How
I became a trauma therapist
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For
two years I spoke to a nearly mute woman.
Much of the time I was just trying to guess what she was feeling and
reflecting it back to her. I just talked. I didn’t really know what was wrong. I knew that she had a history of sexual abuse
but I did not know who had abused her, the nature of the abuse, or details of
the family she came from. I had only the vaguest notion what the issues were
for her or why she wouldn’t talk. I
didn’t know what she needed. I just
talked.
Later
she told me, much to my surprise, that a (imagined) little girl hid behind my
chair while we were in session, a split off, very separate, part of her. Her terror and her trauma were personified by
this mute child. This was my first highly dissociated
client. But I did not know it at the time.
I didn’t know it for a long, long time.
Frances
came to me in the early 80’s after I had attended an inspiring conference in
Boston on the psychology of women. The
counseling center where I was on staff paid for a colleague and I to attend the
conference at Harvard University. One
paper on sexual violence against women stood out among the many wonderful
talks. Judith Lewis Herman asked of the
900 (mostly) female psychotherapists how many had been mugged. People raised their hands. She went on to say that she could not ask for
a show of hands of victims of sexual violence, rape or
childhood sexual abuse, as
victims of these crimes are stigmatized.
The victim is the one left with
the shame, silenced by the shame, damaged by the shame. The perpetrator is mostly unknown, mostly
unmarked.
This
paper turned out to be life changing for me; it was a key moment in shaping my
identity as a psychotherapist. My
colleague, soon to become my friend, and I stood together during the break
sipping tea, munching croissants and sharing bits and pieces of our life story,
intimate pieces. We were moved by both
the paper and by Judith Herman’s tribute to her recently deceased mother who
had been scheduled to deliver a paper at this conference as well. At the break there were dozens of women
flocking to the pay phones to call their mothers. Women and mothers were being honored and the
wounds of women were being witnessed in an open and even welcoming way.
Both
the women’s movement of the 70’s and the anti-war movement of that time had
both fueled the interest and investigation of the twin issues of the trauma effects of war and violence against
women. Judy Herman inspired me to carry
the torch and the impassioned message to the mental health staff with whom I
worked, the town in which I lived, the people that I knew. Eventually I taught this material to graduate
students but it started with my presentation at a staff meeting.
At
the time I was a member of a mostly male staff at a pastoral counseling
center. This material was new and
perhaps not particularly welcome to that group.
I brought my experience of the conference and Herman’s meticulously
researched paper to the staff. I was
excited about what I had learned and somehow empowered by it as well. I was taken aback when I got a lot of
questions like: “Is this really true, that one in three women have been
sexually abused by the age of 18?” In
the early 1980’s the notion that large numbers of women and children might be
victims of sexual trauma and suffering from its aftereffects was not quite
mainstream. I distinctly remember one
staff member asking me, chuckling, “how could
one actually rape one’s wife?”
In other words is it rape if you are married? I could linger on my outrage, but I
won’t.
The
upshot of that presentation was that I became known as the resident “expert” on
sexual abuse.
Frances
was referred to me shortly after that staff meeting. A staff member who was seeing a couple
learned in the first session or two that Frances had a history of sexual
abuse. He referred her to me. “We have someone who is an expert on sexual
abuse,” he told Frances. I knew the truth: no one on that all male staff wanted
to touch this. But I was new at the
counseling center and I was game.
It
actually turned out to be very challenging.
The marriage that had brought her into the treatment, failed rather
quickly. We didn’t talk much about the
marriage or the sexual abuse history. We
didn’t talk about much. She barely spoke
to me for 2 years. Frances was young, mid-20’s, tall, thin, and sad. Very sad. She held herself tightly, rigid with suspicion. When she did
speak her sentences were short and typically unrevealing. The “shame” that Herman spoke of seemed to
leak from her pores. She looked
terrified.
Frances
cancelled appointments more often than not.
Maybe I wasn’t busy at the time, and I certainly was interested in her
and drawn to her sadness, her silent suffering, so I called her each time she
cancelled. She always showed up the
following week. She asked me, many
years later: “Why did you always call me?”
Truthfully, I have no idea.
But
pursue her I did. I think back on that
time and wonder how I managed all that silence.
I did strive to “know” her in some way even though she was too
frightened to tell me who she was. I
knew enough not to let the silence stretch on.
So I talked about fear, her fear,
about safety and how unsafe it might have felt to her to be in the
office with me. Her gaze was either
downcast or wide-eyed.
Today
I would know so much better how to do this then I did then. Today I would consult what was going on in my own mind and
body for clues for how she was feeling: where was I tense? did I notice pain or strong sensation one
place or another within me? did my
breath quicken? was how unmoored I felt in that situation a reflection of how
lost she felt? how was my posture mirroring hers and what did it tell me about
what was going on?
In
retrospect I think she probably was as bewildered as I, as to how to
proceed. Today I know that there is an invisible
force that we call “resonance” that tells us a lot about our companions if we
“listen” in the right way. There is resonance between us all. Today therapists are more familiar with
concepts having to do with interpersonal energy and silent communication, right
brain to right brain. Affect is
communicated silently. We just have to
listen differently. But, alas, all that
knowledge was decades away, way into my future as a clinician.
At
that time my chatter was more about not
leaving her alone with her fear and dread.
The content was less important than that there were words of some
sort. I was groping for a connection,
some thread, a bridge that we could construct together. She never became much of a talker, always
dropping in and out of therapy at critical moments in the treatment. But we did construct a bumpy bridge over time
and most importantly, the little girl, who I did not initially know was there,
listened in to what we were doing together and grew.
Frances
started and finished college, the first in her very large family to do
this. She became a professional and a single
parent. She did a good job of raising
her son, alone, and providing for herself.
She bought and restored a house.
She survived a severe illness, and a near fatal car accident and
rehabbed herself from both.
In
the years to come I was to treat several more severely traumatized women who
had many sequestered part-selves. Frances
and two others remained in treatment for decades.
Like
most therapists of that time I did not recognize the phenomena of multiple self
states until it screamed in my face. I
was among the throngs of therapists who believed that Multiple Personality
Disorder, as it was then known, was a rare condition. I remember saying to a client who was a
criminal lawyer and felt that many of her imprisoned clients had “multiple
personalities,” that that was “highly unlikely, it’s a very rare condition” I
stated with authority. Ha!
Today
the idea of multiple selves does not make us uneasy. This was not always so. When I was starting
out in my work with individuals with much early trauma in their life histories,
over 30 years ago, the concept of multiple self-states was not part of
common/shared wisdom. Today we have a
Pixar movie about animated self- states in the head of a joyous 11 year girl, Inside Out.
Today
we easily grasp the notion that there is the work-self, the part that shows up
at home, distinct from the part that shows up at parties, or sporting events,
or with intimate friends. My daughter,
like many of us, has three different voice mail messages: work, home, cell
phone. At work the pitch of her voice is
low, she is professional, deliberate and someone to be taken seriously. On her cell she is casual, the pitch a little
higher. The home voice mail sounds like a different person altogether:
peppy, cheerful, the pitch at least an octave above the work email. That
woman/girl is young, energetic and fun.
This is both different and not different from having multiple
selves. Each voice mail message conveys
the circumstance and the state of being
that she occupies in each setting. My daughter has easy access to each “self
-state.” She remembers what is going on
at work when she is at home, and if she has to take a work call at home, amidst
preparing dinner and directing the children, she can do so fairly easily. There
is fluidity.
The
difference between individuals who have sharply segregated “selves” that cause
the kind of serious problems that lead them into therapy and more functional
individuals is that the former do not have easy access to all the states that
my daughter, described above, has. Some
“parts” go to work, some parts parent, many parts hold the trauma memories, not
all the parts go to therapy, at least initially. Frequently the parts do not know each other,
or only some do; communication across the system is typically poor.
In
Dissociative Identity Disorder (the new designation for Multiple Personality
Disorder) parts of experience, the really awful bits, are sequestered in
sections of the overall personality so that literally the left hand doesn’t
know what the right hand knows. Tommy
the rock opera, written in the 60’s captures some of what this looks like. Tommy,
was a Rock album by The Who, a movie,
and a musical on Broadway. Tommy is a traumatized
little boy who becomes deaf, mute, blind
and
a wizard at “pinball”. A boy who
cannot see becomes a champ at a sport where participants generally have keen
sight.
Tommy was born with all his senses
intact. When quite small he witnesses
the murder of his father at the hands of
his mother’s lover. The boy is the only
witness. The
mother sings to her son:
You didn't hear it
You didn't see it.
You won't say nothing to no one
ever in your life….
You won't say
nothing to no one
Never tell a soul
What you know is the Truth.
Little Tommy manages to go blind, deaf, and mute to conform
with the pleas and commands of his parents,
But he holds to the truth deep within.
It turns out that there is a great way to do this: its call
“dissociation.”
Sickness will surely take the mind
Where minds can't usually go.
Come on the amazing journey
And learn all you should know.
And I did, I went on the
journey and it changed me.
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