Monday, January 30, 2012

When Therapist Disclosure Can Help

In my experience, I have found that sharing briefly about overcoming my own trauma history is sometimes the only thing that gives a client hope that they can heal. I have used this kind of self-disclosure to resolve therapeutic impasses, especially when a client views suicide as a viable escape from intolerable emotional pain.

 It depends on the individual client's needs and the boundaries of the therapist, as well as the therapist's theoretical orientation. From an experiential, feminist or trauma therapy perspective it can be very appropriate. From a classical psychoanalytic perspective, it can be very problematic.

When I am working with clients with a history of child abuse or neglect, they cannot trust me if they can't read my positive intentions.  Earlier in my career when I tried to remain a blank slate, clients with complex childhood relational trauma histories would commonly experience traumatic transference, projecting their expectation of betrayal onto me, and would sometimes be unable to get past seeing me as an abuser.  Now I am much more transparent about my emotional reactions to my clients. This type of disclosure helps clients with impaired trust to distinguish between the intent of my behavior and that of their abusers.

 On the other hand, clients without impaired trust could very well feel burdened by unnecessary therapist disclosure. I have made this mistake as well.  It is very important  that we monitor our own countertransference reactions to guard against inappropriate self-disclosure and make sure that disclosure is only intended to meet the therapeutic needs of the client.

A good resource is:  Zur, O. (2010). Self-Disclosure & Transparency in Psychotherapy and Counseling: To Disclose or Not to Disclose, This is the Question. Retrieved July 3, 2011 from

What do you think about therapist disclosure?  Is it ever appropriate? Under what circumstances?

Wednesday, January 18, 2012

Bearing Witness to the Pain of Child Abuse Survivors

The chorus of the popular song "Jar of Hearts" by Christina Perri has been playing in my head recently:

And who do you think you are
Running around leaving scars
Collecting your jar of hearts
And tearing love apart...

The song sounds like it was written from the perspective of a woman who was mistreated by her partner.  But I keep thinking of it in terms of someone who was abused as a child.  I've worked with hundreds of survivors of childhood physical, emotional and sexual abuse over the course of my career and at one point or another in their healing journeys , one way or another, almost all end up asking, "who do they think they are?!"

It's a good question. We live in a sick society, where cruelty to animals was a crime long before child abuse laws were enacted. And even now, after a few decades of awareness campaigns, business is still booming for child protective services workers in this country.  Abuse begets more abuse. The intergenerational impact of childhood abuse is staggering.  When parents abuse their children, it is unfortunately common for the children to end up marrying abusers or become abusers themselves --  and the abuse is passed on from generation to generation until somebody breaks the cycle by seeking help.

Help is available. However, it is very difficult for survivors of abuse to trust anyone after their trust has been betrayed by the very people who were supposed to protect them from harm.  And unfortunately, therapists often don't fully understand the implications of this and get frustrated or angry when they feel criticized or rejected by the clients they are trying to help.
Survivors often interpret therapist interventions based on their deeply ingrained expectations regarding  relationships, rather than the actual interactions.  When I say "I have to get off the phone" my client might interpret that as anger or rejection and when I  say" I care what happens to you" my client might respond, "you only care about me because you are getting paid."   No matter how many times I explicitly state that I am paid for my time, not for caring, because my caring can't be bought, many survivor clients continue to believe I only care because I'm paid, until we have done a lot of experiential work on our therapeutic relationship.

I've learned that even if a client can cognitively grasp what I'm saying that doesn't mean that it sinks in on an emotional level.   I had a very rude awakening when I first started doing EMDR therapy with a client who was abused from the age of 4.  The first time we reprocessed a sexual abuse memory with EMDR, she exclaimed in a surprised tone "it’s really not my fault!"  I had been trying to tell her this for two years and found out that she had only been paying lip service to what I was saying because she didn't want to contradict me.  It turned out that every time I said "It's not your fault"  she thought to herself  "yeah, right" with tremendous sarcasm.  Boy did I learn a valuable lesson that day!

As a psychotherapist who specializes in helping survivors of abuse, I am honored to be a partner in their healing.  I bear witness to their pain and help them to know they are no longer alone.  I accept their distrust and I own my own mistakes instead of blaming them, especially since they have often been blamed unfairly by their abusers.  I help them to go from surviving to prevailing and thriving, as I have done in my own healing journey. 

What experiences have you had with helping child abuse survivors to heal? Do you have any wisdom to add? Please page down to comment.