Entering the lived reality of Sexual Abuse

Posted on Posted in Post-modern Therapy, Sexual Health, What is Therapy

When clients first call to make an appointment, it is impossible to summarise an answer to “What therapy do you do?” You can never actually tell what journey lies ahead of them or I. I can, however, remember the first call that Claudia made to enquire about therapy. I can’t recall her exact words but they sounded almost rehearsed, attempting to hide the quiver in her voice. It was only much later that I learned just how giant a leap of blind faith she had taken on that day. Although, in theory, all clients should be treated with the same brush of attention and concern, you are sometimes deeply drawn in to specific client’s lives.   Claudia was one of these.

 

We can, actually, only truly help people when we allow ourselves to enter into their lives, to really journey through the details of the stories they come to tell us. Rather than stop in the doorway to make glib assumptions and diagnostic conclusions, my training encouraged me to pay careful attention to peoples’ experiences and the words that they use to describe them. Listening out for these words and finding out what they actually mean to the person saying them opens up a world of new understanding. In Claudia’s case, I was just a couple of years into practicing and completely in over my head. We consulted widely to try and work out what was “wrong” with her. She endured
more than one psychiatrist, a neurologist, an endocrinologist, a couple of other psychologists and even, as far as I recall, a gastroenterologist. I’m sure I have left out a few. Along the way many diagnostic terms were suggested. But, in the end, we settled on “the funk”.

 

I was introduced by my master’s supervisor, Lourens Human, to the possibility that we live out multiple stories that run parallel through our lives and that the work of therapy is to bring this plurality out into the open in order to empower clients to choose which ones best represented them. The story your family, friends and even foes have about you may not be the story you choose for yourself. From the start, I think some of my colleagues might have seen Claudia as a “difficult patient”, a “help rejecter” as the textbooks might suggest. My experience of her was entirely the contrary. A clear thread that ran through all of the chapters in her life was resilience. She just never gave up, not even on me helping her. So we soldiered on through many hospitalisations and bouts in the ring with “the funk”.

 

Claudia asked me one day if I thought she should study psychology. My reply was an unflinching “yes”. She did and she has made an incredible student of the subject. It would probably alarm many of my colleagues to know that I also ended up as her lecturer and following that, we designed a pain management program together. Over the years, I have found little value in the traditional boundaries of client-therapist and I have learned to, instead, ride this boundary depending on the client and the situation. I have also come to believe that we are only of real value to our clients when we allow them to enter into ours lives too, to some extent. Although an important guiding principle for any therapist is that the therapeutic space needs to be about them and not about me; at the same time, we have to have the courage to really enter the room with them and not take too much refuge in the persona of therapist. With that in mind, I have “ridden the boundary” of client-therapist with most of my clients. Claudia and I have shared recipes; music (most significantly of which her own compositions); photographs of experiences in our lives; personal stories; and therapy in “unconventional” settings. The pivotal moment in our therapy was a four hour session as we circled Emmerentia Dam (where we began to explore the details of her abuse). There was also a day when “the funk” revisited her with great vengeance and we hoped she might find some shelter at a local psychiatric clinic. After the psychiatrist narrowed everything she was down to “a cutter”, I discharged her myself and a clinic was made out of the spare bedroom of my home. We can’t help people by reducing who they are to our clinical ideas of them.

 

Ever since our first consultation, I was immediately drawn in by Claudia’s story. Not just by the heart-wrenching details of the story itself but by her tenacity for dealing with the struggles she met along the way. It was a story that started off as one of physical pain, a breakdown in her jawbone, otherwise known as Temporomandibular Joint Disorder (TMJ). But, the stories we are prepared to tell often run alongside other, unspoken, more painful, yet to be told stories. This is often the case with stories of abuse. Our work together (as client and therapist) is not only to make these untold story known, it is to explore how these stories influence our lives in oppressive ways, and to make room for other more liberating ones. Abuse makes people feel less-than, shame and voiceless-ness. Who was Claudia beyond this abuse? That become our work.

 

As I followed the trail of Claudia’s physical pain it took us down a rabbit hole of much more profound and unlanguagable anguish. Claudia sat strangling her fingers with her necklace as she told me, over a period of difficult sessions, that following the death of her much cherished father, she had been sexually molested by her brother and was about to re-encounter him and the discomfort that his presence brought. Up until this point she had always managed to hide this discomfort and, with a clenched jaw, it had secretly burrowed its way through every aspect of her life.

 

She managed to get through that day with what she began to term as “white-knuckling”. But, there were to be many more “white knuckling” days for Claudia. More than either of us could ever have anticipated. Along the way I learned one of the greatest lessons of my career, that the idea of “cure” was a potential trap for me: My job was not to cure Claudia (although that would have been nice if possible), my job was simply to bear witness to her unfolding story.

 

Claudia recently wrote a 4th year psychology assignment, reflecting on the therapy method founded on the ideas I have been most influenced by – Narrative Therapy. She has generously allowed me to share it with you, a truly rewarding highlight in my career:


 

As I searched for a therapist I remember, years ago, looking at Jason’s profile on a psychotherapy website and reticently deciding that he seemed to be my best bet.  This decision was based entirely on the tone of his biography paragraph and the fact that he had a jazzy black and red profile picture of himself wearing a quirky hat.  As for therapy expectations that was all I had to go on.

 

I could never have predicted the story which would unfold over the following years.  I am privileged that part of my therapeutic journey with Jason took place in the form of writing.  Today the words both he and I wrote provide me with a vantage point to reflect with some perspective on a journey that changed and saved my life.

 

It was only when sitting in a 2012 psychology lecture, four years after my journey of personal therapy began, that I realised my writing was deeply embedded in a process of narrative therapy, a process which helped me become visible to myself.  Re-reading some of our writing highlighted how Jason’s style of therapy helped to shift me from ‘patient’ to ‘person’.

 

Whilst studying academic psychology my eyes have been opened to ways in which various psychotherapeutic models investigate the endless facets of the human mind.  Some approaches advocate for the therapist to remain neutral, a ‘blank screen’; some focus on strategic techniques; and others on behaviour conditioning.  Although studying each approach has enhanced my understanding of human behaviour and emotion, it is narrative therapy, the type of therapy Jason offers, I am drawn to most.

 

You see, out of a reticence to box a person’s individuality and stories into a specific mould, narrative therapists avoid diagnostic labels and complex terminology.  I experienced the pain of becoming a psychiatric label and I desperately yearned to be something more than a diagnosis.  Therefore, I find invaluable the notion that narratives (or stories) are what make up our identities. This concept makes possible the idea that lives can be changed and hurdles overcome through finding different, healthier ways of telling our stories. As Jason so eloquently said: “… labels are less helpful than an intricate understanding of a client’s own understanding of themselves in their own words;… conversation can be a beautiful thing” (Jason, 2013).

 

Another factor that continues to appeal to me is that narrative therapists don’t see themselves as ‘superior’ or ‘the expert’.  In fact, narrative therapists believe in the opposite, that as humans we are all equal and that we inherently have the ability to succeed – although we might need a little assistance along the way.

 

‘Just two people in conversation’

In retrospect, my therapy with Jason and the client-therapist dynamic makes sense, but at the start I grappled with how to understand our therapeutic relationship.  Initially, therapy terrified me.  Jason’s account five years later openly describes the obvious apprehension I initially presented with:  “I remember Claudia’s first few appointments rather vividly. She would sit rigid on one end of the couch, as if clinging to the ledge of a tall building…waiting to fall” (Jason, 2013).  The concept that I should simply trust Jason because of his profession did not put me at ease. As time progressed my unease settled, however I remained perplexed about the nature of therapy.  I was suspicious of an environment that felt so natural on the one hand whilst knowing on the other I was paying a trained professional to render a service.

 

Over years of therapy and academic study I came to better understand the perplexity I felt.  Sometimes people enter therapy with the belief that their therapist will be able to ‘fix’ what is ‘wrong’ with them.  This is not the case with narrative therapy. Narrative therapists do not put their entire store in professional techniques; rather they treat clients as experts in their own lives.  This is exactly what took place between Jason and I, and the reason why a professional space had come to feel so natural to me. Some years after beginning therapy I interrogated Jason about our therapeutic relationship, his reply so clearly explained that we were simply equals working toward a common goal:   “Finding common ground with a client is not so much a question of difference in technique than difference in philosophy… It goes back to that comment way back when about “us just being two people in conversation”… I have learned, through you – your powers of observation and your ability to communicate yourself… In many ways, the relationship is the therapy… a relationship that is difficult to put into a category… and I think that sometimes confuses you… (Jason, 2011).

Collaboration between client and therapist, listening to stories clients tell, and searching for moments of resourcefulness create the bedrock of the type of therapy Jason offers.  This bedrock provided a departure point to explore my life and begin to separate myself from my ‘problems’ and problem saturated stories.  Jason focused on uncovering the effects my problems had on me, whilst being aware of signs of competence and strength evident the stories I told.  Slowly I began to view my problems in more objective ways and see that I was not the problem – the problem was the problem.

 

From the time I was abused as a teenager I had struggled with a deep and pervasive sense of inner disquiet, it was a feeling that could cripple me, paralysing any notion of self-worth. It rendered me a silenced victim, gagged by my own fear. Jason gave this general sense a name: ‘Discomfort’.  I later christened it ‘The Funk’.  By doing this I could begin to see myself as something separate to my problem.  Although self-worth was a distant concept to me and I truly believed I had no value, Jason helped me to separate the effects abuse from my sense of self.  For example Jason wrote:  “I wonder if this is not the sullen art of DISCOMFORT!  Your brother doesn’t have to be physically present for it to do its work, like a bad ABBA tune, it manages to stick with you” (Jason, personal communication, 2008).

“Dear Discomfort”

At times narrative therapists such as Jason use open journal interactions, which enable both client and therapist to freely express any topic that may seem useful in writing to each other.  My writing became a vital component of my healing process.  When time permitted, Jason’s written replies deepened my understanding of what was unfolding in my life.  I felt Jason’s writing acknowledged the battles I was fighting, but at the same time helped me begin to create new, more helpful stories.  To be able to create new stories you often have to pull apart the old ones, deconstruct them so that you can reconstruct them.  It’s a tough process but my writing shows how my story began to shift away from one seasoned with language of fear, self-loathing, anger and frustration: “… words such as breath, faith, freedom and safety, knowledge and trust: these words have become constant, and many of them wouldn’t have taken root if it wasn’t for your belief in a process that I have doubted so many times… Jason, thank you for helping to open my eyes up to new thoughts and feelings; one’s that can make life a truly beautiful place” (Claudia, 2010).

Doubt and Certainty

Six years after beginning my therapeutic journey I began my first fieldwork placement as a student counsellor.  The tables had turned and I faced my initial encounter as practitioner not client.  Although my experience of narrative therapy and the ensuing academic knowledge I gained instilled confidence in me, I was not only forced to consider whether it was the right approach for everyone, but whether I could effectively execute it.  After all, narrative therapy is more dependent on the qualities of the therapist than any theoretical technique.  However, deep within me I could not deny my conviction that fragmented human experiences could find a sense of coherence and clarity through the process of telling and re-telling one’s story. I truly believed that we organise and integrate our experiences through the stories we tell, in order to make sense of the world and ourselves.

 

In my limited experience as a counsellor I have sought to privilege my client’s language and make sure that I pay more attention to listening than questioning.  My own therapy with Jason taught me that these things will open up the space to tell new liberating stories.  Many types of therapy attempt to create a ‘manual’ for human experience, something that outlines the way things ‘should be’.  Narrative therapy does not attempt to do this, because as Jason once wrote: “how do you really measure the agonies of the human heart and the ways we go about making sense of them or, hopefully overcoming them?” (Jason, 2013).

 

Collaboration mean a therapist needs to hear clients on their own terms.  As Jason once said, as a therapist:

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(Jason, 2015)

 

So, as a client, I experience that Jason was there to show that my ideas, resources and strengths belonged at the forefront of overcoming my struggles.  Jason was not there to offer magical solutions; rather he was there to shine a light on my hopes and dreams and help me create a new and beautiful story.  Reflecting on his own experience as my therapist, Jason explained:  “Lastly, along this journey I realised that the idea of “cure” in psychology was perhaps a myth stolen from medicine. I could not cure Claudia. It was not my job to cure her. I was there to appreciate the beautiful unfolding melody of her music and try to reach a hand into the tormented darkness from which it arose in the hope that she would not slip away from herself” (Jason, 2013).

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