Object Relations Therapy of Physical and Sexual Trauma (Library of Object Relations)

Rising above the polemics surrounding sexual and physical abuse. David and Jill Savege Scharff bring a relational perspective to the integration of psychoanalytic and trauma theories in order to understand the effects of overwhelming physical or psychological trauma, including sexual abuse, injury, and birth defect.
The Scharffs draw from their object relations therapy with individuals, families, and couples recovering from trauma an abundance of relevant clinical examples described in their characteristically personal and vivid style. Their treatment approach, influenced by Fairbairn, Klein, and Winnicott, is respectful of the patient's experience. They advise avoiding premature interpretations that impose their own reality on patients because this traumatizes them just as their abuser did. In order to work well with these traumatized people, the clinician must be able to tolerate ambiguity and sustain longterm therapy, for it takes the patience of waiting and wondering to recover deeply repressed memories, explore them thoroughly, and evaluate their meaning and importance for the patient. The Scharffs' demonstration of clinical processes helps therapists contain their own countertransference to trauma so as to be fully present with their clients and consistently able to confront abuse patterns in society. The object relations approach not only deals with trauma's impact on the individual but views it in its cultural and interpersonal context as well. Society alternately emphasizes and ignores trauma so that an encapsulated traumatic experience festers until the next eruption, just as dissociative defenses segmentally protect and exaggerate traumatic experience in the individual case.
The Scharffs review Kramer's Mahlerian approach, McDougall's insights into the silence of the psyche and the words of the soma, and Anzieu's elaboration of the body ego. They resuscitate Freud's seduction hypothesis and the traumatic basis of the repetition compulsion. They compare and contrast the concepts of repression and dissociation. Moving from there to develop an object relations perspective, they draw on Winnicott's concepts of the psychosomatic partnership, the environmental and object mothers, and the potential space: Klein's contributions of the infusion of aggression and death anxiety into developmentally critical relationships: Fairbairn's view of the endopsychic situation with reference to his early unpublished papers on childhood sexual abuse that presage his later theory building; and their own studies of couple and family dynamics.
Classical psychoanalysis introduced theories of trauma but later devoted itself to the study of infantile trauma that caused conflict-based neurosis rather than actual neurosis. Modern trauma theory on dissociative phenomena and post-traumatic stress disorder studied after combat, the Holocaust, and natural disasters comes from the fields of veteran and child developmental psychiatry, hypnotism, and multiple personality research. Trauma theory and psychoanalysis have been on separate tracks.
Object relations theory offers a bridge between individual and societal experiences of trauma and prepares the way for a less dissociated response to trauma issues among the mental health professions and their psychotherapy literature.

David E. Scharff, M.D., is a Co-Director of the International Institute of Object Relations Therapy.