Between Pleasure, Destruction and Protection: Instinct Theories in Treating Trauma and Dissociation
Freud’s theory of instincts and attachment theory are often perceived as oppositional approaches. Most crucially, the two theories differ on the question of whether trauma originates from inside the psyche, as a product of internal conflict between innate instincts (psychoanalysis), or is a result of external assault from which the person was not adequately protected by another person (attachment theory). For clinicians and researchers in the field of trauma and dissociation, such disagreement can appear completely unbridgeable.
Despite their differences, however, the two theories have much in common, not least their emphasis on the biological, instinctual basis of our complex mental life, a basis which shapes normal as well as traumatic development. Indeed, the two approaches are part of a ‘lineage of ideas’, with a gradual shift of emphasis from the primary focus being on the instincts (internal, biological forces) to greater focus placed on the objects (the people or things the instincts strive towards); from object to the Self, and from fantasy relationship to the crucial importance of the actual relationship with the attachment figure. Moreover, we will later see that the attachment instinct can hold within it rather a lot of the pleasure as well as the destruction instincts.
At the core of this talk will stand a common but very difficult clinical problem in our field: that of the dissociative survivor of severe childhood trauma who continues to suffer physical harm, sometimes many years into their therapy. The harm appears to be caused by people in their lives, by some inexplicable ‘propensity for accidents’, or by their own hands, through various forms of self- harm. Typically, survivors’ experience is that this just ‘happens to them’. The vexing question is why.
Searching for a clinical answer, we may suspect this is the work of an instinct- which will explain the tenacity of the phenomenon as well as the inability of the person to explain it. We will use the lenses of the three instincts: The dual classical psychoanalytic instincts towards pleasure and towards destruction, and the one towards protection, the attachment instinct. Each of these lenses will contribute a unique layer of meaning to this phenomenon, and with it additional insights towards treatment.
Potential to Distress: No
At the conclusion of this presentation, participants will be able to:
- Explain the relationship between classical psychoanalysis and attachment theory
- Identify the pleasure, destruction and attachment instincts in clinical setting
- Use the understanding of instincts in clinical practice
- Recognize when harm to the person and obstruction to therapeutic progress are caused by instinct-led behavior
- Respond to instinct behavior using instinct language
Presenter: Adah Sachs, PhD
Presenter Bio: "Adah Sachs PhD is a UKCP reg. Psychoanalytic Psychotherapist and a member of the Bowlby Centre. She worked for decades with adults and adolescents in psychiatric care, was a consultant Psychotherapist, forensic clinical lead and clinical supervisor at the Clinic for Dissociative Studies, and headed the NHS Psychotherapy Service for a London borough at Goodmayes Hospital (now retired).
An ISSTD member since 2008, she was one of the founders of the RA/MC (now OEA) SIG and served on several committees, including two terms on the Board of Directors. She currently serves on the Scientific Committee and is moderator of the Psychoanalytic – Psychodynamic SIG.
Adah lectures, teaches, assesses and supervises worldwide on attachment and dissociation. She is the author of over 200 training days, conference papers, journal articles and book chapters, including a co-edited Special Issue of the JTD and three co-edited books. Her main theoretical contribution is outlining sub-categories of disorganized attachment associated with trauma-based mental disorders. She is a Fellow of the ISSTD.
- 1.50 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
- 1.50 ASWB ACEThe International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved as ACE providers. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. ISSTD maintains responsibility for this course. ACE provider approval period: 08/20/2021 – 08/20/2024. Social workers completing this course receive 1.50 continuing education credits.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program.