psychotherapy

Being Scared-off by EvilLastly, we deny the presence of evil because we are terri_d by the horrendously hurtful, cruel, and bloody kinds of evil people tell us about__f we are willing to listen. This was poignantly brought home during an interdisciplinary case conference involving a resident who was counseling for the _st time a woman who had been sexually abused. As we worked with him, it became clear that he was resisting entering what he called the 'psychic cave" of her sealed__ff experience from which she was shouting for assistance. Because of his resistance, he was not providing her the support and guidance she so desperately needed, and he was not facilitating her working through the abuse and hurt that were continuing to impact her life. As he was confronted about this at one point in the conference, he stated tearfully: "I'm afraid if I help her move into her memories. I will have to go with her, and if I go with her, my view of the world as a basically good and safe place will be shattered. I'm not sure I can handle that for myself, or be able to think about the fact that my wife and kids may be more vulnerable living in this world than I can be comfortable believing" (Means 1995, 299).

Underlying the attack on psychotherapy, I believe, is a recognition of the potential power of any relationship of witnessing. The consulting room is a privileged space dedicated to memory. Within that space, survivors gain the freedom to know and tell their stories. Even the most private and confidential disclosure of past abuses increases the likelihood of eventual public disclosure. And public disclosure is something that perpetrators are determined to prevent. As in the case of more overtly political crimes, perpetrators will fight tenaciously to ensure that their abuses remain unseen, unacknowledged, and consigned to oblivion.The dialectic of trauma is playing itself out once again. It is worth remembering that this is not the first time in history that those who have listened closely to trauma survivors have been subject to challenge. Nor will it be the last. In the past few years, many clinicians have had to learn to deal with the same tactics of harassment and intimidation that grassroots advocates for women, children and other oppressed groups have long endured. We, the bystanders, have had to look within ourselves to find some small portion of the courage that victims of violence must muster every day.Some attacks have been downright silly; many have been quite ugly. Though frightening, these attacks are an implicit tribute to the power of the healing relationship. They remind us that creating a protected space where survivors can speak their truth is an act of liberation. They remind us that bearing witness, even within the confines of that sanctuary, is an act of solidarity. They remind us also that moral neutrality in the conflict between victim and perpetrator is not an option. Like all other bystanders, therapists are sometimes forced to take sides. Those who stand with the victim will inevitably have to face the perpetrator's unmasked fury. For many of us, there can be no greater honor. p.246 - 247Judith Lewis Herman, M.D. February, 1997

Bit by bit, Dr. Driscoll helped me to peel away the layers of protection I had built up over the years. The process was not that unlike the peeling of an onion, which also makes us cry. It has been a painful journey, and I don't now when it will end, when I can say, __K, it's over._ Maybe never. Maybe sooner than I know. I recently told Dr. Driscoll that I feel the beginnings of feeling OK, that this is the right path.

It wasn't a sign of weakness to tell what happened to me. I feel guilt no longer, only regret. The other emotions are coming around too. How much further do I need to go? I'm not sure, but there is comfort in the fact that I am in the hands of expert guides, both in the doctor's office and at home with Sue.

Theirs was the eternal youth of an alternating self, a youth with the constant although unfulfilled promise of growing up

The United States alone sports an inventive spectrum of psychotherapeutic sects and schools: Freudians, Jungians, Kleinians; narrative, interpersonal, transpersonal therapists; cognitive, behavioral, cognitive-behavioral practitioners; Kohutians Rogerians, Kernbergians; aficionados of control mastery, hypnotherapy, neurolingustic programming, eye movement desensitization- that list does not even complete the top twenty. The disparate doctrines of these proliferative, radiating divisions, often reach mutually exclusive conclusions about therapeutic propriety: talk about this, not that; answer questions, or don__; sit facing the patient, next to the patient, behind the patient. Yet no approach has ever proven its method superior to any other. Strip away a therapist__ orientation, the journal he reads, the books on his shelves, the meetings he attends- the cognitive framework his rational mind demands _ and what is left to define the psychotherapy he conducts?Himself. The person of the therapist is the converting catalyst, not his order or credo, not his spatial location in the room, not his exquisitely chosen words or denominational silences. So long as the rules of a therapeutic system do not hinder limbic transmission - a critical caveat - they remain inconsequential, neocortical distractions. The dispensable trappings of dogma may determine what a therapist thinks he is doing, what he talks about when he talks about therapy, but the agent of change is who he is. (186/7)

As I let it out, layer by layer, Dr. Driscoll helped with the bumps and valleys. He knew just how much to draw out of me and how much I could handle. He is such an expert in his profession. He told me that the guilt I was feeling was not guilt, but regret. Guilt is a good thing. It is a mechanism by which we shouldn't make the same mistake twice. If you do something questionable, then the next chance you get to do it, guilt should stop you. I had no guilt. I had regrets, many regrets, but no guilt. It took some convincing, but he prevailed. There was always a nagging in my head, that if only I had had the guts to kill Neary myself, it would have stopped him from harming others, but that was not to be as a small boy. It does hurt that, maybe, just maybe, if I had carried out one of my many plans to kill him and myself then I could have saved victims younger than I. As victims come forward from almost all the churches where he served__nd some are twenty__ive plus years my junior__ feel that they would have been spared, if only I hadn't chickened out as a boy. Therein lies the answer; I was a little boy, a ten__ear__ld boy. Other victims of Neary were as young as six.

The shame, embarrassment, feeling of low self-worth, and scores of "labels" we give ourselves are not fitting. I am beginning to see how I had no control over the situation. He was a big man, I was a little boy.

...some patients resist the diagnosis of a post-traumatic disorder. They may feel stigmatized by any psychiatric diagnosis or wish to deny their condition out of a sense of pride. Some people feel that acknowledging psychological harm grants a moral victory to the perpetrator, in a way that acknowledging physical harm does not.

First, the physiological symptoms of post-traumatic stress disorder have been brought within manageable limits. Second, the person is able to bear the feelings associated with traumatic memories. Third, the person has authority over her memories; she can elect both to remember the trauma and to put memory aside. Fourth, the memory of the traumatic event is a coherent narrative, linked with feeling. Fifth, the person's damaged self-esteem has been restored. Sixth, the person's important relationships have been reestablished. Seventh and finally, the person has reconstructed a coherent system of meaning and belief that encompasses the story of trauma.

To make matters worse, everyone she talks to has a different opinion about the nature of his problem and what she should do about it. Her clergyperson may tell her, __ove heals all difficulties. Give him your heart fully, and he will find the spirit of God._ Her therapist speaks a different language, saying, __e triggers strong reactions in you because he reminds you of your father, and you set things off in him because of his relationship with his mother. You each need to work on not pushing each other__ buttons._ A recovering alcoholic friend tells her, __e__ a rage addict. He controls you because he is terrified of his own fears. You need to get him into a twelve-step program._ Her brother may say to her, __e__ a good guy. I know he loses his temper with you sometimes__e does have a short fuse__ut you__e no prize yourself with that mouth of yours. You two need to work it out, for the good of the children._ And then, to crown her increasing confusion, she may hear from her mother, or her child__ schoolteacher, or her best friend: __e__ mean and crazy, and he__l never change. All he wants is to hurt you. Leave him now before he does something even worse._ All of these people are trying to help, and they are all talking about the same abuser. But he looks different from each angle of view.

When emotions turn and stay sour, when thoughts become cynical and judgmental, good and compassionate treatment is on the line. Helpers who become sour and cynical tend to begrudge their high need clients for their neediness. There is a risk that helpers become too well-practiced at taking a bleak view of those they have avowed to assist. There is a temptation to begin to blame clients for their failure to improve. If treatment ends pre-maturely, with either a client never returning to treatment or a helper 'firing' them out of frustration, there is a tendency for the client to take the fall. Of course what we are talking about here are signs of burnout.

Even you, the professional helper, often mistaken for the enlightened Guru or Staretz, can become lost in your thoughts that you must be competent without fault. You may become enthralled with your identity as a professional, even the pressures of the culture of mastery that expects you to heal your clients without fail. Never mind all of the variables over which you have no control, it is up to you, according to the canons of mastery, to control the health and well-being of those for whom you provide professional care. This potentiates a furthering alienation between you and your clients. You are at risk to become, if you have not already, the one who does to your clients; to be the one the active subject acting upon the passive and receptive objects, your clients; to be the one in possession of special knowledge, technique and mastery. All of this conspires to coax or coerce you into treating your client as reduced, a mere case. Unawareness to these influences gives you little chance to consider their influence on your practice in the clinical setting, much less give attentive efforts to resist or change them.

When psychotherapy began, it was about the practitioner listening to a patient and interpreting what the patient said, in order to afford the patient insights about his or her psyche. But now we understand that the main curative part of psychotherapy is the relationship itself. It appears not to be relevant which psychology school the practitioner belongs to. What matters is the quality of the relationship and the practitioner's belief in what he or she is offering.

For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.

Macbeth: How does your patient, doctor?Doctor: Not so sick, my lord, as she is troubled with thick-coming fancies that keep her from rest.Macbeth: Cure her of that! Canst thou not minister to a mind diseased, pluck from the memory a rooted sorrow, raze out the written troubles of the brain, and with some sweet oblivious antidote cleanse the stuffed bosom of that perilous stuff which weighs upon her heart.Doctor: Therein the patient must minister to himself.

As Louis Cozolino Ph. D., observes, a consistent theme of adult psychotherapy clients is that they had parents who were not curious about who they were but, instead, told them who they should be. What Cozolino explains, is that the child creates a "persona" for her parents but doesn't learn to know herself. What happens is that "the authentic self"--the part of us open to feelings, experinces, and intimicy--remains underdeveloped.

Perfectionism is adaptive if you are mindful of your humanhood.