Category Archives: object relations

>The therapist as an affect overload container

>When working with a traumatised client the therapist acts as a “container for affect overload” (Wilson et. al 2004) to contain the out-of-control effects of trauma re-awakening on the client. This means acting without judgment or shame while continuing to maintain boundaries even as the client is acting out in front of him. Some of the more severe reactions that may be experienced by the clients include traumatic regression, re-enactment and flashbacks. Such abreaction states in a client can seem overwhelming which may leave the therapist feeling helpless. Alternatively, the client may retreat to a “closed dysphoric affect state” where numbness and dissociative states prevail. While in this state, the client may be unreachable and this again could render the therapist feeling shut off and powerless. According to Wilson et. al, while the reenactments of the trauma can be quickly reeneacted in the therapy room, effective work on the trauma cannot be done until it has been effectively understood, accepted and contained.

If the client has reacted with out-of-control reactions, this will be accompanied by shame of the leaking out of these affect overload. The client has to feel that the therapist understands the discomfort at the out-of-control feelings without adding to the shame the client already feels. When the client is sufficiently composed, the task is to piece back what had led to the affect overload. However when the client is closed down and numb, the therapist has to patiently wait and maintain a safe environment which serves to reassure the client. Numbing serves as a defence against affect overload which can take up a lot of the client’s energy to maintain and can only be overcome when the client feels safe and ready. Clients who experience trauma often have lost or never developed any self-soothing mechanisms. \the therapist’s function in calmly holding the therapeutic space and conveying empathy can serve to help the clients develop this ability in themselves.
In addition to these common affects, traumatised clients can experience a fractured sense of identity which can lead to a chaotic state of being. This can lead to a mistrust of the world which is seen as unreliable and this could also include the therapist. As the relationship progresses, there may be points where the need in the client for an idealised object to hold onto may lead to idealisation of the therapist. Conversely disappointment and mistrust of the ability of the therapist to understand can lead to rejection of the therapist. Both patterns may play out in cycles throughout the therapeutic relationship through the transference/countertransference process while the client moves from various points in revaluating the trauma.
The therapist functions as a reparative idealised mother-object for the traumastised client. However this transference may be beset with more negative resonances in its development. In writing about childhood trauma Carpy (1987) speaks of the impulse to blame is present in everyone as it arises from the most primitive psychotic states. In a traumatised client, a sense of grievance has to be maintained in an active state to protect the client from an awareness of actual dependency on the less than ideal object. In the present, any triggers related to the trauma may bring about a fresh accumulation to this feeling of grievance which then may be directed strongly at the therapist.
To work successfully through the trauma, the client has to be into a process of mourning the loss of the idealised object. However, the success and pace of this may be dependent on external circumstances such as historical and societal factors and the internal factors such as the client’s own psychological history.(Garland 1991).  The therapist’s task is to maintain the container for the client’s affect breakthrough and working out during this process while facilitating the development of de-alienating the past from the present.  In doing so, the effects on the therapist experiencing with the client the unbrearable effects of remembering and reenactment may also prove unbearable to the therapist own ego.
References
Carpy, D. (1987). Fantasy and reality in childhood trauma: who’s to blame?’. Tavistock Paper No. 64B.
Garland, C. (2004). Understanding trauma: a psychoanalytical approach. Karnac Books.
Wilson, J. P., Friedman, M. J., & Lindy, J. D. (2004). Treating Psychological Trauma and Ptsd (1st ed.). Guilford Press.