Before you can embark on the road to recovery, you will need to make a decision to act. This is the point that stumps many adult survivors. The challenge here has to do with your willingness to take a risk in promise of a future payoff. Recovery can sound like a risky proposition, especially when you have been let down before. There may be conflicting parts inside you that either call you to action or warn you of potential disappointment. Trying to change but fearing failure may be your greatest motivational challenge. As you encounter these thoughts, you may pass through many layers of defenses and attitudes and fears left over from the past. You may hear a voice encouraging you to give up hope for a different type of life. Better to play it safe, this chorus of doomsayers sing, and muddle through life taking what you can get.
But there may be another part of you heard as a voice or felt in the heart, which represents hope and the possibility for something better. It is that part of you that reached for this book, took control by gaining knowledge about your family and the abuse. From this seed has sprouted a sense of empowerment and determination that can spark change. Use that part to fortify your determination to enter recovery. That part, which will become the core of your new sense of self, is emotionally, psychologically and spiritually linked to your soul. It will fuel your motivation to act.
Your soul was never vanquished by the abuse, although it may have gotten temporarily lost. It still believes in your essential goodness and your right to rejoice in the spirit of human existence. It wants to support you as a person and your burning desire for a better life. Your soul can be one of your greatest sources of strength, if you are able to draw from it. Think of your soul as your cosmic parent pulling for you to heal the wounds and to change yourself so that you can be reunited with your true essence as a person. You must reach for that spark and then hold on to it for dear life, for recovery is a long and difficult journey. With each step of recovery, this spark will burn brighter, eventually forging your new sense of self.
CHALLENGING THE MYTH OF DOING IT ON YOUR OWN
Where are you now in deciding to make a commitment to recovery? For many of you, you may resist admitting the need for outside help. After reading the previous chapters, you may agree that the past has deeply affected you but you are still holding onto the idea of making the changes on your own. Be advised that changing on your own—to the degree that is necessary to truly recover from the effects of child abuse—is just another form of denial. Survivors who try to change on their own procrastinate, rationalize, and avoid. It is hard to sustain the effort to do something so radically different in their lives. It is easy to lose steam when the going gets tough. Ultimately many survivors give up on recovery out of frustration and confusion without necessarily admitting this to themselves. Consequently they are never really happy and the abuse continues to take its emotional toll. Some survivors go through several attempts to change on their own before realizing that they do indeed need help. Others are not so fortunate. The bottom line, however, is that the resistance to getting the help you need is really resistance to change, the resistance to commit, the resistance to believe in yourself and who you can be in a post-recovery life.
WHAT SURVIVORS MAY NEED TO MAKE A COMMITMENT TO RECOVERY
There are specific reasons why it takes survivors of child abuse a long time to get the help that they need. What has to happen for you to get to that critical point? What will it take for you to make that life-changing commitment to recovery? Following are four of the most useful and necessary types of support that survivors may need to obtain before making a genuine commitment to recovery.
Validation and Encouragement from Others
Many survivors need to connect personally with someone who has faced similar challenges and has successfully overcome them. Through this important identification with another person, survivors receive validation for their predicament as well as a sense of hope that recovery is possible, if not likely.
Intuitively I knew that I needed to do something to get healthy, although for a long time I didn't know what. I read Out of the Shadows by Patrick Carnes, which is about sexual addictions, because I was involved with someone who turned out to be an exhibitionist. And then I read a book by Elizabeth Taylor called Elizabeth Takes Off, which somehow spoke to me in a way that the other books didn't. She uses the term "click" to describe when you really understand what you need to do in order to change. I think it's a perfect terminology. Reading that book for me was like clicking on a light switch. I've been in the dark for so long and I was searching for the light—something to either help me or lead me to the help. I strongly believe that it all stems from inside. You have to really want to make that change. So I read that book and thought, that is me. This is what really motivated me to get my butt into therapy.
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The idea of first identifying or connecting with someone who has traveled on the road to recovery is not new. Alcoholics Anonymous and other 12-Step programs encourage new members to take a sponsor—someone who has successfully recovered and is considered wise to the ways of the program and capable of leading another person in the same direction. ASCA groups do not offer sponsors but veterans of the program are more than happy to provide support and guidance. Many businesses recognize the power of this concept when they set up mentor programs that pair a new employee with an older, more experienced manager who guides their development. Whether they find it in a self-help group, a mentorship program, or a church organization, or as in Leigh Anne's case, in a book by a celebrity author, it may provide the extra impetus needed to act.
An Ultimatum to Get Help or Else!
Some survivors would have forever postponed getting the help they needed were it not for the pressure applied by a spouse, friend, family member or even a boss. As described in chapter 8, having a relationship with a survivor who has yet to go through recovery can be a frustrating and conflict-laden experience. Sometimes people who really care about you care enough to give you an ultimatum: get help or they will let go of the relationship. This may be hard to hear and at first, you may feel angry and rejected. But they are doing this for a reason. Your job is to understand that they are doing it out of concern. The message is clear: take action NOW!
I guess it was my wife who really forced me to deal with my mother and the effects of the abuse. After we got married, we were having a lot of conflicts about sharing—the give and take of a relationship. She and I came from similar families in that neither of us got our needs met by our parents. As an adult, she continued denying her needs and I helped her by being demanding and hostile because I was so fed up with living with needy women. So, in a sense we were a perfect match for each other: She did all of the giving and received very little back and I finally got taken care of by a woman I could get mad at. It really was very unbalanced. After a few years of this, the shit started hitting the fan. She started getting sick to death of having to battle me for everything and then getting only crumbs in return. So she started confronting me, which invariably would lead to fighting. When we got into a fight, I became this vicious animal and would start to smash things and she'd get real spooked. She'd say, "I worry that you're really violent like your mother," and frankly, so did I. I forget exactly how it came up, but eventually she said, "I don't think we can go on unless you get into therapy." She meant it. It was an ultimatum on our relationship and I believed her. I hated being pushed into it, but I guess at some level I knew it was the best for me.
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Unfortunately, some survivors will not be able to make the decision to act until they hit bottom under the threat of losing everything. This is a truly sad outcome because it would be better for everyone if the survivor could see what he needs to do before learning the lesson the hard way. Many survivors, like Richard, eventually get the message, but not without being pushed by someone who cares.
Understanding the Source of the Problem
Many survivors are faced with the dilemma of having so many other problems—medical problems, family problems, job problems, financial problems, possibly addictions—that it can be difficult to see the real source of their difficulties. Because you are always putting out one fire after another, you may never develop the perspective to see the overall patterns in your life.
It is difficult to pinpoint when I really began my recovery because I had so many other problems in my life that I was trying to deal with that were either directly or indirectly related to the abuse. My life was a mess at the time—I had physical problems, confusion about my life, frustration about nothing working out. Even my kids were having problems. I eventually became addicted to all the medications prescribed for my illnesses. Finally this one doctor got so frustrated with me for not getting better that he flat out told me my medical problems were psychological in nature and recommended that I get into therapy. The problem was that my first therapist was a real quack and I almost lost faith in therapy as a result. But I continued with the support groups, writing in my journal and taking classes in psychology, which kept me thinking about recovery. I was doing a lot of good things, but I still was running into a wall—not really resolving anything. I decided to give it one more shot—this time with a female therapist. This was the moment when it shifted. The right therapist can make all the difference. She was great because she could see what was happening underneath the surface and helped me to see what was really going on.
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Chronic medical problems that seem physical (and often diagnosed as such by medical doctors) but are driven more by psychological issues can set survivors on the wrong path. When you are treating the symptom but not seeing the deeper problem, the treatment will be limited. Today, with our increasing reliance on medications to treat a cluster of physical symptoms, medication--or over-medication-- sometimes creates another problem. Bad medication choices can rob the survivor of the energy and focus needed to attend to recovery issues.
When physical symptoms do not abate (as often happens when the root cause of the symptoms is not addressed), survivors can feel helpless and confused, often reverting back to the old notion that "something is wrong with me because I can't get well." As in Shirley's case, eventually the medications become yet another problem—a new addiction that must be dealt with first before "talking" therapy can be effective.
Shirley was able to get on the right track with the help of a professional therapist who understood that the medical problems and addictions were one of many manifestations of the child abuse. If you are not able to organize such a plan yourself, it is essential to get professional help to develop a multifaceted treatment plan.
Dealing with an Addiction Before the Abuse
As written in Chapter Five, for survivors who have an addiction, the first step to recovery is facing your addiction first before taking on the more complicated issues tied to the abuse. The best way to do that is to attend a 12 Step program that addresses your type of addiction.
By the time I graduated from high school, I knew that something was wrong, but I really didn't want to face it. My solution was always to run away. So I did a couple of "geographicals"—that's AA terminology for moving around to avoid your problems—but it didn't work and I was still real confused about why other people were getting good jobs and getting married and I was being left behind. I was "twelfth-stepped" was by two guys who knew my dad. They belonged to the AA fellowship in our hometown. They talked to me about AA, gave me some literature, and then I attended a talk they gave. I was initially turned off by the religious fervor, but it planted a seed in my head, because when I moved out here and was still having problems, I finally just reached a point where I had to make a choice for myself. I felt like it was either "do or die." That was really the beginning for me.
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Pete's resistance to AA was long-standing, and like so many people who dismiss this proven program, he cited the religious content of the program as the reason for not giving it a try. But Pete's resistance operated on two levels. He avoided attending the meetings because he was still in denial. It wasn't until he "hit bottom" in an emotional sense that he finally took action. He reached a point with his drinking where he recognized that he was losing control of his life. Many survivors get to this "do-or-die" point with their addictions. Some, like Pete and Jolene, use the crisis to motivate their decision to act. This may be where you are at right now.
Pete ran into a second level of resistance after initially deciding to get help. He held back from making a commitment to AA for eighteen months until he could more fully trust the people and the process. This kind of resistance may be a trust issue played out in the external world of the survivor. It may be related to the fear of being judged or rejected or not wanting to expose one's vulnerability. In therapy, survivors may hold themselves back from their therapists by not disclosing sensitive information. Some survivors may enter therapy and then unconsciously work to defeat its effectiveness. Then the survivor feels entitled to say "Oh, I tried therapy or AA and it didn't work for me so I gave up on it." This is a most unfortunate development because the combination of self-help and professional help is really the only way to truly recover from the effects of the abuse. Ultimately you may be giving up on yourself when you say this. Be careful not to fool yourself into thinking you are making a commitment to change when you are really only going through the motions. Stick with your plan long enough to give it a fair chance to work.
MAKE A CHANGE IN YOUR LIFESTYLE
As you go through recovery, you will be experiencing all sorts of mental, emotional, and quite possibly, physical changes that will create a certain amount of stress on your body. If you are vulnerable to illness because of other factors, the pressure of facing a painful past may further exacerbate or precipitate stress-related. Thus it is often helpful to make changes in your life-style that will support the changes you are making in your life. Look at your eating habits. Are you eating too much junk food loaded with salt, caffeine, and sugar? An unhealthy diet will only sap your energy, trigger mood swings, and increase your blood pressure, leaving you vulnerable to stress-related illnesses. Watch your alcohol consumption. Are you taking prescription or illegal drugs? Are your medications being monitored by a doctor? Are you getting regular exercise? Everyone should be exercising for three hours a week. Exercise also reduces the stress associated with dealing with the abuse and the release of strong feelings. Many survivors report feeling that exercise makes them strong of heart, not just of body. To take action, enroll in a fitness program or join a hiking club.
Recovery is very hard work and you will need to build into your busy schedule some time for recreation and relaxation. Consider taking up a sport that you loved as a child that can be both fun and offers the chance to meet some new people. Aerobic activities like running, biking, swimming, hiking. Hobbies and activities with your children can reduce stress. Try to develop some activities that are rejuvenating and relaxing and arrange your schedule to permit the time. You will probably make these types of changes eventually when it gets easier to act in your own best interests. Why not consider making them now when they can really benefit you?
CREATING A “SAFE PLACE”
Survivors need to be able to create a “safe place” before plunging into the challenges of recovery. Remember that emotional safety and the ability to manage overwhelming feelings are and will be an on-going challenge for the adult survivor. Because trauma during childhood usually involved overwhelming stress that triggered the psychological and somatic symptoms of trauma, recovery must NEVER re-create the same experiential circumstances that might AGAIN lead to traumatization. Recalling abuse memories should never plunge you back into reliving the past as though it was happening again. If working with abuse memories ever makes you feel like you are being re-traumatized, stop what you are doing, contact your therapist, and talk to someone you trust until you feel like your adult self again.
The ability to create a safe place is the first step in learning how to self-regulate emotional responses. Ideally, you want to begin to develop this skill BEFORE you start work on the abuse memories. In order to create your safe place, you must be able to identify what emotional safety means for you. The sense of safety encompasses thoughts, feelings, bodily sensations and other physiological indicators of grounded experience. What does safety feel like? How does your body feel when you are feeling safe? What images represent safety? What places represent safety for you? Are you alone or with others? And if you are with others, who?
Creating a safe place is like drawing of picture that is uniquely suited to your individual preferences—all aligned toward enhancing your experience of safety. As you draw this picture, try to take into account any feature of your safe place that offers comfort, protection and positive experience. You can adapt and modify your safe place over time, making it stronger, or quieter or more soothing. However you define safety should be included. Give the picture as much definition as possible to make it real.
Try practicing going to your safe place so that over time, it becomes more natural and automatic. By becoming familiar with it, you will be able to recall it on demand when you start feeling overwhelmed. Like any skill that you learn, practice makes it all work better.
Eventually, your safe place will be the foundation of your new self-regulated self
INTRODUCTION TO THE THREE-STAGE, 21-STEP RECOVERY PROGRAM
As mentioned previously, recovery from child abuse is a demanding process that may take up to several years to fully accomplish depending on the severity and duration of your abuse. Each of the three stages and twenty-one steps of recovery presented next will help you to address the challenges, issues and solutions in an orderly and sequential way. In essence, recovery is a type of re- parenting, although the parents in this case will be your therapist, members of your support group, and most importantly, YOU!
Steps 1 to 7 involve building the foundation of your new self by reclaiming the past via the memory of what actually happened and then and working through the direct experience of the trauma. The second stage, Steps 8 to 14, involves building the structure of your new self by identifying problematic behaviors, working to minimize their impact and then developing newfound capabilities that will foster effective functioning as an adult. The third stage, Steps 15 to 21, involves strengthening your new personality and taking charge of your new life so that you can thrive in the world. Each step starts with "I" in affirmation of your new self— inside and out—and the healing and change that shape your resolve every step of the way.
Those of you who have attended 12-Step groups aimed at overcoming your addictions should be comfortable with the step program offered in chapters 12 through 14. Don't be put off by the additional nine steps! Recovery from child abuse requires some extra steps compared to recovery from substance abuse or compulsive behavior. Think of the steps as a road map designed to get you to where you want to go. However, not everyone follows this road map in exactly the same way. People are too complex and different to expect that degree of conformity. To be honest, many of you are willful, stubborn drivers who need to explore the side streets of life before deciding to take the main road. This is fine—as long as you eventually get back on track. The steps may be regarded as general markers along the road. You may change the order of the steps somewhat if that seems to work better for you or you may need to repeat old steps as new memories and insights resurface. You may even create some of your own steps that are more relevant to you and your childhood experience. My advice is to make the steps work for you. Use them and refine them as needed.
The concept of self-help has been vastly redefined over the last forty years. Originally based on spiritual/religious practices leading to personal transformations described as being “reborn” or embracing one’s “higher power”, today we see the increasing prominence of the psychological and behavioral health models to promote personal change. While the medical model still prevails in mental health service delivery systems, the new self-help model has emerged as an essential partner in modern allied health programs that are at the cutting edge of personal and behavioral change. Self-help interventions exist on two levels---an individual program adopted by those wanting to maximize self-improvement and a community/group model based on locally organized meetings serving every conceivable purpose and affliction. This chapter will address both individual and group versions of the modern self-help model and identify how they can help survivors during recovery.
Individual Self-Help Strategies That Support Recovery
Individual self-help strategies are designed to support the mind, body and spirit during the recovery process. Recovery can be a long and arduous process. Being in the best physical and mental shape to meet these challenges is the first effort to be made. By taking good care of yourself, you will give yourself the best chance of success in overcoming the negative influences from the past. Many of these strategies reflect basic health recommendations that should be followed throughout one’s lifetime. For the survivor who experienced so much stress during childhood, they provide a refreshing new commitment to self-care that augments your individual efforts in recovery.
Bibliotherapy
Bibliotherapy is defined as the reading of psycho-educational information about a problem that you share while engaging in self-reflective thinking stimulated by others experiences and recovery strategies. If you have read this book thus far, you may be appreciating the value of bibliotherapy. Knowledge is power, as the saying goes. Knowing about what ails you and how to organize a recovery program to address it can be efficiently provided through reading books. There are many valuable self-help books on the market for abuse survivors at every stage of recovery. Soul Survivors is designed to be a comprehensive resource for adult survivors who are committed to recovery. As you continue through the stages, other resources will be recommended that will provide more guidance specific to each step.
Journal Writing
As described in the Introduction, journal writing is a wonderful adjunct in the recovery process and offers many benefits that cannot be appreciated until tried. Writing in a self-reflective way helps create “a coherent and integrated autobiographical narrative” (according to leading trauma researchers) that can increase your capacity to process trauma. Because recovery from child abuse is so personal and tied to your identity as a person, writing about your experience going through recovery is a practice in defining your new self. Writing is the voice of your new post-recovery self that defines who you want to be and how you want live in the world. It also serves as a record of your reflections back to your childhood and a repository for the facts, memories, recollections and minutiae that comes back to you during the recovery process. Ultimately, your journals become a roadmap of where you have been and where you went forward.
Exercise
Cardio exercise is one of the most important ways you can promote physical and mental health. Going through recovery can be an exhausting process. It will demand much from you and your mind and body will need to be strong. Recalling difficult memories and facing powerful feelings will evoke a visceral response that can stress your immune system. You will need energy to push through the process of change. Exercise has been shown to improve mood, reduce anxiety and depression, generate energy, enhance learning and promote memorization, creative problem solving and performance skills. The benefits are plentiful and wide-ranging. When you are in good physical shape, you feel empowered, strong and better able to resist stress and illness. Most importantly, exercise can help you feel safer because you feel stronger. When you are physically and mentally strong, you are more likely to feel optimistic and hopeful that you can make necessary changes.
Sleep
New research is showing that sleep is essential for good physical and mental health. Everyone needs seven to nine hours of sleep per day but surveys show that most of us get far less. If sleep debt is allowed to continue long term, studies have found a variety of negative effects including cognitive decline, memory impairments, proneness to accidents, lower mood and even risk of physical illness. There are two primary reasons why sleep is so essential, especially during recovery. First, sleep allows us to experience rapid eye movement or REM sleep. This stage occurs four times a night and is involved in processing daily experiences, consolidating memories and then passing them into our long-term memory systems. The dream process will be especially active during the processing of past negative life experiences as you continue in recovery. Dream recall can offer a unique perspective on what your unconscious mind is thinking as you process trauma. Sharing dreams with your therapist provides another source of information that will help your therapist help you.
Secondly, new research is also showing that sleep time is when the brain discharges the assorted “trash” that has accumulated during the day. When our brain is working hard to manage the tasks of daily living, it generates negative by-products that need to be removed at the end of the day--sort of like the night shift coming in and sweeping out the trash. When these by-products are not removed because the brain is not given enough time to “sweep up”, the brain runs less efficiently and with age, can increase the risk of neurodegenerative diseases such as dementia and Alzheimer’s. Surveys show that 50 to 70 million people in the US have chronic sleep disorders. For some with sleep apnea, they may need to use a CPAP device that pushes oxygen into them when their breathing cuts out. For others, simpler self-help strategies can do the trick. Reducing exposure to computer screens an hour before bed time, reducing alcohol intake and finishing your drink a couple of hours before going to bed, and developing a quieter nighttime routine can all help promote better sleep.
Nutrition
You are what you eat, as the saying goes. If you eat poorly or irregularly, your body and mind function less well—It’s that simple. The food you eat is the fuel that drives your daily functioning. Sugar, processed food with little nutritious value and an over-reliance on carbohydrates can cause a variety of digestive problems, mood fluctuations, and loss of energy. One problem is that the food we eat offers less nutritious value as before due to over-farming, food processes that reduce vitamins and minerals and reactions to chemical additives. Of course, simply cooking food further reduces the nutritious value of our food. Many survivors also have allergies to certain foods such as fermented foods, foods containing gluten and sensitivities to nuts and even fruits. Eating food that does not agree with you puts added pressure on your immune system which may be taxed already by the recovery work. Some foods such as simple carbohydrates convert quickly to glucose which can amp you up and then cause a crash as they get processed by the liver. Having a healthy and consistent diet provides a foundation of physical stability that can help you feel more in control.
Meditation
Meditation may be the best single self-help activity (besides exercise) you can do to help yourself during the recovery process. Why? Meditation promotes self-regulation of emotional states, increases self-awareness, and aids in attention and focus. It allows you to see the big picture and promotes clarity of thinking. It doesn’t really matter what type of meditation you do. They all do share common benefits but some have different specific effects. Two types of popular meditation are Mindfulness Meditation (MM) and Transcendental Meditation ™. MM relies on focusing on one’s breath whereas TM uses a verbal mantra. The key activity is to sit in a comfortable, quiet place, close your eyes and allow your brain to express itself. Twenty minutes once or twice per day is sufficient for most people. Research has found that you must meditate for several weeks—perhaps as much as six weeks—before you may notice the benefits. Again, the benefits for survivors is that it calms the mind and can promote self-acceptance.
Cardio Imagery & Rehearsal
A new technique called Cardio Imagery & Rehearsal combines moderate cardio (aerobic) exercise with mental imagery to stimulate learning, memorization, creative thinking and skill acquisition. Moderate exercise means a heart rate of approximately 120 – 130 beats per minute. When cardio exercise is combined with imagery, the brain shifts into a particular state that offer opportunities for enhanced functioning. For survivors, you can use this technique to create a “ safe place” by visualizing a mental place in which you feel safe and sound. By repeating or rehearsing the imagery while exercising, you are creating new neural circuits that support that image and allow for easy retrieval of that image. Imagery is not limited to visualization but incorporates all of the five senses, if possible, to recreate a “felt experience” that mimics normal consciousness.
Resource Tapping
Psychologist Laurel Parnell suggests using bilateral stimulation (BLS) to “install” emotional resources that can strengthen your sense of self. This simple technique involves placing a hand on each knee and then using your fore fingers on each hand to tap the knees in a quick, alternating rhythm for about 10 seconds. While tapping right-left, right-left, right-left, you can recall positive thoughts, memories, feelings and experiences. This will open the memory channels in your brain and reinforce positive emotional/cognitive states. Parnell suggests doing BLS on a daily basis, both in your therapy session and on your own. Resource Tapping is particularly helpful prior to working on abuse memories, especially during Stage One Recovery.
The Healing Power of Self-Help Groups
The second part of the self-help model involves participation in a self-help group located in your community and dedicated to the recovery process. Self-help groups provide an enormous opportunity for survivors to enhance their recovery by joining in with others who are also trying to overcome their problems. A closer look at what these groups provide will explain their popularity and why survivors can benefit from them. To begin, most self-help groups cost nothing to join and many do not require registration to become a member, allowing you to remain anonymous as safety and privacy are of primary concern. In most cases, the only requirement is that you share the issue that the group is addressing.
Self-help groups are readily available in most communities and at times convenient for members to attend. They may offer valuable information and tips on current resources, functioning as ad hoc clearinghouses tailored to the concerns of the members. They can provide support during times of crisis as well as an antidote to the universal plague of isolation, stigmatization, and shame that people face today. They can be inspirational, energizing, and empowering. In short, self- help groups can offer a tremendous lift if you are struggling with giving up an addiction or overcoming abuse. But these groups can provide something even more special for adult survivors—a sense of family that you never had.
Attending a self-help meeting is like participating in a group commiseration. A bunch of people sit in a room, share personal stories, receive feedback, and learn new ways of coping with life. While you're there, you don't always know what benefits you're getting. But you leave thinking something that you heard that clicks inside: "God, at least I got a way out," or "At least I heard somebody who had the same story," or "At least I'm not alone." That is the most terrifying experience as a child and as an adult, to feel that sense of aloneness that you are in this thing by yourself. Being in a self-help group teaches you that this is not the case at all. For every crazy problem that I've ever had to deal with, there are 200,000 other people in Western civilization going through the same thing. And there's also the feedback, which I eat up like a bowl of ice cream. I love feedback. My favorite flavor is "Tell me what you think!" And you don't have to use your real name: They let you have your anonymity and still give you the opportunity to speak from the heart. Even if you don't say a word, there's so much to be gained by listening to the sponsors and the speakers. Sometimes, I just think, "God, that's way beyond anything I've every suffered. Maybe my life wasn't so bad after all."
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Self-help groups can provide a sense of belonging that may not have been available in your family. The experience of "fellowship" so often referred to in AA is a powerful remedy to the loneliness and isolation experienced by many adult survivors. If you come from a family that is still in denial or unwilling to change their abusive attitudes toward you, these groups can become your surrogate family. Self-help groups can offer more than information, support, understanding, and acceptance. As Leigh Anne describes, you can be as active or reserved as you want. The choice is up to you. No one should push you to do or say anything before you are ready. Thus, a needed feeling of safety is created for survivors who commonly feel like outsiders, intimidated by strangers and authority figures. Safety and acceptance may be the most important criteria of good self-help groups so that you can be yourself without fear of being judged, rejected, or criticized. Because you will come in contact with group members who have faced and overcome similar problems, you can learn about your own abuse-related behaviors and try out alternative behaviors that are modeled by more experienced group members. Just listening to the stories being told by the speakers can be inspirational. When you are ready to speak directly about your own experience, you can ask for feedback or simply remain silent when you are done, comforted by the guidelines prohibiting others from criticizing you or invalidating your point of view.
GUIDE TO SELF-HELP GROUPS
When Soul Survivors was first published in 1989, there was no self-help group addressing the recovery concerns of all survivors of child abuse. Back then, the field was dominated by the emerging awareness of sexual abuse and the effect on female survivors primarily. Programs addressing other types of abuse were also overlooked. Parents Anonymous had been established to provide support for parents who were at risk for abusing their children, but not all survivors were parents or at risk for abusing their children. Since childhood abuse can be both a cause and an effect of addictive behavior, Alcoholics Anonymous has been the primary self-help resource for many survivors. Over the years, other legacy groups such as Narcotics Anonymous (NA) and Overeaters Anonymous (OA) were developed and spread across the country. Back then, I wrote how it may be only a matter of time before such a group dedicated to adults survivors of child abuse was developed.
As it turned out, we only had to wait for ourselves to create it! Starting in 1993, the Norma J. Morris Center for Healing from Child Abuse began funding the development of Adult Survivors of Child Abuse (ASCA). A group of 12 survivors responded to an ad in a local recovery magazine to organize a new program for male and female survivors. This first Leadership Council developed the program in line with the recovery model described in the first edition of Soul Survivors. After the first meeting in November 1995 at the University of San Francisco Medical School, ASCA has continued to grow with meetings held throughout the United States and around the world.
Adult Survivors of Child Abuse (ASCA)
Adult Survivors of Child Abuse (ASCA) is a three-stage, 21-step recovery program developed by The Norma J. Morris Center for healing from child abuse (TMC), a 501(3) nonprofit organization. ASCA was created with the intention that all members of the survivor community, irrespective of their financial situation, have access to a superior program for trauma recovery. Over the years, TMC has continued to update and evolve the ASCA program, embarking on a bold experiment in 1999 to host all ASCA materials on our website (www.ASCAsupport.org). Individuals and organizations may download and use any materials they consider helpful to their recovery. Look in the appendices for these and other ASCA materials.
The ASCA Recovery Program is a three-stage model for healing containing 21 steps as follows:
Stage 1 – Remembering
1. I am in a breakthrough crisis, having gained some sense of my abuse.
2. I have determined that I was physically, sexually or emotionally abused as a child.
3. I have made a commitment to recovery from my childhood abuse.
4. I shall re-experience each set of memories as they surface in my mind.
5. I accept that I was powerless over my abusers' actions, which holds THEM responsible.
6. I can respect my shame and anger as a consequence of my abuse, but shall try not to turn it against myself or others.
7. I can sense my inner child whose efforts to survive now can be appreciated.
Stage 2 – Mourning
8. I have made an inventory of the problem areas in my adult life.
9. I have identified the parts of myself connected to self-sabotage.
10. I can control my anger and find healthy outlets for my aggression.
11. I can identify faulty beliefs and distorted perceptions in myself and others.
12. I am facing my shame and developing self-compassion.
13. I accept that I have the right to be who I want to be and live the way I want to live.
14. I am able to grieve my childhood and mourn the loss of those who failed me.
Stage 3 – Healing
15. I am entitled to take the initiative to share in life's riches.
16. I am strengthening the healthy parts of myself, adding to my self-esteem.
17. I can make necessary changes in my behavior and relationships at home and work.
18. I have resolved the abuse with my offenders to the extent that is acceptable to me.
19. I hold my own meaning about the abuse that releases me from the legacy of the past.
20. I see myself as a thriver in all aspects of life - love, work, parenting, and play.
21. I am resolved in the reunion of my new self and eternal soul.
Alcoholics Anonymous (AA)
Alcoholics Anonymous (AA), the respected elder of the self-help movement and model for the new generation of “legacy” groups, is now more than seventy years old and boasts a worldwide membership estimated to be 1.5 million people. Most self-help groups rely on the structure and philosophy of the 12 Steps and 12 Traditions as defined by AA. These 12 Steps, which are adapted by each self-help group with AA's permission, offer a specific code of tenets, expectations, and suggestions designed to bring about a spiritual recovery that will result in sobriety. The steps are designed to be worked individually and in progression until resolution is achieved. When recovery is complete, the person is able to work all 12 Steps each day of his or her life in a program that continues well after sobriety is attained. Ultimately a spiritual awakening is what the AA philosophy calls for to create a different type of lifestyle necessary to sustain sobriety.
The 12 Steps of Alcoholics Anonymous
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
AA has meant a lot to me. I know I couldn't have stopped drinking without it. It has offered more than that though. It has saved my life and given me small practical tools as well. I met my wife at AA and we worked the program together. For the first time in my adult life I was able to have some fun without being drunk. It offered me a place to go to hear people who I could relate to on a lot of levels, to air my feelings and to be able to tell the truth, basically. The 12 Steps outline three ideas for a "spiritual design for living" that I try to live with every day of my life: to trust in my Higher Power whom I call God, to clean my spiritual house, and then to share it with others. So what it offered me was a kind of tool kit for taking care of some of my living problems. Perhaps as important, it gave me a community of friends, who, in turn, gave me love, friendship, and acceptance. Even if you're not an alcoholic, these are pretty special gifts. If you are a survivor of child abuse, they can mean the difference between hope and despair.
On a practical level, if you have an addiction, 12-Step groups may be the best strategy for gaining sobriety and control over your life. In most cases, intensive psychotherapy alone is simply not powerful enough to stop the physiological and psychological urges to drink or engage in compulsive activities. Self-help groups patterned after the 12 Steps create a single-minded focus on stopping the behavior that is crucial to breaking the cycle of addiction. The strategy of focusing on achieving this one goal, day by day, or hour by hour, if necessary, and providing the human resources necessary to reach this goal are the main reasons why AA and other 12-Step groups are successful. Once people have some initial success in controlling their addiction, an amazing thing happens. They are flooded with a sense of well being and elation and hope, which in turn can bring about a self-confidence that can stimulate other, more deep-seated changes. Alcoholics are encouraged to "work the steps" because their initial experience tells them that "the steps work." While this may sound like circular reasoning, the bottom line is that the addictive behavior can be halted, at least for the time being. This identification with the program sets in motion a whole new way of thinking about yourself and your identity in the world. The process of attaining sobriety begins to snowball into wholesale recovery, and over time, a different lifestyle. Hanging out at the corner bar is replaced by attending meetings. Friendships with old drinking buddies dissolve as new relationships with group members develop. The simple act of holding on to the bottle of beer or shot glass is also replaced with something new—holding on to the Big Book, the Bible of AA that describes the 12 Steps and
ADULT CHILDREN OF ALCOHOLICS (ACA)
Al-Anon, the group for the family and friends of alcoholics, began a new type of group in 1976 for the adult children of alcoholic parents called ACA. With more than a thousand groups nationwide, these groups have created an awareness of the long-range effects of growing up in an alcoholic family. Although ACA groups are still heavily focused on alcoholism, the discussions in these meetings address all the ways that parents' drinking can affect their relationship with their child and the long-range effects of alcoholism on intimacy and caretaking tendencies. In effect, ACA groups address many of the issues of emotional abuse, and as such, have much to offer survivors who were emotionally abused as children, whether or not their parents were alcoholics.
AA groups and ACA groups are very different. I participate in both so I can see the differences pretty clearly. ACA groups are not as rigid in their focus as AA groups are. While AA members limit themselves to talking about alcohol and the Steps, people in ACA tend to bring in all sorts of related material including what they have learned from their therapy. A lot of people don't like it for that reason. Personally I have found it very helpful because it offers a much more unique perspective: The "shares" are very individualized, and by listening to them, you can learn something really new and apply it to your own situation. People in AA tend to share the same stories over and over again. Most of the people in ACA are also in therapy in contrast to the AA people who are often dead set against it. Primarily the most fundamental thing about ACA is that the emphasis is on what it was like to grow up in an alcoholic family. It allows you to identify with other people's experience, which cuts through the sense of isolation— the isolation that said, "I'm different. My situation was unique and terrible." And, as well, you hear what people are doing about it today. It was at an ACA meeting that I first heard a woman talk about being an incest survivor and that was very important to me. You would never hear that at an AA meeting.
The popularity of the ACA movement has spawned "derivative" ACA groups that are unaffiliated with Al-Anon. These newer ACA groups do not follow the 12 Steps and 12 Traditions of AA and have developed their own meeting formats that reflect a greater variability in subject matter. Many people describe these groups as less structured and focused than the Al-Anon-sponsored groups and as more likely to address general psychological topics in addition to the more general addiction issues. These groups may resemble psychotherapy groups in some ways although the meeting are facilitated by members with no professional training.
PARENTS UNITED INTERNATIONAL (PUI)
Parents United International (PUI), a self-help group for families affected by child sexual abuse, was established in 1975 by psychologist Henry Giarretto. Giarretto had previously started a court-mandated treatment program for child sexual abuse offenders in Santa Clara County, California. Out of recognition that everyone in these families needed help, not just the offenders and the victims, PUI started special small group meetings for the "non-offending" mothers, as well as for the daughters and sons who were molested. PUI has grown rapidly since its inception in 1982 and now boasts over a hundred chapters throughout the United States, Canada, Mexico and Guam. PUI has a directory of programs at http://parents_united.tripod.com/Chapters/PUI.htm. The organization provides services for adults molested as children (AMAC groups) who are no longer living with their families or no longer dependent on them. This component may have the most to offer for adult survivors of sexual abuse who have not developed offender behaviors. Because PUI has a group for every person, adult or child, who was or is affected by sexual abuse, it is the largest community resource for this type of family problem available in the United States today.
Parents United is unique for several reasons. It was the first program of its kind to focus on the issue of child sexual abuse. Besides providing more services to incest survivors, offenders, and families than any other national organization, PUI works with law enforcement authorities on the complex criminal-legal-psychological issues that are raised by these cases. Often the family is referred for help when the father (most commonly) is given probation following the charge of sexual abuse and is mandated to attend the Parents United program. Unlike most other self-help groups, Parents United has affiliations with mental health professionals who may act as the facilitators of groups. In contrast to the spiritual base of AA, Parents United draws from the work of psychologists Abraham Maslow and Carl Rogers. The basic philosophy of PUI is that people who molest children do so not because they are evil but rather due to their violent reaction to their frustrations over not getting their needs met. The focus of the self-help groups is to help all family members develop a "high self-concept" that will enhance the processes of self-awareness and self-management, as well as feelings of family unity and growth."
Instead of the 12 Steps, Parents United International has its own “Creed” developed by three mothers who were charter members:
1. To extend the hand of friendship, understanding and compassion, not to judge or condemn.
2. To better our understanding of ourselves and our children through the aid of the other members and professional guidance.
3. To reconstruct and channel our anger and frustrations in other directions, not on or at our children.
4. To realize that we are human and do have angers and frustrations; they are normal.
5. To recognize that we do need help, we are all in the same boat, we have all been there many times.
6. To remember that there is no miracle answer or rapid change; it has taken years for us to get this way.
7. To have patience with ourselves, again and again and again, taking each day as it comes.
8. To start each day with a feeling of promise, for we take only one day at a time.
9. To remember that we are human, we will backslide at times.
10. To remember that there is always someone willing to listen and help.
11. To become the loving, constructive and giving parents or persons that we wish to be.
When you join PUI, you go through a series of brief, eight- week groups. There are different Pre-orientation Groups for offenders and non-offending parents and children and then a larger Orientation Group where adult victims and offenders are enrolled together. From this "base" group, members move to more specialized "open" groups when the group members and the professionals involved think they are ready. Other groups include the Adults Molested As Children's Groups, Women's Groups, Men's Groups, Couple's Groups, Alcoholic Problem Groups and Re-contact Groups. Re-contact groups are composed of offenders and adult survivors who use psychodrama techniques to confront their parents, who are played by surrogate offenders in the group. These techniques help them re-contact repressed rage and vulnerability that they can vent in a safe, therapeutic way. Groups usually have eight to ten people (with the exception of the Orientation Groups, which can have more than thirty) and are run by a trained professional who is recruited from the local community and may have an affiliation with a community mental health program. The facilitators provide minimal direction and structure, preferring the group process to be more defined by the individual members. Classes and individual counseling are also provided as needed and as requested by members
There have been two criticisms of the PUI program that come mostly from the professional community. The first has to do with the capacity of PU to identify and screen those sex offenders who are true pedophiles—men who have a more serious personality disorder— that are not effectively treated by the PUI program. Because they were not initially screened, there was a question as to whether offenders were getting the proper treatment to gain control of their sex and power urges so they could reunite with their families. In recent years, PUI has instituted a ninety-day assessment period whereby professional staff may observe all offenders and recommend them for outside treatment if their behavior indicates a more serious disorder.
The second concern has to do with reservations about PUI's commitment to family reunification when it is in the best interests of everyone, including the children. But some professionals have concerns that this philosophy may be applied when it is really not in the best interests of the child. Much of this concern goes back to the question of whether the offender has been sufficiently treated so he can be with the child. In this sense, the strategy of family reunification is only as good as the treatment of the offender. As PUI continues to refine its ability to identify and refer those offenders who require more specialized treatment, this concern should disappear.
Parents Anonymous (PA)
Parents Anonymous is the oldest and most recognized self-help group dealing specifically with child abuse prevention. The group was started in 1970 when Jolly K., a parent on the verge of physically abusing her child, walked into a mental health center in southern California and demanded immediate help, only to be given an appointment three months later with social worker, Leonard Lieber. Desperate to get help for herself before turning her rage on her child, she and Lieber began organizing a self-help group for parents who abused or were about to abuse their children. The group, first known as Mothers Anonymous, eventually became Parents Anonymous, and now has a total of twelve hundred weekly meetings nationwide and in five foreign countries.
PA is not based on AA's 12 Steps and instead defines itself as a modified self-help group run by a facilitator-therapist and sometimes with a chairperson, a concerned parent who volunteers to support the group. The facilitator organizes speakers and discussion topics on parenting issues, child development, and the building of the parent's self- esteem. Parents learn alternatives to abusive parenting behaviors, problem-solving techniques, and ways to reduce stress. PA meetings are not supposed to be psychotherapy, but will help with your coping skills and will bring you together with people who are struggling to be better parents. Generally eight to sixteen people meet once per week in community agencies that employ the facilitators. Discussion, sharing, reaching out to others, and supporting personal growth through education and therapy is the philosophy underlying the program. PA is not for people who have been sexually abused. The prevention of physical and emotional abuse is its most basic purpose. PA will provide a specified number of group sessions for the parent who has been charged with felony child abuse as part of a jail diversion program and will cooperate with the probation department to provide follow-up supervision.
PA recently announced the results of the new National Outcome Study of Parents Anonymous® conducted by the National Council on Crime and Delinquency funded by the Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice. This longitudinal study is the only independent outcome research conducted nationwide to assess the impact of parent mutual support-shared leadership groups on child maltreatment prevention. This research includes a national representative sample of diverse parents new to Parents Anonymous® followed over a six month period. All of this evidence is based on standardized scales measuring key child maltreatment outcomes, risk and protective factors and was confirmed in a qualitative study with Latino parents who attended Parents Anonymous® groups. Moreover, a comparison group was utilized to measure the difference in outcomes between parents who did and those who did not continue to attend Parents Anonymous® groups over the six months.
Results showed significant positive benefits were found for parents who participated in PA including the reduction of parental distress and aggression, reduction in risk factors for child abuse as well as increased protective factors that increased parental effectiveness and empathy. Parents who participated reported that they “shared a sense of purpose, belonging and community and were able to give and get help from other parents.” These results support the idea that self-help groups targeting specific problem areas can have meaningful impact on mental health issues and can provide much of what people need to overcome these problems.
Survivors of Incest Anonymous (SIA)
Survivors of Incest Anonymous (SIA) is now the oldest self-help group for adult women and men to address child sexual abuse. SIA was begun in 1982 and now has groups throughout the United States and in countries around the globe. SIA is another “legacy” group guided by the 12 Steps of AA. However, SIA goes to great lengths to use the 12 Steps as “suggestions” and are careful not to impose any reality on a survivor that does not feel accurate. As with other groups, survivors facilitate the meetings and are wholly responsible for how the meetings are run. Mental health professionals are not involved in the meetings and SIA is not intended to replace therapy or any other professional service when needed.
SIA reports that “there is no typical SIA member profile; members are of all racial, ethnic, religious and political backgrounds, with varying marital statuses, sexual orientations, and degrees of ability/disability. The abusers in their lives may be any family member, family friends, clergy, another child or teenager, or anyone who betrayed the child victim’s innocence and trust. They define incest very broadly. Many of those who attend SIA meetings share their struggles and find hope and healing with self-confidence, self-esteem, explosive anger, depression, addictions and compulsions, perfectionism, isolation, thoughts of suicide, and troubled relationships with family, spouses/partners, and authority figures.
SIA has a well organized website at www.siawso.org , which also provides access to online, phone, and in-person meetings. SIA has a headquarters, the World Service Office (WSO), in Harford County, Maryland, operates as a 501(c)3 nonprofit organization. It helps survivors to connect with one another and carries a message of recovery to those who still suffer. The WSO operates a telephone information line staffed exclusively by survivors, makes referrals to local SIA groups, assists individuals in starting new groups; provides literature, a quarterly newsletter, and other helpful materials developed by survivors for survivors; offers a pen-pal program, and manages a speakers’ bureau.
Self-Help Groups Unaffiliated with National Organizations
In many communities, there are self-help or support groups for adult survivors sponsored by local community organizations such as rape crisis centers, child abuse prevention agencies, community mental health centers, county victim assistance programs, women's programs and occasionally, local colleges and graduate programs in mental health counseling. Usually these groups are started when the community expresses a need and staff or volunteers organize meeting times, space, administrative support, and professional consultation. How the groups are set up varies depending on the orientation of the founding members and consulting professionals. These meetings tend to come and go based on who is willing to take responsibility to run them on a consistent basis. The philosophy of these groups is more likely to be a reflection of the group leader's beliefs or those of the group composition in general. How the group is run and how issues of safety, meeting guidelines, meeting format, and group authority has to be worked out for most groups to be effective.
Choosing the Right Group and Right Meeting for You
Besides choosing the right type of group, there are also choices to be made concerning which group meeting to attend. For example, although all 12-Step groups are similar in format and structure, they may have very different "atmospherics" depending on how the meeting "culture" develops. For example, there may be 20 or more different AA meetings scattered around major metropolitan areas, each attracting a particular type of person depending on location, time, and individual characteristics of the core regulars. Over time, the group culture takes on characteristics of the group membership. In this way, self-help meetings are organic and develop their own personality over time. There are groups that advertise themselves as sensitive to special populations such as specific sexual orientations, cultures, genders, management types, single mothers, and foreign language speakers. In short, a group is as much defined by the members who attend it as it is by the underlying philosophical orientation. Consequently, you may like one group more than another. Therefore, when checking out a self-help group, it is important to visit several meetings before deciding on one in particular. If you find that you are not comfortable in one meeting, don't let that sour you on the idea of self-help groups in general. Keep looking until you find the one that offers the right fit for you.
How Meetings Are Organized
Most self-help groups will have different types of meetings depending on the purpose and needs of the membership. ASCA groups are most often peer-based led by trained co-facilitators, but there are some led by a mental health professional. Peer groups may rotate between three types of meetings: share-only in which one may volunteer to begin with a 15-minute share; another with supportive feedback; and a third focused on a specific ASCA step.
Some self-help groups may be limited to men or women or newcomers or those wishing to focus on particular steps. Groups patterned after AA may offer "speaker" meetings where one, two, or possibly three people will speak with no time for discussion provided. In "discussion" meetings, only one person will speak with the remaining time devoted to a general discussion of the topics contained in the speaker's share. In addition, 12-Step groups may have "open" and "closed" meetings, the distinguishing feature being whether visitors are invited or not.
Most meetings follow a relatively consistent format that may adapt somewhat to the shifting needs of the group. Usually the meetings will begin with a brief social time when coffee is served before the secretary calls the meeting to order. The secretary, a member who is well along in recovery, volunteers to facilitate the meeting, making sure there are enough speakers, refreshments, chairs, and so forth. AA's Serenity Prayer may be read followed by the recitation of the 12 Steps leading into a "share": a personal story told by one of the speakers in which he describes his problem with alcohol, the effect it has had on his life, and some lessons derived from his recovery. If discussion is part of the meeting, the group members will comment on what the story may have meant to them. Criticism, judgment, or airs of superiority are surprisingly absent in the group members' comments as care is taken to ensure the safety needs of the speaker'. At the end of the meeting, new business or announcements may be voiced, followed by a prayer, before the meeting is adjourned. Spirituality and prayers are treated as ritual as well as a religious matter, allowing members to participate in a way that is comfortable to their own beliefs. Following the closing prayer is the main social time of the meeting where personal contact can be established between group members, comments exchanged, and statements of appreciation and validation extended to the speakers.
Attending Your First Meeting
Attending your first meeting may be difficult because you are not completely sure of what to expect. Depending on what makes you more comfortable, you can consider going with a friend, or better yet, someone who has attended the meeting previously who can act as your unofficial sponsor. Allow yourself to just get a feel for what it is like: Sitting and listening is always acceptable and you are not expected to say anything if you don't want to. Some of the smaller groups will make a point of giving each person a chance to speak, but if you don't want to, simply tell them you "pass" and they will move on to the next person.
I had tremendous problems about joining AA with all that religious stuff, but finally, I went to a meeting and sat in the back and just listened. Fortunately, nobody bothered me, although everyone was real friendly. It took me almost eighteen months to really join AA in the sense of really participating in the meeting. I just didn't trust anyone. I didn't want them to find out who I was. I just sat in the back meeting after meeting, just feeling scared and uncomfortable. One thing that I really like about AA is that nobody pushes you to talk. That was real important for me because I was really scared. I slowly grew more comfortable and eventually it got to the point where I started confiding in people at the end of the meeting. I also got a sponsor and gradually started working the steps.
How to Get he Most Out of the Meetings
Over time, you will identify what you like about the meetings and may even arrange your schedule so that you can attend a particular meeting that offers what you want. There is an old saying in 12-Step meetings: "Take what you want and leave the rest." For survivors who do not have a spiritual sense or who may feel uncomfortable with the idea of "giving yourself up to a Higher Power," this advice may allow you to still get something from the meetings without feeling obligated to believe in anything that doesn't fit for you. Remember that it is your right to get what you want, not what other people think you should get. The bottom line is making the meetings work for you.
I have gone to all kinds of self-help groups. I started out with AA. I didn't discover ACA until a little later and then also tried OA (Overeaters Anonymous) and CA (Cocaine Anonymous) because coke was my real weakness. But I'm not hard-core about the dogma. I don't work the steps. I go to the meetings for my own stuff, but I don't embrace the whole thing completely. I do maintain total abstinence from coke, however. I believe that most of the 12-Step groups tap into the same stuff—the underlying core stuff inside all of us who grew up in dysfunctional families. Only everyone chooses a different drug to cover it up. That's my personal belief, but it seems to fit a lot. I don't think there's ever been a meeting that I've ever gone to, no matter what the size, where there isn't one person who makes a statement that you really connect with. But I go for other reasons besides the information. I go for that energy and the support and a sense of belonging and total acceptance.
Limitations of Self-Help Groups
Despite the enthusiastic tone of this chapter, there are some limitations of self-help groups that need to be mentioned. Although any healing process demands trust in the caregiver or care-giving organization, the responsibility for your recovery starts and ends with you. This means that you will need to be prepared to go against the advice of real or would-be "experts" if what they are proposing does not feel right to you. Ultimately this responsibility to choose what you think is best for you relates to the empowerment issue that you may be working on. Admittedly, you may make mistakes in choosing what to believe, who to trust, and how to change, but they will be your mistakes, not someone else's.
You must recognize that most self-help groups are run by people without professional training. The members, even those "veterans" in positions of authority, are doing the best they can based on their personality, their level of recovery, and their interpretation of the particular group's recovery model. Consequently, people running a meeting, operating as a sponsor, or even sitting in the audience responding to someone's story will not always know the right thing to say at a delicate moment or will be able to censor an unfortunate word or a destructive suggestion. While many groups follow the 12 Steps and 12 Traditions, remember that, like the U.S. Constitution, everyone seems to have their own interpretation of what it means. Sometimes groups as a whole can get stuck on a particular ideological slant that restricts more accommodating interpretations. Quality control varies greatly from chapter to chapter and meeting to meeting within the self-help field. With the exception of Parents United, the various national organizations do not provide any direct supervision or review of what actually transpires in each group. Therefore, don't take everything you hear as gospel. If you hear something that doesn't feel right, pay attention to that feeling and try to explore its merits and demerits objectively. You may be the one who is right. Because most groups are free and open to the public, they may attract people with more serious emotional problems who may rely on the group for therapy instead of support and information. Self-help groups are not a cure-all. When meetings come to be dominated by a person who is using the group for the wrong reasons, it may be upsetting for survivors who grew up tolerating their parents' inappropriate needs. As groups can reflect a family and offer the opportunity for fellowship, they may also reflect members’ dysfunctional family.
In some groups, members who have yet to resolve their personality problems may gravitate toward leadership positions such as chairpersons of subcommittees, sponsors to new members, and even group co-facilitators. Groups that provide services for both abusers and survivors are especially prone to this kind of problem. People who abuse children have abused their authority, which if never completely treated, makes it more likely that they may do the same in other situations. These organizations recognize this risk and have developed safeguards to protect against inappropriate expressions of power by members within the meeting. However, these safeguards are not always adequate. You have to be aware of when someone is inappropriately expressing their power.
I have heard of situations where people who had supposedly "recovered" have aspired to positions of power within a meeting or organization where elements of their former "offender" behavior manifested in their words and actions toward others. Cleverly, they may cloak this now more subtle behavior in the ideology of the organization, which makes it more difficult to detect. This can be a very dangerous situation for adult survivors because, after much work, you may have grown to feel safe in your meeting and trusting of those members recognized as leaders by the group. If you have not gotten to the point in recovery where you can assert your opinion and stand your ground, it may be difficult to deal with these types of people, especially if they are overly assertive and manipulative.
The best suggestion I can make in this regard is to ask yourself how these people make you feel. Be aware of anyone who regularly brings out your own passive victim part. If in doubt as to what may be happening in a group or with a sponsor, sound out other people whose judgment you trust. You don't have to give your power away or be silent anymore, but you can decide how best to maintain your personal safety.
Some of the limitations of self-help groups for adult survivors have more to do with the 12-Step ideology and the exclusive focus on addictions and sobriety. Some of the issues addressed by the steps are not helpful to the survivor who is dealing with much more than just sobriety. The idea of "giving yourself up to a Higher Power" may work against the idea of personal empowerment that is so important for a survivor who had little control or power as a child. The idea of forgiveness, which is promoted as a step in recovery, may be premature for survivors who have yet to work through their feelings of betrayal and loss of innocence. In the end, the personal experience of being physically, sexually or emotionally abused by a parent, teacher, coach or priest has its own set of dynamics and requirements for healing. Where it is similar, the 12 Steps have much to offer. Where it is not, it is best to look somewhere else.
The 12 Steps certainly offered me a foundation not only for sobriety but for the kind of spiritual healing that recovery from alcoholism demands. But quite frankly, from my experience, working the steps does not fully address the reality of being abused and growing up with a sexually provocative mother. I feel like I tried working the steps. I was just stacking the deck against myself by pretending to feel forgiveness before I had ever worked through the pain and rage and disappointment. It's not meant for it. Step work is not encompassing enough to take into account the enormous impact that incest has on a person. And I think that we in AA try to make AA be a cure-all and it's not. I see other people being confused by it because there are a lot of alcoholics who were also abused as children who get their minds screwed up by it. As an ACA, I feel frustrated that step work can't fix these problems also but we are taught to let something go that we can't change. So now I don't use AA to fix my abuse issues. I recognize that it’s the wrong wrench for the problem. That was when I started going to ACA groups more and then got into my own therapy.
One final concern about self-help groups, AA in particular, has to do with the prevailing bias against professional psychotherapy expressed by some of the more devout members. Much of this negative attitude is a carryover from the past when medical professionals, unschooled in the addiction process, attempted to treat alcoholics with medications and "talk" therapy while diminishing the value of AA. Clearly some damage was done in the past in not fully recognizing that addictions require special treatments. But now many health professionals do have training in treating addictions and have grown to respect the value of AA in helping people achieve and maintain their sobriety. Nevertheless, the negative bias from the past lingers because of the many old-school AA people who insist that there is only one way to recover—the AA way. This kind of rigid thinking does a disservice to those recovering people who are also survivors and who need to deal with both concerns to make the kind of wholesale changes that total recovery requires.
Can You Recover Without Self-Help Groups?
You probably can tell that I am a firm believer in the value of self-help groups, especially when it comes to dealing with addictive behavior. For the survivor facing many of the issues referred to here and in previous chapters, self-help groups offer you so much of what was not available in your family: love, support, acceptance, understanding. Who knows, you might even meet your future spouse there, just like Pete! Why would you not want to consider something that would make your recovery process easier? Examine your resistance to participating in self-help groups and try to understand if your reasons are part of what you are trying to change in yourself. Are you avoiding a meeting out of fear of being rejected? Are you afraid you won't fit in? Perhaps it is still too hard to reach out to others for help. I am not going to say that you cannot truly recover without being involved in a group because I know from my work with clients that many rely more on therapy than self-help groups. Will your participation in a group make it easier for you to cope and possibly break down some of your fears and the tendency to isolate yourself? In most cases, I would say yes. Consider everything you read, listen to what others say, and listen to your soul about what feels like the healthiest choice for you as a person. As always, the choice is yours.
I tried going to AA meetings for a while and it was helpful to some degree—to know that I wasn't alone and that other people were also struggling with their issues. But I did not go to them for long. I wanted to be in groups with women only and that was not available in the AA meetings in my area. Also I found that what a lot of the people were talking about in the meetings, I'd already faced and resolved in my own program. So I found them to be very depressing and not really beneficial. I found that I got more of my needs met through my therapist, through my classes, through my journaling, through talking with friends one on one, than the AA meetings. So I opted out of AA and I admit that I beat myself up for this because so many people tell you that AA is the only way to recover from your addiction from alcohol. But it just wasn't so for me. I needed help to get off the drugs and alcohol, but I did it through professional therapy and my own program. Everyone's different. Obviously some people are going to need that type of program.
Using Self-Help Groups As a Adjunct to Therapy
There are some cases where "more is better," and for adult survivors who are facing painful memories and struggling to make enormous changes inside themselves and outside in the world, the combination of self-help and professional help may be the most powerful therapeutic strategy available in recovering from child abuse. Therapy may also be of great benefit to work through issues that arise within group dynamics.
Personally I think that AA, ACA, and therapy have been a wonderful complement for me. Actually I've felt that I've gotten some real good second-hand therapy in ACA meetings, which I have brought back into my own therapy. But I think that any survivor of abuse needs first and foremost a safe place to be extremely vulnerable, which is what talking about the abuse brings up. At the beginning of this process, I think you need individualized care. You can't get it in a group meeting with forty or fifty people sitting around. I mean it's very difficult to tell even your closest confidante about the intricacies of incest or abuse and to get the right guidance and support back is a tall order for a nonprofessional. For me, the process of one-on-one therapy, week after week, uncovering and discovering what happened and taking apart the complexities involved was essential. Having a trustworthy professional gave me my safe place. That's why, to me, self-help and therapy are such a great complement because there's the sharing and the support that comes from peer-type help that isn't available in therapy once or twice a week. On the other hand, I never would have uncovered what was going on with my mother and my reactions to the abuse without good professional help. Taken together, they both worked for me.
Many survivors are still confused about what how psychotherapy can relieve emotional suffering tied to the abuse. Psychotherapy is, first and foremost, about establishing a "therapeutic relationship" with a trained mental health professional. Unlike the treatment of physical ailments where the doctor is expected to provide a "cure," which the patient passively accepts, the therapist-client relationship needs to be both collaborative and "reparative" in the sense that the interaction is used to establish a comfortable, consistent, and safe place for you to share your inner life and conflicts unhampered by the demands that exist in other relationships. The work of therapy then is to explore, identify, understand and work through these inner conflicts—conscious and unconscious— that hold you back from being who you want to be. In so doing, you are helped to reclaim the old memories, gaining insight as to the impact it had on you and then working to make necessary changes based on those insights.
The idea of a reparative relationship makes extra sense in the case of the adult survivor because your abuse most likely occurred in a relationship with another person. By developing a different type of relationship that is safe, respectful, sensitive to your needs, and dedicated to healing your wounds, you can "re-do," in a sense, the destructiveness you internalized from your parents or offenders. You can then replace it with something very different: a relationship based on trust, gained from your active collaboration with another person. This process unfolds over time, gradually deepening as your understanding of yourself builds and the negative "learnings" you internalized from your abuse begins to shift. As the wounds heal from within, you are free to make healthy changes in your behavior, your relationships, and your attitudes toward the world. Recovery represents a second chance to make close relationships work FOR you, rather than AGAINST you.
But, therapy alone cannot make the effects of the abuse fully disappear. You will always remember what happened and will probably always feel some residue of your childhood pain. The psychological scars may be with you forever. But if these scars fully heal, they will not hurt as they did before recovery. With true recovery, you will not be limited in the way you were in the past. Human beings have tremendous resilience and capacity for change, owing to our capacity for self-awareness and self-corrective action. Our ability to intellectually and emotionally understand ourselves and consciously change our behavior based on this understanding is what makes us so unusual—and so capable for using the psychotherapy process.
CONFRONTING YOUR RESISTANCE
TO GETTING PROFESSIONAL HELP
There are many reasons why some people—survivors or not—are reluctant to enter psychotherapy. Most of the reasons will have to be addressed and resolved before you will pick up the phone to make your first appointment. To begin, there may be vestiges of shame still associated with seeing a "shrink" that have to do with your fears of being seen as "crazy" or blamed for having difficulties. In the last thirty years, however, the mental health field has dramatically improved its image. If you live in a conservative part of the country or grew up around people who thought psychotherapy was a waste of time, you may still be subjected to outdated prejudices about seeing a therapist.
Many survivors avoid seeing therapists out of a fear of dealing with the past and facing the emotional damage associated with the abuse. This fear is especially understandable since no one wants to experience the hurt again. People avoid going to doctors and dentists for the same reason. Unfortunately, recovery is impossible without facing the past, the feelings that come with the past and integrating the experience into your adult sensibilities. Doing therapy with a trained professional who is also a caring and committed to helping your may not be nearly as hard as you think.
Some survivors believe that they can use good friends, spouses, or fellow members of their self-help group to provide what a therapist would provide. This is generally not a good idea since few friends, spouse, or group member can provide professional psychotherapy or handle the emotional demands that a therapeutic relationship must entail. If you try to rely on someone close to you for therapy, even the most caring person is likely to burn out or fall short, leaving you feeling bad and perhaps abandoned. Only a professional therapist has the training, experience, and education to provide that for you. Don't shortchange yourself by not getting the best therapist you can find.
Some men have an even greater difficulty than women in admitting that they need help. In a society that worships the "strong, silent types," boys and men can learn very quickly to be fiercely independent, to handle feelings by themselves, and to resist admitting they need help. They may feel that exposing their vulnerable part will undercut their masculinity.
And there is an additional concern for males. Because boys are often sexually abused by men--90 percent of sex offenders are male—sometimes boys think this will cause them to become homosexual. This belief is inaccurate since we now know that homosexuality is a biological phenomenon and not caused by life experience. But the fear of being perceived as homosexual can cause boys to keep the abuse a secret. Admittedly, this can be very confusing for boys and men to sort out by themselves. It is even more tragic if an erroneous belief prevents you from getting the help you need.
Many people also resist going into therapy because it can be costly. Psychotherapy can be expensive, especially if you select a therapist in private practice. Considering that therapy may take several years, paying the cost of one or possibly two sessions per week can turn into a major financial burden. Fortunately, most insurance programs are provide some coverage for mental health services, although the amount of the reimbursement varies greatly. Look carefully at your insurance policy or consult your company Human Relations department to determine what the mental health benefit covers. If your insurance does not cover "outpatient mental health services," it may be wise to change insurance policies, if possible, to acquire such benefits. My advice is to make any changes before you enter therapy.
It is also possible to receive therapy from a variety of other sources that will not be as costly. Many therapists in private practice offer some low-fee services for those on limited incomes, provided you can attend during off hours (mornings and afternoons). Local hospitals; colleges; graduate programs in medicine, psychology, and social work; public community mental health programs; and private, nonprofit, community counseling centers offer mental health services at a reduced fee, although the experience and training of these therapists may not be as advanced. Counseling interns and psychology assistants who are not yet licensed, but who work under their supervisor's license, are another low-cost therapy alternative. Since these therapists are not yet licensed, be careful to pick someone who is supervised by a fully licensed professional experienced in treating adult survivors. Although your options may be more limited if you cannot afford to pay "full fee," remember that the quality of the service is generally lower when the therapist is not licensed.
Without insurance benefits, your monthly therapy bill may be roughly equivalent to a monthly car loan payment. But, unlike your car payment that starts to depreciate the moment you drive off the lot, the investment you make in your therapy will accrue benefits for the rest of your life. And not just in terms of your emotional happiness. One important gain made by many clients in recovery is that they find better-paying work the more they change. As self-esteem and self-confidence grow, clients are able to raise their expectations of themselves and others and discover richer economic rewards in the process. In other words, the money you invest in your therapy will pay dividends in the form of bigger paychecks for many years to come.
I don't feel at all resistant to therapy now, but I certainly did in the beginning. It always takes a while for you to start to tell somebody all this stuff about yourself—stuff that you're not really clear about or know where it will lead. Part of this resistance was that I have been very pissed off about even having to go through this stuff again. I feel like all this stuff's been done to me, but now I have to be the one to do something about it. I mean, give me a break! Once is enough. It wasn't my fault. It's unfair to have to go through it again. It's taken me a while to say to myself, "Yes, you do have to do something about this if you want to change." Even now, there's always a twinge of resentment that goes along with it.
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CHOOSING THE RIGHT THERAPY FOR THE RIGHT STAGE OF RECOVERY
Psychotherapy is provided in a variety of formats, or modalities, as they are referred to in the field. Each of these therapy modalities has something to offer the adult survivor at particular stages of recovery. Besides more fully describing the different types of modalities available, the listing below will suggest what stage may be the best time to use them and the reasons why.
Individual Therapy
Individual therapy is the prime therapy modality because in most cases it will be the backbone of your recovery program from the first stage to the last stage. Your individual therapist will become your "anchor": the one person who will go through all of the feelings, memories, and changes with you and provide the reparative relationship that can challenge the abusive relationship you had with your parents or offenders.
Many survivors have a common desire when it comes to imagining the kind of personal style they would like in their therapist. Warm, caring, interested, skillful, perceptive, supportive, practical, engaging, and intelligent are just some of the adjectives I've heard from clients. Much depends on your personality style and what makes you comfortable. Yet you may also need someone who can draw you out and help motivate you to share what you need to reclaim and work through. Think about what kind of style may be best for you by imagining what kind of therapist would make you feel the most comfortable.
I like to have feedback: That's my own personal style. And that's why my therapist works great with me because he gives me a lot of feedback. If I'm in a bind with something, we'll explore it together and he will help me come up with ideas on what options I have. Then we talk about whether I'm ready for those kinds of actions. He doesn't push me, although if I am doing something that he doesn't think is completely healthy for me, he will ask questions about it. We've gotten to the point where we can disagree about things, but he is often right! He tells me though that he thinks my judgment has gotten better.
Individual therapy is the safe place where you can first disclose the abuse and face the feelings at a pace that is right for you. You can use the therapy to help you discover what you want and how you would like to proceed. This gives you maximum control, which will help immeasurably in being able to talk about the most personal and difficult aspects of the abuse. From there, you can add other treatment modalities as you and your therapist see fit.
There may be a question about seeing your therapist more than once per week. Although costs need to be considered, it is often extremely beneficial to increase the frequency of therapy to twice or even three times a week during the early stage of recovery. This is the critical time when safety need prevail as memories emerge creating some emotional instability. Seeing your therapist more often allows you to more quickly work through some of your most overpowering feelings. You don't want to feel alone again when it comes time to face the abuse. Your therapist is the one to see you through this especially difficult time.
Group Therapy
Group therapy for adult survivors is especially powerful because it challenges their isolation, stigmatization, and sense of not fitting in. Unlike self-help groups where the stated purpose is mostly educational, supportive, and inspirational, group therapy allows you the opportunity to explore how you relate to others and learn better ways to communicate, resolve conflicts and negotiate your needs. The other group members will also help you to change, as you will be doing for them.
The best time to enter group therapy is at the beginning of Stage Two recovery. Refer to the beginning parts of the next three chapters for an introduction to the goals of these stages. Part of the reason for delaying the group therapy is that you will be hearing other people talk about what happened to them as children. This can stir up a lot of feelings about your own abuse. To get the most from group therapy, you will first need to have some experience in dealing with your own powerful feelings before it can become emotionally safe to hear others' stories. Once you are no longer overwhelmed by your feelings, the group therapy can give you so much.
Listening to how others face and deal with the effects of the abuse can be both illuminating and inspiring. You will learn ways to cope that have never occurred to you. Also, being in a group will provide feedback on how you relate to people—something that might be scary to hear but that you need to know before you can make any changes. You may meet people who will become your close friends—people you do not need to deceive. Acceptance of you and your feelings are legitimate expectations and benefits. Some survivors prefer to start with an introductory group that is very structured and is limited to people of the same sex. Mixed group therapy can be helpful in Stage Three to address the feelings that survivors have toward members of the opposite sex.
Couple Therapy
Couple therapy, as described in chapter 8, involves the survivor and his or her partner or spouse meeting with a therapist to resolve conflicts in their relationship that are directly or indirectly caused by the effects of the abuse. For many survivors in recovery, couple's therapy can be helpful in a crisis situation when the relationship is threatened by divorce or separation. In other cases, couple's therapy may be called for during Stage Two or Stage Three when the survivor has made significant changes in their personality and thus are ready to integrate those changes into the relationship. Couple therapy is usually of shorter duration than individual or group therapy and more focused on particular problems or concerns. Typically many couples will be in and out of couple's therapy as new issues emerge and help is required. If you are already in individual therapy, and couple's or family therapy is advised, I recommend that you and your partner see a different therapist than the one already working with you or your partner. This way the couple's therapy is separate from your individual therapy, reducing the chance of the therapist favoring one partner over the other.
Family Therapy
Somewhat similar to couples therapy in purpose, scope, and duration, family therapy calls for everyone in the survivor's immediate family to meet with a therapist to increase communication, resolve conflicts, and help the family accept the changes being made by the parent who is in recovery. Often family therapy is recommended when one of the children presents problems either at school, home, or as a result of some disciplinary action. Many times, these problems can be seen as a cry for help by the child.
Family therapy is typically based on systems theory, which holds that when anyone in the family changes, such as a parent who is a survivor undergoing recovery, it affects everyone else and in extreme situations calls for a major adjustment in the roles, expectations, and relationships between each of the family members. What often happens in families where a parent is recovering from child abuse is that the children resist the healthy changes that they see their parent making because they may have become used to taking on pseudo-parenting and household duties to help their once dysfunctional parent. Now with the parent making positive changes, the children feel lost, confused, and possibly unneeded when their parent wants to re- assume his or her rightful responsibilities. It may be hard for a child whose identity rests on being a caretaker to go back to being a child again. As the parent gets stronger and the family becomes more stable, the children will feel safer in voicing resentments they may have had during the past when the parent was unable to pull his weight. Children will often go through a payback period when they seek to punish a parent for inappropriate demands they experienced prior to the parent's recovery.
Family therapy is often useful when survivors are in Stage Three, when their parents and siblings have responded favorably to the survivor's disclosure of the abuse. Referred to as family reconstruction therapy, this type of work can be remarkably rewarding for survivors because it offers them a chance to put into practice their personal changes with family members who were responsible for the abuse. And it can establish a new foundation upon which survivors can relate to their family in a healthy way. Not all survivors get to this point, however, but when it happens it represents the highest level of resolution possible. Read on to chapter 15 for more about this.
Sex Therapy
Sex therapy is often recommended in the third stage of recovery for survivors who may still have sexual problems that have their root in their childhood sexual abuse. It is best to delay sex therapy until most of the broader emotional issues surrounding the sexual abuse have been resolved. Sex therapy is conducted by mental health professionals who have had special training in treating sexual dysfunction and have completed a certificate program accredited by the American Association of Sex Educators, Counselors and Therapists. Their methods are more psycho-educational in style than insight-oriented. They often rely on exercises done at home either alone or with a partner. The purpose of the exercises is to desensitize or de-condition the survivor's old feelings and behaviors about sex and to replace them with those that permit healthy sexual enjoyment. These techniques can generally be described as building self-awareness of one's body and erogenous zones, learning progressive muscle relaxation techniques to calm anxieties about sexual contact, and acquiring assertiveness and communication skills to discuss sexual likes and dislikes with a partner. By gradually teaching the survivors new skills and ways of taking control of their bodies, plus reducing the unpleasant associations between sex and the sexual abuse, survivors can overcome their paralyzing inhibitions and can enjoy sex with a trusted partner. Sex therapy is usually short-term, not exceeding six months of weekly sessions.
Many sex therapists prefer to work in a couple format with the survivor's partner or spouse, thereby enlisting him as a collaborator, in helping the survivor overcome her fears of being intimate with another person while teaching her new techniques for managing the intense sensations and feelings that can become aroused. If the survivor is not in a relationship, techniques are offered that can be performed alone. The use of sex surrogates, a controversial strategy involving professionally trained sex partners who work with the client to desensitize him to sexual relations, is not generally recommended with survivors because of the anxiety that being intimate with a stranger typically evokes. However, in special situations, when the survivor has progressed in recovery to the point where the sexual abuse does not contaminate adult consensual relations and where other efforts to achieve sexual pleasure have been tried and failed, this can be cautiously considered with special modifications to suit the survivor.
GUIDE TO SELECTING A PSYCHOTHERAPIST
Selecting the right psychotherapist may be the most important decision you will make in your recovery. Relying on one person to help you reclaim the past, understand what happened, share your most personal feelings and reactions, and help you toward health and healing calls for a special person with special qualities and special training. For this reason, having knowledge about the different types of therapists and therapy options is essential before you begin interviewing therapists and narrowing down your choices.
Confidentiality
You should know that what you discuss in therapy is private, confidential and protected by the law. This concern is may feel especially important for survivors who have so often felt betrayed by parents, authorities, and the legal system. Like any doctor-patient or attorney-client relationship, the information you disclose in therapy is kept private. You control the legal privilege involved in disclosing this information. This means that your therapist does not talk about you or in any way reveal your identity. By law and by ethics, therapists may not disclose whom they see in therapy. Confidentiality is the backbone of a trusting therapeutic relationship. You have a right to your privacy and your therapist is expected to ensure that right. A breech of confidentiality by a therapist is subject to sanctions from professional organizations that establish standards of practice. It is also against the law to disclose confidential information without a signed release from the survivor.
There are a few instances when this confidentiality agreement can and must be broken by your therapist. One such instance is when you make a serious threat to physically harm some individual. According to the 1976 Tarasoff decision, your therapist is legally obligated to report to authorities such threats to protect an innocent person from harm. Therapists who fail to do so commit a crime and can be punished by law or through civil litigation.
Also therapists may break confidentiality if you disclose serious intent to harm yourself and require hospitalization to protect you from committing suicide. Your therapist can inform the police, hospital, other mental health personnel to make sure that you get the help you need to stay alive. You may not always agree with this, but therapists are responsible by law to protect you from harm, even when confidentiality agreements are in place.
One other situation challenges the sanctity of the confidential therapist-client relationship. When professional records are subpoenaed by criminal or civil court to provide evidence in a legal proceeding, you lose the right to confidentiality. This may be a factor to take into account if you choose to seek legal redress for the abuse. If this concerns you, discuss it with your therapist.
Finally, confidentiality is also waived if you disclose that you have committed abuse against a child. Again, the therapist is obligated to report suspicion of abuse to the child protection authorities or the police, whatever agency has been charged with handling such reports.
Qualifications of Therapists
Below are my ideas of some of the basic qualifications that therapists must have to be considered appropriate for treating adult survivors of child abuse. Many of these point are also endorsed by professional associations. These are minimal qualifications and you may have other qualifications that are important to you. Add them to this list. Keep this list with you when you speak to therapists and after the meeting write down your impressions of how they rated.
Types of Professional Psychotherapists
There are five categories of mental health professionals who have received clinical training and supervision that qualify them to provide therapy for adult psychotherapy patients: psychiatrists (M.D.), clinical psychologists (Ph.D., Psy.D., Ed.D., D.M.H.), clinical social workers (D.S.W., M.S.W.), psychiatric nurses (MS.N) and marriage and family child counselors (M.F.T.). All of these disciplines require at least a Masters degree, and psychiatrists and psychologists possess Doctoral degrees. Roughly speaking, the Masters-level disciplines reflect two years of classroom training and two years of practicum training in psychotherapy. The Doctoral-level professions require four or more years of classroom training and two or more years of practicum training.
Many people who consider entering psychotherapy are confused about the differences between the various mental health professions and wonder if the type of therapy offered is influenced by the degree and training that the particular therapist has. Briefly, the differences have mostly to do with the type of training and theoretical orientation provided during the therapist's degree program. For example, psychiatrists are first trained as medical doctors and then receive extra training in psychiatry that permits them to prescribe medications, unlike the other disciplines. Because of this emphasis on medical training and the use of medications to address emotional problems, psychiatrists tend to be grounded in the traditional medical model that emphasizes biological approaches to behavior. In contrast, psychologists' training emphasizes theories of child development, human motivation, perception, cognition, sensation, and mental functioning, all of which explain how psychic processes determine behavior. Social workers are trained in traditional casework methods that emphasize a bio-psycho-social perspective in helping clients to function better in their social environment. Marriage and family child counselors, the newest of the mental health disciplines, are trained in counseling the various members of the family and draw from family systems theory to strengthen the functioning of the family unit. These distinctions are gradually beginning to blur as each discipline borrows from the other's orientation while broadening their treatment approaches.
Which one is best for providing psychotherapy for adult survivors? While some research indicates that the more training and experience a therapist has in providing psychotherapy, the better the service usually is. Other research suggests that the human qualities of the therapist— the caring, intuition, compassion, and genuine-ness—may be just as important. My advice? Naturally, I am somewhat biased because I am a psychologist and I respect the scope and philosophy of a psychologist's training. However, I have also received training from psychiatrists, social workers, and family counselors who were all excellent in their own right. In the end, who the person is and how he or she conducts therapy and the "fit" between their therapeutic style and what feels comfortable to you may be the most important consideration.
Licensed Professionals Only
While there are strengths and weaknesses incumbent in the training of the various mental health disciplines, I strongly suggest that you consider only therapists who are fully licensed. All mental health licenses require the candidate to possess an advanced degree in the field in addition to fulfilling a specified number of hours of clinical training under the supervision of a licensed therapist as well as to pass a written and oral examination. Some states may have other professional licenses that I am not familiar with or no professional licensing structure at all. States vary greatly in their requirements for a mental health degree. Many people in rural areas that do not have many mental health practitioners rely on pastoral counselors who are priests and ministers who have received special training in counseling. In those states where there is no licensing body, your task of sifting out the helpful therapists from those insufficiently trained or who lack experience will be more difficult. In such as case, even greater care should be exercised in getting quality referrals, interviewing potential therapists, and asking for professional references. The one caveat to seeing only professional therapists involves financial considerations. Licensed therapists typically charge higher fees. If the cost of mental health services will determine if you receive therapy or not, then one option is to see a student intern who is in training and working under the supervision of a licensed professional. The costs of services with a student intern will be far lower. In this case, the best strategy is to select an intern who is being supervised by the mental health professional with the best reputation or who has experience working with adult survivors. Finally, the bottom line is that the therapeutic relationship has to both feel right to you and be effective in helping you make necessary changes.
Theoretical Orientation of the Therapist
Each of the five mental health disciplines reflects an underlying philosophy tied to their respective training that shapes their approach to psychotherapy. Clearly some approaches are better than others when it comes to treating adult survivors. Psychiatrists and other therapists who fully embrace the classical Freudian style of treatment may not be sufficiently gratifying for the abused or neglected survivor. The research on positive therapy outcomes suggests the interpersonal characteristics of the therapist , such as empathy, warmth and positive regard count for much more in treatment success that type of theoretical orientation. Likewise the technique of psychoanalysis where the therapist remains extremely reserved and doesn't interact with the client as much as the other types of treatment is not recommended for survivors who may end up feeling neglected. Some therapists who believe that emotional suffering is relieved by manipulating and applying pressure to the body—the bioenergetic approach—is contraindicated for adult survivors who may experience the therapy as a reenactment of the abuse. Other more "fringe" therapies like Primal Scream, which encourages a rapid ventilation of feelings, may actually be harmful for survivors who may already feel overwhelmed by their feelings.
There are many different approaches that can provide effective therapy for adult survivors. That said, I believe the preferred theoretical orientation for therapists treating adult survivors is one that helps you to understand and change the effects of the abuse on your sense of self and personality. Always remember that there are layers of effects, ranging from current difficulties to underlying causes of those difficulties, that will take you back to your childhood and the type of relationship you had with your parent before, during, and after the abuse. It is therefore essential that your therapist have a developmental approach to be able to conceptualize how all of these influences, positive and negative, are incorporated into your personality. Understanding how your experience affected you will suggest specific ways that therapy can help you. These orientations are sometimes referred to as attachment therapy, self-psychology , psychodynamic therapy. Most recently, we hear the term "trauma therapy" applied to the treatment of Post-Traumatic Stress Disorder (PTSD) which is the official label given to survivors of childhood abuse. The goal of all of these approaches is to help you stabilize and then strengthen your sense of self, gain control over your behavior, understand where your feeling connect back to the abuse. I would suggest that this approach is the most beneficial to adult survivors because it is broad-based and can take you from the beginning of the first stage all the way through to the third stage, from reclaiming the past to integrating a new sense of self.
Experience In Treating Adult Survivors
Another important qualification to look for in choosing a therapist is his or her experience in working specifically with adult survivors of child abuse. This is an important criteria because a particular style of treatment is often helpful, which is then modified to address your special needs as a client. Since the end of the Vietnam War, there has been a growing body of research on PTSD. Research is showing that the effects of war trauma are similar to those experienced by survivors of child abuse. Out of this research new ideas about the treatment of trauma have evolved requiring new therapeutic skills and techniques that your therapist should possess. These approaches include strategies that help you to reinterpret the abuse situation and use this new understanding to challenge the old self-destructive tendencies that are as much habit as personality trait. Assertiveness training, stress reduction, and anger management may be helpful sills to learn early in recovery. Other approaches that encourage the resolution of trauma are more appropriate for the second stage, such as guided visualization, creative expression, dream analysis, and in select situations, hypnotherapy. As always, the particular techniques should be employed as part of an overall treatment plan that is tailored to where you are in recovery.
Other Important Considerations
Gender of the Therapist
For many survivors, deciding on the gender of your therapist is a big consideration. Female survivors who were sexually abused by their fathers may not be comfortable with a male therapist. They may prefer a female therapist who they feel can be trusted more. The same may be true for male survivors. Some survivors who were severely abused may base their decision on which parent helped them the most. Even when the father was the offender, some women may prefer to see a male therapist because they may be more angry at their mothers who failed to protect them. Other women may have too much fear or rage toward men to feel safe working with a male therapist. Likewise men who were abused by their mothers may not trust a female therapist to act in their best interests. Considering how important safety is, you should choose whomever you feel most comfortable with, especially if you have never tried therapy before.
No Evidence of Unethical Behavior
It needs to be stated that there are therapists who are unethical, unprofessional, or outright incompetent. Adult survivors who have trouble protecting their interests and saying no to authority figures may be especially vulnerable to exploitation in the therapy situation. Research indicates that sexual contact between therapists and clients is not uncommon despite strong evidence that it is usually very destructive to the adult survivor and can seriously derail their recovery. If your therapist has ever talked of initiating sex or has tried to engage in sexual contact with you or made mention of such activities with other patients, you should know that such behavior is unethical, unprofessional, damaging, and is now illegal in many states. If you are unsure about your therapist's actions, please consult another therapist, doctor, sponsor, or friend to help you determine what would be in your best interests. Adult survivors may be among the most vulnerable to sexual contact with a therapist, especially if you were sexually abused as a child.
Short of this obvious danger sign, there are other indications that the therapist you are considering may not be up to professional standards. Taking phone calls during the session is a practice that some hospital-based therapists do, but if it becomes repetitive or you experience it as intrusive, you may need to address it with the therapist. In a private practice situation, this should not be tolerated. Your needs should come first in the session and the therapist should not be conducting other business during your time.
One therapist I saw met clients in her house, which was kind of weird to begin with. The first session she told me, "I'm going to be answering the phone and I'll be cooking and sort of running around and that's kind of the way that I am. So if you don't think that will work, we should probably not work together." So when she said that to me, I thought, "Well I don't know how I'll feel about that." Inside I didn't like this idea much, but I just wasn't able to really voice my opinion at the time. But later on, I began to resent it quite a bit. We would be talking and she would get up to put something in the oven, and if I wanted to be heard, I'd have to get up and go into the kitchen. At the time, I thought, "Well, this woman told you exactly what she was going to do, and you said that it would be fine, so you can't say anything now." That's how I saw it then. And she was sort of an abrasive personality that kind of intimidated me. It just didn't work out. I could never get comfortable with her. The six months I met with her were really a waste of time.
Another worrisome sign is a therapist who shares too much personal information or refers to himself or his own point of view to that interferes with the focus on how you feel. Therapists have to have boundaries and a high degree of security to allow you to use the time as you see fit. When this essential quality of the therapeutic relationship is violated, you may no longer have an environment conducive to developing trust and working on yourself.
Survivors do have some recourse should their therapist violate some ethical or professional standard. Clients can contact the state board that oversees medical or mental health licensing. If you are unclear as to whether your therapist is doing something unethical or illegal, you can consult with the state board, anonymously or not, to determine what actions, if any, you may want to take. Often, unscrupulous therapists will show their hand during the initial sessions in a way that foreshadows future problems. Go with your instincts if you don't feel right about somebody. You may have other considerations to take into account in selecting a therapist that relate directly to the circumstances of your abuse. Give extra thought to some of the following issues, which may result in a better therapeutic relationship.
Is “False Memory Syndrome” Real?
False Memory Syndrome refers to a psychological process whereby a survivor comes to believe that a “recovered” memory accurately represents what happened when, in fact, it never actually happened. This issue is tied to the effect that childhood abuse has on memory encoding and retrieval and the role that psychological defenses of repression and dissociation play on recovery of memories that had been blocked out of consciousness. This issue is controversial because of survivors’ vulnerability about whether they will be believed when they disclose the abuse. Being able to determine whether a memory represents an actual event that occurred can be very challenging, especially when the memories have been repressed or dissociated for many years. Eyewitness memory research shows that memory is both fallible, and malleable, especially over time. Recovering memories can take time and care must be taken to not contaminate memory fragments as they emerge over time. Memory can be constructed from other sources besides actual daily experience. Dreams and conscious imaginings can create pseudo-memories that can feel very real. Guided visualizations and hypnosis can also generate visual memories that are not a real depiction of reality.
As described in Chapter 12, recovery from child abuse does involve working with the abuse memories. But memory recovery work should not be the primary point of treatment. Awareness of past abuse allows you to create an accurate narrative of your experience and the events that shaped that experience. Memory recovery work is a delicate process that can go awry if mishandled by the therapist. Good treatment needs to adhere to certain guidelines around helping the survivor determine their real and “narrative” truth. Using certain tools such as hypnosis and guided visualization can both help and confuse the uncovering process, especially if the survivor has a history of dissociation. If the survivor is particularly suggestive or if the therapist is unskilled in using these tools, contamination of the survivor’s memory recall is a very real possibility. Some therapists who may be survivors themselves may have their own reactions to their client’s abuse material that interferes with a healthy professional process.
Survivors need to be careful in figuring out what happened. Therapists should respect the time it takes for the survivor to determine what is true for them. In cases where the facts do not add up or questions emerge as to the veracity of a particular memory, the therapist should be fair and balanced in weighing all the evidence. If survivors feel that their therapist has an agenda or belief that something did or did not happen, it can disrupt the therapeutic relationship and undermine the therapy.
Empathic communication, rational thinking and good judgment should always be the guiding principle of good therapy.
Advances In Trauma Treatment: Three New Approaches
Since the first edition of Soul Survivors was published many years ago, several innovative treatments for trauma have been developed that warrant special attention for today’s adult survivor. As a result of new research into the neurobiology of trauma, these new techniques aim to reduce the traumatic symptoms more directly by intervening at the neurological, somatic and cognitive levels. The standard of care for the treatment of adult survivors has shifted away from the sole reliance on traditional talk therapy to integrate new mind-body approaches that have been empirically tested and found to be effective.
Traumatic memories are now understood to be stored differently than non-traumatic memories. These memories are held in the right hemisphere of the brain in fragmented, un-integrated and unprocessed form, separate from the language centers. The implicit memory system is where emotional, behavioral, somato-sensory, perceptual and non-verbal memories are stored. Explicit memory is narrative memory that is biographical, conscious memory that is processed in the hippocampus. Trauma disrupts the processing of memory in the hippocampus so that the traumatic memories are not able to be processed sufficiently to get into explicit memory. For this reason, you may find yourself getting triggered by the implicit trauma memories and feel like the trauma is happening all over again.
Recent research on emotions and how emotions are processed have enormous implications for treatment of childhood abuse and trauma in general. Treatment needs to help survivors keep their pre-frontal cortex and working memory engaged while processing the raw feelings and sensations held in the limbic system, hypothalamus and brain stem. This process spans the more evolved parts of the brain and the more archaic parts of the brain. This is sometimes referred to as the “triune” brain to connect three different brain systems that have evolved over time on top of the previous brain system. One structure that mediates between these different systems is the insula (located closer to the limbic or emotional center of the brain) and the cingulated (which is closer to the cortex). The insula and the cingulate translate the powerful, visceral feelings and sensations so common to abuse survivors into a more nuanced understanding of what happened in the abuse scenario. Making sense of these primitive thoughts, feelings and sensations and restoring the balance and rhythm is a core aspect of healing the mind/body split that characterize child abuse.
Attachment Focused Therapy Using EMDR
Attachment focused therapies have also come into existence in the last twenty years. Researchers and clinicians such as Sue Johnson, Diana Fosha, Dan Siegel, and Laurel Parnell have all made significant contributions to the treatment of trauma using attachment-based models. Some of these clinicians incorporate the use of Eye Movement Desensitization and Reprocessing (EMDR) that was introduced into the mental health field in1990, only one year after the first edition of Soul Survivors was published. Developed by psychologist Francine Shapiro, EMDR has evolved over the last two decades to be a powerful treatment for psychological trauma. A number of clinical studies have established the effectiveness of EMDR with victims of trauma and I have used it effectively in my practice with hundreds of abuse survivors.
EMDR activates the brain’s information processing function that enables unprocessed trauma to be accessed, activated and even “metabolized” so they lose the power contained in the symptom. Traumatic memories tare processed to enter explicit memory and organized into a linguistic narrative. The technique itself is applied by alternating sounds to different sides of the head, hand tapping or one’s knees or stimulating saccadic eye movements by moving a target laterally across the survivor’s visual field. Currently, electronic devices that emit alternating sounds in synchronization with pulsing hand sensors are the most popular delivery method for EMDR.
Although the definitive understanding of how EMDR actually works has yet to be agreed upon, the best explanation is that by synchronizing the left and right hemispheres of the brain while holding a mental image or “target” in mind of the actual traumatic event (thoughts, feelings, sensations, etc.) the REM (rapid eye movement) state is activated. The REM state also occurs during dreaming and is of critical importance in processing events of the day. So it makes sense that turning REM on may facilitate the re-processing of traumatic memories that are “stuck” in implicit memory, unable to be processed. EMDR has been shown in several studies to especially effective in Type 1 trauma that is event driven trauma that temporarily overwhelmed the person’s coping capacities.
More recently, psychologist Laurel Parnell has combined EMDR treatment with attachment focused psychotherapy to create a powerful new approach that combines several treatment approaches to repair the interpersonal wounding caused by child abuse. This approach is founded on the idea of creating a “ corrective emotional experience” with the therapist that helps rework the damaged parent child relationship of the past. Parnell uses “Resource Tapping” to unless the client’s own restorative capacities and healing memories that can build ego strength and resiliency when dealing with abuse memories. Then, when the client is emotionally stable, the work turns to the EMDR technique to process traumatic memories with bilateral stimulation (BLS) of the brain hemispheres.
Therapists need to be trained in EMDR in order to be able to apply it with their clients. The training involves approximately four days and is now available in workshop format around the country. While over 100,000 therapists have now been trained around the world, the availability of EMDR trained practitioners is spotty, especially in rural areas. Survivors who are in therapy with a practitioner who is not trained in EMDR have two options if they want to try it. First, they can suggest that their therapist get the training. This is probably the best option because it allows the EMDR work to be integrated into the on-going therapy. The other option involves the use of an “adjunct” therapist who is trained in EMDR and can provide the treatment on select topics relating to the abuse. This adjunct work is typically short term and when completed, the client returns to their primary therapist. The adjunct therapist shares the clinical material with the primary therapist so that they are updated. This adjunct model works quite well as long as both therapists and the client understand and accept how the adjunct EMDR therapy will be incorporated into the primary therapy.
Somatic Experiencing
Another new approach to the treatment of trauma is called Somatic Experiencing. Psychologist Peter Levine developed this model based on the idea that trauma overwhelms the nervous system and needs to be addressed somatically before emotional processing is possible. Somatic Experiencing also relies on a kind, empathic therapeutic relationship to create enough interpersonal safety for the survivor to release the “powerful and profoundly restorative involuntary reactions” that are the by-products of the abuse. Levine supports the integral role attachment plays in causing trauma. He says that survivors who lack early attachment bonds to parents or caregivers and therefore lack a foundation of safety are more vulnerable to developing entrenched symptoms of PTSD. Levine makes the point that the capacity for self-regulation is what allows us to handle our own states of arousal and difficult emotions. This, he says, provides the basis for “authentic autonomy and healthy social engagement”. Being able to restore this balance is a crucial part of stabilization so essential in the first stage of recovery.
Levine’s understanding of post-traumatic stress is grounded in his study of animal reactions to stressful events. Based on this research, he believes that “tonic immobility” coupled with a strong fear reaction is responsible for trauma. He cites research that 77% - 88% of childhood sexual abuse survivors felt some level of paralysis during the assault. Many do not remember feeling such paralysis because of dissociative reactions that impaired memory of the events. Levine makes the point that many survivors feel guilty about not fighting back but do not understand that the tonic immobility response prevented them from fighting back.
By having the person focus on specific sensations, body movements and position, Levine activates the somatic nervous system in the same way that the trauma might have impacted the body. By re-experiencing some of the disconnected sensations, the emotions can be accessed and integrated into the person’s explicit memory systems. Both EMDR and Somatic Experiencing are probably activating similar neural circuits that hold the trauma allowing them to be processed in different channels and not relying solely on thinking generated in the pre-frontal cortex.
Levine identifies feelings of shame and anger as key players in the traumatic response and must handled in particular ways for the trauma to be overcome. Shame is seen as the result of loss of power and the inability to protect oneself that is internalized as a negative by-product of the abuse. The abuse also activates biologically-driven anger that can feel so overwhelming that the survivor may internalize it, effectively “turning it against themselves” to prevent it from being expressed. However, these anger reactions can get released once the tonic immobility is disconnected from the fear response. He speaks of cases where the survivor’s eruption of anger toward their offender may trigger reprisal actions if a trusted friend or therapist is not there to dissuade them from acting it out.
Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy developed by psychologist Marsha M. Linehan in the late 1980s just as the first edition of Soul Survivors was published. Originally developed to treat borderline personality disorders, it has been shown to be effective with a variety of mental health issues including trauma tied to childhood abuse. This approach emphasizes psychosocial aspects of treatment that teach self-regulation of emotional states that are triggered by interpersonal situations. Because child abuse is an interpersonal assault on a child, this approach gives survivors the tools to better manage situations that can either put them at risk or trigger extreme emotional reactions.
DBT starts out helping clients identify their core strengths and how to build on them to be more effective in daily life. It teaches cognitive skills to identify and alter negative thoughts, beliefs and assumptions that undermine a functional life. Self-talk that undercuts self-esteem such as "I must be a terrible person for my parents to hit me" is changed to "My parents crossed the line in their behavior today me that holds them responsible for the abuse, not me". DBT also emphasizes reworking relationship patterns with key people in their lives, especially therapists, using the skills taught in weekly lectures and homework assignments. DBT consists of two primary treatment modalities: individual weekly psychotherapy that focuses on applying problem-solving behavior to current life situations and group therapy where skills are taught including interpersonal effectiveness, distress tolerance/reality acceptance skills, emotional regulation and mindfulness skills. Many of the emotional regulation skills are similar to the 21 Step program outline in Part II of this book. Identifying and labeling emotions, identifying obstacles to changing these emotions, reducing one's vulnerability to "emotion mind" (hijacking the functional self due to emotional over-arousal), increasing mindfulness to current emotions and applying distress tolerance techniques are some of the practical skills that can be learned and deployed to help stabilize one's mind.
Recommendations
With this information in mind, you can begin the process of finding a therapist who will fit your expectations, theoretical orientation, style requirements and perhaps, financial limitations. Many of the strategies used in selecting any professional service can be a good start in looking for a therapist. Getting references from friends or members of your support group who have used therapists may be the best plan, especially if they have knowledge about specific therapists who have training and experience in working with adult survivors. If this strategy is not productive, try contacting your local child abuse prevention organization, mental health association, or professional referral services for recommendations. Make sure you mention your criteria for the type of therapist that you want.
I began looking by getting out the good old phone book and looking up any agency that was involved in the issues that I was working on. I even wrote a letter to Dr. Ruth because at the time I was living with a sex addict. I called therapists who if they weren't appropriate for me would give me referrals to other therapists who they thought might help. Well, after a while I started getting frustrated because I really couldn't afford the high costs of therapy, so I decided to try the county mental health program because you can pay on a sliding scale basis. I met with several therapists before I found someone who felt right. Dealing with the system was also difficult but you can't give up on yourself—this is your life! If he hadn't worked, I would have continued ranting and raving until I found somebody that I could work with.
Ground Rules for Shopping Around
Even if it may not be easy for you to do so, I strongly recommend that you talk and meet with several therapists before making any decisions. Some therapists may resent this strategy and will encourage you to begin to work with them before you feel ready to make a commitment. Therapists are subject to the pressures of self-interest like anyone else. Stick to your plan to survey the available options before making your decision.
When you contact a therapist on the telephone, state right away that you are looking for a therapist and ask if she will respond to some brief questions. The most important questions to be asked are the ones that may eliminate her immediately from consideration: Is she licensed? How long has she been in practice? Does she have experience working with adult survivors of child abuse? What is her fee structure? If she quotes a fee that is beyond your means, ask if she sees some people on a sliding scale basis.
If therapists are not willing to answer these questions on the phone, it may indicate an unwillingness to accommodate to what you think is important. Considering how essential it is for you to feel empowered in your own therapy, it may be best to continue your search should you get such a response. If she responds in a way that feels right to you, consider making an initial appointment. Let her know that the purpose of the session would be to further discuss what you are looking for and to see if you and she might make a good match. Sometimes it will take more than one session to get a sense of her as a person and her style as a therapist. Expect to be charged for any face-to-face meeting whether you are shopping around or not. Therapists make their living by charging for their time—usually fifty minutes for an individual session—and initial sessions are no different. Therefore, it is unreasonable to expect them to speak with you on the telephone for more than ten to fifteen minutes prior to meeting with you. At the end of the first session, don't feel obligated to make a decision on the spot. But you do need to let the therapist know how you want to proceed from this point. If you are still unclear as to what you want to do, simply tell her that you want to think about the meeting and make your decision in whatever time frame you feels right. Shopping for a therapist can be an extended endeavor. Sometimes too much information can be as bad as too little. Figure out how much time and money you can devote to this process and plan your appointments accordingly.
If you have never been in therapy before, it makes even more sense to see several therapists before making a decision. It will take a few sessions before you will grow comfortable with the therapy situation itself, let alone decide what therapist or what therapeutic style you like best. In other words, there is a learning curve operating here and you won't be really proficient in determining your preferences until you have some experience with this type of "talking" therapy.
Evaluating the Initial Session
There are many considerations—both objective and subjective—in evaluating the first session with a prospective therapist. The objective considerations are easier. Are you certain you can afford his fee? Does he have an opening in his schedule that matches your schedule? Does he accept direct insurance reimbursement? And does he expect to remain in practice in the area for several years? If any of these questions cannot be resolved, then your decision is made for you. The subjective considerations may take far more reflection and soul searching, and may ultimately determine your choice. Ask yourself the following journal questions to organize your impressions.
Journal Questions
1. Did the therapist help you feel comfortable talking about your reasons for entering therapy?
2. Did she show some understanding of your issues and indicate some willingness to be of help?
3. What aspects of the therapist's personality and therapeutic style did you like or dislike?
4. Did she listen carefully and show interest in your comments? Did you feel understood but not intruded upon?
5. Was there anything she said or did that raised questions about her therapeutic skills, professional standards, or knowledge of therapy with survivors?
6. Do her professional qualifications check out?
7. Did you agree on fees, schedules, policy on missed sessions and phone calls?
8. Were you comfortable with the therapist's style of interacting with you? Do you feel confidant you can share painful feelings about the abuse with him or her?
9. Did you feel the necessary personal connection with this therapist so that you could begin to trust her?
10. Is this the therapist you want to see once or twice a week for several years?
The Therapeutic Contract
After a few sessions with the therapist with whom you have begun treatment, it is often a good idea to try to summarize again what therapy can accomplish. Both the therapist and you can once again see what you are aiming to achieve so that you both acknowledge the purpose of your work. This process will culminate in a therapeutic contract that can serve as your common agreement about what you are working toward. This contract will, at the outset, necessarily be a broad outline, to be clarified, altered, and perhaps even suspended as you and your therapist become more familiar and informed about your needs as a client.
You might begin with fairly vague questions such as, "Why do I feel so depressed?" or more specifically, "I want to look at what happened to me as a kid so I can make changes in my adult life." What to work on and in what way will be largely determined by where you are in your understanding of yourself and your past. A skilled therapist will help you determine what needs to be addressed first, such as relationships, jobs, or particular symptoms that have somehow disrupted your adult life, and what can wait until later. Start there and work backward to the past.
Medication or Hospitalization
There may be times when you or your therapist thinks that medication and/or hospitalization might be in your best interests. This is a delicate subject because you may have any number of reactions to this idea, most of which will be negative. But sometimes in the first stage of recovery, survivors may go through a breakthrough crisis and need immediate relief that medications and hospitalization can provide. Anxiety and depression can sometimes become overwhelming and threaten to set you back in recovery, or worse, bring you to the point of suicide. There are new medications on the market that will help in managing your most intense feelings without the addictive potential of other drugs. Some survivors have more biologically based anxiety and depressive states that resist conscious control and can only be managed with the aid of specific medications. If your therapist is not an M.D., you will have to meet with a psychiatrist for a medication evaluation so the proper drug can be prescribed. Your therapist should be able to refer you to one for this purpose. As always, you need to discuss the purpose and plans for using medication with your therapist and make a decision based on what would be best for you. If you do not want medication, you have the power to say no and expect your therapist to accept it. However, in some instances where your therapist feels that medication is crucial to your well-being, he may not want to continue treating you without it. Hospitalization is recommended in several situations to ensure that you are safe while reclaiming memories and feelings associated with your painful experiences. Some survivors may even feel suicidal when they remember what happened to them and face the feelings attached to the memories. When the survivor is exhausted and overwhelmed by daily responsibilities, it may be helpful to enter a hospital briefly. During these times, much work can be done in resolving the traumatic reactions left from the past. Therapy should increase to three or four times a week during such crisis periods. Remember, there are great opportunities for change to be realized during a crisis.
Signs of Progress
You will know when therapy is working by taking note of any number of positive developments. Hopefully, therapy will help your self-awareness--the capacity to see and reflect about yourself in the world. Some psychologists refer to this as your "observing ego" or the part that can see yourself in an objective light. There are other telltale signs of progress. You may find it easier to talk about the past and your feelings about the abuse. Or you may find yourself better able to emotionally connect with people, perhaps even your therapist.. You may feel like you are making progress by cleansing the old wounds. Although you may still feel pain and anguish, now you may notice some relief and hope. You may find yourself making better choices in life and gradually eliminating self-sabotaging behaviors. There may be other concrete changes you notice based on your stage of recovery. Your relationships may have less conflict. You may be better able to manage your money. You may have more patience with your children. Some of the changes may be more emotional. Perhaps you don't feel quite as depressed as you used to. You notice little bright spots in your everyday outlook that spur you on to do more work. You may feel hope where only despair once existed. If the signs are good, you and your therapist must be doing something right. Stay with it and keep up the good work.
I think that my therapy really took off when I started seeing results in my life. I wasn't so scared anymore. I had more resolve. I felt like I could have an impact on myself. I look forward to my therapy once a week. At the risk of sounding egotistical, I really think he likes me. I can tell that he takes pleasure in seeing me come into the room. I save up things that I wanted to talk about and I know that I will walk in there and be able to say anything that's on my mind. He never starts the conversation. I always initiate the topic which I like very much. We can sit there quietly for a few moments, but knowing me and how verbal I am, we always move toward a useful topic. He has a great sense of humor, which is great because I love to laugh. He'll just say something at the right time and make me realize that I'm being too serious, or I'm not being serious enough. We will talk about other stuff like politics or finances or morality or whatever. But we always settle on deeper stuff before long. I can go as deep as I want or stay on the surface. He has helped me to look at obstacles as opportunities. And he has helped me look into the mirror of my soul. I enjoy it, and I embrace it, and I love it.
Signs of Resistance
As you continue on in therapy, you will notice that you go through cycles of high and low productivity as the effectiveness of the therapy seems to ebb and flow. Certainly the type of therapy you are undergoing is very hard work. It is exhausting to face these powerfully painful feelings week after week without wanting to put them aside for a while. When the wish occurs to put issues temporarily aside, or to rest rather than face troubles or problems, you should know that this desire is natural and probably short-lived. Therapists refer to such moments that interfere with moving forward in therapy as resistance. People do not heal and change in a straight line. They go two steps forward, one step back. Plateaus are reached and time is needed for consolidation of the changes being made before going forward again. When you go backward in therapy, the form that your resistance takes can give your therapist important clues on how to help you understand your internal barriers to change.
Resistance happens on the inside—slowing the healing of old wounds—and on the outside—creating obstacles to making needed changes in your life. Sometimes you'll be aware of your own resistance and other times it must be pointed out by your therapist. If and when this happens, try not to take offense. Your therapist is simply doing his job in pointing out the barriers you are unconsciously erecting. Determining the causes for these fallow periods can be very confusing. It is best to discuss your concerns directly with your therapist who may have noticed the same thing. Talk about where the therapy started to go off track for you, if that is what is happening. Do you notice any connection between what you and your therapist have been working on and your reluctance to press ahead? Are you having misgivings about how your therapist has been conducting the sessions lately? Are your feelings about what is transpiring in the sessions similar to past stretches when you felt like avoiding therapy? Are you suddenly more concerned about the cost or time you are investing? Have you started missing sessions without really taking a look at what you are avoiding? Are you thinking about terminating therapy prematurely or seeing another therapist who offers a different approach? These questions are important, but there may also be unconscious reasons for feeling de-motivated in therapy. Explore the meaning behind the feelings and actions with your therapist and try to understand what is really going on before making any big decisions about the therapy.
Signs of Incompatibility
Just as there are signs of resistance, which have more to do with your internal reactions to the therapy, there are signs of incompatibility with your therapist, which may have more to do with the relationship between you and your therapist . Try not to confuse resistance with incompatibility here. Incompatibility can be seen more as a "emotional fit" issue between two people whose communication styles may not mesh well. For instance, you may never have developed the type of close rapport that you had initially hoped for. See if you can identify specific reasons how you feel disconnected or misunderstood or not sufficiently supported or even criticized. Perhaps you want her to talk more or be more engaging or warmer in her interactions with you. Maybe you feel that the therapist's own issues, beliefs, and values get in the way of exploring your thoughts? Perhaps the therapist thinks that different material should be focused on or has ideas about why you think or feel or behave in a certain way with which you don't agree. He may appear frustrated, possessive or heavy handed in giving advice or critical of decisions you have made that seem to make good sense to you. This type of interaction can sometimes develop into a pattern of power struggles that never get resolved. When you try to discuss some of your concerns, your therapist dismisses them and offers an easy explanation that doesn't satisfy you or implies that you're imagining things. You may be tempted to trust your therapist's impressions rather than your own. But if you are unable to work out your differences, it may be in your best interest to consult another therapist or to discuss your feelings with a friend who has been in therapy. Remember therapists are not always right. But it also is true that survivors can reject help from others, want to punish caregivers for the parents' transgressions or act out their interpersonal abuse issues within the therapeutic relationship.
Ultimately, if you feel like you are not getting what you need to aid recovery and you have discussed your concerns with your therapist and tried to make sense of what might be going on make a change to no avail, maybe it is time to make a change. As always, your responsibility is to yourself, not to your therapist.
I first went into therapy in 1978 when I was seeing a psychiatrist who told me I was showing signs of homosexuality. He brought that up every time I brought up the incest issue. He didn't want to talk about incest; he wanted to focus on my being gay and that I was only now going through adolescence and was questioning myself about my sexuality, as most people do during adolescence. I didn't want to deal with it. I started hitting drugs harder. Of course, he was prescribing all of these tranquilizers. He kept upping the dosage and in a way it worked because I could get out of bed and take care of the kids but I was still having all of these physical ailments. Then he decided he wanted to start a group and he wanted me to be a member. So I went twice. I was just shocked. There were women there who were totally incapacitated. Some of them had just gotten out of mental institutions. I questioned him. "Why am I there?" And he said, "I want them to see your strength." That did not seem right. I felt good that he was giving me a compliment, but it finally dawned on me that I was being used again. I left shortly after that.
Taking A Break From Therapy
At times it may seem like you and your therapist are hashing over the same material again and again with little observable gain. Is this a period of resistance or a sign that therapy is not longer helping? You may ask yourself who ever gets completely "cured"? If you reach this plateau and consider temporarily stopping therapy, this may be the time to do it—not permanently stopping but just a temporary breather before resuming at some future date. Discuss your reasons for taking a break with your therapist and listen to his reactions to this idea. Ask him if you could return later and prepare for stopping. Survivors sometimes prematurely leave therapy once the major changes are made and their pain has subsided. This is truly unfortunate because what often happens is that old habits and patterns may reappear if you haven't given yourself enough time to fully assimilate the changes you have made. If you find it difficult to hold your gains after stopping therapy, you may have left too soon.
For many survivors, being on your own can be a fresh experience in sorting through everything that you have accomplished. You deserve some time to relax and reflect on what you have resolved and where you might like to direct your energies in the future. In contrast, many survivors develop enormous pride in what they have accomplished and see no reason to stop a process that gives them so much guidance and promise. Therapy becomes a natural ally in their thirst for continued growth and self-improvement. In short, you can resolve the issues of the past to whatever level feels right to you. The important consideration is to continue working in therapy until you have made the changes necessary to lead a happy and productive life. Only you know when you have arrived at that point.
Knowing When To Terminate Therapy
When you reach a point where you have resolved most or all of the steps outlined in the three stages of recovery, you will probably recognize that it's time to terminate your therapy. You eventually reach a point where you can be your own therapist. You have the perspective to understand your feelings and reactions to life events and the capacity to make additional changes when the need presents itself. You may notice that your relationship with your therapist has changed, as you rely more and more on what you think as opposed to what she thinks. Finally you feel strong and stable and prepared to meet life's challenges.
Discuss your thoughts with your therapist and listen to what she has to say. Give it some time to see if nothing new comes up to resolve. On occasion, the thought of termination may stimulate a particular issue or topic you have left unaddressed. Work this through before setting a date for a final session. Terminating therapy can bring up unexpected anxiety and worry over whether it's the right thing to do, and you may find yourself temporarily regressing to old behaviors. Allow you and your therapist plenty of time to fully air all of the reactions, fears, hopes, and misgivings. Terminating means saying goodbye to someone who has worked along with you through your most personal experiences and painful feelings. It may even bring up once again the old feelings of being alone or losing your parents. Rest assured that these feelings are a natural part of saying good-bye to your therapist. Once you go out the door, you will be carrying much more with you than you had when you first entered. The memories and experiences of your therapy and your relationship with your therapist will stick with you for the rest of your life.
Using Therapy In The Future
Who says you can't go home again? One of the nice things about psychotherapy for adult survivors is that you can leave and return if new work is needed. Many survivors benefit from going back in therapy to resolve special challenges that come over time. Getting married, giving birth, raising children, changing careers, working through conflicts with spouses, having your children move out on their own are a natural span of events. The twists and turns in life may stir up old feelings and you may again consider entering therapy. Many survivors have lifelong relationships with their therapists as new needs arise. Knowing that you can usually return probably offers some comfort when terminating therapy.
STAGE ONE RECOVERY: STEPS 1 TO 7
The twenty-one steps you are about to embark upon are meant to be adapted to your particular situation and needs. In Stage One recovery, your main task will be to acknowledge the reason for your out-of-control life—the long-term effects of childhood abuse—and then begin to regain some stability by working through the symptoms of trauma left over from the past. Out of a new awareness of the long-term impact of abuse, commitment to recovery is born. As you begin to reclaim your childhood, it will also be necessary to identify and then slow down the self- destructive and maladaptive patterns that may currently plague your adult life. It will be very hard to work the steps if your life consists of one calamity after another, as is often the case for adult survivors. Therefore, some degree of calm must be restored before you can begin to face your abuse. Emotional and physical safety is paramount. Re-read Chapter 9 Preparing For Recovery if this is NOT the case at this time. The steps in Stage One will help you begin to heal the wounds inside, paving the way for changes to be made later in Stage Two and Stage Three.
Stage One, like the other two stages, can take anywhere from one to three years to complete, depending on how severely you were abused as a child and the extent of emotional damage you suffered. Sometimes the first stage takes the longest and the remaining two stages take less time because of the momentum you will create as you resolve the most challenging early steps. Remember that recovery is an individual process, the pace of which only you can determine. It is essential that you not try to race through the steps. Find a rhythm that feels right to you. You want your healing and the changes that grow out of it to last a lifetime, providing a stable foundation for your new sense of self and your new beginning.
How do you know when you are finished with one step and are ready to move on to the next? Listen to the voice of your newly developing self—that fair, honest and objective sense inside you—that is growing stronger day by day. This voice will signal when you feel resolved, when you are no longer denying or struggling with the task of the particular step. The step is accomplished if you can demonstrate the task in action with another person: your therapist, partner, or members of your self-help group. If circumstance show that you have moved forward to another step prematurely, simply admit it to yourself and go back to the previous step for a second chance at resolution. You don't have to be perfect in recovery. You always have a second chance to get it right. Do it your way but hold it to the new standards and values that you have for yourself. Listen to this voice and cultivate its own developing wisdom. It will lead you forward to your new beginning.
STEP 1
I am in a breakthrough crisis, having gained some sense of my abuse.
This first step represents the first sign for many survivors that their past has caught up with them. Survivors often experience what I call a breakthrough crisis—when something happens to release a memory, feeling, and even a physical sensation tied to the past abuse. This revelation can hit you like a ton of bricks, capable of turning your world upside down. Powerful emotions are released that can disorient you and render you temporarily incapacitated. Although not all survivors experience the crisis to the extent that it destabilizes their lives, for many it can be the most harrowing time in recovery and provide the impetus to finally face the past.
This dramatic breakthrough crisis of often experienced by survivors of extreme and prolonged physical and sexual abuse where terror or violence repeatedly occurred. It is often triggered by some external event—seeing a movie or having a relationship that unexpectedly turns abusive or a sexual experience that somehow parallels the sexual abuse during childhood. In my psychotherapy practice, I have had clients call me in distress who had a flashback to their past abuse simply from reading a flyer for my group for "Men Abused As Children." You feel like the sacred, little child all over again with none of the control that you have developed as an adult. You may think you are going crazy and oblivious to what is going on.
For those of you who experienced less severe abuse, the breakthrough crisis may manifest itself not as a new revelation but rather as an emerging awareness that feelings, memories or bodily sensations that you have long been aware of means something else—that you were abused as a child. For example, a perpetual state of disorganization in which everything that can go wrong does, day after day, in a never-ending spiral that reinforces your worst feelings of anxiety, depression and shame is now understood as evidence of abuse. This is still revelatory but will not likely cause the same level of emotional disruption as a true breakthrough crisis.
As a child, you developed formidable psychological defenses to protect yourself against this massive assault. In most cases, you likely continued relying on these rigid defenses into adulthood until they no longer worked. This is where you may now be today. A breakthrough crisis means that your psyche is going through a massive realignment designed to bring the past into sync with the present. Like an emotional earthquake, this realignment results in powerful feelings and energy being released and can create periods of disorganization, helplessness, and incredible fear. Survivors of severe abuse often have mini-breakthrough crises with each new set of abusive memories that surface, although they are usually never as tumultuous as the first.
The breakthrough crisis is actually quite normal, although it doesn’t feel normal when you are going through it. Crises are scary. You have been used to screening out stimuli that might trigger these feelings only to now feel like you have lost control of your mind. Although it is scary, it is best in the long run to let these feelings out. This is your mind and body trying to come to grips with the abuse. Your mind is trying to get healthy by “purging” these feelings and sensations. Rest assured that this is a temporary experience that will gradually subside as you express the feelings and learn new ways for regaining a more flexible type of control. Special precautions must be taken to help keep you safe and to promote the healthy integration of these memories and feelings. Anyone is vulnerable in a crisis and there have been reports of survivors making suicide attempts or engaging in impulsive acts in response to the crisis. Remember that the Chinese definition of crisis translates to "danger and opportunity." Your task during the breakthrough crisis is quite simple: Minimize the danger to yourself by reaching out for help while riding this tidal wave of feelings safely into shore.
When I got into my early twenties, I was actually pretty depressed, although I really had no idea why. Not a clue. What made me finally call a therapist was that I'd seen that movie on television called Sybil—the woman with twenty-three separate personalities. As I was watching it, I thought, "My life is being flashed before my very eyes." It was pretty wrenching for me to watch this. I remember feeling so scared and powerless and despairing and I couldn't really figure out why. All I knew was that there seemed to be this storm of feelings suddenly brewing inside me. I felt like I was ready to explode. I started to physically shake and I couldn't control it. I tried to reassure myself that nothing that bad had happened to me as a kid. But that didn't work—these feelings wouldn't go away—they stayed with me and actually started to take on a life of their own. I felt like I was coming unglued. A week later I just couldn't handle it anymore. I decided that I needed help. So I called this therapist who had seen me when I was a kid.
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Self-Help
1. Give yourself permission to get whatever help you need to face this crisis. Reaching out to a therapist, joining a support group, trusting family members or friends –all is important because you do not want to be alone during this time. Attending an ASCA support group may be helpful in this time of uncertainty.
2. Write in your journal some positive affirmations about the breakthrough crisis. "I survived the abuse, I can survive this also." Or "Out of crisis, there can be opportunity." Write whatever sentiments or beliefs that come to mind about managing this crisis even if you don't feel that positive right now. Do whatever is necessary to give yourself the hope and strength you will need to face the past and work through the steps.
3. Learn a simple 7-Step relaxation technique. (1) Sit comfortably; close your eyes; (2) imagine lying down on an ocean beach; (3) listen to the waves build, crest, and wash over the sand; (4) feel your breathing; (5) focus on your breathing—inhale, hold three seconds, and release. (6) repeat the cycle of breathing and washing away tension over and over again until the relaxation gradually washes over your entire body from head to toes; (7) continue the cycle until you attain whatever depth of relaxation you desire.
4. Relieve unnecessary pressures on yourself during your time working on this step. If possible, you may need to give yourself a temporary sabbatical from work, school or even domestic duties while you struggle with the breakthrough memories. Of course, some may actually prefer to work as a way of coping. Judge for yourself what you will need to take care of yourself during this period.
5. Don't make any big decisions right now—including whether give up! It may be hard to think straight and you don't want to make your predicament any more complicated by acting on impulse. If you are suicidal, IMMEDIATELY call your therapist and schedule an emergency appointment. Call a suicide hotline if you are desperate and no one is available. Reach out to friends and sympathetic family members for help. One day in the future when your life is better, you will be glad you did.
6. If you feel overwhelmed and need IMMEDIATE help in managing your feelings, try the following simple techniques: 1) Ground yourself in the present, rubbing your hands or legs, stating your name and current information such as your age, the date, etc.; 2) Let the feelings happen. Don’t fight them, experience them in the safest way that you can; 3) Write in your journal; 4) Talk to someone you trust such as a friend, ASCA member, or your therapist; 5) Remember the strengths that helped you survive as a child; 6) Do exercise, yoga, meditation, deep breathing, or a relaxation exercise; 7) Go to your safe place or call on your spirituality; 8) Do art — drawing, painting or collage — to express your feelings, organize your memories and demonstrate your strength; 9) Call someone on the ASCA meeting phone list; 10) Call a telephone hotline; 11) If you have any doubts about your emotional safety, call 911 or go to your nearest hospital emergency room.
ASCA Meeting Tips:
1. If you are attending your first ASCA meeting, check in with one or both of the Co-Secretaries before the meeting starts and let them know you are a newcomer.
2. In ASCA meetings, you will share time with people who are in a similar situation as you. Being conscious of this can lessen the fear and shame that you may feel. Moreover, you can listen to others’ stories and hear in them insights that can inform your own emerging understanding. Recognize that for many survivors, telling their story may seem overwhelming if you are still putting all the pieces together. Remember that you don’t have to share anything in an ASCA meeting until you feel ready to do so. You can come to a meeting and just sit quietly and listen.
3. When you feel ready to reveal your story, you can volunteer to be a presenter so you can speak your truth about your emerging awareness of what happened to you as a child.
4. Consider accepting feedback to get positive validation.
5. If you are journaling or expressing your feelings in a creative way through poetry or other art forms, consider sharing it during the tag share portion of the meeting.
6. Ask your fellow ASCA members for additional support after the meeting if you feel comfortable. You may even wish go out for coffee after the meetings conclude.
Professional Help
1. The breakthrough crisis can be both a scary time and a productive time in therapy because the memories and feelings are now accessible. However, they may also feel overwhelming, so you may also need help managing the intensity of them. Ask your therapist for help in learning how to modulate these feelings so that you can deal with them piece by piece. Go at your own pace so let your therapist know when it feels too overwhelming to continue focusing on the memories.
2. It may help to see your therapist more frequently than once per week during this time. Discuss with your therapist whether this would be advisable. Also make sure to check that you have an emergency phone number to reach your therapist during evening hours. You and your therapist may want to develop a crisis management plan involving actions that you can take to help calm yourself and gauge if you will need emergency help.
3. This may be a crucial time to rely on your therapist to help provide safety and the type of concern and care that your parents may have failed to provide. As a result of this shared experience, you may also learn how to trust another person—maybe for the first time in your life. Your therapist needs to be able to empathically “hold” your emotional reality—witnessing the powerful feelings, sensations and memories as they surface in your mind. Allow yourself to be as open with your therapist as you can be. If
4. If you feel like you cannot cope, tell your therapist and explore ways to slow this powerful process down. You may need to put some distance between yourself and these memories until you can gain sufficient control to feel safe again
5. Practice going to your safe place to help calm you down and regain a sense of comfort, power and control. Talk with your therapist about starting the session by spending a few minutes going to your safe place. Use the Resource Tapping technique to install emotional resources that will support your work.
6. With the help of your therapist, start identifying what triggers from the past set you off on the emotional whirlwind so common during the Breakthrough Crisis. Write these triggers down and, for the time being, avoid those triggers if you can. Discuss them with your therapist in the session and start to de-construct them so you know what they are about why they are so activating.
7. Be aware of any signs of dissociation which is a psychological defense that splits consciousness. Signs include feeling disconnected from your body, losing track of time, feeling “unreal” or separated from present reality. If you have any of these signs, tell your therapist and learn ways to reduce dissociation. Dissociation is often triggered by internal or external cues. By learning these triggers, you can avoid dissociative symptoms. The best ways to reduce dissociation is to move around, pay attention to your surroundings, focus on the here and now, reaching out to others and BREATHE.
8. If any of the above techniques are found wanting in terms of helping you manage these overwhelming feelings and bodily sensations, talk with your therapist about trying some psychotropic medication. Many survivors are biased against this option, perhaps owing to past substance abuse or if parents or caretakers abused prescription drugs. But medication can be a helpful option and should not be automatically ruled out. Anti-depressant, mood stabilizing, and anti-anxiety medications can be used to help get you through this difficult time. Your therapist, even those who are not medical doctors, usually know if medication should be considered and can provide referrals for psychiatrists. Many general practitioners and internists are willing and able to prescribe psychotropic medications but in more complicated cases, psychiatrists are better trained to select among the many options available today.
STEP 2
I have determined that I was physically, sexually and/or emotionally abused as a child.
Step 2 calls on you to determine if you were abused as a child and if so, how you were abused. This is not a simple determination for many of the reasons previously discussed. However, it is a CRUCIAL that you understand to the best of your knowledge what actually happened. If you were abused but think you were not or if you were not abused but think that you were, it can undermine your future recovery efforts. In other words, you have to get this step right. Until you do, there is no sense in moving on to the next step. Be prepared for this step to take time and some painstaking work. Be patient here. Inform yourself about the signs and symptoms of the various types of abuse that were covered in Part I. Be careful and thorough in identifying facts, memories, feelings and bodily sensations. Try to piece together the abuse scenario(s). Be open to all sources of input—yours as well as others--especially those you trust who knew you as a child. Be careful not to draw any premature conclusions. Let the picture emerge and then make sense of what it means.
Many of you who are still recovering memories of your past may not yet have objective evidence of child abuse. Your sense may be more intuitive—a feeling or a bodily sensation that something was done to you that eludes "picture memory". Despite the absence of hard evidence, these intuitive feelings may be significant and should not be summarily dismissed. Many survivors of abuse were either too traumatized or not psychologically capable of organizing memories into words and images that can be recollected years later. If this is where you are in your recovery, continue to work this step to clarify if and how you were abused.
An important sub-goal in this step is learning to accept your feelings about the abuse, whatever they may be at this time. They may not make complete sense to you, but the feelings are there for a reason. In the same way that the pain from a bruise tells you of a physical injury, the feelings associated with the abuse or specific bodily sensations tied to the abuse signals what kind of wound you suffered. You will need to figure out what those feelings are telling you instead of tossing them aside or deciding prematurely what it means. Remember, survivors usually had their feelings invalidated by their parents, so not trusting your feelings or even important may be more of the same thing. Give yourself the benefit of the doubt when it comes to verifying your feelings. You will need time and help in sorting out what happened without the denial and distortion of the past.
I think the most important thing was for me to realize that what happened to me was sexual abuse. I couldn't minimize it anymore or pretend that it was something else. Once I recognized that, a lot of anger came out and I told myself that it is all right to be pissed off about it. In fact, I think it's probably a pretty healthy reaction to it. Just calling it what it was allowed me to see how so many of these problems that I had were related to it. I used to think it was because I was crazy. Calling it abuse allowed me to have a reason for all of these feelings. I don't know if I could have faced them if it meant that I was crazy or I deserved to be treated that way. I realized that I had always lived life at arm's length from my feelings. My autobiography is just an outline with no color or detail filled in. But now there's a lot of hope and strength that grew out of that realization and it allowed me to go forward.
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Self-Help
1. Pull out the family album and photographs or home movies and look at them over the course of a week or two. Just leave them around the house so that you can ponder them at your leisure. If you have no photographic records of the past, you can do some visualization exercises such as imagining taking a walk through your old house, your relatives' house, or your old school.
3. For those of you who enjoy art, draw a picture of your parents and family members. Draw a picture of yourself as a child. Add as much detail as you can recall. If the words describing the abuse episodes are still escaping you, try drawing pictures of whatever memory fragments you have of the abuse. More details of the visual images will probably come to you as you continue to sketch in what happened.
4. You might consider writing your autobiography, starting with your first memory and working to the present. Some of you may be able to make a trip back to your hometown to research your autobiography. Interview the people who knew you as a child and ask them about their memories and perceptions of you back then. Just let the stories, memories, and feelings wash over you. Record your impressions of whatever they recalled in your journal for future reference.
5. Start recording your dreams and any nightmares in your journal and then reread the dreams a week later. Write down whatever impressions, specific feelings, or images that come to you. Don't worry if everything seems disconnected. As you add the details to the picture of your childhood, the pieces will begin to fall into place.
6. Using your journal, list all the memories that contain experiences, events or situations that felt uncomfortable. Just describe what you recall. Compare the memories of what happened with the definitions of abuse included in Chapter 1. Are they similar or different? What specifically occurred that you identify as abusive according to these definitions? Organize your recollections into the various categories of abuse—physical, sexual (both contact and non-contact), emotional abuse and neglect.
7. If you can determine that you were abused, write down that date. This date will become the birthday of your recovery. Remember it well because you will need to honor this date in subsequent years when you are enjoying the fruits of your labor.
8. Here is a technique to try that offers some relief to the physical sensations tied to the abuse. Take a hot shower for 10 minutes or so and imagine letting your body open its pores and releasing the feelings and sensations associated with the abuse. Let yourself just experience the release and how your body feels. Notice what parts of your body are most expressive. Don’t let yourself get hijacked by your thinking, just let it unfold on an experiential basis. Allow yourself to feel purged of these feelings and sensations.
ASCA Meeting Tips:
1. Give an update of where you are at right now and what you have discovered about yourself recently.
2. Share what led you to this conclusion. Your insights may help others who also may be working on this step.
3. Discuss any issues related to past memories that have recently resurfaced. You can address the concept of repressed memories and hear what others have noticed in the return of old memories.
Professional Help
1. This is where the relationship with your therapist becomes so important. You must reveal your experience of a most vulnerable time of your life and your therapist has to be a caring, interested participant in “holding” what you say and how it made you feel. This is where you are free to be your authentic self who is facing the wounds and needs and desire a warm, supportive connection with another person. Ideally, you will feel that your therapist cares about you and wants the best for you and wants to help in that difficult process. Feel free to address any aspect of your relationship with your therapist. Any feelings that you have for your therapist—positive, negative, ambivalent, whatever—can be brought up and discussed with them. Try to push through the tendency to protect yourself from them or hold them at bay or not disclose your true feelings. Recognize that so much of how you related to your therapist may be shaped by your experience with your parents or abusers. The therapeutic relationship is supposed to be the place where you rework these past relationships into a new model of relating that is more functional, fair and restorative.
2. Talk over with your therapist fears and apprehensions about remembering the abuse. What are you afraid might happen if you remember it all? What reason might there be for wanting to keep these memories at bay?
3. Talk to your therapist about what you might need with to be able to reclaim these memories. What might help you feel safer and in more control, Do you need specific changes in how you and your therapist structure the sessions? Whatever it might be, you have the right to tailor your therapy to your individual needs.
4. With your therapist try Peter Levine’s technique called “Wandering Inward”. Sit comfortably and close your eyes if you prefer. Let your attention wander through every part of your body. Just stay with whatever you experience, don’t judge or get lost in thought. Bring your attention to those areas that holds tension. Stay there and just experience what your body is expressing. Memories, sensations, feelings and thoughts may emerge. Just allow them to express themselves before they will likely dissolve or evolve into something else. Try to breathe in a slow, regulated pace, in though the nose and out through the mouth.
STEP 3
I have made a commitment to recovery from my childhood abuse.
Most survivors who have recovered from child abuse can point to one moment in time when the thoughts about change and the hopes for a better life overcame their wall of denial and resistance. After acknowledging that you were abused and the effects that are undermining your life as an adult, the next step is to do something about it. This is a critical step for many survivors because moving from thinking about the abuse to actually doing something about it in the form of a commitment to a program of recovery is a large leap indeed. In many instances, survivors can flounder at this point for many of the reasons identified in chapters 9 and 11. Because this step is more like a leap, it may mean more to you than many of the other steps when you finally achieve it. Taking this giant step means you are no longer a passive victim of the past. You are now truly a survivor in the sense that you are motivated to overcome the effects of your abuse and are initiating change in the present in the hope of a better future. You are building on your acknowledgment of the abuse and recognizing that although you have been deeply hurt by it, you have not been vanquished.
What does it mean to make a commitment to recovery? Basically, it means taking three steps—building self-awareness, having the intention to change, and taking necessary action such as attending a self-help group and/or entering therapy with an experienced mental health professional. This step will not be achieved until you undertake both of these tasks. If you are still not ready, there is still something you can do to bridge these first two steps in a way that may help you to eventually join a group or therapy. Consider disclosing to a spouse, trusted friend, or clergy what you are struggling with. Disclosing your abuse to someone else can be extremely powerful because it can shatter the silence and secrecy of the past as well as your expectation of a negative response. Choose who you first tell very carefully. You want this to help you and encourage you to go forward, not set you back. Some survivors, like Susan, have gone through the motions of making a commitment to recovery without necessarily putting their heart into it. Like her, you may have attended self-help groups or started therapy without really intending to face the reality of your childhood or the feelings associated with it. During the initial stages of recovery, you too may discover that you are avoiding some crucial aspect of yourself or your problem that may only hinder your progress.
I had been in groups and workshops and even therapy for a few years before I really started my recovery from the abuse. A lot of the help I had gotten before was for my head—intellectual understandings that didn't really capture what was going on inside of me. I would say the real turning point was this one night when I did some coke and I sat down to write a friend, and all of a sudden, all this stuff just started pouring out—feelings and thoughts and fears about the coke, my life, my situation, how I felt about myself. I had never cried for more than a minute my entire life, but that night the dam broke. One of the things I learned in my support groups was to follow through on goals, which for me had been to get back into therapy. I remember just laying there thinking how I needed help and I knew I had to reach out, and that there was one person—my ex-therapist—who if I called and told her this would hold me to it and make me face it. It was four or five o'clock in the morning when I made that call. This is when my recovery really began.
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Self-Help
1. Want to know what creates success in whatever endeavor you commit to? It’s not intelligence, family history, physical looks or luck. It’s something called grit. What is grit?
Psychologist Angela Lee Duckworth describes it as the tendency to sustain interest in and effort toward very long-term goals. To view a video of her TED talk, click on this link: http://www.ted.com/talks/angela_lee_duckworth_the_key_to_success_grit.html . Why am I mentioning this here? Because grit is a key ingredient to what it will take to recover from child abuse. And it begins now, with your commitment to recovery. The 21 step recovery program described here represents a long journey--many steps, tasks, objectives and goals--leading to your personal transformation. You must be committed to the long haul. Do you have what it takes? Click on the link to take a self-test to measure your grit. https://upenn.app.box.com/12itemgrit . Be open to what it tells you. Now is the time for being totally honest with yourself.
2. Write an affirmation in your journal about your commitment to recover from child abuse. It can be a poem, a letter to yourself, a statement of your goals, or an unsent letter to your parents declaring your intentions. This can become your personal manifesto that you can hold on to for strength, inspiration, and encouragement.
3. Try Laurel Parnell’s Resource Tapping technique mentioned in Chapter 11. Close your eyes and sit with each hand resting on the corresponding knee. Start tapping with your forefingers, alternating taps right/left, right/left, right/left at a fairly brisk pace. While tapping, identify the thoughts and feelings you have about committing to recovery. What is the felt sense of this commitment? Locate any sensations in your body that give strength to this commitment. Hold those feelings and sensations that represent your newfound determination. Tap for 10 – 20 seconds.
4. This is a good time to institute your daily exercise program. Twenty to thirty minutes per day for any kind of cardio (aerobic) exercise will both fortify your positive intentions and discharge pent up energy and feelings left over from recovery work. Exercise will help you resist the stress of recovery and help regulate your mind and body. Exercise is activating and during recovery, you need all your emotional, cognitive and sensory systems to be well functioning. Exercise does that.
ASCA Meetings Tips:
1. If you have not already done so, make a commitment to attend ASCA meetings or any other self-help meetings to support your recovery efforts. You might address what strengthens your commitment, as well as what periodically erodes that commitment.
2. If you have not already done so, try sharing at a meeting, even consider being a 15 minute speaker.
3. Connect with other ASCA members and draw support from those who understand what you are going through.
4. Listen to other survivors’ stories for how they broke through to commit themselves to recovery. What has the process been like and how did they maintain it through the various obstacles on the road to recovery?
5. Listen for how others began the process of sharing their stories in meetings.
Professional Help
1. Use the information presented in chapter 11 to select a warm, caring, and experienced therapist, someone who can be there for you when you go through the ups and downs of recovery.
2. Once in therapy, share with your therapist your thoughts on what you want to accomplish and the work you've done to date. Remember that your therapist may be intuitive, but is not a mind reader. By sharing your memories of the abuse as soon as you feel comfortable, you will help your therapist devise a plan for healing that acknowledges your past work, and at the same time, focuses on your present needs.
3. Your therapist should help you with understanding how you represent yourself in the therapeutic relationship. Think about how you manage the relationship in terms of trust, intimacy, self-disclosure, communication, dependency and projection of expectations and fears.
4. Talk to your therapist about what you have read here and in other books about recovery. What would you like to bring into therapy from your readings and talks with other survivors. How can you make recovery best suited to your needs?