Schulman, Gustav

The traumatised patient is unable to integrate his dissociated encapsulations without the help of a containing object. The intolerable flashbacks seem to be stored mainly in nonsymbolic somatic, perceptual and procedural implicit memories. The patient employs automatically pathological projective identification to dissociate the affect storms, the narcissistic hurt and the unbearable shame and envy. Powerful aggression and negative therapeutic reactions will arise. Affect regulation and the tolerance of painful experiences is a uniquely human ability which can only be learned from another human being. Sooner or later in the treatment relationship the traumatic experiences and affects will actualise. This provides the possibility to internalise a capacity to tolerate the intolerable and integrate the dissociated parts. Like any abilities and human skills, affect regulation also requires numerable repetitions before it is installed as a personal capability. Modern psychoanalysis at its best provides the patient with first-hand experiences rather than insights, though the latter is still a necessary tool. A great deal of the assimilation and integration also takes place implicitly or unconsciously. The first step is to awaken the patient to his experience. In this moment he will get a feeling of his experience with a new perspective opening up for him, and reflecting on the experience along with a containing other makes it possible for the patient to internalise and assimilate containing capabilities(AU)

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Enabling traumatised patients to tolerate the intolerable: from encapsulation to containment

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