In traumatic neuroses, the spontaneous attempt to recover is taken in two directions. One trend is away from the traumatic situation, the accumulation of energy to the delayed control: ego functions are reduced and suspended; there is a retreat to restore balance. Another trend is the delayed discharge: activation of motor areas, emotional attacks, the phenomena of repetition. The first mode of behavior can be called the calm, the second one - acting out. In any case, we solve the problem of delayed management.
Therapy can and should imitate both methods. On the one hand, the therapist must by relaxing suggestions to calm, reassure, and satisfy the needs of the patient’s dependence and passivity. On the other hand, it should promote catharsis, the rapid discharge, re-experiencing trauma, verbalization and clarification of conflicts. Application of the second method is helping more directly. The first method is needed when the patient is too frightened and elaboration of traumatic events is still more intolerant, their repetition is too painful.
The therapeutic goal in the traumatic neurosis is to find the optimal combination of two methods for each case. The right balance of catharsis and calming measures is the main task of therapy, specific techniques are not so important. In general, patients should talk about the injury as much as possible, to retell their experiences over and over again, with some patients, however, it is necessary the rest and removal from painful experiences until they are capable of acting out.
The more the traumatic neurosis induces a secondary psychoneurosis, the more urgent must be taken additional measures. In such cases psychoanalysis is needed, the prognosis depends on the nature of the induced psychoneurosis. When traumatic disorders represent a hysterical reaction, analysis is conducted, as in hysteria. We have already mentioned the frequent introduction of narcissistic introductions, making the effectiveness of psychoanalytic treatment doubtful.
Kardiner described the cases in which the traumatic neuroses had no tendency to spontaneous healing; on the contrary, they developed persistent personality disorder. In such cases, blocking or reduction of the ego functions, characteristic to traumatic neurosis, weakens the perception and mental capacity, reduces the interest to the outside world and there is a predisposition to move away from any contact with reality, perhaps out of fear of recurrence of injury. As a result, a person slips on a very low level of primitive life; the patient can be compared with some psychotic or those who have overcome the psychosis to a defect of ego. There are described several such cases. Probably it is due to the unfavorable development of constitutional factors or complications of a narcissistic nature of the psychoneurotic. Psychoanalysis then, too, is difficult. In traumatic neuroses there is showed early treatment for the changes caused by trauma, there is not left an imprint on the personality. Traumatic neuroses provide a unique opportunity to explore the ego as a system that has developed in order to overcome past trauma and to avoid injuries in the future. These neuroses represent a lack of basic ego functions.
