The Complex Nature of Exposure to Early Childhood Trauma in the Psychoanalysis of a Child

When an intense transference relationship evolves during psychoanalysis, sensory and emotional experiences associated with trauma can arise spontaneously. Detailed clinical process material is presented from the psychoanalysis of a six-year-old boy whose severe trauma at age two and a half contributed to his conflicts about aggression and gender identity, impeding his development. A series of analytic sessions during which he spontaneously enacted fantasies, feelings, and defenses associated with the trauma in the immediacy of the transference relationship are used to illustrate how psychoanalysis provided him the safety to rework this overwhelming experience and its aftermath, thereby restoring progressive development. It is hypothesized that while work with trauma was only one feature in an otherwise complex treatment, psychoanalysis provided a sophisticated form of reexposure to developmentally primitive emotions, images, and fantasies that this child had not consciously connected with the trauma. Associated early childhood conflicts pertaining to aggression, separation, and gender identity, warded off with rigid defenses, had become intertwined with the trauma and its aftermath, rendering them otherwise inaccessible.