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In this case, presentation of a patient who experienced severe sexual abuse in childhood and attempted to manage his traumatic dreams and flashbacks with autoerotic asphyxiation, the author describes how she tolerated the anxiety of a life-threatening symptom while engaging in a deep and transformative treatment. She writes about her understanding of the symptoms, how she bore the accompanying anxiety, and what the mutative forces were that led to the patient relinquishing the symptom and progressing forward. Mutative factors included the creation of a relational home, ongoing awareness of forward edge meanings of the patient’s behaviors (including the potentially lethal symptom) and the establishment of deep mutual trust, both generally and specifically in the patient’s capacity to know what he needed in order to grow. These factors helped the patient integrate his sense of shame and self-loathing. The therapist’s deep trust in the patient’s sense of what he needed as she guided the treatment deepened the bond between them and created the paradoxical sense of both intensity and calm that the patient longed for. This paper details dreams that illustrate the nature of the therapeutic relationship and the patient’s internal experience. The therapist details her own experience in the co-transference in this highly charged case. Overall, this paper will help therapists to recognize, connect with, and protect traumatized patients, while not being distracted by the frightening symptoms themselves.

Transforming traumatic intensity: Living with the uncertainty of terrifying symptoms