Women and trauma: a contemporary psychodynamic approach to traumatization for patients in the OB/GYN psychological consultation clinic.

Many patients referred to an OB/GYN psychological consultation clinic were found to be suffering from the emotional effects of early traumatization. Obstetrical and gynecological conditions possess a unique power to reactivate psychological damage originally engendered by trauma. A contemporary psychodynamic model of trauma and its sequelae proved useful in intervening psychologically and in helping these patients and their physicians to improve the management of their medical conditions. This model represents an effort to integrate: (1) Herman's (1992) conception of complex posttraumatic stress disorder, (2) character development in individuals with early traumatic experiences, and (3) Weiss and Sampson's (1986) formulations regarding "unconscious pathogenic beliefs"-the dread that one's worst unconscious fears will be confirmed. Two clinical cases-a pregnant teenager and a woman with hyperemesis gravidarum (excessive and persistent vomiting in pregnancy)-illustrate the frequent emergence of transference-countertransference dynamics centered around "blaming the victim" in work with these patients. Suggestions for therapeutic interventions in short-term consultation with these patients are articulated.