An exploration of the role of the therapeutic relationship in the treatment of complex trauma : a psychodynamic-phenomenological case study

[摘要] ENGLISH ABSTRACT: Sometimes it is not entirely clear why certain clients improve. Critical clinical ingredientswhich may have led to this improvement or recovery are hard to identify and describeand decisions about therapeutic interventions often appear to be intuitive rather thanfollowing a strict modus operandi. This is true particularly if refractory or chronic casesstart to improve and maintain this improvement.Refractory and chronic cases are the norm amongst clients suffering from complex,chronic trauma, also termed complex PTSD. Complex trauma is a multi-facetted, oftenmulti-layered condition. It includes damage to the individuals' self and to her ability tointerpersonally relate, additionally to the DSM IV TR diagnosis of PTSD. Due to themanifold unique presentations of the syndrome, particular after long-term exposure andconfounded by co-morbidities and rigid defenses, it is difficult to diagnose and treat thecondition effectively.This study focuses on one such complex trauma case with an initially very poorprognosis, which improved significantly over a treatment period of eighteen months. Thetherapeutic intervention and progression of the case are closely examined, using thephenomenological method, with the aim of discerning and describing themes andpatterns that could assist in understanding the healing process of this client duringtherapy and to promote further research in this regard.Integration of psychodynamic conceptualization, particularly self-psychology andintersubjectivity, and person-centered, supportive therapeutic methods were foundhelpful in the treatment of this case. The common factor to these approaches is theiremphasis on the relationship between client and therapist. This therapeutic relationshipwas concluded to be the determining factor in the successful treatment of this client,because it addressed damage to self and to her relational ability.The research took place concurrent to the therapy with the client and this process led toa degree of integration on three levels: integration of the client's self and interpersonalfunctioning, integration of the abovementioned approaches to form a creative synthesis in the therapist's individual approach to trauma clients, and the integration of aphenomenological methodology with a psychodynamically conceptualized case study.It is noted that the theoretical explorations and therapeutic procedures described andexplored in this study are but one way to conceptualize and treat complex trauma.

[发布机构] Stellenbosch University