Languages of trauma; towards a phenomenological response

In this article, I explore the possibilities of a phenomenological perspective on trauma in psychoanalytic practice. I highlight the problem of interpretations that universalise experiences of trauma, provide explanations in terms of ‘causes’ and assume particular processes/stages of ‘recovery’ from it. The notion of trauma challenges dichotomies of ‘internal’ and ‘external’ worlds. Traumatic experiences always have a context – that of the immediate relational circumstances of the individual suffering from the trauma, including the wider social/relational context, and the person’s history. I argue for an attunement to the language and specificity of the meanings, verbal and non-verbal, conscious and unconscious, of the client’s suffering within the analytical relationship. This requires the therapist to avoid ‘ready-made’ interpretations from psychoanalytic theory and to be open to the poiesis of the speech, which emerges between therapist and client. My discussion of my reading of the Chilean documentary film, Nostalgia for the Light, which focuses on the traumatic experiences of those who survived Pinochet’s military regime (1973–1989), highlights how diverse responses to trauma are. The originality of the language of the film calls on us as therapists to discover new ways of listening and speaking to our clients’ suffering.     

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.     

儿童期创伤对特质抑郁和特质焦虑的影响：图式中介特异性研究

根据Beck的认知内容特异性假说(Cognitive Content Specificity Hypothesis, CCSH), 本研究假设早期适应不良图式(EMSs)在儿童期创伤与特质抑郁和特质焦虑间存在中介效应的特异性。然后对668名大学生施以儿童期创伤问卷(CTQ-SF), Young图式问卷短版(YSQ-SF), 特质抑郁问卷(T-DEP)以及特质焦虑问卷(T-AI), 经中介效应检验程序分析, 结果表明：(1)三类儿童期创伤：情感虐待、情感忽视和躯体忽视与特质抑郁和特质焦虑相关均显著, 且三类创伤与特质抑郁和特质焦虑的相关系数差异不显著; (2)针对三类创伤的中介分析均表明情感剥夺、羞耻、社交孤立/疏离和自我牺牲等与没价值、无能力有关的图式在儿童期创伤和特质抑郁间起中介作用, 而不信任/虐待和对疾病/伤害易感性等与危险有关的图式在儿童期创伤和特质焦虑间起中介作用。结论：早期适应不良图式在儿童期创伤与特质抑郁和特质焦虑间存在中介效应的特异性。     

大学生主观童年创伤症状对抑郁的影响:抗挫折能力和外向性的多重中介效应

本研究将"童年创伤"定义为"个体14岁以前所经历的,站在主体的角度主观感受到的创伤性事件"。采用问卷调查法对302名大学生进行调查,通过定量加定性的方式探索了童年创伤与抑郁之间的关系。相关分析表明：主观童年创伤症状、外向性、抗挫折能力、抑郁之间两两显著相关;结构方程模型表明：主观童年创伤症状通过外向性、抗挫折能力完全、多重中介作用间接预测抑郁。本研究结果在理论和实践层面对大学生抑郁问题的预防和干预工作提供重要的借鉴依据。     

大学生主观童年创伤症状对抑郁的影响:抗挫折能力和外向性的多重中介效应

本研究将"童年创伤"定义为"个体14岁以前所经历的,站在主体的角度主观感受到的创伤性事件"。采用问卷调查法对302名大学生进行调查,通过定量加定性的方式探索了童年创伤与抑郁之间的关系。相关分析表明：主观童年创伤症状、外向性、抗挫折能力、抑郁之间两两显著相关;结构方程模型表明：主观童年创伤症状通过外向性、抗挫折能力完全、多重中介作用间接预测抑郁。本研究结果在理论和实践层面对大学生抑郁问题的预防和干预工作提供重要的借鉴依据。     

Reflections on trauma,symbolization and psychic pain in a case of neurosis and a case of psychosis

This paper seeks to advance some considerations on trauma, historical reality, its symbolization and the psychic pain generated by the investigation of unconscious processes in psychoanalytic treatment. These themes will be explored by demonstrating the differences arising between traumatic experiences and their expression in phantasy, as they occurred in a case of neurosis and another of psychosis. In each case, the differences in the features of the symbolization and the processes of working through shall also be taken into consideration. Particular attention shall be paid to the specific difficulties encountered by the analyst in the interpretative treatment of the trauma resulting from the amount of psychic pain induced in the patient, which at times proves to be an insurmountable barrier and a destructive distortion of the process.     

PTSD Symptoms in College Students Exposed to Interparental Violence: Are they Comparable to those that Result from Child Physical and Sexual Abuse?

Undergraduate students completed the Trauma Symptom Inventory and a childhood history questionnaire that assessed their experience of three types of childhood traumatic events: physical abuse (CPA), sexual abuse (CSA), and interparental violence (CPV). Six posttraumatic stress disorder (PTSD) subscales previously found to be associated with these types of abuse (anxious arousal, anger/irritability, intrusive experiences, depression, tension reduction behaviors, and defensive avoidance) were examined through multiple regression analyses to determine the extent to which each type of trauma history was most predictive of elevated symptomatology. For several subscales, having exposure to interparental violence was the strongest predictor of elevated symptomatology, suggesting that CPV is at least as powerful as CPA or CSA in producing symptoms of PTSD in adulthood.     

Authenticity as a Mediator of the Relation Between Child Maltreatment and Negative Outcomes for College Women

The goal of this cross-sectional study was to determine if authenticity in relationships mediated the relation between early childhood maltreatment and negative outcomes (depression, low self-esteem, and traumatic symptoms). An ethnically diverse sample of female college students (N = 257, M age = 19.74) completed self-report questionnaires related to early childhood maltreatment, negative outcomes, and authenticity in relationships. Approximately 30% of participants experienced childhood maltreatment including physical maltreatment, emotional maltreatment, or both. Results from multiple mediation analyses indicated that, when controlling for physical maltreatment, authenticity in close relationships significantly partially mediated the relation between emotional maltreatment and depression, self-esteem, and traumatic symptoms (p < .05). However, when controlling for emotional maltreatment, physical maltreatment did not significantly predict any of the outcome variables, so physical maltreatment was not significantly mediated by authenticity in relationships. These results have important clinical implications for women who experience negative mental health outcomes as a result of childhood maltreatment.     

The impact of depression and PTSD symptom severity on trauma memory

Posttraumatic stress disorder (PTSD) and depression frequently co-occur following a traumatic event. Differences in the processing of autobiographical memory have been observed in both disorders in the form of overgeneralised memories and negative intrusive memories. The current study examined how symptoms of PTSD and depression influence the phenomenological characteristics of trauma memories. Undergraduate students who had experienced a traumatic event (n?=?696) completed questionnaires online including measures of PTSD and depressive symptom severity. They rated their trauma memory on several phenomenological characteristics using the Memory Experiences Questionnaire [Sutin, A. R., &; Robins, R. W. (2007). Phenomenology of autobiographical memories: The memory experiences questionnaire. Memory.]. Moderated multiple regression was used to examine how PTSD and depressive symptom severity related to each phenomenological characteristic. Symptoms of PTSD and depression were related separately and uniquely to the phenomenological characteristics of the trauma memory. PTSD severity predicted trauma memories that were more negative, contained higher sensory detail, and were more vivid. In contrast, depressive symptom severity predicted trauma memories that were less accessible and less coherent. These findings suggest that depressive and PTSD symptomatology affect traumatic memory differently and support a distinction between these two disorders.     

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.     

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 construction, reconstruction, and deconstruction of memory in the light of social cognition.

Psychic trauma results when the ego is overwhelmed by intolerable affect. Some childhood experiences are directly traumatic, requiring no intervening interpretive process to render them traumatic. Troublesome affect that falls short of being truly traumatic, in the strict sense of the term, may nevertheless exert a psychopathogenic effect on the child's psychic development. Whether a child is troubled by an experience depends on what that experience meant to the child. Accordingly, the psychopathogenic effects of childhood experience are a function of the child's general level of cognitive sophistication and specific ability to appreciate the subtle nuances of social interactions. If a child's cognitive capabilities are not up to the task of providing the necessary explanations for a given social interaction, the child is left to fall back on fantasy to fill in the gaps. The field of "social cognition" proves particularly helpful in understanding what a child is capable of gleaning from an experience. Research in this area helps psychoanalysts understand how experience becomes constructed and reconstructed in the form of memories. Social cognition also helps psychoanalysts understand when and how a lived experience ends up being psychopathogenic or, alternatively, ceases any longer to exert an ongoing psychopathogenic effect on an individual's psyche. A review of social cognition research leads to a reconsideration of such psychoanalytic concepts as repression, dissociation, reconstruction, and resistance. It also directs attention to the concept of developmental (as opposed to psychoanalytic) reconstruction and deconstruction.     

Examining implications of the developmental timing of maternal trauma for prenatal and newborn outcomes

Separate literatures have demonstrated that mothers’ experiences with trauma during childhood or pregnancy are associated with maternal prenatal health risks, adverse childbirth outcomes, and offspring internalizing and externalizing disorders. These literatures largely align with the intergenerational transmission or fetal programming frameworks, respectively. However, few studies have tested the effects of maternal childhood and prenatal trauma simultaneously on mothers’ and infants’ health outcomes, and no studies have examined these effects on newborn neurobehavioral outcomes. Thus, in the present study, we examined how the developmental timing of pregnant women’s traumatic life experiences associated with their physical health and psychopathology (Aim 1) as well as their newborns’ birth and neurodevelopmental outcomes (Aim 2; for pre-registered aims and hypotheses, see https://osf.io/ygnre/?view_only=cbe17d0ac7f24af5a4d3e37e24eebead). One hundred and fifty-two 3rd trimester pregnant women (M_age = 29 years; 17.1% Hispanic/Latina) completed measures of trauma history and psychopathology. Then, 24–48 h after birth, trained clinicians conducted newborn neurobehavioral exams (n = 118 newborns; 52.6% female). Results indicated that lifetime traumatic experiences associated with multiple prenatal maternal health outcomes, including depression, anxiety, emotion dysregulation, and pregnancy complications. Pregnant women’s experiences with childhood trauma, but not adulthood or prenatal trauma, predicted higher neurobehavioral attention scores among female newborns. Our discussion highlights the importance of considering the developmental timing of maternal trauma on perinatal outcomes and contextualizes our findings within the intergenerational transmission and fetal programming literatures.Data AvailabilityData pertaining to R01MH119070 (MPIs Crowell & Conradt) and that support these findings are uploaded to the NIMH repository.     

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.     

Childhood trauma and psychosis: Review of the evidence and directions for psychological interventions

There is controversy over whether childhood trauma (CT) is a causal risk factor for psychosis. The aim of this study was to provide psychologists with a brief overview of the research into relationship between childhood trauma and psychosis and directions for psychological interventions. It details six of the highest quality studies in the area and tentatively concludes from these that there is evidence for a relationship between CT and psychosis. Hallucinations and delusions have been implicated as important factors in the relationship between CT and psychotic disorder and these are discussed, along with post‐traumatic intrusions and schemas, which have been conceptualised as part of the psychological mechanisms whereby CT confers a risk for psychosis. The development of psychological interventions for people with psychosis who have experienced CT is in its infancy but has been based on evidence‐based cognitive behavioural interventions in psychosis and post‐traumatic stress disorder. A formulation‐based approach is described in this paper, along with a case study.     

Transgenerational processes and the trauma of sexual abuse

The process of the unconscious transmission of trauma between generations has been written about within the psychoanalytic field since Freud. the concept was further developed by psychoanalysts in their work with second generation survivors of the Holocaust. the particular characteristic is that it is a transmission that takes place silently and in secret, but actively. It is especially found in families where there is an inhibition against thinking. It is suggested in this paper that the concept could be usefully considered in families where a parent is a survivor of child sexual abuse but has kept the trauma a secret. Clinical examples illustrate how children in such families may carry the unconscious dynamics which can emerge into consciousness through symptomatology in the child.     

Psychoanalysis in the Workplace: An Introduction

This symposium provides an orientation for psychoanalytic clinicians to the world of psychoanalytically oriented organizational consulting, executive coaching, and related applications of psychoanalysis in the workplace. Psychologists and psychoanalysts have played a significant role in the development of organizational consulting and executive coaching, and many clinicians today express interest in transferring their skills from clinical settings to organizations and corporations. This introduction emphasizes the psychoanalytic clinical skill of ongoing reflection on relational processes and experiences, but it also recognizes that consulting requires additional and highly specific knowledge, skill, talent, and training.     

Witch-mother is which? The potential role of the analyst in facilitating authentic motherhood

Abstract

This paper explores challenges in the treatment of women suffering from disturbances in maternal identification. A review of the psychoanalytic and developmental literature focuses on the frequent finding of early-onset mother–daughter relational disturbance involving maternal narcissistic fragility and exaggerated dependency needs, intergenerational trauma, and related psychopathology including mutual affect dysregulation. A case example of a young woman with a severe anxiety disorder is presented and discussed to illustrate the challenges to the traditional psychoanalytic technique. This patient avoided pregnancy into her late thirties and entered analysis with feelings of inauthenticity, characterological masochism, and a “secret mission” to unmask the witch recurring in her dreams. Through an elaborate working-through of negative maternal transference, the analyst and patient saw through the birth of the patient’s authentic self, a new approach to her career, her relationships with men, and her anticipation of the birth of a child by the sixth year of treatment. The author posits that psychoanalytic technique benefits from contemporary, attachment, and trauma research that supports the analyst’s playing a more active role in approaching, co-regulating, tolerating, and integrating avoided affects and memory traces that are associated with early-onset relational disturbances worsened by the effects of violence, maltreatment, and loss.     

From No Name Woman to Birth of Integrated Identity: Trauma-Based Cultural Dissociation in Immigrant Women and Creative Integration

This paper explores the challenges in integration of ethnic identity among a certain segment of immigrant women who have experienced sexism related traumas in their culture of origin. Unlike other immigrant women who may come from a nontraumatic, average expectable environment of their culture of origin into American culture, these women’s assimilative experiences and integration of identity are more complicated by the fact that their ethnic identity is tied to trauma. These women may find a refuge in the American culture, while defensively dissociating from their culture of origin, disavowing ethnic ties, severing contact with family, or avoiding contact with people from the same ethnic group. Their avoidance of their culture of origin amounts to cultural dissociation. Cultural dissociation is hard to detect and work with because cultural phenomenon in general is a blind spot for most American psychoanalysts. I contend that in order to successfully engage dissociated cultural states, a therapist’s ability to self reflect on her cultural situatedness is crucial. The creative challenge of the analyst-patient dyad is to disentangle the patient’s particular traumatic experiences from nontraumatizing normative aspects of the culture of origin in order to promote a viable ethnic identity.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.