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

Manfroni, Antje (2007-12)

Thesis (MA)--University of Stellenbosch, 2008.

Thesis

ENGLISH ABSTRACT: Sometimes it is not entirely clear why certain clients improve. Critical clinical ingredients which may have led to this improvement or recovery are hard to identify and describe and decisions about therapeutic interventions often appear to be intuitive rather than following a strict modus operandi. This is true particularly if refractory or chronic cases start 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, often multi-layered condition. It includes damage to the individuals’ self and to her ability to interpersonally relate, additionally to the DSM IV TR diagnosis of PTSD. Due to the manifold unique presentations of the syndrome, particular after long-term exposure and confounded by co-morbidities and rigid defenses, it is difficult to diagnose and treat the condition effectively. This study focuses on one such complex trauma case with an initially very poor prognosis, which improved significantly over a treatment period of eighteen months. The therapeutic intervention and progression of the case are closely examined, using the phenomenological method, with the aim of discerning and describing themes and patterns that could assist in understanding the healing process of this client during therapy and to promote further research in this regard. Integration of psychodynamic conceptualization, particularly self-psychology and intersubjectivity, and person-centered, supportive therapeutic methods were found helpful in the treatment of this case. The common factor to these approaches is their emphasis on the relationship between client and therapist. This therapeutic relationship was 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 to a degree of integration on three levels: integration of the client’s self and interpersonal functioning, integration of the abovementioned approaches to form a creative synthesis in the therapist’s individual approach to trauma clients, and the integration of a phenomenological methodology with a psychodynamically conceptualized case study. It is noted that the theoretical explorations and therapeutic procedures described and explored in this study are but one way to conceptualize and treat complex trauma.

AFRIKAANSE OPSOMMING: Somtyds is dit nie duidelik hoekom sekere kliente se toestand verbeter nie. Dit is soms moeilik om die kritiese bestanddele wat tot hierdie verbetering of herstel gelei het, te identifiseer en te beskryf. Besluite met betrekking op therapeutiese intervensies blyk dikwels eerder intuitief, as die gevolg van ‘n streng modus operandi, te wees. Dit is spesifiek die geval wanneer chroniese en hardnekkige gevalle begin om te verbeter en die verbetering volhou. Hardnekkige en chroniese gevalle is nie ongewoon by kliente wat aan komplekse, chroniese trauma - ook genoem komplekse post-traumatiese stressversteuring - ly nie. Komplekse trauma is ‘n multi-fasettige toestand, wat dikwels ‘n verskeidenheid lae of vlakke van versteuring opwys. Dit sluit skade tot die individu se self in, asook verlies aan vaardigheid om met ander mense suksesvolle interpersoonlike verhoudings op te bou. Hierdie kenmerke is toevoegings tot die diagnose van die sindroom soos uitgevoer in die DSM IV TR. As gevolg van die meervoudige unieke voorstellings van die sindroom - in besonder na langtermyn blootstelling en verwarring deur co-ongesteldhede en rigiede verdedigings - is dit moeilik om die toestand korrek te diagnoseer en efektief te behandel. Hierdie studie fokus op die soort geval wat aanvanklik ‘n baie swak prognose gehad het, maar vervolgens oor ‘n tydperk van 18 maande ‘n beduidende verbetering getoon het. Die terapeutiese intervensie en die progressie van die geval is in hierdie studie noukeurig ondersoek, deur gebruik te maak van fenomenologiese ondersoekmetodes, met die doel om temas en patrone vas te stel en te beskryf wat die begrip van die genesingsproses van die klient gedurende terapie moontlik kan bevorder, en wat verdere navorsing op hierdie gebied kan stimuleer. Integrasie van psigodinamiese konseptualisering (spesifiek self-sielkunde en intersubjektiwiteit) asook persoongesentreerde, ondersteunende beradingsmetodes, is as waardevol bevind in die behandeling van hierdie geval . Die gemeenskaplike faktor tot hierdie benaderings is die klem op die verhouding tussen klient and terapeut. Die gevolgtrekking is gemaak dat hierdie terapeutiese verhouding die bepalende faktor in die sukkesvolle behandeling van hierdie klient was, omdat dit sowel die skade aan die self as die verlies aan die vaardigheid om verhoudings te bou, aangespreek het. Die navorsing en die terapeutiese intervensie met die klient het terselftertyd plaasgevind, en die proses het ten slotte tot ‘n mate van integrasie op drie vlakke gelei: integrasie van die klient se self en herstelling van interpersoonlike funksionering, integrasie van die bogenoemde benaderings wat tot ‘n kreatiewe sintese in die berader se benadering tot trauma behandeling gelei het, en die integrasie van fenomenologiese metodes en psigodinamies konseptualisering in ‘n gevallestudie. Dit is belangrik om in gedagte te hou dat die teoretiese navorsing en praktiese prosedures wat in hierdie studie beskryf en uiteengesit is, net een manier is om komplekse trauma te konseptualiseer en te behandel.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/20447
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