Forgotten Memories:

A Journey Out of the Darkness of Sexual Abuse

Book Code: C4542

ISBN: 0-275-94542-1

Hardcover, 176 pages

Praeger Publishers, Publication Date: 8/30/1993, List Price: $58.95

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Book Excerpt: Chapter Ten: Treatment Issues with Survivors of Sexual Abuse

When I left my first analytic experience, I felt traumatized, betrayed, depressed, yet totally driven to perform for others. I didn’t really understand what had happened to me in analysis. I had, in a manner of speaking, gotten worse, because there was no time for happiness or inner peace. I felt disconnected from my past and my present relationships. I looked good on paper, but I still felt bad about myself. The analysis had recreated emotionally the traumatic state of sexual abuse. My shame was suffocating me.
    Specifically, the analysis was a failure for many reasons. First, it was a superficial therapeutic experience because I felt connected to Dr. Z in an unhealthy way. Was Dr. Z just superficial? Or was I just so terribly compliant that it was impossible to go beyond my hunger for accomplishment? I think that there is a frightening amount of truth to the interpretation that Dr. Z wasn’t concerned enough with deep issues, while I was too afraid to do anything but listen to him give me prescriptions and directions. My problem was understandable. Dr. Z’s mis-take was unfortunate and negligent. I accumulated credentials and degrees to bolster my self-esteem as well as his self-confidence as an analyst, which masked the failure of the analysis. But there were other problems as well.
    Certainly, and without a doubt, Dr Z and I were both victims of our times. Analysts in the 1970s thought that issues of sexuality were related to fantasies of an Oedipal origin. The occurrence of sexual abuse was in some ways a secret that the analytic community was not interested in exploring in any organized way. Analysts did not tend to believe that their patients were sexually abused unless they were totally disorganized, had vivid memories of their violent experiences, and needed hospitalization. Zelda Fitzgerald was the typical victim of sexual abuse who was locked up and left to decompensate and to die in a sanitarium. Sybil and her dozens of personalities is another example of what was thought to be a typical victim of incest.
    Dr. Z was just another 1970s analyst who was not alert to the presence of sexual abuse in a conventional family setting. Besides, I had no memories. I had no reason to believe that I was a victim. I was from an upstanding Jewish family that valued education, achievement, and humanitarian efforts. Sexual abuse was supposedly not a common occurrence in a family like ours. I had no information, no insight, that would have led me to wonder about my relationship with my father and my brother. I did not believe that incest was something that could happen in my family. Dr. Z and I entered our therapeutic relationship in ignorance about the insidious nature of incest, which was understandable given the taboos our society held on to in the 1970s.
    Dr. Z was also very invested in making interpretations and giving insights based on his theories about what underlying issues were causing what behavior. For example, I was the bad twin and my sister was the good twin because our “borderline mother” split us into the good part of herself and the bad part of herself. This inaccurate interpretation was the core organizing principle of all his other interpretations. In other words, classical analysis approached the patient by focusing on intellectual understanding and then making judgments based on beliefs about how the individual functioned and why, given the home environment and the family dynamics. Sometimes analysts thought about the genetic transmission of mental disease, but only if nothing else worked. The patient’s feelings were not the focus of analytic work; rather, the patient’s capacity to function was evaluated based on the analyst’s judgments about what was adaptive and what was dysfunctional. Classical analysts knew what was right for the patient and what was wrong. They were objective, neutral, and in charge. They did not accept responsibility for therapeutic ruptures from mistakes or misattunements, as some analysts do in the 1990s. If your patient didn’t get along with your treatment plan, then he or she was resistant—a pejorative term for being either uncooperative and/or untreatable. The analyst was rarely at fault. Any problem in the flow of therapy was always seen as being with the patient who was untreatable.
    My personality structure, or who I was emotionally, was entirely vulnerable to being exploited by the classical analytic method, which was judgmental and authoritarian. I was compliant and cooperative because I got this message about how I should behave from Dr. Z, which was an exact recreation of my childhood experiences. I was afraid to talk back and complain. I was not a bully by nature who could say, “You’re wrong” or “You’re crazy.” (I have patients that can do this to me naturally, and I think in some ways that they are less vulnerable to exploitation.) I didn’t have a typical trust disorder that many survivors of sexual abuse have because I was a twin who overvalued intimacy. I craved talking and feeling connected. I feared abandonment because I got hurt when my sister abandoned me. I was hungry for the attention that came from intimacy.
    I was not your typical incest victim who falls into the categories described in the current literature and research on sexual abuse. I had no trepidation about analysis. I wanted to understand my nightmares. Concerned with insight, I was capable of introspection. I was also intellectually inclined, though inhibited, and I always wanted to feel in control.
    So my personality, the classic analytic method, and the climate of the 1970s with its taboos on incest worked against my getting help. But I think there were more serious problems that led to my sense of betrayal and my ultimate feeling of being victimized by Dr. Z. I believe that another therapist who was more aware and more interested in his or her own strengths and limitations might have gotten deeper into my childhood trauma. I believe that had Dr. Z been more interested in understanding me, we could have gotten further beyond his destructive interpretation about a good and a bad twin.
    After many years of analysis and self-reflection, my conclusion is that Dr. Z was afraid of his own feelings, which made him afraid of the intensity of my feelings. His tendency toward emotional constriction based on his childhood, coupled with my tendency to withdraw, created a therapeutic impasse, which became the core problem of our work together. Dr. Z wanted to translate my passion and creativity into scholarship or art because it was easier for him to think about my life in that way. Trying to understand the intensity of my feelings was too painful for him. A therapist must feel comfortable with his or her feelings, as well as the patient’s, as the literature on survivors of sexual abuse suggests that the intensity of affects is a symptom of traumatic abuse. For Dr. Z, my intensity was something to control, sublimate, or eradicate; understanding my pain was too difficult and too provocative for him.
    I obviously cannot recommend the classical psychoanalytic method to incest survivors because it is judgmental, authoritarian, and self-serving at its worst. At best, it also seems outdated and obscure, remote and uncaring.
    In contrast. Dr. Ace, who had been a classical analyst for many years, has been able to help me. He is a reformed, iconoclastic self-psychologist as well as a kind and caring human being who has been interested in my passion and intensity. Our work centered around developing psychic structure through affect attunement. More simply stated, my feelings were mirrored and valued to foster a more complete sense of myself. Dr. Ace’s focus was not on the interpretation of my psychological history, as it was played out in the 1990s. Rather, he was concerned with how I was feeling about myself and about my relationship with him or with my relationships to significant others—namely my husband, my children, my mother, and my twin sister. His focus from the beginning was on what I wanted from the situation. “I” was the focus of our work. There was no hidden agenda about how damaged I was. There was no room for exploitation.
    Dr. Ace built our relationship on his understanding of my different and fluctuating feeling states. He worked very hard to focus on my feelings, which were a serious problem for me and for him. I had too much training with Dr. Z, which led me to intellectualize and theorize about my life, rather than talking about my emotional experiences.
    Dr. Ace was also very open-minded and protective, as well as supportive of my feelings. My feelings and reactions were of tantamount importance, and we need to understand them I was not labeled or judged. Dr. Ace would always say to me in response to my diagnostic-like self-criticism, “Why do you have to do that to yourself? Why give yourself a label?” His implication was that I was a real person with feelings and experiences who was in pain. I was not a cluster of symptoms with a diagnostic label. I was always an individual who was in pain for reasons embedded in the present and the past. I was always treated with dignity. In this I have been very fortunate, for being treated with dignity and concern was an essential element in the recovery of my forgotten memories and my enhanced sense of self.

* * *

In looking back and reflecting on my treatment, as well as reading a great deal of current research on treating victims of incest or sexual abuse (see Selected References), I can see specific ways in which my second analysis was helpful, ways that might be generalizable to other victims of sexual abuse. As other researchers concur, treating the victim of sexual abuse can present its own particular problems. Specific aspects of my treatment were effective, and I believe they would be useful to other therapists working with victims and survivors of sexual abuse. I have used the ideas discussed below in my own work with my clients.


From the onset of my treatment Dr. Ace was hopeful that we could understand my shame, depression, symptoms of forgetting, and multiple inhibitions. In spite of my strong and persistent transference distortions, my feeling that Dr. Ace was angry with me or that I was worthless. Dr. Ace became a new self object or parental figure for me. I never felt he ever saw me as untreatable or damaged. His interest was in the interpersonal experiences that caused me intense pain. I felt he was always focused on my sense of entitlement, especially my feelings.
    I have been successful in working with my clients who are survivors of sexual abuse because I acknowledge that they are traumatized and afraid but not damaged irrevocably because of the violations to the cohesiveness of their self. I see my clients as injured by an unfair and unwarranted intrusiveness that they never asked for or expected. I try to dignify their pain and feel compassion for their emotional distress or symptoms.

Focus on Intensity of Affect Life

From our very first encounter until the termination of treatment, Dr. Ace was concerned with my fluctuating feeling states and what intensified or diminished my reactivity to people and situations. There was no evaluation of too much intensity or a lack of affect and/or lack of concentration or focus. My different feelings and alternating states of mind were merely reflected back to me within a framework that evolved from our dialogue. This process gradually led me back to my forgotten memories.
    I try to use Dr. Ace’s framework and style when I work with my own patients, focusing on my patients’ feelings and body sensations that might indicate forgotten memories.

Focus on Transference Distortions

My serious problems with self-loathing and shame were resolved through transference interpretations. I became aware that I felt judged by Dr. Ace and that this was my own projection.
He did not judge me. As he often said, “I know how I am feeling. I’m not angry with you!” I tended to believe he was angry and disappointed with me. These displaced feelings from my father and brother were analyzed and understood as determinants of childhood abuse and my previously endured traumatic life situations.
    Focusing on the transference distortions has been useful in my work with patients who are able to work analytically. However, not all patients are able to work in an analytic mode. I have found that forcing the analytic technique on patients is alienating to the therapeutic bonding process and to the progress of therapy.

Empathic Attunement

Dr. Ace was in almost every instance concerned with understanding how I was feeling. But he is human and did, naturally make some mistakes in understanding my subjective experiences. However, he maintained a sense of my pain and did not become overidentified with either the pain or my despair He was able to tolerate my painful states of mind and not worry about my well-being. He was protective, but not overprotective. For example, he took a strong stand about the importance of retrieving my memories. He believed I would remember what I could tolerate remembering. He never forced me or pushed me to remember. He concentrated on what my feelings would allow me to process. He was not invested in my remembering every detail I could as a measure of success in my treatment.
    In working with my own patients, I find that some women are interested in recovering memories of the abuse they experienced and others find it too painful. My experience has led me to believe that pushing the patient to confront the past is not therapeutic. The patient must want to, and be able to, tolerate these intense affect states. I have heard horror stories about women who were forced to remember through hypnosis events that were still too intensely painful to integrate into their current experiences. Because of an overemphasis on remembering through hypnosis, patients can regress to painful psychotic states, which are not curative, just overwhelming or even psychically fragmenting and damaging.

Equal Partnership

From the beginning of therapy I felt that there was a mutuality to our work together. Dr. Ace did not profess to know the answers to my questions and fears. Rather, he focused on information to which I might be able to associate, which would help us understand more deeply the core issues of treatment. This approach encouraged me to associate to my own dreams. Ace considered his interpretations of my dreams as a distancing mechanism that would cover up important feelings and memories. He never said, “This means . . . “ Instead, he asked, “What do you think this dream suggests?”
    When I work with survivors of sexual abuse, I am careful to stay with their feelings and associations. I do not think that I know what will help them feel better about themselves. I do encourage my patients to focus on protecting themselves from being victimized again.

The Bond

Because Dr. Ace and I were equal partners in exploring the recesses of my past psychic life, disruptions in the bonding process were inevitable. Working through and understanding disruptions in our bond enhanced genuine intimacy and understanding. I’m sure that it is more difficult for me to come up with a specific example of misattunement and reparation of the bond than it would be for Dr. Ace. It really wasn’t my work to stay connected. It was his job. So it is more difficult for me to describe how he managed to work through disharmony. There is one blatant example, I remember, which was not really reminiscent of our work together. This incident is funny now and illustrative of the bonding process. During my second or third year of analysis, I was lying on Dr. Ace’s couch and having difficulty remembering the details of an experience crucial to my analysis. I was, of course, having trouble explaining my state of mind. He directed, “Can you try to just stay with that idea and give me your associations?” I retorted, with intense anger, “You are just such a mother-fucker from hell—stop pushing me.” We tried to end the session calmly, but I remained upset. The next day, of course, I mentioned his lack of empathy and my reaction. His reply was funny. He told me that he had been called lots of different names in his long life as an analyst, but that I was the first person in his long and illustrious career to call him a “mother-fucker from hell.” He was pleased that I felt some conviction about being angry at him and that I had expressed my feelings directly. This openness made our relationship stronger.
    I believe that the bond established between me and my patients is what is ultimately the most curative aspect of treatment. My experience is that the bonding process with survivors of sexual abuse is particularly important and intimate. Victims and survivors are very sensitive to how others react to them. They yearn for more intense attachments. In addition, because of their traumatic experiences, when they do enter an intense relationship, they feel violated or hurt more easily than other patients.


That my analyst focused on my feelings about what had happened to me without labeling them was extremely important. He always viewed my feelings as valuable. I never felt objectified by my analyst.
    The issue of dignity is central with survivors of childhood trauma because they feel so intensely ashamed and humiliated. Any type of objectification of their problems or labeling or stereotyping of their experiences is not therapeutic. Objectification of experiences or labeling may lead to a disruption in the bond between patient and therapist and to further repression and false-self interactions between the patient and the therapist.


The issue of protection was very important for me. Doctor Z gave me a sense of protection by predicting or prescribing things to me. This turned out to be a false sense of protection. On the other hand, Ace was very careful not to make predictions or prescriptions for me. By focusing on my feelings, I was able to feel protected by him. In other words, because he often took my feelings more seriously than I did, he was able to establish a sense of safety so important to establishing a profound sense of trust in the process of my analysis. For example, if I said, “I am afraid to stay alone in that hotel room,” he would respond, “Then trust your feelings and don’t do it. You know what is best for yourself. If only you would trust your inclinations.” He never said, “I don’t think that you should do that,” as Dr. Z had done all too many times.
    I find that as a clinician I am very careful myself about giving my patients the message that they are fragile and in need of advice on how to run their lives. I try to help them come to their own conclusions about what might make them feel safer and more self-confident. This is something Dr. Z never fostered in me.

* * *

My treatment proceeded in a natural fashion, it unfolded, and it was successful. However, and interestingly enough, my treatment was also similar to case histories I have read about and listened to at conferences. This leads me to suggest that there are five phases of treatment common to survivors of incest or sexual abuse. They are outlined below.

Phase One: The Toleration of Affect

The initial work of psychotherapy is to establish a bond with the patient, which is based on the therapist’s understanding of the patient’s feeling states. Dr. Ace’s dealing directly with my feeling states and the intensity of my affects, including my bodily sensations, was crucial. His sensitivity allowed me to trust him as a new self object or parental figure who could accept and tolerate who I was emotionally. This attunement was crucial in lessening my pervasive sense of shame.
    Oftentimes it is very difficult for therapists to tolerate the affects of survivors of sexual abuse because their feelings may be too overwhelming to tolerate even for the therapists themselves. Incest survivors, intensely sensitive to others, often sense the therapist’s capacity or incapacity to tolerate their feeling states. This monitoring system, already in place from childhood, unconsciously influences the patient to tell the therapist only what is acceptable. Therapists need to understand their countertransference feelings. If the therapist feels revolted, overstimulated, or overwhelmed by the patient, then they will be unable to work together.
    Dr. Ace encouraged me to know my feelings and my inclinations. He encouraged me to talk about my emotional pain. He was not frightened or repulsed by my feelings and experiences. On the other hand, neither was he remote or removed from my trauma. I experienced him as separate from me but still emotionally available for me. This is a difficult position to take when dealing with traumatic emotional illnesses. Often the therapist becomes overidentified with the patient’s pain or is revolted by the patient’s experiences. Dr. Ace was able to maintain compassion for me. He was hopeful that I could also feel compassionate for myself. In this way he helped me to retrieve my forgotten memories, those remembrances that because of their intense pain had remained buried for so many years.
    This focus on the acceptance of feeling states, including memory fragments and body pain, was the first step in our work and a thread that ran through the entire analysis. I believe that focusing on what the patient brings to the therapeutic session is the initial phase of working with survivors of sexual abuse. In addition, a lack of memories is a signal to me that there is a possibility of sexual abuse.

Phase Two: Reduction of Stress

A common personality characteristic of survivors of sexual abuse is an overzealous need to accomplish too many unrealistic goals in order to defend against their deep sense of defective-ness, their ensuing depression, and a need to feel in control. Dr. Ace worked very hard with me to help me reduce some of my overdetermined and compulsive need for overachievement in order to reduce the number of stressful situations in my life, which often left me feeling overwhelmed and burdened. By reducing stress in my life, I was able to focus on more internal issues.
    The reduction of stress is essential for all survivors in treatment. Overachievement, eating disorders, drug abuse, alcohol problems, and sexual promiscuity are all used to mask the horrible sense of defectiveness and other overwhelming feelings of incest victims. Understanding how food, drugs, alcohol, and sex are used to tolerate pain is necessary if such use is to be reduced.

Phase Three: Uncovering Forgotten Memories

With a firm connection to my analyst and a lifestyle more contained and supportive of my idiosyncrasies, I was able to begin to retrieve memories of my past. The task of confronting my pervasive early childhood amnesia for in-house experiences, dissociation experiences, and memory lapses was tedious and required a great deal of focus on painful states. The survivor needs to be able to deal with serious traumatic problems exclusively for a long period of time.
    I find that when I work with patients, both of us need a strong commitment to the therapeutic process in order to recover for gotten memories that have been repressed. This type of connection between therapist and patient is not always possible, as the arousal of shame and intense pain can often feel totally consuming and overwhelming for the patient and the therapist.

Phase Four: Confrontation

It was important in my experience to try to confront people m my past who might be able to help remember what had happened. Confrontation with other people, whether supportive or nonsupportive, helps reduce overwhelming feelings of shame and increases a sense of entitlement. Speaking up about the past also allows the incest survivor to develop a support network outside of psychotherapy.
    I find that confrontation with significant others in the survivor’s past is necessary if the patient is going to feel better about him or herself in a lasting way. A group support system is also very useful to help survivors accept the importance of their own painful experiences, for others view them as important also.

Phase Five: Integrating the Trauma

Working through traumatic experiences from the past occurs during the last phase of treatment. The survivor needs to learn to deal with the world from a position of power, rather than helplessness. This capacity to deal with others assertively is the ast phase of treatment and may continue as long as the patient feels vulnerable. Although I believe that it is difficult to forget what has gone before that has been traumatic, I know that old demons gradually seem less scary and more manageable.

* * *

Dr. Ace wrote the following summary about my treatment.

October 15, 1992

Barbara has asked me to write a brief description of my understanding of the nature and vicissitudes of her psychological pain for the purpose and clarification for her editors of her forthcoming book:
    Relatively early in our work, I came to understand her pain as derived from her personality organization. She seemed to be organized on the basic principle that her very existence depended on how successful she was in putting herself at the disposal of others. This means total mental attention to her perception of significant others’ changing needs and pleasures, with total inattention to her own needs, feelings, and inclinations: a life of painful slavery with the ever-present danger of banishment and annihilation if she didn’t do well enough. I am speaking of her definition of her own identity and required role in life. How this psychological organization developed, what early experiences fed into the development of this life view, is another matter, beyond the purpose of these notes.
    These words clarify for me the nature of her ever-present psychological pain, always afraid of not doing well enough for the other, and risking annihilation or the alternative of rebelling and suffering the pain of loneliness and isolation.
    She did demonstrate that she had several refuges from pain—all inefficient and costing a high price. I will try to describe three: disassociation, achievement, and amnesia. Early in life, she developed the ability to disassociate herself from the experience of pain—by viewing the situation intellectually, rather than experiencing it. This cost her the tendency to become more and more cut off from her feelings. Thus, this primary need to please the significant other enough in quantity and quality. This mechanism, despite her unusual productivity, offered her only brief relief before the doubts about whether she had done well enough crept in and resumed her torment. Understandably, this also left her in a chronic state of fatigue and with the burden of what was still to be done to earn acceptance.
    Achievement: Her natural talents led her to superior academic achievement early, and later as a clinical psychologist and author. But usual accompanying and stimulating feelings of mastery, enhanced self-worth, and pleasure were mild and brief or sometimes completely absent. Instead she was plagued by the question of whether she was doing well enough in quantity and quality to please the other, enough to stave off destruction for another day. In brief, achievement was accompanied by a transient good feeling followed by long painful anxiety and terror.
    Disassociation: Early in life she developed the ability to disassociate her painful emotional reaction in a situation from the event by viewing herself in the situation from without—this helped her disassociate herself and her feelings from the traumatic event. It successfully relieved pain at a high price, namely, becoming detached from her own feeling life, and ultimately led to a deadened existence.
    Amnesia: She developed amnesia for large blocks of her childhood, with only isolated innocuous memories surviving. Forgetting the traumatic events protected her from the pain of reexperiencing the painful attendant feelings. Again, the price was pain of another sort: feeling ashamed that her secret, kept even from herself, must be horrible; and in addition, maybe she was even responsible for the events. She lived with the conscious private pain that she embodied a terrible secret whose dimensions she did not know.
    In considering how to describe the treatment of Barbara from my point of view, I have decided to divide it into phases, somewhat artificial and oversimplified, but I can’t think of a better way in a brief description.
    With her personality organization, I am sure you will anticipate that in the first stage of treatment it was necessary to address her theories about my motive for taking her as a patient. They all had one common thread: She had to make the experience nice for me, interesting for me, and not stressful for me. Although this was in the foreground in the beginning, this took a long time to die. Finally, she seriously considered that I didn’t require her to devote herself totally to my comfort. Then she needed a considerable period of time to trust that getting reacquainted with her own feelings and inclinations was safe. There was a period of pleasant anticipation mixed with apprehension about the forbidden and unknown.
    The pain of this period can be understood as her being encouraged to trust a new view of herself and the world—as possibly without risking annihilation. Finally, she tentatively and apprehensively experimented with a new, inner-directed life experience where she was motivated by her inner personal, unique interests and inclinations rather than the previous almost complete focus on what the other needed and wanted. Again, this stimulated feelings of excitement and feelings of an unknown dread. The dread, of course, was due to the variance in behavior with her lifelong pattern and the inability to completely trust that it was safe to change. Now, when she did act in the other’s behalf, her motivation was her own caring, compassion, and understanding, rather than from outside pressure and outside need.
    During this phase, as she experimented with a new life view, she repeatedly experienced pain-free periods of longer and longer duration. When the pain returned, she could be helped to recover her pain-free state quickly by bringing her attention again to her own feelings and inclinations and point of view. It was at this time that she first mentioned her inclination to write a book about her own experience.
    In the termination phase of our work, the old tendency reasserted itself but was easily put to rest as she continued to feel better. Characteristically, she rushed herself toward termination for my benefit. When she recognized this tendency, it was easy to again respect her own inclinations and wait until it felt right to her to end the treatment.
    In closing, I have a need to remind you that my description of Barbara’s pain and recovery comes from my own subjectivity, retrospection, and reconstruction and is in no way objective reality. I truly believe that Barbara is really the ultimate authority about descriptions of her pain as well as her healing.

*  *  *

I have been able to work with sexually abused patients because I can consciously and unconsciously identify with their shame. In addition, I have a sense of hopefulness and compassion, which helps my patients to strive on, even when life and therapy feel overwhelming, bleak, and hopeless.
    My ability to identify with a patient is useful to the progress of therapy. For example, I remember my first clinical experience as a trainee at Camarillo State Hospital (CSH). A young woman who had been seriously sexually abused by her stepfather was suffering from multiple personalities, which in the 1980s was a misunderstood diagnosis. I was, so to speak, the new kid on the staff, and this young woman was my first patient but somehow I was able to work with her. She made a strong attachment to me, even when she was changing personalities. I, in turn, was very concerned about helping her. I had, truly, the finest and most experienced supervisors of psychotic illness, and even they were amazed at my intuitive sense of how to work with this young woman. I remember speaking at “grand rounds” to the entire hospital about the case and getting the go-ahead to follow my sense of how to work therapeutically with this young woman.
    I saw Becky and her 12 personalities three times a week in analytic therapy for nine months. She was able to leave the hospital and return to her board and care. She writes to me now to tell me how she is doing on her own.
    Some of the staff at CSH thought that Becky would quickly return to the hospital. Others thought that I was a weird but clinically gifted genius. I know, however, that it was my ability to connect unconsciously with her pain that allowed me to help her begin to recover some of her strengths to face the world. I cannot exactly remember and then analyze what I did and said, for she was literally my first patient. I now remember that when she slit her wrists or changed personalities in front of me, I was not afraid that she was untreatable. I wanted to help her out of that horrible hospital. I won the battle.
    I have also worked extensively with Lori, my young actress patient, who was sexually abused by her father and emotionally tormented by her mother’s ambivalence about her painful experiences and her memories. Lori has been made to feel like a liar or someone just not strong enough to take what life had given her when in fact she was seriously abused. She has given up hope for reconciliation with her father, but her mother remains connected to Lori through her own guilt and shame and a wish to change Lori’s mind for her own peace of mind. Perhaps her mother’s childish attitude will change, although the prospect is bleak, given Lori’s mother’s network of friends.
    Along the road of my clinical experiences I have met other women and men who were sexually abused and who have developed differing symptoms, from high overachievers to recovering alcoholics and to drug users. Some individuals know they are victims of incest or sexual abuse, but they cannot deal with what has happened to them. They really can’t bear to break down their defenses and work on their hidden terror and sadness. Other victims have put their secrets about being sexually abused aside in a box that is buried under success and the “good things” in life.
    I have worked with many children who seem to be able to openly confront their own confusion related to being violated sexually. It is most often the shame of the parents that makes the children’s problems with self-loathing even more serious.

*  *  *

Surrendering to understanding the trauma of sexual abuse takes a great deal of courage by both therapist and patient. Therapists need to have the tenacity, insight, and self-understanding to deal with the hidden, scary issues and the intense affects that these issues arouse. Patients need to give another individual the trust that was destroyed by the violations of their ego boundaries when they were abused. This is a difficult yet worthwhile journey.