Knowing Terrible Things: Engaging Survivors of Extreme Violence in Treatment

Survivors of extreme violence can be difficult to engage in treatment. Often this is caused by a sense of isolation drawn from the belief that no one who has not shared their experience can comprehend it. The only others who know what they know are those who have died of the violence, fellow survivors and the perpetrators. The clinician attempting to treat such patients may be placed in a dilemma: how to convey the capacity to know terrible things without being destroyed by the survivor, while at the same time not conveying that one is dangerous oneself. This paper suggests a method of utilizing unconscious aggressive fantasy to access the capacity to convey to the survivor that it is possible to hear, understand and contain violent experience. Case illustrations indicate how such capacity might be conveyed, so that a treatment alliance can begin. [PUBLICATION ABSTRACT]