THE UNBEARABLE AGONY OF BEING - INTERPRETING TORMENTED STATES OF MINDIN THE PSYCHOANALYSIS OF SEXUALLY TRAUMATIZED PATIENTS

This article focuses on the clinical importance of the disturbing tran sference-countertransference matrix in the psychoanalysis of patients whose ego development was decisively influenced by early, traumatic se xual abuse. Dissociative defensive operations and ''automatic'' identi fications are emphasized in accounting for the sadomasochistic and oth er characteristic features of the ''traumatic'' transference-countertr ansference ambiance. Two clinical vignettes depict the analyst's need to take his or her own disturbing experience as an object of analytic examination, while illustrating how ''here-and-now'' transference cues are used to interpret the patient's efforts to cope with overwhelming , traumatized states of mind. (Bulletin of the Menninger Clinic, 61 [4 ], 495-519).