Trauma and the transference‐countertransference: working with the bad object and the wounded self

Abstract

This paper focuses on the transference-countertransference dynamics that manifest in work with those individuals who experienced severe early relational trauma and, in particular, childhood sexual abuse. The literature is surveyed from Davies and Frawley's (1992a) seminal paper through to more current trauma-related and sensorimotor approaches, which deepen our understanding greatly. The rapidly shifting, powerful, conflicting and kaleidoscopic transference-countertransference dynamics are explored in the light of these views and in relation to a lengthy clinical example. The author elucidates the dual-aspect of the traumatic complex, whereby the abuser figure, which is disavowed by the patient, becomes manifest in prosecuting the analyst for the 'wounds' that the analysis evokes. The paper also explores the particular nature of the splitting processes, whereby pressure is put on the analyst to adopt an idealized role, in particular to act as a self-object, in order to enable the patient to safely express and 'be' themselves in an attempt to make up for what was not possible in childhood; the analyst will necessarily fail in this task. In the context of powerful masochisto-sadistic dynamics, the analyst's masochism is likely to be called up in the spirit of caring 'humanity' (another inevitable enactment), which can impede the progress of the analysis if not addressed. The extreme woundedness, intense affect and moral outrage associated with these dynamics are characteristic and compelling. Issues relating to disclosure, enactment and analytic attitude are also discussed.

Eating Disorders and Therapist Emotional Responses

“…Self-harm and dissociative symptoms can increase negative therapist emotional responses such as hostility, disorganization, and inadequacy. These results fully support clinical literature about countertransference reactions with traumatized patients (Davies and Frawley, 1992;Gedo, 2013;Knox, 2013;West, 2013) and suggest that these patients may evoke maladaptive interactions in which traumatic experience has the potential to be reenacted or repaired in the therapeutic relationship (Gabbard, 2009).…”

Understanding the Healing Potential of Ibogaine through a Comparative and Interpretive Phenomenology of the Visionary Experience

“…Such internal states, until integrated, are likely to be unstable and may oscillate around a paranoid representation of the self as victim, the world as persecuting, and ibogaine as rescuing—or flip to an inverse configuration where the self is the “bad” perpetrator and the world is the addict's underserving victim (cf. West ). In both configurations, ibogaine may remain idealized as the rescuer (or in Kleinian terms the “good breast”), which if successfully internalized—by both the literal “ingestion” of the plant‐drug and subsequent “digestion” of the associated experience—may facilitate the integration of “good” and “bad” self‐parts, allowing the recovered addict to see both self and world as it more closely is, undistorted by projection.…”

“…The projected miracle of ibogaine thereby becomes appropriately reclaimed and recognized as the more general “miracle of being”—experienced by, but not identified with, the ego (cf. Eigen ; West ).…”

Working in the borderland: early relational trauma and Fordham's analysis of ‘K’

“…In working with individuals with a borderline personality organization I have become increasingly aware of the primitive responses to early traumatic experience which underlie borderline states of mind; specifically, the so‐called primitive mammalian defences which aim to ensure survival and prevent trauma to the core self – the fight, flight, freeze and collapse responses. I have therefore proposed (West , , in press) that the complex ‘contains’ (is constituted of) not only the trauma‐related internal working models, as Knox () suggests, but also these primitive defences of the core self.…”

“…K's papers contain a powerful sense of taboo against the analyst being anything like his rejecting, annihilating, self‐preoccupied father or his unresponsive, unhearing mother. I see this moral outrage as characteristic of the self's response to the threat of retraumatization: ‘This is wrong and should not happen!’ I have described it before as a moral defence (West , , in press). It is, perhaps, an externalized ‘fight’ version of Kalsched's archetypal defences of the personal spirit, where the individual preemptively attacks themselves to prevent their risking further exposure and traumatization (Kalsched , ); in the situation I am describing the individual attacks the other.…”