Παρασκευή 13 Φεβρουαρίου 2015

Transference & Countertransference Positions when working with Survivors of Sexual Abuse: 2) The Sadistic Abuser and the Helpless Impotently Enraged Victim

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

Δεν υπάρχουν σχόλια:

Δημοσίευση σχολίου