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In an Introduction to a volume on “Theoretical and technical approaches to psychic trauma” for the Journal of the American Psychoanalytic Association (Hoffman, 2003), I wrote how, “In 1927, Freud described the non-psychotic disavowal of reality of two young men who lost their fathers in childhood. In these men, two mental states existed side by side: one which fitted in with the wish and the other with reality.” In his posthumously published, “An Outline of Psychoanalysis,” discussed further the idea that splitting, as a mechanism, was ubiquitous in childhood. Children, he stated, in addition to coping with undesirable instinctual demands by repressions, often find themselves in positions needing to fend off distressing demands from the external world. They do this by means of disavowal of the perceptions from reality. “The disavowal is always supplemented by an acknowledgement; two contrary and independent attitudes always arise and result in the situation of there being a splitting of the ego” (pp. 203-204).
Etty Cohen provides the reader of this volume with her experiences treating patients with such profound splitting mechanisms, as described by Freud long ago. Her focus is on the work with multiply traumatized adolescents. My first thought in reading this book was: How does any analyst or therapist, of any theoretical bent, cope day in and day out listening to these tragic stories of rape, murder, mutilation, and abandonment? How does a therapist deal with his or her inner experiences of dread, anxiety, fear, shame, guilt, rage, guilt-ridden sexual excitement, and countless other unpleasant affects? Undoubtedly supervision, study groups, and having one's own listening ear seem to be singularly important to prevent one's own burnout. Cohen copes through the use of countertransference analysis. For Cohen, this process seems to privilege the analyst's associations, to include self-disclosure, one outcome of countertransference analysis, but hopefully, not the only