Trauma-centered psychoanalysis: transforming experiences of unbearable uncertainty

Ann N Y Acad Sci. 2009 Apr;1159:51-62. doi: 10.1111/j.1749-6632.2009.04350.x.


By destroying the certainties that pattern psychological life, trauma plunges a relational system into chaos and exposes its victims to experiences of unbearable uncertainty. When viewed from this perspective, trauma regains its original position at the heart of psychoanalysis. To show how this conceptualization grows out of and improves upon her earlier writings, the author traces the evolution of three ideas that have informed her work for over 20 years: (1) trauma is relational, (2) trauma is a complex phenomenon involving both a shattering experience and efforts at restoration, and (3) trauma goes hand in hand with dissociation. The chapter focuses on ways in which the systemic transformation of experiences of existential uncertainty affects posttraumatic life. Special attention is paid to reductions of complexity by means of relational patterns involving denials of sameness and difference and the emergence of rigid dualities. Insofar as analysts are no more strangers to trauma than are their patients, these patterns often come to organize treatment. An illustrative clinical example describes the treatment of a woman who was severely traumatized by incestuous abuse and emotional abandonment in early life. A crisis in the analytic relationship arose when the patient's pattern of relating to men revived painful memories of trauma in the author's own life. The chapter concludes with a discussion of analytic treatment as a "a tyranny of hope" and the bilateral nature of healing.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Dissociative Disorders / psychology
  • Female
  • Humans
  • Male
  • Professional-Patient Relations
  • Psychoanalysis / methods*
  • Self Psychology
  • Wounds and Injuries / psychology