Other Psychodynamic Approaches and Techniques

Judith Chertoff (1998) proposes treatment of PTSD from an ego psychology perspective. She defines the ego as "a complex dynamic system of internal, and often unconscious, defenses and function that mediate between the physiological and emotional needs of the self, such as food, nurturing, or erotic gratification, and the demands of the external world" (p. 37). Practitioners from the ego psychology perspective work from a foundation in Freud's structural model (ego, id, and superego) and view trauma as an external event that overwhelms the ego's defenses and results in regression.

Treatment begins with a specific psychodynamic-oriented assessment that examines current functioning, past treatment, early development, relationships, and ego functioning. This may take several sessions. Early on, the therapist attempts to understand the meaning of the trauma for the patient, with specific reference to his or her developmental history. Treatment then focuses on helping the patient see the unconscious meaning of the trauma while taking care not to overwhelm his or her current ego defenses. The tact, dosage, and timing of interpretations are critical issues when attempting to uncover the unconscious without overwhelming the patient.

Marshall, Yehuda, and Bone (2000) suggest that psychodynamic treatment of PTSD should focus on facilitating the resumption of the patient's stalled attempt at processing the event. They state that psychodynamic therapy helps,

. . . by constructing a verbal narrative of the experience and exploring its associated meaning. Psychotherapy consists of reconstructing the event, exploring the patient's associations, and encouraging him or her to identify and express the patient's associations, and encouraging him or her to identify and express these beliefs and emotions. (p. 356)

In a model from Jacob Lindy (1996), trauma treatment focuses on interpretation of symptoms, memory reconstruction, and insight. He provides a summary of the technical principles of his approach as follows:

1. Trauma reconstructions should occur when intrusive rather than numbing aspects of PTSD are present.

2. Under ideal circumstances, the alliance should be strong and the general transference positive; the intrusion should be limited and should be occurring within the context of a generally improving clinical condition.

3. However, when the therapist is faced with a rapidly deteriorating clinical situation in which there is a significant negative component to the transference, reconstruction of trauma can provide a new temporary structure around which ego functions can be consolidated rather than fragmented and an alliance has the opportunity to develop.

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