Treating The Adult Survivor Of Childhood Sexual Abuse: A Psychoanalytic Perspective
Entering the tumultuous, dissociated world of the adult survivor of childhood sexual abuse presents an intimidating challenge for clinicians. But as the authors of this innovative book argue, therapists must be willing and able to work within the powerful and rapidly shifting relational paradigms of transference and countertransference commonly found in treatment of these patients. Such dual roles enacted in treatment include the unseeing, uninvolved parent and the unseen, neglected child; the sadistic abuser and the helpless, enraged victim; the idealized rescuer and the entitled child; and the seducer and the seduced. This is the first model for treatment of adult survivors of childhood sexual abuse that takes advantage of a relational approach and that integrates psychoanalytic thinking with the latest findings from the literature on psychological trauma and sexual abuse. Diverging from a more classical perspective, the authors view dissociation as the means by which a person adapts to and expresses traumatogenic material and by which such patients defend against traumatic memories, affects, and fantasy elaborations emerging into consciousness. The authors also detail how dissociation helps organize the patient's personality and presentation of self. Richly illustrated case examples bring to life the authors' treatment model and show how clinicians can work through the relational paradigms between patient and therapist and, ultimately, reach the core of the patient's deeply buried experiences of self and other.
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CHAPTER 1 Trauma and Childhood Sexual Abuse in Psychoanalysis
CHAPTER 2 LongTerm Sequelae and Diagnosis of Childhood Sexual Abuse
CHAPTER 3 An Integrative Model of Childhood Sexual Abuse
CHAPTER 4 Dissociation
CHAPTER 5 Disclosure and the Recovery of Memories
CHAPTER 6 Reality Testing and the Question of Validation
CHAPTER 7 Exposure to Danger the Erotization of Fear and Compulsive Selfabuse
CHAPTER 8 The Impact of Trauma on Transference and Countertransference
abused child adult patient adult survivors affective analyst arousal aspects attempt aware become behavior Belinda body memories borderline borderline personality disorder capacity child persona childhood abuse childhood sexual abuse clini clinical clinician consciousness countertransferential defenses disclosure disorganization dissociated early emergence emotional enactment ence encoded evoke experience experienced fantasy father fear feel ﬁrst ﬂashbacks Freud functioning hyperarousal identiﬁcation incest integration intense interpersonal interpretation introject intrusive Kolk ment mother multiple personality disorder object relationship object representations occur oedipal opioid organization overstimulation pain paradigms parent patient and therapist projective identification psychic psychoanalytic psychological psychological trauma PTSD rage reactions reenactment regression relational response riences sadistic sadomasochistic seduction theory self-abusive session sexual trauma shift signiﬁcant somatic speciﬁc split stress struggle survivors of childhood symbolic symptoms terror thera therapy tient tion transference and countertransference transference-countertransference transferential traumatic events traumatic memories treatment ultimately unconscious unsymbolized verbal victim vivors Winnicott