How the Therapeutic Relationship Is Critical to Heal Trauma

In Part 1 of this series, I described the concept of Identification with the Aggressor as developed by psychoanalyst Sándor Ferenczi (1949). In Part 2, I discussed how it can help us understand many of the adult consequences of childhood trauma. Identification with the Aggressor is a relational phenomenon with a profound impact on our psyche. In order to feel safe, we mold ourselves to the needs and expectations of those who abused or neglected us. By “identifying” with someone else’s image of us, we dissociate from our own needs, wishes, and from a sense of self and agency while internalizing our Aggressor and a deep sense of shame.

In this article, I will discuss how psychotherapy can help disentangle the complexity created by the dynamics of identification, internalization, and dissociation. These unconscious processes will unavoidably become part of the therapeutic relationship, which provides an opportunity to work through these relational wounds from the inside out. Within the framework recognized by most complex trauma experts (e.g., Cloitre et al., 2012), these relational dynamics would likely play a central aspect in the phases of processing, re-appraisal, and integration of traumatic experiences.

How trauma enters the relationship with your therapist

Patients tend to have a hard time disagreeing, confronting, criticizing, or expressing anger, hurt, or disapproval toward their therapist. Ferenczi (1949) considered this as a way in which past relational trauma, through Identification with the Aggressor, enters the therapeutic relationship: “Patients have an exceedingly refined sensitivity for the wishes, tendencies, whims, sympathies and antipathies of their [therapist]. Instead of contradicting the [therapist] or accusing him of errors and blindness, the patients identify themselves with him” (p.226).

Recognizing and appreciating this process can be challenging for therapists because it requires us to be willing to be experienced as potential “aggressors” by our patients, as an “other” whose needs and wishes can feel subjugating. This collides with the attributes therapists aspire to embody: genuinely attuned, empathic, caring, selfless, or healing. I believe our personal investment in this kind of self-representation might, at times, promote idealization, envy, and shame in our patients, leading to a repetition of past traumatic experiences.

In this way, the therapeutic relationship can become a setup for a re-enactment of Identification with the Aggressor, as our patients might “feel they must collude with the [therapist’s] mask of goodness” (Frankel, 2004). Efforts to “connect” with our patients, such as bending the boundaries of the relationship, engaging in reflexive self-disclosure, or feeling rushed to provide the advice they seek, can be equally problematic. These attempts often stem from the therapist’s own anxieties and needs. Acting on them is a form of prioritizing them, leading to a potential enactment of identification with the Aggressor dynamics.

Ferenczi was ahead of his time by suggesting that, instead, therapy provides a space where the here-and-now experience of the therapeutic relationship can and should be interrogated and explored. This can help our patients develop trust and, over time, the ability to experience previously dissociated states in a new relational context.

The therapeutic relationship as a stage for repetition and healing

The therapeutic relationship has been established as a main factor of change (see Norcross & Lambert, 2018). Ferenczi and psychoanalysis as a whole encourage us to consider this broadly, beyond finding ways to collaborate, support, and empathize with our patients. A therapist working relationally through trauma must not only recognize the importance of early relationships, but also be willing to examine their own feelings and reactions and explore the depths of their own dissociated, troubling states in the service of their patient’s healing.

The process will also likely involve ongoing experiences of rupture and repair with the therapist, of meeting and missing each other at times. Misattunements, conflicts, and enactments inevitably emerge sooner or later since the process of identification with the Aggressor does not work perfectly: “Behind the submissiveness or even the adoration,” Ferenczi (1949) writes, part of the child will hold “an ardent desire to get rid of this oppressive love.”

Working through complex trauma in therapy goes beyond mastering skills, achieving self-regulation, or gaining insight into the past. Bringing back and processing older memories is, at times, less the point. The “memories” that may matter most are not episodic fragments of our past we might be able to recall but procedural and implicit memories, intrinsically linked to the person we became and how we relate to ourselves and others. As Freud (1914) noted, repeating unconscious and deeply rooted patterns from the past is a form of remembering.

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As a result of identification with the Aggressor, the “other” will be “repeatedly experienced as an ever-present threatening aggressor” (Gurevich, 2015). The therapist is an “other” who will potentially be experienced in a similar way. This is not a problem in itself but a necessary part of the therapeutic journey. Therapists who are not open to considering this can happen between them and their patients, assuming that their relationship is somehow exempt from the pressures of history and trauma, do so at their own peril and to the detriment of the people they work with.

However, therapy can help because the therapist might also become an “other” who is able to hold the patient’s experience and reality, while acknowledging and grappling with their own. It behooves the therapist to own up to their own struggles, challenges, shortcomings, mistakes, failures, vulnerabilities, and retraumatizing potential through this process. Whether we openly discuss this with our patients or not is a separate question, but we must be open to feeling disturbed by what we find within ourselves if we are to connect with our patient’s disturbed states. It is through the therapist’s ability to recognize and hold their patients’ and their own experience that the possibility of offering something new is created.

Therapy is not only about linking past events to present experiences or about imagining a different future with a renewed sense of hope and agency. It is also a space where two minds can meet, confront, and survive the deeply familiar, even if unconscious, fear of breakdown, disaster, and annihilation. This requires the therapist to truly join their patients in their dissociated despair, dread, and desire. This genuine joining and deep witnessing, while potentially disturbing for both parties, can afford our patients the experience—perhaps for the first time—of not having to hide or become someone they are not.