Working With Traumatised People

In a way, the title ‘Working with traumatised people’ could be said to encompass the whole of psychoanalysis. All the great theoretical visions within the psychoanalytic panoply have referred to unbearable conditions that placed excessive demands upon the subject and resulted in extreme and crippling responses. We read the effects of psychic trauma on the splits and scarrings of the ego, and our evolving technique has extended our therapeutic efforts over a widening scope of these calamities. The panel chaired by David J. de Levita was squarely in this tradition, addressing contemporary ways of responding to victims of trauma seen regularly in clinical practice, as well as directing psychoanalytic attention to phenomena at the interface between the private and social worlds, pushing the boundaries beyond the intrapsychic sphere.

The first paper, a careful clinical study by W. Bohleber, ‘Trauma and dissociation’, presented the treatment of a 30-year-old diabetic woman suffering from dissociative states and depersonalisation. In his admirably documented report, Dr Bohleber described his initial efforts to create an atmosphere of safety and ‘holding’ within which he became gradually a good object with whom his patient could begin to speak about the traumatic events of her life. His account is consistent with the well-known model that equates trauma with unsymbolished experience that returns as action or repetition, with the exception that he emphasised external intrusions as traumatic disruptions of inner space rather than as stimuli for over-excitation. In his reconstruction of the history, the invasive traumas of the patient's early eye surgery and the subsequent onset of her diabetes damaged her nascent selfobject structures, promoting the use of dissociation and splitting as predominant defensive operations. Within the safety of an empathic treatment relationship, she was able to address directly for the first time the traumatic experiences of her childhood and to b