ABSTRACT
The definition of the word trauma, in a psychological sense, combines internal experience and external events: it suggests helplessness, and an event that confronted us with a realistic threat to our life or personal integrity. This chapter talks about a caseload of patients with the severe character pathology of so-called post-traumatic stress disorder. It is easy to criticize colleagues who have lost their way in the treatment of severely traumatized patients. The desirable patients accept life and want to make changes so that living can be extra gratifying and enhance the capacity for joy. The therapists’ task is to find the insight such patients need to transform their perception of life into an expedition worth attempting. Sexual boundary-violations occur for a variety of reasons, and the mismanagement of a traumatized patient is only one of them. Therapists may experience the patient’s nightmares, and indeed their suicidal ideation, as threats or attacks on their competence, as ultimate narcissistic injuries.
