Early Relational Trauma and the Development of the Self

Tomás Casado-Frankel is faculty and supervisor in the Child & Adolescent Psychotherapy Training Program at the William Alanson White Institute. He is a graduate of that program and its psychoanalytic program. He is also a graduate of the Couple & Family Therapy program at the Universidad Pontificia Comillas, in Madrid, Spain, and holds a postgraduate diploma in Conflict & Dispute Resolution Studies from Trinity College Dublin, in Ireland. He is in private practice in New York City.María Eugenia Herrero holds specialities in Psychiatry (Madrid), Forensic Psychiatry (Madrid) and Family Psychotherapy (Tavistock Clinic/San Pablo CEU, London & Madrid). She founded Project Sirio in 1998, and was the director of its two therapeutic communities for twenty-two years. The Project treats children and adolescents who have histories of severe neglect and/or abuse. Many have attachment related difficulties or disorders, and exhibit traits of, or at risk of developing, borderline personality disorder. She is in private practice in Madrid, Spain.

• 1. Introduction, 1.1. Attachment disorder, 2. Therapeutic accompaniment, 3. The budding bond, 3.1. The construction of an attachment: defining the relationship, 4. First trimester's wait: who are we?, 4.1. The guiding-accompanying-generating a wish for treatment dance, 4.2. The relationships of confusing affects, 5. Second trimester's wait: where do we come from?, 5.1. The therapeutic accompaniment system as a fluctuating space, 5.2. Work outside the therapeutic setting, 6. Third trimester's wait: problems in communication, 6.1. Traps and paradoxes of abuse: the communicative significance of play, 7. Autumn: crisis as danger and opportunity, 7.1. Times of crises and the dilemmas of adoption-foster care, 8. Winter: silent speech, 8.1. Appearances of a different nature: the surrogate family, 9. Spring: responsibility and freedom, 9.1. Angsty freedom, 10. Creating a time of our own: China and Pandora's box, 10.1. Chinese culture: an experience beyond the culinary, 10.2. The disintegrating environment, fears and flights to other worlds, 11. Running out of time: where to now?, 11.1. In search of a dynamic equilibrium and the new technologies, 11.2. Towards a reparative attachment, 12. Individuation and autonomy, 12.1. Separation, attachment and time to stop

This book is a case study of a pregnant teenage girl in Madrid and the therapeutic educator who accompanied her. The broader context is of attachment disorder, borderline personality disorder, adoption, immigration, and abuse, as the girl succumbed to and fought against the lure of prostitution and exploitative men. Dedication, humor, roleplaying, metaphor, and presence characterized over two years of hard work. Simultaneously the book is a primer in relational and systems theory. Lyrical, emotional, personal, and gripping, the story is of successful therapeutic work with intensely painful feelings.Daniel Gensler, PhD., William Alanson White Institute, New York, NY.This book is an original and outstanding contribution to the psychotherapy of troubled adolescents. Casado-Frankel and Herrero have written a richly detailed, deeply empathic, and unusually self-reflective account of intensive therapeutic work with a traumatized adolescent girl. It is both an engrossing story and an insightful meditation on the ambiguities, interpersonal nuances, and potential rewards of this difficult and uncertain work. Readers of this book will come away, as I did, with a deeper understanding of the complex, malignant effects of trauma in the lives of children and how, with time and patience, therapy can be a healing process.Kenneth Barish, PhD., Clinical Professor of Psychology, Weill Cornell Medical College. Author, How to Be a Better Child Therapist: An Integrative Model for Therapeutic Change. This book is a noteworthy and creative contribution to the burgeoning clinical literature on treatment of early relational and intergenerationally transmitted trauma. The authors demonstrate and integrate a discussion of early relational trauma as relevant to work with international adoptees, cultural complications, and the psychoanalytic developmental theories upon which the Accompaniment Model is based. De-mystifying theory while bringing to life the complexity of this work, the struggles of a young therapist attempting to maintain a reflective stance during a stormy journey make this a worthwhile read for novice and sophisticated therapist alike. Susan C. Warshaw, EdD, ABPP, Editor in Chief, Journal of Infant, Child and Adolescent Psychotherapy.