Metaphor-Work in the Treatment of Complex Psychic Trauma

Patients who have suffered multiple psychic traumas during childhood often form an important part of all analysts' practices. These patients enter treatment lacking the cognitive skills to get better, and their analyses are necessarily long-term, longer than typical. Early severe psychic trauma arrests the capacity for thinking in the processing sense described by Bion. The result is a kind of concreteness, an absence of metaphor, in which the analyst's capacity for containment helps the patient to make sense of experience. Much as the mother works with the primal projections of the infant, the analyst acts as intermediary between the patient and a terrifying world of reactivated trauma. With time and process, however, the capacity for thinking emerges, led by a new capacity for metaphor. This achievement brings into focus the value of metaphor and metaphor-work to conceptualize experience and point to what is new and not yet apprehended. Clinical examples are provided to illustrate the processes described. By being alert to the presence of metaphor, even when rudimentary inform, a collaborative, co-creative process becomes possible between patient and analyst in which non-symbolized agony can be transformed into meaningful narrative.