Abuse Therapy

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Author: Lisa Ferenc

Translated by Ivan Strygin

“ My best teacher in trauma therapy was not a trauma specialist, clinical expert, or even a colleague: she was a client, a very unusual woman who first scared me to death.

Marisa started visiting me in the early 1990s - about ten years after I started working as a therapist - because of her frightening obsessions about her choking her four-year-old daughter with a pillow every time she heard her daughter was crying. She said that something in connection with this cry caused unbearable feelings of rage and helplessness. “We need to make her stop screaming! I just want her to shut up!” At the same time, Marisa felt deep inside fear and was ashamed of these thoughts, claiming that she would never harm her child. At 35, Marisa was a highly intelligent woman in a stable marriage. She had a successful career in the library and was the mother of an 8-year-old boy who did not provoke such thoughts in her

I was Marisa's first therapist and we quickly developed a good relationship. She didn’t skip sessions and followed - or tried to follow - the behavioral guidelines I gave: taking breaks when feeling stressed, learning to knit to relax, reading parenting books I recommended to her, listening to my advice on how to deal with crying baby. She even brought her husband for a few sessions so that I could work with them as a parenting team. I saw that she was trying very hard, but these measures did not seem to help at all. And, since I did not want to let her down, I also continued to try.

The therapy continued, and Marisa had the courage to share her other difficulties as well. In the sixth month of therapy, I learned that she pours stress with alcohol, cuts herself, and fights various diseases, from chronic gastrointestinal upset to migraines and possible fibromyalgia. I felt uneasy. I thought, “This is a troubled woman with 10 different diagnoses. It’s too tough for me.”

Then, in a session at the beginning of the second year of therapy, it happened. Right here, in my office, in front of my eyes, Marisa turned into a different person. While I was frightened sitting in my chair, she got off the couch, sat on the floor with her legs crossed, and began to speak like a 4-year-old. "Let's play a game?" she asked, her face beaming like a child with anticipation. And before I even had time to think about the answer, she added: "Or let's draw?"

“Your mother! What should I do? - I panicked. This was the first time I had seen a “switch” in real life - a behavioral manifestation of what was then called multiple personality disorder and what is now called dissociative identity disorder.

That session lasted over an hour because, as a four-year-old, Marisa couldn't drive herself home, and I couldn't let her leave my office like this. I drove her around the room, desperately trying to reorient her to the present and space, until finally the grown-up part of her who knew what to do with the car keys dangling in her hands returned. But my sense of incompetence haunted me. At the next meeting, I said, “Look Marisa, I can guess what is causing your problem, but this is something that I have no experience with. You deserve the best help possible, and I know a therapist who can help you. I would like to redirect you to her.”

“No,” Marisa said, her voice harder than usual. "I'm not going anywhere. I want you to help me. Just go on, you can read whatever you need, talk to your supervisor, search for whatever you need, but I'm not going anywhere. " This is how my express trauma therapy began. I felt overwhelmed, but Marisa insisted. I was afraid that if I refused to work, she would not continue therapy.

During that period of my career, I did know a thing or two about how to treat trauma. But the approach I was trained in in the late 1980s was based more on the idea that clients like Marisa have horrific experiences that need to be unearthed and fully relived in order to be healed. Little attention was paid to the inner strengths that traumatized clients could regain if given a chance. With such a constant emphasis on pathology, it's no surprise that therapists have tended to treat clients as a one-dimensional bundle of dysfunction and pain.

And I could easily start treating Marisa the same way. I soon learned that she was sexually abused for most of her life, from 4 to 20 years old. She was abused by both her parents, her sister's boyfriend, and an unknown number of teenage boys who raped her when she dissociated. But by actually ordering me to come to my senses and become a competent, rather than confused, therapist, Marisa showed a trait that I had not noticed before. In front of me was a supposedly “severely disturbed” woman who showed determination and will, as well as the realization that it was she who needed to be treated. No matter how difficult her difficulties and no matter how terrible her past was, at that moment she was able to defend herself, making it clear that the best opportunity for her to heal was to stay with me, in a trusting, authentic, secure relationship. which arose between us.

The process frightened me, but I felt the excitement. I read every new book on trauma, attended every seminar I could sign up for, and started working with the trauma experts who were presenters in the early 1990s. I learned the importance of creating a safe environment, taking the time to build trust, assessing and modifying cognitive biases, and increasing external supportive resources.

At some point in the therapy, a kind of insight came over me. Not only did I realize that Marisa was teaching me about her dissociative identity disorder, but wisdom is contained even in the symptoms of her condition. Everything she struggled with - thoughts, feelings, behaviors that were pathologized in literature and proved how it was violated - were in fact creative coping strategies that helped her stay alive.

Although the parts of Marisa sometimes scared me, it became clear to me that they were not inherently pathological. On the contrary, they were members of the inner family that had been created who helped her to function. Parts of it quenched her deep-seated rage so that she could keep in touch with her abusive parents and interact with peers. Other parts separated her memories of abuse so that she could come to school and concentrate on math and history. I even began to look at her self-injurious behavior - alcohol abuse and cuts - as creative attempts to communicate and distract her pain at the same time as horrible memories seethed close to the surface and threatened to overwhelm her. Her symptoms were life-saving extreme measures. And I began to treat her with admiration, even reverence, for the strength of mind and spirit that allowed her to survive.

I started to work with clients differently. I understood their symptoms as both painful and traumatic, and creative and life-saving. Through this understanding of “and, and” I was able to bring more hope into my work. Both my clients and I became curious about their inner abilities and about other, more enduring aspects of their lives. I talked less and listened more, and what I heard confirmed that my clients were much more than their injuries. Not only did they struggle and grow at the same time, but, in many cases, their growth was a side effect of their struggle.

When I later worked as a trauma specialist, I often heard Marisa's voice in my head: “Read more, go to conferences, learn from specialists so that you understand how to help me”. And I did just that. I used strategies from focusing and sensorimotor psychotherapy, while working with movement, body sensation, and breathing, to recycle Marisa's painful memories of sexual abuse. With my support, she painted images of safe places and wrote poetry dedicated to both her four-year-old daughter and her four-year-old wounded inner girl.

Creative work seemed to empower many of my trauma clients, in part because they were already creative, inventing all of these strategies for safety and survival. Now they used their imaginations to look beyond pain and even make some sense out of horrific events. Marisa, for example, has scheduled speeches for teenagers in local schools about rape. She said, "I will do everything in my power to help save the girls from the terrible trauma I have endured."

While I continued to witness similar processes in other clients with trauma, I stumbled upon the paradigm of positive psychology developed by psychologist Martin Seligman at the University of Pennsylvania, which was based on research on the qualities that help people cope with adversity. Contrary to his initial assumptions, Seligman found that not everyone responds to trauma with an acute sense of helplessness. For some, the side effect of the trauma has been significant growth, hope, and even strengthening. It echoed in me: I watched it in my office. Research has also shown that clinicians can foster this growth by redirecting clients to positive emotions and thoughts and encouraging them to seek supportive relationships.

After seven years of therapy, although Marisa continued to experience ups and downs, she began to feel more compassion for herself, for her fragmented parts, and, surprisingly, even for her abusers. “My parents themselves went through terrible abuse when they were growing up,” she told me. “I'm not trying to justify them. I'm just starting to realize that there are generations of sacrifice and pain in my family. My parents didn't understand this. Yes, they should have learned to be better parents, but they had a 9th grade education, no money, and no way to get therapy.” She sat up straight in her chair. “I know that I will never let my children suffer the way I did. The cycle of violence and ignorance will stop at me.”

In a marked shift from PTSD to post-traumatic growth, Marisa began using the needles she had used to cut herself for years to sew stunning bedspreads on the beds of children living in orphanages. She released the parts of herself that punished her body and released pain through self-injurious behavior.

Over 32 years of working with trauma, I have learned to see my clients as real heroes - wise, brave, creative even when they are very hurt and sad. And I am honored to help them conduct the orchestra of their inner parts until they can do it on their own. I know I can't play their instruments for them, but I can guide and inspire them, hoping that, phrase by phrase, they can create their own music."