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As Jill and David Scharff confess, little is more emotionally taxing for the psychoanalytic clinician than the treatment of the survivor of abuse: “As writers, we procrastinated, studied everything else, and wrote other books first, because recording our countertransference reawakened the memory of our reception of the patient's trauma. As therapists, and then as writers, we have felt nauseated, anguished, frightened, guilty and helpless” (p. xvi). The authors call attention to their private subjective concerns about “exhibitionism, betrayal, breaking of boundaries, exploitation of the patient and traumatizing the reader” and have produced a work rich in clinical detail that is at times horrifying because of their patients' hellish experiences (p. xvi).
For four years in the 1930s, Fairbairn worked in a clinic devoted to the treatment of children and adolescents; in 1935, he published a remarkably candid and progressive assessment, for the times, on the ubiquity of child abuse (reprinted in Volume II of From Instinct to Self). This clinical experience, as the Scharffs suggest, was of considerable import to the later development of his object relations theory, which for them has the greatest explanatory power for understanding and treating the abused patient. Fairbairn's work with abused children was undoubtedly key to his view that the more unsatisfying (and traumatizing) an object is in reality, the more the child is forced to internalize it in order to both deny and control its real and imagined malevolence. Fairbairn (1952) expressed this concept poetically when he wrote, “It is better to be a sinner in a world ruled by God than to live in a world ruled by the Devil” (p. 66). Similarly, Fairbairn's mechanism of splitting and repression is seen by the authors as the cause of the splits in the self regularly found in the survivors of abuse, taking its most extreme form in multiple personality disorders.
Inevitably, the authors engage the fantasy versus reality of tra