Rising above the polemics surrounding sexual and physical abuse, David and Jill Savege Scharff bring a relational perspective to the integration of psychoanalytic and trauma theories in order to understand the effects of overwhelming physical and psychological trauma, including sexual abuse, injury, and birth defect. The Scharffs draw from their object relations therapy with individuals, families, and couples recovering from trauma and abundance of relevant clinical examples described in their characteristically personal and vivid style. Their treatment approach, influenced by Fairbairn, Klein, and Winnicott, is respectful of the patient's experience. They advise avoiding premature interpretations that impose their own reality on patients because this traumatizes them just as their abuser did. In order to work well with these traumatized people, the clinician must be able to tolerate ambiguity and sustain long term therapy, for it takes the patience of waiting and wondering to recover deeply repressed memories, explore them thoroughly, and evaluate their meaning and importance for the patient. The Scharffs' demonstration of clinical processes helps therapists contain their own countertransference to trauma so as to be fully present with their clients and consistently able to confront abuse patterns in society. The object relations approach not only deals with trauma's impact on the individual but views it in its cultural and interpersonal context as well. Society alternately emphasizes and ignores trauma so that an encapsulated traumatic experience festers until the next eruption, just as dissociative defenses segmentally protect and exaggerate traumatic experience in the individual case.

The Scharffs review Kramer's Mahlerian approach, McDougall's insights into the silence of the psyche and the words of the soma, and Anzieu's elaboration of the body ego. They resuscitate Freud's seduction hypothesis and the traumatic basis of the repetition compulsion. They compare and contrast the concepts of re