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TRAUMA, A PSYCHOANALYTICAL APPROACH



Central to the psychoanalytic view is that trauma always involves loss. The loss can be actual, like a loss of a loved person or symbolic, like loss of hope, country or identity. When one is caught up in a ‘traumatic event’ or situation, unresolved pains and conflicts of childhood get stirred up and can overwhelm a person. This trauma model is rooted in Freud’s writing which poses that knowledge and memory of the traumatic event needs to be worked through psychologically so it can be integrated and become part of one’s conscious psychic function.

Figure 1: Trauma Model – Possible Outcomes © 2013-2015 Dr Ruth Manasseh D.Psych.Psych

WHAT IS TRAUMA?

In 1920 Freud borrowed the word trauma from Greek where it refers to piercing of the skin. He used the word trauma metaphorically to portray that the protective shield of the mind (the functioning ego) can be breached and that the mind can feel pierced and wounded. In terms of the mind, it is the equilibrium between our sensitivity to external stimulation and our ability to maintain a working capacity to receive the stimulation. This is central to the analytic view because it links to the presence (or absence) of good, robust internalized experiences and objects with which to bear, and to manage extreme challenging events. For infants and young children this capacity develops as part of good parental provision. This is the capacity of the mother (or caregiver) to think with the child about the child’s mental state and the child’s capacity to assimilate feedback. As adults, some of us have developed the capacity to care for our own well-being (for example, to protect ourselves from seeking out unnecessary risks or extreme stimulations) whereas some might still struggle to do so.

However, while any individual may feel they can look after themselves (i.e. manage), some events or situations might overwhelm the person and override his or her capacity to patch up the damage.

Early difficult or traumatic events can remain repressed or unrecognized in our unconscious mind and can get stirred by a later traumatic event, leaving the individual feeling vulnerable.

This implies that early relationships, conflicts, and challenging events stored in our mind are fundamental to our ability to reflect and assimilate a current traumatic event so that we can continue to function. It also implies that when a traumatic event in a person’s life is not reflected upon, and the loss involved (actual or symbolic) is not processed and assimilated, it could lead to an impasse state of mind (melancholia).

How the person processes or does not process a loss (or the threat of a loss) is central to the impact the traumatic situation has on his or her psyche. Helping an individual to process and reflect on a traumatic event, mourn the loss involved (symbolic or concrete), work through stirred emotions such as guilt, and integrate the experience into their conscious everyday life is the task of therapy. Talking to a professional psychotherapist can help relieve psychological symptoms, generate change and so bring about a greater sense of well-being.

My current research explores the effects of using film extracts as a supplement to analytic group work with severely traumatised patients who remain in an impasse, despite their having undergone previous pharmaceutical, cognitive and psychodynamic interventions.

The main innovation, which I call Applied Cinematherapy, is the controlled way in which film extracts are introduced into a traditional brief, trauma-focused, group psychotherapy setting governed by established psychoanalytic psychotherapy practices. Initial findings indicate that this method enables a containing, transitional space for patients to gradually work through the more concealed parts of their trauma.


© 2013-2015 – Dr Ruth Manasseh D.Psych.Psych - All rights reserved

Dr Ruth Manasseh is a Psychoanalytic Psychotherapist in private practice in Singapore.