CHOOSING A THERAPIST
For an unbelievably long time, therapists fooled themselves into believing they could assume the role of therapist yet keep themselves from influencing their clients. Many therapists believed they should merely serve as "mirrors" to their clients--reflecting but not directing. If a client asked for advice ("Doctor, what should I do about this?"), the therapist "skillfully" dodged the question by answering with another question ("What do you think you should do?"). Their desire to avoid influencing their clients was entirely unrealistic given that chents come in for help and answers--in other words, expecting to be influenced in positive ways. Influence in therapy is inevitable, but many therapists still don't recognize their ability to influence their clients, and so avoid feeling responsible for the direction the therapy moves in. They actively deceive themselves and believe their own self-deception.
How do you find a therapist? The best way, of course, is by referral from a client or colleague who has worked with the therapist and can attest to his or her competence. Be realistic, though. Your experience of the therapist may not be the same as another person's. Each therapy relationship is as different as the two people who comprise it. Another source of referral is your local (city or county) psychological and psychiatric societies, which usually maintain a list of practitioners according to specialty. Given the family-oriented nature of abuse issues, the American Association for Marriage and Family Therapy (AAMFT) can be especially helpful in providing a local family therapist who is sensitive to these issues. Their address and phone number is: 1100 17th Street, N.W., 10th Floor, Washington, D.C. 20036; (202) 452-0109. AAMFT has local chapters in most major cities that you can contact as well.
It is important as a starting point to know that your therapist can and will offer support and direction as needed. The therapist has to be comfortable in acknowledging that he or she has impor tant information and valuable perspectives. He or she has to be able and willing to share them responsibly and have a good sense of timing about doing so. Information introduced too early or too late may lose its therapeutic impact.
I think it is clear from the data presented in Chapter 2 that what a therapist knows and believes is more important than what professional degree he or she has (despite the established hierarchy, M.D.'s are not automatically better therapists than Ph.D.'s, and Ph.D.'s are not automatically better therapists than M.A.'s). If a therapist believes, for example, that the path to recovery includes processing memories from infancy or even "past lives," or that memory isn't influenced by suggestion, he or she is misinformed and should be avoided. Abuse issues are far too important and volatile to be diverted onto paths involving esoteric and arbitrary beliefs. There is far too much real work to do to help individuals and their families deal with these devastating issues to go off chasing past incarnations or give air time to misinformation.
Thus, it is not only desirable but necessary that you interview therapists before you commit to working with one. Some you will get a "feel" for as you talk to them on the telephone, others you might need to spend a session or two with before you have a sense of their unique style. Whether you are sure you are an abuse survivor, suspect abuse but aren't really sure, or have been accused, you should ask the following questions of potential therapists:
Although asking these questions may provide some insight into therapists' beliefs and practices, be aware that there can be a substantial difference between what therapists say they do and what they really do. It may take a few sessions before you conclude that a particular therapist's approaches are not for you or that you can work with him or her comfortably. The most important point to remember is that you are not obliged to blindly obey. Do not get swept up in therapeutic double-talk or let yourself get convinced of anything that violates your own beliefs. The therapist can and should be responsive to your feedback and wishes, not necessarily agreeing, but certainly giving them respectful consideration. If you experience subtle--or not so subtle--pressure to comply with an individual treatment plan that you did not cocreate, the therapy relationship holds greater potential for harm than good. And if the therapist does not respond to your reasonable questions with clear, straightforward answers, then you have your answer: Find another therapist. There is no legitimate basis for a therapist's withholding information about his or her methods and intentions.
Choosing a therapist requires some patience, a willingness to ask questions and think critically about the answers, and a greater desire for things to get better than to be "right." A good therapist can be an invaluable ally in the toughest of times, so it is most worthwhile to be a "smart shopper."
Some Therapy Guidelines for the Abuse Survivor
If you are currently in therapy, or are considering going into therapy, and you are starting to face the harsh reality that you were abused, it is essential that you get skilled help. If you have always known you were abused, this book has less relevance for you. It is primarily for the person who has discovered what seem like repressed episodes of abuse in his or her past as a result of either therapy or some other such external source, like a talk show or magazine article. Even so, the specific path you choose to follow when you are coming to terms with what happened to you is critical in determining what your therapy is like, meaning where it focuses, how it progresses, and what it helps you to accomplish. By now you know that not all therapies are alike. There are serious consequences associated with choosing a therapist and the kind of therapeutic process you will undergo while in his or her care. Be assured that a skilled therapist can do a world of good for someone needing to come to terms with a history of abuse. It is a complex, multifaceted problem that generally precludes quick and simple interventions. Having survived abuse affects one's self-image, mood, relationships, sexuality, motivation, and almost every other aspect of human experience. People are typically unaware of their own "blind spots," and a good therapist who is experienced in working effectively with abuse survivors can do a great deal to expand your range of vision while supporting you emotionally as you reach new conclusions about old experiences. Therapy obviously can't change what happened to you, but it can do a lot to change the way you look at it and how you feel about it.
The conventional wisdom in the recovery field has been that you must recall and work through nearly every detail of every abusive experience you suffered. Sometimes the process involves vivid imagery and recall, and sometimes it involves screaming and kicking and crying. Other times it's simply gut-level insight that shifts people's ideas about themselves and their experiences. Is it necessary to spend hour after hour, day after day, dredging up more and more details of the terrible past to work on in therapy? Sometimes it is desirable, but necessary? No, not always. To ignore or discount your feekngs, your body sensations, or your perceptions is obviously undesirable. But, amplifying feelings of hurt or shame about the past in order to promote a sense of well-being in the present is not a particularly sensible strategy of recovery, either. Some therapists who work with abuse survivors have expressed their concerns to me that bad therapy can be one more trauma for the client. They suggest this is most likely to happen when the therapist requires the client to follow a formula of some sort that the therapist thinks is important despite the client's openly expressed disinclination to do so.
How do you find a good recovery group? Follow the same recommendations I provided earlier about finding a therapist. Call individual therapists whose names you have obtained and ask them to recommend some therapists who run groups for survivors. Then contact them and ask to attend a meeting or two.
You don't have to sign your life over to a recovery group just because you attend some of its meetings. Go to a meeting or two, and get the flavor of what goes on there. Talk to other members and find out things like:
Dealing with your past is an inescapable part of treatment: The crucial variables are how much focus on the past and when in the therapy process. When an abuse survivor is already overwhelmed with flashbacks and nightmares, crippled with fear, and on the verge of falling apart, does it make any sense to go digging up more painful memories? The client is clearly already overwhelmed and lacking the necessary abilities to cope effectively. On this basis alone, it has been and continues to be my practice to build coping resources first before dredging up more of what is already too much to handle. Getting into all the painful details of what happened to you may be necessary at times, but certainly not all or even most of the time. When you do get into hurtful memories, it is best to do so armed with the necessary resources to use them to your best therapeutic advantage.
One commonly expressed piece of information stated as fact by some in the recovery movement is that memories of abuse surface only when the person is ready to deal with them. This position is stated succinctly in the following quotation published by the Association for Humanistic Psychology:
When children are traumatized, they repress their memories longer than adults and on average do not recover their memories until their thirties or forties. It appears that their subconscious minds somehow know when they are mature enough to process the memories consciously.
While this is an interesting viewpoint, it is hardly true. People do not have a subconscious that wisely recognizes opportunities. Symptoms exist, the abuse survivor seeks help, and the alert therapist determines whether he or she has the resources necessary to resolve them yet.
When I say build coping resources first, what kinds of resources am I referring to? Such skills as
When is it important to be in touch with your feelings, and when is it best to set them aside (compartmentalize) in order to responsibly do what must be done? Or when is it desirable or necessary to set aside your personal interest and make a sacrifice of sorts, and when is that unhealthy self-denial? Knowing which "part" of yourself to access at a given moment for a given purpose is a most powerful way of going through life. If you think about it, symptoms often arise when someone taps into the "wrong" part--for example, so-and-so gets into her feelings when they are irrelevant, or she gets into her rational self when she would be better off following her heart. Each part of you is valuable at some time, in some place--even the parts of you that right now you don't like very much. A good therapist can help you come to recognize that and teach you how to access the "best" part(s) at the "right" time.
There is no precise formula for abuse therapy. Despite the popular term "recovery process," the process is as individual as each person who undertakes it. When you find a therapist who can work with you as an individual and is more interested in your wellbeing than in following "the process," you have found someone worth working with. And when you have found a support group (which I would recommend doing) that speaks English and not "program," then you have found a group worth participating in.
Some Therapy Guidelines for the Doubtful
In light of everything I have described about suggestibility and the potential harmful influence of the therapist's perspectives on the client, you can easily appreciate that you are more vulnerable to untoward influence when you are in doubt. If you are starting to uncover what seem to be--and very well could be--previously repressed memories of abuse, try as best you can to be objective. Consider these questions: (1) What are the memories? Are they vague impressions or vivid recollections? (2) How did the memories surface? Are they directly available to you as memories, or are they something you deduced from confusing symptoms? (3) Did the memories arise through external influences (like a therapist suggesting them through some memory recovery process, or through a magazine article you read or a television program you saw), or did they surface independently? (4) Is your mind already made up that your memories are (or are not) true? (5) Are the abuse scenarios feasible, or have they gotten increasingly bizarre and improbable as time goes on? (6) Do they involve memories exclusively from early infancy?
I have discussed the implications associated with your answers to each of these questions. I have suggested that when the line between reality and fantasy is blurred, it is best not to work at having to "believe." If you are doubtful and you are in therapy, note the position your therapist takes. Consider these questions: (1) Does your therapist seem certain abuse occurred even if you aren't? (2) Is your therapist condescending in some way, suggesting that "when you are ready, you'll come to accept it"? (3) Is your therapist so intent on your believing it that he or she is willing to terminate the therapy relationship if you don't? (4) Is your therapist gently pressuring (or even bullying) you into removing all doubts and believing it "or else you'll never get well"? (5) Is your therapist forcing you to confront your family and risk losing them forever, even though you're not really sure it happened? (6) Is your therapist leading you to believe that the explanation of child abuse is the only way to explain your symptoms? (7) Does your therapist seem so stuck in the belief you must have been abused that he or she is unable to view your problems in any other way?
If you answered "yes" to any of the above questions, your therapist may be making the very mistakes that can lead you to get absorbed in a potentially destructive situation. It is very important, especially when you are uncertain, that the therapist be as objective as possible and not impose his or her beliefs on you at such a vulnerable time. The common denominator underlying all the questions above is coercion. It is important that you feel the freedom to choose what to accept or reject in the therapy relationship, rather than feel pressured to conform to a belief that you feel uncertain about.
Some Therapy Guidelines for the Falsely Accused
It is the worst sort of nightmare to be accused of something you know you did not do. To prove you didn't do something is nearly impossible, and once the false accusation is made, it alters your life forever. At this time when your emotions are explosive and rationality is hard to come by, you most need to keep your wits about you. I strongly encourage you to seek professional help. You canít realistically expect your family and friends to experience no doubts about you at all once the allegations are made, and you will need an outside source of both support and objectivity. You would be wise not to demand or expect an immediate and unwavering statement of support from your family or friends, or you will likely push them in the opposite direction. That is not because they are being disloyal to you or because they immediately believe you did what you are accused of doing. Rather, it is because doubt is inevitable in the situation. It is not personal, even though since it affects you, it feels personal. Do not make the mistake of isolating yourself from others because you are feeling abandoned while they work through their own reactions to the allegations. Reread Chapters 7 and 8 and try to understand why each person will likely have doubts. If you happen to garner immediate support from others and no one hesitates to affirm their belief in your innocence, consider yourself unusually lucky. Doubt is the most typical reaction, with disbelief and denial following right behind. Expect it, allow it, and don't personalize it, even though it may hurt. Getting support is crucial to staying sane while dealing with this sort of trauma. Your therapist can be a very valuable source of emotional support and a good costrategist for dealing with the circumstances. A support group of others who have also been falsely accused can provide further support as well as an exchange of information and strategies for coping. Your therapist will likely know of such local support groups, but in the event he or she does not, you can contact the False Memory Syndrome Foundation (FMSF) in Philadelphia. Their address and phone number is: 3401 Market Street, Suite 130, Philadelphia, PA 19104; (215) 387-1865. They provide current information and valuable support, publish a newsletter, and can most likely refer you to a support group in your area.
Meeting Your Accusing Child's Therapist
If your child has been in some sort of therapy through which he or she has recovered memories of abuse that you know never actually occurred, it is entirely possible that you may be invited to meet with your child's therapist. Therapists often prescribe such meetings to enable your child to confront you and to extract a confession of your guilt as well as an apology. There are many potential hazards in meeting the therapist involved in your child's memory work, and you need to know what they are if you are to have any hope of handling the interaction well. You should work out ahead of time what you will say and do (and not say and do) in response to the wide range of things that can happen in such meetings. If you go into such a meeting without a realistic plan, you run the risk of getting blindsided.
Take the time to sort out and think about the facts available to you. Your child has been in therapy and has developed the idea that you sexually abused him or her. Preposterous as this might seem if you know you are truly innocent, your child believes it. Do you expect the therapist to be neutral in this matter? Or can you safely predict that the therapist is largely responsible for your child's coming to believe what he now believes? If the therapist is neutral, there is room for discussion. If the therapist has already predetermined your guilt, there is not going to be much room to change his or her mind.
It helps to know who wants the meeting and why. Was it suggested by the therapist? Did your child ask to arrange it? For what purpose? These are questions you can and should ask ahead of time.
Go to the meeting, but be prepared for the worst. The therapist may already believe you are guilty. You can easily feel ganged up on and backed into a corner. If you react by getting angry or defensive, then you merely confirm for them that you cannot deal with your feelings rationally. You thereby confirm your guilt in their minds. Heads, they win; tails, you lose.
I suggest you try to tape the session, so bring a tape recorder. At the outset of the meeting, you can ask for permission to record the session for your later review. Of course, the meeting is confidential and taping it without permission is a violation of that confidentiality. If the reaction you get is negative or defensive, then don't press it. Some therapists will welcome the chance to have a record of the conversation, but others will fear it and refuse to allow taping. Let it go if you're told no taping will be permitted.
If it soon becomes clear to you that the meeting was called so that you can confess, you must take charge and bring focus back to the session. You must say clearly and nondefensively, "I did not do the things I am being accused of. I don't know why this is happening, but I have no intention of letting my future relationship with my child be held hostage in order to coerce a false confession out of me. Now, are you open to any other possible explanations for these allegations or my child's symptoms, or are you fully intent on maintaining the abuse explanation despite its being untrue?" Make your denial firm and clear, for to not do so can be taken as a passive confession.
Do your best to encourage further objective exploration by the therapist. Ask that other family members be interviewed, that medical and school records be obtained, that childhood friends be interviewed, and that other sources be used to investigate the fake allegations. Remind the therapist that while his or her intentions are obviously to help your child, he or she cannot take the role of rigidly confirming the allegations without allowing room for open discussion. Hopefully you will appeal to some objectivity on the part of the therapist.
In the event that the predetermined verdict is that you are guilty and there is simply no avenue open for further discussion or consideration, then you can verbalize your disappointment that the session was unproductive because the agenda was so rigidly predetermined, precluding an honest exchange and a deeper look into the matter. Calmly, but matter-of-factly, state your willingness to talk again anytime it might be helpful, but only on the condition that the meeting have a purpose beyond seeking a confession for something you never did. Provide an address and telephone number to the therapist should he or she want to reconsider his or her approach, and provide your child with the assurance that despite the pain and confusion involved in the situation, you would welcome the chance to reconcile in the future. Do not blame your child as wrong or crazy and do not attempt to employ guilt by asking variations of "How could you do this to me?" Say your piece and then go.
The analogy of losing your child to a religious cult is an apt one. Why people become cult members is a topic I touched on earlier. You can't just kidnap and deprogram cult members, despite whatever hype you sometimes hear. You can't control the choices another person makes, and though it is heartbreaking when an impasse is reached, all you can really do is continue to make yourself available. Continue to send birthday cards, send greetings, do the little things generously that let your child know you are still there. No one can predict the future, and you never can tell whether an eventual reconciliation may be possible. Keep your options--and your door open. And, in the meanwhile, get on with your own life. Making a painful situation that is out of your control the centerpiece of your life is a guaranteed path to depression. Take charge of your life and make sure you have more to it than heartache from a mixed-up kid.
A NOTE TO THERAPISTS
Therapy can hurt people, as I suspect you already know. Who hasn't had to clean up someone else's botched case? As you read the case histories in this book and evaluate the advice I give here to people caught in the trap of suggested abuse, I hope you are touched by the realization that things are not always as they seem. I implore you to appreciate these basic points regarding therapy: (1) Clients typically come to therapy believing they are personally powerless to effect meaningful change in their lives; (2) clients believe that a trained "expert" can, through an "objective" perspective and refined techniques, help resolve their problems; and (3) clients assume they must conform to the therapist's perceptions and comply with the therapist's treatment plan if they are to improve.
In the unique context of therapy, conformity and obedience are often defined as necessary in order to recover from oneís symptoms. Thus, your perspective as the therapist is critical in determining the focus of treatment.
There are no reliable means for determining whether a previously repressed memory is authentic or confabulated. In light of everything I have stated here about the role of suggestion in making the diagnosis of abuse when that was not a presenting problem, it seems prudent and respectful that you avoid becoming a basis for the kinds of problems described throughout this chapter.
I would encourage you not to (1) preclude open communication at all times among family members; (2) act as your client's "hired gun"; (3) act as if corroboration of allegations of abuse were unnecessary; (4) jump quickly to the conclusion abuse occurred simply because it is plausible; (5) suggest a history of abuse to someone who is not your client; (6) refer a client out for hypnotic confirmation or disconfirmation on the false premise that hypnosis is some kind of lie detector; (7) ask leading or suggestive questions; (8) assume repression is in force when someone does not have much memory from childhood; (9) rely on your memory of the interaction. Tape your investigative sessions and review them later for any evidence of possible unintentional contamination of your client's recollections.
As a therapist, too, I want our work to be taken seriously and be favorably regarded by the rest of the society in which we live. We are now embroiled in intense controversy over the issues of memory, trauma, and recovery. How we deal with these sensitive issues will determine in large part how we will all eventually be viewed. Let's admit openly that there is much we don't yet know and use our advanced knowledge to create avenues of objective exploration. In the meanwhile, let's try not to destroy people's lives by presuming guilt on the basis of inadequate evidence and arbitrary subjective beliefs.
KEY POINTS TO REMEMBER