The Adult Legacy Of Childhood Sexual Abuse
Individual Therapy With Adult Mental Health
Referrals Where CSA Is The Key Factor
Dick Agass And Mike Simes
HELEN
Helen was referred by her GP. She had a history of recurrent depressions and had
reached the point where she wanted to 'do something about it' rather than carry
on taking pills.
It was an enormous step for Helen to come to see a male worker. She later confessed
that she very nearly abandoned the whole idea, and only came to the second session
because the worker made some remark in the first one about her being 'worthwhile'.
Work then got underway on a weekly basis.
The details ofHelen's childhood abuse emerged slowly and painfully, and only after
a great deal of tension had built up in the sessions. Like many abuse victims, Helen
had suffered an emotionally deprived upbringing and had always had a very poor relationship
with her mother. This woman had such a succession of male companions that for many
years Helen was not even sure which one of them was her real father. In her teens
she was left to look after her younger brother when her mother went to live abroad.
She had blanked out much of her childhood and was left with a legacy of poor self-esteem
and chronic unhappiness. Her marriage was a misery, since she had chosen a man who
treated her in much the same style as her mother, ignoring her emotional needs and
undermining her self-confidence.
The sessions put Helen back in touch with her childhood. This produced such an emotional
upheaval that after a few months she was reacting to the worker as though he were
responsible for her suffering. She was aware that in some curious way he had come
to represent 'father' for her, and she started hinting at painful secrets which
gave her good reason to be angry with him. Eventually she was able to talk about
the sexual abuse she had suffered around the age of eight from Tom, the most important
father-figure of her childhood. It transpired that this abuse had come back to her
quite forcefully in a nightmare soon after the beginning of therapy. She felt she
had spent the whole night holding something off, and actually woke up with arm-ache.
As the work progressed she realised that this 'fending oft' had become her primary
mode of relating to other people in general.
As more and more of these buried feelings resurfaced, the work. became tense and
difficult. Helen suffered agonies of self-blame for the 'stuck' sessions, feeling
(as with the abuse) that it was all her fault. When she reverted to being a trapped
and helpless child - at times so agitated that she had to flee the room - the worker
began to feel like an abuser himself. At such times he felt there was nothing for
it but to sit tight and see it through. As Mollon (1988) remarks: 'The therapist
just has to endure being seen as an abuser, and indeed feeling like an abuser, at
least for a time'.
There were a number of complicating factors about the original abuse. Cruelly, Tom
was the only adult who brought anything good into Helen's life. He had time for
her, told her stories and made her laugh. He was the one ray of light in an otherwise
dismal childhood. But as well as bringing the best he also brought the worst, violating
the natural boundary between them in a way which permanently affected Helen's development.
She was caught in a terrible trap, in her own words 'resisting something I wanted
but didn't want at the same time'. She recalled going numb and frozen whenever Tom
fondled her, dissociating herself in the way that so many victims describe (Gelinas,
1983). Briere and Runtz (1988) observe that this 'going away' defence, which serves
such a vital purpose at the time of the abuse, can often be generalised maladaptively
to other anxiety-provoking experiences. This accurately describes what happened
in all Helen's social relationships. For the most part she simply 'wasn't there'.
The final complication was Tom's sudden, unexpected death. Helen recalled her mother's
grief and the total chaos to which their family life reverted. She was left with
a crushing burden of sadness, anger and guilt, and with no-one to turn to for help.
Not surprisingly the unresolved issues relating to Tom were still being acted out
in Helen's adult relationships with men. At one point she advertised for a male
companion, and when it came to choosing between a 'safe' candidate and a riskier
one she chose the path of risk. She then embarked on a striking replay of abusive
themes with a chosen partner who even had the same build and colouring as Tom. As
with Tom the relationship began playfully but became more and more oppressive. Her
feelings in this relationship made it quite clear that she was re-enacting the earlier
situation. For example, the man insisted to her that any problems between them were
her fault. She knew she wanted rid of him but feared that life without him would
be worse. In one session she even said she felt paralysed, unable to get rid of
him because it would be cruel to 'kill him off. Here was a clear indication that
for Helen as a child Tom's death had added a cruel twist to the abuse: it had left
her believing at some level that her anger had killed him. This conviction later
surfaced in a close relationship with another man when Helen became frightened that
he would die.
After much exploration Helen was able to see what was happening in the 'risky' relationship
and to end it. It seemed as though this re-enactment had in some way helped her
to unfreeze the childhood experience and begin to resolve it. Perhaps the vital
new element was that she could at last do this in the presence of a trusted parental
figure who could provide the help she was unable to get as a child. In classic psychodynamic
terms Helen was able to re-live the repressed trauma and make sense of it with someone
who not only believed her but also helped her to put the experience into words (cf.
Spurling, 1988). In this way she could begin to free herself from the unconscious
compulsion to repeat it (Freud, 1914; cf. Miller, 1985, p.162).
When the sessions came to an end Helen was still experiencing problems in close
relationships, but her life was much more open and self-directed than it had ever
been before. Like so many victims, Helen had been left feeling 'stupid': rejecting
the knowledge of abuse by a trusted adult had meant throwing out other learning
too (Sinason, 1988). Now her capacity to make sense of her experience and to communicate
(both with herself and others) had improved dramatically. As far as the abuse itself
was concerned, she reported a dream which seemed to reflect the current state of
her internal processing of it. She dreamed of a dead man and a dead child moulded
together in clay. She was cutting them with a spade, producing neat clay slices
which could be made into something else. The worker took this to mean that the part
of Helen which had died with Tom (note their union in the clay) was now available
to be fashioned into something new. It was even possible for her to relate to him
with a certain controlled aggression (neatly slicing with the spade) for what he
had done.
After reading the above account, Helen wrote to the worker: 'It is not clear to
me whether you knew that from the first moment we met you were communicating with
the 'dead child'. She that died had hardly lived before, due to all the other factors
preceding the sexual complication. The main reason I mention this is that 'improved
dramatically' doesn't quite convey the intensity of the dramatic journey I have
made, almost manages to minimise your/our achievement'.