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.
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
requires an exceptional therapeutic alliance (psychodynamic therapy), modifications in automatic negative thoughts (cognitive therapy), changes in unhelpful behaviors, like self-medication of pain (behavior therapy, and combinations like very well executed cognitive-behavioral therapy), commonly long-term healing outcomes have been somewhat disappointing. Perhaps an experienced and skilled therapist able to develop a high quality psychodynamic clinical alliance as well as highly effective cognitive-behavioral interventions may achieve admirable outcomes; however, that specific combination of skills is not common. I am suggesting that a high quality helping alliance and successful interventions in thinking and behavior problems may be helpful for people suffering from serious trauma. However, most of these approaches (other than informed and skilled DBT) miss the mark when it comes to integrated positive impact on the mind-body system. Even in DBT (and CBT), it is common for it to be used as a form of cognitive therapy – leaving the important behavioral and body-based areas out all together. To take a new look at the traumatized mind-body, witness current successes in trauma-informed yoga and meditation for PTSD. Recent meta-analytical reviews have noted that meditation (and yoga to a lesser degree) do improve depression, anxiety, physical pain (emotional pain?), and emotion regulation. Therefore, such body-based approaches improve three (depression, anxiety, self-medication) of the common clinical conditions associated with serious trauma.
mindfulness-based interventions in trauma, the best therapists are also practitioners in these practices. Limbic and prefrontal interventions, NOT psychodynamic and cognitive interventions, may be highly helpful in effective trauma-informed psychotherapy.
teaching, in therapy, and in self-care. I have had many years of experience training educators, therapists and the public on such topics. Here I plan to simply list 20 ways to use mindfulness and contemplation practices in education and therapy. I will not differentiate between the two; I assume educators, university faculty, and therapists can figure out on their own the contextual, topic-related, and age-appropriate implementation realities. Here is my list.
personally, but you do know they have suffered. Have an open-hearted heart-mind experience abut the person’s suffering. Care! Later you may be able to actualize this by doing something helpful to that person or persons.
Skinner in his explanation of operant conditioning explained negative reinforcement as a behavioral response being strengthened by avoiding or removing a negative (in this case emotional) consequence or aversive stimulus. Behaviors are negatively reinforced when they enhance escape from aversive stimuli. Here the behavior of avoidance is reinforced; such conditioning leads to habitual avoidance of trauma-related cues and stimuli. This conditioned behavior is adaptive in that it reduces painful emotional suffering. In a sense, it is a form of emotional self-medication: short-term emotional relief by avoidance behavior but long-term suffering continues. The removal of a punishing experience is a highly reinforced, conditioned outcome. Therefore, a person suffering from psychological trauma learns that avoiding trauma-related stimuli leads to less suffering. Thus avoiding traumatic stimuli reduces emotional suffering activated by those same stimuli. Avoidance is learned as an adaptive coping response to 
traumatic fear of suffering on-going traumatic symptoms and reactions. In behavioral chain analysis, the person suffering from trauma learns avoidance improves their emotion state because it reduces consequential emotional suffering. The positive consequence is often immediate, making the reinforced conditioning stronger; habit formation occurs quickly. The behavior becomes stronger over time. As avoidance becomes habitual, the person cannot benefit from successive approximations – the slow, safe. steady approach behaviors related to facing and being with traumatic cues and stimuli. Longer-term, slow and safe exposure to these traumatic cues and stimuli improves emotional coping as it reduces negative physiological and emotional reactivity. The consequence of learning the avoidance cycle implies little progress will occur in recovering from powerful traumatic experience/s.
regulation, and recovery process. People suffering from trauma can get well, but only if their therapists and medical providers understand how to treat psychological trauma. It is not just prescribing another medication. Co-occurring conditions (depression, other forms of anxiety, substance abuse) often mean that the treatment of trauma is NOT unidimensional in nature.
