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A remarkable degree of ambiguity, imprecision, and disagreement characterizes the literature on dissociation and the clinical theory of treating dissociative psychopathology. I admire very much, therefore, Michael Diamond's effort to clarify some of the complex theoretical and technical issues central to the psychoanalytic treatment of people suffering the sequelae of trauma and dissociation. I particularly appreciate his position that a “psychoanalytic treatment model that addresses only linguistically represented conflict is destined to fail because the weakly symbolized traumatic material accompanying dissociative states primarily resides in somatic experience” (p. 847). In my view, psychoanalysis must address more completely and explicitly the important conceptual and technical implications of the fundamental role of unsymbolized, “somatic” experience in trauma-related psychopathology and of the nonverbal therapeutic processes relevant to its treatment.
But as I read Diamond, I am also far less certain than he seems to be that it is necessary or desirable to “integrate” the technical approach that follows from conflict theory with that of trauma theory. It depends, of course, on exactly what he means by “integrate.” I am not clear on this point and find myself confused, for instance, by his initial emphasis on “integration” followed by his eventual endorsement of a “dual-track” technical approach (p. 856). Perhaps by “integration” he means something like