Somatic Experiencing: Enhancing Psychoanalytic Holding for Trauma and Catastrophic Dissociation - Contending with the Flood and the Fog

Abstract

ABSTRACT I continue here the project of interweaving principles and approaches from a somatically based trauma therapy, Somatic Experiencing (SE), into psychoanalytic treatment. I focus on patients with severe early traumas who are chronically vulnerable to states of catastrophic dissociative dissolution. When dissociation takes this form, not merely compartmentalization, but dis-mentalization, there is no self who is present, who can hear, take in, and participate in desperately needed holding and containment. Traumas in the patient’s history and mind/body, which are precariously held behind a dam of dissociation, can burst through with such violence as to annihilate any semblance of “going on being.” While this must occur in treatment, and while we must accompany our patients there, it is a terrible dilemma when the floods, and then the fog, interfere with reception of psychoanalytic provision. When this goes on for too long, it may become iatrogenic more than therapeutic. I review various forms of holding and containment, but focus on one specific type of holding, protecting the patient from annihilating impingements. While Winnicott emphasized impingements from the outer world, I extend this to impingements that burst through from within, the catastrophic states themselves. I present a case to demonstrate how my drawing upon SE substantially enhanced this form of holding, and how it interwove more broadly into my psychoanalytic ways of looking, listening, thinking, and responding. I also illustrate how a somatically based therapy, such as SE, can be interwoven in ways that are constitutive and facilitative of psychoanalytic modes of therapeutic action.