Journal of Traumatic Stress

, Volume 2, Issue 3, pp 289–304 | Cite as

Differentiating intervention strategies for primary and secondary trauma in post-traumatic stress disorder: The example of Vietnam veterans

  • Donald R. Catherall
Article

Abstract

A model of treatment of PTSD is presented. Two central psychological issues are addressed: (1) the conflict between ego forces oriented toward recalling and assimilating the traumatic material (thereby achieving ego integration) versus ego forces oriented toward repressing and avoiding the reexperience of the trauma (thereby defending against ego disintegration); and (2) the loss of self-cohesion which results from the breakdown between the trauma survivor's self and his social milieu. Clinicians are advised to use two different theoretical orientations (ego psychological and self psychological) in treating these two basic issues. The concepts of primary and secondary trauma refer to the initial traumatic experience and the subsequent breakdown in the relationship between the survivor and his social environment and are offered as tools for distinguishing which issue is uppermost in the patient's material at any given time.

Key words

PTSD treatment Vietnam veterans integrative treatment model 

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References

  1. Catherall, D. R. (1986). The support system and amelioration of PTSD in Vietnam veterans.Psychotherapy 23(3): 472–482.Google Scholar
  2. DeFazio, V. J. (1984). Psychoanalytic psychotherapy and the Vietnam veteran. In Schwartz, H. J. (ed.),Psychotherapy of the Combat Veteran Spectrum Publications, New York.Google Scholar
  3. Dermatis, H., and Kadushin, C. (1986). Is the Vietnam generation politically alienated? In Boulanger, G., and Kadushin, C. (eds.),The Vietnam Veteran Redefined: Fact and Fiction Lawrence Erlbaum Associates, Hillsdale, N.J.Google Scholar
  4. Egendorf, A. (1982). The postwar healing of Vietnam veterans: Recent research.J. Hosp. Commun. Psychiat. 33(11): 901–908.Google Scholar
  5. Erikson, E. H. (1968).Identity, Youth and Crisis Norton, New York.Google Scholar
  6. Figley, C. R. (1978).Stress Disorders among Vietnam Veterans Brunner/Mazel, New York.Google Scholar
  7. Figley, C. R. (1983). Catastrophes: An overview of family reactions. In Figley, C. R., and McCubbin, H. I. (eds.),Stress and the family, Volume II: Coping with Catastrophe Brunner/Mazel, New York.Google Scholar
  8. Furst, S. (ed.) (1967).Psychic Trauma Basic Books, New York.Google Scholar
  9. Greenson, R. R. (1965). The working alliance and the transference neurosis.Psychoanal. Quart. 34: 155–181.Google Scholar
  10. Haley, S. A. (1978). Treatment implications of post-combat stress response syndromes for mental health professionals. In Figley, C. (ed.),Stress Disorders among Vietnam Veterans Brunner/Mazel, New York.Google Scholar
  11. Jung, C. G. (1928).Contributions to Analytical Psychology Routledge and Kagen Paul, London.Google Scholar
  12. Kardiner, A. (1941).The Traumatic Neurosis of War Hoeber, New York.Google Scholar
  13. Keane, T., and Fairbank, J. (1983). Survey analysis of combat-related stress disorders in Vietnam veterans.A. J. Psychiat. 140: 348–350.Google Scholar
  14. Kohut, H. (1971).The Analysis of the Self International Universities Press, New York.Google Scholar
  15. Kohut, H. (1972). Thoughts on narcissism and narcissistic rage.The Psychoanalytic Study of the Child, Vol. 27 Quadrangle, New York, pp. 360–400.Google Scholar
  16. Kohut, H. (1977).The Restoration of the Self International Universities Press, New York.Google Scholar
  17. Kohut, H. (1984).How Does Analysis Cure The University of Chicago Press, Chicago.Google Scholar
  18. Kohut, H., and Wolf, E. (1978). The disorders of the self and their treatment: An outline.Int. J. Psychoanal. 59: 413–425.Google Scholar
  19. Lifton, R. J. (1973).Home from the War Simon and Schuster, New York.Google Scholar
  20. Lindy, J. D. (1985). The trauma membrane and other clinical concepts derived from psychotherapeutic work with survivors of natural disasters.Psychiat. Annu. 15(3): 153–160.Google Scholar
  21. Lindy, J. D. (1986). An outline for the psychoanalytic psychotherapy of post traumatic stress disorder. In Figley C. R. (ed.),Trauma and Its Wake II: Traumatic Stress Theory, Research, and Intervention Brunner/Mazel, New York.Google Scholar
  22. Lindy, J. D., Green, B. L., Grace, M. C., MacLeod, J. A., and Spitz, L. (1988).Vietnam: A Casebook Brunner/Mazel, New York.Google Scholar
  23. Lipkin, J. O., Parson, E. R., Blank, A. S., and Smith, J. (1982). Vietnam veterans and post-traumatic stress disorder.Hosp. Commun. Psychiat. 33: 908–912.Google Scholar
  24. MacPherson, M. (1984).Long Time Passing: Vietnam and the Haunted Generation New American Library, New York.Google Scholar
  25. Moses, R., and Cohen, I. (1984). Understanding and treatment of combat neurosis: The Israeli experience. In Schwartz H. J. (ed.),Psychotherapy of the Combat Veteran Spectrum Publications, New York.Google Scholar
  26. Parson, E. R. (1984). The reparation of the self: Clinical and theoretical dimensions in the treatment of Vietnam combat veterans.J. Contem. Psychother. 14(1): 4–56.Google Scholar
  27. Polner, M. (1971).No Victory Parades Holt, Rinehart and Winston, New York.Google Scholar
  28. Shapiro, R. B. (1984). Transference, countertransference, and the Vietnam veteran. In Schwartz, H. J. (ed.),Psychotherapy of the Combat Veteran Spectrum Publications, New York.Google Scholar
  29. Solnit, A. J., and Kris, M. (1967). Trauma and infantile experiences. In Furst, S. (ed.),Psychic Trauma Basic Books, New York.Google Scholar
  30. Symonds, M. (1980). The “second injury” to victims.Evaluation and Change, Special Issue, 36–38.Google Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Donald R. Catherall
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesNorthwestern University Medical SchoolChicago

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