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This book provides an overview of trauma theory and elaborates ways of working with patients with early relational trauma, with clinical examples. Borderline states are assumed to result from early relational trauma.
In his introduction West says: ‘The book offers an integration of analytic theory, trauma theory and relational theory, yet represents a critique of each… it critically revisions analytic understanding, attitudes and techniques in the light of trauma perspective, offering … a different view of borderline states of mind’.
Chapter 1 introduces the subject. The central theme is that experience of early relational trauma gives rise to feeling-toned complexes which disrupt normal development and come to dominate the individual's personality. It manifests in ways that sets the person at odds with himself and the world through the early experience of indifference, deprivation, neglect and abuse. West argues this personality structure (borderline states of mind) requires a relational approach to the analytic work and a micro-analysis of ruptures in the relationship, to enable understanding and repair. West points out that memories of trauma may have no verbal component, no narrative about what happened. The clue to this is often in enactments during the analysis that need to be thoroughly explored and unpicked before they can be understood. He states such patients feel like a colander that can't retain a good sense of themselves: an apt simile.
West outlines traditional psychoanalytic understandings of borderline phenomena. He cites Stern, Gunderson and Singer, Kernberg, Fonagy, Liotti, Meares and many others. Jung is notable by his absence, which is a pity, since dissociation, a feature of Jung's work, is so relevant to borderline functioning. West gives a useful overview of trauma theory beginning with van der Kolk's definition of trauma: ‘an inescapably stressful event that overwhelms the individual's existing coping mechanism’ (p. 25). Jung and the complex are