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I have read no other publication that resonates so well with the disturbing, challenging, and exciting experience of treating survivors of childhood sexual abuse psychoanalytically. Davies and Frawley begin by stating their central theoretical tenet: whenever childhood sexual abuse occurs, the survivor's subsequent self and object worlds consist of an interweaving of the actual abuse with fantasied elaborations of it. Clinicians should be concerned with both and need not feel obligated to choose between the two. Using a psychoanalytic relational perspective, the authors expect reenactment, and even desire it, within the context of the analytic dyad; valuable information is communicated in this way and can then be interpreted. More important, change occurs as the patient experiences a new type of relationship, the analytic one, modifying the patient's internal object world and, ultimately, interpersonal relationships. Neutrality is understood as keeping reenactments fluid, not perseverative. While abstinence is necessary, especially in order to maintain the analytic frame and avoid corruption of the analyst, the gratification provided by the nurturing, holding, containing, and protecting that is automatically part of psychoanalysis is necessary for the creation of the analytic space. The authors caution that treatment can be successful only when the analyst is knowledgeable in three areas: psychoanalysis, trauma, and sexual abuse.
The integrated model of childhood sexual abuse presented here is based on the development of five intrapsychic capacities: containment of physiological and psychological hyperarousal and disorganization subsequent to trauma; recovery of memories and fantasied elaboration; symbolization of memory and fantasied elaboration; integration of related object relationships; and internalization of a new object relationship via the analytic dyad. The emotional availability of the analyst enhances the development of the new object relationship.
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