Trauma: Object Relations Therapy

Object relations therapists, D. W. Winnicott especially, have presented a logical analysis on how to provide object-relations-oriented therapy to people suffering from the effects of psychological trauma. Such attachment-based trauma therapy provides support and healing from trauma, loss and long-term trauma-effects.  The interventions below combine the best of object relations therapy, mindfulness therapy (MBSR, ACT), and cognitive-behavioral therapy. Here is the listing of therapeutic functions and interventions.

1. Provide support for “going-on-being” in the therapeutic alliance and the therapy itself. (Winnicott)
2. Unconditional positive regard is a must. (Rogers)
3. Recognize, work with and work through the splitting process as it activates in therapy. (Lineman)
4. Safely and with effective skill help to re-connect the person with safe transitional space. (Winnicott)
5. Carefully build and monitor the emotional “holding environment” in both alliance and therapy. (Rogers, Winnicott)
6. Include contextual stimuli and symbols of the traumatic experience, from very general to specific and shift slowly over time. (Briere)
7. Once there is a firm alliance and safety in the therapy, be more specific in exposure to traumatic experiences – monitor carefully. (Briere)
8. In all exposure work, best to utilize SUDs scores from 0 to 100 – larger range between numbers allows deeper investigation and specificity.
9. Work hard to understand and utilize body-based communications. (Ogden, Fisher, van der Kolk)
10. Use mindfulness attention and skills (MBSR, ACT) to remain in The Middle Way between traumatic re-exposure and the safety of “going-on-being.” (Briere, van der Kolk)
11. Check in with the experiences of transference and countertransference as you use images and defenses to support progress. (A. Freud)
12. Use multi-sensory interventions in gentle, safe, re-exposure to traumatic materials – using one step removed and cognitive processes first. (Quintiliani)
13. If skilled in its use, utilize the Attachment-CABs-VAKGO-IS-Rels formula for interventions. (Quintiliani – see mindfulhappiness.org for more details)
14. Using items #s 8-13 above, aim for development of a safe cognitive schema and narrative clarification about the traumatic event/s.
15. Work closely with the person to help them internalize the growth-benefits of all of the above. Take time with this process.
16. Be a “good object” and always return to safety over and over again – check-in and stabilizes often.
17. Slowly and with safety move up the hierarchy of trauma exposure process, possibly experiencing the full array of sensory experience. (Briere, Foa)
18. Listen, support emotionally, radically accept, validate and understand the process and the person. This is your best way to develop a “good enough” self-object via “transmuting internalization.” (Kohut)  Various mindfulness and CBT skills will be used here.
19. Use mindfulness and good CBT to make space for acceptance and validation for post-traumatic growth. (Lineman)
20. Help to impact these positive changes into a “different” memory system as you expand and deepen the narrative.
21. Support and directly reinforce (behaviorally) the improved self – a “felt sense” of a healthier self psychologically and physically.
22. Place more and more safety into the transitional space, and generalize this process into therapy and life practices.
23. Finally, expand the person’s capacity for pleasure, joy, self-esteem, success and HAPPINESS before therapy ends.

For more information refer to Savage Scharff, J. and Scharff, D. E. (1994).  Object Relations Therapy of Physical and Sexual Trauma. Northvale, NJ: J. Aronson.

Note: The ideas have been presented in this text, but I have added more current interventions and details based on new research and treatments.

Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness  

New Edition of Mindful Happiness in Production…Coming soon!