You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
I want to commend Michael J. Diamond's effort in JAPA 68/5 (“Return of the Repressed: Revisiting Dissociation and the Psychoanalysis of the Traumatized Mind') to integrate (or encompass) a range of psychoanalytic theories and clinical interventions. As Diamond points out, the responses of the commentators, despite their insight and erudition, are concerning, given the vehemence of their critiques and the suggestion that there is a “right” model and clinical approach for most patients. The responses highlight long-standing schismatic tendencies of various psychoanalytic schools, to the detriment of a treatment that requires further development of its research and scientific base. For those new to the field, these papers could suggest we are in a muddle, with no clear way to determine which of several disparate approaches are most appropriate in a given clinical circumstance. I maintain that an integrated model is more theoretically and clinically sound and enables a more constructive engagement in dialogue among practitioners of different schools.
I have put forward models that attempt to integrate dissociated, unrepresented states and intrapsychic conflict, and have discussed relevant clinical approaches that overlap with those presented by Diamond (Busch 2017). I emphasize, as Diamond and others suggest, that individuals operate on multiple levels and self-states (“a dynamic amalgam of states of mind” [Diamond, p. 912]). Thus, their cognitions, affects, symptoms, and behaviors are simultaneously influenced by unrepresented and dissociative states, as well as by conflict and repression. Some of these states of mind are symbolized and readily accessible to consciousness, whereas others are more dissociated or sequestered. For example, patients with panic disorder can experience self-states in which they are highly aware of angry feelings and fantasies, and others, often related to traumatic developmental experiences, in which they lack any awareness of anger, a lack t