Tuesday, April 3, 2012

Bruce's Flashback

One of the most important challenging aspects of Harold's treatment comes when he begins to face his dysfunctional attachment to his primary caregiver. From this attachment, Harold developed a deep sense of betrayal. Through the dysfunctional bonding, Harold internalized the wound and ended up feeling that, because he was not worthy of love, the betrayal by his caretakers was his own fault. What ultimately develops from this wounding is an entire psychic life that rests on a bed of shame and resentment.

I like the idea that it is my responsibility as a therapist to hold temporarily for the client the burden of this shame. I respectfully and skillfully urge the client to describe his or her shame and the behavior it has generated. The client hands it off to me for storage until that time in our therapy when I can hand it back to him or her for inspection. At that point, the client has grown able to appreciate that he or she is not endemically evil, but is a victim of abuse.

I am able to hold the shame, the anxious hope, whatever belief system, or whatever emotion the client is feeling, and say to this suffering and trusting person, "You know what? I believe you can work through this, and that you can and will become even more that you now believe is possible. And I will hold all the shame or other emotion for you while we are doing this work together."

In our subsequent meetings, I want Harold to confess and describe all of his sexual behaviors in detail. I have a checklist of about forty types of behaviors, each of which can cause arousal (including sex with animals, with a minor, urination, asphyxiation, voyeurism, exhibitionism, sadomasochism, cross-dressing, and so on).

I ask Harold to tell me whether he participated in any of the aberrant activities in the checklist. Going through the checklist often facilities the first trusting moments in my relationship with a client. When he or she realizes in our first or second meeting that I am comfortable discussing these activities, the client realizes that I cannot be shocked. He or she senses that I have enough experience to know that whatever behavior the person has engaged in, I am there to understand, and not to judge. This was best described by a veteran client who said, "The first time I trusted you was when you pulled out that checklist of sexual behaviors, because if you could ask those questions and not seem to freak out, I figured you could handle my problems."

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