Psychodynamic Therapy
Psychodynamically based approaches emphasize the interpreta-tion of the
traumatic event as being a critical determinant of symptoms. Treatment is
geared to alter attributions, usually by means of slow exposure and through
confrontation and aware-ness of the negative affect that have been generated by
the trauma. Conflictual meanings begin to appear, and it is the task of
treatment to reinterpret the experience in a more realistic and adaptive
fashion. During such treatment, it is important to ensure that the affect
intensity is not overwhelming or disor-ganizing. Obviously, support needs to be
provided throughout, and sometimes other treatment approaches are used
adjunc-tively. Excessive and maladaptive behaviors such as avoidance, use of
alcohol or work, or risk taking may occur as a means of coping with the
experience and these need to be identified and addressed.
Using psychodynamic concepts, Horowitz (1973) de-veloped a
trauma-focused, time-limited, psychotherapeutic approach. Periods of intrusion
are considered an attempt at mas-tery rather than a failure in defenses,
whereas emotional numb-ness is seen as a result of defensive overcontrol.
Overwhelmingly intrusive symptoms are counteracted by means of structuring, and
avoidance and numbing are met with procedures to mini-mize such behavior. With
this approach, as with any psycho-therapeutic approach, the establishment of a
safe therapeutic alliance is essential and medications are used sparingly. The
goal of such trauma-focused therapy is to achieve an end point in which the trauma
is meaningfully integrated into the survivor’s life schema, with reduction of
intensity and frequency of the in-trusive and avoidant phases of PTSD. Although
this approach awaits controlled testing, it aspires to reduce all aspects of
PTSD symptoms.
Roth and Newman (1991) presented a conceptual frame-work for
understanding the emotional impact of sexual trauma. The survivor must come to
understand the affective impact of the event so that she or he is no longer
preoccupied or driven by negative feelings or self-defeating behaviors. It is
also important for the survivor to grapple with the meaning of the trauma so as
to reach adaptive resolution. Preliminary studies utilizing this approach show
promise of efficacy.
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