Presentation on theme: "TRAUMA: the unique individual experience, associated with an event or enduring conditions, in which (1) the individual’s ability to integrate affective."— Presentation transcript:
TRAUMA: the unique individual experience, associated with an event or enduring conditions, in which (1) the individual’s ability to integrate affective experience is overwhelmed or (2) the individual experiences a threat to life or bodily integrity. The pathognomonic responses are changes in the individual’s (1) frame of reference, or usual way of understanding self and world, including spirituality, (2) capacity to modulate affect and maintain benevolent inner connection with self and others, (3) ability to meet his/her psychological needs in mature ways, (4) central psychological needs, which are reflected in disrupted cognitive schemas, and (5) memory system, including sensory experience (Pearlman and Saakvitne, 1995).
Freud Seduction Hypothesis Abreaction
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 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
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”.
Both actively separate mental concerns and disrupt a smooth and continuous sense of self. Dissociation vs. Splitting
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
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 Hungry Baby Unavailable Mother Affect: Rage + Bad Self Bad Object
Internalization of Object Relationships II Satisfied Baby Nursing Mother Affect: Pleasure Satisfaction + Bad Self Bad Object Good Self Good Object
Projective Identification – Step 1 Bad Self Bad Object Good Self Good Object Patient disavows and projects bad internal object into treater. Patient Treater
Projective Identification – Step 2 Bad Self Good Self Good Object Patient Treater Bad Object 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.
Modified Bad Self Modified Bad Object 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). Projective Identification – Step 3
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