Goals,
Process, and Themes in Treatment,
Richard Gartner, Ph.D.
From
Betrayed As Boys
What can we hope will happen by the end of psychotherapy
for an adult who was sexually abused in childhood? Price
(1995) anticipates that “the patient will move from
being an incest survivor to being a person with a history
of incest”. Dimock (1988) looks forward to him becoming
“an adult who can take care of himself in a better
way than he was cared for as a child”.
A
number of writers have addressed the steps and/or the process
of therapy with sexually abused adults. In general, the
recovery process described in these works involves:
Acknowledging that the victimization occurred;
Seeing
its historical and familial contest;
Discharging
the intense affect surrounding it (particularly grief,
terror, and rage), having first buttressed the patient’s
capacity to endure intense feelings and thus having created
a greater sense of safety;
Recognizing
its impact and separating out the child’s traumatic
reaction from the adult’s greater capacity to withstand
overwhelming experience;
Perceiving
its dysfunctional influences on the adult’s current
day-to-day functioning and relearning patterns of living;
and
Consolidating
learning and putting the abuse into perspective so it
recedes in importance and no longer dominates how the
patient lives.
In my experience, these stages of recovery are conceptually
useful, but they certainly do not occur in the ordered way
this description implies. Further, I believe therapeutic
work is rarely over when abuse is accepted and integrated
into a man’s self image. This may be true in some
cases, but for most patients this point marks the beginning
of the hardest part of their treatment. This is the long
period when they struggle with the many ramifications, both
subtle and overt, of their abuse experience. During this
phase my interpersonal psychoanalytic training most obviously
affects how I work. It leads me to focus with the patient
on his relational world, both outside the therapy room and,
most powerfully, within the live context of our therapeutic
relationship.
It is,
of course, essential to be able to help a man heal from the
directly disabling effects of trauma. However, although this
is necessary objective of treatment, it is an insufficient
goal. In order to stop a sexual betrayal from being the engine
that runs a man’s life, therapy must also deal with
the spreading effects of sexual abuse. In particular, such
relational aftermaths as interpersonal isolation, distrust,
and the ability to live intimately in relation to a loved
one must also be addressed. This takes a long time, and I
believe that in the majority of cases long-term treatment
is most effective for this task. At the same time, specific
situations may require shorter-term interventions because
of the constraints of time, finances, or the reluctance of
a man to stay in treatment longer. Such shorter treatments
can be very useful; indeed, for some men, they are all that
is needed. Others may need a period of time out of therapy
to see how they now fare in the world. Some of these may return
for future treatment sequences when they feel ready to continue
therapeutic work.