1 Life as an Experience of Ambivalence: good & bad Most manage with more or less support Professional Intervention - on Request Traumatic Event Intervention 2 3 1
Social Networks Family Networks Internal Resources 4 Breakdown of Capacity to Manage Mobilisation of own Resources in a time-limited Intervention Long-term Therapy 5 Symptoms Overwhelming Incapacitating Cannot be managed Psychically Cannot be contained in the Mind through Thought Bion (1967) A Breakdown in the capacity to transform beta into alpha elements. Klein (1929a, 1945) Mind is an internal world. Populated from the beginning of life, via uc phantasies, internal objects. IO IO {benign & helpful or malevolent & dangerous} All events are, in phantasy, felt to be caused either by good or bad objects. Internal Experience of Trauma: Experience of being abandoned by loving good internal objects which contain - left to the mercy of hateful and hating objects In a case of real external disaster: This Protection failed - which was expected from the good object 6 2
Consultation Experience of being understood Good experience of Containment Via Interventions begin to re-esablish an internal good object, necessary for healthy psychic functioning 7 Client's Expectations Come to Trauma Unit Not wanting Pt Looking for help with overwhelming external event Restore to 'how things were before' It is not 'helpful' for them to be 'assessed' or offer a long term intervention The consultation is an assessment and a therapeutic intervention What we find External Event Meaning of it Aftermath 8 Support To be able to begin to think about what has happend to him from this other perspective Not relinquish the wish to 'recover' - deny How Not structured - Not providing directions and themes Therapist follows rather then lead Allow the emergence of transference and CT Maybe further Pt or not. 9 3
The First Session The Second Session The Third Session The Fourth Meeting Intro Oil on Fire Symptoms of PTSD 10 To England from Ireland - early 20s - Now > 40 Pleasant appearance - overwhelmed by attitude of utter despair and defeat Probation Officer - reached top of his field 3 y ago I prison hospital, while talking to a client, attacked from behind Beaten in head & face, assailant stood on his neck. black out Physical pain - die Several minutes before help came. 11 Vist by 2 staff Should not say exactly what happened - say another version They threatened him Hearing 2 Acted as indicated - subject of disciplinary hearing Demotion Outcome: 2 Staff subject of disciplinary investigation Mr A was exonerated 12 4
Symptoms of PTSD Despite acquittal - referred to Trauma Unit. "Life has lost meaning", Loss of optimism Not working at all Fear of going outside Chronic Anxiety Nightmares Flashbacks Marriage Difficult Loss of self esteem 13 14 15 5
16 17 For some 4 consultations is enough - they do not want/need more Many who go on for more do so not because of the trauma 4 Session: Disengage from central preoccupation with the trauma itself Reconnect with past life and personality and disowned aspects of the self Especially destructiveness Developing the Capacity to Formulate and Think (What has happened and continues to happen & contain it within the mind) 18 6