The treatment of an adult survivor of incest: a self psychological perspective.

Abstract

That the victims of childhood incest suffer grave and lasting psychic wounds is understood to be true by all the major schools of psychoanalytic thought. But what is the nature of these psychic injuries, why are they so enduring and deep, and what are the aspects of psychoanalytic treatment that may ameliorate these wounds? Price's (1992) paper, "The Psychoanalysis of an Adult Survivor of Incest: A Case Study," describes the developmental history and the psychoanalytic treatment of an adult incest survivor from a Horneyan theoretical perspective. Price articulates the major Horneyan principles that inform her understanding of and treatment of this patient and of other victims of severe childhood trauma. In this paper, I will demonstrate how the application of certain crucial principles of self psychology can augment our understanding of the psychological development of this incest survivor and illuminate the factors that proved to be therapeutic in Price's psychoanalysis of this patient. From a self psychological point of view, events are traumatic when they severely damage an individual's sense of self in relation to the selfobject world. In the aftermath of trauma, an individual does his or her best to restore the sense of self, but inevitably must resort to methods of self-restoration for which a heavy price is paid--that, for instance, of ignoring and disavowing large sectors of one's own emotional reality, or of dissociating from the experience of traumatic events. According to Ulman and Brothers (1988), trauma results in the shattering of "central organizing fantasies of self in relation to selfobject (p. 2)," along with faulty and damaging efforts at the restoration of these fantasies. Thus, therapy will be ameliorative to the extent that it enables patients to work through these effects of trauma. This paper is based on an invited discussion of Michelle Price's paper, "The Psychoanalysis of an Adult Survivor of Incest: A Case Study," at the Continuing Education Series, Training and Research Institute for Self Psychology, 1/1 1/92.