We know that any child who is sexually
traumatized over time, especially by a parent, will internalize and identify
with those aspects of the perpetrator, who is also a loved and trusted figure
in the child’s life. Though this identification, the child attempts to preserve
her bond to the perpretator by becoming like him. As an adult, the patient’s
unconscious identification with her victimizer allows her to keep at bay
experiences of herself as helpless, terrified, violated. Instead, she projects
her “weakness” on to another, thus feeling to some extend empowerment.
A) In the transference, one
manifestation of a patient’s abusiveness is her tendency to penetrate and
invade the therapist’s personal and psychic boundaries. Some patients, for
instance, literally burst on the treatment scene, entering the room in an
intrusive and forceful manner.[…] In addition, some patients have a way of
staring intently and penetratingly at the therapist as if they are trying to
get inside and control him. Other patients persistently notice and comment on
many aspects of the clinician’s personal appearance or office. […] Through her
invasion of the therapist’s boundaries, the patient betrays her identification
with her abuser(s).[…] In doing so, she is replicating in the treatment her
perpetrator’s ruthless lack of respect for and greedy smashing of psysical and
psychological boundaries. Countertransferentially
the therapist[…] may experience great discomfort at and anticipatory anxiety
about being exposed and penetrated. Identified with split-off victimized
aspects of the patient, the clinician may find himself dressing differently,
straitening up the office, trying to be in the right mood, and avoiding eye
contact with the patient in order to stave off episodes of intrusion. The
clinician may think about upcoming sessions well in advance with anxiety and
dread. At this point of course the therapist is reenacting many of the
behaviours and emotional states the patient experienced in relationship with
her abuser(s) and tries to protect himself from the inevitable intrusions by
guessing what might set off the patient and fixit it ahead of time or by
avoiding real engagement with the patient. All this, of course, replicates the
kinds of strategies the patient employed to try to protect herself form her
victimizer(s).
B) Another way in which a patient can
abuse her therapist is through entitled demands for attention, such as extra
sessions, between-session phone contact, lengthened sessions and so on. Often
the therapist has set the stage for this by responding to crises with increased
availability […]. Gradually however the therapist begins to feel used, furious,
but helpless to extricate himself from what has become a regular way of
relating to this patient. […] The patient, in this case, exploits the
willingness of the clinician to be available and, as her perpetrator did
before, develops an insatiable demand for more. In turn, the clinician
experiences aspects of the patient’s victimized self; the therapist assumes the
blame for the abuse, feels violated and enraged but helpless to do anything
else but accede to the patient’s demands. (p. 173)
C) Yet another manifestation of the
patient’s identification with her perpetrator(s) is the self-destructive or
violent enactments in which the patient often engages[…]. When the patient acts
self-destructively and presents the therapist with a fait accomlit, often accompanied
by disturbing, visible physical evidence such as cuts or burns, it is, at one
level, a vicious attack on the therapist’s holding and containing
effectiveness. There is often a sense of the patient saying, “Take this. Don’t
think for one minute that you can really have an impact on me because, in the
end, I’ll do exactly what I want”. The clinician confronted with a patient’s
self-destructive acting out often is shocked and paralyzed by the intense rage
and violence inherent in the acts. Frequently, the clinician feels unable to
interpret or to intervene in any way, fearing that to do so will provoke an
escalation of action. The therapist feels attacked, helpless and fearful about
where the acting out might ultimately lead. The therapist also feels trapped by
the patient’s acting out; he may search for exactly the right intervention in
order to prevent his patient from spinning completely out of control […]. Like
her abuser, the patient translates impulses into direct action, action that
terrifies and impotently enrages the therapist, who in turn, assumes the role
of victim. Identified with the victimized aspects of the patient, the therapist
feels trapped paralyzed and intent in somehow, preventing escalation of action.
This of course is congruent with what the patient experienced as a child as she
struggled to prevent escalation of sexually abusive activities. (p. 173-174)
D) There is at least one more way in
which these patients enact identifications with their abusers and is to destroy
hope. In most cases, adult survivors are terrified that good things cannot
last, that promises will always ultimately be broken. Rather than waiting for
the inevitable disappointment to occur, patients with sexual abuse histories
often intervene in the buildup of anxiety that accompanies hope by assuming
control of the situation and shattering what they are convinced is only an
illusion anyway They do this by threatening premature termination, resuming
self-destructive acting out after long period of abstinence, developing new
symptoms such as psychosomatic disorders, or sabotaging extra-therapeutic
successes in relationships or jobs. Countertranferentially, the therapist feels
deflated by these attacks on hope that often occur when things seem to be going
particularly well in treatment. The clinician may become depressed and is
sometimes tempted to passively accede to hopelessness through relational
withdrawal, loss of energy, muted affect.[…] Often the sexually abused child
experiences periods of hope, during which the perpetrator stops abusing for one
reason or another, presenting himself more consistently as the good object form
whom the child yearns. Inevitably, however, the abuse resumes, or a younger
sibling begins to be victimized by the same abuser with our patient’s knowledge.
In treatment, when things are hopeful, the patient may identify with the
perpetrator and seemingly smash to buts progress and hoe. Identifying with the
victim, the therapist experiences the despair and deflation once held by the
victimized child.
To the extent that they (the therapists) remain
locked into a countertransference experience of victimization, they are likely
to evoke intense feelings of toxicity and guilt in the patient. These patients
perceive themselves to be powerfully toxic anyway and struggle with chronic,
free-floating guilt. Why they sense unconsciously that they have victimized the
therapist, unbearable states of shame and guilt are engendered. Protecting
themselves from conscious awareness of these intolerable affects and
self-representations, they project them onto the therapist, who then is
perceived as toxic and deserving of attack, and the cycle begins again.
Eventually the transference-countertransference
paradigms in play have to be made explicit, so that the patient can begin to
tame and integrate currently disowned self-representations and
identifications. This is delicate work
when the self-representation or identification that is activated is that of
abuser. The thought that she might actually sadistically mistreat another after
having been so badly used herself nauseates and enrages her. Premature
interpretation, which can be precipitated by the clinician’s desire to
extricate himself from the role of victim, can engender defensive denial and
rage, along with further splitting off and enactment of the identification. Too
early interpretation also can evoke intensified guilt and self-punishment, with
concomitant submerging rather than integration of the abusive representation.
Other more subtle ways in which the therapist
enacts abusiveness are through premature interpretations, intrusive
questioning, or encouraging a patient to stay with a traumatic memory beyond
what is therapeutically indicated in order to satisfy voyeuristic fascination
with the abusive experience […]. The patient, in turn, may respond with
woundedness, or she may passively submit to the victimizing aspects of the
therapist while storing up uncommunicated impotent rage.
It is crucial for the treatment for the
therapist to experience and enact the role of victim to the patient/abuser.
Only this way can the clinician begin to truly appreciate at a visceral level
the terror, paralysis, hopelessness, and impotent rage lived by the patient
when she was a child.
Davies, J. & Frawley, M (1994) Treating
the Adult Survivor of Sexual Abuse: A Psychoanalytic Perspective, United
States of America: Basic Books
