The Traumatised Memory - Protection and Resistance

1.3                The SPIM 30 Concept of Beseelbare Symbolization Media to Resolve Severe Transference Problems in Dissociative Trauma Disorders

Ralf Vogt

        Introduction

As has been described in Vogt before (2006, 2008, 2015), we pay particular attention to problems arising from atmospheric transference when dealing with dissociative trauma disorders. Violent interpersonal trauma will generally leave traces of the transgression of psychophysical boundaries (cf. Vogt, 2012). Trauma victims will therefore find it harder, compared to other people, to distance themselves from various kinds of stimuli and manipulations. As a result, they will suffer from a greater number of atmospheric impressions in relationships and situations in the here and now. This refers to atmospheric triggers, which often share important characteristics of dissociated traumatic experiences in the past and manifest in everyday life in the form of nightmares or a multitude of fear triggers, for example. The SPIM treatment program tries to utilize this high sensitivity and irritability for diagnostic purposes as well as for therapeutic interventions.

In the SPIM 30 case studies (Vogt, 2015, pp. 107-127), we already distinguished between factual, symbolic and atmospheric data in client interactions. Typically, dissociative trauma patients will primarily display atmospheric perception and communication data - next to a series of symbolic data but usually less factual data in their narratives or interaction symptoms, at least at the beginning of therapy.

Example: A dissociative patient declines the therapy offered to him because he felt uncomfortable in the initial sessions. He is unable to find a plausible hypothesis how his feeling uncomfortable in the relationship might be connected to inner mechanisms. How could we engage with this patient in a constructive way, without making him feel overwhelmed?

        Exploring Transference Media for the Treatment of Trauma

During the development of the SPIM treatment program about 20 years ago, my aim was to design media that would increase the space for psychodynamic transference. In the psychotherapy of dissociative disorders, media objects are a suitable option to expand the psychotherapeutic work on transferences because of the clients' high sensitivity and rather limited ability to set boundaries. Since dissociative patients tend to ensoul everything in the room and establish references to themselves with almost magical power, I saw my task in taking these influences into account more systematically, fabricating them for therapy and evaluating them on sound clinical foundations. I had to structure the field clinically and empirically by trial and error since there were no models for such a procedure at the time.

The first thing I noticed was that dissociative trauma clients show particularly strong reactions to proportions and regress faster when they perceive large spaces, objects and oversize stuffed animals, sometimes in child-like terms.

In the majority of cases, these object perceptions were fear-inducing and somehow bizarre. In explorations of well-reflected dissociative trauma patients, it quickly turned out that the negative transference feelings had to do with intuitive, condensed perpetrator memories. Clients themselves made the connection between the size of the object and the perceived omnipotence of the perpetrator or with the inevitable impotence in their own position as victims. After months of variations in tests, it finally became evident that an inordinately large, "giant" red block with a solid foam core would regularly elicit a mild to moderate feeling of discomfort, unpredictability and anxiety in most dissociative patients (Fig. 1.1).

therapeutic coach on the patients' "strange feelings of transference". As a result, the clients' acting out was effectively contained and, step by step, we were able to address the actual origins of the patients' transferred fears of experiences from their traumatic past. In addition to the triggering effect rooted in the essence of the original traumatic experiences, the Beseelbare transference objects also had and have a specifying and associatively stimulating component to intuitively complement the scene. Since dissociative trauma memory is, by nature, only fragmentary and often hard to access semantically, we need to search for additional implicit memory impressions and learn how to interpret them. The Beseelbare therapy media can also be an aid for associative work because they offer themselves as intuitive dialogue partners for the clients' process of self-exploration in ensouled interactions. Almost like in child's play, virtually by chance, significant fragments of traumatic experiences come to light. They can only implicitly be reflected on by the client in the concrete, action-oriented creative dialogue with an object. Thus, they also become visible for their therapeutic companion. The mere presence of the object helps clients to remember other critical incidents they experienced in the past with problematic attachment figures in their lives. With this in mind, I further explored the main problems dissociative clients typically have to deal with. My aim was to design atmospheric objects that would be equally conducive to the overall problem-solving potential of trauma patients. Further patient explorations supported designing another object that could trigger a feeling of powerlessness. But this object should ideally be yielding and hard to grasp. This research hypothesis lead to developing the giant black slack bag which even the strongest of my clients were unable to lift or carry (Fig 1.2 a und b).

(a) (b)

Not being able to move it, is another interactive experience that will leave dissociative clients feeling sad and powerless. Often, they had to take care of their depressive or suicidal parents. Their parents did not act responsibly enough to get themselves the professional therapeutic help they would have needed but instead forced their children into parentification, continuously demanding more of their children than they could cope with.

While the foam core of the giant red block was meant to be rigid and unyielding, very much like the authoritarian, unapproachable or violent perpetrators who had transgressed the patients' boundaries, the giant bag filled with pieces of felt and foam is exactly the opposite; but it is also heavy and hard to carry for one person alone. It was designed in this way because this allows for an ensouled interactive situation that corresponds to the traumatic world of experience of the emotionally harmed child. ln our trauma patients, this oversize transference object will cause feelings of grief and disgust as well as feelings of powerlessness and stress (like with difficult parents). These feelings are of great importance for associative self-explorations of dissociative patients.

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