Transference and Post-Traumatic Stress: Combat Veterans' Transference to the Veterans Administration Medical Center

In dynamic psychotherapy or clinical psychoanalysis the therapist or analyst works with the patient's cognition, affect, memory, fantasy, and symbolism, as well as with interpersonal and internalized (object relations) human relationships. These are all examined in their past and present aspects, within the confines of the bipersonal mutuality between patient and analyst. It is within this bipersonal field that transference reactivations are expressed and explored in order to effectively assist the patient to work through pathological defenses. The concept of transference is thus central to dynamic therapeutic processes; it is perhaps the most important property of the therapeutic or analytic relationship. Transference is the here-and-now reliving of dimensions of parental originating internalized patterns of thinking, feeling, and behaving in relation to the person of the analyst or therapist.

When these reactivations of repressed memories and “unmetabolized” cognitions and feelings are directed toward an inanimate object, such as an institution, and the patient is a veteran with combat stress pathology, the treatment context becomes very complex. This is in part because of the patient's: (1) chronic adaptations to internalized “war-tainted bad objects” ; (2) over-valent, split-off psychostructural operations marked by “drive-dominance”; and (3) strong affective attachment (cathection) to an inanimate, nonhuman object. Split-off, dissociative intrusive recollections of war traumatic episodes foster ego-regressive patterns of functioning, resulting in a