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Treating Abuse and Trauma
"Therapists who work with adults abused as children have one overriding goal, that is to repair the client's self-image. Once the client's self image is repaired, he or she is on the road to full recovery."
Eliana Gil - Treatment of Adult Survivors of Childhood Abuse
If you think it happened, it probably did.
Many times clients are ambivalent about the therapeutic process. Why treat abuse? It’s so painful; I just have to block better. If you could block it better you wouldn’t be here in the first place. The primary reason to treat your abuse is because in addition to limiting and impairing your own life, if you don't deal with your abuse, you may very well repeat it with your own or other children.
At the same time that we begin to treat the trauma we need to help clients understand what happened to them psychologically when they were abused.
Their boundaries were violated.
Their sense of control in the world was undermined
It was confirmed to them that they were powerless
It gave them the message that they were of little value and were meant to be used.
It created shame and guilt - they were a part of something ugly and it kept happening - maybe at some point they even allowed it or liked it. They made a pact with abuse in order to survive.
That last point is very powerful - whether they disassociated, started to manipulate the survivor, responded inappropriately to the abuse or found some other means to get through it - they now blame themselves for their survival instincts. The self-loathing is very intense.
If they did try to tell someone and they weren't believed, or if they were punished for attempting to tell the truth, they were further traumatized, and it was confirmed that they were worthless and dirty. Ever since then they have felt as if there is something inherently wrong with them - this belief isolates them. They can't allow anyone to get too close because they will discover what a worthless, evil person they are.
If you were abused - your true feelings and instincts were shut down.
You may feel that your primary worth is sexual and use it as a weapon or you may totally cut off from sex and your sexuality.
If you were also severely emotionally abused, there may be no sense of primary worth. Research shows that the lowest self-esteem is found among those who have been emotionally abused, next come the sexually abused, and the least affected are those who have been physically abused (except of course in extreme conditions). Adult survivors of sexual abuse can go on to lead successful "outer" professional lives - adult survivors of severe emotional abuse have a much harder time navigating their external, professional lives.
Trauma resolution goes hand in hand with treating the psychological problems caused by childhood abuse. Trauma resolution is a kind of repair process that parallels the process of development. In adult survivors, development has been blocked. These clients must be helped to complete the developmental process. The therapist acts in some respects as a parent, providing a corrective experience.
Recovery from trauma unfolds in three stages:
The central task of the first stage is the establishment of safety.
The central task of the second stage is remembrance and mourning. The therapist must help the patient move back and forth in time, from his/her protected anchorage with you in the present to immersion in the past, so that they can simultaneously re-experience the feelings in all their intensity while holding on to the sense of safe connection (with you) that was initially destroyed during the traumatic moments of the past.
While this is going on it isn't enough for the therapist to be neutral or non-judgmental about the abuse or their abusers - it is enormously important for the therapist to affirm a position of moral solidarity with the survivor. You have to be the believer, the supportive parent, the witness that makes them finally feel understood and validated and not alone! The two of you construct a new interpretation of the traumatic experience that affirms the dignity and value of the survivor. This is the re-birth, the point where we can help them pick up where they left off in the original developmental process.
The central task of the third stage is reconnection with ordinary life.
Per the psychologist Mary Harvey, there are seven criteria for the resolution of trauma:
1. The physiological symptoms of PTSD are brought within manageable limits - and I will come back shortly to how that is done
2. The person is able to bear the feelings associated with traumatic memories.
3. The person has enough authority over his/her memories to be able to elect both to remember and to put memory aside.
4. The memory of the traumatic event is a coherent narrative, linked with feelings. If the memories are implicit, then it is necessary to build a narrative around what they suspect happened and link that narrative with the feelings.
5. The person's damaged self-esteem has to be restored.
6. The person's important relationships need to be re-established.
7. The person has constructed a coherent system of meaning that encompasses the story of the trauma - simply put she/he makes sense of it and of the people involved - those involved passively as well as actively.
This brings me to the enabling parent.
Clients come in hating the abuser but a lot of times they realize that they are much angrier with the parent who let them be abused by not noticing. Because as they come to see it - the abuser couldn't help himself - the enabling parent knew better and should have done something about it.
How do people initially survive abuse?
1. Splitting - black and white thinking - good father and bad father or complete disassociation - there is a lot of disassociation among abuse survivors
How do survivors cope as adults?
2. Eating disorders
4 avoiding intimacy
6. Compulsively seeking or avoiding sex
7. Depression, anxiety, & Personality Disorders (Dissociative and Borderline, in particular)
8. PTSD - automatic triggers:
So how do we help bring those within manageable limits? Here is a four-step model:
STOP and become aware.
AFFIRM your present reality and take time to try and figure out what set you off
CHOOSE a new response if possible. Or if another person is present - you may want to remove yourself.
At some point, partners get confused with abusers. Partners can help survivors identify triggers to automatic responses and they can figure out together what the survivor needs from the partner -i.e. To be held, to be talked to, to be encouraged to express feelings, to be allowed to stay inside your body without minimizing your feelings or yourself for feeling them
In summation, there are eight stages of recovery:
1. Deciding to do something or realizing that you can't go on like this anymore
2. Breaking the silence - with another individual (not necessarily the abuser) or with your therapist
3. Confronting the past through therapeutic processing (oftentimes memories emerge and so this can be the most frightening stage)
4. Stopping the minimization, believing that it happened and beginning to trust yourself in the process
5. Grieving the loss and getting past the pain
6. Understanding that it wasn't your fault - beginning to forgive yourself - starting to nurture yourself and take care of the child within.
7. Deciding whether or not you want or need to confront the abuser and doing so if it is necessary. I personally don't believe that you need to confront to get past it - ultimately; it’s the survivor who has to make that decision. 8. Reclaiming your life and moving forward.
"Change involves accepting our intrinsic vulnerability"
"Once we identify the ways we replicate past abuse, we can begin to reduce the mystery and power our impulses have to control us.”
Wendy Maltz - The Sexual Healing Journey
Roni Weisberg-Ross LMFT
© Copyright 2013 by Roni Weisberg-Ross, therapist in Los Angeles, California . All rights reserved.