Learning to Trust: Two Clinical Journeys

In this paper, the author seeks to honor Joseph Palombo’s legacy through presenting two treatments of young women whose severe child abuse has caused not only PTSD, but also damage to their capacity to develop an integrated and positive identity with stable self-esteem. To provide a context for the clinical material, a brief overview of self psychology is presented. When what is called the “empathic mode of listening” is consistently utilized by the therapist, patients generally develop selfobject transferences, which function to temporarily stabilize the patient’s fragmented self. Over time, the psychoanalytic exploration of these transferences gradually leads to their internalization in the form of more integrated psychic structure, more stable self-esteem, and less vulnerability to fragmentation. The therapeutic journeys of Emily and Maia, including my own at times intense internal responses to them, illustrate in detail and depth how this process has enabled them to begin to feel an integrated sense of self and enhanced self-esteem, despite the traumatic impact of their extreme child abuse and severe PTSD. They also illustrate how a self psychologically informed treatment, often in conjunction with medication, can be a powerful tool in promoting recovery from even extreme child abuse.