Phase 2

This chapter provides an overview of the central psychodynamic techniques of the middle phase of TFPP. Core intrapsychic conflicts that contribute to PTSD symptoms are identified and actively addressed. Interpretation of defenses aids in the elucidation of conflicts. A prominent defense in PTSD, identification with the aggressor, is described in more depth. Exploration of the transference is discussed with attention to the ways in which core conflicts emerge with the therapist. Patients with PTSD trigger particularly intense countertransference reactions, knowledge of which furthers the therapeutic process. The technique of working through is articulated, in which the therapist and patient elucidate how various conflicts and defenses emerge across a range of symptoms, contexts, and relationships. Case vignettes are used to illustrate these approaches.

Identification With the Aggressor and Inward and Outward Aggression in Abuse Survivors

Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors’ aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator’s experience, identifying with the perpetrator’s aggression, and replacing one’s agency with that of the perpetrator were significantly associated with survivors’ inward and outward aggression. Moreover, profile type—that is, having high versus low levels of identification with the aggressor—was implicated in participants’ SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others.

Knowing the Abuser Inside and Out: The Development and Psychometric Evaluation of the Identification With the Aggressor Scale

Identifying with the aggressor is a process wherein victims of abuse, particularly during childhood, take on their perpetrator’s experience. The victim defers to the perpetrator and adopts the perpetrator’s experience, learns the perpetrator’s desires and needs, and gratifies them. Although the clinical and theoretical literature suggests that identification with the aggressor occurs in the aftermath of abuse and has negative long-term implications, to date this concept has not been empirically investigated. To facilitate an exploration of this subject, the current study evaluated the psychometric properties of a new measure: the Identification With the Aggressor Scale (IAS). The study was conducted among convenience samples of students using online surveys. In Study 1, the IAS was administered to 318 students. In Study 2, the IAS, and a battery of questionnaires assessing features of abuse, dissociation, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic guilt were administered to a convenience sample of 368 students. Four reliable IAS factors emerged from Study 1: Adopting the perpetrator’s experience concerning the abuse, identifying with the perpetrator’s aggression, replacing one’s agency with that of the perpetrator, and becoming hypersensitive to the perpetrator. In Study 2, a confirmatory factor analysis confirmed the scale’s underlying factor structure. A history of childhood abuse, recurrence and severity of abuse, and the perpetrator being a parental figure were all associated with higher IAS scores. In addition, IAS scores were correlated with dissociation, PTSD symptoms, and posttraumatic guilt. The present findings indicate that the IAS has good psychometric properties, making it useful as an assessment tool in future research.

Silence is violence: psychic trauma and its working-through

One hundred years ago Freud set mourning against melancholia in the belief that endured losses leads to depression. However, it is not only unmourned grief, but unworked-through violence that leads to destruction and enables the victim the possibility of ridding themselves of unbearable psychic pain. The solutions to this predicament are different; from identification with the aggressor to turning this pain against himself, resulting in depression, self-injuries, and suicide. This article illustrates the principle at three different, but interrelated levels: personal, familial, and social. It suggests that not only individuals or families resist mourning, but that multiple generations in different countries may not be able to complete the working through of these traumas. This may lead to constant re-enactment of the scenario and strangles development.