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