Wounded By Reality: Understanding and Treating Adult Onset Trauma, 1st Edition (Hardback) book cover

Wounded By Reality

Understanding and Treating Adult Onset Trauma, 1st Edition

By Ghislaine Boulanger


216 pages

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The culmination of three decades of studying and treating survivors of adult onset trauma, Wounded by Reality is the first systematic attempt to differentiate adult onset trauma from childhood trauma, with which it is frequently confused.

When catastrophic events overtake adult lives, they often scar the psyche in ways that psychodynamically oriented clinicians struggle to understand. For Ghislaine Boulanger, the enormous challenge of working with these patients is unsurprising. Survivors of major catastrophe, whether a natural disaster, a life-threatening assault, a serious accident, or an act of terrorism, experience a near-fatal disruption of fundamental aspects of self experience. The sense of agency, of affectivity, of bodily integrity, the capacity for self-reflection, the sense of time, and the ability to relate to others - all are called into question.


"An extraordinarily rich and helpful guide to conceptualizing the emotional and mental state of the adult trauma survivor and to treating such an individual in psychodynamic therapy. Boulanger writes clearly and with passion, offering many illustrative clinical vignettes that demonstrate dedication, expertise, bravery and imagination in her work with trauma survivors. Her technical suggestions stress the importance of following the patient's material without straining to place it within a particular theoretical context….an impressive accomplishment that provides a coherent theoretical and technical approach to the psychodynamic treatment of the adult who has experienced massive trauma."

- Marie G. Rudden, Ph.D., International Journal of Psychoanalysis 89, 2008

"Ghislaine Boulanger’s Wounded by Reality is an eloquent, beautifully written, and much-needed book illuminating an often overlooked topic: the dissociative impact of trauma suffered by adults. It is informative, clarifying, and moving; and it is a breakthrough. Wounded by Reality is a must read for clinicians treating traumatized patients, and especially for those treating people who have suffered posttraumatic dissociation in adulthood."

- Elizabeth Howell, Ph.D., Contemporary Psychoanalysis 44.4, 2008 and author, The Dissociative Mind (Analytic Press, 2005)

"Ghislaine Boulanger has filled a critical gap in our knowledge with this beautifully written, exhaustively researched, highly readable book on catastrophic trauma in adulthood. Even those of us with secure childhoods, it turns out, are much more fragile than we would like to believe. Boulanger explores this harsh reality gently but authoritatively, in the context of a wealth of scholarship, and draws wise and clinically useful conclusions about helping the traumatized and those who love them. Because therapists of all orientations and interests may find themselves working with traumatized adults, and because prior approaches to the traumatized person have mostly neglected those wounded in adulthood by literally unbearable realities, this eloquent work deserves a place on the bookshelf of every clinician."

- Nancy McWilliams, Ph.D., Author, Psychoanalytic Psychotherapy: A Practitioner’s Guide

"Ghislaine Boulanger’s remarkable book begins a new era of trauma therapy. She has overcome difficulties in psychoanalytic metapsychology to make two significant contributions: She clearly distinguishes the consequences of adult onset catastrophic trauma from childhood trauma; and she spells out the details of treating adult trauma. She shows how, in confronting sudden death and other overwhelming situations, the self is shattered; its component parts, such as memories and affect, are broken up and scattered. They become shield-like obstacles rather than tools to enhance the capacity to experience life and happiness fully. The life-maintaining resources are rendered ineffective. Boulanger demonstrates the obstacles that an analyst (or other therapist) encounters. She supplies the techniques to make treatment effective. She gives us a whole new way to help people whose problems are very difficult to treat."

- Henry Krystal, M.D., Author, Integration and Self-Healing: Affect, Trauma, Alexithymia (Analytic Press, 1993)

"One of the pleasures in reading this book is how well it is organized…Information does not appear in clusters of facts, simply stated and left to the reader's zeal in making connections. Insights from various disciplines, once explored, become part of discussions of case material. With great frankness about her reactions to her patients, Boulanger both enlivens her discourse and encourages the reader's thoughtfulness about the reader's own clinical experience. Beautifully stated and direct, her descriptions make palpable what it means to work with people who can manage to go on after terrible trauma only by numbing themselves, unable to construct a trauma narrative, at the mercy of harrowing bits and pieces of isolated memory. Despite its scholarly value, this book passionately entreats the reader to see what a traumatized adult must resort to in trying just to go on."

- Johanna Krout Tabin, Ph.D., ABPP, Psychoanalytic Psychology 25.1, 2008

"[Wounded by Reality is] timely and insightful, particularly in its analysis of the subjective experience of adults who have survived devastating trauma, and it will be of interest not only to therapists who treat adult trauma survivors but also, more generally, to scholars hoping to understand the psychological consequences of traumatic events."

- David Manier, Ph.D., PsycCRITIQUES

"Valuable and comprehensive as the theoretical richness of this book is, the most precious and spiritually moving part is Boulanger's ability to share her clinical self. For the purposes of teaching about trauma to psychology students, Wounded by Reality is a perfect example of the theoretical masterwork that does not lose its touch with clinical reality. The clear, strong writing make it suitable for all: advanced undergraduates, graduate students, psychoanalytic candidates, and practicing clinicians. She has written a book that poses the explicit and implicit questions to us as clinicians - where can we find the courage to enter into the world of the shattered adult? Boulanger shows the way, for she has been there."

- Elizabeth Hegeman, Ph.D., Psychologist-Psychoanalyst, Fall 2007

"Wounded By Reality is an exceptional work. Scholarly and inquiring, it integrates many theories and disciplines to address a neglected issue: adult onset trauma. Boulanger has a unique and expansive vision of dissociation; she challenges psychoanalysis even as she cherishes it. Her clinical material reflects a commitment to her patients' darkest times."

- Sue Grand, Ph.D., Author, The Reproduction of Evil: A Clinical and Cultural Perspective (Analytic Press, 2002)

"Wounded by Reality, as its provocative title suggests, inspires the reader to follow the author Ghislaine Boulanger into the pain, horror and grief that is the emotional like of surviving 'the extremes of experience.' Written with sensitivity, grace and honesty, the ideas, insights and suggestions clear enough to be accessible to non-analytically oriented readers, clinicians from varying backgrounds and experience with trauma will find this book heartwarming and instructive."

- Elizabeth Goren, Ph.D., Trauma Psychology Newsletter 3.1, 2008

"This book is both fascinating and rewarding and provides the reader with a rich source of ideas and insight into a topic that is so relevant to the twenty-first century and clinical work."

- Journal of Analytical Psychology 53, 2008

Table of Contents

Toward a Psychodynamic Understanding of Adult Onset Trauma. Catastrophic Dissociation and Childhood Trauma: Some Distinctions. The Cost of Survival: Historical Perspectives on Adult Onset Trauma. Wounded by Reality: The Relational Turn. The Core Self in Crisis: Deconstructing Catastrophic Dissociation. The Relational Self in Crisis: Further Deconstructing Catastrophic Dissociation. From Voyeur to Witness: The Crisis in Symbolic Functioning During Catastrophic Dissociation. The Ancient Mariner's Dilemma: Constructing a Trauma Narrative. The Strength Found in Innocence: Resistance to Working Psychodynamically with Survivors of Adult Onset Trauma. The Psychological Politics of Catastrophe: Local, Personal, and Professional.

About the Author

Ghislaine Boulanger is a psychologist and psychoanalyst in private practice in New York City and a member of the Relational faculty at New York University’s Postdoctoral Program in Psychotherapy and Psychoanalysis. Her interest in adult onset trauma began when she joined a congressionally mandated research team doing an epidemiological study of Vietnam veterans. Her findings about the long-term consequences of surviving violence in adulthood have led to a career of research, writing, and teaching about the psychodynamic causes and consequences of adult onset trauma.

About the Series

Psychoanalysis in a New Key Book Series

When music is played in a new key, the melody does not change, but the notes that make up the composition do: change in the context of continuity, continuity that perseveres through change. Psychoanalysis in a New Key publishes books that share the aims psychoanalysts have always had, but that approach them differently. The books in the series are not expected to advance any particular theoretical agenda, although to this date most have been written by analysts from the Interpersonal and Relational orientations.

The most important contribution of a psychoanalytic book is the communication of something that nudges the reader’s grasp of clinical theory and practice in an unexpected direction. Psychoanalysis in a New Key creates a deliberate focus on innovative and unsettling clinical thinking. Because that kind of thinking is encouraged by exploration of the sometimes surprising contributions to psychoanalysis of ideas and findings from other fields, Psychoanalysis in a New Key particularly encourages interdisciplinary studies. Books in the series have married psychoanalysis with dissociation, trauma theory, sociology, and criminology. The series is open to the consideration of studies examining the relationship between psychoanalysis and any other field – for instance, biology, literary and art criticism, philosophy, systems theory, anthropology, and political theory.

But innovation also takes place within the boundaries of psychoanalysis, and Psychoanalysis in a New Key therefore also presents work that reformulates thought and practice without leaving the precincts of the field. Books in the series focus, for example, on the significance of personal values in psychoanalytic practice, on the complex interrelationship between the analyst’s clinical work and personal life, on the consequences for the clinical situation when patient and analyst are from different cultures, and on the need for psychoanalysts to accept the degree to which they knowingly satisfy their own wishes during treatment hours, often to the patient’s detriment.

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Subject Categories

BISAC Subject Codes/Headings:
PSYCHOLOGY / Applied Psychology
PSYCHOLOGY / Psychotherapy / General
PSYCHOLOGY / Mental Health