Disintegration of the self and the regeneration of "psychic skin" in the treatment of traumatized refugees

This paper presents a tentative understanding of the characteristics of the extreme traumas, elsewhere called “complex PTSD”, that refugees and asylum-seekers bring into therapy. It suggests that these kinds of traumas suffered during adulthood may involve a disintegration of the self and a loss of “psychic skin”. This conceptualization is derived from the treatment of a refugee who survived multiple extreme traumas and with whom efforts were made in therapy to identify a complex methodology making use of supplementary, therapeutic tools in addition to individual psychotherapy. The case demonstrates how the disintegration of the self implies not only a deep somato-psychic dissociation but also a loss of intrapsychic and interpersonal space. In the treatment this was worked through via repetition of victim-aggressor dynamics at multiple levels. In the end, the therapeutic context was structured like a set of concentric layers, creating a “bandage” over the patient’s wounds whilst his “psychic skin” was able to regenerate. The conditions triggered by extreme traumas in refugees challenge some of the cornerstones of individual psychoanalytic technique as well as the idea that individual therapy exists in an environmental vacuum.

Keywords: dissociation; extreme trauma; psychic skin; refugees; self; victim-aggressor complex

Monica Luci, La disintegrazione del sé e la rigenerazione della "pelle psichica" nella terapia dei rifugiati traumatizzati in "STUDI JUNGHIANI" 49/2019, pp 17-37, DOI: 10.3280/jun1-2019oa7888