Meetings of the New York Psychoanalytic Society

October 13, 1970. PSYCHOTHERAPY AFTER TRAUMATIZATION CAUSED BY PERSECUTION. E. de Wind, M.D.

The author reviewed the limited material concerning psychotherapy, including psychoanalysis, of concentration camp victims, and mentioned that even in this small sample treatment results varied. He felt there was undue pessimism on the part of some therapists who have worked with such patients. In studying the treatment of concentration camp victims there can be considerable elucidation of the degree to which massive adult trauma alone causes psychopathology; this can be contrasted to individuals in whom the psychopathology seems more determined by early infantile experiences and in which the concentration camp trauma is used as a defense against infantile, most usually Oedipal, genetic childhood material.

Dr. de Wind sent questionnaires to psychoanalysts and other therapists who have treated concentration camp victims. Their responses emphasized the patient's difficulties in working through the actual trauma and the countertransference problems, as well as the trauma being the realization of an infantile fantasy. From these responses, Dr. de Wind reached several conclusions about the treatment of massively traumatized patients. 1. Massive adult trauma does not necessarily contraindicate psychoanalysis although there may be need for some modification of technique to get patients to re-experience the painful affect; also it may be necessary for patients too preoccupied with the trauma to undergo preliminary supportive psychotherapy. 2. It is important to distinguish between trauma in early life and later trauma: in the former developmental defects are seen; in later trauma such defects are not seen but the patient regresses, occasionally irreversibly. 3. Some patients are irreversibly traumatized and refractory to any treatment. 4. Patients cannot work through their problems when they see the therapist as the persecutor, have a marked negative therapeutic reaction be