Trauma, Shame, and Group Psychotherapy: A Self Psychology Perspective

This paper attempts to define trauma from a self psychology/intersubjective perspective and explores shame as a basic aspect of trauma. Self psychologically oriented group therapy is examined as an effective treatment modality for dealing with issues of shame as well as the after effects of trauma.     

Traumatic origins of intimate rage

I posit that a triad of childhood events found retrospectively in populations of batterers constitutes a powerful trauma source and that many aspects of the personality structure and function of intimately abusive men are best understood from a trauma- response framework. The trauma stressors include witnessing violence directed toward the self or the mother, shaming, and insecure attachment (cf. Dutton; Dutton; Dutton and Dutton). Bowlby (1973) considered insecure attachment itself both a source and consequence of trauma. Since the infant turns to the attachment-object during periods of distress seeking soothing, a failure to obtain soothing maintains high arousal and endocrine secretion. Van der Kolk (1987) considered child abuse an “overwhelming life experience” and reviewed the defenses that children use to deal with parental abuse: hypervigilance, projection, splitting, and denial. Terr (1979) also described driven, compulsive repetitions, and reenactments that permeate dreams, play, fantasies, and object relations of traumatized children. Shaming, conceptualized as verbal or behavioral attacks on the global self, has been found to generate life long shame-proneness or defenses involving rage. A combination of all three early experiences is traumatizing, and evidence exists in adult batterers both for the presence of trauma symptoms and the childhood experiences described above. Conceptualizing the affective, cognitive, and behavioral features of intimate abusiveness from a trauma perspective has many advantages over social learning models. A basis for the internally driven and cyclical aspect of the behavior becomes clearer as does the problems with modulation of arousal, anger, and the high levels of trauma symptoms found in populations of abuse perpetrators. The narrow social learning definition of aggression as a reaction to an appraisal of controllable threat is broadened to include reactions to trauma: uncontrollable-unbluntable-inescapable aversive stimuli.     

Psychological Dysfunction in Southeast Asian Refugees as Mediated by Sense of Coherence

Investigated Antonovky's (1979, 1987) construct of sense of coherence (i.e., an individual's belief that the world was comprehensible, manageable, and meaningful) as the internal psychological mechanism mediating the effects of external stressors (generalized resistance deficits) and resources on psychological dysfunction (measured by depression, anxiety, and psychosocial dysfunction) in 2,234 Vietnamese, Cambodian, Laotian, Hmong, and Chinese-Vietnamese refugees. Generalized resistance and deficits significantly predicted sense of coherence as well as psychological dysfunction. The amount of variance accounted for increased significantly when the mediating effect of sense of coherence was tested using a path analysis. Sense of coherence significantly reduced the predictive power of generalized resistance and deficits in the psychological dysfunction models. Results support the hypothesized mediating role of sense of coherence. Thus, interventions aiming to enhance Southeast Asian refugees' functioning may gain in effectiveness by targeting and promoting their sense of coherence.     

Trauma,narcissism and the two attractors in trauma1

In this paper, the author sets out to distinguish anew between two concepts that have become sorely entangled‐‘trauma’ and ‘narcissism’. Defi ning ‘narcissism’ in terms of an interaction between the selfobject and the self that maintains a protective shield, and ‘trauma’ as attacks on this protective shield, perpetrated by bad objects, he introduces two attractors present in trauma‐‘the hole attractor’ and the structure enveloping it, ‘the narcissistic envelope’. The hole attractor pulls the trauma patient, like a ‘black hole’, into a realm of emotional void, of hole object transference, devoid of memories and where often in an analyst's countertransference there are no reverberations of the trauma patient's experience. In the narcissistic envelope, on the other hand, motion, the life and death drive and fragments of memory do survive. Based on the author's own clinical experience with Holocaust survivors, and on secondary sources, the paper concludes with some clinical implications that take the two attractors into account.     

Pentheus rather than Oedipus: On perversion,survival and analytic ‘presencing’1

Following an introductory review of the main developments in the psychoanalytic thinking on perversion, the author focuses on her own understanding of perversion and its treatment, based on the psychoanalytic treatment of patients with severe sexual perversions. This paper uses the term ‘autotomy’ (borrowed from the fi eld of biology) to describe perversion formation as an ‘autotomous’ defence solution involving massive dissociative splitting in the service of psychic survival within a violent, traumatic early childhood situation; thus, a compulsively enacted ‘desire for ritualised trauma’ ensues. The specifi c nature of the perverse scenario embodies the specifi c experiential core quality of the traumatic situation. It is an actual repetition in the present of the imprint of a past destructive experience which is pre‐arranged and stage‐managed; it thus encounters haunting scenes of dread or psychic annihilation while, at the same time, controlling, sanitising and disavowing them. Hence, the world of severe perversion is no longer oedipal, but rather the world of Pentheus, Euripides's most tragic hero‐a world dominated by a mixture of a mother's madness, devourment, destruction and rituals of desire. According to this view, the (diffi cult) psychoanalytic treatment of perversion focuses on patient‐analyst interconnectedness‐brought about by the analyst's ‘givenness to being present’ or ‘presencing’‐at a deep, primary level of contact and impact (the emphasis being on the ontological dimension of experience). This evolving therapeutic entity creates and actualises a new, alternative experiential‐emotional reality within the pervert's alienated world, eventually generating a change in the perverse essence. The author illustrate this approach with three clinical vignettes.     

Early trauma and narcissism—autism bipolarity1

The analyst makes a series of considerations taken a posteriori from the analysis of a small number of patients. These patients have saved themselves from an early narcissistic catastrophe by developing precocious mental processes, while affective relationships rudimentarily repeat the impact with the original trauma. Primitive defences, essentially denial and vertical splitting, dissociate the tear in the psyche and structure a narcissism–autism bipolarity, revealed in aspects of the character which oblige the patient to automatically repeat a single matrix of experience. In therapy, it is necessary to construct a rst time of the trauma, by pending and linking threads of the primary relationship and strengthening them in the analytic relationship. This reconstruction of the background, a screen to project what had originally been rejected, is the prerequisite for coming out, in deferred action, from the hold of the pathological identifications. The author dedicates particular attention to the undifferentiated background, the nature‐environment torn by the trauma, and to the need to reconstruct this fabric of experience in the analytical relationship, as a fundamental element to the recomposition of the dissociated nuclei. In the clinical case, the analyst describes in particular how the analyst's words encounter an unbridgeable gap, a failure in the capacity for representation when opening the autistic nucleus. Through a regression lasting for about a year, a patient was able to live the experience of primitive agonies and that of an unbearable helplessness and, at the same time, was able to feel how the analyst supported her sense of existence. Subsequently, the patient was able to give shape, through visual images, to deep states of being and start the process of metabolising and symbolising the trauma.     

Group Therapy with Individuals and Families Coping with Illness or Disability in Israel

This paper illustrates a group intervention with individuals and family caregivers coping with illness/disability, and focuses on the relationship between the process of group development and the process of coping with the illness/disability. People experiencing illness/disability cope with a great deal of pressure and stress that stem from the illness's biopsychosocial demands. A group can provide encouragement and support and reduce helplessness, isolation, and despair through cooperation and use of mutual resources. The design of the intervention was based on our clinical experience with numerous groups for ill/disabled individuals or their family. The process is described and analyzed using examples from three documented groups, and is presented in terms of four variables: group process, group atmosphere, group content, and group intervention.     

Trauma, forgiveness and the witnessing dance: making public spaces intimate

In this paper I explore the concept of forgiveness as a response to gross human rights violations. I present a conceptual examination of the effects of massive trauma in relation to what I refer to as the 'unfinished business' of trauma. Using a psychoanalytic framework, I consider the process of 'bearing witness' about trauma and examine how this process opens up the possibility of reciprocal expressions of empathy between victim and perpetrator. I then argue that, in this context of trauma testimony and witnessing, empathy is essential for the development of remorse on the part of perpetrators, and of forgiveness on the part of victims. Using a case study from South Africa's Truth and Reconciliation Commission (TRC) I clarify the relationship between empathy and forgiveness, and show how the restorative model of the TRC can open up an ethical space and create the possibility of transformation for victims, perpetrators and bystanders. In my conclusion I suggest that forgiveness in politics is the only action that holds promise for the repair of brokenness in post-conflict societies, particularly if, as in South Africa, victims have to live together with perpetrators and beneficiaries in the same country.