14 Aug Transference & Countertransference Reenactments

Transference, Countertransference and reenactment in Therapy by Richard B. Gartner- Director of centre for the study of psychological Trauma and The Sexual Abuse Program New York city. Recurrent themes affecting the transference and countertransference with people who have suffered huge trauma in early childhood, start with the patient’s wariness of the therapist and the dangers involved in intimacy. In addition, dependency, reliance and counter dependent and counter phobic defenses tend to emerge, often-cloaked in overt idealization of the therapist. In this idealization, patients may expect the therapist to be all attentive, nurturing, non-seductive and nonabusing parent who will heal and undo the trauma. All these themes tend to appear in concerns about boundaries, secrecy, control and power and in dicussion of fees, confidentiality, and other issues related to the frame of the treatment.
Behavioral reenactments in treatment allow a patient to communicate previously dissociated and therefore unsymbolised, material to the therapist. By exploring verbally what has been communicated through behavior the therapist and patient initiate a process by which the dissociated material becomes encoded in language, and therefore available for conscious consideration.Behaviors associated with a reenactment in therapy are unconscious messages from the patient to the therapist and to himself about a traumatic past. They represent an attempt to bypass the need for symbolized experience. Reenactments are most likely to occur when the patient has a reduced capacity for self-reflection, another result of being unable to verbalize traumatic experiences that were never encoded when they first occurred, as a result of not have a present witness to their pain. Memories became trapped encased within a wordless world. Incapable of articulating what he has never symbolized verbally, the patent repeats behaviorally or reenacts an aspect of his dissociated trauma.
Such reenactments are crucial disclosures about un-integrated, un-symbolised unformulated experience. Understanding the unconscious communication within a reenactment is often pivotal point in therapy with a traumatised adult, in particular a sexually abused adult.Seen in this light, enactment is a way for the patient to allow himself/herself to be known by co constructing, with the therapist, a means of living out a new, less disabling version of the original trauma. In this co construction, cognitive symbolization of trauma occurs when the trauma is reenacted within a therapeutic relationship, reproducing the original interpersonal context but not leading to the original outcome. Once this happens, dissociated experience is transformed to internal conflict and human relatendness, which are more available for verbal consideration in psychotherapy. By working through reenactments the therapist thus gradually obtains access to the patients various multiple dissociated self-states. The exploration of the reenactment is embedded in the therapeutic relationship. The therapist is both the magnet that draws out the reenactment and the architect of a transitional arena in which the patients experiences of self and other can be reconfigured in more harmonious ways. We rely upon the hope that the therapist and patient together will become enmeshed in complicated reenactments of early unformulated experiences with significant others, that can shed light upon the patients current interpersonal and intrapsychic difficulties by reopening in the therapeutic relationship, prematurely foreclosed areas of experience.
If the reenactment is to be integrated as other than the original trauma, however something essentially different must happen . The relational models of transference and countertransference are reenactments of different aspects of the dissociated relationships involved in victimization by a parent or a caregiver. Many therapists assert that, abusive countertransferential reenactments are an inevitable part of the treatment of sexually abused patients.
Transference – countertransference reenactments are vehicles for communication to the therapist about the internal relational experience of the child as he/she was being abused. As such they are powerful tools but they are also forceful and often coercive catalysts in the therapeutic relationship. Reenactment compels the therapist to experience the patient’s original reactions to abuse, reactions that are dissociated aftermath to a deeply traumatic childhood experience. To heal the patient of the trauma, the therapist must experience that trauma in some way.
The reenactment may be symbolic of the abuse but the feelings engendered in the therapist are very real. Theses may include helplessness, impotence, rage, inadequacy, shame, guilt, idealization, omnipotence, overstimulation, humiliation, torture and fear, all internal states with which the patient is very familiar.
Thus treating patients whose relationships and personalities are organized by dissociation involves a challenge psychological encounter with the trauma that caused the dissociation in the first place. Therapists can easily feel traumatized themselves under such circumstances, yet it is important to remember that neither reenactments nor countertransference reactions to them are necessarily mistakes rather they are unavoidable phases in the treatment of traumatized dissociated patients. It has commonly been noted that the abused patients tend to identify with their abusers and then to be transferentialy abusive to their therapists. In doing this they are repeating with the therapist what happened to them as children. The abuse-victim relational configuration is particularly upsetting work with both patient and therapist because of its ubiquitous intense transference and countertransference enactments.
Trauma Recovery Institute offers unparalleled services and treatment approach. Trauma Recovery Institute offers unique individual and group psychotherapy. We specialise in long-term relational trauma recovery, sexual trauma recovery and early childhood trauma recovery. We also offer specialized group psychotherapy for psychotherapists and psychotherapy students, People struggling with addictions and substance abuse, sexual abuse survivors, people suffering with cancer or recovering from cancer and their family members, Parents exploring the art of conscious parenting and people looking to function in life at a higher level. Trauma recovery Institute offers a very safe supportive space for deep relational work with highly skilled and experienced psychotherapists accredited with Irish Group Psychotherapy Society (IGPS), which holds the highest accreditation standard in Europe. Trauma Recovery Institute uses a highly structured psychotherapeutic approach called Dynamic Psychosocialsomatic Psychotherapy (DPP).

 
Dynamic Psychosocialsomatic Psychotheyapy (DPP)
Dynamic Psychosocialsomatic Psychotherapy (DPP) is a highly structured, once to twice weekly-modified psychodynamic treatment based on the psychoanalytic model of object relations. This approach is also informed by the latest in neuroscience, interpersonal neurobiology and attachment theory. As with traditional psychodynamic psychotherapy relationship takes a central role within the treatment and the exploration of internal relational dyads. Our approach differs in that also central to the treatment is the focus on the transference and countertransference, an awareness of shifting bodily states in the present moment and a focus on the client’s external relationships, emotional life and lifestyle.
Dynamic Psychosocialsomatic Psychotherapy (DPP) is an integrative treatment approach for working with complex trauma, borderline personality organization and dissociation. This treatment approach attempts to address the root causes of trauma-based presentations and fragmentation, seeking to help the client heal early experiences of abandonment, neglect, trauma, and attachment loss, that otherwise tend to play out repetitively and cyclically throughout the lifespan in relationship struggles, illness and addictions. Clients enter a highly structured treatment plan, which is created by client and therapist in the contract setting stage. The Treatment plan is contracted for a fixed period of time and at least one individual or group session weekly.
 

“Talk therapy alone is not enough to address deep rooted trauma that may be stuck in the body, we need also to engage the body in the therapeutic process and engage ourselves as therapists to a complex interrelational therapeutic dyad, right brain to right brain, limbic system to limbic system in order to address and explore trauma that persists in our bodies as adults and influences our adult relationships, thinking and behaviour.”