Abstract
Survivors of extreme violence can be difficult to engage in treatment. Often this is caused by a sense of isolation drawn from the belief that no one who has not shared their experience can comprehend it. The only others who know what they know are those who have died of the violence, fellow survivors and the perpetrators. The clinician attempting to treat such patients may be placed in a dilemma: how to convey the capacity to know terrible things without being destroyed by the survivor, while at the same time not conveying that one is dangerous oneself. This paper suggests a method of utilizing unconscious aggressive fantasy to access the capacity to convey to the survivor that it is possible to hear, understand and contain violent experience. Case illustrations indicate how such capacity might be conveyed, so that a treatment alliance can begin.
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Notes
The issue of the constitutional and environmental factors that have made some people resilient, while others are not, is the subject of its own literature and beyond the scope of this paper.
Klein and her followers spell fantasy with a “ph” to indicate that it is unconscious.
Intersubjective theory offers new insights and ways of looking at many of the issues discussed here and will be discussed in detail in a forthcoming paper.
The term screen memory in psychoanalysis refers to visual representations of events from childhood that may be less than precise, and like dreams in that they symbolize something complex and important in this case, the snake in the shoe, representing the entry of danger into ordinary life. Freud elaborates this in “Remembering, repeating and working through” (1914).
This called for intensive, often painful, and continuous scrutiny of my own countertransference throughout the life of the case.
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Bragin, M. Knowing Terrible Things: Engaging Survivors of Extreme Violence in Treatment. Clin Soc Work J 35, 229–236 (2007). https://doi.org/10.1007/s10615-007-0099-z
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DOI: https://doi.org/10.1007/s10615-007-0099-z