Chefetz comes from a psychoanalytic viewpoint which appears to be informed by both cognitive psychology and affect theory. His guidelines and examples are helpful for therapists, but he clings to the idea that abreaction is a central curative element in therapy. He appears to conclude that abreaction is "baby" rather than "bathwater.
I'm not so sure. Abreaction does seem to be an inevitable part of therapy with some patients, but I'm not sure that we fully understand its role. In patients who spontaneously abreact, our role is clearly to help them shut down these re-living experiences and return to calm. Is Bennett Braun's BASK model obsolete? Do patient's need to work through all levels of a trauma to heal from it? New techniques such as EMDR suggest to me that this is probably not true. We may be able to help people heal without the potential re-traumatization that accompanies abreaction.
In working with a dissociative patients I've found that a focus on integration works well, with abreaction occurring only when necessary - as defined by the patient. When parts of a fragmented personality integrate there is shared knowledge and information, and sometimes an accompanying abreaction. I believe that this sharing is the essential curative process, not the abreaction.
For now I believe that we should hold these two notions side-by-side. Abreaction happens. It happens primarily in trauma survivors. It is a powerful phenomenon which can re-traumatize and can also be a part of healing. Let's recognize that there are unanswered questions here, and let's keep an open mind to both possibilities. When we can use techniques to facilitate healing without abreaction, let's try those. If abreaction appears to be occurring spontaneously, then let's work to avoid re-traumatizing while maximizing the healing potential that seems to accompany abreaction.
*Title is adapted from Richard A Chefetz, M.D. "Abreaction: Baby or Bathwater" Dissociation Vol.X, No.4, 12/97.
