Treatment of Stress Response Syndromes by Mardi J. Horowitz

Author:Mardi J. Horowitz
Language: eng
Format: epub, mobi

tity experiences may result. The more the person has coherent linkages of multiple self-schemas into supraordinate schemas, the more continuous will be that person’s sense of identity over time. The less the integration before the trauma, the greater the possibility for chaotic identity experiences in the posttraumatic period.

Role Relationship Models

Identity experiences are associatively primed and supported by current relationship experiences. Associations of self with other can be captured as a role relationship model. Such a model forms a cognitive map of the attributes, characteristics, and scripts of potential transactions of self and other. Scripts include future plans of self-intentions to move toward desired possible future identities and away from dreaded ones.

In associative processing, the possible meanings of a trauma are compared with each organized schematization of self in a relationship. Some people fear that usually latent schemas of personal vulnerability may be activated because of associative linkages of the actual vulnerability of self with the stressor events. If these dreaded schemas have not been previously attenuated by supraordinate schemas that can contain and diminish them, a regressive decompensation may occur. For example, an adult who has recently endured a traumatic experience may become especially distressed if the roles of a similar childhood trauma have never been mastered. Conversely, if those roles were mastered, the adult may adapt resiliently.

Role relationship models can be formulated for each salient state of mind (desired, dreaded, problematic, and protective). Doing so is valuable because the models are predictive of possible transference reactions that may complicate the therapeutic alliance. Such reactions are based on both positive and negative expectations. An illustration of an expanded configuration related to the states already discussed is shown in Figure 4-3.

As shown in Figure 4-3, the most dreaded state is one of intrusive horror. In terms of a negative transference expectation, the patient sees him-or herself as a helpless victim and the therapist as a powerful aggressor who mercilessly requires the patient to recount the story of the traumatic event, repeatedly subjecting the patient to an unwanted reliving of memory. The expectation is that the patient will express all of his or her vulnerabilities experienced during the trauma, will then be attacked by the therapist for not expressing his or her memories better or fully enough, and will experience terror at having to endlessly repeat a story that is so disturbing. Although this is not a rational expectation of a therapy situation, the traumatic repetition can be an unconscious expectation. For example, a victim of a rape assault may unconsciously expect that the therapy, in and of itself, will somehow represent a repetition of the rape—in effect, penetrating the patient’s mind by forcing him or her to talk about some of the physical acts.

A less intense negative transference expectation can occur in the problematic compromise state, one of anxious hypervigilance. In this state, the patient may self-identify as a needy victim who is making demands for help but expects that the therapist will be an inexpert or inconstant helper who will fail to meet his or her needs.

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