Trauma and the Transition to Parenthood

This paper examines some psychoanalytic ideas about trauma and how the experience of trauma may impact on the transition to parenthood. The following will examine some of Freuds ideas about trauma, then consider some more recent psychoanalytic developments, including those relating to identity formation and the development of the capacity to think. The transition to parenthood, looking at pregnancy, birth, and the development of the capacity to be a parent, will be explored, using some clinical examples. In conclusion there will be some consideration of how trauma can impact on the capacity for the development of parenthood.


**Trauma **

Trauma can occur as a single event, or it can be an accumulation of events, and these can vary from a sudden unexpected event, to many incidents, which are insidious and ongoing. The effect of the trauma will depend on ones subjective, emotional experience of the event, as well as the result of the event, say for example the loss of a loved one, which will have long-term effects on the persons immediate environment.

Traumatic situations can also occur because of unmanageable emotional pain and anxiety. Some events, because of their meaning, can overwhelm a person, even though they may seem small to an external observer. Other events would generally be regarded as traumas and can vary from wars to earthquakes: from trauma on a global scale to trauma at the level of the family, including early bereavement, illness, domestic violence, and the abuse of children (Garland, 1998).

Freud

Freud was originally very interested in the idea of external trauma. He came to understand that trauma was created by the effect of the event on the mind. In 1893 in his paper On the Psychical Mechanism of Hysterical Phenomenon, he wrote: Any experience which calls up distressing affects such as those of fright, anxiety, shame or physical pain may operate as a trauma of this kind.

In his paper Thoughts for the Times on War and Death (1915), Freud addressed the subject of death and mans attitude to it. He outlined that even in loving relationships there is some ambivalence and a feeling of unconscious triumph in the survivors mind. The guilt of survivors who have experienced traumatic events is a further complication to the pain of loss and can impede the process of mourning. This mourning must include the loss for the mourner themselves, whose world has been ruptured and who then has to deal with the loss of his former life and identity.

In his great paper Mourning and Melancholia (1915), Freud wrote about the difficulties in mourning that can take place when the mourner turns away from the painful work of grief, perhaps because of the pain of guilt, and instead identifies with the dead loved one. Turning away, and refusing to acknowledge the loss, can create a descent into melancholia, or what we would today call depression.

In a later paper, The Ego and the Id, written in 1923, Freud described how the ego could, by dividing into parts, take part of itself as its own object. Freud based his structural theory of the mind on the concept of introjection (or internalisation). He described how external objects are taken into the mind and incorporated there, where they are added to by internal phantasies. For example the super-ego can develop a cruel nature because of inner destructiveness that is added to, or projected onto the figures that have been internalised.

Karl Abraham further developed Freuds ideas when he described how his patients had an internal world into which objects could be taken or from which they could be expelled. Introjection was the process by which the object (person) from the outer world was taken in and became a phantasised object in the inner world. Projection was the process of expulsion from the inner to the outer world (Hinshelwood, 1994).

Melanie Klein developed Karl Abrahams ideas of the existence of internal objects in the unconscious mind. She described an inner world made up of internal objects that existed in complex and dynamic relationships to one another. Klein described a process of projective identification, which she first identified in children, in which, for example, bad parts of the self are projected into the other (a person in the external world). In 1946, she said: In so far as the mother comes to contain the bad parts of the self, she is not felt to be a separate individual but is felt to be the bad self(p.8) There is a continuous interplay between internalisation and externalisation in the mind: i.e. between introjection and projection.

Klein also described alternating states of cohesion, the Depressive position, and disintegration, the Paranoid Schizoid position, which exist from the beginning of life. In the paranoid schizoid position the self and the object (the other person) are split, into good and bad elements. This is a way of preserving the good mother from the angry destructive feelings of the infant. Violent and destructive impulses can be projected outward; however the infant is then threatened by these frightening figures, which appear to be attacking him from the outside (Klein, 1946).

If development occurs normally and the mother appears unharmed after absences and subsequent angry attacks by the infant, he can then feel reassured. Over time he will come to feel that his attacks have not destroyed the mother whom he also loves. With this kind of continuing reassurance, the infant can gradually come to develop a good object inside and integration can occur. He can recognise his attacks and feel guilt and a desire to make good by restoring the other through reparation. This step towards the Depressive position requires the ability to bear the pain of guilt and sadness about the attacks that have been made (Klein, 1940).

However a different picture may develop when negative experiences take place in the mother-infant relationship. For example if the mother is depressed or has a mental illness, the baby may fear that his attacks have harmed his mother, and destroyed his external world and himself. In this case there is no good-enough whole mother to reassure the baby and integration will become difficult. The baby may be left with an inner world of damaged or dying objects.

An understanding of the persons internal world can help us to understand difficulties that may arise for someone who has experienced early trauma and who must in later life adapt to the task of parenthood. When the internal world is populated by objects that are dead, damaged or persecuting, the effects can be especially problematic to the persons expectation of relationships and will shape the development of the parent-child relationship. The person who is now a parent may expect the baby to be difficult or even persecuting, for example never giving the parent any space, making endless demands.

The baby may be seen as damaged or damaging, and the parent may reject the child, or mourn for the damage to the hoped-for ideal baby. This will be described later with clinical examples.****

Identifications and the development of identity

Donald Winnicott, a pediatrician who later became a psychoanalyst, wrote about the development of mothering or parenting and about the babys experience of being parented. He stated that in most situations, as the new parent has had the experience of having been parented, there are memories of that experience from which they can draw to help them care for their newly born baby. He described how a childs identity is influenced by progressive identifications with his/her mother, father, siblings and extended family, and their ability to relate to one another (Winnicott, 1988).

He described how traumatic experiences such as the loss of a parent, seduction, incest, mental or physical illness and other major changes in the familys life would negatively influence the development of the growing childs identity formation. How the child would be affected by such traumatic events would be determined in part by the parents reactions as well as the reactions of other close family members or the reactions of significant others (Winnicott, 1988).

In situations of trauma the affected person may identify with the aggressor as a way of dealing with feelings of helplessness and anxiety, in order to develop a feeling of mastery over the traumatic or frightening situation. An example of this might be of a child who was bullied at home by her frightening older sibling who may herself become a bully in the school playground. Children who were mistreated by their parents may grow up and mistreat their own children in the same way.

Survivors of trauma may become preoccupied with rescue fantasies or driven by a desire to rescue others. Part of this may be a wish to protect others and repair the damage that was done to them. The survivor may also wish to project their own feelings of helplessness, pain, shame and guilt into others (Srinath, 1988).

A young man, who was depressed and had a past history of having an abusive violent alcoholic father, came for therapy, due to symptoms of abdominal pains and his fear that he might harm his own children. He could not imagine feeling safe within himself or how he could ever create a safe, loving environment for his family. He had internalised a violent inner father who could not be trusted to maintain self-control. One day, he saw a man punishing his child in the street. Unable to control himself, he assaulted the father in such a rage that the police had to be called (Srinath, 1988).

He had identified with the child who was being threatened, and this aroused intense anxiety. As a result of his anxiety, he could no longer contain his own aggression, his violent inner object, which was then projected onto the father.

Feelings may be avoided by denial of the experience in an attempt to wipe out the event or minimise its impact. Bettleheim (1952) wrote: Every denial requires other denials to be able to maintain the original one and every repression, to be continued, demands further repression.

Trauma and its influence on the capacity to think

Bion (1962) wrote extensively about the development of the capacity to think. According to Bion the baby needs to be in a secure environment, where the mother/parent is open to her babys feelings and can help to emotionally transform the babys experience. In this way the baby is helped not only to deal with states of distress or overwhelming feelings, but also, in time, to find a way of dealing with these states on his own. In other words he will learn to think for himself and process his own emotions. Bion described the mothers open state as maternal reverie, and the process as one of containment of experience.

Bion (1962) described Beta elements, which are raw, unprocessed emotional states such as anxiety, fear, terror and dread. Beta elements are transformed by containment into Alpha elements, which are in potentially thinkable form.

When the mother cannot deal with her babys difficult feelings, there is a state of lack of containment and the baby can suffer a feeling of being dropped - a feeling akin to terror of annihilation, which Bion called nameless dread(Bion 1962, p. 116).

When maternal function is fragile or otherwise inadequate, monstrous aspects of the mind cannot be transformed by reverie and can be amplified. If Beta elements cannot be transformed, they may be evacuated by excessive projective identification, for example the person become violent or may indulge in perverse behaviours. If unprocessed emotional experience is projected into others in the persons life, they may be experienced as dangerous, inferior, even hated (Ferro, 2002).

Professor Joan Raphael-Leffs paper The Presence of Absence describes the way in which traumatic experience, such as loss, which cannot be processed, can become encysted in a psychic geode, a radically sealed space within the psyche. The existence of such an enclosed space may inhibit symbolisation and psychic growth (Raphael-Leff, 2002).

The development of symbol formation

Using Bions concept of maternal containment, Hannah Segal wrote that good-enough maternal containment was necessary for development of the capacity to symbolise. In symbolic thinking the symbol stands for something, but is different from it. Using symbols events can be thought about, dreamed about, worked on and eventually transformed in a number of ways (Segal, 1978).

However after trauma symbolic thinking may become damaged or lost. Then the symbol no longer stands for something, it becomes the thing in itself. Thinking has become concrete. Mind-body separation may develop with a preoccupation about bodily states (Garland, 1998).

The following example shows how trauma may lead to the development of a symbolic equation instead of symbolisation. A patient who had survived being caught in a fire, where a number of people were killed by smoke inhalation could no longer leave the house when the weather was foggy. While part of her knew that it was fog, and not smoke outside, another part of her mind felt that it really was smoke. She then had to protect herself from the smoke/fog by stuffing cracks in the door with towels. In her mind the fog no longer stood for smoke; to her it was the smoke (Garland, 1998, p111).

After the experience of trauma, verbal communication can be lost. To utter the words relating to the trauma is felt to re-experience the trauma. Survivors of the Holocaust often could not describe their experiences to their children, who in many cases knew little of their parents life at that time. Only much later when oral histories were taken by historians, and the parents were able for the first time to speak of their experiences, did the children learn what had happened to their parents.

In psychoanalysis the patient can be helped by the experience of containment and understanding, as much as this is possible. Hopefully this will lead to the development of a capacity to think in a different way and to contain difficult feelings without needing to evacuate them.

Developing the capacity to parent

We can think of parenthood as a rite of passage, a developmental crisis that leads to greater maturity. It is a process that begins early in someones history, in ones personal experience of being parented. In so far as this has been a satisfactory experience, a certain capacity for understanding has been developed. Through being known and loved, through the experience of empathy, the future parent has learned some of the essential elements of being a parent. The new parent-to-be has hopefully developed symbolic thought and a capacity to put aside his/her immediate needs in the interests of caring for a baby. Having had the experience of a containing parent, the new parent can connect with an internal object that can deal with and contain the infants fear and distress when this occurs.

Pregnancy allows a time and space for the development of parental thinking to take place. Pregnancy can be viewed as a normative crisis of development that offers, to quote Bibring, an opportunity to work through unresolved conflicts from earlier phases of development (Bibring, 1961) such that a transition to parenthood can be accomplished.

The commitment to parenthood is a lifetime decision. Motivations are multiple and complex. For example, a woman may wish to recreate her baby experience with her own mother by becoming pregnant and re-living the state of fusion with her future child. The woman experiences the physical and emotional changes in a very direct way, and at an emotional level the future father is also very much affected.

Initial exhilaration at discovering the pregnancy may mask unconscious anxieties. Intense nostalgia for union with mother may exclude the role of the father.

In men, positive motivations, including the desire for increased maturity, and a wish to develop his potential, may alternate with a fear of expressing his femininity. In some men there is a fear of letting go of the ideals of adolescence.

During pregnancy a number of transformations take place throughout the three trimesters, and I will briefly describe the trimesters, with examples of difficulties created by experiences of trauma.

In the first trimester,** **bodily changes are subtle, including morning sickness, aversion to or cravings for certain foods, fatigue and mood swings. Some women describe the sensation of having an illness without being sick. Some women feel reassured by the ability to become pregnant, to create a new life together with their partner. They feel capable and that their body is functioning normally. In relation to states of integration vs non-integration, the pregnant woman is reassured that she is a good person, who deserves to have something good in her life. However, when there have been experiences of trauma, difficulties can occur in relation to being able to feel good within and in feeling deserving of a good and creative experience.

The following is a clinical example:

Mrs E had an early childhood characterised by early parental separation. Her mother re-married and had three further children and insisted that E look after her step-siblings. Her mother saw in E a reminder of her good-for-nothing father, a trait that mother tried to beat out of E. E felt unloved, even hated by her mother who saw the worst aspects of her hated ex-husband in her child. Despite this, E was able to develop a loving and nurturing relationship with the youngest of her step-siblings.

E married when she was 20 years of age to a man 20 years older than herself. At 21 she became pregnant. At first she was ecstatic; however by the third month of pregnancy she began to vomit and realised that she did not want to have the baby. She started to take antihistamine tablets and tranquillisers against the advice of her doctors.

She felt that her baby was an alien invader, taking her over from the inside. Her husband provided a constant source of love and support, and was able to help her through this difficult period (Anthony and Benedek, 1970).

In the second trimester the mother becomes aware of fetal movements. Some describe this as the feeling of a butterfly within. This is often a period of fulfilment and delight for the pregnant woman. Erickson spoke of the sense of a vital inner potential. The body begins to change shape. Some women are proud of their physical capacity, while others may feel concern at the loss of youth and beauty.

Often the woman turns inward, and this may affect the relationship with her partner. She seeks the connection with an internal mother, who will guide her in the development of her capacity to mother her child. If she cannot locate this internal mother, or the internal mother is in a sickened, disabled or worse, a dead state, serious problems may arise. There may be a fear of making contact with the inner life, a fear that knowing about something frightening will immediately translate into action. For example when a child is brought up in a home characterised by violent and impulsive behaviour he/she may grow up to be afraid of knowing about their feelings, as feelings are followed by uncontrolled behaviour. This can be a serious problem in parenting, as the parent must connect with their babys state of mind, to help them to survive and grow emotionally.

Mrs D had to take care of her infant brother when she was eight years old. At times she felt so enraged and jealous that she hit him, causing bruising. On another occasion she remembered allowing her cousin to place a pillow over the babys face. When she became pregnant, and her husband became excited at the prospect of having a baby boy, D found herself feeling angry and jealous, unloved and excluded, in the same way as she had felt when she was eight years old and forced to look after her infant brother (Anthony and Benedek, 1970).

Women often describe feeling haunted by the fear of producing a monster or a dead baby. This may be connected to deep-seated feelings of guilt and unworthiness. However, these feelings may alternate with feelings of love and happiness and with loving images and fantasies about the unborn child.

In the third trimester** **the feeling of wellbeing may change, and bodily changes become more pronounced. The fetus may again feel a usurper to the woman, taking her over from the inside - a monster, depriving her of rest and sleep.

In those who have enjoyed the experience of symbiosis, the approaching labour and delivery may be particularly frightening. There may be the additional fear of the separation of birth as a violent sudden rupture. Many women mourn in advance the loss of the state of inner wholeness that they have experienced during the pregnancy.

Delivery also brings with it fears of death, as well as phantasies of re-birth. After the birth of the baby everything will change. The woman will be a mother of one or more children, and a great adjustment will take place in the life of the family. In a couple who have previously not had children, both will have to continue with the work of adjustment to perhaps one of the greatest changes of their lives. Subsequent children also demand a new adjustment, and many factors will influence how this develops.

Although the father has not had the same physical contact with the baby as the mother, who has felt the baby within her during pregnancy, he has also started to develop an attachment to the baby during that time.

During the first stage of pregnancy, the father will be aware of changes in his partner; however his image of the baby may be vague. In the second stage when he can feel the fetal movements his image of the baby may clarify.

Expectant fathers describe how they find themselves much more attuned to other children in their environment when their wives reach the third stage of pregnancy. One father commented: Fatherhood is something that grows on you.

The development of paternal feeling is influenced by many factors, such as the wish to produce a child of their own to love, a confirmation of his own capacity to generate life, a wish to identify with his father. He may also experience some envy of his wifes capacity to create a child. With the babys birth, he can hold, nurture and begin to develop a strong bond with his newborn.

The newborn creates many demands, and the parents for some time find that most of their emotional and physical time centres around caring for the child. This may be a stressful and uncertain time, as the parents and newborn get to know one another and the baby comes to know him/herself. However there is potential for great rewards and the development of maturity and creativity in the parents.

Winnicott (1952) described the state of primary maternal preoccupation, which begins in pregnancy and persists for some months after the birth of the infant. The mother who does not suffer from serious emotional difficulties will usually be able to find a way to identify with and understand her babies needs and meet them. She will develop the capacity for what Winnicott called good-enough mothering, which does not mean that she is a perfect mother and that she makes no mistakes, but that her capacity to hold and love the baby is good enough to ensure that the baby is well cared for and can mature in a satisfactory way.

Insecurity in one partner during pregnancy and after the delivery can often be compensated for by strength of the other. If there has been serious mental or physical illness in either parents own mother, it may be very difficult for the mother to care for her own child, without identifying with an absent or damaged mother within. She may become depressed, and in more severe instances, reject her child. Her difficulties can be mitigated by the support of her husband, family and friends. However if this is not possible it will be necessary to seek further help from skilled professionals.

If dependency needs are considerable in either parent, he/she may over-identify with the babys needs. This may lead to difficulties caused by the lack of attention the parent now experiences in the marriage.

If this is the case for the father, he may turn away from his partner to his work, their family of origin or to other male friends. Women have described how their husbands spend less and less time at home with the birth of each subsequent child.

Now let us consider a situation that has been overshadowed by the experience of serious trauma in either parent. Depending on the kind of trauma that has been experienced, the effect on the person will vary considerably. The notion of internal objects - which can be dead or damaged so that a good-enough mother/parent cannot be found - will have a major impact on the development of the parent and may adversely affect the infant-parent bond. If the parent cannot find within themselves the capacity to hold and love the child, then the baby can experience severe states of anxiety which are not relieved.

Winnicott (1988) has described emotional states within the baby of going to pieces, of falling forever; of losing all vestige of hope of the renewal of contacts. While in many cases these experiences of the baby can be modified by the presence of a caring adult, if this is not the case, an inner experience of a disaster may be carried within, and life in the future may need to be organised so that this pain is not experienced again.

I would like to illustrate with some clinical examples of trauma and how it has affected parental capacity (Anthony and Benedek, 1970).

Mrs C was 15 years old, living in Poland, when she was sent to live in a ghetto and later transported to concentration camp in Auschwitz. Of her family she was the only survivor.

After the war, she emigrated to Israel, where she worked and lived for years, a lonely and somewhat empty life. Eventually she married a widower who had a two-year old child. She was able to look after his child and later had two sons of her own. However both of these children developed severe emotional difficulties.

The eldest was five years old when brought for help by Mrs C. The child had problems of hyperactivity, uncontrolled aggression, bed-wetting and anxiety. He said of himself: I will go to school, then become a soldier, then a father, then I will die. When asked why he responded in this way, he replied: Because when one finishes everything one dies. In this way the child is identifying with the lost, dead family of his mother.

Mrs C could not face his distress or his anger. She was unable to discuss her experiences of trauma or tolerate anything that reminded her of the Nazis or any other violence. The child had also internalised a violent and out-of-control inner object, unconsciously projected into him by his mother who he had no help with to modify or contain.

As I have mentioned earlier in my comments about the damage to thinking that can occur as a result of trauma, this mother had lost the ability to think symbolically and had separated mind from body. She could only care for her children in a physical way, as any connection with their emotions exposed her to intense and overwhelming psychic pain. Her children were then left feeling neglected and emotionally starved, while out of control with respect to their aggression. She and her son were helped with psychotherapy.

Another patient Mrs Q, a 34-year-old woman, brought her baby for assessment, as she was very frightened that he would become blind. The child had been born with an early congenital cataract in one eye. Despite reassurance that this could be adequately and easily treated at an appropriate time, the mother continued to fret. She became teary when she discussed his minor defect. She blamed herself openly for this and questioned everything she had done during her pregnancy (Brazelton, 1990).

Although the baby grew and developed well, the mother became increasingly anxious. She stated Wont people notice his defect? Wont he be teased about it later?

She worried excessively when he was developing gross motor skills, pulling himself to standing and walking around the furniture, afraid he would fall. She could not allow him to feed himself, afraid that he might choke on a small piece of food. At night she went into his room every four hours to make sure he was still breathing. Her husband described how when the baby awoke during the night she rushed to him, rocking him in her arms, saying poor baby and crying with him. As one would expect, the baby started to wake often during the night. After many months, she was referred to a psychoanalyst by her pediatrician, who could see that there was a danger that if the situation proceeded without intervention, the child might come to develop a sense of himself as vulnerable, and inadequate, which could dampen his naturally outgoing temperament.

It seemed that Mrs. Q was having great difficulty in dealing with the traumatic blow to her idealised phantasy of having a perfect baby. Her rushing to the child could be seen as a way of dealing with her disappointment and rage about the situation, in an expression of overconcern.

At the first assessment interview, it was apparent that Mrs Qs concerns had grown. She ruminated about her childs handicap, wondered why it had happened to her, and became increasingly depressed. Her anxiety and hypervigilance led her to sleep lightly and with interruptions, so she was also exhausted. She described her terror that the child would need surgery. She clearly experienced sleep itself as a threat. This prompted her to check on her child repeatedly as she wanted to make sure no harm came to him while he was asleep.

With further therapeutic work she recalled that when she was eight years old her sister suddenly developed a paralysis of the left eyelid during the night. She remembered the familys grief and suffering and how the sisters classmates ridiculed her. It became clear that the illness appeared during the night. This echoed her anxiety about her childs sleeping, and indeed his symptom, which affected his eye. In this mothers mind her child had developed the same problem as her sister.

Further exploration over time revealed that the mother had harboured longstanding ambivalent and jealous feelings towards her sister, feeling that the sister was her fathers favourite. Mrs. Q felt that her childs disorder was retribution for her early negative feelings towards her sister. In this way the mother had made an unconscious identification between her sister and her baby.

During psychoanalysis Mrs Q was able to develop an understanding of these factors and this gave her considerable relief. She was then able to learn to allow her baby to sleep, and resettle himself when he awoke during the night. Her depression lifted and she began to think about him in a different way. Rather than seeing him as having a handicap she could relate to him with pleasure and allow him to move about without hovering over him.

Furthermore she subsequently decided to go ahead with another pregnancy. Some months later she became pregnant again. Hope for the growing baby and another chance to develop as a mother led to a growing ability to love her first child. She was able to bond to her second child immediately after the baby was born, and did not become depressed in the postpartum period. She was able to mother her second child well.

Finally I would like to mention a very interesting recent project that was described at an international psychoanalytic conference in 2005.

An example of an active intervention and documentation of results of the trauma on parental adjustment and early childhood development can be found in the work of a group of psychoanalysts that formed as a response to the 9/11 tragedy. This group, which called themselves the World Trade Centre Project, were aware that there were more than 100 women who were pregnant when they lost their husbands and would require help in dealing with this loss and making an adjustment to their new babies. They set up support groups as well individual sessions, which they video-taped.

They described various reactions of mothers to the loss and the way in which it was transmitted to their children. Some mothers who were stunned continued to search for their husbands. They found it difficult to develop a state of primary maternal pre-occupation and therefore had problems in bonding with their babies. These became lost babies, and these mothers were unable to contain their babies distress. Some mothers could not take care of their babies and sought others to take care of them, and some mothers could not leave their babies at all.

The task for the therapists was to facilitate an environment in which the mothers could bond to their babies and allow the development of a space for the baby in the mothers mind. This necessitated the work of mourning for the lost father/husband.

One mother had difficulty in bonding to her baby as she felt that a part of her had died with her husband. She confused her other children by saying that their father was dead but not really dead. This frightened them, and they wondered if they might die too.

Another mother who could not face the loss, became preoccupied with external details in relation to her husbands death and often left her baby with others. The baby appeared withdrawn, and as a toddler had developed an ambivalent attachment.

Responding in a different way, one mother felt that a bird she noticed was the embodiment of the fathers spirit, who watched over her and her child.

These vignettes illustrate the many and varied responses that can develop as a result of a disaster. Some women were unable to face the pain of mourning, and this led to varying responses in their capacity to mother their children. Other women were able to deal better with their considerable loss, and this also was transmitted to their children, so that not only could the children be helped with the immediate results of the trauma, but they could learn how to think and how to deal with such difficult circumstances in a way that could promote growth and development.

Early traumatic experience can become the organiser of the whole of mental and emotional life for a person who has had this kind of experience.

In psychoanalysis the patient repeats his earliest traumatic experiences with the analyst in the same way as he does throughout his life. The hope is that by repeating the earlier disastrous situation in analysis, a way could be found to make the inner experience less toxic.

Analysis may become a place where these traumas can be reconstructed on a micro-level, and where, if the patient, the analyst and the setting can hold, the initial trauma may be transformed.

In summary:

This paper has discussed issues pertaining to trauma, from earlier psychoanalytic ideas to more recent thoughts about the development of identity formation and the capacity to think. The development of the capacity to become a parent has been considered, including adaptation to pregnancy by both mothers and fathers.

This paper has considered how the experience of trauma may have complicated the growth of parenthood, and clinical examples have been used to illustrate these points.

There are many different mitigating circumstances in relation to the impact of trauma on the person and how it may be modified or reduced. Facing the pain and loss - whether that is done on ones own, through creativity, or with others, whether they are family and friends or therapists - appears to be of great importance in reducing long-term effects on the lives of the people who have experienced the traumatic event. Facing their difficulties may help these people to be able to more effectively and happily learn to parent their children.

In some cases it may not be possible to reduce the effect of the trauma substantially and it may be preserved in a dead, walled-off space encysted within the psyche, perhaps waiting for a time when it may be possible for it to be addressed.

In 1909, Freud stated that traumatic experiences that cannot be faced are re-experienced. He said, A thing that has not been understood inevitably re-appears; like an unlaid ghost it cannot rest until the mystery has been solved and the spell broken (p. 122).