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This book is a gem. It combines a masterly command of the literature on relational therapy and trauma, decades of clinical work with severely traumatized adolescents, the courage of a gifted therapist to tolerate
and use intensely difficult countertransference feelings, and good writing. I also feel a personal relation to some of the work described in the book. I served as director of the clinic where Cohen ran the longterm group for girls whose parents died or were dying of AIDS. I am glad that her work there became a central part of such an excellent book.
The trauma described in the book is substantial, arising from multiple severe stresses or ongoing traumatizing situations. The patients include teenage girls whose parents are dying of AIDS, Israeli army soldiers traumatized by exposure to death, and adolescents in inpatient units of mental hospitals.
For example, Cohen offers a vignette about Carmen, a fifteen-year-old girl whose father abused her mother throughout her pregnancy and abandoned her mother when Carmen was born. Her father remarried, was later imprisoned and then murdered, and her stepmother and baby halfbrother then died from complications from AIDS. Carmen's mother also developed AIDS. As a baby, Carmen smeared feces on herself, developed asthma, had delayed speech, and showed social and behavioral problems from a very early age. Physical and sexual abuse was suspected. When she was referred to Cohen, Carmen was anxious, angry, and hyperactive; she lied, stole, and destroyed furniture. This girl could not verbalize her feelings, and instead let her actions and stories show what she could not describe. Once, she brought an abandoned dog into the group session. She worried that if she left the dog on the street, it would die. She alternated treating it with love and with aggression during the session, a perfect screen for projecting and expressing her feelings about her own mother.
The book is organized into sections dealing with ways of surviving t