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Assessment, Trauma, Narcissism

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New psychoanalytic perspectives
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Medium 9781855757905

5 - Working Over

Karnac Books ePub

CHAPTER 5

Working over

R. Peter Hobson

As a consultation proceeds, things that have happened at the beginning of the session need to be worked over, as patterns of anxiety and conflict, defence, and relatedness repeat and resurface in different forms, again and again. Each time they do, a therapist's picture of the patient acquires depth. Whatever disturbance and distress erupted at the commencement of the interview is now set in the context of other, often more reflective states of mind that the patient may bring to bear on making sense of what his or her feelings mean. The picture is also enriched by what the person recounts about his or her past and present life.

In psychotherapy, as in life, all is in movement. A particular form of movement is especially important as an expression of a patient's ways of dealing with anxieties and conflicts stirred by an intimate relationship. This kind of movement involves shifts in intersubjective engagement. Such shifts entail that patient and therapist feel how things alter in relation to one other. Although the determinants of the respective positions of therapist and patient are complex, the attitudes of each have a shaping influence on the attitudes of the other. Psychotherapists need to hone their awareness of how they are being induced to feel things, as well as how their own attitudes and interventions influence a patient's state of mind.

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Medium 9781855756663

CHAPTER 7: THE HUNGRY SELF: WORKING WITH ATTACHMENT TRAUMA AND DISSOCIATION IN SURVIVORS OF CHILDHOOD ABUSE

Karnac Books ePub

Sue Richardson

This paper explores some features of attachment-based work with people with dissociative conditions. It describes work T with a very wounded and vulnerable part of the self within a client, “Sally”. It concludes that the capacity for repair does not rest on the severity and chronicity of abuse or developmental dependency on the abusers, but rather on establishing a secure therapeutic base from which a relational bridge (Blizard, 2003) can be built and some communication established across dissociative barriers.

Sally suffered serious attachment trauma, including emotional and sexual abuse from early childhood. She has had considerable difficulty in forming supportive companionable relationships and her relational experience has been of dominance and submission (Heard & Lake, 1997). She is also in poor physical health, much of which arises from long-term anorexia.

At the beginning of therapy, the wounded, vulnerable part of Sally was in a double bind, caught between the longing for care and the fear of approaching a care-giver. Sally regarded the emotional and physical hunger of this part of the self as dangerous and intolerable. In turn, the hungry self had become a separate,dissociated self, of whose needs and responses Sally was persistently dismissive.

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Medium 9781855757905

8 - Trauma

Karnac Books ePub

CHAPTER 8

Trauma

Joanne Stubley

My aims in this chapter are twofold. First, I consider how a brief series of consultations might be of value for individuals who present with trauma. Second, I discuss how the psychological effects of trauma yield insights into the workings of the mind. Such insights are relevant for therapeutic work beyond that with traumatized patients.

I begin with a clinical description, but not of someone who came for consultation.

A person's story of trauma

A young college student, walking through a park on the way home from a party, is brutally raped. In the following weeks two other women are attacked in a similar manner, but they lose their lives at the hands of their attacker. The college student experiences post-traumatic stress reactions in the form of nightmares, flashbacks, difficulty sleeping, feelings of isolation and distance from friends and family, emotional numbness, and withdrawal.

Unable to return to classes, the student leaves college and returns home. There she finds it difficult to speak about her experiences. She finds herself embroiled in pointless arguments and disputes within the family. She breaks up with her former boyfriend and sees many of her old friends drift away. Eventually she begins to pick up the pieces of her life, restarting college in another town.

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