As I indicated in Chapters 3 and 5, enacted processes fi gure prominently in the treatment of individuals in whose lives trauma and dissociative processes play a central role. It is important to keep in mind, however, that psychic trauma, as well as the dissociative mechanisms employed to cope with such experience, exist on a continuum. The kinds of trauma we encounter in our patients range from “small t” trauma, the kinds of environmental failures found in the Sandler and Renik vignettes described in Chapter 5 (the second being more severe than the fi rst), to the kind of early physical trauma described in the Casement vignette in Chapter 6, to the trauma of object loss in adulthood (as in the case of Jimmy in Chapter 12), and from these to the more extreme kinds of “capital T” trauma such as that experienced by patients who suffered early, severe sexual and physical abuse, as will be exemplifi ed here in the case of Sara, and the profound existential trauma experienced by survivors of the Holocaust (as in the case of Ann presented in Chapter 13).