Relational Trauma and its Psychoanalytic-Existential Response
Theoretical and Technical Considerations
~Amelio A. D'Onofrio, PhD
We human beings are all born into a world in which we have already been partially formed in our parents’ imagination. Through our parents' gaze their hopes, fears, and conflicts become inscribed in our psyches and constitute the canvas from which we struggle to emerge as individuals in our own right--able to embody our own desires, speak those desires with our most authentic voices, and courageously author our own lives. When, however, our early experiences are flavored with extremes of intrusion or neglect—when there is a failure of containment and soothing—we experience loss. We begin to lose the possibility of emerging as a self. Our subjectivity fades. This kind of subtle yet insidious trauma ruptures and fragments meaning; it contracts the psyche and shrinks our existential possibilities. It does so in part by immobilizing time and keeping us in dissociated states unable to move freely, forever lurching to grasp for what was lost—what should have been but wasn’t, or, what was, but should not have been. It sets in motion a life lived in automatic, insistent, repetitive, obligatory and stereotyped ways; and, in living that life we become estranged from ourselves. With the shattering of our psychic identities, we develop an ontological insecurity that continually reminds us of our having been forsaken which cripples our capacity to narratively weave the pieces of our life together into a coherent whole. Our ability to feel and speak is muted and hope recedes into the background thus disabling our ability to love well. Our enduring experience becomes one of being alone and of living in exile.
In this seminar, we'll explore how traumatic suffering manifests itself, how it is felt, enacted, and how it often remains hidden from our awareness. We'll also consider the ways we therapists may make contact with our patients suffering, take it in, metabolize it, and help transform it into something new and into something that liberates and empowers. To this end, we'll explore ways we might be able to cultivate our own capacity for a deeper and more attuned form of listening. How do we create clearings in our inner spaces so as to open ourselves up to and receive the "otherness" of the other--regardless of how seemingly stunted or deformed that subjectivity may be? We'll ask: How is my listening a generative kind of listening that can hear the story of the patient's symptom and allow that story to unfold, to be rewritten, to blossom and to allow me as an I to engage and meet the Thou of the other and, in so doing, welcome them back home and help to end their exile.
Utilizing psychoanalytic theory and insights from existential philosophy we'll work to construct a therapeutic narrative of human psychological suffering and its recapitulation and reparation in and through the therapeutic encounter. Participants will be challenged to examine their clinical assumptions, increase their fluency with interactional unconscious processes, critically assess the implications of their technical comportment, and refine their ability to help patients transfigure inchoate and stultifying psychological pain into words and symbols that can liberate and help lead them toward greater wholeness.
In this seminar, we'll explore how traumatic suffering manifests itself, how it is felt, enacted, and how it often remains hidden from our awareness. We'll also consider the ways we therapists may make contact with our patients suffering, take it in, metabolize it, and help transform it into something new and into something that liberates and empowers. To this end, we'll explore ways we might be able to cultivate our own capacity for a deeper and more attuned form of listening. How do we create clearings in our inner spaces so as to open ourselves up to and receive the "otherness" of the other--regardless of how seemingly stunted or deformed that subjectivity may be? We'll ask: How is my listening a generative kind of listening that can hear the story of the patient's symptom and allow that story to unfold, to be rewritten, to blossom and to allow me as an I to engage and meet the Thou of the other and, in so doing, welcome them back home and help to end their exile.
Utilizing psychoanalytic theory and insights from existential philosophy we'll work to construct a therapeutic narrative of human psychological suffering and its recapitulation and reparation in and through the therapeutic encounter. Participants will be challenged to examine their clinical assumptions, increase their fluency with interactional unconscious processes, critically assess the implications of their technical comportment, and refine their ability to help patients transfigure inchoate and stultifying psychological pain into words and symbols that can liberate and help lead them toward greater wholeness.
Overview
In the beginning there is narrative. Life is about narrative. We are constituted through the stories inscribed in us by others and by the stories we attempt to compose for ourselves. Likewise, psychotherapy is about narrative. Within the intersubjectivity of the patient-therapist encounter we attempt to ascribe significance to our experience, particularly that which is often painful, unmetabolized, and dissociated from our capacity to formulate that experience into words. Without the capacity to speak our experience we can neither know who we are as subjects nor recognize the desire that shapes that subjectivity. When our founding trauma amputates our ability to speak with a human voice, allow ourselves to be known, and love others well, our subjectivity fades and we are thus condemned to an inauthentic existence.
In this seminar we'll explore how to help patients reconcile the "me" given to them by the gaze and words of the other with the "I" atrophied and buried in one's depths. We'll examine how the therapeutic relationship--how we listen to the symptom and to the patient's unconscious communication, how we create and manage the interactional space where the work transpires, and how we are able to carry the burden with the patient of what they have suffered--helps in the work of symbolization which lies at the heart of the therapeutic endeavor. Since technique and our manifest interventions are in themselves relational acts, we'll attempt to build a therapeutic narrative that will link technique to theory--in particular, the healing elements of the therapeutic relationship and the activity necessary for converting unmetabolized pain into the symbolic. In doing so, we'll work to connect our technical recommendations with our constructed therapeutic narrative. And, of course, we'll do all of this through a psychoanalytic-existential sensibility and through case material from our work.
In this seminar we'll explore how to help patients reconcile the "me" given to them by the gaze and words of the other with the "I" atrophied and buried in one's depths. We'll examine how the therapeutic relationship--how we listen to the symptom and to the patient's unconscious communication, how we create and manage the interactional space where the work transpires, and how we are able to carry the burden with the patient of what they have suffered--helps in the work of symbolization which lies at the heart of the therapeutic endeavor. Since technique and our manifest interventions are in themselves relational acts, we'll attempt to build a therapeutic narrative that will link technique to theory--in particular, the healing elements of the therapeutic relationship and the activity necessary for converting unmetabolized pain into the symbolic. In doing so, we'll work to connect our technical recommendations with our constructed therapeutic narrative. And, of course, we'll do all of this through a psychoanalytic-existential sensibility and through case material from our work.
Schedule of Topics and Themes for our Conversation
Monday
Orienting Considerations
Orienting Considerations
- Introductions and Overview of the Week
- Therapeutic Narrative and Archetypes of the Therapeutic Journey
- The Person of the Therapist, the Choice to Be a Therapist, and the Countertransferential Starting Point
- The Founding Trauma
- What does early life relational trauma do to the psyche? To the emerging subject? To one's defining desire?
- How are terror, rage, shame, guilt, and despair created through the founding trauma?
- What is lost through the founding trauma? What is internalized and retained from that loss?
- How does that loss send into motion patterns of repetition and insistence?
- How does this founding trauma inform the nature, process, and dynamics of the psychotherapeutic endeavor?
Tuesday
The Symptom, Death Anxiety, and the Unconscious Implications of our Therapeutic Comportment
The Symptom, Death Anxiety, and the Unconscious Implications of our Therapeutic Comportment
- The Symptom
- How does the symptom speak for the subject who is rendered mute?
- How do we allow the patient to express his or her symptom?
- What is the economic gain the symptom creates and sustains?
- How is ego a symptom and how might we conceive of the process of dissociating and disentangling the subject from its ego?
- How do we help the subject move toward greater integration and restitution of his or her wholeness?
- Trauma, Death, and the Origin of Subjectivity
- How does death emerge as a peremptory force in life?
- How does death anxiety impel us toward not-knowing and to resistance in everyday life?
- How do we distinguish between death simply as an event and as a constantly lived relationship?
- How do we bind the destructiveness of death anxiety and authentically appropriate its emancipatory power?
- Death Anxiety and the Therapeutic Space
- What are the elements of an ideal therapeutic hold? The fixed frame? The intervention frame?
- How does a secure therapeutic frame function to contain unmetabolized affects?
- What are the unconscious implications of a secure therapeutic frame?
- How a secure therapeutic frame function to activate therapeutic material?
- How does a secure frame magnify death anxiety in both patient and therapist?
- Managing the Frame and Responding to Death Anxiety in the Moment
Wednesday
Listening and Therapeutic Relating I
Listening and Therapeutic Relating I
- Listening and its Relationship to the Modes of Therapeutic Relatedness
- Reviving and Deepening the Art of Listening
- How do we appropriate maieutic silence as the generative starting point for engagement?
- How do we create a clearing in our inner spaces so as to receive the otherness of the other?
- How do we listen to the story of the patient's symptom?
- How do we listen to the derivative unconscious communication replete in patient narratives?
- How do we attune to the unconscious-to-unconscious discourse at play in session?
- How do orient ourselves so that we can listen for what we don't already know?
- How do we validate our clinical hypotheses within the listening process?
Thursday
Listening and Therapeutic Relating II
Listening and Therapeutic Relating II
- The Relationship as the Vehicle for Transmuting Pain into the Symbolic
- What is the role of separateness and merger in therapeutic symbiosis?
- How do we embody the maternal/paternal function as therapist?
- How might we love in the face of the patient's aggression?
- How might we therapists fortify the symptom through therapeutic misalliances, our own possible madness and parasitic forms of relatedness?
- The Transference
- What is the function of the therapist? As mirror? As other? As sustainer of patient's desire?
- What's the role of projective identification in the work and how might we use it clinically?
- Therapeutic and Non-Therapeutic Regression in the Therapeutic Dyad
Friday
Toward Integration: Humanizing Desire and Constituting the Subject
Toward Integration: Humanizing Desire and Constituting the Subject
- Working with Patient Defenses and Resistances
- Forgiveness and the Interactional Nature of the "Cure"
- Beyond the Relationship: Insight, Symbolization, and Internalization
- The Patient as Unconscious Supervisor to the Therapist
- Therapist and Patient as Artists
- Concluding Remarks, Seminar Evaluation, and Celebration with Wine and Good Cheer
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