Between Primary Maternal Preoccupation and Exposure Therapy: From Challenges in Integrative Treatment of Children with PTSD to a Reexamination of Transitional Space

Processing a traumatic event is one of the central junctures in treatment of children who suffer from post-traumatic stress disorder (PTSD). This crucial stage makes it particularly difficult for the therapist to assume an integrative position and to combine concepts and interventions promoted by different theoretical approaches. In this article, the authors use D. W. Winnicott's conceptualizations to propose an integrative model that strives to find the balance between two seemingly opposing positions: (1) empathy focused, which is close to the patient's experience (primary maternal preoccupation) and (2) reality focused, an intersubjective position (prolonged exposure therapy). The proposed model enables a dialectical movement between these therapy approaches. The clinical case described in this article focuses on children, but the theoretical insights rising from it may be relevant to adults who suffer from post-trauma issues.