Part of this text was presented in the Hellenic conference “Abuse-Neglect of Children: in search of scientific knowledge. The shock of the real. The return of the symbolic”, organized by the Centre for the Study and Prevention of the Abuse– Neglect of Children, Child Health Institute, 2011, May 9-10.

Summary

Neglect, premature loss of close emotional bonds and abuse constitute serious traumas, which impact people’s ability to achieve emotional attachment and give cohesive meaning to their life’s experiences. Psychotherapy offers a context of emotional healing and reparation. The dialogical creation of psychic space where adults with traumatic experiences can tell their stories and establish a trusting relationship with the therapist is of great importance. Making sense of traumatic and painful experiences and creating a coherent story can provide traumatized adults with the possibility of healing their emotional wounds and prevent the transmission of insecure attachment from one generation to the next, allowing them to go on living, beyond the limits and restrictions from their traumatic past and thus have a better possibility to participate in the formation of their story.

Key words: emotional bond, meaning, trauma, repetition, reparation, therapeutic relationship, narration

 

Who somebody is can be learnt from cradle, who somebody becomes, is formed through innumerable transactions.                                                                                                                                                            

                                                                                                                                    Bertrand Cramer (1999)

Nothing seems to be more painful for somebody than the lack of sense and coherence in things. His failure to give an explanation to the world around him or to what is happening to him, always leads him to a deep depression. Such situations lead to the unbearable emotion of a chaotic universe inside him, with no points of reference, no protective barriers, where anything could happen and where the worst is always possible.                                                                                                                                                                     

                                                                                                                      Enriquez (see P.Thomassin, 1993)

 

Introduction to the attachment theory

Attachment theory as defined by Bowlby (1988α), holds that people have an innate predisposition to form emotional bonds to one another, with a lot of meanings and involving both positive and negative emotions. The first form of attachment is the one that infants develop towards the person who satisfies their needs and takes care of them (usually the mother). This is essentially a biologically determined bond, developing through the infant’s need for safety, stability and protection, which secures his psychosomatic survival. The attachment person’s role is not only the provision of a safe base from which children can explore their environment, but also the provision of a safe haven  to retreat to, when feeling threatened or endangered.Under normal conditions, the mother’s glance, voice, steps, touch and hug, create, a sense of relief, safety, warmth and pleasure  and suitably prepare the ground for the child to open up to the outer world,  discover it and manage his freedom. Therefore, Bowlby’s theory suggests a suitable context for understanding a person’s emotional development as well as the potential interpersonal difficulties he may encounter during his life. According to the theory, our primordial relationships with those, who have  taken care of us, are introjected as models of relating (internal working models) and determine the type and pattern  of our subsequent relationships, the way we understand ourselves, and others, how we respond to our relationships with them and what we expect from them.

The parent’s ability to observe, comprehend and respond to the baby’s intentions and it’s inner world, seems to affect the development of a safe emotional bond and allows the child to gradually build αcomposed, coherent and creative self. The child internalizes the parent’s functioning and this allows him to come to terms with himself and his relationships. As other people respond to him and comprehend him, he then can comprehend others the same way. According to Holmes (2009), a sense of history comes from the maternal consistency: the reliability of the mother’s response towards the infant becomes the nucleus of autobiographic competence. From maternal holding comes the ability to “hold” one’s self in one’s own mind; the capacity for self-reflection, the conception of human behavior as having meaning, emotions, beliefs, goals, aims and causes (Allen et al, 2008, Fonagy et al, 1995). Manolopoulos (2004) poetically reminds us of the fact that the mother’s ability to guess the infant’s emotional experience, is the benign fate that wakefully spins and weaves the meanings and holds disaster away. The baby’s mother or carer, is the one who welcomes and takes in the unwrought components rejected by the child, processes them, gives sense to them and then gives them back to the child. (Bion,1978). As the mother transforms the infant’s painful sensations into tolerable emotions, she provides a soothing sense of calmness and consolation, and teaches the child to deal with his emotions. The child receives his mother’s responses, processes and internalizes them, and uses them to create his own mental space, i.e. he learns, how to embrace his experiences as a subject. Through maternal mirroring, the infant obtains a symbolic representation of his own mental state as well as that of the others’, gradually obtaining the ability to regulate his emotions and control his impulses (Allen & Fonagy, 2002). In conclusion, mother’s safe holding (both physical and emotional), her response and attunement with her baby, leads to safe children, which then develop into composed adults, able to comprehend and predict, to some extent, other people’s behaviors (as they think of what they have in mind), think of what they feel and at the same time feel for what they think of, connect facts with thoughts and emotions and are generally capable of interpreting what is happening and dealing with it (see Charalabaki, Kati, Thanopoulou, 2012). In the opposite case, as we shall see below, the lack of reflective ability, is seen as a significant factor for the transmission of abuse through generations.

Connection between systemic theory and attachment theory

The advent of the systemic approach in the field of therapy, in the second half of the 20th century, shifted the field of observation from the subjective world of the individual to the significant context of his relationships, in the family. At first, the focus was on behavior, the models of interaction between family members and the way the problems remained “here and now”. The exception here was the intergenerational approaches in the systemic field, which, maintaining its psychodynamic influence, put emphasis on family history and the transmission of unresolved emotional issues through generations. Over time, the predominance of constructivism and social constructionism influenced family therapy and caused changes to the therapeutic practice. Specifically, in the 1980’s the movement of constructivism, with its emphasis on how people construct reality and interpret their experiences, changed the idea of a single objective reality and claimed that reality is an invented mental construct (Glasserfeld, 1987, Maturana & Varela, 1980, Hoffman, 1988). In the 1990’s, social constructiοnism saw personal meaning as part of a concrete historical and cultural environment, and reality was thus seen as a social lingual construction (Gergen, 1985, 1994). These developments brought forward for exploration such new concepts as personal and social construction of reality, meanings, beliefs, narrative, language, dialogue. Looking at the course of systemics, we would say that it continuously evolves, integrating and combining different movements and trends and embracing many different schools and models of therapy and at the same time showing some important combinatory tendencies. Many systemic therapies in the last decade have turned to the use of attachment theory and are trying to link it to the systemic theory and practice (see Byng-Hall, 1995, 1999a, Hughes, 2007, Erdman and Caffery, 2003, Johnson and Whiffen, 2003, Akister and Reibstein, 2004, Dallos, 2006, Dallos, Vetere, 2009, special feature on attachment theory, Family Process magazine, 41: 3, 2002, special issue of Context, April, 2007).

Bowlby’s attachment theory is linked to systemic theory, due to the emphasis on the interactive nature of relationships. It considers carer and cared as a system in mutual interaction which is regulated by positive and negative feedback. An example of this is the child’s closer attachment to an abusive parent, as the source of abuse is simultaneously the object to which the child is programmed to turn when in danger (Holmes, 2009). As Byng-Hall (2008) states, bonds are part of family life, and is something that family therapists have to deal with, when they treat a family or couple, even if they do not explicitly state it in their theory or practice. Indeed, it was Byng-Hall himself who, influenced by the attachment theory, used the term secure family base and defined as secure the family that provides a reliable network of attachment relationships, helping its members of all ages to feel secure enough to probe into their relationships with other family members or third parties (Byng-Hall, 1995).  In 1949, Bowlby wrote one of his first articles on family therapy, describing the discovery of a new method which entailed seeing the whole family, when individual theory seemed to come to a dead lock. The attachment theory combines contributions from ethology, developmental and cognitive psychology, the systemic theory, cybernetics and psychoanalysis. It is a relational theory of the evolutionary course of humans and their inner world which can enrich and broaden the systemic point of view, providing a broader comprehension of relational dynamics. Moreover, attachment theory provides a useful basis for understanding and dealing with unresolved traumas, in essence, it is a theory which describes and explains the trauma caused by neglect, loss, abandonment or even excess stimulation by the carer and its consequences on the individual’s psychosomatic development. Bowlby himself started his career studying the consequences of maternal deprivation and parting on a young child’s psyche. Ηe observed that children confined in foundations for antisocial  behavior, turned into adults, deprived of emotions, who developed superficial relationships and hostility towards others. Children without the experience of attachment to a significant person, in their early years, suffer from failure to create close interpersonal relationships (Siegel, 1999). Finally, attachment theory and the studies behind it, provide a safe basis for understanding and explaining intergenerational transmission, i.e. how both secure and insecure attachments are transmitted through generations. It is thus especially helpful when working with intergenerational issues and issues relating to the patient’s parental families, since it provides a useful context for investigating the effect of the past on functionality and dysfunctionality of the individual and his family, as well as, for tracing possible recurrent  models of behavior or interaction.

The prison of trauma repetition

Traumatic experiences, especially when repeated, disturb the individual’s sense of trust and safety towards both himself and others, leading to the lack of a stable conception of self and of a consistent identity, and if they are not healed they may have repercussions on his life and even lead to psychopathological issues. Parents of traumatized children, due to their own unprocessed and unresolved traumatic difficulties, are unable to recognize and handle their children’s emotional needs. Their own primordial needs were not recognized from their parents, and as a result they repeat this experience with their children, too. As they leave their children exposed to experiences of dread and anxiety without providing adequate mirroring and holding, the children end up with a reduced ability to represent their thoughts and emotions. According to Fonagy (Fonagy, 1991) seriously traumatized adults have a limited capacity to think reflectively and in depth about themselves and the experiences they get from their relationships. In addition, they find it extremely difficult to recognize others as individuals with their own emotions, intentions, desires and thoughts, as well as to define their own mental state and thus they fail to assume responsibility for their actions. Furthermore, the experience of systematic abuse within a relationship of attachment, where the attachment figure is a source of both safety and threat, usually leads to a vicious circle of disorganized attachment, where fear triggers the search for proximity and then, proximity brings more anxiety due to the anticipation of abuse (Bartholomew et al., 2001). Since traumatized individuals lack the experience of a caring relationship which would help in alleviating the trauma, they end up pursuing the relationship with the same abusive parent (a relationship fraught with danger and threat), as it is important for their survival, otherwise they would have to deal with the painful emotion of abandonment and solitude.

Traumatized individuals find it difficult to comprehend and interpret the world around them in a coherent way since they lack the ability of emotional processing their experiences. In order to handle their frequent painful emotions, they resort to primitive defensive mechanisms such as dissociation, splitting and projective identification and are frequently tormented by a sense of futility and of lack of meaning (Holmes, 2009). As they grow up in an environment where their own senses’ conception is absent and is frequently distorted or even rejected, they learn to hide their emotions and thoughts and as a result they are led to expect a lack of care, as well as a risk associated with expressing emotions with disastrous consequences for their self-esteem and their relationships (Holmes, 2009). It is as if they live in a prison, afraid to think, because they are essentially afraid of remembering and feeling (Allen et al., 2008). The inability to symbolize or use their imagination, frequently leads them to impulsive enactments (Zulueta, 2006). They tend to believe that their conceptions are real facts and not just ideas. Their thoughts, as well as the way they understand themselves is very specific. They usually believe they were bad children who deserved to be punished. Despite the fact that this shame and guilt could be explained up to a point from their introjected identifications with their bad parents, self-accusation represents a desperate attempt to make a dreadful situation acceptable, otherwise the thought that their parents had wanted to harm them, would be deeply painful (Gabbard, 2006). This means that, in order to explain and justify their parents’ behavior, they persuade themselves that their parents are basically good people who care for their children and the fact that they got to the point of abusing them, shows that they themselves are bad children who deserve such treatment. In 1952, Fairbairn, described the traumatized children’s defensive need for self-incrimination as “moral defense”. According to van der Kolk (1989) there may be an adaptational aspect to this behavior of abuse’s victims as the centre of control is perceived as internal other than external. Through this behavior, traumatized individuals try to gain a sense of control and power towards the reality of total weakness they felt during their traumatic experience, but we could also add that they are struggling to preserve their relationship with their parents. On a deeper level, traumatized individuals, consider themselves to be passive victims (Gabbard, 1997) and suffer from a form of learned helplessness, according to which they think that none of their efforts can change their destiny (van der Hart et al., 1993). Finally, the mechanism of self-fulfilling prophecy which is also reinforced by the broader social environment, (that gaze which stigmatizes the traumatized child/subsequent adult and pins them down to the role of either predator or prey), reproduces a vicious- circle of violence which perpetuates the consequences of abuse itself on the self-image of traumatized individuals and outlines a life succumbed to a fate, from which no escape seems possible.

 

Repetition or repair

 In an old house, there is always listening and more is heard than is spoken.And what is spoken, remains in the room, waiting for the future to hear it. And whatever happens began in the past and presses hard on the future. The agony in the curtained bedroom, whether of birth or of dying, Gathers in to itself all the voices of the past and projects them into the future.

                                                                                                               T. S. Eliot, The Family Reunion, 1969

 

Freud (1920), saw in the repetition compulsion, a way in which the individual tries to handle, control and assimilate a traumatic event or a stressful condition, which, is essentially an unsolved problem for his/her psyche. He connected the repetition compulsion with the impulse of destruction. Russell (see Pomini, 2011), refers to the compulsory repetition as a phenomenon that at once conceals and reveals the existence of older traumas which have severely impaired emotional attachment. According to him, compulsory repetition, represents the scar from the loss of the ability of feeling and comprehending emotional experience. What is repeated, is something painful, dreadful, which the person tries to avoid in every way, yet   unconsciously he tends to repeat it while searching for a solution.

According to the psychodynamic point of view, the repetition of the trauma can be understood as a result of the unconscious identification with the aggressor (Anna Freud, 1936), through which the injured individual, gets an essentially a false sense of control and power. In addition, identification with the abusive parent, justifies in a way the parent’s behavior, implying that the child deserves to be abused, and thus considers himself to be bad and full of hatred; the unbearable emotions are continuously acted out and are either attributed to another person via  projective identification or  lead to self-destruction inclinations (Zulueta, 2006). In such a distorted and confused context of relationships, the trauma is reproduced and repeated from generation to generation, with disastrous consequences on people’s lives, if it is not dealt with in a suitable way.

The intergenerational dimension of the trauma is widely known and has been studied by many therapists and researchers. Abusive parents were usually abused themselves as children (Egeland et al., 1988, Oliver, 1993, Pianta et. al. 1989, Troy and Sroufe, 1987, van der Kolk, 1989). Parents who repeat the abuse on their children do not have representations for their children, cannot think of their children as individuals separate from them, with their own characteristics, nor can they see things from their children’s perspective. Their children are not important to them and the abuse seems to cover a gap of meaning, where the importance of their child should be. It is very frequently observed that maltreated parents, having experienced rage for the early loss of their innocence, take it out on their children and use violence to attack with envy and deprive them of what was snatched away from them in the same way (Grotstein, see Gabbard, 2006). The child who is maltreated by his parent may well be a reminder of the parent’s own unfulfilled need for love and protection, and as a result the child is used as an object of rage and perverse satisfaction (Zulueta, 2006).

A reasonable question at this point concerns the extent to which we are captives of the past and our history and fated to mechanistically repeat our traumatic experiences or whether we can brake free.  Are we able to rework our past and free ourselves from its effect? Or, does our history imposes itself on us and defines us? And if our early childhood experiences determine the formation of our adult self to such an extent, what possibilities of intervention and correction of the negative experiences of our past, does the psychotherapeutic procedure afford?

Next, we will examine some research findings which relate to the theory of bonding and can be used in the context of psychotherapy, in order to help our traumatized individuals break the vicious circles of negative intergenerational patterns and be freed from the adverse effects of their past.

Main and her associates (Main et al., 1985), developed the Adult Attachment Interview, an original research tool that studies the form of the parents’ narratives concerning their childhood experiences, as regards their relationships with their own parents. As this interview has shown, there are differences between the narratives of parents of children with a secure attachment and those of children with an insecure attachment. Moreover, many independent studies have shown significantly consistent correlations between the attachment condition of infants in the strange situation(the well- known experiment of Ainsworth and her associates, where infants’ reactions were studied in the case of separation and reunion) and of that of their mothers in the Adult Attachment Interview(see Holmes, 2009). Interestingly, the Adult Interview can predict fairly accurately, before childbirth the type of emotional bond the parent is going to develop with his/her child (Fonagy et al., 1991). Specifically, as research has shown, autonomous, secure individuals (equivalent to secure children in the strange situation), give clear and cohesive descriptions of their childhood experiences. Their narration is characterized by coherence, contact with the suitable emotion and conceiving realistic perception of the parents, as individuals. The picture they present is relevant to the experiences they narrate and are able to separate their own experience from that of others. They have a positive view of themselves and other people and show trust in relationships. Moreover, it is particularly important that a group of individuals with traumatic experiences as children, were able to contain and narrate them with coherence, without being deluged by them or conversely, evading them, while as parents, themselves they had developed safe emotional bonds with their children. Insecure dismissing – detached individuals (equivalent to children with insecure-avoidant type of attachment in the strange situation), cannot remember much about their attachment relationships and in some cases idealize their parents without being able to support their idealization with specific examples. They often resort to a stereotyped version for themselves and their past, and rationalize any negative emotions. They tend to diminish the importance of primordial attachment relationships and while they show no outward signs of anxiety, they hide anger, solitude and anxiety inside them. Insecure, preoccupied–entangled individuals absorbed with attachment relationships from the past (equivalent to children with insecure ambivalent type of attachment in the strange situation), use an incoherent and disjointed discourse and unconvincing stories. Their main preoccupation is unresolved emotional issues and they seem to be living in the past. They cannot present an organized, cohesive narration and are deluged with charged emotions from which they cannot distance themselves. Finally, disorganized adults (equivalent to children with an insecure-disorganized type of attachment) have undergone traumatic experiences which they have not solved, so when the conversation turns to subjects referring to loss or trauma, they are shaken and their narration seems to be discontinued, fragmented and incoherent.

Secure bonding is thus linked with the parents’ ability to narrate their childhood events and their relationships with their own parents coherently (autobiographic ability), regardless of any traumatic experiences. The trauma itself does not determine the form of narration nor does it preconceive insecure relationships. The individual’s ability to work out the painful events of the past seems to be of key importance. Once the individual has understood what happened in the past, seen the motives of his own parents’ behavior and the difficulties, they faced, and is generally able to talk about his past experiences with coherence and clarity, no matter how  painful  they may have been, without any denial or overflow of emotions, this is an indication of safety and reflective ability,  which, essentially functions protectively and prevents the transmission of insecure attachment relationships to the next generation (Main et al., 1984). A study conducted by Egeland et al.(1988), demonstrated that parents with a history of insecure attachment had formed a relationship of safe attachment with their children. These parents had sought therapeutic aid, had accepted their negative childhood experiences and were emotionally reconciled with them and had formed a satisfying relationship with their partner. Another study (Hunter et al., 1979) indicated that abused mothers, who repeated the abuse on their children, differed from abused mothers who did not behave towards their children this way, in their inability to recognize and acknowledge their own history of abuse. Fonagy and his colleagues (1995) in a study of the emotional bonding between parent and child, noticed that women who had been seriously neglected by their parents in childhood could have children with secure attachment, as long as they had developed the reflective function, in comparison with women of low reflective ability. We would say therefore, that people evolve and are shaped through their relationships in which they are involved. Apart from the effect of the environment and the early experiences on an individual’s formation, the quality of one’s subsequent interactions and relationships is equally important. New emotional experiences, such as the ones provided in the context of psychotherapy via the psychotherapeutic relationship, or even other significant relationships in one’s life, can weaken old fears and dysfunctional conceptions and lead the individual to re-consider and re-negotiate the patterns of relating and thus, the way they conceive themselves and their relationships.

 

Sonia’s story

“What does that mean tame”? “It is an act to often neglected”…. ,said  the fox. “It means to establish ties ….if you tame me, then we shall need each other. To me, you will be unique inall the world. To you, I shall be unique in all the world”. “I’m becoming  to understand”, said the little prince.                                                                                                     

                                                                                                Antoine de Saint-Exupery, The little prince, 1977

 

Sonia came to Greece from the former Soviet Union in 1992 with her husband and her son Michael, who was then four years old. At some point, her husband, formed a relationship with another woman and when their son was sixteen, he abandoned them. Sonia said she had not had a good life with him and was relieved by the divorce although she emphasized, that she would never have left him, herself, because she is not “for” the idea of divorce. Their son, during this period, became reserved and started spending long hours at his computer. Relatively soon afterwards Sonia met Marius, formed a relationship with him and they got married three years later. They turned to the Family Therapy Unit initially as a couple, because of problems and conflicts between them, that stemmed from the relationship between Marius and Michael. Sonia is worried about her son as he remains reticent and seems not to be acting his age. He has neither friends nor a job. The couple therapist, researching Sonia’s personal history, discovered that all four of her siblings had died, and that she, the youngest and the only girl, was the only survivor. Due to the fact that her siblings’ deaths, as were presented through her narration, seemed to be inexplicable, unlamented and unresolved, the couple therapist suggested that she did some personal therapy alongside the couple therapy.

In our personal therapy sessions, Sonia seems to be very kind and dignified. Although she is punctual, I get the sense that she is emotionally absent and only comes, because she was recommended to do so and not because she really needs and wants it. About her siblings, she says that they were not really closed to one another. Their father always told them they behaved like strangers, as if they did not have any emotions for each other. As she says, she cried for their death but she cannot say she misses them. She understands that what happened, cannot change. Her father died from a heart attack in 1998; the first death in the family was that of her third born – brother, in 1982, when Sonia was still back home. He was a student and had gone to spend his summer holidays working at a village in Siberia and was murdered for the money he had raised from his job. Indeed, his body was only found three months later. At the time Sonia had already left home to study English literature. She soon met her first husband, they got married and she gave birth to their son. Her other siblings died in the span of a decade, when she and her family were living in Greece.

As she says, Sonia felt emotionally closest to her father. He was a more giving and tender person than her mother, who is described as cold and uncaring. She used to work very hard in mining and Sonia cannot remember her taking any interest in her children. When Sonia left for Greece, her mother never called to hear her news. She always felt as if she did not exist for her mother, as if she were not her child. When she asked her at some time “why do you behave to me as if I were a stranger”, her mother coldly answered “you have your own life”. When talking about her mother, Sonia seems annoyed; as she says “it does not make sense, I don’t get her at all”. In the last three years, her mother has come over from the former Soviet Union to live with them because of her health problems. Cohabitation creates difficulties to Sonia, her mother sometimes interferes, but Sonia tries to face her with stoicism and remoteness. Sonia has learnt to function by freezing her emotions and needs, dealing with reality through rules and do’s. She remembers her father telling her “we must not keep memories from the past, in life we must keep going forward”. He also advised her to tear up the letters they exchanged. So, after his death, she impulsively tore up all his letters to stop the pain. Strangely enough, in his personal affairs, there was a letter from his own father, whom he had lost prematurely in the war. When Sonia tells her story, I often find myself moved. I have the impression that in her family history, people have learnt to bury deep any painful emotions around unconfessed losses and mourning. I wonder if Sonia is somehow asking to host within me the emotions, she has learnt not to recognize and ignore. In our fifth session, when I ask her to tell me how she feels about our sessions, she says very politely “you give up your time for me without getting paid by me, and that deserves respect……you listen carefully and you make me feel that we we’ve bonded together…….I understand it from the way you behave to me, the way you listen to me, the way you empathize…….I am moved when you are moved, when I tell my story”. Inspite of the effort she makes to control herself, tears roll down her eyes and she says sobbing: “Perhaps I won’t allow myself to bond yet……..it may be easier for me not to, this way you do not get hurt. I won’t let myself open up emotionally”. When I ask her: “Have you ever thought why you avoid it?”…..she tells me impulsively: “It is distressing……I feel like crying all the time…..So many things have happened in my life……all my brothers died, what an unfair destiny to bear…..and my mother, the only person in my family to be alive, acts as if I don’t exist, as if I have died, too. Yet, most of all, I am concerned about my son……he is so reserved….I am worried about him, what’s wrong with him?”.That’s when I get the chance to tell her: “He may be covering up some sensitive and painful emotions, just like you do……he, too, may be silently carrying un-confessed pains, and perhaps not just his own……If you won’t change, why should he?” And our session ends around that point. A crack seems to have opened up and the personal therapy acquires a more personal meaning for Sonia.

 

The therapist as an attachment figure. The significance of the therapeutic relationship.

A good therapeutic atmosphere and the quality of the relationship between therapist and patient, are highly important aspects of the therapeutic procedure. The therapeutic relationship constitutes a secure basis for the traumatized individual to explore his inner world and recognize different aspects of his experience, as well as painful emotions which remained disjointed and unprocessed due to the trauma. The therapist tries to create some space in order to help the patient make sense of his hitherto fragmented and unconnected experiences, so as to incorporate them in the continuity of his story. Like an effective parent, the therapist is available, stable, sensitive to the patient’s needs, conveying the sense that he can understand him, feel him, bear his pain and instill hope. At the same time, the therapist sets some limits and helps him become independent. The therapist plays the role of a “good listener” as well as a “witness”, who confirms the reality of the traumatized individual’s experience (Thanopoulou, 2003), alleviating the pain of the trauma, and using the therapeutic relationship and dialogue, to provide an alternative way of reading and retelling his traumatic story; by taking his emotions and thoughts into account, he helps him build an increasingly  coherent narrative, which provides a satisfying, coherent meaning to his experiences and will gradually allow him to build more positive relationships and experiences.

Taking into account that the experience of the trauma has impacted the patient’s sense of trust and safety, it is evident that the establishment  of a therapeutic relationship will go through many trials and adventures; the therapist, as an attachment figure, may have to deal  with a lot of challenges, from the patient’s side, which he must confront and exploit, by turning them into opportunities for emotional growth and healing of the trauma(on building the emotional relationship and the attendant pitfalls and dilemmas, see Thanopoulou, 2010). In any case, the therapist should be aware of the role he usually assumes towards the traumatized individual (e.g. the role of savior, carer and so on) and must follow up and analyze the emotions the patient shares, so that they can be used to the benefit of the emotional relationship, providing the patient with space for emotional processing and reflection which will help him obtain greater emotional awareness and self-confidence.

 

Myrto’s story

Perhaps everything terrible, is in its deepest being something helpless that wants help from us.                                                                                               

                                                                                                                                 Rainer Maria Rilke, 1995

 

Myrto is an attractive young lady, an architecture school’s graduate who works for a construction company and lives with her father, his second wife and her stepbrother. She has also an older sister who recently got married and gave birth to a baby. At first, I am stuck by the way Myrto tells her life story. She talks sensibly, neutrally, keeping her emotions at bay. She seems to be frozen and reserved. As she admits about herself, she is a person who tries to think carefully because she has made some tragic mistakes in the past. She states that she comes from a family with “loose-disjointed” bonds which broke down and were soon replaced. Her mother, who came from the Middle East, fell in love with another man when Myrto was eleven and abandoned her children and husband, moving abroad. Her father, on the other hand, soon brought home a new wife in her place. The older sister, who was then fourteen, would not accept the advent of a new mother and provoked lots of conflicts and quarrels in the family. Myrto, on the other hand, seemed to be adapting very fast in the new family, trying to act as a counterbalance and taking over the role of the good child that never creates problems. Besides, as it later transpired in her therapy from the processing of her emotions, this acceptance of a new mother reflected a need for warmth and love which seems to have been totally neglected and ignored by her significant others.

Myrto had experienced much rejection and hurt in her family, so she learned to ignore her emotions in order to get by. Her survival strategy was to entrench herself behind the role of parentified child who takes care of the others’ needs, a recovery mechanism which allowed her to experience a false sense of safety, power and control. As she says characteristically, she often undertakes the role of mother out of care but also as confirmation that she is a good and beloved person; she is afraid of letting down others as well as herself.

Myrto’s mother remained in contact with her daughters and they used to spend their summer vacations together. On the phone she always cried for being away from them and wouldn’t stop to allow them to express their own complaints or needs. She is presented as an immature and impulsive person who constituted a negative identification model. She often took her daughters along on her dates with other men and then bought them expensive presents, to buy their silence. She treated her children more like her friends and would not hesitate to discuss sexual matters with them. Myrto feels ashamed of her mother. She never admits to others that her mother abandoned her family for another man. She remembers of the day, her mother left home. Two days before, she talked to her and her sister and told them “I’m thinking of getting divorced from your father, what do you think?” Myrto responded very sensibly and calmly, saying “if you are not happy together, you should get divorced” while her sister was crying and asking her mother to stay.

Her father, on the other hand, is portrayed as absent, serious (in contrast with his wife’s frivolity), busy with his work, rather weak, who always sought a woman’s support. He never had direct and open contact with his children.

Myrto seems to be very confused in her relationships with men. She says “I always start with good if somewhat romantic intentions, but end up, acting in a selfish way, although in fact the decision to leave causes me distress and anxiety”. She recognizes she has had a wild love life with many partners, which is to her a source of concern, shame and guilt. She has always had a voracious need to be noticed and have her narcissism confirmed. Her relationships with the opposite sex, were essentially a quest for what her parental figures had denied her. She wanted to be unique and special. Once someone desired her, she’d want to be with him, too. As Myrto states, her mother relied heavily on her looks and her allure. She, herself, seems to have followed the same pattern. She comes to recognize that in her relationships with men, she was unconsciously becoming her mother, and acting just like her. At times, her mother told her “you are just like me, you won’t be tied down”. It may have been a way, I mirror her in one of our meetings, to keep a special and unique relationship with the mother whom, she had always felt, to be closer to her older sister.

Some six months after the beginning of her therapy, Myrto arrived in one of our sessions, very shaken and upset. She had learnt from a cousin that her mother had worked as a prostitute, before she got married. Myrto’s father knew it but it appears that it did not stop him from marrying her. She wonders about her father and his choice –“what kind of idea did he have for women?” Myrto reports feeling “as if the door of emotions has opened”. Buried memories and emotions emerge. She remembers her mother insulting and attacking her at the slightest provocation. When Myrto had tantrums and cried as a child her mother would yell at her to shut up and sometimes lock her in her room. Her mother was emotionally absent long before she left and sometimes became abusive and incontrollable. Myrto learnt how to control the expression of her emotions and suppress them in order to avoid the pain of rejection from her own mother.

In the following sessions, Myrto, allows herself for the first time, to express her real emotions about her mother’s leaving. She talks about how lonely and sad she felt. She allows herself to cry and realizes that other people protected her from sensitive and painful emotions. In this phase of her therapy, Myrto feels linked to the child she had suppressed and her fears, anger and misgivings come to the surface. At night, as she states, she finds it difficult to sleep and leaves her bedroom door open. Encouraged by her therapist, Myrto makes brave efforts to express her emotions and thoughts. She confesses that she has always behaved timidly and avoided quarrels as she yearned for the warmth and coziness of a home, where peace and love would reign. She was afraid of confrontation and felt too guilty to upset her parents, who had enough difficulties with her sister. She finds the opportunity to express to her father and her stepmother her complaint that they never visited her in the place she spent her years as a student. It was a very difficult time for her, but they knew she always coped and did not pay attention to her. For the first time, she bursts out to her father “no-one ever came to see me, I was the good kid and you trusted me because it was convenient”. Indeed, at some point, she referred to her mother and attacked him, saying “since you knew who she was, why did you leave us to her?” He did not know what to say. He told her they would talk about her mother sometime. He said that he did not throw her out because Myrto and her sister would ask for explanations. Myrto told him that she had been beaten by her mother; he seemed not to believe her. The only thing he accepted was that he did not spend enough time with his children. That evening at dinner, Myrto’s stepbrother who had heard them shout, wanted to know what was going on. The father readily admitted that Myrto had some complaints from the past and was now speaking out instead of suppressing them. The son tried to defend him but the father stopped him; for the first time he seemed to understand and sympathize with his daughter.

Myrto is coming to realize how contradictory her emotions about her mother are. She feels rage, sadness, love and hatred and all these emotions seem to shatter her own self-esteem into pieces, as to certain point she sees herself as a copy of her mother. On the other hand, it is no accident that she feels guilt and shame for herself, sometimes identifying with her mother and sometimes deeply angry with her to the point of rejection, since she sees her mother as a bad influence in her life.

The way she experiences herself and her love affairs, seems to indicate that Myrto carries the guilty, sinful and unprocessed past of her mother. She fears, as she confessed to me, that her punishment for the way she has related to men, will be never to have a lasting relationship. Behind these fears, Myrto carries her mother’s traumatic story, a story of abandonment which tends to be repeated over the generations. Her mother’s family came from the Middle East and when her mother was ten years old, her father abandoned them for another woman. Soon, their mother left, too, and followed another man to Saudi Arabia. Myrto’s mother with her five siblings stayed with their grandmother. Their mother returned after five years with a new child. Myrto realizes that her mother repeated what she had experienced in her own family and wonders if this, is to be her own destiny, too.

In this phase of her therapy, Myrto is struggling to differentiate emotionally from her family and process the painful emotions about her parents. She recognizes that she was an uncared-for child, who lacked the acceptance and warmth of her own people. She has always sought acceptance and recognition and she learnt to care for other people’s needs, in order to get it, neglecting her own. She feels incredible loneliness and pain. She never felt important enough to her parents and this causes her pain and deep hurt. She wonders “are these gaps, inside me, to remain forever?” I point out that very important changes and processes are taking place inside her. Emotions she had learnt to cover through an attempt to avoid pain, are now surfacing. This may be the pain that her parents never had the courage to handle. As she gradually learns to recognize emotions and express them, she feels closer to herself and her needs. It is important for Myrto to reconcile with the feminine part of her identity, to accept it and give it the place it deserves, without being afraid of it or disguising it as aggressiveness; this will enable her to define her femininity in a way which will make her proud of her gender and herself. She does acknowledge that so far, she has managed to process much better the emotions and needs, she tended to dramatize in the past, resorting to ephemeral and shallow relationships, which were supposed to protect her from getting hurt. She feels she has a long way to go, but as she points out, the non-critical look and the accepting attitude of her therapist, relieve her.

 

Narration, meaning and trauma

Storytelling is fundamental to the human search for meaning …each of us is engaged in  inventing a new kind of story.                                                                                                                                                                              

                                                                                                                          Mary Catherine Bateson (1990)

 

The primordial human experience of dialogue, emerges during the first weeks of life as both parent and child engage in an exquisite dance of mutual emotional attunement by means of facial expressions, hand gestures and tones of vocalization (Trevarthen, 1979a). As we have already pointed out, this primordial inter-subjective experience will be internalized as reflective ability, as the child progressively gets to know his inner world, and later, as he develops and grows up, he will be able to express in words what is happening inside him and narrate a story about himself.

Through narration, the individual organizes him/herself, and turns this experience in a story, trying to give coherence and meaning to his experiences and at the same time connect with other people. As he narrates and shares his story, he negotiates and constructs meanings with his interlocutors. Moreover, the experience of how his story sounds can help the initial narrative to change and evolve, uncovering new angles or connections. According to Neimeyer, a coherent narration assures a sense of safety, of purpose and meaning (Neimeyer, 1994) but also is more easily understood by the listener. The form the individual gives to his stories (the way something is said)¹, as well as what he chooses to narrate (the content), are of great importance, since they reveal the way with which the individual defines himself and his relationships.

The trauma, especially when it occurs early and repetitively, surpasses the individual’s abilities to process it in a way that makes sense and allows it to be  incorporated in the continuity of his story, in a picture of self unity. It seems like a ghost which invades and haunts the life of the individual, as it attacks the foundations of his identity and threatens his internal coherence, his ability to conceive reality and his worldview. Traumatic experiences are not organized in a narrative form, but are saved in memory more like fragments of sensations than verbal accounts. They are characterized by confusion, disorganization and the sense that one has stopped still, as if the events occurred without any cohesion. The confusion and the absence of incidental details, makes it difficult for traumatized individuals to comprehend their experiences or talk about them (see Bonanno & Kaltman, 2007).The silence or even the denial which often accompanies the trauma, may protect the individual from mental pain but prevents the processing, the provision of a coherent meaning and as a result the healing of the trauma, isolating the traumatized individual from both him/herself and others.

The telling of the traumatized individual’s story in the context of the therapeutic relationship, once an atmosphere of safety and trust has been established, allows him to explore different aspects of his internal world which had been suppressed or disconnected.

Painful or menacing emotions can be explored with the aid of a therapist who is available and emotionally harmonized, with whom the traumatized individual can share the distress of the trauma. The understanding offered by the therapist, decreases the sense of fear and isolation that often comes with traumatic experiences, relieves the sense of solitude and helplessness; the pain becomes more tolerable and the traumatized individual’s realization that he is finally heard by somebody, reinforces his sense of worth. This procedure creates an environment where the traumatized individual is given the chance to internalize a repairing relationship, as a counterbalance to the initial deprivative, abusive relationships. The traumatized individual gradually learns to recognize and verbalize incontrollable emotions and impulsions, which he had hitherto dramatized, without any awareness of what was going on inside himself. As he encounters his emotions and recognizes them, he gradually obtains more control and responsibility for his own life. According to Cyrulnik (2005), narration allows us to sew back together the pieces of a split ego, as by sharing his story the traumatized individual, gains his place in the world of humans. To talk about the trauma is to convert passivity into action. Narration resembles play in that repetition gives the narrator control over a situation which occurred against his will. Through the action of narration the helpless prey turns into a capable narrator (Wollenstein, see Jannot- Bulman, 1992), who retells or rewrites his autobiography giving meaning to his trauma and turning pain and suppression into a story of healing and integration of the trauma (also see Thanopoulou, 2012).

Through the therapeutic procedure, the traumatized individual gets in touch with his experience’s hidden impact and realizes how many behaviors and emotions come from past experiences and his family history. Holmes (2001, describes this stage as “coming to terms with one’s ghosts”. The traumatized individual may go on to feel rage towards his parents for the way they behaved to him, recognizes grievances and deficiencies on their side, which affected his growing up in a negative way and tries, in every way to make use of the therapeutic procedure, to diminish the effects of the past in the hope for personal growth and development. As Holmes (2001) puts it, this is the stage of exterminating the ghosts. Then, the traumatized individual is called upon to  forgive his parents to some extent, recognizing that they, too, had been the victims of some other parents and seems to emotionally recognize the difficulties his own parents have probably faced. According to Holmes (2001), this is the stage of reconciliation with the ghosts. The therapeutic process helps the traumatized individual to gradually obtain a sense of personal participation in his life, form his story and realize that everything that is happening inside him is neither accidental nor due to powers out of his control; and if he once experienced situations over which he had no control, as an adult, he has choices and the ability to act. As he breaks free from the hidden effects of his history, the way he conceives internal and external reality and his relationships, becomes more personal and conscious and he takes over more responsibility for the course of his life.

The narration that the traumatized individual builds during therapy, contains also the internalization of his therapeutic relationship. The therapist’s gaze, availability and empathetic response, his presence in the painful journey of the therapy, but also the creation of the appropriate atmosphere for the unhindered expression of emotions -both painful and aggressive- so that they can be managed on the part of the traumatized individual- all these parameters shaped jointly by the therapist, the patient and perhaps other parties as well (intrapersonal or even interpersonal) help the traumatized individual gradually reinstate coherence in his story and his life.

 

Epilogue

In conclusion, it is evident that neglect, premature loss of close emotional bonds and abuse, constitute serious traumas, which impact people’s ability to form emotional attachments and invest their life experiences with cohesive meaning. Under these circumstances, the therapeutic relationship, a deeply human relationship, may provide the context in which the traumatized individual’s experiences will be recognized rather than dismissed, as it happened with his/her parents. We would say, indeed, that the power of psychotherapy consists in its ability never to confirm the traumatized individual’s traumatic scenario of relationships, but provide, through the on-going relationship with the therapist, new possibilities to process, think and experience the events of his/her life and hence the new narration for his history. The containment and the coherent meaning of traumatized individuals’ traumatic experiences, may constitute a repairing, empathetic experience, which may then be internalized and lead to an internal sense of safety, allowing them to go on living, beyond the limits and restrictions of a  traumatic past and thus be better able to participate in the shaping of their own story.


¹ In a qualitative research, in which we examined the narrative form of client’s stories  (Androutsopoulou et. al., 2004), we found that the clients’ emotionally charged issues – about the past and their childhood experiences as well as the present and  their  relationships as adults –  were expressed as stories with a low degree of coherence. In cases of safer topics, their stories had a higher degree of coherence. The aspects of coherent narratives were codified as it follows: (1) acknowledgment of contradictions and acceptance of any discrepancies as something “human”, (2) in touch with emotions (reference to a broad variety of emotions without avoiding or diminishing their importance), (3) flexible, non-dogmatic, non-critical, “systemic” thought of the  individual which considers other people’s points of view and makes him assume responsibility for his choices, (4) acknowledgment of the audience’s needs, in terms of following the narrative and registering emotional reactions. It is noted that the criteria used to evaluate the coherence of narratives, as they came up in this specific research, have a lot in common with the Adult Attachment Interview.

 

Bibliography

Akister, J. and Reibstein, J. (2004). Links between attachment theory and systemic practice. Journal of Family Therapy, 26: 2-16.

Allen, J.G., Fonagy, P.(2002). The development of mentalizing and its role in psychopathology and psychotherapy. Topeka, KS: Menninger Clinic, Research Department.

Allen, J.G., Fonagy, P.,& Bateman, A.(2008). Mentalizing in Clinical Practice. Washington: American Psychiatric Press.

Androutsopoulou, Α., Thanopoulou, Κ., Economou, Ε., Bafiti, Τ. (2004). Forming criteria for assessing the coherence of clients’ life stories: A narrative study. Journal of Family Therapy, 26: 384-406.

Antoine de Saint-Exupery (1977).The liitle prince. Athens: Lihnari [Greek edition].

Bartholomew,K., Kwong,M.J & Hart,S.D.(2001). Attachment. In W.J. Livesley (Ed.), Handbook of Personality Disorders: Theory, Research and Treatment. New York: Guilford Press.

Bateson, M. C. (1990). Composing a Life. New York: Atlantic Monthly Press.

Bion, W. (1978). Second Thoughts. London: Heinemann.

Bonanno, G.A., & Kaltman, S. (2007). The supposed necessity of processing traumatic memories. In P. R. Duberstein & J. M. Μasling (Εds.), Psychodynamic Perspectives in illness and health. Athens: Typothito [ in Greek] .

Bowlby, J. (1988a). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.

Bowlby, J. (1995). The making and breaking of affectional bonds.Athens:Kastaniotis [Greek edition].

Bowlby, J. (1949a). The study and reduction of group tension in the family. Human Relations, 2: 123-8.

Byng-Hall, J. (2008). The crucial roles of attachment in family therapy. Journal of Family Therapy, 30: 129-146.

Byng-Hall, J. (1995). Rewriting Family Scripts: Improvisation and Systems Change. New York and London: Guilford Press.

Byng-Hall, J. (1999a). Family and couple therapy: toward greater security. In J. Cassidy and P. R. Shaver (Eds.), Handbook of Attachment: Theory, Research and Clinical Applications. New York: Guilford Press.

Charalabaki, K., Kati, A., Thanopoulou, Κ. (2012). Demeter and Persephone: Mother – Daughter Conjoint Family Therapy. Electronic Journal Systemic Thinking and Psychotherapy, (HESTAFTA), issue 1.

Cramer B. (1999).Women’s secret. From mother to daughter. Athens: Kastaniotis[Greek edition].

Cyrulnik, B. (2005). The sensitive self. Athens: Libanis [Greek edition].

Dallos, R. (2006). Attachment Narrative Therapy: Integrating Systemic and Narrative Approaches. Maidenhead and New York: Open University Press.

Dallos, R. &Vetere A. (2009).Systemic therapy and Attachment Narratives. London: Routledge.

Egeland, B., Jacobitz, D. B.,&Sroufe, A. (1988). Breaking the cycle of abuse. Child Development, 59: 1080-1088.

Eliot, T.S. (1969). The complete Poems and Plays of T.S. Eliot. London: Faber and Faber.

Erdman, E. and Caffery, T. (2003). Attachment and Family Systems: Conceptual, Empirical, and Therapeutic Relatedness. New York and Hove: Brunner- Routledge.

Fairbairn, R. (1952). Psychoanalytic Studies of the Personality. London: Routledge & Kegan Paul.

Fonagy, P., Steele, M., Steele, H., Leigh, T., Kennedy, R., Mattoon, G., & Target, M. (1995). Attachment, the reflective self, and borderline states: The predictive specificity of the Adult Attachment Interview and pathological emotional development. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental and clinical perspectives (pp. 233-278). New York: Analytic Press.

Fonagy, P., Steele, M., Steele, H., Moran, G., & Higgins, A.(1991). “The capacity for understanding mental states: the reflective self in parent and child and its significance for security of attachment”. Infant Mental Health Journal, 12: 201-18.

Fonagy, P. (1991). Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient. International Journal of Psychoanalysis, 72 : 639-56.

Fonagy, P., Steele, M.,& Steele,H. (1991). Mental representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Development, 62: 891-905.

Freud, S. (1920). Beyond the pleasure principle. In James Strachey (Ed.),The Complete Psychological Works of Sigmund Freud, Vol.18, 3-64. London: Hogarth Press.

Freud, A. (1936). The Ego and the Mechanisms of Defense. London: Hogarth Press.

Gabbard, G.O. (2006). Psychodynamic psychiatry in clinical practice. Athens: Vita [Greek edition]

Gabbard, G.O. (1997). Challenges in the analysis of adult patients with histories of childhood sexual abuse. Canadian Journal of Psychoanalysis 5: 1-25.

Gergen, K.J. (1985). The social constructionist movement in modern psychology. American Psychologist, 40 : 266-275.

Gergen, K.J. (1994). Realities and relationships. Cambridge, MA: Harvard University Press.

Glasserfeld, E. (1987). The construction of knowledge. Seaside, CA: Intersystems Publications.

Hoffman, L. (1988). A constructivist position for family therapy. Irish Journal of Psychology, 9: 110-129.

Holmes, J. (2009). John Bowlby & the attachment theory. Athens: Ellinika Grammata [Greek edition].

Ηolmes, J. (2001). The search for the Secure Base. Attachment Theory and Psychotherapy. East Sussex: Brunner- Routledge.

Hughes, D.A.(2007). Attachment-Focused Family Therapy. New York: W.W. Norton & Company.

Hunter, R.S.&Kilstrom, N. (1979). Breaking the cycle in abusive families. American Journal of Psychiatry, 136:1320-1322.

Thanopoulou, Κ. (2003).”Terata kai metamorfosis. H varia klironomia enos mistikou somatikou simptomatos. In  Ch. Kataki & Α. Androutsopoulou (Eds), Me goma kai kathrefti: Enea Istories Sistimikis Psihotherapias. Athina: Hellinika Grammata.

Thanopoulou, Κ. (2010).H simasia tis therapeftikis sxesis stin therapeftiki antimetopisi enilikon epizonton seksoualikis kakopoiisis.Dinatotites kai periorismi.Metalogos, issue 21: 77-97.

Thanopoulou, Κ. (2012).A murder, a funeral and an unresolved traumatic grief. Electronic Journal Systemic Thinking and Psychotherapy, (HESTAFTA) , issue 1.

Janoff-Bulman,R.(1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press.

Johnson, S. M. and Whiffen, V. E. (Eds) (2003) Attachment Processes in Couple and Family Therapy. New York and London: Guilford Press.

Manolopoulos, S. (2004). H prosvasi tis miteras sto psihismo tou vrefous. Psihologika themata, 10, issue 1-2: 19-29.

Main, M., Kaplan, N.,& Cassidy, J. (1985).Security in infancy, childhood, and adulthood: Αmove to the level of representation .In I. Bretherton & E. Waters (Eds.),Growing points of attachment theory and research (Monographs of the Society for Research in Child Development, Vol.50, Serial No.209, Nos. 1-2). Chicago : University of Chicago Press.

Maturana,H., & Varela, F. (1980). Autopoiesis and cognition: The realization of living. Boston: D. Reidel.

Main, M., & Goldwyn, R. (1984). Predicting rejection of her infant from mother’s representation of her own experience: Implications for the abused-abusing inergenerational cycle. Child Abuse and Neglect, 8, 203-217.

Neimeyer, R.A.(1994).The role of client generated narratives in psychotherapy. Journal of Constructivist Psychology, 7: 229-242.

Oliver, J., E. (1993). Intergenerational transmission of child abuse: Rates, research, and clinical implications. American Journal of Psychiatry, 150, 1315- 1324.

Pianta,R., Egeland, B., & Erikson, M. (1989). The antecedents of maltreatment: results of the Mother-Child Interaction Project. In D. Cicchetti and V. Carlson (eds), Child Maltreatment: Theory and research on the causes of and consequences of child abuse and neglect. New York: Cambridge University Press, 158-74.

Pomini, V. (2011). Diageneaki Metadosi tou Traumatos: Psychodinamikes enies se Sistimico Plaisio. Metalogos, 19: 48-61

Rilke Rainer Maria (1995).Letters to a new poet . Athens: Ikaros [Greek edition].

Siegel, J.D. (1999). The Developing Mind. New York: The Guilford Press.

Thomassin, P. (1993).Anazitontas tis rizes. Apo ton kosmogoniko mitho sto prosopiko paramithi.Athina: Kedros.

Trevarthen, C. (1979). Communication and cooperation in early infancy. A description of primary intersubjectivity. In M. Bullowa (Ed.), Before speech the beginning of human communication. Cambridge, England: Cambridge University Press.

Troy, M. & Sroufe, L.A. (1987). Victimization among preschoolers: role of attachment relationship history. Journal of American Academy of Child and Adolescent Psychiatry, 26 : 166-172.

Van der Hart, O., Steele, K., Boon, S. & Brown P.(1993). The Treatment of Traumatic Memories: Synthesis, Realization, & Integration. Dissociation, 6(2/3): 162-180.

Van der Kolk(1989). The compulsion to repeat the trauma: re-enactment, revictimization and masochism. Psychiatric Clinics of North America, 12: 389-411.

Zulueta, F.de (2006). From pain to violence. The traumatic roots of destructiveness. New York: John Wiley & Sons, Ltd.