Trauma and psychic wounds: the function of the therapeutic relationship
The word "trauma" comes from the Greek τραῦμα, which means < >, < >. In organic medicine it indicates a tissue injury. As early as 1920, Freud used the term in a metaphorical sense to emphasize the fact that the mind can be pierced and wound from events.
In this sense the trauma it is an attack on thought that cools and blocks emotions, placing the individual in front of a feeling of total impotence.
Consequently, the consolidated way of living one's existence is shattered, the preconceived beliefs and mental structures collapse, which reflected a stable "defensive organization".
Losses of any kind imply a mourning and change it represents its first tangible sign. Trauma on the one hand can damage the psychic balance, on the other it requires the mental work to face, manage, contain and negotiate traumatic anxiety.
Among the most common trauma, which can be experienced directly or indirectly, we find:
- physical, verbal, sexual assaults;
- natural disasters (earthquakes, floods, etc.) or man-made (conflicts, wars, collapses of structures, buildings, etc.);
- road accidents, serious accidents, etc .;
- bereavements, separations, abandonments, etc .;
- domestic violence, abuse, psychological violence perpetrated over time.
What are the characteristics of trauma?
- Unpredictability
- uncontrollability
- indecipherable
These three characteristics do not allow the individual to decode at the beginning what happens; see you submerged without being able to defend themselves.
The combination of different factors such as the nature of the event, the biological moment of the individual's life cycle, the defensive peculiarities, the presence or absence of environmental and relational support factors, are crucial in subjects exposed to trauma, with possible acute or chronic psychological consequences.
The time of waiting: traumatic emotions and memories
The time of the trauma repeats itself and always presents itself as itself. It is a time that in repetition sees the return of a fragment of reality that has not been elaborated symbolically. The traumatized subject remained caged in the memory of past, of what he was, of what he knew. It no longer experiences a sequence of moments, but the recovery of a non-existent time that tries at all costs to revive.
Trauma is therefore an emotional experience that can upset the relationship with time, with space and with reality.
Traumatic memories can resurface to consciousness in the form of flashback o nightmares, can burst intensely, suddenly, expressing themselves in the form of fear e anxiety attacks, unmotivated outbursts of anger.
Traumatic contents continue to exert a significant influence in the life of the individual, who will put in place forms of defensive avoidance towards potential traumatic experiences and will maintain a controlling attitude.
The trauma therefore opens up a wound he has profound effects on the mind, on the body e on interpersonal relationships.
The function of the therapeutic relationship
THElistening of a traumatized patient is often a lot distressing. Listening without being overwhelmed by the intensity of the experience of traumatized patients is extremely difficult.
Theoretical training, supervision and personal analysis offer the psychotherapist the "possibility of becoming aware of this influence" (Gilliéron, 1994).
In this way we can offer help and not be overwhelmed by ourselves, being open enough to the experience of the survivor really considering their state, but firm enough not to be unbalanced by it. All true processes of care they generate in the encounter and through the report.
Il role of the therapist should be to help the patient recover lost functions by trying to create a new balance attuned to real needs, adapting to socio-cultural changes, somatic symptoms, traumatism.
Il role of the therapist should be to help the patient recover lost functions by trying to create a new balance attuned to real needs, adapting to socio-cultural changes, somatic symptoms, traumatism.
It is not a question of focusing exclusively on the traumatic event but of considering the progressive unfolding of the relationship between patient and therapist. This leads to containment: a tiring process because it implies a reworking of the traumatic experience with all its emotional impact and all the sense of guilt, fear and hatred triggered by the original event, with someone able to offer support that evokes what the mother unconsciously he offered to his child when he was invaded by anguish.
The frustration of the words that are not uttered, the difficulty of pausing in the very long silences to be able to grasp their dense meaning, being able to recover the ability to be in a waiting position, between patience and safety, are the crucial elements of the sessions with many traumatized patients .
The ability of the person to effectively overcome the trauma depends on the level of maturity achieved by his personality and the ability to cope with the changes and conflicts that one experiences, the ability to process them by integrating them into one's psychism through dreams and communication.
Rita Fiorentino
* Notes on the author:
Rita Fiorentino, Clinical Psychologist, Psychodynamic Psychotherapist with Psychoanalytic Orientation, Family Mediator, Head of Operational Coordination of Psy + Onlus. Since 2013 she has been collaborating as a psychologist in the School Area and is part of the team of psychotherapists of the Clinical Psychological Counseling Center. She gained experience as a psychologist and coordinator of intercultural projects, school psychology and emergency psychology. He currently works within the “Pe.R.Co.rrere” project aimed at the populations affected by the earthquake in Central Italy and carries out psychotherapy activities with children, adolescents, adults, couples and families.
psychotherapy, trauma, PTSD, therapeutic relationship, therapist
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