The unbearable agony of being: interpreting tormented states of mind in the psychoanalysis of sexually traumatized patients.

This article focuses on the clinical importance of the disturbing transference-countertransference matrix in the psychoanalysis of patients whose ego development was decisively influenced by early, traumatic sexual abuse. Dissociative defensive operations and "automatic" identifications are emphasized in accounting for the sadomasochistic and other characteristic features of the "traumatic" transference-countertransference ambiance. Two clinical vignettes depict the analyst's need to take his or her own disturbing experience as an object of analytic examination, while illustrating how "here-and-now" transference cues are used to interpret the patient's efforts to cope with overwhelming, traumatized states of mind.