Feelings of terror, fear and helplessness in response to trauma are profoundly human responses to events that are experienced as life-threatening to the self and others. Alongside these emotions, there are bodily responses such as trembling, a pounding heart, an inability to speak or move and a difficulty in breathing, all of which dramatically indicate the indivisible link between feelings, body and mind. During more normal life experiences it is easy as a psychotherapist to forget about the body. The treatment of trauma will not allow this to happen.
My interest in the technical difficulties of treating traumatised children started with the two children with whom this chapter is concerned. At the time that the original paper was written in the mid-1980s, there was surprisingly little psychoanalytic literature about the treatment of trauma in children. The extent of physical, sexual and emotional abuse that we are now so well aware of was not known at that time. Clinically, I think it is probably fair to say that the emphasis was mainly on the child's internal world first and foremost, and that this led to a technical emphasis on the centrality of interpretation in bringing about psychic change.
Lesley and Derek were therefore very unusual patients at the time. Lesley, who was 9, was referred to me very soon after being raped. She had lived an entirely ordinary life until this point. Derek was referred to me many years after probably witnessing the murder of his mother by her partner, who was subsequently imprisoned. It happened that I was seeing both children at roughly the same time, which was what made the
1 Many of the ideas as well as the clinical examples in this chapter were originally published in 1985 as 'Surviving trauma-dilemmas in the psychotherapy of traumatised children', British Journal of Psychotherapy, 2(1):50-62. The observation of the therapeutic value of a particular form of quietness in the therapist has been helpful to me since this time. My current thinking and understanding of why this is so have led to the expansion of the original paper into this chapter.