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Reviews

“In The Therapist’s Emotional Survival:  Dealing with the Pain of Exploring Trauma, Stuart D. Perlman, a therapist and psychoanalyst with wide experience in treating the victims of sexual abuse and other forms of trauma, takes the reader on a journey into the emotional heart of this most difficult work.  Drawing on extensive case material, Dr. Perlman reveals the special hardships, personal and emotional, that confront the therapist; he is honest and courageous in using his own reactions to illustrate these difficulties in ways that will be most helpful to all — mental health provessionals and others — who deal with this population.  While there are many recent books dealing with this topic, I know of none that do so with the depth and honesty of this one.”

– Louis Breger, Ph.D., Founding President, Institute of Contemporary Psychoanalysis, Los Angeles

“This book represents a ‘one of a kind’ contribution to the growing literature on treating adult survivors of childhood abuse and trauma.  More than any book to date, it opens up the inner world of the therapist working with this group of patients, and explores the intersubjective arena in which patient/therapist vulnerabilities comingle and actively shape the therapeutic experience.  Whether one agrees or disagrees with its specific therapeutic approach, this book is bound to stimulate heated discussion of issues having to do with countertransference and the role of each therapist’s unique subjectivity.”

– Jody Messler Davies, Ph.D.

“The Therapist’s Emotional Survival is a unique study of the challenging and complex interplay between the personalities of the therapist and patient in working through trauma and sexual abuse.  It accurately and authentically depicts the lived experience of both participants of this difficult, often harrowing journey, backed up by dramatic clinical illustrations.  The self-analytic sections include powerful self-revelations of a kind one almost never sees in clinical writing.  Perlman’s book will be of value and interest to a wide audience, from new therapists to seasoned analysts.  No other book of which I am aware gives as detailed a picture of what the treatment of these patients is actually like.”

– George Atwood, Ph.D.

Table of Contents

Acknowledgements

Introduction

PART I:  THE PATIENT-THERAPIST RELATIONSHIP

1        Pioneers

2        The Survivor’s Shattered Existence

3        Bearing the Pain of Treatment

4        My Introduction to Treating Sexually Abused and Traumatized Patients

5        Therapist Rescue Fantasies

6        Therapy Openings

PART II:  OPENINGS TO TRAUMA AND PAIN

       First Stage of Treatment: Establishing Safety and Connection

7        Will You Hurt, Ignore, or Help Me?  Fear and Self-Protection

8        Can I Take Control Over My Own Physical and Emotional Needs?

9        Can You Hear Me?

Second Stage Of Treatment:  Deep Experience

10        Can You Listen to the Trauma and Validate Me?

11        Am I Lovable?  Feeling Deep Love and Bonding

12        Can You See Me?  Discontinuous and Shattered Existence

13        Who Is Bad and Who Is the Abuser?

14        Is This My Body?  Touch

15        Can You Believe in Ritual Abuse?

PART III:  EMOTIONAL SURVIVAL

16        Reality, Countertransference and the False Memory Controversy:  Guidelines

17        Thearpist Survival:  Concluding Perspectives and Strategies

References

Index

Introduction

Treating sexually abused and traumatized patients has tested my ability to manage my own emotions and has been a pressurized experience.  These disrupted patients appear to need therapists to understand the pain they feel on a daily basis.  I hope by sharing my experiences, I will help other therapists and patients to more effectively bridge the gap between them.  The following internal dialogue begins to present the central issues. It also illustrates how I have used insight and self-analysis to explore and manage my experience with such patients.

As I sit waiting for my patient, my stomach feels edgy and my teeth are clenched.   Exploring these sensations in self-analysis in the past, I have found fear, anger and a sense of doom.  What comes to mind at this moment is that these feelings have been triggered by the patients message on my answering machine, telling me she is going to kill herself.  How can she keep threatening to kill herself when I have gotten so attached to and involved with her?  I sit with these feelings and explore further how this patient is affecting me.  What emerges is a recurrent childhood dream familiar from my own psychotherapy:

My younger sister is falling into a dark, bottomless well, probably to her death. I grab her hand. I’m holding her hand with all my might but she is slipping away. I wake up distraught.

The patient’s message feels like the relationship with my sister in the dream.   One of my sorrows is that I could not save my sister and that inability is part of my motivation in treating traumatized and abused patients. l  realize that I am confusing my patient with my sister. This is a relief.

I continue exploring.  Each of these patients is in part my sister to me. I knew this before but, had forgotten it. Each patient I treat is some penance for not saving her. This is a new realization.  I could not save her from my parents when they went into violent rages.  My sister has lived out this emotional damage. The adult side of me says, “I was just a child and not responsible.” This makes me feel less guilty. The memories of insights from my original analysis soothe me as my original analyst did. I feel less responsiblee for the patient’s suicide threat.  I feel proud that I could do this piece of self analysis and calm down.

Later, when I see the patient, she has switched to a different emotional state, one that is more hopeful and business-like. Yet I am still reverberating from her earlier phone message.

The thought of my sister falling down the well returns, and I realize the patient has come to represent the needy child part of myself. l fear l would lose myself if this patient were to die. Others have not survived the traumas of childhood, yet I have been selfish enough to go on and have a better life.

My own unresolved baggage has been overloading my reactions to this patient’s intense but shifting affect states.

This example illustrates the use of my own dreams, memories and self-analysis to understand my work with traumatized patients.  Like many therapists, I hoped that by studying psychology and helping others to heal, I would learn to heal myself and enhance my understanding of people.  My personal therapy and analysis revolutionized my life. This book is an attempt to give something back to the field.  It is also an attempt to help hurt and damaged individuals to improve their emotional states and levels of function.  I am deeply touched by my patients pain and inspired by their courage and fortitude, as well as by the many therapists who help these patients. One purpose of the literature on abuse is to break the silence that is part of the original trauma; speaking out is intrinsic to the healing process.  The many patients who have given me permission to use their personal material in this book have been motivated by the desire to reveal their experience.

Another goal of this book is to help therapists accept their own experience as useful in understanding the bewildering process of treating severely traumatized and sexually abused patients. During the therapy process there will periods of not understanding what is happening in the patient and in the treatment. During these periods, feelings and thoughts will percolate inside the therapist and patient that might only later be understood.

A central task for therapists is to learn how to process their own feelings about their patients without getting stuck in guilt, shame or self-punitiveness.  Therapists can understand and learn what to expect of  themselves, and to detect the warning signals that indicate that their reactions and concomitant dynamics need attention.  They can begin to contain their inner process and use it to enhance the treatment.

The ultimate goal of treatment is to create a new existence for the patient. Yet the treatment can also profoundly change the therapist. Because of this, the therapist needs empathy and support to enable him or her to make these changes. Usually, this empathy comes from the therapist’s therapist, supervisors and/or colleagues. One analyst told me that he finds rereading my papers soothing in the middle of the night when he feels overwhelmed by the material presented by some of his patients. I hope that this book will serve as a similar guide for therapists who engage in this challenging work.

If the therapist is prepared with a map and support, there is more of a chance that the process will deepen with less strain. The map presented in this book is one I, and those that I have supervised, have found useful and fits with the choices that I have made regarding levels of emotional availability to my patients.

This book can be read on different levels.  First, this book explores the therapist/patient interaction, with descriptions of what is triggered in each person as the treatment proceeds.  I will use myself as well as my patients for the purpose of case illustration. On another level, this is a book about the psychotherapeutic process; it presents a conceptualization of treatment, involving a series of developmental stages and tasks which the patient and therapist probably need to navigate together. This developmental view of treatment is especially tailored to traumatized people, but could be applicable to others as well.  I have focused primarily on the therapist’s feelings, and the interlocking dramas in which the therapist and patient often become enmeshed. Both patients and therapists phenomenological perspective is described. The openings to deeper experience and treatment will be explored.  Patients who have been traumatized tend to recreate their traumas in the treatment, and the therapist needs to learn about and contain this.

I will draw on over twenty years treating and supervising the treatment of many sexually abused and traumatized victims. The interactions between my patients and I are examined as they have changed over the years.  The reader is given a glimpse of  how therapeutic issues can be encountered in the therapeutic process, and how treatment may change patient and therapist. This book will be weaving together these different levels of experience, hopefully, into a guide for the journey with the patient in treatment and possible impact of this work on the therapist.