The goal of early treatment is to help clients trust that I respect them in their full humanity, even the darkest parts. I want them to understand that I can deal with their demons and find the healthy soul trapped within. This is the beginning of the holding of shame.
"So Harold," I begin, "I will read this list, and you tell me whether you have participated in any of these behaviors."
Harold's eyes once again dart around the room as his body stiffens. I surmise that Milton's discomfort has just shifted to overdrive.
"Just let me know whether you have ever done any of these. And if you have and would like to explain anything," I attempt to say in a reassuring tone, "go right ahead."
There is no visible shift in Milton's expression or posture.
It is only through much discussion and "excavation" that Harold is able to admit to other acting-out behaviors not previously disclosed, including multiple affairs and exposing himself.
"Withholding information is very common in early treatment," I say to Harold. "It is shame that keeps us from telling the truth," I continue. "Nobody wants to talk about these behaviors, but by taking this step, you come that much closer to healing."
Milton seems less than reassured by my comments as he sits, staring blankly into space. He looks as though he's had the wind kicked out of him and may be on the verge of hyperventilating. Even though this early work is painstakingly tough for the client, I find it fascinating.
The first time I meet a new client, I am looking at a history about to be told, a life about to be given form. At first the story of this life was a complex puzzle, which will fit together into a coherent clinical picture. My client, usually my only source of information, lives in delusion and denial. I had better be very attentive and very patient.
I gather information on a lot of different levels. First of all, I look at what is happening to my clients' bodies: how they are sitting, the tone of voice they are using. Are they angry, are they shy, are they uptight and withholding, are they shamed, are they animated or enervated? I want to find out how they hold their wounding and all the shame associated with that. What postures they molded into their "suit of armor" to protect against the attacks of their shaming.
When I was a primary therapist at The Meadows (a multidisorder inpatient facility specializing in treatment of a broad range of addiction), I would never look at my paperwork about a client until I had met with the individual personally. I wanted to understand what she or he was like, to experience the texture of what she or he had to say, and to reflect on her most repeated themes. Only then would I recall all the clinical and written material that had been gathered about her and her problems.
Like most clients, Milton is lost in confusion about what lies behind his addictive behaviors. The next task in treatment, therefore, is to help Harold understand his behavior... to unravel the reasons he engages in these specific sexual acts, and determine how these patterns and beliefs came to be. I am "normalizing" Harold's behavior for him, not condoning it. He will come to understand that the way he was abused created traumatic templates for him, which he was powerless to change.
As I listen to Harold's story, I look for patterns in his trauma. This historical evacuation must unveil the connections between his wounding and his acting-out behaviors. As we explore the layers of traumatic events in Milton's life, I want to be able to make those connections--even more importantly, I want Harold to begin to connect the dots.
As this begins to happen, Harold happily reports, "I feel less and less like a perverted sicko."
I am particularly keen about victimization. Do patients see themselves as victims? How did they become victims in their own minds? Who taught them to be victims? What are they gaining from being victims? How do they use the power of victimhood to manipulate others?
And so I notice that, when Milton explains his childhood and history of significant relationships, he repeatedly uses the phrase, "She (or he or they) made me feel this way..."
"When I was a kid," he begins, "my mother was always telling me what to do, and that made me feel like I was a bad kid. When my father would scream at me and call me stupid in front of my friends, that made me feel mortified. In high school, my girlfriend had this really loud laugh, and it made me feel like crawling in a hole. My wife is so demanding, it make me feel inadequate." On and on it goes.
This theme, which was indicated and perpetuated by Harold's inability to be supportive, taught him to feel like a victim.As children, we are all victims when exposed to any type of abuse, because we are unable to defend or protect ourselves from it.
Abuse can take many forms and be experienced in many ways. Most abuse is not intentional. It usually is an unconscious pattern or repetition of what the caregiver learned from his or her own childhood. The definition of abuse I use in from Pia Mellody's work, and is defined in her book the Intimacy Factor as "anything less than nurturing."
When I train therapists and share that definition, I can sense a definite shift in the room. A collective gasp erupts and the audience members take inventory of their own parenting skills, and realize that they have at times been less-than-nurturing parents.
(To be continued.)