Our second conference took place onthe 1st October 2011 in London and was a huge success. Seventy people gatheredat the NVCO in Kings Cross and unlike the previous conference, where it snowed,the weather this year was truly glorious.
The theme of the conference was Inside Out:A relational transactional analysis approach to trauma. We were richlystimulated by presentations on trauma by Jo Stuthridge from New Zealand andJean Maquet from France. These were interspersed by clinical discussion groups.
Jo's presentation was called: Traversing theFault lines: A relational approach to the treatment of trauma.
She talked about the challenges we face astherapists as we set out to transform the experience of trauma, as we “traversethe fault lines in therapy” without falling into the abyss of traumaticrepetition. Using powerful client examples she talked about how in therapy,trauma emerges as transferential enactment that creates ruptures between clientand therapist. She linked this to the metaphor of the abyss, which represents a collapse of reflective space.
Jo Stuthridge (left) and Jean Maquet (right) giving their presentations
Emma Haynes, a psychotherapy student at theMetanoia Institute, who is currently preparing for her CTA exams, gives her response to Jo’s presentation:
“I was struck by the photographs shown to us by Jo of her home town, Christchurch in New Zealand, in the aftermath of therecent earthquake with its parallel to trauma. The photograph of the fault linein the road, with the title of “Fracture in Relationship” was dramatic and highly evocative, as were the images of the damaged buildings. I had the sense, as I watched, of irreparable damage to Christchurch and its inhabitants, both physically, emotionally and psychologically. Jo linked this to the damage ofrelational trauma to the child and how this forms fault lines within the mind of the traumatised child, fracturing the ego almost like the way an egg shellfractures when cracked.
Jo explained how in response to relationaltrauma, which is a gross violation of the self, a child gets stuck in a stateof unbearable affect and faced with this intolerable situation, cuts off part of self to survive – or in other words defends their sanity by dissociation. Jo explainedher belief that, in the treatment of trauma, enactment is both inevitable andnecessary, serving to bring the dissociated parts of the self into theconscious awareness of the client.
Using powerful client examples from her ownwork, she described and explained how she sees an enactment as an intersection between the two scripts of client and therapist, where the vulnerabilities ofeach become interlocked.
Whilst enactments can and inevitably doprovoke bad feelings of shame, betrayal, etc within both parties, they alsooffer an opportunity for healing. When the therapist is willing to reflect onthe mess that follows and find a way to communicate her understanding, what isimplicit is made available for explicit understanding. Jo suggested thatshared understanding occurs with “an act of recognition” (a crossed transactionthat creates a disjuncture, disturbing the client’s script). Resolution of theenactment helps to form a bridge between tentative states of self. This processincreases the client’s capacity to contain internal conflict, for symbolisationand for expression of previously dissociated parts of the self, so that theycan be integrated”.
Another conference attender, Briony Nichols, a PTSTA also gives her views:
“Earthquakes and fracturing of the landscapebecame a key theme of Jo Stuthridge’s presentation, as she prepared for theconference in the context of the Christchurch earthquake in New Zealand. Shediscussed how trauma produces intrapsychic fracturing and dissociation. In thisway, a coherent self-narrative is sacrificed in order to maintain arelationship and prevent internal conflict. When these intrapsychic faultlinesare re-triggered, the trauma will emerge as a transferential enactment that canthreaten the therapeutic relationship. Jo presented case examples of her workwith these fractures – ‘traversing the faultlines’ in the interpersonal realm.In particular, she discussed the attention she pays to assaults on thetherapeutic frame, where thesents often emerge”.
Jean's presentation was entitled: How thetherapy of patients who were abused in childhood creates paradoxes in thetherapeutic relationship.
He talked about his work with survivors ofchild abuse and explained how he considers the therapeutic relationship to bethe main vehicle of therapeutic change.
Focusing on "relational paradoxes"he offered a framework for understanding and containing paradoxical experiencesin the therapist-patient relationship. Within this he considered fourdimensions: contact-working alliance, contract, emotions and countertransference and linked each of these to their role in helping a traumatisedclient to learn how to symbolize and to manage their shame.
Emma Haynes, also commented on Jean’spresentation.
Jean suggested that working with someone whohas been traumatised is similar to touching someone who has been burnt –contact hurts. In fact, he suggests that they have been burnt, psychologicallyburnt, and their fear of being burnt again creates many difficulties during thetreatment.
“As psychotherapists, we have to accept tolive this relationship in its paradoxical nature and not try to resolve theparadox ... but to (almost) let it resolve by itself.
Continuing the metaphor, he suggests thatto rebuild the psychic tissue that has been burnt, the traumatised clients needto re-learn how to symbolise. He defined symbolisatio as the psychicinternalisation of an object – which allows the baby to replace the mother witha comforting object when she is not there – something that is very difficultfor anyone who has been traumatised and who does not trust contact.
Jean believes that 'the frame' (the business contract in TA) provides a set of constants for the client and becomes thecontainer of the therapy process, supporting symbolisation. He suggested thatmost acting out in the therapeutic relationship, occurs around the frame,coming early; refusing to leave; forgetting payment; going over time; phoningthe therapist in between sessions etc. He believes that if the therapist canaccept challenges to the frame, without retaliation or collapse and use this asthe basis for meaning making with the client, then they will come to trust inthe constant and safe nature of the therapeutic relationship, viewing andinternalising the symbol of the frame (object) as something useful andcontaining for them”.
Jean used a very moving account of his workwith a traumatised client to illustrate his presentation.
Briony Nichols described how each of the-
“… two hour-long presentations (one in themorning one in the afternoon), was followed by a short question and answersession then hour-long discussion groups. These small facilitated groups gaveus delegates time to discuss the presentations in the light of our own clinicalexperiences, integrating the learning and expanding on some of the themes thathad been presented. This made the conference a deeply reflective one, as therichness of the clinical and theoretical material evolved throughout the day”
The two presentations were separated by a wonderful and plentiful lunch, which many, taking advantage of themini heat wave, ate outside in the grounds of the NCVO. We finished with awell-attended AGM and overwhelming support for another conference next year.
Videos of both presentations can be found onthe members area of the IARTA website at www.relationalta.com