Psychoanalytic psychotherapy with traumatized refugees: integration, symbolization, and mourning

The author takes as a point of departure that severe trauma, such as torture, is "unresolved" because it is not symbolized and is thus dissociated or existing as warded-off parts of the personality. Depending on the severity and character of the trauma, the depth of the regression experienced, and the age and life-circumstances of the patient at the moment of trauma, this can have more or less severe impact on the personality structure. The consequences may at worst be fragmentation and total lack of trust in others. In psychotherapy these patients often fear retraumatization when narrating and working through their traumatic experiences. This pinpoints the paradoxical nature of psychotherapy, where painful aspects of the healing process are brought into focus. The totality of the psychotherapeutic situation must then explicitly be taken into consideration. The author discusses how different aspects of this address different aspects of the psychopathology of the patient. Clinical vignettes illustrate some salient points.