The role of individual and group treatment and self and other representations in predicting posttraumatic symptoms and growth was examined among 115 Palestinian former political prisoners. Twenty participated in individual therapy and 19 in group therapy; 76 belonged to the control group. The results showed that posttraumatic symptoms decreased only in the individual therapy, whereas no decrease was found in group therapy or control groups across 1 year. Somatic symptoms decreased generally, whereas no general or treatment-related change was found in posttraumatic growth. As hypothesized, representations characterized by positive contents (benevolent, ambitious, and nonpunitive) predicted decrease in symptoms and increase in posttraumatic growth. Furthermore, positive content and mature, differentiated, and nonambivalent structure of representations predicted decrease in posttraumatic symptoms and increase in posttraumatic growth in group therapy, but not in individual therapy. The role of cognitive-emotional reworking of interpersonal representations in trauma therapies is discussed.
Allodi, F., & Cowgill, G. (1982). Ethical and psychiatric aspects of torture: ACanadian study. Canadian Journal of Psychiatry, 27, 98-102.
2.
Allodi, F., & Randall, G. (1985). Physical and psychiatric effects of torture: Two medical studies. In E. Stover & E. O. Nightingale (Eds.), The breaking of bodies and minds (pp. 58-78). New York: W. H. Freeman.
3.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text rev.). Washington, DC: Author.
4.
Amnesty International. (1984). Torture in the eighties: An Amnesty International report. London: Pitman Press.
5.
Amnesty International. (1989, May 18). Urgent action bulletin. London: Author.
6.
Auerbach, J.S., & Blatt, S.J. (1996). Self-representation in severe psychopathology: The role of reflexive self-awareness. Psychoanalytic Psychology , 13, 297-341.
7.
Basoglu, M. (1992). Torture and its consequences: Current treatment approaches. Glasgow, UK: Cambridge University Press.
8.
Basoglu, M., Livanou, M., & Crnobaric, C. (2007). Torture vs other cruel, inhuman and degrading treatment: Is the distinction real or apparent? Archives of General Psychiatry, 64, 277-285.
9.
Bisson, J., & Andrew, M. (2007). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, (3), CD003388. DOI: 10.1002/ 14651858.
10.
Bisson, J.I., Shepherd, J.P., & Joy, D. (2004). Early cognitive-behavioural therapy for post-traumatic stress symptoms after physical injury: Randomised controlled trial. British Journal of Psychiatry, 184, 63-69.
11.
Blatt, S.J., Auerbach, J.S., & Aryan, M. (1999). Representational structures and the therapeutic process. In H. Kurtzman (Ed.), Cognition and psychodynamics: New perspectives (pp. 131-158). Oxford University Press.
12.
Blatt, S.J., Auerbach, J.S., & Levy, K.N. (1997). Mental representations in personality development, psychopathology, and the therapeutic process. Review of General Psychology, 1, 351-374.
13.
Blatt, S.J., Chevron, E.S., Quinlan, D.M., Schaffer, C.E., & Wein, S.J. (1992). The assessment of qualitative and structural dimensions of object representations (Rev. ed.). Unpublished research manual, Yale University, New Haven, CT.
14.
Blatt, S.J., Stayner, D.A., Auerbach, J.S., & Behrends, R.S. (1996). Change in object and self-representations in long-term, intensive, inpatient treatment of seriously disturbed adolescents and young adults. Psychiatry, 59, 82-107.
15.
Blatt, S.J., Wiseman, H., Prince-Gibson, E., & Gatt, C. (1991). Object representations and change in clinical functioning. Psychotherapy, 28, 273-283.
16.
Bracken, P.J., Giller, J.E., & Summerfield, D. (1995). Psychological responses to war and atrocity: The limitations of current concepts. Social Science & Medicine, 40, 1073-1082.
17.
Bradley, R., Green, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227.
18.
Brewin, C.R. (2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44, 765-784.
19.
Chemtob, C.M., Tolin, D.F., van der Kolk, B.A., & Pitman, R.K. (2000). Guidelines for treatment of PTSD: Eye movement desensitization and reprocessing. Journal of Traumatic Stress , 13, 569-570.
20.
Diamond, D., Kaslow, N., Coonerty, S., & Blatt, S.J. (1990). Changes in separation-individuation and intersubjectivity in long-term treatment. Psychoanalytical Psychology, 7, 363-397.
21.
Diguer, L., Barber, J., & Luborsky, L. (1993). Three concomitants. American Journal of Psychiatry, 150, 1246-1248.
22.
El Sarraj, E., Punamäki, R.L., Salmi, S., & Summerfield, D. (1996). Relations between torture experiences and posttraumatic stress disorder among Palestinian prisoners . Journal of Traumatic Stress, 9, 595-606.
23.
Emmelkamp, J.K., Van Ommeren, M., & Schagen, S. (2002). The relation between coping, social support and psychological and somatic symptoms among torture survivors in Nepal. Psychological Medicine, 32, 1465-1470.
24.
Foa, E.B., Hembree, E.A., Cahill, S.P., Rauch, M.A., Riggs, D.S., Feeny, N.C., et al. (2005). Randomized trial of prolonged exposure for traumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 75, 953-964.
25.
Foa, E.B., Keane, T., & Friedman, M. (2000). Effective treatment for PTSD. New York: Guilford Press.
26.
Foa, E.B., Rothbaum, B.O., & Steketee, G.S. (1993). Treatment of rape victims . Journal of Interpersonal Violence, 8, 256-276.
27.
Ford, J.D., Fisher, P., & Larson, L. (1997). Object relations as a predictor of treatment outcome with chronic posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 65, 547-559.
28.
Foy, D.W., Glynn, S.M., Schnurr, P.P., Jankowski, M.K., Wattenberg, M.S., Weiss, D.S., et al. (2000). Guidelines for treatment of PTSD: Group therapy. Journal of Traumatic Stress, 13, 571-572.
29.
Franklin, C.L., & Zimmerman, M. (2001). Posttraumatic stress disorder and major depressive disorder: Investigating the role of overlapping symptoms in diagnostic comorbidity . Journal of Nervous & Mental Disease, 189, 548-551.
30.
Friedman, M.J., Davidson, J.R.T., Mellman, T.A., & Southwick, S.M. (2000). Guidelines for treatment of PTSD: Pharmacotherapy. Journal of Traumatic Stress, 13, 563-566.
31.
Gonsalves, C.J., Torres, T.A., Fischman, Y., Ross, J., & Vargas, M.O. (1993). The theory of torture and the treatment of its survivors: An intervention model. Journal of Traumatic Stress , 6, 351-365.
32.
Gorst-Unworth, C., Van-Velsen, C., & Turner, S.W. (1993). Prospective pilot study of survivors of torture and organized violence. Examining the existential dilemma. Journal of Personality and Social Psychology, 50, 992-1003.
33.
Gruen, R.J., & Blatt, S.J. (1990). Change in self- and object representation during long-term dynamically oriented treatment. Psychoanalytic Psychology , 7, 399-422.
34.
Harvey, A.G., Bryant, R.A., & Tarrierc, N. (2003). Cognitive behaviour therapy for posttraumatic stress disorder. Clinical Psychology Review, 23, 501-522.
Hull, J., Clarkin, J., & Kakuma, T. (1993). Treatment response of borderline inpatients. Journal of Nervous and Mental Disease, 181, 503-509.
37.
Janoff-Bulman, R. (1985). The aftermath of victimization: Rebuilding shattered assumptions. In C. R. Figley (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder. New York: Brunner Mazel.
38.
Kanninen, K., Punamäki, R.L., & Qouta, S. (2002). The relation of appraisal, coping efforts and acuteness of trauma to PTS-symptoms among former political prisoners. Journal of Traumatic Stress, 15, 245-253.
39.
Kanninen, K., Salo, J., & Punamäki, R.L. (2000). Attachment patterns and working alliance in trauma therapy for victims of political violence. Journal of Therapy Research, 10, 435-449.
40.
Keane, T.M., Fairbank, J.A., Caddell, M.T., Zimering, R.T., & Bender, M.E. (1985). A behavioral approach to assessing and treating post-traumatic disorders in Vietnam veterans. In C. R. Figley (Ed.), Trauma and its wake: The study and treatment of posttraumatic stress disorder (pp. 257-294). New York: Brunner/Mazel .
41.
Kessler, R.C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C.B. (1995). Posttraumatic stress disorder in the National Co-morbidity Survey. Archives of General Psychiatry, 52, 1048-1060.
42.
Kudler, H.S., Blank, A.S., Jr., & Krupnick, J.L. (2000). Guidelines for treatment of PTSD: Psychodynamic therapy. Journal of Traumatic Stress , 13, 572-574.
43.
Lane, R.D., Quinlan, D.M., Schwartz, G.E., Walker, P.A., & Zeitlin, S.B. (1990). The levels of emotional awareness scale: A cognitive-developmental measure of emotion. Journal of Personality Assessment, 55, 124-134.
44.
Litz, B.T., Orsillo, S.M., Kaloupek, D., & Weathers, F. (2000). Emotional processing in posttraumatic stress disorder . Journal of Abnormal Psychology, 109, 26-39.
45.
Mikulincer, M., & Solomon, Z. (1989). Causal attribution, coping strategies, and combat-related post-traumatic stress disorder. European Journal of Personality , 3, 269-284.
46.
Mills, E.J., Singh, S., Holtz, T.H., Chase, R.M., Dolma, S., Santa-Barbara, J., et al. (2005). Prevalence of mental disorders and torture among Tibetan refugees: A systematic review. BMC International Health and Human Rights, 5, 15-20.
47.
Mollica, R.F., & Caspi-Yavin, Y. (1991). Measuring torture and torture-related symptoms. Journal of Consulting and Clinical Psychology, 3, 581-587.
48.
Mollica, R.F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard Trauma Questionnaire: Validation a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180, 111-116.
49.
Näätänen, P., Kanninen, K., Punamäki, R.-L., & Qouta, S. (2002). Trauma-related emotional patterns and their association with posttraumatic and somatic symptoms. Anxiety, Stress, and Coping. 13, 1-17.
50.
Ogrodniczuk, J.S., Piper, W.E., Joyce, A.S., & McCallum, M. (2001). Investigating follow-up outcome change using hierarchical linear modeling. Psychotherapy Research, 11, 13-28.
51.
Pearlman, L.A., & Courtois, C.A. (2005). Clinical applications of the attachment framework: Relational treatment of complex trauma. Journal of Traumatic Stress, 18, 449-459.
52.
Piper, W.E., Boroto, D.R., Joyce, A.S., McCallum, M., & Azim, H.F.A. (1995). Pattern of alliance and outcome in short term individual psychotherapy. Psychotherapy, 32, 639-647.
53.
Piper, W.E., McCallum, M., Joyce, A.S., Azim, H.F.A., & Ogrodniczuk, J.S. (1999). Follow-up findings for interpretative and supportive forms of psychotherapy and patient personality variables. Journal of Clinical and Consulting Psychology, 67, 267-273.
54.
Punamäki, R.L., Kanninen, K., & Qouta, S. (2002). The role of defenses in moderating and mediating between trauma and post-traumatic symptoms among Palestinian men. International Journal of Psychology, 37, 286-296.
55.
Qouta, S., Punamäki, R.L., & El Sarraj, E. (1997). Experiences and coping strategies among political prisoners. Peace and Conflict: Journal of Peace Psychology , 3, 19-36.
56.
Quinlan, D.M., Blatt, S.J., Chevron, E.S., & Wein, S.J. (1992). The analysis of descriptions of parents: Identification of a more differentiated factor structure. Journal of Personality Assessment, 59, 340-351.
57.
Ramsey, R., Gorst-Unworth, C., & Turner, S.W. (1993). Psychiatric morbidity in survivors of organized state violence including torture: A retrospective series. British Journal of Psychiatry, 149, 55-59.
58.
Riggs, D.S. (2000). Guidelines for treatment of PTSD: Marital and family therapy. Journal of Traumatic Stress, 13, 584-585.
59.
Rothbaum, B.O., Meadows, E.A., Resick, P., & Foy, D.W. (2000). Guidelines for treatment of PTSD: Cognitive-behavioral therapy. Journal of Traumatic Stress, 13, 558-564.
60.
Salo, J.A., Punamäki, R.-L., & Qouta, S. (2003). Associations between self and other representations and posttraumatic adjustment among trauma victims. Anxiety, Stress, and Coping, 16, 421-439.
61.
Salo, J.A., Qouta, S., & Punamäki, R.-L. (2005). Adult attachment, posttraumatic growth and negative emotions among former political prisoners. Anxiety, Stress, and Coping, 18, 361-378.
62.
Schultz, L.H., & Selman, R.L. (1989). Bridging the gap between interpersonal thought and action in early adolescence: The role of psychodynamic processes. Development and Psychopathology, 1, 133-152.
63.
Selman, R. (1980). The growth of interpersonal understanding developmental and clinical studies. New York: Academic Press.
64.
Shalev, A.Y., Bonne, O., & Eth, S. (1996). Treatment of posttraumatic stress disorder: A review. Psychosomatic Medicine, 58, 165-182.
65.
Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford Press.
66.
Sherman, J.J. (1998). Effects of psychotherapeutic treatments for PTSD: A meta-analysis of controlled clinical trials. Journal of Traumatic Stress, 11, 413-435.
67.
Silove, D.M., Steel, Z., McGorry, P.D., Miles, V., & Drobny, J. (2002). The impact of torture on post-traumatic stress symptoms in war-affected Tamil refugees and immigrants. Comprehensive Psychiatry, 43, 49-55.
68.
Stæhr, A., Stæhr, M., Behbehani, J., & Bøjholm, S. (1993). Treatment of war victims in the Middle East. Copenhagen, Denmark: International Rehabilitation Council for Torture Victims (IRCT).
69.
Tedeschi, R.G., & Calhoun, L.G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress , 9, 455-471.
70.
Tedeschi, R.G., Park, C.L., & Calhoun, L.G. (1998). Posttraumatic growth: Positive changes in the aftermath of crisis. Mahwah, NJ: Lawrence Erlbaum.
71.
Turner, S., & Gorst-Unsworth, C. (1993). Psychological sequelae of torture. In J. P. Wilson & P. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 703-714). New York: Plenum Press.
72.
Turner, S.W., McFarlane, A.C., & van der Kolk, B.A. (1996). The therapeutic environment and new explorations in the treatment of posttraumatic stress disorder. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experiences on mind, body and society (pp. 537-558). New York: Guilford Press.
73.
van der Kolk, B.A. (2002). The assessment and treatment of complex PTSD. In R. Yehuda (Ed.), Treating trauma survivors with PTSD (pp. 127-156). Washington, DC: American Psychiatric Press.
74.
van der Kolk, B.A., & McFarlane, A.C. (1996). The black hole of trauma . In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experiences on mind, body and society (pp. 3-23). New York: Guilford Press.
75.
van der Kolk, B.A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18, 389-399.
76.
Wenzel, T. (2007). Torture. Current Opinion in Psychiatry , 20, 491-496.
77.
Westen, D. (1991). Clinical assessment of object relations using the TAT. Journal of Personality Assessment, 56, 56-74.
