From Resistance to Realization: Integrative Psychotherapy Approaches with Challenging Trauma Patients
Many chronically traumatized patients experience protracted crisis, distress, dysregulation, and confusion, all of which can be transmitted to the therapist. They present with a paradoxically chaotic and rigid organization of personality and self. We will explore the protective nature of resistance, particularly with those who have developed enduring personality strategies to avoid or otherwise ineffectively cope with painful inner experiences and relational ruptures. We do not always respond at our best when confronted with a patient’s humiliated fury, entrenched shame, profound dissociation and disavowal, demands and needs, regression, entitlement, sadomasochism, unbearable suffering and loneliness, emptiness and numbness, extreme avoidance and silence, jealously and revenge, intense self-injury and suicidality, etc. Even seasoned therapists can become overwhelmed and find it difficult to remain grounded, present, and effective with their most challenging patients. This lecture will address integrative approaches to the highly “resistant” trauma patient. We will examine different types of resistance and integrative approaches to address them. We will consider strategies to “join the resistance” with the patient, inviting him or her to become a participant-observer with us. This approach supports development of regulation, mentalization and integration. The importance of a collaborative rather than care-giving attachment model will be described. Finally, we will examine the challenges of remaining relationally engaged with these patients, attentive to our own defenses, but not embedded in them.