suffering. The malaise is often “low key” or silent but functions as a saboteur, undermining satisfactory existence. The trauma child is constantly seduced by regressive functioning and bound by numerous strategies of resistance of reality and often incapable of relinquishing the boundless pleasure of omnipotence. On the basis of my clinical work with the “trauma child”, I will explore the different processes of introjection in transference and counter transference, paying particular attention to the dynamics of identification between analyst and patient and its implications for object relations. Instead of “healthy” identification with the other, taking account of difference and reality, the mode of object relations can be that of “pathological imitation” based on fantasies of oral incorporation. A kind of regressive defense against “mature” relationships; it is an attempt to acquire a substitute identity through magical imitation. Analytical listening, associative work and interpretation stimulate maturational processes within the patient and help him/her to let go of immature relational modes fixated in childhood.     

Assessment of Trauma History and Trauma-Related Problems in Ethnic Minority Child Populations: An INFORMED Approach

Youth who experience traumatic events are at risk for a range of negative outcomes, including posttraumatic stress disorder, other anxiety disorders, depression, substance use, and health risk behaviors. It is important to identify valid methods to assess individuals for exposure to traumatic events, as well as the types of problems or symptoms they may be experiencing as a result of these events.

An individual's cultural values, beliefs, and practices can affect the ways that trauma-related sequelae are manifested and presented upon evaluation. Obtaining information about a child's ethnic background, including cultural beliefs and practices, can be a useful component of a trauma assessment. In this paper, the authors will (a) review standard guidelines for assessment of trauma in the general population; (b) present an argument for modification of standard trauma assessment strategies used with culturally diverse populations; (c) describe the culturally INFORMED model, comprised of 8 empirically based recommendations for modifying trauma assessment of culturally diverse populations; and (d) provide an example of how this model has been applied to a trauma assessment protocol with a Mexican immigrant population. Implications of how culturally modified assessment can be used to inform culturally modified cognitive-behavioral treatment of trauma symptoms in children also are addressed.     

Biographical truths and their clinical consequences: Understanding ‘embodied memories’ in a third psychoanalysis with a traumatized patient recovered from severe poliomyelitis

The relationship between ‘narrative’ and ‘historical–biographical truth’ in psychoanalytic treatment has become the subject of many controversial debates in recent years. Findings of contemporary memory research have lead to great scepticism as to whether therapists are able objectively and reliably to reconstruct biographical events on the basis of their observations in the therapeutic situation. Some authors even claim that psychoanalysts should concentrate exclusively on observing the here and now of the patient′s behaviour within the transference relationship to the analyst. In this paper it will be discussed whether the baby has been thrown out with the bathwater in this debate. Centred around the insights from a third psychoanalysis with a patient who suffered from a severe case of childhood polio, the hypothesis will be discussed that working through the traumatic experience in the transference with the analyst, as well as the reconstruction of the biographical–historical reality of the trauma suffered, prove to be indispensable for a lasting structural change. Integration of the trauma into one′s own personal history and identity is and remains one of the main aims of a psychoanalytic treatment with severely traumatized patients. The reconstruction of the original trauma is indispensable in helping the patient to understand the ‘language of the body’ and to connect it with visualizations, images and verbalizations. The irreversable wounds and vulnerability of his body as the ‘signs of his specific traumatic history’ have to be recognized, emotionally accepted and understood in order to live with them and not deny them any longer. Another important aspect in psychoanalysis is to develop the capability to mentalize, in other words, to understand the intentions of central (primary) objects related to the trauma. The concept of ‘embodied memory’ might be helpful in understanding precisely in what way ‘early trauma is remembered by the body’. Observing in detail the sensory‐motor coordinations in the analytic relationship enables one to decode the inappropriate intensity of affects and fantasies which match the original traumatic interaction and are revealed as inappropriate reactions in the present, new relationship to the analyst.     

Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain

This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach.     

Family processes in the midst of urban poverty: What does the trauma literature tell us?

Consistent with a family systems framework, this paper examines the clinical and research literatures to clarify the connection between chronic trauma exposure and family processes with a focus on the social ecology of low-income, urban neighborhoods. Strong empirical evidence demonstrates the impact of chronic trauma on individual family members and, in turn, on multiple family subsystems. Additionally, there is evidence that living under chronically harsh, traumatic circumstances slowly erodes family processes, specifically structure, relations, and coping. However, existing research reflects the problems inherent in sorting out relationships among multiple, often interrelated factors. Future research requires comprehensive theoretical models, such as systemic, transactional, or ecodevelopmental, along with sophisticated research designs, prospective, longitudinal or intervention, and multilevel analytic methods.     

On aggressiveness and violence in adolescence1

When considering aggressiveness and violence during adolescence, we must take into account multiple senses, which range from the healthy assertion of one's own space before others to the repetition of traumatic violent experiences such as the violation of bodily and spatial‐temporal boundaries. The author presents a survey of the views of different authors within psychoanalytical literature which allows us to question these terms, and turn then to the exploration of clinical practice. In studying the latter, acting out is brought to the fore, noting that not every adolescent act connotes a risk. The acts tackled in this case are those that, owing to their characteristics, may often endanger the very life of the adolescent. The author presents clinical material that focuses on adolescent acting out, highlighting the question of how to create, through the transference‐countertransference axis, a space within the analytic session where the patient's capacity to think may be incorporated, thus allowing the anticipation of action.     

Silence as the Voice of Trauma

Silence is a key to the unspoken world of the patient. Rather than interpreting silence as a defensive maneuver, the analyst may understand this disruption as a royal road to the patient’s traumatic experiences. The author proposes to recognize traumatic silences in the analytic process and the transference as a re-experiencing of past, unpredictable traumatic affective states and memories. Silences in this context are both a repeat of a disconnecting experience as well as a manifestation of a silencing identification with the original silencer. The clinical material illustrates effects of a German mother’s World War II (WWII) personal traumata and collective shame-based silence on her daughter’s self and good object development. In the daughter’s analysis, the patient and the analyst, who herself experienced similar WWII traumata, face the pain of trauma recovery and un-silencing. The author suggests that the deadening effect of past traumata may be reversed by an analytic process of re-membering and re-speaking for both the patient and analyst. This allows for a more transparent, subjective experience in the transference and a verbal integration of ego functions.     

Vicarious Trauma in Social Workers: The Role of Trauma History,Social Support,and Years of Experience

Vicarious trauma, a disruption in schemas and worldview often accompanied by symptoms similar to those of posttraumatic stress disorder, occurs as a result of chronic secondary exposure to traumatic material. The aim of this study was to examine the role of personal trauma history, social support, and experience level in the development of vicarious trauma among licensed social workers in Maryland (N = 160). Results indicated an increase in social support and in experience level of social workers predicted less severe vicarious trauma. In addition, an interaction effect between trauma history and social support trending on significance indicated higher levels of social support might help protect those without a trauma history but not those with a trauma history against vicarious trauma. Research and clinical implications are discussed.     

The synergy of memory, affects and metaphor

Recently, the concept of metaphor has been revitalized as a result of the convergence of interest in this subject from a variety of disciplines including neurobiology, linguistics and cognitive science. Metaphor is now viewed as an emergent property of mind. Metaphor is rooted in the body in two senses: metaphor is used to organize bodily sensation cognitively, especially affects, and secondly, metaphor is rooted in the body as it rests on the border between mind and brain. Metaphor is therefore viewed as a developmentally early, primitive mental function related to synesthesia. There is a significant distinction between frozen or foreclosed metaphors and open and generative metaphors. The foreclosed metaphor will dominate the perception of others in cases of trauma and can be understood as an explanation of transference repetition. Clinical examples of foreclosed metaphors are illustrated by vignettes of patients who have suffered traumas. Examples taken from two artists are used to illustrate instances in which the artist's own unassimilated experiences appear as generative metaphors.