TRAUMA: the unique individual experience,
associated with an event or enduring conditions, in
which
(1)
(2)
the individual’s ability to integrate affective experience is
overwhelmed or
the individual experiences a threat to life or bodily
integrity.
The pathognomonic responses are changes in the
individual’s
(1)
(2)
(3)
(4)
(5)
frame of reference, or usual way of understanding self
and world, including spirituality,
capacity to modulate affect and maintain benevolent
inner connection with self and others,
ability to meet his/her psychological needs in mature
ways,
central psychological needs, which are reflected in
disrupted cognitive schemas, and
memory system, including sensory experience (Pearlman
and Saakvitne, 1995).
Freud
Seduction Hypothesis
Abreaction
Ferenczi
Vietnam
Women’s Movement
Child Protective Services
ACTING OUT: behaviors during the
course of psychotherapy that are
characterized by the patient’s acting
instead of thinking, talking or
reflecting about feelings and
attitudes.
Dissociation as Discontinuity in
Experience
Constituents of the Continuity of
Experience
self
memory/affect
consciousness
Trigger for Dissociation
?
Experience in the Gap
(a)
?
(b)
(c)
Endpoint of Dissociation
?
Amnestic Barrier
?
The Nature of Dissociation
Arises as a defense against trauma –
Performs the dual function of
removing victims from the trauma
while also delaying the necessary
working-through that places it in
perspective with the rest of their lives.
The Nature of Dissociation
(Cont’d.)
Dissociation
 A response to trauma, a fallback
strategy when repression fails.
 Intact implicit and impaired explicit
memory.
 The division of attention and state of
mind during trauma leads to the
inhibition of explicit memory.
The Nature of Dissociation
(Cont’d.)
Dissociation (Cont’d.)
 A vertical barrier is created in which the
traumatic experience and the self- and
object-representations associated with it
are stored in parallel, compartmentalized
states of consciousness.
 Prohibition against talking openly about
trauma may prevent it from entering
personal memory system.
The Nature of Dissociation
(Cont’d.)
25% to 50% of trauma victims
experience some kind of
detachment from the trauma.
Repression-horizontal split;
dissociation-vertical split.
Repression
 A defense that banishes from consciousness
unacceptable thoughts and feelings arising
from within.
 Often characterized as a horizontal barrier
between consciousness and
unconsciousness.
 Trauma overwhelms the ego’s capacity to
repress.
The Spectrum of Accuracy in
Memory of Trauma
Actual Trauma History
#1
#2
#3
#4
#5
Continuously/clearly remembered with corroboration
Delayed/fragmentary memory with corroboration
Continuously/clearly remembered without corroboration
Delayed/fragmentary memory without corroboration
Exaggerated/distorted memory
No Trauma History
#6 False memory – Patient constructed
#7 False memory – Therapist suggested
SPLITTING: the cutting off of the
unacceptable aspects of the self or
of its objects, unconscious rigid
separation, usually of the “good”
from the “bad”.
Dissociation vs. Splitting
Both actively separate mental concerns
and disrupt a smooth and continuous
sense of self.
Dissociation vs. Splitting (Cont’d.)
 Amnesia is the rule in dissociation;
amnesia is rare in splitting.
Dissociation vs. Splitting (Cont’d.)
 Impulse control and anxiety
tolerance are impaired in splitting;
memory and consciousness are
affected in dissociation.
Dissociation vs. Splitting (Cont’d.)
 Both defensively ward off
unpleasant experiences and
affects.
Somatic Symptoms / Responses
Alternating arousal and numbing
Denial
Identification with the Aggressor
Withdrawal / Isolation
Inability to contain affect
ATTACHMENT AND TRAUMA: The role
of the right brain and its development in
trauma psychopathology
Security of the attachment bond is the
primary defense against trauma-induced
psychopathology
Characteristics of Psychodynamic
Groups
1. Vital enactment of the characterological
dilemmas of the members.
2. Exposure and the resolution of shameful
secrets.
3. Support around the universality of the
member’s wishes, fears, and distress.
4. Reintegration of the split off parts of the
self.
(Alonso, 1993)
Transference
The displacement of patterns of feelings,
thoughts, and behavior originally experienced
in relation to significant figures during
childhood onto a person involved in a current
interpersonal relationship.
B. Moore and B. Fine
Transferences in Groups




Therapist
Group members
Group-as-a-whole
Co-Therapy Pair
Special Transferential Aspects
 Confused, quickly shifting transference
 Patient difficulties discussing sex and
sexual fantasies, especially regarding
therapists
 Termination problems
 Acting out
 Countertransference
 Externalization/taking too much blame
Countertransference
The analyst’s feelings and attitudes toward a
patient which are derived from an earlier
situation in the analyst’s life that have
displaced onto the patient…or all of the
analyst’s emotional reactions to the patient,
conscious and unconscious.
B. Moore and B. Fine
Regression
A return to a more developmentally
immature level of mental functioning.
B. Moore and B. Fine
Interpretation
The central therapeutic activity of the analyst
during treatment…whereby the analyst
expresses in words (understanding) about the
patient’s mental life…including how the
patient distorts the relationship with the
analyst to meet unconscious needs and to
relive old experiences.
Object relations group psychotherapy is a
modality of psychological treatment wherein
exploration and understanding of the
relationship between real external people and
internal images and residues of relations with
them as well as the possible significance of
these residues for psychic functioning is
utilized within a group setting to facilitate
emotional change and growth.
Components of an Object
Relationship
 Object
 Self
 Affect
Internalization of Object
Relationships I
Bad
Self
+
Hungry
Baby
Unavailable
Mother
Bad
Object
Affect:
Rage
Internalization of Object
Relationships II
Bad
Self
+
Satisfied
Baby
Bad
Object
Good Good
Self Object
Nursing
Mother
Affect:
Pleasure
Satisfaction
Projective Identification –
Step 1
Bad
Self
Bad
Object
Good Good
Self Object
Patient
Treater
Patient disavows and projects bad internal object into treater.
Projective Identification –
Step 2
Bad
Self
Good Good
Self Object
Patient
Bad
Object
Treater
Treater unconsciously begins to feel and/or behave like the projected bad object in
response to interpersonal pressure exerted by the patient. This step may be referred
to as projective counteridentification.
Projective Identification –
Step 3
Modified Modified
Bad
Bad
Object
Self
Good
Self
Good
Object
Patient
Treater
Treater contains and modifies the projected bad object, which is then re-introjected
by the patient and assimilated (introjective identification).
Purposes of Projective Identification
1. Defense: to distance oneself from
the unwanted part or to keep it alive
in someone else.
Purposes of Projective Identification
(Cont’d.)
2. Communication: to make oneself
understood by pressing the
recipient to experience a set of
feelings like one’s own.
Purposes of Projective Identification
(Cont’d.)
3. Object-relatedness: to interact with
a recipient separate enough to
receive the projection yet
undifferentiated enough to allow
some misperception to occur to
foster the sense of oneness.
Purposes of Projective Identification
(Cont’d.)
4. Pathway for psychological change:
to be transformed by reintrojecting
the projection after its modification
by the recipient.
Group Change Agents






Conformity
Observation and modeling
Cohesion
Safety
Theory
Projective identification
Group Boundaries






Frequency
Starting and stopping
Changes
Location
Billing and payment
Outside contacts
General Principles of
Time-Limited Groups




Clearly define goals
Maintain time limit
Manage basic assumption life
Maximize positive transference
Problems Responding to Intervention
with Homogenous Time-Limited Groups
 Shame and low self-esteem
 Alienation and isolation
 Low motivation to change
Open-ended Heterogeneous Group
Psychotherapy for Trauma
Trauma
Character
Working Through
Containment of Affect
Integration of Scattered Sense of Self