By Horacio Arias, M.D.
TBIPS hosted a workshop by Richard Chefetz, M.D. on October 25, 2008 entitled "Recognizing and Treating Dissociative Adaptations to Trauma in Adults." I felt that one of the goals of the presentation was to identify some of the approaches used to treat these patients according to Chefetz, Bromberg, and others who work with severe trauma. There were several theoretical issues that I found practical and which kept my interest, including the idea of developing some object relations and avoiding others.
As I expected… there were differences clinically from within the psychodynamic point of view and I have some thoughts and feelings that I would like to share. I felt uneasy when he described the traumatic history and process with one of his patients, particularly the patient's feelings of fear and anger. I found myself needing to deal with my own personal traumatic issues and also reflected on my higher functioning severely traumatized patients. Others had expressed their thoughts and ideas while I was gathering my own. I thought of Kleinian ideas that are often forgotten in this country.
Klein was the first psychoanalyst who consistently took the time to deal with aggression and love in humankind. She was among the great analysts of her time who connected aggression with love in a common way during the most primitive of relationships of pre-oedipal life. She dealt with disassociative processes within the individual, a subject that comes to mind in dealing with severe trauma.
I found that the confusion within the traumatized patient and the patient's disassociation permeated the group at many levels, eliciting idealization or internalization to more unrealistic or unexpected feelings. A wide range of comments were offered about aggression, length of treatment, and enactment. I found our reactions thought provoking. Did we feel confused? Blocked in our thinking process? Were we trying to unblock the thinking on this type of patient …among other issues? Sometimes there can be a parallel process that occurs in those listening to and presenting patient material.
As I expected… there were differences clinically from within the psychodynamic point of view and I have some thoughts and feelings that I would like to share. I felt uneasy when he described the traumatic history and process with one of his patients, particularly the patient's feelings of fear and anger. I found myself needing to deal with my own personal traumatic issues and also reflected on my higher functioning severely traumatized patients. Others had expressed their thoughts and ideas while I was gathering my own. I thought of Kleinian ideas that are often forgotten in this country.
Klein was the first psychoanalyst who consistently took the time to deal with aggression and love in humankind. She was among the great analysts of her time who connected aggression with love in a common way during the most primitive of relationships of pre-oedipal life. She dealt with disassociative processes within the individual, a subject that comes to mind in dealing with severe trauma.
I found that the confusion within the traumatized patient and the patient's disassociation permeated the group at many levels, eliciting idealization or internalization to more unrealistic or unexpected feelings. A wide range of comments were offered about aggression, length of treatment, and enactment. I found our reactions thought provoking. Did we feel confused? Blocked in our thinking process? Were we trying to unblock the thinking on this type of patient …among other issues? Sometimes there can be a parallel process that occurs in those listening to and presenting patient material.
TBIPS thanks Richard Chefetz for sharing his work and clinical expertise with our group. We are looking forward to additional workshops on trauma as the series, "Healing Haunted Lives" continues with presentations by Lycia Alexander-Guerra, MD (1/10), Bruce Reis, PhD (2/7), and Ghislaine Boulanger, PhD (3/7).
HORACIO ARIAS, MD
HORACIO ARIAS, MD
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