TRAUMA: the unique individual experience, TRAUMA: the unique individual experience, associated with an event or enduring associated with an event or enduring conditions, in which conditions, in which (1)(1) the individual’s ability to integrate affective the individual’s ability to integrate affective

experience is overwhelmed or experience is overwhelmed or (2)(2) the individual experiences a threat to life or the individual experiences a threat to life or

bodily integrity. bodily integrity.

The pathognomonic responses are changes The pathognomonic responses are changes in the individual’s in the individual’s (1)(1) frame of reference, or usual way of frame of reference, or usual way of

understanding self and world, including understanding self and world, including spirituality, spirituality,

(2)(2) capacity to modulate affect and maintain capacity to modulate affect and maintain benevolent inner connection with self and benevolent inner connection with self and others, others,

(3)(3) ability to meet his/her psychological needs in ability to meet his/her psychological needs in mature ways, mature ways,

(4)(4) central psychological needs, which are central psychological needs, which are reflected in disrupted cognitive schemas, and reflected in disrupted cognitive schemas, and

(5)(5) memory system, including sensory experience memory system, including sensory experience (Pearlman and Saakvitne, 1995). (Pearlman and Saakvitne, 1995).

FreudFreud

Seduction Seduction HypothesisHypothesis

AbreactionAbreaction

FerencziFerenczi

VietnamVietnam

Women’s MovementWomen’s Movement

Child Protective Child Protective ServicesServices

ACTING OUTACTING OUT: : behaviors during behaviors during the course of psychotherapy the course of psychotherapy that are characterized by the that are characterized by the patient’s acting instead of patient’s acting instead of thinking, talking or reflecting thinking, talking or reflecting about feelings and attitudes. about feelings and attitudes.

Dissociation as Dissociation as Discontinuity in ExperienceDiscontinuity in Experience

Constituents of the Constituents of the Continuity of ExperienceContinuity of Experience

selfmemory/affectconsciousness

Trigger for DissociationTrigger for Dissociation

?

Experience in the GapExperience in the Gap

?

(a)

(b)

(c)

Endpoint of DissociationEndpoint of Dissociation

?

Amnestic BarrierAmnestic Barrier

?

The Nature of The Nature of DissociationDissociation

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 The Nature of Dissociation Dissociation (Cont’d.)(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 The Nature of Dissociation Dissociation (Cont’d.)(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 The Nature of Dissociation Dissociation (Cont’d.)(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 The Spectrum of Accuracy in Memory of Traumain Memory of Trauma

Actual Trauma History#1 Continuously/clearly remembered with corroboration#2 Delayed/fragmentary memory with corroboration#3 Continuously/clearly remembered without corroboration#4 Delayed/fragmentary memory without corroboration#5 Exaggerated/distorted memory

No Trauma History#6 False memory – Patient constructed#7 False memory – Therapist suggested

SPLITTINGSPLITTING: : the cutting off of the cutting off of the unacceptable aspects of the unacceptable aspects of the self or of its objects, the self or of its objects, unconscious rigid unconscious rigid separation, usually of the separation, usually of the “good” from the “bad”.“good” from the “bad”.

Both actively separate mental Both actively separate mental concerns and disrupt a concerns and disrupt a smooth and continuous sense smooth and continuous sense of self. of self.

Dissociation vs. SplittingDissociation vs. Splitting

Dissociation vs. Splitting Dissociation vs. Splitting (Cont’d.)(Cont’d.)

Amnesia is the rule in dissociation; amnesia is rare in splitting.

Dissociation vs. Splitting Dissociation vs. Splitting (Cont’d.)(Cont’d.)

Impulse control and anxiety tolerance are impaired in splitting; memory and consciousness are affected in dissociation.

Dissociation vs. Splitting Dissociation vs. Splitting (Cont’d.)(Cont’d.)

Both defensively ward off unpleasant experiences and affects.

Somatic Symptoms / Somatic Symptoms / ResponsesResponses

Alternating arousal and Alternating arousal and numbingnumbing

DenialDenial

Identification with the Identification with the AggressorAggressor

Withdrawal / IsolationWithdrawal / Isolation

Inability to contain affectInability to contain affect

ATTACHMENT AND TRAUMAATTACHMENT AND TRAUMA: : The role of the right brain and its The role of the right brain and its development in trauma development in trauma psychopathologypsychopathology

Security of the attachment bond is Security of the attachment bond is the primary defense against the primary defense against trauma-induced psychopathologytrauma-induced psychopathology

Characteristics of Characteristics of Psychodynamic GroupsPsychodynamic 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)

TransferenceTransference

The displacement of patterns of The displacement of patterns of feelings, thoughts, and behavior feelings, thoughts, and behavior originally experienced in relation to originally experienced in relation to significant figures during childhood significant figures during childhood onto a person involved in a current onto a person involved in a current interpersonal relationship.interpersonal relationship.

B. Moore and B. FineB. Moore and B. Fine

Transferences in GroupsTransferences in Groups

TherapistTherapist Group membersGroup members Group-as-a-Group-as-a-

wholewhole Co-Therapy PairCo-Therapy Pair

Special Transferential Special Transferential AspectsAspects

Confused, quickly shifting Confused, quickly shifting transferencetransference

Patient difficulties discussing sex Patient difficulties discussing sex and sexual fantasies, especially and sexual fantasies, especially regarding therapistsregarding therapists

Termination problemsTermination problems Acting outActing out CountertransferenceCountertransference Externalization/taking too much Externalization/taking too much

blameblame

CountertransferenceCountertransference

The analyst’s feelings and attitudes The analyst’s feelings and attitudes toward a patient which are derived toward a patient which are derived from an earlier situation in the from an earlier situation in the analyst’s life that have displaced onto analyst’s life that have displaced onto the patient…or all of the analyst’s the patient…or all of the analyst’s emotional reactions to the patient, emotional reactions to the patient, conscious and unconscious. conscious and unconscious.

B. Moore and B. FineB. Moore and B. Fine

RegressionRegression

A return to a more A return to a more developmentally immature level developmentally immature level of mental functioning.of mental functioning.

B. Moore and B. FineB. Moore and B. Fine

InterpretationInterpretation

The central therapeutic activity of The central therapeutic activity of the analyst during treatment…the analyst during treatment…whereby the analyst expresses in whereby the analyst expresses in words (understanding) about the words (understanding) about the patient’s mental life…including how patient’s mental life…including how the patient distorts the relationship the patient distorts the relationship with the analyst to meet unconscious with the analyst to meet unconscious needs and to relive old experiences. needs and to relive old experiences.

Object relations group psychotherapy is Object relations group psychotherapy is a modality of psychological treatment a modality of psychological treatment wherein exploration and understanding wherein exploration and understanding of the relationship between real of the relationship between real external people and internal images external people and internal images and residues of relations with them as and residues of relations with them as well as the possible significance of well as the possible significance of these residues for psychic functioning these residues for psychic functioning is utilized within a group setting to is utilized within a group setting to facilitate emotional change and growth. facilitate emotional change and growth.

Components of an Object Components of an Object RelationshipRelationship

ObjectObject SelfSelf AffectAffect

Internalization of Object Internalization of Object Relationships IRelationships I

HungryBaby

UnavailableMother

Affect:Rage

+ BadSelf

BadObject

Internalization of Object Internalization of Object Relationships IIRelationships II

SatisfiedBaby

NursingMother

Affect:Pleasure

Satisfaction

+BadSelf

BadObject

GoodSelf

GoodObject

Projective Identification – Projective Identification – Step 1Step 1

BadSelf

BadObject

GoodSelf

GoodObject

Patient disavows and projects bad internal object into treater.

Patient Treater

Projective Identification – Projective Identification – Step 2Step 2

BadSelf

GoodSelf

GoodObject

Patient Treater

BadObject

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.

ModifiedBadSelf

ModifiedBad

Object

GoodSelf

GoodObject

Patient Treater

Treater contains and modifies the projected bad object, which is then re-introjected by the patient and assimilated (introjective identification).

Projective Identification – Projective Identification – Step 3Step 3

Purposes of Projective Purposes of Projective IdentificationIdentification

1.Defense: to distance oneself from the unwanted part or to keep it alive in someone else.

Purposes of Projective Purposes of Projective Identification Identification (Cont’d.)(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 Purposes of Projective Identification Identification (Cont’d.)(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 Purposes of Projective Identification Identification (Cont’d.)(Cont’d.)

4.Pathway for psychological change: to be transformed by reintrojecting the projection after its modification by the recipient.

Group Change AgentsGroup Change Agents

ConformityConformity Observation and Observation and

modelingmodeling CohesionCohesion SafetySafety TheoryTheory Projective identificationProjective identification

Group BoundariesGroup Boundaries

FrequencyFrequency Starting and Starting and

stoppingstopping ChangesChanges LocationLocation Billing and paymentBilling and payment Outside contactsOutside contacts

General Principles of General Principles of Time-Limited GroupsTime-Limited Groups

Clearly define goalsClearly define goals Maintain time limitMaintain time limit Manage basic assumption lifeManage basic assumption life Maximize positive Maximize positive

transferencetransference

Problems Responding to Problems Responding to Intervention with Homogenous Intervention with Homogenous

Time-Limited GroupsTime-Limited Groups

Shame and low self-esteemShame and low self-esteem Alienation and isolationAlienation and isolation Low motivation to changeLow motivation to change

Open-ended Heterogeneous Group Open-ended Heterogeneous Group Psychotherapy for Trauma Psychotherapy for Trauma

TraumaTrauma

CharacterCharacter

Working ThroughWorking Through

Containment of AffectContainment of Affect

Integration of Scattered Sense Integration of Scattered Sense of Selfof Self