Davis Frawley Dissociative Processes AndTransference-Countertransference
Davis Frawley Dissociative Processes AndTransference-Countertransference
Davis Frawley Dissociative Processes AndTransference-Countertransference
Though Freud came to doubt that early sexual trauma could account
for all neurotic manifestations and turned the attenno n of the psycho
analytic community, therefore, from the realities of childhood trauma to
the complexities of infantile fantasy and intrapsychic structuralization,
he did dramatically underestimate the incidence of actual sexual abuse
and inadvertently cast aside an enormously rich body of literature on
the nature of intrapsychic processes specific to adult survivors of
childhood sexual abuse. Only today is this literature beginning to
resurface, as Freud's conclusions about the psychical integration of
infantile traumatogenic events are subject to empirical study. indeed,
Freud's (Breuer and Freud, 1893-1895) earliest psychoanalytic writings
on the predisposition to altered states of consciousness and ego
dissociation and splitring in the victims of childhood sexual trauma are
almost entirely suppor(ed by the results of contemporary research (Van
der Kolk, 1987; Krys(al, 1988; Ross, 1989; Putnam, 1989; Ulman and
Brothers, 1988).
Clearly, Freud believed that his early hysterical patients had been
sexually abused. in "The Aetiology of Hysteria" Freud (1896) concluded:
['
10
lody Messler Davies/Mary Gail Frawley
I therefore put forth the thesis that at the bottom of every case of
hysteria there are one or more occurrences of premature sexual
expenence, occurrences which helong to the earliest years of child
hood but which can be reproduced through the work of psychoanal
ysis in spite of the incervening decades [po 203].
In this Context we turn back to Breuer and Freud's earlier clinical
papers in and attempt to review their prescient description of the clinical
manifestations of early sexual overstimulation in their adult hysterical
lJatienrs. The theme of dissociation and the dual nature of consciousness,
with which we are particularly concerned in this paper, assume a central
role throughout their early writing. In their "Preliminary Communica
tion, The Mech:mism of Hysterical Phenomena" (Breuer and Freud, 1893
to 1895), the authors state unequivocal!y;
The longer we have been occupied with these IJhenomena the more we
have become conVinced that the splitting of consciollsness which is so
striking in the wel!-known classical cases under the form of "double
conscience" is present to a rudimentary degree in every hysteria, and
that a tendency to such C\ dissociation, and with it the emergence of
abnormal states of consciousness (which we shall bring together under
the term "hypnoid") is the basic phenomenon of this neurosis....
Ideas which emerge in them are very intense but are cut off from
associative communication with the rest of the content of conscious
ness [po 12].
ity of the memories (later impulses) contained therei~1, he :md Breuer are,
at this time, stili describing In their hysterical patients not a layering but
I1
In the first of 1115 published case studies, that of Frau bnmy Von (\;.,
Freud describes the phenomenon unmistakably:
What she tolJ !lIe \vas perfectly coherent and revealed an unusual
degree of education and intelligence. This made it seem all the more
strange when every two or three minutes she suddenly broke off,
contorted her face into an expression of horror and disgust, stretched
our her hand towards me, spreading and crooking her fingers, and
exclaimed, in a changed voice, charged with anxiety: "Keep stiW Don't
say anything! Don't tollch me!" She was probably under the influence
of some recurren t hallucination of a horrifying kind and was keepmg
the intruding material at bay with this formula. These interpolations
came to 8n end with equal suddenness and the patient took up what
she had been saying, without pursuing her momentary excitement any
further, and without explaining or apologizing for her behavior
probably therefore without herself having noticed the interpolation
[Breuer and Freud, 1893-1895, p. 49].
The case studies in this volume contain many such evocative examples
of recurrent dissociative episodes. Unfortunately, Freud's abandonment
of the seduction theory in September 1897 relegated these early clinical
and theoretical conceprualizations to the anClllary position of scientific
history. For the most part, clinicians today read "Studies on Hysteria" to
learn about the early stages in the development of psychoanalysis and
Freud's struggles to develop a working model of the mind and to elucidate
a technique that would overcome the powerful forces of repression,
unconscious conflict, and symptom formation. The brilliant clinical
descriptions so richly depicted in the text and so pertinent to work with
adult survivors of childhood sexual abuse were to be lost for many yeClrs
to come.
l\ot until the work of Sandor Ferenczi did the actualities of early
childhood trauma and their psychologically devastating sequelae again
become the focus of serious psychoanalytic inquiry. Ferenczi (Freud's
pup:l, cmalys:md, and, after Fliess, his closest personal friend) would
eventually jeopardize his relationship with Freud and his respect and
esteem within the psychoanalytic community to promulgate his belief in
the primacy of these events. In a letter to Freud dated December 25,
192 9, Ferenczi wri tes:
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but also included in the diaries are comments about iuentiflcation with
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15
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~.
Most survivors of childhood abuse are faced with the dilemma of having
authority, career, and so on, in spite of the fact that, relatively early on,
they have been betrayed by a person with whom they share one of the
ing core of a wounded and abandoned child. This adult self has a dual
with relative success and at the same time protect and preserve the
abused child who lives on, searching still for acknowledgment, valida
dissociation at the core of the personality and its effects on all later
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intensity of the child's rage and shame and the content of her thoughts
episodes where the child is given full reign to express, remember, and
case with true multiple personalities, patients, for example, report losing
remembering how they got there. One patient would report, with some
regularity, sitting down to write business reports only to find thilt they
had already heen done and done to perfection! "It's like the shuemaker
and the elves," she would say. "I gu to sleep and when I wake up, there it
is!" This panicl] I~r patient entered treatment becQuse of persistent prob
lems on her job. Though it was immediately clear that her personcd life
was also extremely restricted, she kept these issues out of the early phase
tll
Patient: It's like there's this baby part of me.... She's scared and
pitiful sometimes, and I hate her for that
but then she turns h:Heful
and demanding.... She won't be satisfied
I try, but I can't. She
wants more and more, but I don't know of what. She won't leave me
alone, and she won't grow up. Sometilnt:s I think she takes over
completely, and part of me gets scared of what she'll do. I go away, I
think.
! JUS! can't bear to listen.
Therapist: It seems to me she's likely to stay around until someone
hears Whet! she's trying to say.
Patient: The less attention she gets, the better. The only thing Lean
do is ignore her ... starve her out ... otherwise, she'll never leave. If
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I give her nothing at all, maybe she'll go away and leave me alone.
[quietly] Maybe she'll die .... J really want her ro die.
Here again are the hatred and death wish for the child-self, not, this time,
the omnipotent seductress who is blamed by the adult for her own abuse,
but the raging and entitled child who makes her pain clear but keeps its
source a mystery to all, including herself. Nor yet on the analytic scene,
but struggling to emerge, is the terrified. child, living in a dissociated
world of perpetual abuse and terrotlzed not only by the actions of
another but by the prospect of speaking her own words and knowing her
. 1
own mlnc"
It is almost always the adult-self who presents herself for treatment.
Either she is struggling with overt, nightmarish memories of childhood,
or, in her amnesia, she is plagued with one or many of a list of vague,
debilitating complaints: sexual dysfunction, depression, intense guilt,
poor self-esteem, self-destructive impulses, drug and alcohol abuse, and
so on (Gelinas, 1983). Only slowly and after much careful testing does the
child persona begin to make her presence known. She may step forth
boldly and dramatically, as in the development of sudden panic attacks
or in the eruptLon of painful and frightening somatic complaints. The
child may a[,;o enter quietly, almost imperceptibly. The therapist may
first become aware of her presence by an oddly childish mannerism-a
way of wiping away tears or twisting a lock of hair. At other times, the
child may signal her arrival with a subtle change in vocabulary, gram
mar, body postures and movements, different styles of clothing, a
particular VOLLe or facial expression. Many times the therapist's first
awareness of change has to do with a perceived shift in the nature of the
transference or in his or her own experience of the countertransference.
Regardless, however, of the specific manner of entrance, it is most often
the case that the child enters the analytic scene sometime before the
recovery ur dlsclosure of specific memories of past abuse begins.
The reasons here are clear. From the child's perspective the analyst lS,
as yet, an unknown quantity, a stranger. True, she has been listening,
bur what she has heard has been limited by the nature of the adult
analyst mteractlon. From the child's point of view, the analyst and the
adult mtervlewed and chose each other. It is they who have evolved a
relationship and have begun to define the limits of their trust and to deal
with painful and intimate issues. As a dissociated self system with a
separate object world and ego structure, the child has been kept very far
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away from the analytic field. The child has had little or no impact on the
analytic relationship, and this relationship has affected her only insofar
as she has perceived enough trust between the analyst and the adult to
encourage her participation. To be sure, the emergence of the child in the
treatment signifies that the early work has proceeded well and that the
heart of the treatment is about to begin.
There are now two different patients on the analytic scene: an
adult-self whom the analyst has already begun to know and an elusive
child-self who appears and disappears at will; introducing endless confu
sion into the analytic process. It behooves us to pause here and take a
closer look at this child-self system and at the ways in which he or she
attempts to engage the analyst in playing out unconscious wishes,
dreams, and fears.
Without question, the most singularly important thing to understand
about the child is that he or she exists only in the context of a perpetually
abusive, internalized object relationship. This aspect of the self and this
aspect of the object have been literally ejected from 'the patient's more
integrated personality functioning and allowed to set up an independent
existence for the sake of pursuing its separate needs. Let us propose, as
others have done (see, for example, Kernberg, 1976; Volkan, 1976;
Ogden, 1986), that mature personality organization IS an amalgam and
integration of a multitude of widely varying self experiences and object
experiences, each with its own unique affective-ideational-instinctual
charge. This integration leads ideally to internal representations of the
self and object that are wide ranging, at times contradictory, but not
mutually exclusive. Love and hate coexist, are modulated by each other
and give rise to the potential for ambivalence and mourning, as well as
intense passion and ambition.
In the patient who has been sexually abused, the child aspect of the
self representation, along with that of the abusing other and their
complex system of emotional connection and exchange, is cordoned off
and isolated from the rest of the personality. It remains virtually frozen in
time, the images unmodulated by any others of a different, perhaps
gentler nature. These images become the embodiment of the murderous
rage and pcTnicious self-loathing that drive the child in his or her
relationships with others. In their intensity they fuel the psychotic-level
terrors of annihilation and world destruction that so infuse the patient's
internal experience. The child cannot grow. Her anger and self-hatred go
untempered, therefore unintegrated. Her world is a world of betrayal,
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Jody Messler Davies/Mary Gail Frawley
terror, and continued emotional Hooding. Her reality has been pene
trated by a hostile, invasive force and her perceptions tragically distorted
by her abusive experiences. What is bad she is told is good; what hurts is
somethIng she has been told she secretly wants and asks for. Her body
aches. Her mind is 1[1 a constant state of upheaval and confusion. When,
as a child, she turned to those around her for a way out, she was
confronted either with threilts and further abuse or with neglect and
formidable' denial. The child is incapable of expecting anything different
from the analyst. She experiences herself as terrified, completely alone,
and heipless. Only the adult persona can ask for and receive help. The
chilJ cannot ask, and it is, indeed, a long while before the analyst's "help"
begins to penetrate the formidable dissociative barriers.
The extreme dissociation of the abused child into a separate self and
object system is, essentially, an attempt by the patient at damage control.
As Dhysicians attempt to isolate and remove a potentially invasive
malignancy before it can affect healthy tissue, the adult survivor of
childhood sexual abuse attempts to isolate and eject the toxic introject
and accompanying self representation before the capacity to trust oneself
and others is entirely destroyed. The child-self may be condemned to a
world of unrelenting paranoia, but the adult persona, having ejected
these toxic experiences, attempts a rudimentary integration where self
and object representations coalesce at a higher level of development.
Indeed, the adult persona of many of our patients is marked by 8 Tilther
hypomanic defensive style, where aggression is routinely projected and
then denIed. The adult in these instances takes on an air of uncanny
innocence. He or she is often eager, if not compulsively driven, to help
others. The consummate self-denier, the patient is unaware of the ways
of. She struggles but fails to make sense of her complete inability to say
Clearly, the balance attained here between adult and child is renuous
at its best, with a codetermined i:npilirmenr of ego functioning that
makes successful 8d8ptmion VIrtually impossible. Secondary proccss
thmking IS
to the constant intrusion of more primi[ive id,:;uioIl;,]
strains. Reality testing is impaired by the pathological defeI:sive patterns
and the dissouative trends that give rise to a confusing dU<llity in
functioning. Somatic complaints are rampant, and the struggle against
self-abusive urges is constant and unrelenting. Unlike diseased tissue that
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adult listens to the child's words and slowly begins to understand theIr
significance, new meaning is given to previously inexplicable symptoms.
The acceptance and integration proceed slowl y, but ldeall y the mterpen
etration of these two personas provides each with some compensation for
this intensely painful process
The aeLlt, no longer terrified of the child's experiences, comes to
appreciate the reasons for her rage and co acknowledge its justification.
There is d new compassion for this former enemy and a wish to heal her
wounds. Because the adult slowly comes to aliow the child back into a
shared consciousness, she can also provide the child with some sorely
needed parenting. In providing understanding and acceptance for her
child-self, the adult can go a long way toward gratifying a painfully
frustrated developmental need. The child, on the other hand, is no
longer driven to undermine the adult's successes. Her program of insur
ger1Ce can, at last, come to an end. The adult's thought processes are no
longer subject to constam invasion and disruption. In addition, the adult
is revlvlfied by once again integrating the child into her inner world. 'In
excising the dangerous child persona, many other important childlike
capacities have been lost to her. The child, now freed from her painful
and all,cu:1surning burden. is released to dIscover, perhaps for the first
time, these other capacities and to bnng them back to the adult, wflO also
expenences them anew. Vitality and the shameless passion known only
to children can reinfuse the adult's interpersonal world. Play and fantasy,
for so long dangerous, regressive forces, will enrich her internal life and
breathe creativity into her practical, survival-oriented mind. Ambition,
always too clme to aggression and exhibitionism, either dissociated or
inappropriately acted out, can assume a more readily modulated pOSItion
and spur the adult to a greater enjoyment of her successes. One patient,
for example, presented her dysphoric, anhedonic, rigid adult-self for
treatment. Some time later, when she had made considerable progress in
inregrattng the dlssociated child-self, she reported to her cl(ldlyst d ddy
spent at an amusement pClrk. She had ridden the fastest rides, eaten
cotton candy, flown a balloon, and reveled with delight in all these
pleasures. In her next session she began to muse about returning to
school for a mClster's c.legree in her field.
This is the force and these are the consequences of integration. But
during this intenselY painful phase of treannent, the forces of mtegration
exist in a constant battIe with the ever-ready tendencies toward dissoci
ation and disorganization. For during this pha.se a.dult and child together
must come to terms wLth the twO most deadening realities: the first, the
realities of the abuse that occurred and the second and perhaps more
difficult facr, a. childhood that was destroyed and will never be reclaimed.
It would appear, in this regard, to be a universal fantasy among all
adult survivors of childhood sexual abuse that once the horrible facts of
the abuse become known, the world wlll be moved to provide a new and
idealized, compensatory childhood. This fantasy had always been the
antidote, the cbtly pall1killing drug that became an addiction for the
cortured child. She fed herself, in one patient's words, "dady doses, pm
for pam," in order lO go on living. Often the renunciation of this wish
proves to be even more unimaginable for the child than accepting the
realities of her abuse. Acknowledging the impossibility of bringing this
fantasy to realiz;Jtion represents a betrayal of her most sacred inner self.
Often chis issue gives rise to the most serious suicidal ideation, a threat
that must, particularly in this context, be taken seriously. Even when
suicide is not an issue, however, renunciation of this idealized, compen
sarory childhood almost always results in a refortification of dissociative
defenses and hatred for the child-self. Through a purel y childlike piece of
logic, the dissociated self believes some form of these words uttered by
one patient:
If what happened to me was unfair ... if I did not deserve it, then I
would get what I did deserve ... what all the other children had. If
people only knew, they would make sure that I got it. If I am not going
to get it, even now when they know the truth ... then I must have
deserved what happened to me after all. 1 must be bad.
Another patient:
This is roo much. I can deal with the abuse ... I think ... maybe I can.
But the idea thlt thIS is all there will ever be, that when I think of being
little, all I will fed is pain and terror ... that's too much .... I can't live
with that. I want to feel what I see in the eyes of little children. You
[therapist] say I deserve this ... so why can't I? The sense of safety, 1
want a place that's safe. 1 want ro get into troLlbL: and be mischievous
... safe trouble ... usual trouble. 1 want someone else to do the
worrying and the punishing. I'm tired. You say I can feel some of these
things as a grown-up .... You tell me about th~L)' But how can I feel
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them when I'm not sure what they are ... words. It's like trying to
describe a color to someone who was born blind.
This underlying theme, which runs throughout the treatment, does
call forth periods of the most profound and intractable mourning. It tests
a patient's determination to survive the threat of overwhelming disorga
nization, and it challenges the analyst's capacities to withstand his
patient's despair and the limitations of his own abilities to aileviate
suffering. Ahove all else. the analyst must allow the patient to experience
and express filS grief in full measure. This expression must be
unencumbered by a need to appear better for the analyst's sake. The
patient must recognize and come to terms with the finality and irrevers
ibility of the traumatic loss. This is a lung and arduous process of wor king
through intense rage and profound pain. Every resistance possible will be
called up by the patient to avoid this mourning process, and the analyst
will inevitably be swept up into a maddening conundrum of elusively
shifting transference-countertransference enactments. The child will
hold on, first, to her denial, then, to her expectation of compensation,
with a ferocity that the analyst may not have experienced previously. In
addition, the analyst may experience some trepidation about allowing
such primitive transference paradigms to play themselves out and about
tolerating such extreme regressive disorganization in a previously func
tional patient. Our contention, however, is that this regressive process is
unavoidable and that only by allowing the child-self to emerge, speak,
and mourn will the emotional trauma be healed and the structural
insufficiencies mended.
In attempting to analyze this kaleidoscopic pattern of rapidly changing
transference-countertransference resistances to the mourning process,
the therapist must keep in mind what has been learned about the
internal obJect world of the dissociated child-self. Specifically, the inter
nal object world of thIS child-patient is organized around the represen
tations of only three major players: a victim, an abuser, and an idealized,
omnipotent rescuer. Any resistances that emerge during the analytic
process will represent some fantasied relationship among these three.
Unless all comhinations and permutation" are reexperienced and wurked
through in the transference-countertransference analysis, the treatment
will not be complete.
Indeed, many attempts at analyzing adult survivors of childhood
sexual abuse fail because both the therapist and the patient become
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locked into acting out one partlcular paradigm to the exclUSIon of, and as
a resistance to, any others. The most common deadlock would appear to
occur when the therapist assumes the role of omnipotent rescuer and the
patient that of the helpless victim. The patient fails to experience her
own potential for growth and change and instead credits the analyst with
supreme power over her. In many ways this occurrence is a natural,
perhaps a necessary precursor to analyzing more complex object relation
ships, and it can inadvertently contribute to the establishment of a
powerful working alliance. The therapist, quietly listening to the pa
tient's memories of overwhelming childhood terror and helplessness, is
deeply moved. He relates to his own experiences of terror and helpless
ness; he perhaps places his own children or fantasied children in such a
hideous predicament. Empathic concern for the abused, helpless child is
surely the countertransference response most readily and non
conflictually available to the analyst. His grandiose fantasies of rescuing
a frightened child represent perhaps the best part of himself or herself.
The child, for her part, has found an ally at long last, someone who will
listen, care, and respect her particular needs for support, while she
recovers and works through memories of her abuse. The analyst will
tolerate the patient's regression during this time and provide the neces
sary ego support to make the working through, mourning process
possible. Indeed, some therapeutic modifications may become necessary,
for example, double sessions, additional sessions, phone contact between
sessions. A safe holding environment must be created to contain the
intense affective discharge and ego disorganization that will accompany
the traumatic levels of stress reawakened during periods of the treatment.
The therapist's very willingness to accede to the patient's often neces
sary demands for extra-analytic contacts, however, gives rise to a major
therapeutic dilemma. As the analyst struggles to rescue the tortured child
from her endless nightmare, he or she may inadvertently interfere with
the mourning process - which must go on - by refortifying the child's
expectation that complete compensation will be made to her. It is
eventually from the: analyst, who seems so eager to help, that this
compensation will come to be expected. The child, who at first needs
certain modifications in analytic technique to begin the recovery and
mourning process and to tolerate the regressive disorganization that
ensues, eventually comes to expect and demand these interventions as
evidence of the analyst's real concern for her and devotion to her. The
treatment parameters thus lose their original ego-supportive function
.. ... ,
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and become symbolic expressions of the analyst's love. They become "the
stuff that compensation is made of." An entire1y different transference
paradigm now exists. The demands that were at first reasonable and
uttered with quiet urgency become more strident and entitled. They
slowly call for greater sacrifices on the part of the analyst and become
increasingly difficult to keep up with. The re1ationship has, in essence,
become an addiction for the patient, who must receive larger and larger
infusions of compensation to be satisfied. As with any addiction, each
dose stimulates an inevitable demand for more, and ultimately the
demands can simply not be met. One must remember that though the
child demands ever-increasing expressions of love as compensation, she
has in her dissociated state never experienced anything but abuse,
neglect, and betrayal. The analyst must, therefore, fail her. This experi
ence is ali she has known.
What has happened? It appears that in attempting to prove himse1f
trustworthy to his ever-doubting patient, by acceding to necessary and
sometimes unnecessary demands, the analyst has acted out a masochistic
surrender and in so doing has reawakened and called forth the sadistic
introject within the patient, that is, that part of the patient who is closely
identified with her own abuser. This sadomasochistic reenactment is
even further intensified by the fact that in presenting himself as an
omnipotent rescuer, the therapist becomes, in Fairbairn's (1944) terms,
an "exciting bad object," one who stimulates and awakens deep-seated
desires that cannot at the same time be gratified.
The patient who was sexually abused as a child is vigilantly defended
against those who make promises and attempt to resuscitate hope.
Promises are broken, and hope leads inevitably to disappointment. Only
se1f-sufficiency and a renunciation of all dependency needs create a
margin of safety. To refortify her counterdependent defenses against the
"exciting" analyst, the patient calis upon the sadistic introject to launch
a full-scale attack upon the therapist's integrtty and competence. It
becomes the mission of the abuser, within the abused-child persona, to
trap the therapist into tevealing the emptiness of his promises, thereby
rescuing the frightened child from giving hope, in the form of a trusting
relationshlp to the analyst, another chance. Paradoxicatly, the mecha
nism of failure begins with the analyst's most ardent wish to help and
rescue. It is by dint of his need to be seen as the good and nurturing
rescuer, that the analyst assures his position as the exciting, therefore
29
On one leve1 we hear the cries of the terrified, abused child recoiling from
the presence of her seducer. They are in the latent meaning, of the
language and not the manifest content, of the passage "Please, I beg you,
please don't; go away, don't touch me again, or I will die." Here the
patient clearly perceives the analyst, who has dared come too close, as a
dangerous seducer.
The analyst, however, is at a most delicate choice point. To the extent
that he backs off, he re-creates the neglect and denial of all the adults
who originally failed to rescue the abused child. To the extent that he
reassures the patient of his ability to "go all the way," he sets in motion
the sadistic introject who will set about the task of proving that the
analyst just does not have what it takes and that he in no way means
what he says. The analyst's best intentions, experienced as dangerously
seductive, must be spoiled. Whether by dint of ineptitude or deceit, the
patient views the :malvst as unhelpful.
The patient, on the other hand, has gone from the role of helpless
victim to that of a demanding, insatiable, and constantly critical abuser.
She seduces the analyst into rescue attempts, doomed to fail. The analyst
has moved from his cherished role as savior to the increasingly masoch
istic role of victim who will do, say, give anything to appease the
encroaching other. Via projective identification and counterident
ification, the patient experiences herself as a victim but is experienced by
the analyst as a seductive abuser; the therapist experiences himself as
concerned and avallable, determined to rescue. while to the patient he is
cruelly withholding or dangerously seductive.
Our contention is that all of these paradigms will be played out in the
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such panic and terror for the pattent during recovery and dIsclosure, can
once again be denied. They are bad thoughts, belonging to an evil
child-self, and as such are intellectualized, discredited, and dismissed via
classical interpretation.
The clinical danger of such an approach is twofold. Certainly, it
represents a secondary betrayal of the child whose original abuse was
ignored, denied, and unattended to by the significant adults in his life. In
addition, the therapist's denial of facts that are struggling so mightily to
emerge deals a senous blow to a system of reality testing already damaged
by all. intricately interwoven set of pathological defenses needed to keep
the truth from awareness.
The analyst, too, must initially favor a system of interpretation that
allows him to avoid confronting the reality of widespread sexual abuse
among children. In particular, there is a need to deny the traumatic
childhood terror of patients with whom the analyst has developed a close
and intimate bond.
For all of these reasons it is easy for the adult and analyst to agree on
a theory that appears to silence the child and at the same time make sense
out of her nightmares. This approach has the added advantage of not
causing regressive ego disorganization, but rather, of strengthening
preexisting defenses and allowing the adult to resume control of her life.
As long as the patient remains in treatment, the child knows she will be
safe. She may choose not to speak directly in this treatment, for fear that
her words will be ignored or misunderstood; however, she does experi
ence a holding effect wherein she knows she is safe, both from the
dangers outside and from the sadistic introjects within.
In the most traditional sense we have here a transference cure, whose
limited effectiveness does not become clear until after the treatment has
been terminated. Every analyst who works with adult survivors of sexual
abuse is confronted regularly with patients who have "completed" other
treatments but have yet to open up for analytic scrutiny the raw,
primitive, internal world of the abused child-self.
Vastly different is the treatment that ensues when the analyst accepts
the reality of early childhood sexual abuse, when he is familiar with
current research and understands how to distinguish such a realitY from
wishful oedipal fantasy. We, by no means, wish to imply here that the
latter does not exist as an important clinical entity, accounting for a
wide-ranging spectrum of neurotic symptomatology, but the presenta
tion of these twO clinical phenomena is so vastly different that they can
35
Dissociati ve Processes and T ransference-Countertra nsference
34
---
--
very serarate agenaa, takes m every wmu and filrers it through the
matrix of her own internal system of obwer-related needs, wishe:', and
fears.
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:::,';tnpOSH1;Y\
(~n Survivors
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M.D.
CCORDlNG TO LEGEND,
Dr. Gabbard is Director of the C.F. Menninger Memorial Hospital and Training and
Supervising Analyst at the Topeka (KS) Institute for Psychoanalysis
37