Challenges in the Analysis of Adult Patients With Histories of Childhood Sexual Abuse

Almost exactly a century ago Freud (1896) noted that “at the bottom of every case.. there are one or more occurrences of premature sexual experience, occurrences which belong to the early years of childhood but which can be reproduced through the work of psycho-analysis in spite of the intervening decades” (p. 203). He rapidly abandoned his view that childhood sexual abuse was ubiquitous in neurosis and decided that fantasy was probably more central to neurogenesis. This shift involved an emphasis on psychic reality (as opposed to material reality) and the view that fantasies of seduction might actually defend against memories of guilt-ridden infantile masturbation (Freud 1905). However, contrary to popular misconceptions about the evolution of Freud's thinking, he never entirely abandoned the importance of real trauma, only its pervasiveness. In fact, as late as 1931 Freud noted, “Actual seduction is common enough. It invariably disturbs the natural course of the developmental processes, and it often leaves behind extensive and lasting consequences” (p 232)

Freud's clinical acumen led him to recognize that analysts must not uncritically accept everything their patients say. Teasing out fantasy from real trauma is a formidable challenge. Hence it is particularly