Psychopathology I: Neurotic-Level Character and Symptom Disorders

Second Year Adult Psychoanalytic Training (APT)
2022-23, 3rd Trimester — Fridays, 1:45-3:15pm
Michael Pauly, MD
Kelly Lippman, LMHC

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April 28, 2023 — Trauma and Its Implicit Level Re-enactment

[38 pages]

Khan first walks the reader through a history of the conceptualization of anxiety, ending with the emphasis of the subjective experience of helplessness being at the center of all trauma. Heavily influenced by Winnicott, he then turns his attention to the “mother as protective shield”, which he says constitutes the “average expectable environment” for the anaclitic needs of the infant. He proposes that breaches in the protective shield (failures in the environment) achieve traumatic status cumulatively and in retrospect and that the failures, occurring at the pre-verbal stages of the mother-infant relationship, are not seen directly but rather are observed in the derivatives of the child / adult patient’s implicit mental processes and relational styles.

Fosshage is paired with Khan to offer a contemporary way of working with the implicit memory system and relational style (derivatives of the pre-verbal experiences) of the patient. He stresses that patients need help with both the autobiographical scenarios of the explicit memory system and the mental modes of the implicit memory system, as each contributes to the sense of self, other, and self-with-other.

Khan, M.M.R. (1963). “The Concept of Cumulative Trauma.” Psychoanalytic Study Of the Child, 18:286-306.

Fosshage, J.L. (2004). “The Explicit and Implicit Dance In Psychoanalytic Change.” Journal of Analytic Psychology, 49:49-65.