REGISTER | Trends and Controversies in Psychoanalytic Conceptualizations and Treatment of Trauma Study Group

Houston Psychoanalytic Society

Study Group

Trends and Controversies in Psychoanalytic Conceptualizations and Treatment of Trauma

Facilitated by

JoAnn Ponder, PhD, George Bombel, PhD & various guests

19 Wednesdays

September 13, 2023 - May 22, 2024

7:00 PM - 8:30 PM Central Time

Live via Zoom

*Pre-Registration required for Zoom invitation

No sessions will be recorded

28.5 CEU/CME/CE credits

Instructional Level: Intermediate - Advanced

Registration Fees

This reading and discussion group was developed to honor two HPS members, Jean M. Goodwin, MD, MPH and Jon G. Allen, PhD, both of whom have made, and continue to make, significant contributions to our understanding and treatment of trauma.* In this study group, participants will explore the trends and controversies that have occurred over time in the psychoanalytic conceptualizations and treatment of trauma. The purpose is not to examine history as static and resolved, but to consider how the prior issues keep evolving, influencing the ways in which we view trauma, its origins, and treatment. In addition, we will consider new developments that have occurred over time, such as findings from neuroscience, which have had a bearing on our concepts and interventions. We will read pre-circulated journal articles and book chapters for each study session. Some of these consist of historical reviews, while others are classic or contemporary case studies, in order to learn about the theories and influences on our treatment of patients who have experienced trauma.

The study group will be limited to 25 registrants. Participants should have a basic grasp of psychoanalytic theory and be willing to commit to completing the reading assignments and attending the study group regularly. We look forward to lively and engaging discussions!

PART I (5 sessions, 7.5 CEs)

Part I begins with Freud’s renunciation of the seduction theory of child trauma, how this changed our views of the origins of trauma, and how it influenced the interventions that we use to treat trauma. There were dissenters such as Ferenczi, but mainstream psychoanalysis came to emphasize drives, fantasy, and repression over external events and dissociation. We will explore how analysts recovered memories of patients’ childhood abuse to reconstruct trauma. Psychoanalysts gradually became aware of the devastating effects of neglect, rejection, and cumulative trauma. With the increasing news about, and advocacy for, Vietnam war veterans and childhood victims of sexual abuse, analysts began to acknowledge the external realities that cause PTSD among children and adults.

PART II (7 sessions, 10.5 CEs)

Part II begins with a consideration of unformulated experience, preverbal trauma, and ways of dealing with such experience in treatment. We then explore some major controversies in our field, such as recovered memories, false accusations of abuse, and doubts about the existence of what was then termed “multiple personality disorder.” We will discuss ways to address recovered memories and distinguish between dissociation as a normal defense and the dissociative structuring of the mind. We will explore whether a patient’s issues reflect an inner conflict or a deficit, and repression or dissociation, and how to respond when we are not yet certain about their defenses. We also consider the manifestations and treatment of relational trauma as well as adult-onset trauma.

PART III (7 sessions, 10.5 CEs)

Part III examines how psychoanalysis differs from, and was influenced by, trauma models and body-based models. Some psychoanalytic treatments have begun integrating interventions from somatic treatment models, while others advocate for “plain old therapy.” We will discuss a new subtype of PTSD, complex PTSD, and consider the treatment ramifications. We consider Jungian influences as well as the relational turn in the conceptualization and treatment of trauma. To wrap up, we will discuss whether the term “trauma” has become overgeneralized, and whether there is a substantive difference between Big T and small t trauma.

OBJECTIVES

Part I

1a) Explain how Freud’s renunciation of the seduction theory of child trauma changed how trauma was viewed and treated in psychoanalysis.

1b) Describe Ferenczi’s dissenting view of the origins of child trauma.

2a) Explain why attachment theory was devalued by psychoanalysts and why Ferenczi is considered the forerunner of the interpersonal school of psychoanalysis.

2b) Define Khan’s concept of cumulative trauma.

3a) Explain how psychoanalysts sought to uncover memories in psychoanalysis.

3b) Describe the psychoanalytic process of the reconstruction of trauma.

4a) Identify 2 patient populations and advocacy movements that helped shift psychoanalysis from a fantasy basis to a more reality-based view of the origins of trauma.

4b) Describe some common symptoms and transference-countertransference paradigms seen in adult survivors of sexual abuse.

5a) Identify 5 symptoms that child victims of abuse might evidence.

5b) Explain why adult survivors of incest in childhood show varying patterns of psychopathology.

Part II

6a) Define the term “unformulated experience.”

6b) Describe how babies remember trauma.

7a) List 5 factors that may cloud memories of trauma.

7b) Explain the importance of distinguishing between the event and the trauma, and between the event and psychic reality.

8a) Explain why multiple personality disorder became distanced from the mainstream of contemporary psychoanalytic inquiry.

8b) Compare and contrast repression and dissociation.

9a) Explain the meaning of Bromberg’s concept of “the multiplicity of self.”

9b) Describe salient differences between dissociation as a normal defense and the dissociative structuring of the mind.

10a) Define and distinguish between conflict and deficit, and describe how each is typically addressed in treatment.

10b) Describe the best course of action when the clinician is not certain whether unmentalized or repressed contents predominate in the patient’s mind.

11a) Explain how exposure to parental narcissistic pathology constitutes a cumulative relational trauma and why episodes of mutual patient-clinician dissociation are inevitable in working with these patients.

11b) Explain what is meant by the phrase “living in an airless world” as an intrapsychic response to growing up with extreme parental negation, and the central task of the clinician in working with these patients.

12a) Describe symptoms of massive psychic trauma that occurs in adulthood and explain how this trauma differs from cumulative childhood trauma, including the dissociative processes utilized.

12b) Describe the collapse of the core self in the patient with adult-onset trauma, and ways for the clinician to address this.

Part III

13a) Describe Kernberg’s primary psychoanalytic interventions in treating patients with borderline personality disorder.

13b) Describe how Herman’s trauma model identifies the origins of trauma and primary interventions for treating it.

14a) State van der Kolk’s view of where human trauma is stored and how it is expressed.

14b) State the primary goals of psychotherapy according to Pat Ogden’s Sensorimotor Psychotherapy approach.

15a) State at least 2 aspects of trauma and dissociation that may not be amenable to psychoanalytic conceptualizations and interventions.

15b) Describe a somatically-based intervention that may be useful in a psychoanalytic treatment to assist in holding and containing.

16a) Explain why specialized evidence-based therapies are seldom sufficient to treat the sort of patients we actually see in clinical settings.

16b) Describe some of Jung’s contributions to the understanding and treatment of trauma.

17a) Describe how complex PTSD differs from “core” PTSD, and give some treatment implications.

17b) Describe what mindfulness approaches are, and explain how they might augment a psychoanalytic approach to the treatment of trauma.

18a) State what the relational model of the mind has contributed to the conceptualization and treatment of trauma.

18b) Describe how an understanding of hypnosis could, in turn, foster an increased understanding of dissociation and its manifestations.

19a) State your opinion, supported by rationale from the professional literature, about whether the term “trauma” has been overgeneralized.

19b) State your opinion, supported by the professional literature, about whether there is a substantive difference between Big T trauma and small t trauma.

Facilitators

JoAnn Ponder, PhD, is a psychologist-psychoanalyst who has a private practice in Austin, Texas working with children, adults, couples, and consultees. She completed her psychoanalytic training at the Center for Psychoanalytic Studies in Houston, where she previously served on the faculty. She also completed postgraduate training programs on infant-parent mental health intervention, object relational family and couples therapy, and Jungian sandplay therapy. JoAnn is an active member of the American Psychoanalytic Association, the Society for Psychoanalysis and Psychoanalytic Psychotherapy (APA Division 39), and the International Association for Relational Psychoanalysis and Psychotherapy. She has presented at national and international psychoanalytic conferences and led study groups on topics such as trauma and embodied experience. Her publications include journal articles on sexual victimization, the first mass school shooting in the U.S., and hurricanes on the Gulf Coast, and a book chapter on childhood loss of a parent.

George Bombel, PhD, is a Clinical Psychologist in Houston Methodist's Behavioral Health Program, and a therapist in private practice. He completed his psychoanalytic training at The Austen Riggs Center (Stockbridge, MA), with emphasis on intensive inpatient psychoanalytic psychotherapy, group psychotherapy, systems consultation (Bion/Tavistock), and personality assessment. For almost a decade, he was a senior psychologist at the Menninger Clinic (TMC), where he treated individuals with severe personality disorders, generally stemming from early attachment trauma. This work included (a) assessing how the development of self and object representations were affected by the early trauma, (b) exploring how they eventually came to painfully dominate the individual’s interpersonal world, and importantly, (c) examining how they would emerge in the therapeutic dyad itself. During his time at TMC, he also taught psychoanalytic diagnosis to psychology and social work fellows, and psychiatry residents, with emphasis on this relationship between early trauma and object representations. His publications include co-authored articles on aspects of Rorschach personality assessment, and a co-authored psychiatry textbook chapter on treating professionals-in-crisis with primary personality issues.

Schedule/Syllabus/References

Compiled by JoAnn Ponder, PhD with helpful suggestions from Sheldon Itzkowitz, PhD & Jon Allen, PhD

PART I: From Reality to Fantasy and Back Again

Sep. 13: Early and Conflicting Views of the Origins of Childhood Abuse and Trauma

1) Simon, B. (1992). "Incest—See under Oedipus complex": The history of an error in psychoanalysis. Journal of the American Psychoanalytic Association, 40: 955-988.

2) Ferenczi, S. (1949). Confusion of tongues between the adults and child—(the language of tenderness and passion). International Journal of Psychoanalysis, 30: 225-230.

Oct. 11: Recognition of the Effects of Childhood Neglect and Cumulative Trauma

1) Ferenczi, S. (1929). The unwelcome child and his death-instinct. International Journal of Psychoanalysis, 10: 125-129.

2) Spitz, R. (1945). Hospitalism—An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 1: 53-74.

3) Khan, M. R. (1963). The concept of cumulative trauma. Psychoanalytic Study of the Child, 18: 286-306.

Nov. 8: Psychoanalytic Reconstruction of Trauma

1) Kris, E. (1956). The recovery of childhood memories in psychoanalysis. Psychoanalytic Study of the Child, 11: 54-88.

2) Blum, H. P. (1986). The concept of the reconstruction of trauma. In Rothstein, A., The reconstruction of trauma: Its significance in clinical work, 80: 7-27.

3) Wetzler, S. (1985). The historical truth of psychoanalytic reconstructions. International Journal of Psychoanalysis, 12: 187-197.

Nov. 15: From Drive Theory (Fantasy) to a Reality-Based View of Psychic Trauma and Diagnosis of PTSD

1) Phillips, S. (1991). Trauma and war—A fragment of an analysis with a Vietnam veteran. Psychoanalytic Study of the Child, 46: 147-180.

2) Davies, J. M., & Frawley, M. G. (1991). Dissociative processes and transference-countertransference paradigms in the psychoanalytically oriented treatment of adult survivors of childhood sexual abuse. Psychoanalytic Dialogues, 2: 5-36.

Nov. 29: The Reality of Childhood Trauma

1) Terr, L. C. (1979). Children of Chowchilla—A study of psychic trauma. Psychoanalytic Study of the Child, 34: 547-623.

2) Goodwin, J. (1988). Post-traumatic symptoms in abused children. Journal of Traumatic Stress, 1: 475-488.

PART II: Controversies and Differing Types of Trauma

Dec. 6: Unformulated Experiences of Trauma

1) Stern, D. B. (1983). Unformulated experience —From familiar chaos to creative disorder. Contemporary Psychoanalysis, 19: 71-99.

2) Coates, S. (2016). Can babies remember trauma? Symbolic forms of representation in traumatized infants. Journal of the American Psychoanalytic Association, 64: 751-776.

Dec. 13: Controversies About Recovered Memories

1) Allen, J. G. (1995). The spectrum of accuracy in memories of childhood trauma. Harvard Review of Psychiatry, 3: 84-95.

2) Target, M. (1998). The recovered memories controversy. International Journal of Psychoanalysis, 79: 1015-1028.

Dec. 20: Doubts About the Credibility of MPD (Multiple Personality Disorder)

1) Kluft, R. P. (1992). Discussion: A specialist’s perspective on multiple personality disorder. Psychoanalytic Inquiry, 12: 139-171.

2) Howell, E. F. & Itzkowitz (2016). From trauma-analysis to psycho-analysis and back again. In E. F. Howell & S. Itzkowitz, Eds., The dissociative mind in psychoanalysis: Understanding and working with trauma. Routledge, pp. 20-32.

Jan. 10: Dissociation as Normal Defense Versus the Dissociative Structuring of the Mind

1) Bromberg, P. M. (1996). Standing in the spaces: The multiplicity of self and the psychoanalytic relationship. Contemporary Psychoanalysis, 32: 509-535.

2) Howell, E. F. & Itzkowitz (2016). The everywhereness of trauma and the dissociative structuring of the mind. In E. F. Howell & S. Itzkowitz, Eds., The dissociative mind in psychoanalysis: Understanding and working with trauma. Routledge, pp. 33-43.

Jan. 17: Conflict or Deficit?

1) Sugarman, A. (1995). Psychoanalysis: Treatment of conflict or deficit? Psychoanalytic Psychology, 12: 55-70.

2) Busch, F. N. (2017). A model for integrating actual neurotic or unrepresented states and symbolized aspects of intrapsychic conflict. Psychoanalytic Quarterly, 86:75-108.

Jan. 24: Conceptualizations and Treatment of Adults with a History of Relational Trauma

1) Shengold, L. (1978). Assault on a child’s individuality: A kind of soul murder. Psychoanalytic Quarterly, 47: 419-424.

2) Shaw, D. (2010). Enter ghosts: The loss of intersubjectivity in clinical work with adult children of pathological narcissists. Psychoanalytic Dialogues, 20: 46-59.

3) Stern, S. (2019). Airless worlds: The traumatic sequelae of identification with parental negation. Psychoanalytic Dialogues, 29: 435-450.

Feb. 21: Adult-Onset Trauma Versus Cumulative Trauma

1) Boulanger, G. (2002.) The cost of survival: Psychoanalysis and adult onset trauma. Contemporary Psychoanalysis, 38: 17-44.

2) Boulanger, G. (2002). Wounded by reality: The collapse of the self in adult onset trauma. Contemporary Psychoanalysis, 38: 45-76.

PART III: Differing Conceptualizations of Trauma and Models of Treatment

Mar. 20: Psychoanalytic Approaches Versus Trauma Models

1) Kernberg, O. F. (1976). Technical considerations in the treatment of borderline personality organization. Journal of the American Psychoanalytic Association, 24: 795-829.

2) Lewis, J. L. (1996). Two paradigmatic approaches to borderline patients with a history of trauma: The expressive psychotherapy of Otto Kernberg and the trauma model of Judith Lewis Herman. Journal of Psychotherapy Practice and Research, 5: 1-19.

Apr. 10: Body-Based Approaches to Trauma

1) Van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of post-traumatic stress. Harvard Review of Psychiatry, 1: 253-265.

2) Ogden, P. (2014). “I can see clearly now the rain has gone”: The role of the body in forecasting the future. In Petrucelli, J. (Ed.), Body states: Interpersonal and relational perspectives on the treatment of eating disorders. Routledge, pp. 92-103.

Apr. 17: Integration of Trauma Models with Psychoanalytic Models of Treatment

1) Kluft, R. (2000). The psychoanalytic psychotherapy of dissociative identity disorder in the context of trauma therapy. Psychoanalytic Inquiry, 20: 259-286.

2) Levit, D. (2022). Somatic Experiencing: Enhancing psychoanalytic holding for trauma and catastrophic dissociation - Contending with the flood and the fog. Psychoanalytic Dialogues, 32: 235-252.

Apr. 24: Treating Trauma with Psychotherapy

1) Allen, J. G. (2012). Chapter 5: Plain old therapy. In Restoring mentalizing in attachment relationships: Treating trauma with plain old therapy. American Psychiatric Publishing, pp. 159-215.

2) Kalsched, D. (2016). Jung and dissociation: Complexes, dreams, and the mythopoetic psyche. In E. F. Howell & S. Itzkowitz, Eds., The dissociative mind in psychoanalysis: Understanding and working with trauma. Routledge, pp. 85-96.

May 8: Further Developments in the Conceptualization and Treatment of Trauma

1) Matheson, C. (2016). A new diagnosis of complex Post-traumatic Stress Disorder, PTSD—a window of opportunity for the treatment of patients in the NHS? Psychoanalytic Psychotherapy, 30: 329-344.

2) Fisher, J. (2017) Twenty-five years of trauma treatment: What have we learned? Attachment: New Directions in Relational Psychoanalysis and Psychotherapy, 11: 273-289.

May 15: The Evolution of Relationality in the Conceptualization and Treatment of Trauma

1) Howell, E.F. & Itzkowitz, S. (2022). The unconscionable in the unconscious: The evolution of relationality in the treatment of trauma. In M.J. Dorahy, S.N. Gold, & J.A. O’Neil (Eds.), Dissociation and the dissociative disorders: Past, present, future (2nd Edition) New York: Routledge, pp. 728-745.

2) Kluft, R. P. (2022). A mutual appreciation of differences: My conversation with Philip M. Bromberg. Contemporary Psychoanalysis, 2: 438-460.

May 22: Open Discussion

What is trauma? Has the term been overused/overgeneralized? Is there such a thing as Big T Trauma versus small t trauma?

Study Group Honorees

*Jean M. Goodwin, MD, MPH graduated with an MD from Harvard Medical School in 1971 and a Master of Public Health in epidemiology from UCLA in 1972. She did her first two years of psychiatric residency at Georgetown University Hospitals and finished her residency at the University of New Mexico School of Medicine where she stayed on as faculty directing the psychiatric residency. It was in Albuquerque in the late 1970’s that she began consulting to child protective services and discovered that children’s complaints about sexual abuse were assumed to be fantasies. Correcting this assumption led to three books: Sexual Abuse: Incest Victims and Their Families; Rediscovering Childhood Trauma; and Splintered Reflections: Images of the Body in Trauma (with Reina Attias). Jean worked as a Professor of Psychiatry at Medical College of Wisconsin and at the University of Texas Medical Branch where she retains a clinical appointment. She is board certified in General Psychiatry, Forensic Psychiatry, and Psychoanalysis. Since 1998 she has been in full time private practice in Galveston, Texas. She began psychoanalytic training at the Chicago Psychoanalytic Institute and completed training at the Houston-Galveston Psychoanalytic Institute (now the Center for Psychoanalytic Training) in 1999 where she continued on the faculty and is now a training and supervising analyst. Since 2005 she has taught the standard dissociation course through the International Society for the Study of Trauma and Dissociation (ISSTD), together with other members of the Houston-Galveston Trauma Consortium. She is a fellow of ISSTD and of the American Psychiatric Association. She has published over 100 articles and book chapters, many focused on trauma.

*Jon G. Allen, Ph.D, holds the position of Clinical Professor as a member of the Voluntary Faculty in the Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine in Houston, Texas. He is a member of the honorary faculty at the Center for Psychoanalytic Studies in Houston and the adjunct faculty of the Institute for Spirituality and Health at the Texas Medical Center, also in Houston. After completing postdoctoral training at the psychoanalytically-oriented Menninger Clinic, he remained on staff there, where he taught and supervised fellows and residents; conducted psychotherapy and diagnostic consultations; and led research on clinical outcomes. He and his colleagues developed an intensive inpatient treatment program for trauma, in which he created what became a hospital-wide psychoeducational program on recovering from trauma. Having retired from clinical practice after 40 years at the clinic, he continues to teach, write, and consult with psychotherapists. His books include Trusting in Psychotherapy; Restoring Mentalizing in Attachment Relationships: Treating Trauma with Plain Old Therapy; Mentalizing in Clinical Practice (with Peter Fonagy and Anthony Bateman); Coping with Trauma: From Self-Understanding to Hope; and Coping with Depression: From Catch-22 to Hope, all published by the American Psychiatric Association. Additional books are Mentalizing in the Development and Treatment of Attachment Trauma (Karnac/Routledge) and Traumatic Relationships and Serious Mental Disorders (Wiley).

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