Epidemiological studies have revealed high rates of criminal victimization in the general community as well as in treatment seeking populations. As a consequence, many crime victims present with a broad range of psychological and physical health impacts which exceed far beyond the current conceptualization of posttraumatic stress disorder. Accordingly, the current project aimed at an exploration of the complex problems faced in the context of severe interpersonal violence, using a mixed methodological design within a pragmatist paradigm. The first study (n=58) involved a quantitative exploration of the psychological and physical health problems in victims of crime as compared to a normally stressed community sample without a history of traumatization. Psychological impacts were assessed by standardized psychological measures, whereas influences on physical health were captured by an analysis of biochemical markers that reflect stress- related changes in immune functioning. Once impacts on psychological and physical health were established, a second study (n=17) was conducted to gain a better understanding of individual stress conceptualizations. This study involved a qualitative framework analysis of semi-structured interviews with victims of crime. The results from Study I and II informed the development of a phase oriented psychological treatment program for victims of crime, using cognitive-behavioural and hypnotherapeutic treatment components. This was followed by an outcome –and process evaluation of a combined CBT/Hypnotherapy treatment in comparison to a CBT treatment only to explore additive benefits of hypnotherapy. Although a multiplicity of traumatic sequelae was indicated by the results of the preceding studies, the treatment process revealed an even greater complexity of traumatization which was difficult to accommodate in the proposed treatment program. Moreover, twelve out of nineteen participants discontinued treatment, making it difficult to determine the additive benefits of hypnotherapy. A qualitative analysis of the treatment sessions was conducted to elucidate critical treatment variables with a particular emphasis on the differences between treatment completers and non-completers. The results were interpreted with respect to recently suggested theories and associated treatment approaches such as the Theory of Structural Dissociation (Van der Hart, Nijenhuis, & Steele, 2006) which may better accommodate the needs of complex trauma survivors encountered in a real world clinical practice. Furthermore, the challenges associated with interventions and treatment evaluations involving a highly complex clinical sample such as victims of crime are discussed in light of the current debate on evidence-based practice and the dilemma of providing reliable, methodologically sound evidence without compromising internal validity of the treatment. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1347975 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

Epidemiological studies have revealed high rates of criminal victimization in the general community as well as in treatment seeking populations. As a consequence, many crime victims present with a broad range of psychological and physical health impacts which exceed far beyond the current conceptualization of posttraumatic stress disorder. Accordingly, the current project aimed at an exploration of the complex problems faced in the context of severe interpersonal violence, using a mixed methodological design within a pragmatist paradigm. The first study (n=58) involved a quantitative exploration of the psychological and physical health problems in victims of crime as compared to a normally stressed community sample without a history of traumatization. Psychological impacts were assessed by standardized psychological measures, whereas influences on physical health were captured by an analysis of biochemical markers that reflect stress- related changes in immune functioning. Once impacts on psychological and physical health were established, a second study (n=17) was conducted to gain a better understanding of individual stress conceptualizations. This study involved a qualitative framework analysis of semi-structured interviews with victims of crime. The results from Study I and II informed the development of a phase oriented psychological treatment program for victims of crime, using cognitive-behavioural and hypnotherapeutic treatment components. This was followed by an outcome –and process evaluation of a combined CBT/Hypnotherapy treatment in comparison to a CBT treatment only to explore additive benefits of hypnotherapy. Although a multiplicity of traumatic sequelae was indicated by the results of the preceding studies, the treatment process revealed an even greater complexity of traumatization which was difficult to accommodate in the proposed treatment program. Moreover, twelve out of nineteen participants discontinued treatment, making it difficult to determine the additive benefits of hypnotherapy. A qualitative analysis of the treatment sessions was conducted to elucidate critical treatment variables with a particular emphasis on the differences between treatment completers and non-completers. The results were interpreted with respect to recently suggested theories and associated treatment approaches such as the Theory of Structural Dissociation (Van der Hart, Nijenhuis, & Steele, 2006) which may better accommodate the needs of complex trauma survivors encountered in a real world clinical practice. Furthermore, the challenges associated with interventions and treatment evaluations involving a highly complex clinical sample such as victims of crime are discussed in light of the current debate on evidence-based practice and the dilemma of providing reliable, methodologically sound evidence without compromising internal validity of the treatment. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1347975 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / "May 2007" Includes bibliographical references (leaves 199-209).

Thesis (M.A.)--Brigham Young University. Dept. of English, 2005. / Includes bibliographical references (p. 73-74).

Inledning: Ett psykiskt trauma kan ibland medföra utveckling av dissociativa symtom. Syfte: Studien undersökte vad som varit betydelsefullt för psykoterapeuten i det psykoterapeutiska arbetet med patienter med trauma och dissociation. Metod: En kvalitativ studie valdes. Fem legitimerade psykoterapeuter intervjuades, alla med lång erfarenhet av traumaterapi och psykodynamisk terapi. Resultat: I denna studie menar informanterna att trauma och dissociation är ett underskattat forskningsområde och betonar vikten av diagnosen, enkel PTSD och dissociativa störningar. Informanterna beskriver sina erfarenheter och svårigheter av att arbeta med traumatiserade och dissocierade patienter.  Den terapeutiska ramen står för trygghet och stabilitet men också gränssättning i det terapeutiska kontraktet. Informanterna indelar det psykoterapeutiska arbetet i 3 faser: Stabilisering, bearbetning och integrering. I terapeutrollen belyser Informanterna att det är särskilt viktigt med egenvård, kompetensutveckling, handledning och andra stödfunktioner vid arbete med patienter med trauma och dissociation.  Informanterna beskriver hur de påverkas starkt känslomässigt och kroppsligt i sitt terapeutiska arbete. Traumatisk överföring och motöverföring betonas som en viktig del som informationskälla för att kunna föra processen framåt vid traumabehandling. Slutsatser: Framgångfaktorer vid traumabehandling är att blanda olika teorier och tekniker som anknytningsteori och terapier som i, EMDR, hypnos och symboldrama men även kroppsterapi som integreras med psykoterapi. Psykoterapeutens roll har stor betydelse för att föra fram arbetsprocessen. Kroppsliga och starka överföringar och motöverföringar sker i mötet med dessa patienter, de tar ofta med sig skräckupplevelser in i terapirummet som måste härbärgeras av psykoterapeuten.

Les événements d’Auschwitz, d’Hiroshima et du 11 septembre 2001 ravivent un questionnement ancien sur le pouvoir du langage, ainsi que sur la responsabilité et les modes du témoignage. Tenter de dépasser les interdits de la représentation dans ce contexte historique relève d’un acte de résistance envers tous les préceptes linguistiques, éthiques, épistémologiques ou politiques. Écrivains juifs-américains séculiers et polymorphes, Paul Auster et Jerome Rothenberg redéfinissent le réel grâce à l’imagination, à la mutation du medium et au dérèglement des sens dans leurs textes défigurés. S’inscrivant dans la rupture d’après 1945, ils recherchent une voie détournée, un langage premier et organique dépassant l’inadéquation du signe et l’impulsion iconoclaste. S’inspirant d’un héritage juif diasporique et mystique, des avant-gardes européennes et américaines, du transcendantalisme, du rituel archaïque ou encore du poststructuralisme, ils contribuent au renversement des images mythiques issues de la spéculation sémiotique. Le trauma ne peut être dit, mais se crie, la présence s’écrit dans la répétition et dans la rencontre de l’infini, le cœur de l’œuvre se dévoile dans l’excentration et l’excentricité de la lettre pétrifiée. Dire l’indicible, c’est se taire et écouter la mort qui sommeille dans l’ombre du verbe, dans le silence d’une musique naissante ; c’est rêver éveillé, se remémorer les pulsions et les cauchemars enfouis ; c’est accueillir une non-langue conjuguée à contretemps dans une grammaire du désastre. Traduire une parole qui ne dit rien et qui ne peut être comprise, telle est la contradiction qui informe ces écrits en souffrance. / Auschwitz, Hiroshima and September 11, 2001 revive the ancient issues of the power of language and of the responsibility and modes of testimony. Trying to overcome the taboos and restrictions of representation in this historical context is a matter of resistance against all linguistic, ethical, epistemological and political precepts. Paul Auster and Jerome Rothenberg are multi-faceted secular Jewish-American writers who redefine the real thanks to the imagination, thanks to medium mutation and the derangement of the senses in their disfigured texts. Coming within the scope of the post-1945 breakdown, they seek a roundabout means, a primal and organic language overcoming the discrepancy of signs and the iconoclast impulse. Drawing from a diasporic and mystical Jewish heritage, from the European and American avant-gardes, from transcendentalism, from archaic ritual and postructuralism, they contribute to bringing down the mythical images shaped by semiotic speculation. Trauma cannot be said, but the wound is voiced in a scream. Presence writes itself in the repetition and the discovery of infinity. Depth is unveiled by a whirligig of nameless sticks and stones. Speaking the unspeakable means keeping quiet and listening to the death that sleeps in the shadow of the word, in the silence of a new song. It means daydreaming, recollecting repressed drives and nightmares; cradling a no-tongue conjugated in a grammar of the disaster. Translating a word that says nothing, that cannot be understood, such is the contradiction which informs these pending works of pain.

Varje år suiciderar 800 000personer världen över. I Sverige 2016 avled 1 129 personer till följd av suicid. Efter ett suicid är det ett stort antal närstående som lämnas kvar. Ett suicid kan av närstående upplevas traumatiskt och leda till en stor sorg och ett enormt lidande. Syftet med denna litteraturstudie var att beskriva närståendes upplevelser av att en anhörig suicideraroch tiden därefter. Studiens resultat bygger på en kvalitativ innehållsanalys med manifest ansats där narrativ i en bok har analyserats. Detta resulterade i tre kategorier: Att nås av beskedet och söka förklaringar; Att klandra sig själv och känna skuld; Att det är viktigt att få dela sin sorg med andra och få stöd. Närstående har ett behov av stöd och tröst, både professionellt samt från vänner och familj. Sjuksköterskan kan hjälpa dessa personer genom att lyssna och identifiera deras styrkor och behov, på så vis kan närstående erbjudas rätt hjälp och stöd.

[pt] A tese tem o objetivo de desenvolver um estudo acerca do trauma e de seus efeitos sob uma perspectiva dinâmica e não meramente econômica, como tem sido o caso de muitos estudos no campo da psicanálise até os dias de hoje, tendo como referência a observação clínica de atendimentos psicanalíticos prestados a policiais militares na cidade do Rio de Janeiro. Assim, além das noções de Schreck (susto) e de excesso de estímulo pulsional apresentados por Freud em 1920 para explicar o trauma a partir de uma invasão energética do aparato psíquico, incluiremos nesta pesquisa o papel do supereu, cuja imposição de gozo – masoquista – a serviço da pulsão de morte pode levar à compulsão à repetição do trauma. O trauma, que deve ser entendido como um esfacelamento das fantasias sexuais, faz com que as referências subjetivas estruturantes caiam por terra, processo que leva à sensação de aniquilamento psíquico, daí a idéia de que resta um corpo estranho no psiquismo. Identificado com o morto, o que gera um estado depressivo que ameaça a sobrevivência do sujeito traumatizado, ele pode se encontrar num estado melancólico ou até num estado paranóico, sem que seja um psicótico; visto que a ação superegóica de castigar e espezinhar o eu, que pode inclusive levá-lo a completar a ação não finalizada (morte), pode ser atribuída a um Outro (perseguidor), quando em realidade, esta ameaça é interna, como será mostrado em alguns casos clínicos. / [en] The thesis has the objective of developing a study concerning trauma and its effects under a dynamic perspective and not merely economical, as it has been the case of many studies in the field of the psychoanalysis since now, taking as reference the clinical observation in psychoanalytic services rendered to the Military Policemen in the city of Rio de Janeiro. Besides the notions of Schreck (fright) and of an excess of energy invasion presented by Freud in 1920 to explain the trauma, we will include in this research the role of the superego, whose imposition of a masochist enjoyment at the service of the death drive can lead to the compulsion to repetition of the trauma. If we understand trauma as the shattering of the sexual fantasies, it causes the subjective references to dismount, a process that leads to the sensation of psychic annihilation. That is the reason of the idea that a strange body remains in the psyche. Identified with the dead, a position that generates a depressive state that endangers the subject s survival, he can fall in a melancholic state or even in a paranoid state, without being a psychotic; because the action of the superego of punishing and trampling on the ego, taking him to complete the inconcluded action (death), can be attributed to a pursuing Other, when, in reality, this threat is internal, as it will be shown in some clinical cases.

[pt] Esta dissertação tem como objetivo a análise e articulação dos conceitos de trauma, repetição e pulsão de morte em Freud, embora algumas contribuições de psicanalistas pós-freudianos também sejam consideradas. A riqueza dos conceitos em questão se apresenta pelo seguinte paradoxo: ao mesmo tempo em que testemunham um limite do aparelho psíquico, lançam para o trabalho. O que motiva essa pesquisa, portanto, é justamente a indagação sobre as vicissitudes destes limites - limite do psiquismo e da representação, com o intuito de problematizá-los. Pois é preciso pensar sempre em uma dupla potencialidade do que se apresenta como limite: por um lado potência de abertura e por outro, agente de fechamento. Não queremos com isso diminuir a importância da representação no trabalho analítico como objetivo essencial, mas apontar para a importância da valorização e discriminação de modos de trabalho do psiquismo que não o trabalho representacional, buscando enfatizar a importância da negatividade para a o enriquecimento e complexificação do psiquismo. / [en] The purpose of this thesis is to analyse and articulate the concepts of trauma, repetition and death drive in Freud, although some contributions of post-freudian psychoanalysts will also be considered. The richness of these concepts can be sustained by the following paradox: they witness a limit of the psychic apparatus, at the same time that lances it for work. What motivates this research, therefore, is precisely the question about the vicissitudes of these limits - limits of the psyche and representation, in order to discuss them. One must always think about a dual capability that presents itself as a limit: one for the power of opening, and the other as a closing agent. This is not to diminish the importance of the representation in an analytical work as an essential goal, but to point out the importance of the valuation and discrimination of other working modes of the psyche rather than a representational work, in order to emphasize the importance of negativity for the enrichment and complexity of the psyche.

Trauma preparedness of medical care of a particular region represents the professional core of public health emergency preparedness. The key subjects are medical rescue service and hospital service provider. Current legislation imposes the providers of medical service with duty to work out the trauma plan which covers the system of activities used if some mass disaster happens. Topic of this diploma thesis focuses on trauma planning, specifically on mass health damage and on knowledge mapping and medical staff orientation in trauma plans and preparation on not common accidents with great number of wounded. I focused on non-medical staff of the regional emergency rescue service and the regional hospital. I focused on their knowledge and orientation in terms of trauma preparedness of the given subject. The theoretical part serves as a base for the research. It is split into chapters which deal with pre-hospital necessary care, co-operation of the integrated rescue system members and procedures of participating rescuers- mostly medical staff. I paid more attention to the terminology of mass health damage and separation of wounded at the place of an accident. I also described the subsequence of medical care at medical facilities. While searching for the level of preparedness of subjects for an uncommon accident I used the method of data comparison. There I focused on comparison of trauma plans of two subjects: the regional hospital and the regional emergency rescue service and I was researching the level of co-operation of both subjects based on the similarity of the trauma plans. In the second part I was mapping the medical staff knowledge of the trauma plan directive via quantitative research, for that purpose I used the survey. The respondents had to circle the correct answer. The questions were modified and applied to directives of both trauma plans. The respondents were non-medical workers of emergency rescue service in CB and non-medical workers of the hospital of CB. I tightened the workers of the hospital to trauma emergency staff and the resuscitation department staff. The survey consists of 28 questions. Five of it had rather an information character, they were searching for: the sex, age, years of praxis, education and a grade. The rest 23 were used for the statistic research. Those questions dealt with the theory presented in directives of both subjects. The received information I worked out in the chapter results. The comparisons of trauma plans were presented at charts. The survey was evaluated by nonparametric testing and a chi-square test of a good match.