Adult Survivors Of Childhood Abuse: The Psychotherapeutic Process

From an early age we learn to be silent. Embedded deep in our collective thoughts are proverbial beliefs such as “Children should be seen and not heard” and ‘If you have nothing good to say, then say nothing at all.”  This “looking away” attitude of society has resulted in generations of adults who suffer the pain of silence -- the pain associated with being a victim of childhood abuse.

How can a child, who must be dependent upon adults for nurturance and guidance, accept the terrible reality that his or her parental figures are non-trustworthy, out of control and capable of harmful abuse?  How can such a child, whose basic trust and sense of self was violated, learn to trust another individual or allow for an intimate and bonding relationship?

As a means of survival, victims of childhood abuse learn, early on in life, coping strategies to defend against thoughts and feelings to painful and frightening to put into words.

While these defense mechanisms serve important functions at the time of the abuse, as the child psychologically develops they tend to hinder adaptation to adulthood. The traits and behaviors that were at one time beneficial in terms of helping the child survive an abusive situation become maladaptive when applied to more appropriate relationships.  Healthy relationships rely upon basic trust and intimacy – two characteristics survivors of abuse tend to lack.

The adult survivor relives the past in the present as if the environment they currently occupy is as dangerous, unpredictable and uncontrollable as their childhood realities.  As a result, many survivors tend to be non-trusting, guarded, avoidant of intimacy and hyper vigilant.

The three coping mechanisms most widely used by adult survivors to defend against painful and intruding thoughts and feelings are repressions, denial and dissociation.

Many adults who have been abused as children are unaware of their own victimizations. They are unable to remember, at least on a cognitive level, their past history of abuse. By repressing these traumatic memories, the individual tempts to go on with life as if the abuse had never happened. “What I don’t know can’t hurt them” is the faulty premise upon which this defense mechanism rests.

Repression, however, can only go so far. The more the individual attempts to push these negative thoughts and feelings out of mind, the more they can return in the form of flashbacks, nightmares and even psychosomatic symptoms.

For example, repressed anger may result in tension headaches, fear of abandonment can manifest as gastro-intestinal problems, and feelings of guilt can appear as back or should trouble, not to mention the array of sexual, dysfunctions, eating disorders, addictions or characterological traits that can signify some form of unresolved issue related to the abuse.

Victims tend to distort the facts surrounding the abuse.  They deny their victimizations.  They believe they desired, deserved, or willingly participated in the abuse. Many abusers threatened their victims into secrecy, leaving them to carry these concealed burdens well into adulthood.

Certain victims blame themselves for the abuse as a means of gaining mastery over the abusive situation. “If I am responsible for the abuse, then I am also capable of controlling and possibly preventing the abuse.”

Other victims blame themselves for the abuse because they confuse their age appropriate need for affections with abuse they received.  “I am to blame because I wanted my father to come into my bedroom and cuddle.” Victims, who blame themselves for the abuse, tend to suffer from excessive guilt, depression, low self-esteem and self-defeating thoughts and behaviors, including suicidal thoughts and gestures.

Dissociation in another coping strategy abuse victims use to defend against painful thoughts and feelings.  When adult survivors are confronted with situations or events that symbolically remind them of the childhood abuse, they defend against these intruding recollections by either temporarily losing touch with reality or numbing their bodies so they don’t experience the pain associated with the abuse.

Like a circuit breaker, dissociation shuts down a person’s cognitive and emotional processes in order to prevent an overload of painful stimuli. Dissociation, however, is only a temporary solution; it does not resolve the underlying issues that are triggering the problem.  The moment the individual is confronted with internal or external stimuli that bring forth painful recollections, the maladaptive mechanisms arise and prevent the person once again from performing everyday functions.

It is difficult for an abuse victim to seek professional psychological help. They are caught in a vicious circle of maladaptive defenses. To break the silence, develop trust and intimacy with a therapist, and begin to work through one’s pain is a frightening, but much needed process.

For the adult survivor of childhood abuse, what is most frightening about the therapeutic process is its demand for verbal communication and intimacy. Many victims are unaware of their past history of abuse or find it too difficult to speak openly about their painful memories, especially to a therapist.

Victims of abuse are conflicted about how they should relate to a therapist. They desire their therapist’s understanding and care, but fear if they let down their defenses they might become vulnerable once again to possible abuse.

Childhood abuse rarely appears as the presenting problem. To diagnose a victim of abuse, the therapist must learn to read between the lines of what the person is saying or even not saying. It is within the silence that victims express their suffering and need for help. The abuse victim communicates less with speech, and more with the symbolic language of the body.

There they sit facing the therapist, scared, frightened, hyper vigilant, numb, looking away from the therapist’s eyes in order to avoid what they perceive as their therapists’ piercing and critical gaze.

As a perceived parental figure, therapists can easily become screens for the victim’s projections. The individual may experience the therapist as if he or she is an abuser and the therapeutic session an abusive situation. If this occurs, the conflicts and struggles the adult had as a child may be acted out within the realm of the therapeutic relationship.

It is understandable why even a seasoned therapist might be disturbed by the victim’s inappropriate and situationally dystonic behaviors and actions. To cope with their own level of anxiety, some therapists might choose to relate to the patient in a defensive manner.

The most common form of defense used by therapists to create distance between themselves and the acting out patient is the diagnostic procedure.  By labeling a person with a diagnosis, the patient as subject is transformed into an object that can then be defined, manipulated and controlled.

Because of their hyper vigilance, victims are sensitive to how others perceive them. If they feel the therapist is relating to them as an object rather than as a fellow subject, their acting out tendencies will escalate.

The feeling of being objectified by the therapist will serve as a catalyst for the victim to re-experience and reenact the past abusive situation within the present therapeutic relationship. In other words, the defensive therapist will be perceived by the victim as being manipulative and controlling and as a result will react in a defense fashion against what they perceive to be a threat.

The goal of treatment is not for the therapist to diagnose the victim, but rather for the victim to begin to learn how to identify and understand their patterns of thoughts, emotions and behaviors. By organizing their experiences into language, their victim will develop the psychological distance and personal integrity required to gain a sense of mastery and control.

Over and against the victim’s negative projections, the therapist must relate to the victim with unconditional compassion and support. For it only by developing a safe and highly structured milieu that the victim will be able to let down his or her defenses and begin to work through the issues related to the abuse.

It is understandable why the victim’s defense mechanisms might be interpreted by both the therapist and patient as maladaptive character traits. No one would dispute the negative effects these defense mechanisms have in terms of sabotaging and resisting the therapeutic process. However, to continue to view the victim’s defense mechanisms as a form of “resistance” will have a negative effect upon treatment. To critically confront the defenses can make the victim feel as defective and helpless as he or she felt at the time of the abuse.

By recontexualizing these defenses mechanisms, from within the horizon of a developmental/ historical perspective, the victim will begin to realize the important role these personality traits played in terms of their survival. Defense mechanisms are, in fact, coping strategies that, in the past, helped the victim adapt to a maladaptive environment.

By reinterpreting these defense mechanisms as coping strategies, the patient will begin to develop more positive self-image and begin to fell more integrated and in control. In time, they will realize that these maladaptive defenses mechanisms are no longer appropriate or needed.

In addition to basic trust, self doubt is a problem that also plagues victims of childhood abuse. The victim does not trust his or her own thoughts and perceptions – especially past memories associated with the abuse. In fact, many victims are unsure if their memories are fantasy or reality.

To help the victim overcome self-doubt, it is important for the therapist to validate his or her memories. What matters is not the historical facticity of the memories, but rather what psychological significance these memories have in terms of the person’s current experience.

To accomplish this goal, the therapist, must keep in mind that the victim’s recollections of the past are based upon a child’s perspective – a viewpoint that is very different from how we as adults perceive ourselves, others and the world. For example, children tend to perceive adults as being bigger than life and also do not have a proper understanding of sexuality, aggression, or even a clear demarcation of self and other. From this vantage point, it is understandable why the victim’s memories might have a limited or distorted child-like quality to their narrative.

Working through the defenses, learning to trust oneself and the therapist, reconnecting thoughts with feelings, and beginning to integrate the past with the present is both a frightening and exciting process.

What is most frightening about the process is that it requires the subject to face the unknown, What is most rewarding about the process is that if offers the subject the freedom for personal expansion and growth.

Dr. Klein is a clinical psychologist who practices in Fairfield and Westport CT.  He specializes in the treatment of trauma, Post Traumatic Stress Disorders (PTSD) and adults survivors of  emotional, physical and sexual childhood abuse.