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This paper addresses the centrality of conflict in psychic trauma, as evidenced in the psychoanalytic treatment of an adolescent girl with a congenital life-threatening and disfiguring condition that necessitated multiple surgical procedures in early childhood. The focus is twofold: to elucidate certain characteristics of analysis in the adolescent phase that promote the integration of early trauma; and to shed light on the modes of therapeutic action of psychoanalysis. Case material is presented indicative of the psychic consequences of early medical traumata, including the impairment of the ego's capacity to utilize anxiety as a signal function that mobilizes defense, the failure of repetition to effect mastery of the trauma, the predominant use of aggression in the interest of defense, and distortions in self and object representations. The author offers evidence to show that conflicts over aggression and oedipal desires, characteristic of adolescent girls who have not been subject to trauma, were involved in the defensive function of her patient's
I gratefully acknowledge the invaluable contribution of my discussions with Dr. Alan B. Zients, whose insight and support were instrumental in my treatment of this patient. I thank also Drs. Boyd Burris and Charles Brenner for their thoughtful critique of an earlier version of this manuscript.
pervasive sense of defectiveness. She postulates that the interpretation of conflict and defense is the analyst's attuned response to the mind of the patient, and points to the resulting increase in the capacity to observe and to exercise volitional control over heretofore unconscious, automatic mental processes as evidence of the mutative function of dynamic interpretation.