Dissociation : Volume 10, No. 4, p. 203-213 : Abreaction: baby or bathwater?
Chefetz, Richard A.
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Chefetz, Richard A.
Abreaction refers to the discharge of pent-up affect through spoken language that relieves pathogenic intrapsychic tensions which are residua of trauma (Laplanche, 1967; Moore, 1990). This definition is inadequate and mired in Freud's early models of the mind, both the hydraulic and topographic models, and nineteenth century models of hypnosis. Abreaction may more usefully be defined as the verbal or non-verbal expression of intense affect, which when associated with a coherent narrative of experience, may provide relief of chronic anxiety states. Affect is the centerpiece of experience. It is the prime contextualizer of meaning. Ego mechanisms of defense all alter the meaning of experience in an effort to reduce threats to psychological equilibrium. The destruction of context and meaning via dissociative adaptations is an effective and primitive mechanism of protection from both external impingement and internal conflict. Isolation of affect (Freud, 1955), is a dissociative process. It is important to understand that dissociative phenomena do not bypass ego functions. Post-traumatic adaptations may include a profound secondary alexithymic state. This may seem hidden in the wake of powerful affective storms. The affect-phobic nature of the person prone to abreaction is a major impediment to treatment. The primary task of treatment is stabilization of the patient prior to "working through" the sequelae of trauma. The mid-phase of treatment may involve continued psycho-educational efforts to identify and name affects, the use of "dream-rules" in the interpretation of abreactive narrative, and a utilization approach which welcomes affect into the treatment setting in a safe, skilled environment. Management of countertransference responses to avoid enactment which could lead to boundary violations is essential.