Object Relations in Severe Trauma: Psychotherapy of the Sexually Abused Child

202 Pages·2004·5.38 MB·English

by  Stephen Prior

OBJECT RELATIONS
IN SEVERE TRAUMA

OBJECT
RELATIONS IN
SEVERE TRAUMA
Psychotherapy of the
Sexually Abused Child
STEPHEN PRIOR, PH.D., PSy.D.
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Lanham· Boulder· New York· Toronto· Oxford
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Published in the United States of America
by Rowman & Littlefield Publishers, Inc.
A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
www.rowmanlittlefield.com
POBox 317, Oxford, OX2 9RU, UK
Copyright © 1996 by Stephen Prior
First Rowman & Littlefield Edition 2004
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of the publisher.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
Prior, Stephen.
Object relations in severe trauma: psychotherapy of the
sexually abused child / by Stephen Prior.
p. cm.
Includes bibliographical references and index.
1. Sexually abused children-Rehabilitation. 2. Sexually abused
children-Mental health. 3. Sexually abused children-case studies.
4. Object relations (Psychoanalysis). 1. Title.
RJ507.S49P75 1996
618.92'85836-dc20 95-32752
ISBN 978-0-7657-0018-6
ISBN 0-7657-0018-2 (pbk.: alk. paper)
Printed in the United States of America
eN
The paper used in this publication meets the minimum requirements of American
National Standard for Information Sciences-Permanence of Paper for Printed Library
Materials, ANSIINISO Z39.48-1992.
CONTENTS
Preface vii
Aclmowledgtnents xi
1 Introduction 1
2 Trauma and Tragedy 17
Joey 20
Fred 23
3 On the Absence of an Adequate Theory 29
The Conceptual Setting 31
Borderline Children 33
The Changing Conceptual Framework 42
Attempts at Integration 51
vi Contents
4 Relational Dilemmas of Abused Children 59
Relentless Reliving
of Victim-Victimizer Experiences 62
Identification with the Aggressor 64
Perverse Object Contact 68
Self-Blame 70
Possession 73
5 Internalized Models of Relationship 79
Psychic Structure 82
Masochism, Perversion, and the Need
for Relatedness 84
Attachment Theory's Perspective
on Internalized Object Relations 88
On the Function of Negative Introjects
in the Psyche 93
Theoretical Summary 104
6 Where Is Trauma in Traditional Theory? 107
7 The Dilemma of Therapy
and the Uses of Violence 125
8 A Case Study 139
9 Summary 165
Appendix: Contraindications 171
References 175
Index 185
PREFACE
This book outlines an object relational theory of the
consequences of the sexual traumatization of children.
It is based on the intensive psychotherapeutic treatment
of seriously disturbed boys who had suffered multiple
forms of neglect and abuse. To understand the suffer
ing of these children and to create forms of treatment
suited to them, I found that I had to develop theory as
I went along, for there were no existing conceptual
izations that explained the distress of these children or
their treatment. Using object relations theory, I have
attempted to characterize the ways in which neglect and
abuse distort fundamental needs and psychic structures
in the child.
What I present is clinical theory. By this I mean
theory in which conceptualization and therapeutic
viii Preface
practice are integrated in such a way that each explains
and elaborates the other. The ideas and methods
evolved together, and their joint presentation illumi
nates more, I believe, than one without the other. The
case material is presented in some detail, to reveal the
nature of the treatment process and the fundamental
transference issues. The theory is nonetheless quite
comprehensive. Based in part on the work of W. R. D.
Fairbairn, Bernhard Berliner, and Rudolf Ekstein, it
analyzes the psychological response to trauma in terms
of the repetition of abusive patterns of relationship,
identification with the aggressor, self-blame, and the
seeking of object contact through sexuality or violence.
This scope makes the theory applicable to a variety of
treatment situations, such as the psychotherapy of
adults who were abused as children. The overall per
spective may be of value in other contexts as well, such
as group and family treatment, milieu therapy, case
management, and forensics.
As the integration of the concepts and methods
described in this book took shape, it began to reveal
why both psychodynamic and trauma-oriented theories
have had difficulty conceptualizing and treating the
psychological consequences of overt trauma. Psycho
dynamic theory has seemed unable to give a substan
tive causal role to overt events and relationships and
has had difficulty conceptualizing the impact of abuse.
Trauma theories have focused on external events to
such an extent that the scope and depth of psychic in
jury contingent on psychological trauma is often not
fully appreciated or conceptualized. Articulation of the
difficulties within existing theories clarifies the propos
als I have made and will, I hope, lead to further advances
Preface ix
in the treatment of those who have suffered interper
sonal trauma.
I have attempted to synthesize these various consid
erations in order to present a coherent perspective on
sexual traumatization in children and its treatment.
Theory, practice, and metapsychological reflection
must, I believe, evolve together-in part because we
know so little in each domain. I hope that this book
weaves these strands together in such a way that greater
clarity is brought to each area. I also hope that my ef
forts might inspire others to attempt this kind of inte
grative venture.