Primitive processes, metaphor, and recognition in the treatment of traumatic loss

This paper explores how traumatic loss and emotional abuse ruptured a patient's symbolic process and shattered her experience of the reality of her self. In treatment, metaphoric investigation of physical processes of expulsion and incorporation led to a transformation of projective identification into the containment she sought. The therapist's ability to metabolize pain, shame, and the risks of incestuous merger re-experienced in the treatment grew out of his recognition of disturbing experiences of his own that she brought to life. Mutual recognition, linked to the therapist's reverie, was a key treatment factor as both patient and therapist changed.