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 survivorâ€™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.