THE COMPLEX NATURE OF EXPOSURE TO EARLY CHILDHOOD TRAUMA IN

When an intense transference relationship evolves during psychoanalysis, sensory and emotional experiences associated with trauma can arise spon-taneously. Detailed clinical process material is presented from the psycho-analysis of a six-year-old boy whose severe trauma at age two and a half contributed to his conflicts about aggression and gender identity, impeding his development. A series of analytic sessions during which he spontane-ously enacted fantasies, feelings, and defenses associated with the trauma in the immediacy of the transference relationship are used to illustrate how psychoanalysis provided him the safety to rework this overwhelming expe-rience and its aftermath, thereby restoring progressive development. It is hypothesized that while work with trauma was only one feature in an otherwise complex treatment, psychoanalysis provided a sophisticated form of reexposure to developmentally primitive emotions, images, and fan-tasies that this child had not consciously connected with the trauma. Asso-ciated early childhood conflicts pertaining to aggression, separation, and gender identity, warded off with rigid defenses, had become intertwined with the trauma and its aftermath, rendering them otherwise inaccessible. A t age two and a half, Carlton was standing just inside the doorway of a Chicago apartment building when, out in the street, his eight-year-old brother Mark was shot and disabled. When I met Carlton at the age of six, I wondered what part this had played in his difficulties and how I could best help him