Cycles of Denial and Awe: Working with Trauma through the IPTAR Clinical Center's School-Based Service

In running a group for adolescent girls with histories of exposure to violence and loss, it has been useful to superimpose three approaches to understanding trauma: the American exploration of posttraumatic stress disorder (PTSD) phenomena, the British application of Kleinian theory to working with traumatized patients at the Tavistock Clinic's trauma unit, and the South American Kleinian conceptualization of witness and impunity, which roots trauma work in a political and moral matrix. Looking through the lens provided by American researchers, much of our students’ affect and behavior comes into focus as the hyperarousal, avoidance, and reexperiencing/reenacting that are typical of PTSD. The British Kleinians’ descriptions of traumatized patients struggling to reconnect to the healthy parts of themselves despite crippling defensive patterns have helped us to recognize and nurture our students’ attempts at resilience. The South American perspective, which demands thinking about the milieu in which trauma occurs, locates our clinical work in a larger context. Before discussing theory and presenting clinical material, it is necessary to describe the school-based service at the Clinical Center of the Institute for Psychoanalytic Training and Research (IPTAR).