Most of the information in this article comes from my experiences in working with people who have been abused as children and from reading a lot of books and articles dealing with abuse. This will not be a technical article, as such, but one in which helpful reminders are presented which we often forget when tired, or distracted, or we are overloaded with paperwork in the process of helping clients. Much of what I write will reflect my own opinions and experiences while working with adults abused as children.
First, clients resent any reference to them being abnormal. Many of them had to deal with abnormal circumstances and coped the best way they knew how at the time. From their perspective, the abuse was abnormal. Some learned to cope by running away, or raising hell to attract attention and get the message across that something was wrong in their environment and they were angry, anxious, and depressed. ( Not such a bad coping skill when you think about it.) Others became withdrawn, mute, created their own little world to escape to. They shut out hurtful stimuli and learned not to feel. They didn’t talk because they were threatened if they did. They were told they would be labeled a liar or worse by others. Who would believe them any way? Many turned to drugs, alcohol, over-eating, or not eating as a way to gain control over their bodies or perpetrators. Some decided to live out the labeling given to them such as bad, promiscuous, stupid, etc. Others took their anger out on people in the form of crimes, domestic violence, child abuse, or rape, etc.
Clients do need to learn different coping skills for dealing with problems that are occurring now, but if they are triggered, they may resort to the old ways for a time. They need to be reminded that this is now, and they can put down old coping skills and relax. Once they renew their spirits, once they feel safe, they can be taught new ways to deal with life. They are not abnormal. They lived through experiences most of us can’t even begin to imagine. They are survivors and deserve all the respect we can give them. How would we cope with being burned by cigarettes, being beaten because we did not want to go to sleep by fathers who hated and wanted to erase us from their lives?. How would we feel being constantly criticized, called hurtful names, and being yelled at for no good reason? These clients need respect, acceptance, caring, and someone to believe in their ability to learn new skills for survival. Most of all, they need your patience that trust will take time, learning to live with fear will take time, and getting better will take time. Reassurance from someone they can believe in is crucial. Some times, you will need to do an intervention as many times as it takes to get the desired result. Let them heal at their own pace.
Second, clients need to connect with someone, but trusting someone is hard, and over the years, they have experienced rejection after rejection, betrayals, being used by others, broken promises, rules constantly changing so that their anxiety and depression increases, and constant threats of being turned over to other people, being threatened with abandonment, if they don’t do as they are told. This often gets translated by them as: ” If I am good or allow you to control my very being, then you will keep me, work with me.” They will fight against trusting, and connecting because to do so makes them vulnerable and open to unbearable pain. Let them learn through repeated interactions, repeated sentences, repeated acts that you can be trusted. It will take time and patience. They cannot be shamed in this process when they try, try and fail. They need the reassurance you know it’s hard and you will stand by them, encourage them, no matter how long the process takes. Giving up on them is not the answer. Too many people have done that already. They need comforting, they need responsiveness if they have the courage to cry. They need acceptance of all their feelings, even anger. They need to regulate it, but it needs to be acceptable for them to feel and voice it.
Third, in the Therapeutic relationship, clients need to be the focus of attention: their thoughts, their feelings, their needs. It is normal for clients to want to know how others perceive them, feel about them. They need feedback, honest feedback given gently. They need a mirror in order to know who they are and what they are becoming. Parents do this with their children, but clients never got the things they needed from parents. They do not need feedback on your feelings such as being overwhelmed, or feeling you aren’t being treated fairly by them, or why don’t you trust them, or that the client frustrates you. That will put them in a position of taking care of you when they need to take care of themselves and allow others to help them. They need to learn to ask for what they need, even though its hard for them. If there are too many no’s, they will give up asking. They also need to know that when they are vulnerable, you will help them and not ignore them, that you are consistently there for them. Establish boundaries, but too many boundaries that are placed on them because of your needs and not the client’s needs, becomes problematic. They will not be able to breathe or function under that much control. You may be sending a message they have to be who you want them to be, and not their own unique selves. Appropriate touching is needed at times. It teaches them the world is a good place to be in, and that you are human.
Fourth, when clients interact and respond to you, with intensity, frustration, lots of anxiety, or depression, that’s usually a good indicator that transference is going on. They may shut down, become defensive, be too wordy, write too much, call too much. They may feel out of control at those times. . It isn’t necessary to discuss things that should be addressed in session, but you can say:” I know it’s overwhelming now, but in time it’s going to be Ok. We are still OK. I believe in you and your ability to find a solution. If not, we’ll work on it together.” To ignore or become frustrated is not the answer. They need to know you are in the driver’s seat and it is going to be OK. They need to know you are reliable if they have to give up old coping skills. It is very important not to expect them to give up all the coping skills of the past unless they have others to take their place.
Finally, clients need help in building up their self-esteem. They need to believe they matter, that they count in this world. This is a fundamental need of everyone. Most clients were never exposed to this. They need to be able to express and feel their feelings and you be OK with that. If you find you are uncomfortable, it is vital to find a way to cope with your own thoughts and feelings or get help to learn how. We are constantly asking clients to deal with uncomfortable feelings or thoughts. They are not there to help you cope with your uncomfortable feelings. They are coming for you to help them deal with theirs. Clients need to feel successful, they need to be able to give something to other people. That is a tenet of society. They give to feel joy, to feel a part of something, as an expression of themselves. A poem, a note, a drawing, something they have created, makes them feel a part of the human race. It gives them joy, and your response lets them know if they matter in this universe. There are boundaries on expensive gifts. That is a given. When giving meets a therapeutic goal, perhaps, it deserves more thought from us. Below are some authors I highly recommend and I have read many of their books.
Colin Ross, M.D.; Richard Kluft, M.D.; Judith Herman,M.D.; Dena Rosenbloom, Ph.d ; Mary Beth Williams, Ph.d, LSCSW, CTS.; Glenn R. Schiraldi, Ph.d; David J. Wallin, Ph.d; and Aphrodite Matsakis, Ph.d.